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The former president of the Romanian College of Physicians, Vasile Astărăstoae, returns with an interesting discussion on the concept of SHEEP IMMUNIZATION, a concept seen by many as the saving solution. In the discussion, he presents the spectacular Case of Manaus, the capital of the Brazilian state of Amazonas, a city presented in the international press as collapsed a few months ago due to the large number of infected and dead by COVID-19 and without any miracle solution. returned to normal.
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What would be the explanation? Is it herd immunity or something? Professor Astărăstoae quotes specialists who speak of the concept of “sensitive subpopulation”.
Here’s all the related discussion:
“On a previous note, I made the following statement:”He (SARS CoV-2 nn virus) it continues to circulate and will continue to circulate until 80% of the population is immunized. “. A friend, Teodor Nedelcu ask a question “The professor, an ignorant in medicine, like me, would like to comment a bit on the statement “the virus will continue to circulate until 80% of the population is immunized.” What about the other 20 percent? “ Hurry, I don’t stop to think and I give the answer with which epidemiologists and infectious diseases indoctrinate us ”.The other 20 percent are protected from the immunity of others.“Taken by the wave, I forgot about genetics, individuality, group specificity, etc. I behaved like a “proud and limited expert”.
The miracle of Manaus -as the press calls it- it was like a cold shower, which made me fall to the ground with my feet.
Manaus It is the capital of the Brazilian state Amazon. It is the seventh city the largest in Brazil, with an estimated population in 2019 of 2,182,763 people and an area of approximately 11,401 km2. It is located near the confluence of rivers. black and Solimões. The city was founded in 1669 as São José do Rio Negro Fort. Manaus It is located in the center of the largest rainforest in the world. It was one of the twelve host cities of World cup since 2014, as well as the host of one of the five subsections of Summer olympic games since 2016.
The first case SARS CoV-2 infection in Manaus was reported on March 24, 2020, after which (mainly due to the attitude of the conservative president of Brazil, Jair bolsonaro) triggers a “apocalyptic” campaign from the international press.
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This is what it says The Guardian April 30, 2020:
Total disaster: Manaus fills common wells as Covid-19 reaches the Amazon “Day and night, the dead are buried in the land of the Amazon, the latest victims of a devastating pandemic, which is now deep in the heart of Brazil’s rainforest. Sunday, 140 corpses they were buried in Manaus, the capital of the state of Amazonas. Saturday 98. Normally, the number would be closer to 30, but these are no longer normal times. Experts and officials say that several factors explain the intensity of the catastrophe, which affects the largest city in the Amazon region. One is that the coronavirus epidemic has reached the end of the rainy season, when respiratory illnesses are common and hospitals are already overcrowded. Another aspect is that the Manaus underfunded chronic health service was poorly equipped and understaffed even before medical staff started contracting COVID-19. But many blame that the government failed to effectively implement containment measures after COVID-19 was detected. On March 23, the State Governor instituted a state of emergency, ordering the closure of all companies (overruled by the president nn), Brazilian President Jair Bolsonaro must take the blame for the deliberate undermining of these measures. (sursa The Guardian)
A month later he intervenes BBC With the news “How the coronavirus passes through Brazil“. Appointment “The coronavirus outbreak in Brazil is one of the worst in the world, with more than 2 million cases registered since March. In fact, it is the second most affected country after the United States. More than 74,000 people died from the virus there. In the capital of Manaus, a man can be seen mending coffins in a funeral home. Authorities have warned that stockpiles of caskets in the region could run out. They were forced to dig large cemeteries as deaths soared, and poverty and malnutrition made fighting the virus in the heart of the Amazon rainforest a great challenge. (…) But despite the increase in the number of cases, there was still no national stagnation. States and cities have taken their own measures, (…), and the data subsequently showed that their compliance has decreased over time. The house arrest warrants and other restrictions have been criticized by far-right President Jair Bolsonaro, who has called them “dictatorial.” She even joined protests against the blockade in the Brazilian capital. He claimed that regional blockades have a more damaging effect than the virus itself and accused the media of spreading panic and paranoia … (BBC sursa).
