It was predictable and even predicted, especially since the SARS-1 outbreak in 2002-2003, that a new corona virus infection was a possibility.
Covid-19 is a new virus from the corona family (Covid means Corona Virus Disease) known until around the 2000s for the common cold, a contagious but not serious condition.
A dangerous mutation, leading to lethal infections by affecting the lungs, first appeared in humans during the SARS-1 or SARS-C or SARS-Cov-1 (Severe Acute Respiratory Syndrome, Corona Virus associated disease) in 2002 in China in Guandong (8,096 cases in around 30 countries, causing “only” 774 deaths), spreading throughout the world until 2004. Another Corona epidemic occurred in 2015 in South Korea: MERS (Middle East Respiratory Syndrome) appeared in 2012 in Saudi Arabia: 1,154 cases of confirmed infections including at least 434 fatalities. Viruses which were therefore quite lethal, fatal, but relatively non-contagious.
Conversely, fatality rates are low for Covid-19 (0.5 to 1% for the WHO). However, this rate is higher than that of seasonal flu (0.1% on average). Here we measure the “infectious fatality rate” (IFR), which is the ratio between the number of deaths and the number of people who have been infected. We therefore do not relate the number of deaths to the cases that test positive, but to the estimate of all those who have been infected with the virus.
The epidemic
The Covid death figures are often broadly underestimated, either out of ignorance (as in the case of care homes for the elderly in France) or for political reasons (China, Brazil, Russia and so on). So while China recognizes about 50,000 cases and 2,531 deaths (still 5% mortality) for Wuhan (11 million inhabitants), the distribution of urns for Tomb Sweeping Day suggests 50,000 to 100,000 deaths, or even more. In an interview with {Sciences et Avenir la Recherche}, Dr Georges Ga Fu Kao, director of the Chinese CDC (Centre for Disease Control and Prevention), in fact speaks of 82,000 cases, with one symptomatic case for 6 to 7 asymptomatic ones.
Overall, while there have not been any additional large numbers of deaths in Wuhan recently, the Chinese numbers and even the timeline are questionable, contributing to the fuel of conspiracy theories. For Brazil, the official figures under Bolsonaro are completely underestimated, but it is extremely difficult to get an idea of the real number of cases and deaths. In addition, in the different countries, the count of deaths attributed to Covid is not based on homogeneous methods.
The origin
The “new virus” for humans is a coronavirus from the bat and then from the pangolin, with recombination with a pangolin virus, an intermediate host. It is also possible that the virus has recombined in direct transmission from bats to humans. The other guess is that the virus has been there and dormant for a long time. In any case, it seems to have “appeared” on a market in Wuhan (Hubei province) in early December 2019.
This type of transmission has already existed: Ebola, AIDS (Africa, originating from the chimpanzee and/or the green monkey). Trump's idea of a “Chinese virus” does not fit the H1N1 flu that originated on a farm in Mexico, for example. As for a conspiracy by the US army or Chinese laboratories, it comes up against the “Spanish flu” which appeared in China in the Canton region, before any genetic engineering work, the virus coming from the duck and passed to humans via pork. The hypothesis of a leak of this virus from a laboratory during routine studies of bat viruses cannot be totally ruled out, but appears extremely unlikely.
Clusters, “waves” or rebounds
The virus spreads in foci (clusters). This is the reason why there are geographical disparities within the same country which sometimes distort the assessment of the progression of the epidemic if we limit ourselves to national statistics. Apart from the diversity of populations, these differences are poorly understood, but, unsurprisingly, in the same wave, it is the poorest populations who are most affected.
The hypothesis of a heat-sensitive seasonal virus does not hold up in the face of disparities. On the other hand, it seems established that the virus temporarily depletes a hotbed before subsequently re-exploding, and cofactors (as for the flu) are to be sought for seasonality, but here again we are rather ignorant. We can note differences between countries. Thus, the epidemic exploded in North and South America during a relative respite in Europe during the summer. As far as Europe is concerned, a halt came in late spring with the success of lockdown policies.
Since September (with disparities) the infection curve has been rising, and this is not due only to increase in the number of tests, and therefore of patients detected, because the positivity rate has gradually increased, followed by a resumption of hospitalizations, and a delayed resumption of resuscitation admissions. The progress made (anticoagulants, dexamethasone, new oxygenation procedures and so on) has, however, reduced the percentage of deaths, and the rate of progress is slower than in March-April.
We can also note the protective effect of barrier measures and the decrease in viral load through the wearing of masks. We can nevertheless speak of a rebound or a second wave.
