Letter to Belgium Prime Minister urging government to act from virologist Marc Wathelet
Dear Prime Minister, dear members of the government,
Already on March 5 the director of the WHO urged you:
There are a good number of countries who have left the epidemics up to the ministry of health and the health emergency institutions. We’re saying that’s wrong. It needs whole government approach. That’s why my statement today was focused on advising all countries on Earth to trigger the whole government approach.
Five days later, you talked a lot, I guess, but you haven’t made any of the right decisions.
The choice that presents itself is very simple. We can take extreme measures now, or later.
Because we will not be able to avoid extreme measures with a doubling time of 3.3 days. If we take them now, all the costs, human and economic, will be much lower.
This doubling time has been publicly challenged by Professor Gilbert of the Space Epidemiology Service at ULB. But Professor Gilbert is a man of integrity and I would like to salute the courage he showed, extraordinary in the current circumstances, when he wrote to me:
I agree with you on three things. On the need to work together, on the fact that a television set is not the best place to debate sensitive scientific questions and on the doubling time of cases. It was an interpretation error on my part, I will correct it publicly if I have the opportunity, and I apologize for this erroneous reaction made in public.
In our email exchange, I criticized the prognosis of a mortality rate in Belgium similar to that which would have been observed in China in the provinces other than that of Hubei, namely 0.7%, and which would correspond to a mortality rate when the hospital system is not overwhelmed, according to him.
My review is based on what scientists call the case fatality ratio,CFR, which is the best indicator at the start of an epidemic of the death rate that can be calculated once the epidemic is over. At this point in the epidemic outside of China, the CFR is 37% in Italy, South Korea is at 24%, and Iran is at 9%. The CFR is calculated as death / (death + recovered).
These figures are not final and only indicators. In particular, I have yet to find the demographic profile of deaths and recoveries in these countries, and I can only hope that the final toll will not be as heavy. Professor Gilbert reproaches me for not considering the case of Germany where there are only 2 deaths out of 1176 cases and for not having an explanation for the big differences between countries in what is called the crude fatality ratio, the number of deaths out of the total number of people infected.
The explanation is obvious, a pandemic virus keeps on evolving as it propagates: there are quite simply several strains of SARS-CoV-2 that are circulating in the world today, and which differ in particular in their virulence, causing distinct diseases, COVID-19A, COVID-19B, -19C, etc., and I estimate that there are currently 5-6 different strains circulating in the world.
Unfortunately for Belgium, the cases that circulate among us come mainly from Italy, not from Germany and that is why the CFR of 37% in Italy is so worrying. Even if the final figure is reduced, it probably will not go down to 0.7%.
And that is why the decision not to put the people who returned from Italy in quarantine was a monumental error with serious consequences for the country, when this CFR was already known at the time of making this decision.
We will have a number of deaths which could have been avoided in Belgium, as a result of this criminal negligence of not having the good sense to follow the most basic public health measures which were essential at that time.
With a doubling time of 3.3 days confirmed by Professor Gilbert, what do these figures tell us, figures that have no feelings and no agenda? They tell us that every day we lose procrastinating will lead to more cases, more hospitalizations, more deaths, and greater economic cost.
Why wait ?
It’s hard to understand how it’s even a choice. People seem to think that the economic cost justifies waiting, while the longer we wait, the greater the economic costs.
What do you gain by waiting?
If you put Belgium in hibernation for three weeks today, what will happen? People who are already infected will only infect those who live under the same roof. Instead of multiplying the number of people infected by 64 during these 3 weeks, not only is the number multiplied, at most, only by the number of people living under the same roof, but in addition we will know exactly where they all live, and it becomes possible to stop the spread of the virus!
In contrast, if you wait another three weeks, you will have 239 x 64 = 15.296 cases, and not 9 weeks to reach this figure as your experts said‼ I take the official figure announced for Belgium, but I quote Dr. Marc Van Ranst who in today’s Het Laatste Nieuwstells us “The real number of patients with coronavirus is probably 10 times higher“. So around 150,000 cases in 3 weeks if we don’t act today.
If the example of South Korea and Italy is a guide, the situation will already be very difficult for our hospitals with 15,000 cases, and we will not be able to locate most of these cases…And this is where putting strict measures in place will no longer be necessary because people will have done it on their own, but the hospital system will have been overwhelmed and it is a price that it is not necessary to pay.
Your experts were all too optimistic. I too was too optimistic when I calculated that the hospital system would have problems from 1% of symptomatic people, while the figure of Dr. Philippe Devos shows that in practice both Italy and South Korea already have concerns from 0.062% of cases! An error of a factor of 30 and that is why I asked the SPF service to do the calculation, because they have figures to which I do not have access.
What do the numbers say? They say that every 3.3 days we wait, the number of cases is doubled, the number of hospitalizations is doubled, the number of deaths is doubled.
What do the numbers say? They say that if we wait a week, the number of cases is quadrupled, the number of hospitalizations is quadrupled, the number of deaths is quadrupled.
What do the numbers say? They say that if we wait two weeks, the number of cases is multiplied by 16, the number of hospitalizations is multiplied by 16, the number of deaths is multiplied by 16.
I am a scientist and I am providing you with the key figures necessary to make the necessary decisions.
Is human life no longer of value to our leaders?
Deputy Prime Minister Koen Geens declares on a newscast on March 8 on RTL-TVI, I quote: “1 to 2% of mortality, it’s not so big, I am sorry, it is like with a flu, quite normal”. A pathetic response for the false comparison with the flu, and above all a pathetic response because it betrays a lack of compassion for and solidarity with the population on Belgian territory.
It is the kind of disconnection from reality that involves the false belief that he or his family are immune from the disease.
The government can take the courageous decision to join Italy and quarantine the whole of Belgium by declaring a state of national emergency. If you don’t, don’t count that those of you who will physically survive this pandemic will survive politically.
It is obvious that most of you have not yet emotionally accepted the reality of the pandemic situation. You have to get out of denial and face reality, or you will make the biggest mistake of your life.
You still do not understand the exponential progression: it is utterly shocking that no one in government seems able to understand the basic mathematical truth that the best way to flatten the curve is to act as soon as possible! In fact, we cannot avoid a quarantine of 3-4 weeks for the whole country anyway with a doubling time of 3.3 days. This doubling time will hardly be lengthened by the measures proposed today.
Your job is to save the country and to do that you must not panic the public, simply inform them that absolutely everything, everything, everything must be done to fight the virus. And it starts with a government that sends the message to the population that the situation is extremely serious by implementing all the public health and quarantine measures that are available.
Your job is to save the country and to do that you have to put the country in hibernation, in quarantine, now, in the same way that it is sometimes necessary to put a patient in a coma to save it!
Union is strength, Madam Prime Minister and other members of the government, all together! All together, we can beat the virus!
I remain at your disposal,
The author has a Ph.D. in molecular biology, studied the interactions between viruses and the innate immune response throughout his career, led a small group of researchers in the US to work on human coronaviruses in general and on the one responsible for the 2003 SARS outbreak in particular, both as a faculty member of the University of Cincinnati College of Medicine, and as a scientist at the only institute focused exclusively on respiratory diseases, in Albuquerque.