Day 216: Why did Austria fuck up the second wave?

Bucklige Welt, 10. Oktober 2020

The best connoisseur of a society is a non-native staying.

Georg Friedrich Simmel

Being autistic I feel like a stranger my whole life. It’s a different way of being and thinking. I can’t remember being ever happy about just following rules. I always wanted to know the reasons behind. Needless to say you will always have problems with authorities and hierarchy with such an attitude. Feel free to criticize but we decide whether it’s justified or not. Don’t ask, just carry out orders! I simply can’t live like that. Well before the lockdown I refused to built up stocks at home. I live alone and nobody told me what to buy. The situation has been very scary for me. I’m too young to feed upon 14 days of tinned food, not to mention baking bread which I never did. Actually I bought some meal but never used it. In contrast to all these recommendations supermarkets remained open throughout the lockdown and it has been completely nonsense to buy the shop out for toilet paper. I also remember painstakingly keeping distance to other people outside, rather changing the sidewalk at all instead of just passing by. In the first weeks of the lockdown, the government rose the impression the Coronavirus was like measles, black death or smallpox, instantly jumping from host to host. In this article, I try to sum up the biggest mistakes dealing with SARS-CoV-2 and to a lesser extent the economic mistakes.

As an outsider (german) and being autistic I do not suffer neither from a monarchistic heritage nor obedience to authority. It is therefore possible for me to think outside the box and look behind the reasoning of rules.

Outdated set of rules against virus transmission

[…] Austria has coped fairly well with this pandemic; however, current recommendations, such as maintaining physical distancing of at least 1 m, wearing cloth face coverings if this is not feasible, washing hands often, covering coughs and sneezes, staying home when ill and frequently cleaning high-touch surfaces remain critical for reducing transmission.[…]

Kreidl et al. (20.08.20)

The referred paper of Kreidl et al. has been published on 20th August 2020, i.e., about five months after the official onset of the pandemic. Thanks to my extensive database of chronological scientific progress, I’m able to say that world’s scientists knew quite a lot about the mode of transmission at the beginning of July. According to the leading aerosol scientist Jose-Luis Jimenez, superspreading events can only be explained by aerosol transmission. Later on, he commented in detail on a paper claiming aerosols were not an important pathway for SARS-CoV-2 stating the opposite. In Germany, aerosol scientists demanded early to develop another way of handling ventilation in indoor spaces. The close collaboration of RKI, Hermann-Rietschel-Institute and Charité Berlin whose chief virologist Christian Drosten is advisor to the german government is also the reason for which Drosten mentioned aerosol transmission as early as May in a NDR podcast episode. He assumed that about 40% of transmission is due to aerosols, 40% due to droplets and about 10% as a result of fomites (contact infection). Current scientific consensus is that aerosol transmission plays the dominant role in spreading SARS-CoV-2. Ballistic transmission rather happens by chance since it requires the infected person to be symptomatic, coughing and sneezing and accidently spitting large droplets onto the mucosa in the face (eyes, nose and mouth) of a potential host. You have to be at the wrong time at the wrong place. Infection by fomites is even expected to be more infrequent which is in contrast to early findings. However, lots of studies in the first months started with unrealistically high virus amounts under labor conditions. The paradigm shift in the mode of transmission also questioned the famous rule of 6 feet distance, in Austria with 1m rather a low threshold. Likewise, the 15 min talking rule is not a safe number, too.

Evidence for transmission through droplets, fomites and aerosols,
Source: FAQ on Aerosol-Transmission

To sum up the recommendations in the paper mentioned above, what is necessary and what is insufficient? Physical distancing of 1m isn’t possibly sufficient even in the (rare) case of droplet transmission. If someone is sneezing or heavily coughing, droplets will likely travel far behind the 1m threshold, more in the range of 4-6m.

Sketch by Dr. John Campbell, discussing scientic papers about SARS-CoV-2 from the beginning on a daily basis

Therefore wearing a mask only in situations where physical distancing is not possible won’t prevent infection in situations where physical distancing is maintained. The authors didn’t take aerosol transmission into account, i.e., the continuous increase of infectious aerosol concentration in poorly ventilated and crowded indoor spaces where people tend to talk loudly or cry and sing, like in a bar or in a choir. The authors seem to support masks only to inhibit droplet infection. Washing hands and frequently cleaning surfaces indirectly points to droplet infection since there is no other way to carry viable virus from respiratory pathways to the surface which is, in fact, another strong argument for wearing masks indoor all the time. If you can’t sneeze and cough on the table or armrests, you can’t infect others by fomites. Even if the mask was unable to block infectious aerosols completely, the amount of virus would be significantly reduced.

