The small chance of being infected

What always strikes me about the experts in the Dutch media is that they always follow the same pattern, “We don’t know, but…” . And then there comes another sentence, in which the average viewer/listener has to think how great the risk is of being infected.

On logical grounds, some of the dangers seems rather improbable. And then when I look for the empirical basis, it is nowhere to be found. Since the beginning of March more and more research is coming out about Covid-19, so we know better and better how Covid-19 is spreading.

But it strikes me, how little of these new findings the Dutch media get. Although that seems to change one baby step at the time.

That’s why I’ll give you a brief summary and a calculation.

  • While WHO/RIVM still explicitly state that there is a considerable risk that you can become infected by touching surfaces, it now turns out that that chance is (virtually) nil.  (So all that cleaning of those supermarket trolleys has made no sense at all).  Prof. Streeck reported this at the beginning of April based on his research in Heinsberg. Now the American CDC (the counterpart of our RIVM) also indicates that the chance is small.  My logical interpretation: if the spread of the virus through objects really were to occur regularly, it would be incomprehensible that patients’ roommates at home would not be infected much more.
  • I’ve been saying for a long time that the chance of being infected outside is very small. (And draw the conclusion from that, that the infection is mainly -or even only- through the air). I did this on the basis of various studies from around the world, where time and again is concluded that contamination outdoors is virtually undetected. When I reported this via my blogs and via an interview in newspaper De Telegraaf, it was dismissed in the daily newscast Op1 as “an opinion”.  But it was based on the presentation of the virologic lab of Home Security in the US where they literally said “Move activities outside”.  Until this headline yesterday in newspaper De Volkskrant: “Research: hardly any chance of contamination outside”, after RIVM chief Van Dissel had said something in the Lower House about the smaller chance of contamination in the open air. He also stated:

 

“Research around the world has not shown that the chance of contamination outdoors is lower”. No, the chance of being infected outdoors is empirically virtually zero!

A little prediction: it won’t be long before it is confirmed that the majority of infections are airborne, contrary to the WHO/RIVM claim that this hardly ever happens.

I get a lot of mails from people, who, because of all the reporting from March onwards, have become anxious about the chance of being infected themselves. And because of my blogs and interviews on the internet, they have become calmer, because the danger is much smaller than they thought. That’s partly why I want to make the following sum to show how big (or better, how small) that chance is:

We have calculated that every hospital admission in the Netherlands represents almost 200 infected persons. In the meantime, the number of hospital admissions has dropped to about 10 per day.  This is the RIVM’s current graph.

So if 10 hospital admissions are reported today, it would mean that about 10 days ago, 10 x 200 = 2,000 new infections took place.

Let’s assume for a moment that there were 2,000 new infections every day for the past 10 days (and I think it’s even less), what does that mean for the risk that those people infect you or me?

We know that it takes about 5 days before someone starts showing symptoms and can infect others. So every day there are 5 x 2,000 infected people who can infect someone else.

At the same time, we know that the reproduction factor is 1. We can also use that in this indicative calculation. Those 10,000 infected people will then on average infect 10,000 others.

Let’s assume that someone who is infected meets on average 5 people in those 5 days. I think that’s a low estimate. Some of them are sick at home and only meet a few people. But there are also a lot of people, who don’t even know they are contagious and they might meet quite a few others.

So (and I know it’s a weird way to put it like that) if you meet that infected person, then you have a 1 in 5 chance of being infected by that person.

Now we have all the ingredients to make the following calculation:

10,000 people a day who could infect others. And if you meet that person, you have a 1 in 5 chance that that person will infect you. So that gives the number 10,000/5 = 2,000.

The Netherlands has over 17 million inhabitants: 2,000 relates to 17 million is like 1 relate to 8,500.  So that gives an indication of how small the chance is that you will be infected. To put it another way: of the 8,500 people you meet, 1 person will infect you.

I realize it may be a somewhat absurd way to calculate your chances of infection. Of course, it is also about what region you live in, what kind of work you do etc. But if you don’t belong to the profession with a higher chance of being infected (and in England you even have overviews of the professions of the deceased) then your risk of being infected is much lower.

I think a lot of Dutch people – also because of the way of reporting – think that their chances of being infected are many times higher.  (And how proportional are all the measures that are taken, such as setting up a 1.5 meter society, and the major consequences that this has on the economy and society).

I wonder when politics in The Hague, the media and the citizens in the Netherlands, will wake up and realize how much over-reaction has taken place and how much damage we have caused ourselves. (More than a month ago I wrote this blog that we committed hara-kiri).

