Thoughts about the corona pandemic – Dr. med. Alex Rosen with an appeal for reason

Dr. med. Alex Rosen is chairman of the IPPNW (German Section of the International Doctors for the Prevention of Nuclear War / Doctors in Social Responsibility eV) and specialist for pediatric and adolescent medicine. On March 22, 2020, he wrote an email to the members of the IPPNW with the subject „Thoughts on the Discussion of the Current SARS-CoV-2 Pandemic“. weltnetz is very grateful that we are allowed to publish the thoughts and we hope that they will contribute to an objective examination of the pandemic.

 

Dear members,

I enjoy the lively exchange and also the large number of interesting and thoughtful articles on the subject.

 

When friends of mine ask me what they can do to help, I always ask them two things:

  • make sure that they do not spread the virus (social distancing, hygiene measures, isolation in case of symptoms, etc.)
  • make sure that they do not spread false information and rumors unchecked and unreflected

The second point is probably as important as the first, if not more important.

 

In view of the far-reaching political decisions of the past few weeks, an intensive and critical debate about the need for measures to restrict freedom and interference with privacy is just as necessary as a discourse about why the virus apparently affects some people very hard, while others have almost no symptoms. We have to understand the virus better in order to be able to counteract it medically and we have to try to find the right measure and the right measures in the difficult trade-off between health protection for individuals and interference in the social, emotional and economic life of everyone. We at IPPNW have to talk about that too – so thank you again to everyone who takes part in this discourse.

 

What we don’t need is unscientific trivialization or repression. We can talk about whether it is really necessary to restrict freedom of movement without neglecting the dramatic medical situation in Lombardy, Iran or Alsace. We can identify the underlying causes of the current crisis (lack of nursing staff due to decades of failed health policies, economization and privatization of the health care system, fine dust pollution, unhealthy lifestyle that leads to cardiovascular diseases or diabetes, etc.) without denying the scientific facts.

 

  I would therefore like to address a few points:

  • We know so far that around 80% of SARS-CoV-2 infected people have a relatively mild course and only a minority develop the lung disease COVID-19. At the same time, it is a novel virus on which the world population has not yet been able to develop immunity and therefore it poses a much greater risk than endemic pathogens for which large sections of the population have already developed an immunological memory. We know the phenomenon of the „new virus“ from the history of medicine and we know that viruses, which are not so dangerous because of their pathogenicity, can lead to massive effects in the first contact. The European settlers and conquerors brought viruses to the American continent that were considered a childhood disease in Europe, but wiped out entire civilizations in the Americas. We saw similar developments around a hundred years ago with the novel Spanish flu influenza A / H1N1 virus. We cannot yet estimate how high the case-related lethality of SARS-CoV-2 will be in the end. The mortality rates of individual countries vary widely: in Germany 92 deaths are currently measured in 23,974 cases (0.4% mortality), in Italy 5,476 deaths in 59,138 cases (9.3% mortality). As always, the truth lies in between and depends heavily on epidemiological factors, temporal courses, therapy decisions, test strategies and health policy conditions. Solid estimates indicate a case-related lethality of around 0.5-1%, about 5 to 10 times higher than normal influenza (0.1%). That additional deaths („excess deaths“) ) are not to be expected to be disputed, i.e. people who would not (yet) have died without the current virus pandemic. We don’t yet know how high this number will be in the end. The current all-cause mortality at the country level will definitely not help us with this question and therefore does not represent a meaningful measure in the assessment of the pandemic. The natural death rates are simply too high for this to register smaller fluctuations in undifferentiated country-wide considerations. Nevertheless: if one believes the 0.5-1% mortality and assumes a 60-70% infection in the population, then we would expect 250,000-580,000 SARS-CoV-2-related additional deaths for Germany in the next few years. Would that be enough to put the total statistics of around 820,000-950. 000 deaths a year in Germany to cause a significant dent? Questions for medical statisticians … Meanwhile, we practitioners should try to prevent people from dying prematurely just because there is insufficient health care capacity to provide them with the medical help they need.

