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The chief physician at the Infectious Disease Clinic at St. Gallen Cantonal Hospital Pietro Vernazza experienced the AIDS epidemic 35 years ago. According to the infectious disease specialist, fear is a bad advisor.
Many decisions would be made without a sound scientific basis and, unlike in healthcare, without the question of benefits and costs.
Public life is still still, how do you think we can get out of this situation?
Pietro Vernazza: The discussion about the coronavirus in this country is based too much on opinions and beliefs. I see a dramatic separation between political and scientific committees. By that I mean not only doctors and virologists, but also economists. The virus simply cannot be. The scientific opinion that the virus cannot be eradicated is not timely. Paths other than the chosen one are no longer discussed.
Was the closure correct?
They accused me of being against confinement. That is not true. This protected hospitals from overload. It worked more than. But now it is a question of immediately converting new scientific knowledge into measurements.
For example?
The closing of the school. Many virological and epidemiological studies have been conducted in the past six weeks showing that school closings are not an effective measure against the spread of the coronavirus. This is what Daniel Koch of BAG says. Children do not contribute to the spread of the virus. So there is no reason to keep schools closed. Schools should have reopened on April 19 after the holidays.
And the protective masks?
There is simply little scientific evidence that healthy people wear masks. A small additional benefit is possible. But we overestimate the effect. Now hairdressers have to figure out the best way to wear the masks. Only intestinal decisions remain, professional competence is not required. Even those of economists.
Up to what point?
If we can extend our life for another year for another CHF50,000 for another disease, we will be positive. If we have to pay half a million for very expensive drugs during a year of life, there will be heated debates in the media. Economists now tell us that the effort we are putting into practice is to extend the life of one year in the order of CHF 10 million. It amazes me how we only see deaths in Corona now, but our measurements are not based on a cost-benefit assessment.
Do you think this also applies to other areas?
The measurements for the restaurants are not based on evidence either: we know that the drops are transported from one to one and a half meters. Now the safety distance has been increased to two meters for no reason. Now the innkeeper has to offer four square meters of space per guest, with a distance of 1.4 meters that would still be two. Hygiene measures would be much more important to reduce the most important transmission route, direct contact through the hands.
Is the discussion too fear driven?
Sure As an infectious disease specialist, I experienced this 35 years ago in the AIDS epidemic. We saw examples of irrational acts every day. Fear has been in the population for as long as people believed that the disease could directly affect them. After that, the handling was more relaxed. Everyone is now affected by the corona virus, and many have high blood pressure. No one can avoid it. Now many measures are being decided, also comparatively expensive, without really having any indication that they will work. I called masks. An application that shows us possible contacts with infected people. Two thirds are in favor. But what exactly I do with this information is still unclear. Will we be quarantined after possible contact? And after the second and the third too?
Don’t you think that the BAG strategy is convenient? Less than 50 cases per day to isolate the infected and their quarantined contacts?
The decision to investigate each individual case and its contact persons again and to put them in quarantine prescribed for ten days is heroic. In any case, it will be extremely complex, also for the working world and I am excited to see how well it is implemented. Imagine that an employee in a production unit becomes ill. Now the cantonal doctor orders ten days of quarantine for the entire production unit. Do we want that? We will have major implementation problems.
Are the experts too motivated by panic?
Can be. The main problem is that we perceive Sars-Cov-2 as a very dangerous virus. This contrasts with the fact that the virus is harmless to most. And yet, for some, the disease is serious or even fatal. The question is whether we can keep the virus completely away from us. The fact that many infected people are contagious without symptoms makes this highly unlikely. Summer weather can reduce the virus a bit, but that doesn’t change the fact that we have to live with this disease.
What would you suggest
I would rather have chosen a strategy in which we particularly protect vulnerable people, not overburden hospitals, but basically allow disease and the build-up of immunity in the population. Just as Sweden does. Now the Federal Council has decided otherwise. Now is the time to follow this strategy with determination and wait. But implementation will challenge us.
Does this mean that the only way to control the coronavirus is through immunization?
There are now enough indirect hints that we are immune after being infected. It is a biological principle that a virus produces an immune response and the antibodies neutralize a virus. If you don’t believe in an immune response, you can’t wait for an early shot. It works on the same principle.
Can we expect a vaccine?
This is a realistic scenario. I don’t know if that will be the case in a year.
A recent study in Geneva shows that 5.5 percent of the population is currently immune. Is that a realistic number?
I think so. I also expect that from us. A study in New York has already shown that 20 percent of the population is immune. We are currently conducting a similar test with antibody testing at St. Gallen Cantonal Hospital. The more people are immune, the slower the disease will spread. About 60 to 70 percent are immune to herd immunity. Then the disease no longer spreads. It still takes a long time. But even with 20 percent immunity, the virus will spread more slowly. Five percent is a good start. If 10 to 20 percent were immune in the summer, we could already see an effect.
American experts hope the virus will not go away in the next four to five years. A coming and going, up and down, is that possible?
It is likely, as with other respiratory viruses, as with the flu. So we cannot turn the world upside down. We have to treat it differently: protect people at risk, but allow others freedom of movement. For young, healthy people, a closure is over the top in the long run.
Danger is part of everyday life.
Sure, young people can also die from it. But I also experience this in daily medical life with the flu. Every year AND older people should also be allowed to decide whether they see their grandchildren at some risk or prefer to isolate themselves for a year or more. Most older people also go through the disease without symptoms and become immune. We cannot eliminate the decisions of the highest risk people about their own lives. Personal responsibility must remain. We have to take state measures to avoid overloading hospitals and health facilities. Because we want to be able to offer people at risk the best possible treatment. And we can do it.