Two points in conclusion:

The meat processing industry: It’s always been said about the outbreaks in that industry that it’s because people work so close together. But 3 weeks ago I already wrote this blog about this subject. Because it’s significantly colder in those companies than in normal working environments, the conditions for aerosols to stay in the air for a long time are very favorable. That’s why you see outbreaks in and around those factories (where sometimes more than 1,000 employees are infected) almost everywhere in the world.

When I wrote that, I was also approached by people who set up cooling and ventilation systems at those factories, who confirmed the content of my blog. But yes, if you only acknowledge that the contamination is through direct contact, then you don’t recognize the great importance of ventilation in those factories and you don’t take the right measures.

The mink farms: I recently got an e-mail from someone who builds stables for years. He reported that the system of air ventilation (and temperature control) is very important to prevent the outbreak and spread of diseases. Because that happened quite often. He indicated that if they ensured that a lot of fresh outside air entered the barn, the chance of outbreaks of infectious diseases among the animals fell to almost zero. It wouldn’t surprise me if in those mink farms hardly any fresh air comes in and those animals get infected easily. (And the people who walk through those stables as well, because of the aerosols in the air).

That information was also confirmed by a number of people active in horticulture in greenhouses. They also told me that allowing fresh air significantly reduced the risk of plant infections).

The blind spot with huge consequences

Introduction

It is important to know where that 1.5 meter which we hear so often, actually comes from. And how logical that rule is in the light of the recent studies, which have been carried out on Covid-19.

First of all, the WHO indicates on its website, that a distance of 1 meter should be maintained. But where does this distance of 1.5 metres actually come from?

In the literature on influenza it is stated that the transmission of that virus is mainly via droplets and direct contact. To a much lesser extent, this is indirectly via aerosols. These are tiny droplets that float through the air.

This diagram by Dr. Walter Hugentobler makes that very clear.

The Dutch RIVM (and all prominent virologists in the Netherlands) echo that the spread of Corona-19 happens via direct contact and if you stay at 1.5 meters distance there is very little risk. According to Prof. van Dissel of the RIVM, the impact of alternative transmission methods is very small.

From that perspective, keeping a distance is a good strategy. But how certain is it that the direct transmission of the Coronavirus within a radius of 1.5 metres of an infected person is indeed the prominent method of transmission?

 

The inexplicable seasonal patterns of influenza

Influenza has been studied a lot over the past 80 years. But if you look at those studies, there still appears to be a lot of uncertainty about how the transmission of the virus really takes place.

These are studies from which it can be determined how much we don’t know yet. (1), (2)

In 2014 there was a big congress in Dubai on infectious diseases. A doctor associated with the WHO gave a presentation on the search for an explanation for the differences in seasonal patterns in countries below 30 degrees North latitude.

You can tell when you read that presentation that they have absolutely not figured it out yet. It is best indicated with the text of this sheet.

All kinds of possible explanations come along in that report (slide 14 et seq.), but the author always observes that it is not a conclusive explanation for the differences in the patterns that exist. (Really recommendable to read).

But if that can’t be made appropriate, how can we be sure that the spread of the influenza virus is predominantly via direct contact forms within 1.5 meters of each other? That doesn’t really make sense.

With what we now know from scientific research into the spread of Covid-19, there are even more illogical matters. Just 5 questions:

  1. There are various studies that show that the contamination takes place much more indoors than outdoors. A score of 1 out of 350 is reported in China and 1 out of 20 in Japan. In his research in Heinsburg, Prof. Streeck found that the vast majority of the infections had also taken place indoors.

So the first logical question is: if direct transmission within 1.5 metres between two people is so dominant in the infection of others, why doesn’t it happen outside to about the same extent as inside?  After all, we also meet many more strangers outside than inside, so that should lead to many more infections.

  1. At least four studies by Covid-19 show that housemates of a patient are much less infected than you would expect.(1) (2) (3) (4). In these four studies we see percentages between 5% and 35%. So the vast majority of household members were not infected. But that’s actually completely illogical. After all, within a household the 1.5 meter distance will have been observed much less, especially when it was not yet known that the patient’s symptoms were the result of a Covid-19 infection.
  2. On March 10, a choir rehearsal of 60 men took place near Seattle. They kept to the 1.5 meters, did not touch each other and used disinfectants. Three weeks later, 75% were infected, some were dead. Similar figures, which we also see in a choir in Amsterdam. Also 75% sick and some dead. But they didn’t hold 1.5 meters.

Prof Streeck’s research in Heinsberg showed that those who had been infected during the carnival meeting had become more seriously ill than those who had contracted the virus at home.

But how is that possible? How is it possible that at superspreading events a significantly higher percentage is infected than at home and that they are even sicker (16% of the infections without symptoms, 36% at home)? Is this compatible with the view that the vast majority of transmission occurs via direct 1-to-1 contact within 1.5 metres?