That the virus continually mutates is a reality, even though it is much less mutagenic than HIV or polio, for example. Twelve punctual mutations have been described, with no effect on the contagiousness of the virus or its lethality. But while this explains the growing preponderance of this mutant, its lethality is not affected. There is currently no evidence, for example, that the virus “became more (or less ...) dangerous” between August and the end of September
Aspects of political ecology
Epidemics and pandemics are increasingly frequent. Ecosystems are plundered for plantations, precious wood, and “confront” humans with viruses without previous contact, therefore without protective immunity, whether the contact is direct (handling, butchering, food) or indirect (ticks, for example) . The historical example is the smallpox brought to America by the Spaniards, and then the intentional deposit of infected blankets and clothing in Indian communities.
Let us add the trans-forest roads and savannahs “opening up” previously isolated micro-communities - which limited the spread - and the markets for live animals, with limited hygiene - ticks, flies and so on. Added to this is capitalist globalization: jumbo jets, cruise ships and so on, ideal and fast places of contamination. The spread of the virus also followed trade routes and took place first via intercontinental links favouring cities and sparing the countryside and low density areas.
Research aberrations
Coronaviruses have been known since SARS-1. Their structure makes it possible to determine elements common to the family, targets of neutralizing antibodies and killer cells, as well as targets for antivirals. It is therefore possible to envisage “anti all corona” vaccines (“pan vaccines”) and specific corona antivirals. This is exactly what several labs have done since SARS 1. I will take the example of France, but it is also the case elsewhere.
But, for that, we need either regular credits to finance fundamental research, or to go through the “calls for tenders” in particular of the ANR ( National Research Agency) which are very often determined by immediate economic interest and/or rapid feasibility.
Which is in fact aberrant in biology and denies the role of chance and serendipity. For example, everyone knows that neither the discovery of the accelerating expansion of the universe nor that of “dark matter”" were originally planned.
The history of French “pan corona vaccines” is exemplary in this respect. There was a dedicated laboratory, with promising leads. As Bruno Canard, virologist at the CNRS, says in {Le Monde}: “We had just launched [in 2002] major structural genomics programs on viruses to try not to be caught off guard in the event of an emergence. The process is very simple: how to anticipate the behaviour of a virus that we do not know? Well, simply by studying all the known viruses to have knowledge that can be applied to new viruses. A European project launched for this purpose at the time was followed by other programs. The outbreak of SARS-CoV in 2003 illustrated the relevance of this approach. This led us to describe a first crystallographic structure as early as 2004. […] I think a lot of time has been wasted between 2003 and today in finding drugs. By 2006, interest in SARS-CoV had waned; we didn't know if it was coming back. We then had trouble funding our research.”
Likewise, Didier Sicard (president of the National Ethics Committee until 2008 and very much involved in the creation of the Institut Pasteur in Laos) observes to what extent the transformation of the primary forest brings man closer to bats and denounces the underinvestment by France in this Institut Pasteur. “What always strikes me is the indifference at the starting point. As if society was only interested in the point of arrival: the vaccine, the treatments, the resuscitation. But so that it does not start again, we should consider that the point of departure is vital. But it is impressive to see how much this is neglected. The indifference to wild animal markets around the world is dramatic. These markets are said to bring in as much money as the drug trade.”1 Obviously, trudging around to analyse bat viruses is not immediately or long-term profitable for big pharma. Even the systematic search for antibiotics by analysing wild plants, for example, has withered away.
A short term policy
When the first cases were declared, there was, in Europe, and in France in particular, an underestimation of the danger whereas the health system had suffered the blows of neoliberal policies. To quote Agnès Buzyn, the former Minister of Health, “The risk of introduction into France is low but cannot be ruled out” while the WHO increased its “warnings”. And Olivier Veran: “We are acting quickly, we are working hard to face the epidemic threat”, with the announcement that “all metropolitan departments will have at least one hospital centre capable of taking on patients from start to finish”.
In reality: hospitals overwhelmed (nearly 20,000 beds lost under Sarkozy-Hollande-Macron) transfers by TGV, lack of masks (liquidation without renewal of stocks; lies about their uselessness in March making their subsequent imposition almost illegible; masks which were not free of charge; lack of tests due to lack of PCR reagent purchases, shortage of drugs, gowns and so on.
In research and hospitals, we had to deal with a policy of just-in-time and divestment, the consequences of which we can see. And it was to be feared that shortages and hiccups would repeat themselves when lockdown was lifted with, in addition, threats to individual freedoms. This is exactly what we got in the second wave.
