Questions for Merkel

Stamford, Connecticut is a ghost town, with virtually everything closed after 9:30pm and only a few furtive-looking people roaming the streets. Identical green signs on restaurant windows advise that they are open for takeout. However, the convenience stores and big chains (McDonald’s, Subway) are the only establishments that aren’t closed and locked at this time of night. My favorite restaurants are all shuttered, two of them possibly forever. Quiet, dark and nearly deserted, the city center feels post-apocalyptic.

Thus, with 401 laboratory-confirmed coronavirus “cases” (is that the right term for infections, which may not manifest symptoms?), a city of 130,000 people has been effectively shut down. How long will this last? It’s not clear.

The public may be under the impression that there a consensus among the experts about the wisdom of this approach. There is not. In Germany, a distinguished medical research scientist had some pointed questions for Angela Merkel a few days after the Chancellor announced a nationwide “contact ban,” and I am posting the full text of this important document here:

Open Letter from Professor Sucharit Bhakdi to German Chancellor Dr. Angela Merkel

An Open Letter from Dr. Sucharit Bhakdi, Professor Emeritus of Medical Microbiology at the Johannes Gutenberg University Mainz, to the German Chancellor Dr. Angela Merkel. Professor Bhakdi calls for an urgent reassessment of the response to Covid-19 and asks the Chancellor five crucial questions. The let­ter is dated March 26. This is an inofficial translation; see the original letter in German as a PDF.
Open Letter

Dear Chancellor,

As Emeritus of the Johannes-Gutenberg-University in Mainz and longtime director of the Institute for Medical Microbiology, I feel obliged to critically question the far-reaching restrictions on public life that we are currently taking on ourselves in order to reduce the spread of the COVID-19 virus.

It is expressly not my intention to play down the dangers of the virus or to spread a political message. However, I feel it is my duty to make a scientific contribution to putting the current data and facts into perspective – and, in addition, to ask questions that are in danger of being lost in the heated debate.

The reason for my concern lies above all in the truly unforeseeable socio-economic consequences of the drastic containment measures which are currently being applied in large parts of Europe and which are also already being practiced on a large scale in Germany.

My wish is to discuss critically – and with the necessary foresight – the advantages and disadvantages of restricting public life and the resulting long-term effects.

To this end, I am confronted with five questions which have not been answered sufficiently so far, but which are indispensable for a balanced analysis.

I would like to ask you to comment quickly and, at the same time, appeal to the Federal Government to develop strategies that effectively protect risk groups without restricting public life across the board and sow the seeds for an even more intensive polarization of society than is already taking place.

With the utmost respect,

Prof. em. Dr. med. Sucharit Bhakdi

1. Statistics

In infectiology – founded by Robert Koch himself – a traditional distinction is made between infection and disease. An illness requires a clinical manifestation. [1] Therefore, only patients with symptoms such as fever or cough should be included in the statistics as new cases.

In other words, a new infection – as measured by the COVID-19 test – does not necessarily mean that we are dealing with a newly ill patient who needs a hospital bed. However, it is currently assumed that five percent of all infected people become seriously ill and require ventilation. Projections based on this estimate suggest that the healthcare system could be overburdened.

My question: Did the projections make a distinction between symptom-free infected people and actual, sick patients – i.e. people who develop symptoms?

2. Dangerousness

A number of coronaviruses have been circulating for a long time – largely unnoticed by the media. [2] If it should turn out that the COVID-19 virus should not be ascribed a significantly higher risk potential than the already circulating corona viruses, all countermeasures would obviously become unnecessary.

The internationally recognized International Journal of Antimicrobial Agents will soon publish a paper that addresses exactly this question. Preliminary results of the study can already be seen today and lead to the conclusion that the new virus is NOT different from traditional corona viruses in terms of dangerousness. The authors express this in the title of their paper „SARS-CoV-2: Fear versus Data“. [3]

My question: How does the current workload of intensive care units with patients with diagnosed COVID-19 compare to other coronavirus infections, and to what extent will this data be taken into account in further decision-making by the federal government? In addition: Has the above study been taken into account in the planning so far? Here too, of course, „diagnosed“ means that the virus plays a decisive role in the patient’s state of illness, and not that previous illnesses play a greater role.