It gets even weirder when we also know that a large proportion of the infections occurred at superspread events before the lockdowns.

  1. A lot of people have been infected on naval and cruise ships. This also seems to be the case with quite a few care institutions. Could that really be because all those Navy people came within one and a half metres of an infected person? Or is there another reason?
  2. We repeatedly see footage of poor countries in Africa and refugee camps on television. Also how it goes in India. People who live shack by shanty and shanty by shanty. Even keeping a distance of 50 centimeters would be difficult there. For two months it’s been threateningly said “if it’s going to erupt here, it’s going to be a disaster…” . But that disaster didn’t happen. Not on Lesvos, not in Africa. In India there are now 2,000 deaths out of a population of more than 1.3 billion.

So these are already 5 different kinds of observations, so you can question the proposition, that the contamination mainly occurs through direct transmission within 1.5 meters. Together with the lack of explanation of seasonal flu patterns, there can only be one logical explanation.

“Influenza and COVID-19 transmission does not occur primarily through direct contact within 1.5 metres between one infected person and another”.

 

So what’s another logical explanation?

But how does it go?  Based on recent studies, this is my hypothesis:

“The transmission of influenza and COVID-19 is almost entirely via aerosols. You breathe them in and with that the virus enters your body.  You have to be exposed to it for a certain period of time, because otherwise you won’t be infected/not sick of it”.

This is an extensive article by Prof. Shelley Miller, which describes the aerosols well.

Let’s revisit the 5 questions and assume that the hypothesis is true:

  1. Because aerosols dissipate in the open air and do not stay in one place, people are almost never infected outside.
  2. Even if you have a patient at home, it does not have to be the case that the rest of the members of the household are infected by aerosols long enough. It may be due to ventilation and humidity in the house, or that one does not stay with the patient long enough and that the patient emits few aerosols.
  3. In superspreading events, you spend 2 to 4 hours in an enclosed space with the aerosols of an infected person. At home, there is usually much less time in a row or there is ventilation. So that’s why more people get sick at these events.
  4. Through internal ventilation systems, aerosols are spread over rooms and stay there for a long time. As a result, so many people present on ships and in care institutions become infected.
  5. In refugee camps, in Africa and India, people’s houses/tents are such that natural ventilation always takes place. Even if aerosols are ejected by an infected person, they do not remain there long enough to infect someone. That’s why we see so few infections there.

So this new hypothesis provides satisfactory answers to each of these five questions.

It would be marvellous if the large and year-long search by virologists and epidemiologists for an explanation of the seasonal patterns of influenza would also lead to results. Yet another proof that they were looking for this and found no explanation. This can be found in a paper from 2016.

So let’s see if with this hypothesis we can find an explanation for the start of an influenza epidemic in those areas. And I can already tell you, it’s been found.

So the hypothesis is, “you’ll be infected by aerosols, which will stay with you for a long time and breathe in enough to make you sick.”

  1. Infected north of the 30th parallel:

When the humidity is low, the aerosols remain in a poorly ventilated room for a long time. This condition only occurs in autumn or winter. This is when the flu epidemic occurs.

  1. In the rest of the world:

The humidity level is too high for an aerosol to stay indoors for long.

(Air conditioning is unfavorable, but if that happens in rooms where only one’s own family is present, it doesn’t lead to major outbreaks).

We see many different patterns of that flu outbreak:

This study in India shows that the flu wave in Srinagar, in the north of the country, is only in winter (as is the case with us). There in winter the weather was about the same as in the Netherlands. In the much more southern Delhi was the flu wave during the monsoon (between July and September).

– In that same study from 2014 is a list of countries below 30 degrees North latitude with different patterns of the flu. In all countries, except near the equator, we see that the flu wave is there during the rainy season.

– But close to the equator we don’t see a clear pattern. Malaysia is mentioned as an example (also near the equator) and if one counts several years together, the picture becomes very diffuse.

How does the above fit into the hypothesis about the large role of the aerosols?

Manaus offers the explanation

I found that explanation in Manaus.

There are the daily figures for COVID-19 infections. Around March 19 the outbreak started. So something must have happened between 12 and 15 March. But what?

I found no major events. But something else. The graph below shows it. On Saturday morning, March 14, there were “heavy rains”:

From my experiences in Cuba with my in-laws, I know what happened. In the house (where there are no glass windows and the door is almost always open) live about 20 people. Sometimes you are with 8 people, sometimes with 4, sometimes with 12. People often live outside. And inside they try to keep a cool head by means of natural ventilation of the air, where everything is open. Plus some fans. Possible aerosols are driven out of the house so quickly and disappear. If they don’t precipitate quickly because of the high humidity.