 

  • Most people who have severe COVID-19 disease are old and have pre-existing conditions. This is exactly what we expect from all respiratory diseases – whether from coronaviruses, influenza or pneumococci. People with cardiovascular diseases, respiratory diseases, immune defects or people who are immunosuppressed, e.g. oncological or rheumatological patients, are the worst hit. But statistically, of course, young, healthy people and yes – in rare cases children – will also be among the victims. We also see this in the data from Italy and China. The solidarity currently being shown by politicians and society to the different groups of risk patients is remarkable and should be remembered in the future, when it comes to other health risks, such as the consequences of climate change or the economization of health care. What is to be warned is the attempt to downplay the dangers of SARS-CoV-2, with the argument that the majority of the deceased had previous illnesses. That ALWAYS applies to death rates from serious illnesses. Whether heart attacks, cancer, pneumonia or appendicitis – ALWAYS those who have previous illnesses will die more and more. One cannot deduce from this that SARS-CoV-2 is not dangerous. that most of the deceased had previous illnesses. That ALWAYS applies to death rates from serious illnesses. Whether heart attacks, cancer, pneumonia or appendicitis – ALWAYS those who have previous illnesses will die more and more. One cannot deduce from this that SARS-CoV-2 is not dangerous. that most of the deceased had previous illnesses. That ALWAYS applies to death rates from serious illnesses. Whether heart attacks, cancer, pneumonia or appendicitis – ALWAYS those who have previous illnesses will die more and more. One cannot deduce from this that SARS-CoV-2 is not dangerous.

 

  • Some people who are not currently on the front line use PCR testing to make no sense. We here in Berlin have been testing patients with respiratory infections for SARS-CoV-2 for weeks. At the beginning we did not have a single positive result. Over time it grew. It is currently around 5% of those tested who have positive results – and the trend is rising. All with the same test. By the way, the same one that is used in other countries. It is similar everywhere: initially everyone is negative, then there are occasionally positive results, then more and more and with the accumulation of positive tests, the rate of serious respiratory infections increases, since a certain proportion of those infected have severe courses. Then how can you say the test would only give false positive results or the infection had been in circulation everywhere for a long time and would the new tests simply „uncover“? Anyone who claims something like this either has no idea or is playing a bad game. One can argue about the specificity of a test and about the pre-analytical factors that inevitably cause problems for a swab test, but please on a scientific level and with solid arguments.

 

  • The majority of those infected die in Italy outside of intensive care units. Every life is fought in the intensive care unit, so many of them manage to survive. Those who do not make it to the intensive care units (due to lack of beds, staff or respirators, for logistical reasons, for reasons of delayed access to medical help or for lack of access to health care) are then killed at home, in the tent- Military hospitals in front of the clinics or in normal wards. I am in daily contact with friends of mine in Italy who are currently enduring and performing enormously in the hospitals. I cannot understand how to discuss the current situation in Lombardy or explain it with the increased pollution. No, it’s not normal that in Bergamo the clinics have to set up tents in front of the emergency rooms. It is not normal that people do not come to the intensive care unit because there is no space. It’s not normal for funeral directors to have to ask the military for help because they don’t have the capacity to deal with all the dead. Yes, northern Italy has air pollution. This is similar to regions in the Balkans, Poland, Slovakia and in individual locations in Germany, France, Spain or Great Britain. Of course, there are also many regions worldwide where the Air Quality Index (AQI) is still clearly (see e.g. that funeral directors have to ask the military for help because they don’t have enough capacity to deal with all the dead. Yes, northern Italy has air pollution. This is similar to regions in the Balkans, Poland, Slovakia and in individual locations in Germany, France, Spain or Great Britain. Of course, there are also many regions worldwide where the Air Quality Index (AQI) is still clearly (see e.g. that funeral directors have to ask the military for help because they don’t have enough capacity to deal with all the dead. Yes, northern Italy has air pollution. This is similar to regions in the Balkans, Poland, Slovakia and in individual locations in Germany, France, Spain or Great Britain. Of course, there are also many regions worldwide where the Air Quality Index (AQI) is still clearly (see e.g.https://www.airvisual.comor https://waqi.info/), for example also in China. Air pollution may be a reason for the prevalence of cardiovascular and respiratory diseases, which are now leading to poorer forecasts in the pandemic situation, but without the current pandemic situation, the locally very different morbidity and mortality developments could not be explained: thousands of deaths in Wuhan but not in Beijing; in Bergamo but not in Milan; in Alsace but not in Paris. No – the regionally different epidemic with SARS-CoV-2 plays a role here.

 

I hope that we will all deal with this pandemic with the necessary seriousness – in everyday medical life, in the political struggle for adequate measures, as well as among families and friends.

 

With this in mind, I wish you and us strength, stamina and resilience in the coming days and weeks. The crisis is testing us as a society and so far we seem to accept the challenge with a lot of solidarity, commitment and helpfulness. That encourages. Courage that we will all need.

https://weltnetz.tv/story/2312-gedanken-zur-corona-pandemie

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