3. Dissemination

According to a report in the Süddeutsche Zeitung, not even the much-cited Robert Koch Institute knows exactly how much is tested for COVID-19. It is a fact, however, that a rapid increase in the number of cases has recently been observed in Germany as the volume of tests increases. [4]

It is therefore reasonable to suspect that the virus has already spread unnoticed in the healthy population. This would have two consequences: firstly, it would mean that the official death rate – on 26 March 2020, for example, there were 206 deaths from around 37,300 infections, or 0.55 percent [5] – is too high; and secondly, it would mean that it would hardly be possible to prevent the virus from spreading in the healthy population.

My question: Has there already been a random sample of the healthy general population to validate the real spread of the virus, or is this planned in the near future?

4. Mortality

The fear of a rise in the death rate in Germany (currently 0.55 percent) is currently the subject of particularly intense media attention. Many people are worried that it could shoot up like in Italy (10 percent) and Spain (7 percent) if action is not taken in time.

At the same time, the mistake is being made worldwide to report virus-related deaths as soon as it is established that the virus was present at the time of death – regardless of other factors. This violates a basic principle of infectiology: only when it is certain that an agent has played a significant role in the disease or death may a diagnosis be made. The Association of the Scientific Medical Societies of Germany expressly writes in its guidelines: „In addition to the cause of death, a causal chain must be stated, with the corresponding underlying disease in third place on the death certificate. Occasionally, four-linked causal chains must also be stated.“ [6]

At present there is no official information on whether, at least in retrospect, more critical analyses of medical records have been undertaken to determine how many deaths were actually caused by the virus.

My question: Has Germany simply followed this trend of a COVID-19 general suspicion? And: is it intended to continue this categorisation uncritically as in other countries? How, then, is a distinction to be made between genuine corona-related deaths and accidental virus presence at the time of death?

5. Comparability

The appalling situation in Italy is repeatedly used as a reference scenario. However, the true role of the virus in that country is completely unclear for many reasons – not only because points 3 and 4 above also apply here, but also because exceptional external factors exist which make these regions particularly vulnerable.

One of these factors is the increased air pollution in the north of Italy. According to WHO estimates, this situation, even without the virus, led to over 8,000 additional deaths per year in 2006 in the 13 largest cities in Italy alone. [7] The situation has not changed significantly since then. [8] Finally, it has also been shown that air pollution greatly increases the risk of viral lung diseases in very young and elderly people. [9]

Moreover, 27.4 percent of the particularly vulnerable population in this country live with young people, and in Spain as many as 33.5 percent. In Germany, the figure is only seven percent [10]. In addition, according to Prof. Dr. Reinhard Busse, head of the Department of Management in Health Care at the TU Berlin, Germany is significantly better equipped than Italy in terms of intensive care units – by a factor of about 2.5 [11].

My question: What efforts are being made to make the population aware of these elementary differences and to make people understand that scenarios like those in Italy or Spain are not realistic here?
References:

[1] Fachwörterbuch Infektionsschutz und Infektionsepidemiologie. Fachwörter – Definitionen – Interpretationen. Robert Koch-Institut, Berlin 2015. (abgerufen am 26.3.2020)

[2] Killerby et al., Human Coronavirus Circulation in the United States 2014–2017. J Clin Virol. 2018, 101, 52-56

[3] Roussel et al. SARS-CoV-2: Fear Versus Data. Int. J. Antimicrob. Agents 2020, 105947

[4] Charisius, H. Covid-19: Wie gut testet Deutschland? Süddeutsche Zeitung. (abgerufen am 27.3.2020)

[5] Johns Hopkins University, Coronavirus Resource Center. 2020. (abgerufen am 26.3.2020)

[6] S1-Leitlinie 054-001, Regeln zur Durchführung der ärztlichen Leichenschau. AWMF Online (abgerufen am 26.3.2020)

[7] Martuzzi et al. Health Impact of PM10 and Ozone in 13 Italian Cities. World Health Organization Regional Office for Europe. WHOLIS number E88700 2006

[8] European Environment Agency, Air Pollution Country Fact Sheets 2019, (abgerufen am 26.3.2020)

[9] Croft et al. The Association between Respiratory Infection and Air Pollution in the Setting of Air Quality Policy and Economic Change. Ann. Am. Thorac. Soc. 2019, 16, 321–330.