Until it starts raining and storms and everyone flees into the house. The doors and windows still remain open. So still good ventilation.

But that’s not the case with such a heavy downpour. And I’ve heard that statement from an expert in that field. That’s how he described it

“In a rainstorm, an additional resistance will be created for air flowing in or out through an open window. So ventilation will become more difficult and this will get worse with more rain. The air has to go straight through the falling rain drops and this costs pressure drop, pressure of the air in front of and behind the rain screen”.

So when it rains hard there’s like a wall of water around the house. But there is more, and that seems to be the most important component. And that’s thunder. I remember very well how we used to unplug the TV and radio at home when there was a thunderstorm. Apparently that’s still wise. I certainly understand that poor people still do, because they are afraid that their device will break down (or a fire will break out).

So when it rains hard and it thunderstorms, in those countries they unplug the fan(s) they have. So that’s the only moment in those countries that the air indoors more or less stays still. The rainstorm closes off the escape of the air to the outside. And turning off the fan(s) ensures that the air remains fairly still in the house.

There is also an archive from the website where thunderstorms around the world are recorded. And if you go and look at Manaus it hasn’t been there for days in that period, but on the morning of March 14th.

The air in the house cannot flow through and there are no airflows in the house. If there is a person within the household who was already infected, that person can easily infect a large part of the 15 to 20 family members.

So these are the “distributed superspreading events” of the tropical regions. And from the information I got from Manaus, it appeared that after that there were a few more similar weather conditions and each time after that there was an increase in the number of victims.

Also in Guayaquil in Ecuador something similar was noticeable. There was a thunderstorm on the morning of Saturday 8 March. And below that, in Wikipedia, we read about the new infections in Ecuador (Los Rios is located north of Guyaquil and it had also ignited there):

 

Another possible relationship with the thunderstorm could be what I came across here. Prof. Galembeck has done research on the electrical charge of water droplets. He found that during a thunderstorm the electrical charge in the air changes. This could be another explanation for the fact that the aerosols, which normally do not float at high humidity, show a different behaviour during a thunderstorm and remain in the air.  This is a paper about his research.

Which of the two explanations is the correct one needs further investigation, but it is obvious that this thunderstorm was the starting point of a super-preadevent in Manous and Guayaquit.

Therefore one could not see a pattern at the flu waves in the areas near the equator! If you look at the averages in a few years time, you don’t see the specific moments that triggered the outbreaks. Because maybe a year before, it didn’t thunderstorm on March 14th, but on March 28th or March 2nd!

And with this explanation you can suddenly explain the differences in the patterns of the flu waves in the tropical areas.  The outbreak of flu and Covid-19 occurs when it rains heavily and thunderstorms…That’s the only moment that in those areas there is no air flow in the houses and also no fresh air from outside, because “the rain screen” blocks that fresh air as it were.

In conclusion: this hypothesis about infecting someone else with aerosols is much more robust than the one that the WHO and others have been working with for years, that it is almost only within 1.5 meters. A hypothesis that does answer the 5 questions asked above and also provides an elegant and complete explanation for the long sought-after holy grail of flu research.

The major consequences

This would show that the one and a half meters is much less important than how the aerosols move through the room and whether or not they can infect people. And that has major consequences for the approach to prevent contaminations.

If the WHO (and the CDC’s) do not take this information into account quickly, this could have major consequences.  If the WHO indications are (partly) based on the wrong assumptions, this will lead to many more deaths worldwide and much more damage to the economy than is necessary.

Not only is the one and a half meter society nonsensical if it is mainly the aerosols that can cause problems indoors. Combating them is much simpler and the economic and social restrictions are much less drastic.

And what protection do mudguards provide if it is mainly the aerosols floating in the air that cause the contamination?

But in terms of human lives, these indications can also lead to major disasters. Take India. There’s not much going on there right now. But in a large part of India, the rainy season will start in two months’ time. And if you don’t know the risk indoors by then, there could be a lot of casualties. While the best advice for them is to take care of air circulation (via a ventilator or otherwise) when it rains heavily (and thunderstorms).

The big question is whether all those people who thought for so long that the contamination came almost exclusively from direct contact are now prepared to recognise that a dominant role of aerosols gives much better answers to the search for seasonal patterns and the results of the most recent studies.

But hopefully there are enough people in the medical world who are willing to face facts and logic and then do everything in their power to come up with the right approaches. Fortunately, this is already a website of a group of professors and doctors who call on the WHO to measure aerosols and humidity in their policy advice.