Asian choices
It was preventive treatment and a strict, long-term lockdown that helped China locate and apparently contain the epidemic. At the cost of drastic measures that it is difficult to envisage being applied in France. After a significant provincial delay, the provincial authorities of Hubei blocked everything in Wuhan, Huanggang and Ezhou (22 million inhabitants) and on 25 January the authorities extended the quarantine to almost the entire province of Hubei (56 million inhabitants) , with lockdown in houses (including closing/welding the locks of contaminated apartments). At the same time, strict border controls were introduced, while the urgent construction of field hospitals was launched. These measures completely contained the epidemic in Wuhan.
But it should be noted that the resumption of work then exposed to a second wave - outside Hubei - the uninfected areas, Beijing and Shanghai for example. This is in fact unlikely, as the regime's response to any reboot is as in Wuhan, while strict border control and imposed quarantines seemed to block any resurgence of the virus. Nationally, only a few new patients are counted each day, almost all of them Chinese returning from abroad and placed in quarantine upon arrival. But the discovery in Qingdao of six cases of coronavirus and six asymptomatic cases caused a temporary virtual isolation and the screening of five districts of Qingdao “within three days”" and the entire city “within five days”, i.e. at least 5 (and maybe 9) million people.
Very similar measures have been taken in Vietnam, with general lockdown and quarantine, and re-lockdown of entire cities such as Da Nang in July (with the evacuation of 80,000 tourists). The result: 268 cases and zero deaths for 93 million people, but 1,122 cases in total and 35 deaths after the peak in July and a mini peak in October. We have talked a lot about this “resurgence” but with 35 deaths compared to European figures, that's no comment. This strategy will remain in place until at least the end of 2021. Such strategies seem hardly applicable in Europe, judging by the effect of the bar closures in Marseille, Liverpool, Madrid and so on.
This extreme strategy is in fact not the one implemented in Korea or Taiwan. Korea in 2015 suffered from the MERS corona from Saudi Arabia: there were 1,154 confirmed cases of infection and at least 434 fatalities. A low alert but Korea learned from it and braced for the next inevitable epidemic. Hence, for example, the availability of more than 10,000 tests per day, with more than forty ambulatory clinics. Then outbreaks are isolated, masks and gloves widely distributed, and once diagnosed, the outbreaks are analysed: the relatives of all infected people are thus searched systematically, before being “offered” a screening test. Finally, there was disinfection of premises, streets, and this from the first wave of contamination (7,755 cases on 11 March), and a very large number of PCRs (diagnostic test). The movements of patients before they tested positive were reconstructed by means of CCTV images, the use of their bank card or the demarcation of their smartphone (which also serves Stop Covid-type applications), then made public. What matters (as in Taiwan, another model) are the tests (more than 10,000 per day) involving ambulant clinics, all in an orderly manner, and planned.
New Zealand also has a good track record at the cost of drastic measures. Borders were closed in March, with seven weeks of national and strict lockdown between March and May. Here again, an application - NZ Covid Tracer app - was set up to trace all the contacts of an infected person. In addition: every business, every store, every restaurant has the obligation to display a QR Code at the entrance that everyone must scan before entering.
In all these countries, the discipline of the population has been almost total. If this has caused economic damage (greater in New Zealand than in Taiwan, Singapore, Korea and so on), the fact remains that the Pacific zone has managed the crisis. Economic figures from Korea and Taiwan show a much smaller drop in GDP than in European and American countries or in India where poorly managed containment has not prevented the epidemic from being almost out of control, all of this combined with an abysmal drop in GDP (- 23.9% from April to June).
Europe and the Americas
This was not at all the case for European countries (we will not talk about Russia here given a certain opacity of the figures, as for Iran and others), Latin America and North and Central America. Two types of strategy were applied: lockdown/restrictions or seeking herd immunity. The latter strategy, which has been implemented more or less openly, is based on the view that the infected population will develop an antibody (and cellular?) response and that the epidemic will end. Let’s overlook the fact that there is no evidence (on the contrary) that immunity lasts more than 5-6 months under natural conditions.
This was the approach applied in Sweden. In this context, no lockdown, no masks, among others. Such a strategy has eugenic aspects with regard to the elderly, and above all requires that at least 60% of the population have been infected. We are far from it, and the disease has started to affect young people massively. It is a mark of failure of the collective immunity response, with the icing on the cake of a mortality per million inhabitants 6 to 10 times higher compared to the Scandinavian neighbours of equivalent density and lifestyle (Finland, Norway) . A “success” which in the autumn led Sweden to toughen its system.
