BRUSSELS (Pakistan Point News / Sputnik - 21st March, 2020) While China, Korea and Japan are coming out of the trough, with zero new cases in Wuhan, Europe is getting deeper in the crisis, with stricter confinement measures have been taken in the worst-hit countries � a strategy fundamentally different from the one of some Nordic EU states, including the Netherlands, Denmark, Sweden and the UK, that envisages letting the epidemic develop to a point.
Professor Philippe Juvin, the head of the Emergency Department in Pompidou hospital in Paris, outlined the point behind these two approaches. According to him, the strategy of waiting is based on an assumption that when 75 percent of the population gets infected, people will develop an immunity to the virus.
"There are two solutions: either we wait until the whole population is infected. When 50 percent of people have been reached, the epidemic decreases. At 75 percent of the affected population, the epidemic ends, provided that people have developed immunity. By then, you have major problems, you have a number of deaths," Juven says.
Meanwhile, according to the professor, the containment strategy is still the only way to curb the outbreak.
"The alternative solution is total containment. This is the only way to stop the epidemic ... The real issue is the number of patients arriving at the hospital emergency room at the same time. If I have 100 new patients tomorrow, I am overwhelmed. If their arrival is spread over two months, there is no problem. We have to spread the wave," he continues.
Who is right? Sweden, for example, said that confinement was not necessary and that with a 1-percent death toll, the epidemic would not be worse than a "normal" seasonal influenza. However, the World Health Organization does not take any of the sides, stressing at the same time that the situation in the world is worsening.
"The number of confirmed cases worldwide exceeds 200,000. It took over three months to reach the first 100,000 confirmed cases, and only 12 days to reach the next 100,000," WHO said in its situation report 59 on March 19.
'HERD IMMUNITY' OR NORDIC APPROACH
Such countries as the United Kingdom, the Netherlands or Denmark chose the "herd immunity" strategy and took the view that it would ultimately slow the spread of COVID-19 in their country without drastic confinement measures that could hurt the economy.
UK Government Chief Scientific Adviser Patrick Vallance told BBC broadcaster on March 13 that the aim of such an approach was not to completely fight the contagious virus but to "suppress" it by developing an immunity.
"If 60 percent are infected and are then become unable to pass on the virus, it is a good evolution. So, we want to suppress it, not to get rid of it completely, which you cannot do anyway. Our goal is not to suppress it, so we get a second peak of the epidemic, but to allow enough of us who are going to get it, to be mildly ill and to become immune to this and to help with a whole population's response that would protect everybody ... One of the key things Britain needs to do, is build up some kind of herd immunity so that more people are immune to this disease and we reduce the transmission," he said.
In the Netherlands, where the same path is followed, conservative Prime Minister Mark Rutte closed schools and restaurants like neighboring Belgium and Germany, but said that a total shutdown would unlikely to be imposed in his country.
"A total lockdown in our country would not work. The Netherlands is considering a controlled distribution of COVID-19 among groups in the population that are least at risk," Rutte stated.
Sweden is of the same opinion. The authorities made tests for COVID-19 available only for well-protected hospital staff, senior citizen homes as well as other groups more at risk.
"I repeat my earlier advice not to visit older relatives and keep social distancing. We are following developments closely, and it is extremely important now to think about the vulnerable groups, the elderly ... Our main purpose now is to slow down the spread of infection as much as possible, and build up some kind of immunity in the society," Sweden's state epidemiologist Anders Tegnell says.
However, some scientists bluntly declare that this approach is a "dangerous farce." When doctors play on the people's fears and increase global anxiety, it is almost impossible to keep the line of the "herd immunity," that is why the UK, as well as Sweden or the Netherlands have slowly toughened their rules too, although there is still a big difference with Germany, Belgium, France, Italy or Spain.
"On a strictly political level, it does not seem entirely surprising to me that, faced with different strategic options submitted to them by the medical experts and epidemiologists, the authorities were led, in a crisis situation, to take divergent paths. I note, however, that these divergences tend to fade over time: look, for example, at the reversal of [UK Prime Minister Boris] Johnson on the policy adopted first of collective immunity. The public opinion, fears and pressure are difficult to avoid," Michel Liegeois, the professor of the crisis studies center (CECRI) at the University of Louvain in Belgium, told Sputnik.