It will save a lot of people’s lives worldwide and it can help the economy and society all over the world to return to normal faster if WHO and the CDC’s take all this seriously

The new big bad wolf: the second wave

Working with data all my working age, I must confess that I pull the hair out of my head every day when I notice how badly people deal with data. (That’s handy because I haven’t been able to go to the hairdresser for 8 weeks).

There have been interventions by the authorities, which we couldn’t have imagined until three months ago. However, they have intervened on the basis of very shaky data. And this in cooperation with professionals, who very often use the word “evidence-based”. And the sad thing is, most politicians as well as the media seem to hang on the lips of these experts.

A few examples:

The vague reproduction factor

The so crucial reproduction factor (R0) is not a G’d given formula that you can apply just like that. Choices have to be made when defining R0. The choices you make influence the outcome.

If you know exactly how many infected people there are per day in the Netherlands, you can easily calculate that figure. But we do not have these figures (which are impossible to obtain). Th amount of testing only provides a small part of them. In the absence of that data, you have to approach it via other methods. But because of that, the R0 is only an indication of what is really happening with the spread of the virus in the population:

  • The Corona mortality rates used by the RIVM are based on the mortality of people who had been diagnosed of having Corona. Based on the population registrar, Statistics Netherlands (CBS) determents how many more Dutch people die each week, than the average for that week in recent years. Anything more is called excess mortality and is then assigned to this virus. The CBS count is 2 weeks behind on average. If we then know that on average it takes 3 weeks between becoming infected and dying, the total delay is 5 weeks.
  • Assuming the number of people actually found to be infected in the Netherlands (currently more than 45,000), the number found depends entirely on how many people have been tested. If we are going to double the number of tests in the near future, you will find more infected persons.
  • If you base yourself on daily hospital admissions, which the RIVM apparently does, then these is another problem: It could well be that, because hospitals are less crowded now, they are less strict when accepting patients. That would mean an increase in the number of hospitalizations without the number of infections in the country increasing.

So the data is just an approximation of reality with considerable margins of uncertainty.

This was the last presentation of the R0 figure by the RIVM at the session with the Lower House on May 7th.

 

So on May 7th the R0 was presented based on the hospital admissions until May 1st. Hospital admissions will take place 10 to 12 days after the infection. So on average there is already a delay of 3 weeks.

To add insult to injury: The RIVM refuses to disclose which values they use in the R0 formula. Plus they don’t want to disclose what the current values are, as this tweet from a journalist shows:

So we can’t check how the figure is calculated, and we don’t get to hear the actual values.

A number of German universities show on their website the development of R0 in a number of countries, including the Netherlands. And then you see exactly the problem I outlined above. Those figures are based on the number of people infected. So if we start testing significantly more in the coming month, we will find more infected people and R0 will go up in this overview.

We regularly hear that “the R0 goes back to 1”, or even “that it’s passing it”. But realize that that R0 can be lower or higher at that moment. (The continuing decline of all key figures since the beginning of April suggests that over that period we must certainly have been well below 1).

 

Too few specifications in the numbers

But even if we had the perfect insight into the number of infected persons or hospital admissions or deaths, that wouldn’t mean anything to the policy if we didn’t specify it better.

Let’s assume that, thanks to the lock down in society, no one is infected anymore. But that there were still major outbreaks in care institutions. Then the key figures would indicate large numbers of victims, while there is nothing going on anymore outside these health care institutions.

Policy would then be determined by the overall figures, because we have no other choice. And that would lead to decisions with major consequences for the economy and society.

Imagine that the figures do indeed rise. Is it because the schools have opened, the contact professions have become active again, we go outside more, the swimming pools are open or because there are new developments in the meat industry?

Spoiler alert: we don’t know because we do not have the data!

And so we run the risk, that if the increase is only due to the swimming pools (which I don’t think), the consequence will be that we will reverse the whole package of measures.

And it could easily have been different. If we had just taken a questionnaire from every infected person, including questions that can be used to determine what caused the infection. Then we would be able to follow the spread of the virus over time. And we could see the pattern changing per day with every new case. (Which is quite simple to do. I have been using NoTies software for almost 20 years.  Usage costs are very low and it can be used on any device.

But it just seems that people don’t realize how important it is to collect data in order to have the best possible policy.

 

Crash the Curve, impossible in the Netherlands

There are several experts who say on TV that it is better to stay in lock down for a while longer to minimize the number of infected people. Because if we only open up after that, then we can keep things well under control by means of a targeted policy on the people who are still infected.

May I help those who suggest that to wake up? The way in which we organize contact research and set up and maintain quarantines in the Netherlands, would lead to laughter in South Korea. Just follow the discussions in the media about organizing the contact investigation. National newscast Newsuur has devoted several reports to it. This was the most recent, more than 2 months after the start of the pandemic.

