Health crisis management: recovering common sense
Dr. David Bensaid (physician), Prof. Steve Ohana (economist)
More than a year has passed since the beginning of the COVID-19 crisis, but it seems that few useful lessons have been learned from this experience. Our management of the health crisis continues to be haunted by the same dogmas, the same fears, the same false beliefs, the same errors in reasoning, which prevent us from providing the right solutions. The purpose of this article is to review what we have learned from field medicine and research, but continue to ignore to our detriment.
I. Lockdowns and Public Health
A year of observation has taught us that COVID-19-related morbidity is not only determined by the severity of government-imposed social restrictive measures but also, crucially, by the general health status of populations as well as the quality of health care systems.
For example, Sweden, which did not impose strict lockdowns during the first wave of contagion in March-April 2020, admittedly experienced higher mortality than its Nordic neighbors who did contain. However, its overall excess mortality during 2020 was only +8%, the 23rd lowest annual excess deaths out of 30 European countries — lower than the UK (15.1%), France (10.4%), and Spain (18.9%). Sweden also had fewer deaths from COVID-19 per million population than these three countries, all of which were under strict lockdown during the pandemic.
Consistent with this observation, a study based on international data found no correlation between the intensity of non-pharmaceutical measures imposed by governments (particularly the severity of lockdowns) and COVID-19 mortality. The first factor correlated with mortality is high life expectancy, as this determines the average age of the population, and thus the proportion of the population at risk of contracting severe COVID-19. Other factors correlated with COVID mortality are the public health context (prevalence of comorbidities related to COVID-19 mortality, such as obesity, hypertension, diabetes, cardiovascular diseases, cancers, compared to the mortality due to infectious diseases, which is, in turn, negatively correlated with COVID mortality), sedentary lifestyle, as well as the environment (temperature and UV index are both negatively related to COVID mortality).
Second, public health investment before the crisis is also predictive of lower mortality during the crisis. In particular, a study on a panel of European countries indicates that a lower mortality rate was observed in countries with a high level of public health expenditure per capita (which translates in particular into a higher number of hospital beds and doctors per capita). The quality of care for the sick and elderly (particularly in nursing homes) was a key determinant of mortality during this crisis, with European data suggesting that nursing home residents accounted for more than 40% of all COVID-19-related deaths.
In addition to being highly uncertain in terms of reducing COVID-19 mortality rates, widespread lockdowns are also detrimental to the general health of the population. The closure of the school system and of economic activity generates very important health costs, through the economic anxiety it creates, the increase in intra-family contamination, the restriction of access to care for many patients requiring medical treatment (such as those suffering from cancers or coronary syndromes), the effect of stress on the immune system, the increase in eating disorders, obesity problems, drug use, violence, depression and suicides (especially among young people). These lockdowns are also a very important aggravator of social inequalities: the closure of schools has reinforced the educational inequalities depending on the income and the level of education of the parents, low-skilled workers are the most affected both on the sanitary and the economic levels, while cramped housing is a factor of aggravation of the stress and the contaminations associated with confinements.
II. The role of children in crisis management
Children were very much involved in the management of the crisis: compulsory wearing of masks from the age of 6, compulsory screening tests by swabbing, closure of entire classes and isolation of families in the event of a positive test, closure of the entire school system during lockdowns… Israel has been particularly notable for having the highest number of days of school closure among OECD countries.
The measures described above have a very important impact on the growth and development of our children, the first years of a child’s life being particularly crucial in his/her neurodevelopment. As psychologist Sonia Delahaigue explains, “wearing a mask, not being able to see faces, is far from harmless, it is not just ‘a piece of cloth’ on a child’s face. While they try to immerse themselves in learning, this piece of cloth constantly reminds them that the disease is present all around them. “
Yet epidemiological and health data show that children have an extremely low risk of contracting a severe form of COVID-19 and are not more important transmitters than adults. A new study even indicates that risk of infecting contacts is the lowest for young children, and that it is significantly lower in outdoor activities and education than at home. A recent meta-analysis examined the results of 40 studies on the subject of school closures and reopenings, showing a very uncertain impact of this type of measure on the transmission of the virus. In addition, as WHO reminds us, the PCR test is a diagnostic test, not a screening test. It is a complementary test used to confirm or refute a diagnostic hypothesis based on symptoms observed by a physician. It is not a test designed for mass screening. PCR is a technique that allows the detection of a virus (or a fragment of the virus) in very small quantities. The very high cycle threshold currently used in PCR tests leads, in some cases, to a probability of less than 3% that the person tested positive is contagious! Moreover, a study published in November 2020 and carried out in the city of Wuhan on nearly 10 million people over the age of 6, found that asymptomatic positive individuals were not contagious. The use of this invasive and potentially painful testing technique on perfectly healthy young children, followed by the possible isolation of their entire family for ten days, are therefore particularly difficult to justify.