[10] United Nations, Department of Economic and Social Affairs, Population Division. Living Arrange­ments of Older Persons: A Report on an Expanded International Dataset (ST/ESA/SER.A/407). 2017

[11] Deutsches Ärzteblatt, Überlastung deutscher Krankenhäuser durch COVID-19 laut Experten unwahrscheinlich, (abgerufen am 26.3.2020)

Here is a widely watched video from two weeks ago in which Professor Bhakdi attempts to dispel the corona hysteria:

Germany has decided to keep the contact ban in place until April 20, at which point… well, again, it’s vague. Merkel said that restrictions can only be eased if new infections do not double within a 10-day period. On the other hand, her chief of staff is saying this:

“Should we be able to quantify the success of our measures in the coming days, we’ll work out a strategy for the time after April 20,” Braun said. A vaccine needs to be in place before the country can fully return to normal life, he said.

A vaccine will not be widely available for at least 12-18 months. The famous Imperial College London paper, which I cited previously, touches on the issue that lockdowns need to be maintained or the virus will come roaring back:

The main challenge of this approach is that NPIs [non-pharmaceutical interventions] (and drugs, if available) need to be maintained – at least intermittently – for as long as the virus is circulating in the human population, or until a vaccine becomes available. In the case of COVID-19, it will be at least a 12-18 months before a vaccine is available. Furthermore, there is no guarantee that initial vaccines will have high efficacy. […]

However, if intensive NPI packages aimed at suppression are not maintained, our analysis suggests that transmission will rapidly rebound, potentially producing an epidemic comparable in scale to what would have been seen had no interventions been adopted.

This basic problem, which seemingly everyone wants to dance around, may explain why China is again going into lockdown mode after having allegedly won its battle against the virus:

Henan province in central China has taken the drastic measure of putting a mid-sized county in total lockdown as authorities try to fend off a second coronavirus wave in the midst of a push to revive the economy.

Curfew-like measures came into effect on Tuesday in Jia county, near the city of Pingdingshan, with the area’s roughly 600,000 residents told to stay home, according to a notice on the country’s official microblog account.

Special approval was required for all movement outside the home, it said.

After months of restrictions to contain the spread of the coronavirus, China has reported a decline in domestic cases of Covid-19, the disease caused by the virus. On Wednesday, the National Health Commission reported 36 new infections – all but one imported cases.

China also recently ordered all cinemas to close again after re-opening 500 venues.

In the US, the experts are working on a plan that will involve more than a year of intermittent lockdowns combined with (enforced) social distancing until the vaccine arrives:

“It’s like a fire. If you don’t completely put it out, it will come back. You have to keep suppressing it,” Michael Osterholm, professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told The Daily Beast. […]

Repeated periods of social distancing might not be popular. But neither would “promoting an 18-month total lockdown of the country,” he told The Daily Beast. “So, how do you try to thread a rope through this needle?”

The article further supports my contention that “lockdowns” do not have a proven track record of success:

The authors of the paper, a preprint posted at medrxiv.org that hasn’t yet been peer-reviewed, determined that one long period of stringent social distancing could potentially backfire in a greater resurgence of infections come fall and winter, unless other interventions are put in place. The finding was consistent with the course of the 1918 influenza pandemic, during which cities that had low peaks during the first wave of infections—thanks in large part to social-distancing measures—were at a greater risk of a higher second wave after those interventions were lifted.

The issue is time. Obviously, if you lock everyone in their homes forever, the spread of an infection is more or less impossible. But that’s not a viable strategy. The question is whether a reasonably-brief lockdown is an effective approach, given the risk of a second wave of infections – to say nothing of the colossal economic damage and health costs of suspending social life and forcing people to stay home.

In related news, Bill Gates is calling for a full national lockdown of the US, Chinese-style, including beaches and sit-down restaurants from coast to coast.

Italy on full lockdown

It has been less than seven weeks since Wuhan and nearby cities began to impose travel bans – and only three weeks since Hubei province itself (population: ~58 million) was placed on full lockdown by the authorities.