And if we are not perfectly able to investigate new cases and to warn and control all their contacts, the numbers will rise again.

Meanwhile, Crash the Curve is also Crash the Economy (if it hasn’t already happened anyway).

We are neither trained, nor prepared, to keep the number of new cases close to zero.

 

The latest big bad wolf: the second wave

It’s really laughable if it wasn’t so sad. Recognize the drastic measures based on unreliable figures and the colossal consequences they have.

I am convinced that when our governments’ measures are evaluated in a couple of years, conclusions will be that they promoted total panic worldwide, based on a primary fear of death. That fear is understandable for an average citizen, but not for policymakers and their advisors.

Take the threats of “the second wave”. Using that term gives the feeling that if the number of cases rises again, we will end up in the “Bergamo scenario” again. The ICU’s can’t handle it anymore. The dead pile up in the corridors.

A we have to prevent that as much as possible,  let’s maintain the lock down for a few weeks (preferably months).

First of all, I have already shown that the R0 is not a hard figure. And that rises can also be related to special circumstances in a certain place, or in a certain sector.

In addition, the number of ICU admissions (if that is the indicator) is now around 10 per day. At the end of March this was well over 100 per day.

So if in autumn the numbers were to rise a bit, it will not see that high Bergamo level by a long shot. The simple fact that we have banned (super spread) events in the Netherlands, implies that the figures can only be as high as I show in a graph below.

The yellow line concerns the development in 5 municipalities BEFORE THE LOCK DOWN.  In those municipalities no superspreading events were held (as in the municipalities with a blue line). Two groups of municipalities with the same number of inhabitants (150,000).

So in a period of 12 days (between March 10 and March 22), while doing everything that was forbidden by Prime Minister Rutte after March 15, the increase in the number of sick people was very clear (a doubling).

I repeat: that was when we were living our normal lifes. No social distancing, no restaurants and cafes that were closed and with people still working at the location of their company.

There could indeed be a somewhat larger increase in new cases in the autumn, but only if we have not learned anything this summer and if governments still pursue a policy that is not based on data. And don’t try to gather data through all kinds of targeted tests, as explained here.

So realize, that every time we hear an expert in the media threatening with “the second wave” that it is mainly fear mongering. And not based on the evaluation of data.  A continuation of the pattern that I’ve been observing for 2 months now, in which people say all kinds of things, without having a numerical basis/proof for it. With the additional fact, that it seems that in those two months hardly any more attempts have been made to collect the data.

Were they even talking about the Covid-19 virus?

Yesterday I heard the RIVM briefing and then I followed the debate in parliament. And I wondered if they were talking about the Covid-19 virus. So much more is known by research, but at no time did I hear that back yesterday. Really from no one.

In Dutch politics and in the media, the latest research findings play virtually no role. On the one hand this is because so little research is done in the Netherlands itself, while on the other hand, research from abroad is hardly picked up in the Netherlands. Not even if it is carried out a stone’s throw away from our borders (in Gangelt).

If you do follow those studies, then the discussions within Dutch politics – like yesterday in Parliament – and the interviews with experts in talk shows, to put it very kindly, are astonishing. As if it were a totally different virus.

First a few important issues regarding the virus, on which there is now quite some international consensus, and then some recent information:

  • Transmitting an infection with Covid-19 by touching objects does not happen. I repeat: does not take place.
  • Everything we do to prevent contamination by touching objects is of no value.
  • The chance of being infected with Covid-19 in the open air is very, very small. Especially when the sun is shining.

Unfortunately, no contact studies have been published in the Netherlands (they have barely been carried out). So we are investigating the contacts of infected people with those around us. Fortunately, abroad they do. There are studies from China, South Korea, the USA and Germany.

From these, the same picture emerges:

  1. Infection takes place through close and prolonged contact within confined spaces, but not through incidental and brief contact. So if you are close to an infected person for a while (in the first 5 days of his symptoms) then you are most likely to be infected. So the time factor is important. (The time is not specified in the examinations, but it is more a haf hour than 5 minutes).

The image that you get infected because you are near an infected person for a short period of time, from which you “catch” a drop, is completely misplaced.

  1. The longer you are in a place where you get the virus, the more severe the symptoms are on average, the sicker you become.
  2. Roommates of an infected person do not get infected nearly as often as was thought. Percentages that have been established are between 5 and 25%. The vast majority of household members are not infected. Even those who are infected are usually (much) less sick than if they were infected during a super spreading event.
  3. In places where there are many people and the aerosols can remain floating with the virus, many people can be infected at the same time. The time you spend in that room and the number of aerosols with the virus in the air play an important role in the extent to which you become ill. (These are the super spreading events)
  4. The effects of aerosols are reduced by good ventilation and a humidity of 6gr/Kg.
  5. The exponential growth in the number of infected persons is caused by super spreading events and not by direct contact between an infected person and non-infected persons.
  6. The risks of infection are greatest in places where you are in the same room with an infected person for a long time. These include households, public transport, offices and restaurants. Places where many people speak/shout/song are a clear risk that many of those present will become infected.