III. Treatments exist and must be prescribed early
The media in our so-called “developed” countries, convinced that they hold the truth, have been hammering into the heads of resigned populations since the beginning of the pandemic that “no-treatment-is-effective-against-covid”. This is what the majority of doctors, politicians and eminent personalities repeat over and over again on television and other media, whose common goal seems to be the advent of a single mandatory way of thinking. If you have the misfortune to express a different opinion, you are categorized as a stupid fantasist, or even worse, a conspiracy theorist or even a denier.
Paradoxically, “underdeveloped” countries have much better results than “developed” countries, especially in terms of mortality, without anyone being surprised, in the current atmosphere poised with arrogance and mediocrity. As a matter of fact, Algeria has recorded 70 COVID deaths per million inhabitants, twenty times less than France and the United States and ten times less than Israel! Many other examples could be cited: COVID-related morbidity in African countries is insignificant when compared to that of Western countries. One of the reasons for this success is that countries such as Algeria, Senegal, Nigeria, Chad, Cameroon and Guinea have prescribed the early treatment recommended by Professor Raoult and based on the hydroxychloroquine-azithromycin association (see the review of 231 trials on COVID-19 treatment with hydroxychloroquine here) from the beginning of the infection, which has limited the severe forms and the mortality rate.
But as the saying goes, “No one is a prophet in his own country”, and this same Professor, adulated in Africa, is scorned in his own country, France, and treated as a charlatan, even by his medical colleagues… Everyone now knows about the hydroxychloroquine-azithromycin association, which is the source of fierce polemics from another time. A bad debate maintained by our mainstream media, which put on the same level the opinion of uninformed people or in situation of conflicts of interest with those of the most reputed field experts.
Professor Raoult, ranked among the world’s best specialists in his field for the scope of his work in infectiology, should be considered and listened to. Another great French professor, Professor Christian Perronne, who was humiliatingly removed as Head of Department because he expressed his opinion and simply wanted to treat his patients, confirms Professor Raoult’s early treatment therapeutic strategy of patients infected with COVID-19 with the combination of hydroxychloroquine and azithromycin.
Numerous biased studies have tried hard to prove that the proposed therapeutic strategy does not work. The vast Recovery study carried out in the United Kingdom even presented a gross bias that Professor Perronne denounced, namely the doses of hydroxychloroquine used in the trial were 2400 mg on the first day, whereas the dosage authorized by the marketing authorization is 600 mg, i.e., three 200 mg tablets per day. With Recovery, it is 12 tablets on the first day! Professor Perronne’s remark was of course accepted by the editorial peer-review board of the New England Journal of Medicine. The Recovery study, which tried to prove that hydroxychloroquine was dangerous, was thus discredited. But of course, the mainstream media did not report this information…
We are now going to give you the experience of field medicine concerning the management of COVID-19 patients, which is more or less in line with the strategic approaches mentioned above.
First of all, we insist on the fact that the treatment exists and that, when prescribed early, the patient, in the vast majority of cases, will not develop a serious form of the disease and will be cured in almost all cases.
Here is a summary of the mechanisms of action of this viral infection that are important to know for the implementation of the therapy:
1) An action of the virus itself on the lung
2) A frequent bacterial superinfection
3) An inadequate immune response
In addition, the psychological impact is enormous, especially on breathing, and must always be taken into account in the treatment of the patient. Indeed, the patient is terrorized when he learns that he is positive to COVID-19. The fear that is conveyed 24 hours a day by our society makes this news a real trauma because the patient fears that he may die… It is therefore necessary to start by reassuring him that he will get better and to introduce him to sophrology techniques. A single consultation is not enough, the psychological follow-up is very important, but also the monitoring of life parameters, in particular the oxygen saturation. The current technologies of communication facilitate the follow-up of the patients at a distance (pulse, tension, saturation in oxygen, ECG, clinic, psychological follow-up…). Without going into detail, depending on the patient’s clinical situation and history, chronic medications, presence of allergy or not, it is advisable to start a dual therapy that combines a cephalosporin and a macrolide, a very effective synergy given the complementary action of these two antibiotics (bactericidal cephalosporin and bacteriostatic macrolide). This dual therapy covers almost 100% of pulmonary bacterial infections with, in addition, a presumed intracellular antiviral action of the macrolide (the famous azithromycin is the most widely publicized, but there are other macrolides such as clarithromycin for example), and an anti-inflammatory action. It should be noted that this combination has very few side effects, apart from the non-specific allergy to these drugs. Depending on the patient’s response to antibiotic treatment and the stage of the infectious disease, a strong corticosteroid therapy such as dexamethasone may be prescribed, which acts on the immune response that is often inadequate. The timing of treatment is important and cortisone should not be prescribed without prior antibiotic coverage as cortisone can flare up the viral and bacterial infection if combined. It is also possible to prescribe anticoagulation to avoid thrombosis, a complication of COVID infection, as well as home oxygen therapy.