Now the Western, democratic world is witnessing its first lockdown on a similar scale, with Italy (population: 60 million) extending quarantine measures across the whole country.

At this rate, how long before Governor Cuomo blocks the roads and trains out of New York City?

Bonus: notes from a very interesting podcast chat with Scott Adams and Naval Ravikant.

Italy quarantines a quarter of its population

Escape from Milan (source)

Wuhan-style mass quarantines come to the West:

Italy announced a sweeping quarantine early Sunday, restricting the movements of about a quarter of its population in a bid to limit contagions and end the virus’ advance at the epicenter of Europe’s outbreak.

Shortly after midnight, Prime Minister Giuseppe Conte signed a decree affecting about 16 million people in the country’s prosperous north, including the Lombardy region and at least 14 provinces in neighboring regions. The extraordinary measures will be in place until April 3.

“For Lombardy and for the other northern provinces that I have listed there will be a ban for everybody to move in and out of these territories and also within the same territory,” Conte said. “Exceptions will be allowed only for proven professional needs, exceptional cases and health issues.” […]

In its daily update, Italy’s civil protection agency said the number of people with the coronavirus rose by 1,247 in the last 24 hours, taking the total to 5,883. Another 36 people also died as a result of the virus, taking the total to 233.

There was chaos and confusion hours before Conte signed the decree, as word leaked that the government was planning the quarantine.

Packed bars and restaurants emptied quickly as people rushed to the train station in Padua’s Veneto region. Travelers with suitcases, wearing face masks, gloves and carrying bottles of sanitizing gel shoved their way on to trains.

All this over 233 deaths? Yes, yes, I understand the concept of exponential growth; still, this seems extreme.

Next up: Seattle?

The West Coast?

New York?

The Northeast? (Oh wait: “Amtrak to suspend nonstop Acela trains between DC, NY amid coronavirus concerns”)

South Korea, Italy begin to shut down as virus spreads

As if there wasn’t enough evidence already that COVID-19 is a lot more serious than your garden-variety seasonal flu, the mayor of South Korea’s fourth-largest city, with a population roughly the size of Chicago, is telling everyone to stay home:

South Korea reported its first death from the new virus on Thursday while the mayor of a southeastern city urged its 2.5 million people to stay inside as infections linked to a church congregation spiked.

The death was the ninth confirmed from the virus outside mainland China. Other deaths have occurred in France, Hong Kong, Japan, the Philippines and Taiwan. […]

Twenty-one of those new cases were in and around the city of Daegu, where the mayor urged citizens earlier Thursday to stay home and wear masks even indoors if possible.

In a televised news conference, Mayor Kwon Young-jin expressed fears that rising infections in the region will soon overwhelm the city’s health system and called for urgent help from the central government.

Update on caseload:

South Korea reported a jump of 142 additional cases overnight, bringing the country’s total to 346, according to the South Korean Centers for Disease Control and Prevention (KCDC).

Meanwhile, in Italy:

10 towns in northern Italy have been put on a virtual lockdown due to coronavirus, according to local media

More:

For those 10 towns (50,000 people):
– Residents are asked to stay at home for 1 week
– All public events are suspended
– No work and commercial activities
– No recreational activities
– All schools are closed
– Public transport won’t stop in those areas

Buckle up.

A new bloc on the block

Sergey Karaganov

Sergey Karaganov

The day (in 2000) when Putin suggested that Russia would be willing to join NATO if it was treated as an equal partner seems like a very long time ago. Of course, the offer was never made, and NATO proceeded to expand eastward to within 100 miles of St Petersburg.

In retrospect, shutting Russia out of the Western alliance was a colossal mistake, possibly one of the great strategic blunders in all of history. Because now Russia is hellbent on forging an alliance with China:

Russia’s view of China has shifted significantly over the past five years. Moscow has abandoned any hope that the Chinese economy is an example it might emulate. Instead, foreign policy experts now talk of how Russia can use China to further its geopolitical goals.

There was no doubt at Valdai that China knows how to do economic growth, and that Russia does not. Russia’s elite — always so ready to resist any sign of Western hegemony — have no problem admitting China’s economic superiority. Their acceptance reminded me of the way Britain gave way to the United States as the world’s dominant economic power.