It would be nice if all those involved in the political and public debate were aware of these international research results. So that discussions can be held in a meaningful way and decisions can be taken on a sound basis. Now it seems that people are not even heading for 50% of the knowledge.

It also prevents many Dutch people from thinking that their chance of being infected is many times higher than it really is. In this way they worry too much and limit their behaviour (much) too much.

Interesting research figures from Prof. Streeck from Gangelt

Prof. Streeck, who researched Covid-19 spread in the severely affected Heinsberg/Gangelt area (Germany) was on the ZDF News cast last night. The interesting paper of his research in Gangelt (just across the border near the Dutch city of Sittard) has just been published. It paints an excellent picture of what happened there after a superspreading event on 15 February 2020. Moreover, it is characteristic of what happens in a community after such an event with a major outbreak. In the community of over 12,000 people, a sample of 919 people from 405 households was taken. A questionnaire was taken, blood was taken, a sample was taken from the back of the throat and samples were taken from surfaces in the house. The most complete random survey I have seen so far. With interesting results.

Before I go into the results, this for me shocking and unfortunately significant finding. Around the 15th of February it was Carnival, which turned out to be a superspreading event. When on February 28th it was realized that a lot of people were infected in Gangelt, a complete shutdown took place. Schools closed, all places where groups of people could gather, public transport stopped and a variety of other measures were taken. 1,000 partygoers went into quarantine.

So this was on February 28th, near the Dutch border. On March 5th, a charity event with 500 people took place in Kessel, 40 kilometers from Gangelt. That was also a superspreading event, which I wrote about earlier. Shortly after, a lot of people turned out to be infected. No specific measures were taken in Kessel. Except the generic measures that were taken around March 19th for the whole of the Netherlands. No specific investigation was started in that municipality either. At the end of March the outbreak was picked up by the regional press. The Kessel case did not reach the national media until around mid-April. On April 19th, National newscast EenVandaag brought a segment with the significant title “But why here, in this small village?”. In 6 weeks 165 people had died in that municipality. In week 13 (end of March) 5 times as many people died as the average in weeks 1 to 10.

In the meantime, the municipality belongs to the top 5 municipalities in the Netherlands in terms of the number of infected people, hospital admissions and deaths.

So while Gangelt locked down 2 weeks after the superspreading event on February 15th, there was no intervention in Kessel. Nor that at the end of March a major research program was started in that community. What a difference of approach between the Netherlands and Germany! The qualification “well-meaning amateurs” for the approach in the Netherlands is the most positive thing you can say.

Prof. Streeck was interviewed in the ZDF newscast.

He presents his most important findings. Meanwhile I have also read his paper and this is what I think are the most important findings..:

  • 22% of the people who were infected didn’t notice it themselves and had no complaints.

 

  • 0,41% of all infected people have died. This means that the IFR (Infected Fatality Rate) is calculated at a maximum of 0.52%. If this percentage were to apply to the whole of the Netherlands, the infection rate would already be somewhere between 15% and 20%.

 

 

  • Streeck shows that the people who were present at the superspreading event had more symptoms and were sicker than the people who were infected elewhere (by a factor of 1.63). Those infected at that superspreading event showed no symptoms in 16% of the cases. Those who were infected elsewhere (especially in their own household) showed no symptoms in 36% of the cases. This confirms the image that patients become sicker the more exposed they are to the virus. But also that you apparently come into contact with the virus more intensively during a superspreading event (with floating aerosols) than when you are infected, for example because you live at home with an infected person.

 

  • The chance that you were infected by a family member turned out to be clearly lower than you would expect. In spite of the fact that you have been in the vicinity of an infected person a lot (and therefore have certainly not held a 1.5 meter distance). In a family of 4, you therefore have a 40% risk of being infected as well. Of that, x% shows lighter symptoms.

The results are in line with findings in other studies and also from what I’ve written in my blogs over the past month and a half.

Those scientific findings should have major consequences for the policy that is now being pursued in the Netherlands (and around the world). Combined with what we already knew from other studies, these are my conclusions:

  • Superspreading events are the most important source for the exponential growth in the number of infected people.

 

  • The extent to which you become infected (and ill) is significantly greater if you are infected by floating aerosols than if you are infected by a form of direct contact with an infected person.