This is a winning combination, and once again, follow-up is essential because the treatment can vary according to the evolution. Hydroxychloroquine (review of 231 trials on COVID-19 treatment here) and ivermectin (review of 50 trials on COVID-19 treatment here) have undeniable qualities without major side effects and are other complementary therapeutic weapons if the previous treatment proves insufficient. It is necessary to insist once again on early treatment: waiting and prescribing only paracetamol without any follow-up is irresponsible, even criminal in our opinion, because the respiratory aggravation can go very quickly after the first week and of course the treatments are not the same and the mortality is very high in this phase of the disease, often requiring resuscitation. We do not understand why our developed countries so much denigrate these simple and ancient treatments, which work on the current viral infection, why many medical colleagues remain locked in dogmas and prescribe for the most part only paracetamol during this first phase.
“They still haven’t understood anything,” laments Professor Christian Perronne in his latest book, which we strongly recommend reading.
We could go on for a long time proclaiming our incomprehension, but we don’t know if it will be of any use. A very simple question comes to mind: Why alert doctors to the precautions to be taken about the truly minimal adverse effects of the above treatments when experimental phase 3 vaccines (consisting of having the infectious agent’s antigen produced directly by the host’s cells by injecting it with the DNA or RNA encoding the viral protein in question) pose a much greater risk, judging by the adverse effects already presumed in the short term, with a definite unknown of the adverse effects in the medium or long term? No one, not even the manufacturers of these vaccines, can predict the adverse effects in six months, one year, three years… How many booster shots will be needed? Two, three, four per year? No one knows… The Israeli authorities even encouraged the vaccination of pregnant women before the official launch of Pfizer’s tests and continue to do so, even though possible side effects of the vaccine on menstrual cycles and vaginal bleeding are beginning to be reported. They are also encouraging vaccinating teenagers, whose risk of developing severe forms of COVID-19 is extremely low. This is an inconsistent and irresponsible attitude on the part of the authorities, especially in rich countries, who have taken their citizens for guinea pigs. African countries, which rely on existing treatments and see their effectiveness, are rightly reluctant to use these vaccines.
We would like to end this discussion on treatments on a positive note and share with you our perception of this unique profession. Medicine requires knowledge, of course, but above all a sense of observation and analysis of symptoms, experience helps, common sense is essential, medicine is not an exact science and mathematicians who want to demonstrate everything are in the wrong profession. The good doctor is an artist, capable of questioning himself at any time, giving up his ego to make his art shine, always in search of the truth for the good of his patient. Humility, doubt rather than certainty, prudence that does not exclude boldness, are all qualities that a good doctor must possess. But the essential quality is empathy, which consists of putting oneself in the place of the patient and applying this beautiful quote from Hillel the Wise when he was asked to define in one sentence the definition of justice: “Do not do to others what you would not like them to do to you”. For medicine is also a matter of justice, and what could be more unjust than a disease that strikes us when we are innocent!
IV. Dangerous utopias
Over the past few months, in the face of the myths of the “absence of treatment” and the inevitability of repeated lockdowns to curb the epidemic, mass vaccination has been imposed as the ultimate panacea for managing the health crisis.
However, the public debate on vaccination most often ignores some crucial questions in terms of public health. The first of these questions concerns the very possibility of acquiring collective immunity to an “intelligent” virus that is constantly adapting and mutating. One may even fear that vaccination will introduce a selective pressure that will eventually lead to the emergence of more dangerous mutants than today. The second question concerns the variation of the benefit/risk balance of the vaccine with age and health conditions. Is it appropriate, in the name of an unrealistic herd immunity objective, to vaccinate young and healthy populations with an extremely low risk of developing a severe form of the disease, with a treatment for which certain short-term undesirable effects are already presumed and whose long-term side effects are still unknown? The third question concerns medical ethics and fundamental rights. To disregard the informed consent of populations in order to subject them more easily to experimental treatments such as COVID-19 vaccines based on mRNA or DNA, and to coerce them with “vaccine passports”, constitute flagrant violations of the Nuremberg Code, and can therefore be qualified as crimes against humanity. Besides, is it ethically justifiable to apply an experimental treatment to the younger generations, for whom this treatment could have a negative benefit/risk balance, in the name of protecting their elders, who already have the possibility of protecting themselves by being vaccinated?
V. Recovering common sense
Our collective response to the virus, far from bringing us effective remedies, is today a factor of aggravation of the crisis, a large part of the suffering we are experiencing being self-inflicted.
While it continues to ignore the treatments that work, the public debate confronts us with an impossible choice between freedom destroying measures, whose effectiveness is uncertain and whose cost is extremely high, and a “universal vaccine solution”, whose benefit/risk balance is still impossible to evaluate.
It is time to get out of this false alternative, which is artificially imposed on us.
Recovering common sense implies regaining confidence in our medicine, in our treatments, in our doctors, reinvesting in our health care system, in our hospitals, healing our fears, licking our wounds.
This also implies, in the present circumstances, a certain intellectual and moral courage, to have the audacity to get out of the mental prison in which we keep ourselves locked up. For it is only at this price that we will be able to reconquer our freedom.