After having long hesitated on the policy to follow, Italy, then Spain and finally France organized a total closure and total containment of the population. The French authorities now prohibit people to walk, even alone, on the beaches of the country. People can go out of their house, but one must remain "close to his/her home".
"I am a keen sportsman and run every day. I am now forbidden to run alone on our immense beaches, where you rarely see anybody in this season. It is ludicrous. Yesterday, I had chosen to run in the opposite direction, inland from my apartment, but the police stopped me after five minutes, judging that I was already too far from my domicile," Henri Billet, a young executive from France's Dunkirk commune, told Sputnik.
Nevertheless, the worsening situation in Italy, France and Spain make the governments apply tougher rules and even arrest people if regulations are not respected. Spain counts 767 deaths, which represents a 30-percent increase in two days, with a total of more than 17,000 cases confirmed across the country.
In Italy, doctors in Lombardia's hospitals say that the disease could not be compared to the ordinary flu, noting that it is much heavier and provokes tough pneumonia.
"The apocalypse ... It is not comparable to the flu. This is heavy pneumonia. Despite using respirators, we have people dying all the time, about half of them, and hard choices have to be made all the time. I have never been so stressed," an emergency ward specialist doctor says on Italian tv.
The great fear is that the health system will not be able to cope and collapse. Even if collective immunity is intended to be sustainable and helps to avoid the resurgence of the virus in the future, it is still very costly in terms of human life. Researches from Imperial College London revealed that 30 percent of those hospitalized require intensive care, corresponding to 16 days of hospitalization in total. According to researchers, about 50 percent of people in intensive care will die, in addition to those at risk who are not in intensive care.
It would mean more than 250,000 deaths in the United Kingdom and 1.1 million in the United States, with simple collective immunity measures. The advantage of this strategy is that it is supposed to reduce the duration of the crisis and therefore have a much lighter impact on a country's economy.
British virologist Professor John Oxford from the Queen Mary University of London, said that letting the virus spread also takes governments into murky ethical waters.
"As a virologist, I am totally unnerved by it. I do not like it, I say that it is got a touch of eugenics, which I am frightened about. I feel nerve-wracked about it, I think, it is kind of a huge experiment when you are indulging letting the virus go like this, rip through the community. People will die. What will their relatives say?" the professor stated.
Meanwhile, Pierre-Antoine Plaquevent, French author and political analyst, understands the ethical dimension and the difficulty for politicians to take full responsibility in a democracy.
"The quarrel of egos in the scientific community is striking about COVID-19. Distinguished professors find incredible that some wanted to keep schools open. In the old days, when there was an epidemic of measles, parents sent their children to school to make sure they caught it young and not later when they were adults. The Dutch, Swedish or British position was maybe realistic, but many experts make it impossible to discuss. Is confinement of the entire population the right solution? If you look at the number of victims in Italy which experiences the highest mortality in the world, in France or Spain, it is not convincing that they have the right approach, or is it because they were first?" he says.
As Professor Didier Raoult, the director of IHU Mediterranee Infection Center in France, suggests the solution would be to diagnose and confine those who got infected instead of the entire population of a country.
The opinion of Raoult is dissonant given the fact that France has been confined for two days now. This infectious disease specialist, a member of the COVID-19 scientific council mandated by the government, refuse to give in to panic. In a video message, he explains that the latest measures taken by the French, Spanish and Italian governments will not solve the problem.
"Italy, France and Spain are not models. The confinement in Italy does not prevent that there continues to be an exponential evolution. There continues to be an exponential development in France and in Spain as well. These three countries have decided to put containment at the forefront," Raoult said, adding that there was a need to multiply tests, treat people and isolate only COVID-positive people.
Notably, Raoult tested a treatment called Plaquenil, one of the trade Names given to chloroquine, on 24 patients. Six days later, only 25 percent of those tested still hosted the virus. While 90 percent of those who have not received treatment are still positive.
"It is spectacular. The average viral load with this virus is normally 20 days. And all the people who die from coronavirus still have the virus. Not having it anymore changes the prognosis," the professor said.
For him, it is therefore essential to "return to simple things."
"Infectious and contagious diseases mean that when there is a microbe or a virus present, we are contagious. If we do not have it we are not contagious. When there is a drug, we use the drug, so that people are not sick. This is medicine," the scientists stressed.