Seen from Moscow, there is no resistance left to a new alliance led by China. And now that Washington has imposed tariffs on Chinese exports, Russia hopes China will finally understand that its problem is Washington, not Moscow.

In the past, the possibility of an alliance between the two countries had been hampered by China’s reluctance to jeopardize its relations with the U.S. But now that it has already become a target, perhaps it will grow bolder. Every speaker at Valdai tried to push China in that direction.

Both Russia and China have obvious shortcomings, but the fact is that the US, Russia and China are the world’s foremost military powers; and an alliance of two of those powers against the third could prove to be a geopolitical game-changer.

This alliance, if it becomes concrete, would overturn how we do global politics. Imagine an international crisis in which Russia and China suddenly emerge as a single bloc. The impact would be considerable, and to some extent unpredictable: Psychologically, in the mind of the West, it would combine the fear associated with Russia with the apparent invulnerability of China. Washington would feel under attack; Europe, intimidated and unsettled.

The old Continent would also face the threat of a split between Western Europe and the nations of Central and Eastern Europe, which could turn their focus east under the influence of a cash-happy China ready to invest in the region.

The author, a former Europe minister for Portugal, describes a scary meeting between former Putin adviser Sergey Karaganov and some Chinese officials and think tank people:

There, a number of Chinese participants said they doubted Russia’s assertions that the world is in the midst of a new Cold War.

Karaganov dedicated himself to convincing them otherwise, arguing with increasing passion that China is deluding itself if it thinks issues between Beijing and Washington can be conveniently resolved to the benefit of both sides.

If Beijing places its bets on peace and cooperation, the great Chinese adventure will come to an end, and China will have to live in the shadow of the U.S. for another generation — perhaps forever, Karaganov said. Chinese authorities, he argued, have no more than five years to make a decision.

The clock is ticking.

Very old stories

This is intriguing:

In a new study published in the journal Royal Society Open Science, a folklorist and anthropologist say that stories like Rumpelstiltskin and Jack and the Beanstalk are much older than originally thought. Instead of dating from the 1500s, the researchers say that some of these classic stories are 4,000 and 5,000 years old, respectively. This contradicts previous speculation that story collectors like the Brothers Grimm were relaying tales that were only a few hundred years old.

It turns out that it’s pretty hard to figure out how old fairy tales are using simple historical data. Since the tales were passed down orally, they can be almost impossible to unwind using a historian or anthropologist’s traditional toolbox. So the team borrowed from biology, instead, using a technique called phylogenetic analysis. Usually, phylogenetic analysis is used to show how organisms evolved. In this case, researchers used strategies created by evolutionary biologists to trace the roots of 275 fairy tales through complex trees of language, population and culture. […]

As they tracked, they found evidence that some tales were actually based in other stories. More than a quarter of the stories turned out to have ancient roots—Jack and the Beanstalk was traced back to the split between Western and Eastern Indo-European languages more than 5,000 years ago and a tale called The Smith and the Devil appears to be more than 6,000 years old.

If true, this would mean that elements of present-day Western culture date back to before the Epic of Gilgamesh and before the first (legendary) dynasty of China. From the study:

Wilhelm Grimm argued that the traditional German tales that he and his brother Jacob had compiled were remnants of an ancient Indo-European cultural tradition that stretched from Scandinavia to South Asia…

In case you were wondering:

The Smith and the Devil is a European fairy tale. The story is of a smith who makes a pact with a malevolent being—commonly the Devil (in later times), Death or a genie—selling his soul for some power, then tricks the devil out of his prize. In one version, the smith gains the power to weld any material, he then uses this power to stick the devil to an immovable object, allowing the smith to renege on the bargain.

(Sound familiar?)

Let them eat debate

Somehow I don’t think this initiative by the French government will succeed in mollifying the angry wearers of high-visibility garments:

In 1789, Louis XVI summoned France’s aristocracy, clergy and citizens to discuss ways to plug the crown’s dismal finances and quell popular discontent over a sclerotic feudal society.

It marked the start of the French Revolution. Within months he was powerless and four years later beheaded by guillotine.