 

 

  • The chance of becoming infected if you are close to an infected person unprotected is significantly smaller than previously assumed. (If you only have a 40% chance of being infected at home by a family member, how much risk do you run on the street or in a shop if you are close to someone who is infected?)

 

  • Stopping meetings of many people, as has actually been done worldwide, has a greater impact on the reduction of the outbreak of the virus than keeping the 1.5 meter distance.

 

  • In combination with the fact that you have a much lower chance of infection outside than inside, any restriction you impose on people’s manners in the open air is actually nonsensical. It has virtually no effect on the extent of the spread of the virus!

 

 

  • In indoor areas you do have to be more careful to be infected by aerosols, rather than directly by an infected person. Caution (e.g. by mouth protection) is wise however. 1.5 meters distance is actually much less relevant.

Let us hope that the RIVM and virologists in the Netherlands will also take this study quickly and then take the right measures, so that the Netherlands can quickly emerge from the lockdown in a smarter way.

Our Experts’ outdated “mantras” and their major consequences

We know more and more about how COVID-19 is spreading. Unfortunately, there does not seem a learning curve in what the experts who advise our government, have known since February.  This interview serves as proof.

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Sailing in the fog, with old maps and a broken rudder

In recent weeks, several very important studies about the spread of COVID-19 have come to light. With these in hand, it would be quite possible to develop a smart and fast exit strategy. Without the danger of a rapid increase in the number of seriously ill people and casualties.

Tonight’s government announcements show, that these recent investigations are at least being ignored (and I say this kindly) by the Dutch team of advisors. The fear of a second wave is being stirred up, giving the citizens the impression that we will be back in the situation of 1,400 people in ICUs in no time.  That chance is -at least until the autumn- nil.

Yes, there is a chance that we will go to 10 or 20 more deaths a day, but that is mainly due to the blind spot at the OMT and government, for other ways of contamination than within 1.5 meter distance.  But even that doesn’t justify the kind of frightening “threat of a second wave” that we get sprinkled over us every night like a mantra by virologists and administrators.

A smart and fast exit strategy, taking into account the latest research results, would be much better for the economy and society, while the chances of increasing the number of casualties are even smaller than the approach being followed now.

It is an approach that is not based on a 1.5-metre society. That too has become a kind of mantra. In many places this is practically, economically and socially unfeasible, besides creating a false sense of security.

I wonder why the crucial results of Prof. Streeck’s special research, just across the border in Germany, as explained in an extensive interview on Monday evening in the ZDF newscast Heute, are virtually ignored in the Dutch media yesterday and today?

The following example shows how many people are sailing in the fog and how weak the basis for decision making is now and in the near future. In the coming weeks, the measures will be lifted a bit: primary schools will be half-open, contact professions will be allowed to get back to work, certain sports activities will be allowed again (e.g. at Golf we now apparently get “a hole in one and a half”) and we are allowed to stay at home a little less.

Let’s just presume, that one of these is not working as well as it should and infections rise. That will surface in two weeks or so. But if you just see how badly organized the research into contamination is in the Netherlands (professional data collection appears to be difficult for our government), then you already know what happens: they will not be able to clearly attribute the increase to one of those extensions. Perhaps it is caused by another development, which they did not focused on (such as an increase in the use of air-conditioning in houses, because the temperature is rising outside)? What does one do then?  Reverse everything? Or postpone the next phase a bit?

How can you steer well under difficult circumstances, when so much crucial data is missing? And journalists do not ask our specialists the right e.g. crucial questions? Like:

  • you keep saying that there’s a high chance of infection if you come into contact with an infected person within 1.5 meters. But how can it be that in Germany, just as in China and South Korea, it has been demonstrated that the vast majority of family members of an infected person are not infected themselves?
  • How is it possible that two months after the start of this crisis you still do not know which part of the Dutch population is infected? How can you then formulate policy?
  • Why are there so few infections in the province of Groningen and so many in Brabant/Limburg? Are the chances of being infected greater in Groningen now, or smaller in Brabant?
  • What is the consequence of the fact that it has now also been established in Germany that 22% of infected persons have no symptoms?
  • How is it possible that those attending a superspreading event have much more serious symptoms than people who are infected at home? And how is it possible that people who are infected at home have noticed much less of their infection than people at a superspreading event?
  • What are the consequences of the findings in studies in different countries that it is hardly possible to be infected outdoors?
  • What conclusions do you draw from the findings in the US that indoor temperature and humidity need to be raised?
  • Last but not least, what have you actually learned about the spread of the virus since it broke out in China 4 months ago?

I’m afraid the answers to these questions support my thesis, “we sail in the fog, with old maps and a broken rudder”.