Lockdown is an effective health measure. First, it has a certain economic cost on the production side for the capitalists and on the distribution side through the restriction of consumption. It is catastrophic for certain sectors (catering, tourism, culture). The social cost is considerable for a very large number of workers without unemployment benefits and for young people.
It is not possible here to go over the different national policies. In France, after the first wave already mentioned, the government let things slip during the summer and announced its rejection of a new lockdown before instituting a curfew, then an “improved” lockdown. The major places of contamination often continue to operate without sufficient resources: workplaces, transport, schools (it has been established that children are paucisymptomatic – presenting few symptoms - or asymptomatic, but contaminants), care homes. The concern to preserve the economy at the expense of the socio-cultural life of individuals is obvious.
Treatments and vaccines
With “grey rhinos” prevalent, no research has taken place on the metabolic routes of coronas: there is no interest in an upcoming epidemic and an uncertain market. This is what is still slowing things down now: if we have a vaccine, there will be no room for a potentially expensive treatment to develop which will no longer be amortized, and of no interest for the labs.
So the existing antivirals were tested, all of which had shown their in vivo ineffectiveness on SARS-1 and MERS (including hydroxychloroquine). However, progress is underway on the complementary routes, interleukin, the role of interferons and so on. The most notable progress has been obtained in intensive care in a symptomatic manner: anticoagulants, dexamethasone and new oxygenation procedures have significantly improved the prognosis.
The race for vaccines is emblematic. Phases 1 and 2 gave positive results in antibody response. But - when measured - the results in cellular response (although often known to be the most important) are not always clear. Sometimes they have been measured very indirectly (production of interferon gamma for a Chinese vaccine). But the dengue case shows that economising on a phase 3 can end in disaster.
Especially since there is little information on the temporarily halting of the testing of the Astra Zeneca or Johnson and Johnson vaccines. We can simply note that both are directed against Spike, a viral protein that binds to ACE2. However, ACE2 is a protein which may very well have a receptor/activator on poorly studied cells. Other mechanisms (DNA, RNA vaccines and so on) have been the subject of more or less advanced studies and tests. Another problem: the traditional route of vaccine administration would not be the right one. A route should be chosen which more specifically targets a secretory antibody response (associated with mucous membranes) and therefore a nasal route.
Finally, it is very likely that two injections will be needed. Example: The Russians have adopted a mix between what is done in Oxford with Astra Zeneca, using adenovirus 26, another human adenovirus, and a vaccine based on adenovirus 5, as in China. Their vaccine is a mixture of the two, the first injection being given with adenovirus 26, the second injection boosting the immune system with adenovirus 5 (Georges Fu Gao).
Either way, we can say that 70% of the population should be vaccinated. So if you do a little calculation on the world's population of 7 billion people, that's about 5 billion people to be vaccinated, the necessary production could take a year, if all the vaccines are available. In addition, enormous logistical measures will have to be implemented.
Conspiracy theories
We unfortunately cannot avoid saying a word about conspiracy theories, very present in the USA, but also in Europe, and notably in France. There has been the case of the Marseille-based professor Didier Raoult who stands accused by his peers of spreading false information about the benefits of the anti-malaria drug hydroxychloroquine as a coronavirus treatment. His promotion of hydroxychloroquine was taken up by the US and Brazilian presidents, Donald Trump and Jair Bolsonaro, who trumpeted its unproven benefits in a way critics say put people’s lives at risk. Raoult’s rate of “success” was based won treating mild cases only, with severe cases being transferred to Marseille hospitals. This did not prevent him subsequently denying the immunizing nature of the disease (serotests must be done with phantom antibodies) to deny the second wave.
Much more astounding still are Laurent Toubiana, a modelling epidemiologist trained at Thomson CSF, and Jean-François Toussaint, a professor of sports medicine, both “great virologists and immunologists” who have been appearing on French TV since August claiming that nothing is happening or that the epidemic is clearly decreasing. There are also “specialists” in the “non-pandemic”, “specialists” in the uselessness of masks, including somebody fired from the University of Ottawa, Denis Rancourt. All denouncing - despite the fierce competition from big labs like Sanofi vs. Sandoz Novartis, or the start-ups - a single “Big Pharma” entity manipulated by Bill Gates, manipulating the WHO. It is unfortunate that, from the Hydroxychloroquine saga to anti-vaccines, there are a number of left-wing activists in this galaxy.
- 1France Culture, 27 March 2020 “Didier Sicard : ‘Il est urgent d'enquêter sur l'origine animale de l’épidémie de Covid-19’, https://www.franceculture.fr/sciences/didier-sicard-il-est-urgent-denqueter-sur-lorigine-animale-de-lepidemie-de-covid-19.