Why we should take Covid-19 seriously

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You may have encountered them in the (social) media: emphatic messages and posts from the conviction that covid-19, caused by an infection with the SARS-CoV-2 virus, would be over-broadcast and has led to worldwide hysteria. The craziest arguments are brought in to support this view. For example, it is quoted that so far in Belgium ‘only’ 40 people under the age of 45 have died of Covid-19. If we include the 45-65 age group, we see 500 additional deaths. So, it is argued, the mortality of the -65 year olds has not increased from what we normally observe. Therefore, it has often been suggested to shut down the younger generation of the older ones to protect the older ones and let the young live normal lives and keep the economy going.

Yes, it may sound familiar to you…

It is true that many infected people have no or mild symptoms. Unfortunately it develops one in five patients has severe symptoms requiring hospitalization. A significant part of this is admitted to intensive care. Depending on country to country, 0.5% to 1.5% of patients die.

Of first wave (March – June 2020) caused about 10,000 deaths in Belgium. The older population was the hardest hit, causing the infection fatality ratio to show a steep increase. Men older than 85 years had an infection fatality rate of 13%, in women it was 11%. In other words, one in six men over the age of 85 who became infected and one in nine women died.

It is correct that children relatively speaking what spared remain: their infection rate is low and deaths remain very exceptional. Young people who have passed puberty become infected more easily, but most survive well. In this group too, however, there is a significant part who become seriously (critically) ill and sometimes have to be cared for in the intensive care unit for weeks, in a coma, with ventilation and a long rehabilitation afterwards.

It will be It is increasingly clear that people with mild or moderate infections also have serious lung and heart injuries. Cardiovascular problems are now becoming visible: scar tissue in the heart causing arrhythmias with, in addition to an uncomfortable feeling, an increased risk of heart attack. We see these injuries in young people with mild infections. So, who says, “Just let us run covid-19, let’s get it over with, and get our lives back,” plays Russian roulette as well. There is a small risk of dying but a significant risk of damage to the heart or lungs. Moreover, there is more and more evidence that damage to the brain can also occur. These consequences worsen with increasing age.

Of incubatieperiode is relatively long, about a week. One of the difficulties with this disease is that some people who are contagious are often very contagious 4 days before they develop symptoms. The so-called super spreaders and super spreading events also make it difficult. These phenomena were not well known in the period February-March 2020, but are now becoming clearer and clearer. There are indications that the number of super spreaders is increasing, although this requires further careful investigation.

Another important aspect that we do not understand right now is how immunity works. It takes a while for antibodies to become detectable and then the antibodies decrease again. Immunity may work differently, for example, via T cells. How long does the protection last? Is this protection complete or partial? We do not know. It is still too early.

To live a carefully adjusted ‘normal’ life, we must work at different levels:

  • We must respect the important social distance and hygiene measures.
  • We must be careful with every social contact.
  • Governments must have an efficient and operational system for contact tracing and cluster monitoring.
  • We need antivirals. The more we have and the better they work, the more people we can protect against very serious symptoms and consequences.
  • Of course we need a vaccine, and this will take a while. Although the speed with which vaccines are now being developed is unseen, it takes time to accurately evaluate the safety and effectiveness of vaccines. In the longer term, the virus may become milder and milder, but we should not hope for that too soon. We hope for a vaccine.
  • April 2020 was the most deadly month in April since World War II. A number of January and February months in the 1950s and 60s were about as deadly from the flu pandemic. However, no social distance measures were imposed during this period. If we had not introduced social distancing and hygiene measures in the fight against covid-19, we might have looked at 50,000 to a quarter of a million victims, a scenario reminiscent of the Spanish Flu. After all, a pandemic that is not being fought against will cause the health system to be completely overloaded. We see such scenes all over the world, with the mass graves in big cities like New York City as poignant evidence.
  • A second wave may be even more dangerous because there is already quite a lot of virus circulating while the population is still largely susceptible. We must therefore ensure that we flatten the curve and bring it down until we reach a very low level of virus circulation. In New Zealand and Finland this has been applied and the population can lead a reasonably normal life.

We must (continue to) take Covid-19 seriously. Anyone who takes covid-19 seriously follows the measures and protects themselves and their surroundings while awaiting a vaccine. We can and must build on the strength of our own behavior and the advancing scientific understanding to fight the epidemic.

Geert Molenberghs (UHasselt / KU Leuven), Pierre Van Damme (UAntwerp), Sarah Vercruysse (UHasselt), Niel Hens (UHasselt / UAntwerp)

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