Two centuries on, President Emmanuel Macron, often criticized for a monarchical manner, is also calling a national debate to mollify “yellow vest” protesters whose nine week uprising has set Paris ablaze and shaken his administration.

He will launch the three-month “grand debat” initiative on Jan. 15. As during the rule of the ill-fated king, the French are already writing complaints in “grievance books” opened up by mayors of 5,000 communes.

The debate will focus on four themes — taxes, green energy, institutional reform and citizenship. Discussions will be held on the internet and in town halls.

There’s a catch, though, that seems to defeat the purpose:

But officials have already said changing the course of Macron’s reforms aimed at liberalizing the economy will be off limits.

“The debates are not an opportunity for people to offload all their frustrations, nor are we questioning what we’ve done in the past 18 months,” government spokesman Benjamin Griveaux told BFM TV. “We’re not replaying the election.”

Meanwhile, the protesters have come up with another disruptive tactic:

Members of the “yellow vests” protest movement have vandalised almost 60% of France’s entire speed camera network, the interior minister has said.

Christophe Castaner said the wilful damage was a threat to road safety and put lives in danger.

The protest movement began over fuel tax increases, and saw motorists block roads and motorway toll booths.

Some protesters feel speed cameras are solely a revenue-generating measure which takes money from the poor.

A novel tactic

Remember the yellow vest protests in France? They haven’t stopped. Indeed, as one journalist reports, “Saturday insurrections are now institutionalised in Paris, and also across the country, as far as Marseille and Toulon.”

Some 80,000 law and order agents, including 5,000 in the capital, will be mobilised this weekend, along with armoured cars, water cannons and apparently unlimited supplies of chemical weapons. Luc Ferry, a former conservative education minister, has already suggested that live ammunition should be used to quell growing attacks on police.

And now it looks like some of the protesters are preparing to level up the disruption:

Activists from a French protest movement encouraged supporters Wednesday to set off a bank run by emptying their accounts, while the government urged citizens to express their discontent in a national debate instead of weekly demonstrations disrupting the streets of Paris.

Activists from the yellow vest movement, which started with protests over fuel tax increases, recommended the massive cash withdrawals on social media. One protester, Maxime Nicolle called it the “tax collector’s referendum.”

“We are going to get our bread back … You’re making money with our dough, and we’re fed up,” Nicolle said in a video message.

The movement’s adherents said they hoped the banking action will force the French government to heed their demands, especially giving citizens the right to propose and vote on new laws.

In the meantime, copycat yellow vest protests have been spotted in Belgium and the NetherlandsBritainCanada, and even Bulgaria, Israel, Iraq and Taiwan. The Egyptian government banned the sale of yellow vests in December.

Silk Road to the Atlantic

Port of Sines Portugal

Portugal’s Port of Sines

The Belt and Road Initiative now stretches to the Iberian Peninsula, as Portugal has signed up to promote China’s multi-grillion-dollar mega-boondoggle:

Portugal signed two deals last week during a state visit from Xi Jinping that seemed to undermine efforts elsewhere in Europe to counter Beijing’s influence.

The bottom line: Portugal is not alone in playing nice with Beijing, but these instances show that China, with the promise of big investments, can poke holes in European or Transatlantic efforts to confront it.

Detail: With a wary eye on China, a deal was struck in Brussels last week for closer inspections of foreign investments in “strategic technologies and infrastructure such as ports or energy networks,” per Reuters, which noted there was opposition from countries including Greece, Luxembourg, Malta and Portugal.

The deal makes the Port of Sines part of the B&R. Sines, located on the Atlantic coast, handles about half of Portugal’s cargo.

Chinese trade with Portugal is rising and the European country now wants to “attract large-scale industrial investment, notably in the automobile and agro-food sectors”:

Chinese investment accounted for 3.6 per cent of Portugal’s GDP between 2010 and 2016, according to figures from Spain’s ESADE business school.

China now owns a 28 per cent stake in Portuguese energy utility EDP, the country’s largest firm, via China Three Gorges and China’s state-owned international investment company CNIC.

It also has a stake in Portugal’s biggest private bank, BCP, and its leading insurance company, Fidelidade.