The international press affirms that the situation in Manaus is dramatic. The hospital system is collapsing. Coronavirus patients are denied admission. The basic needs – beds, stretcher, oxygen – are not met. Ambulances refuse to carry patients. People die at home. The gravediggers could not keep up with the burials. Images are shown with ambulances lined up at the hospital door, coffins lined up, medical personnel accusing the population of not following the recommendations and spreading the virus, etc. (sounds familiar?). The excess mortality is 3000 cases. (to a population of more than 2 million inhabitants). A human catastrophe is predicted. The mayor of Manaus, Arthur Virgílio Neto, I declare that “fought for social isolation”. „The attempt failed“, he said. “There was no real social isolation. People have come out yet and it is not clear why. In the most difficult hours, I would go to the field hospital, get stuck in traffic and think: “Why aren’t there people at home? What I do?”. (sursa Washington Post)
Then in mid-July, unexpectedly, without an explanation, Things are improving. The number of patients hospitalized for coronavirus decreases (from more than 1,300 in May to less than 300 in August), intensive care units are released, excess deaths decrease (from 120 per day to practically zero), the number of tests decreases positive (asymptomatic). Life in Manaus has returned to normal, much earlier than expected by the WHO, scientists and public health officials.
How can we explain this phenomenon??
Manaus did not impose never a lockdown or other strict containment measures used in Asia and Europe. Most people ignored the few recommendations issued (including wearing a mask). We deduce that there are other factors that “drove away” the virus. Probably “group immunity. But Manaus never happened more than 20% of infections. Then, we have to dig deeper the meaning of this concept. Determine the level of transmission and actual immunity in a community where the virus is disrupted.. When I said that 70-80% of the infected population would curb the infection, you may have been wrong by exaggeration in the case of SARS-CoV-2. In other words, surely in this proportion the transmission chain is interrupted. This reasoning starts from the justification and explanation of the purpose of mass vaccination campaigns where, Based on the rate of disease transmission, the percentage of people who must be vaccinated to be successful is determined.. But at the same time, we must not leave the wrong premise that we are all the same. Individuals differ, being doubly determined: genetic and ontogenetic. Genetic through the set of genes (no two individuals are genetically identical, the closest are monozygotic twins) and ontogenetic through evolution from birth to death (some people are more socially active, some are more physically active, some have spiritual concerns, other specific eating behaviors, etc.). Under these conditions, many researchers claim that we must take into account heterogeneity which can reduce the percentage of infection that can occur group immunity. People are more likely to contract the disease and pass it on. the most active from a social point of view or the most sensitive, vulnerable, who get infected first. But once they have been immunized and are out of the potential victims, the risk is lower for everyone else. However, we do not know the effect (percentage) of their immunization, but it may be an explanation of how the epidemic has evolved in Italy (differences between Lombardy, Rome, Sicily) Sweden, Netherlands, Central and Eastern European countries where different measures medical results were close identical and in identical measures different results.
Gabriela Gomes et all., at Individual variation in susceptibility or exposure to SARS-CoV-2 lowers the threshold for herd immunity, came to an astonishing conclusion: herd immunity may be less than 20%. It states “As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads, the sensitive subpopulation is depleted, causing the incidence of new cases to decline. Variation in individual susceptibility or exposure to infection increases this effect. People who are more susceptible or more exposed tend to become infected earlier, depleting the sensitive subpopulation of those most at risk of infection. This selective depletion of susceptibilities intensifies the deceleration in incidence. Over time, susceptible numbers become low enough to prevent an increase in the epidemic or, in other words, the threshold for personnel immunity (HIT) is reached. Therefore, accurate measurements of heterogeneity are of crucial importance in controlling the COVID-19 pandemic. “
In conclusion, the concept is worth re-analyzing “herd immunizationAnd as for the individuality and susceptibility of the person. Regarding the current pandemic, I rectify what I said before and say that The SARS CoV-2 virus continues to circulate and will continue to circulate until part of the population is immunized. What percentage of people are infected to carry out the “herd immunization”? It remains to be seen.
PS: For those who post comments and send me all kinds of data and graphics, trying to convince me that either the virus does not exist or it exists and the apocalypse awaits us: my unshakable faith is that the virus exists and causes a disease with the 1 % of cases severe and critical and 80-90% asymptomatic. That is why the pandemic must be treated responsibly: neither trivialize it nor exaggerate it. This pandemic, due to its peculiarities, does not justify measures to limit civil and social rights ”.
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