To conclude, the current set of basic rules against transmission should be:

Avoid Crowding, Indoors, low Ventilation, Close proximity, long Duration,
Unmasked, Talking/singing/ Yelling

Don’t ask, don’t think for yourself!

Europe is on a really bad trajectory. Virus spread needs to be slowed down, otherwise this could get worse than in spring.

Florian Krammer, Virologist, 10th October 2020,

While there is overwhelming evidence for the efficacy of masks against the transmission of SARS-CoV2, some reluctant so-called experts still doubt their use in public. Mask deniers try to circumvent the mask obligation in creative ways, e.g. claiming they can’t get enough oxygen to breath wearing a mask for hours which is clearly disproved by studies carried out with COPD patients. Anecdotal evidence from people with asthma or mucoviscidosis reassures these findings. On the contrary, especially people with serious difificulties in breathing or lung diseases should protect themselves stronger than healthy persons. A rather comfortable way of refusing masks are face shields or even “chin shields”. The Austrian labor minister allowed face shields as equal substitute for cloth masks.

“Chin shield” alias “Virus jumper”

Current status is that a majority of service workers and in trading wears these useless pieces of plexiglass in front of their face.

Lindsley et al (2020), efficacy of covering the face depending on professional masks, cloth masks, gaiters and face shields

Experimental studies clearly show why face shields should only be worn with masks. The Swiss Health Office warned of face shields in Mid July as infections could be traced due to worn face shields in restaurants. Chin shields hardly covering the nose are even more useless. Current guidelines issued by the Austrian Health Office AGES still refuse to acknowledge the importance of aerosol transmission. The vast majority of the Austrian population, irrespective of their educational background is convinced that the virus is mainly transmitted by large droplets and plexiglass shields were sufficient to block the drops. However why does someone wear a face shield without a mask at all? Is it to protect himself from accidently being splashed on? In general, wearing a mask has been considered as a solidary act to protect others if being (asymptomatic/presymptomatic) infected. So when people with a face shield breath and talk, most of their aerosols with leak from the shield. When they cough and sneeze, most of their droplets will fall to the ground – or onto the plate with food and drinks waiters carry to their customers. It is moreover alarming that quite a lot of elderly and sick people wear these face shields without a mask. If I were you, I would do everything to protect myself as much as possible. Elderly and sick people are at a much higher risk to die, so why playing with god?

Despite the evidence, masks are only recommended by the health minister and face shields are not explicitly forbidden. Chin shield wearer won’t be punished, either. At the moment, it is not possible to safely go shopping or eat in a restaurant, not even outside. It’s just a a slap in the face for all the people at enhanced risk for severe Covid19 disease. In the first couple of weeks the slogan has been to “flatten the curve” and to protect the elderly people and those with pre-existing conditions. Now we’re heading deep into the second wave and people at risk do not seem to count anymore. Hell, the officials didn’t even provide sufficient FFP2 masks for vulnerable people and groups.

I’m on the verge of resignation. I understand the history of the Austrian soul but I refuse to accept it. Lots of scientists are complaining about the slow updates of scientific findings with the WHO, lately acknowledging the importance of masks, still refusing to see the importance of aerosol transmission. The AGES is in strong accordance to the WHO. The Health Minister strongly relies on the guidelines of the AGES and on the “Corona commission experts”. So when the Austrian governments forms a set of rules, the population will follow it stupidly irrespective of making sense or not. If the rule is to keep distance of 1m indoor, the restaurant owner will place the tables within the room in an exact distance of 1m. If the rule is to wear a mask in motion but not sitting at the table, in the office or during a theater performance, all people will do so as if the virus will sit well-behaved and wait until you stand up again and walk around. These rules are not set up to protect you from the virus but to register you in the case of a transmission event.

I often hear people asking “Do I need a mask?” or “How many people are allowed to be in that room?”. I never hear them asking “What’s the likelihood to be infected?” or “What can I do to reduce the risk?” We urgently need to shift the focus on prevention instead of bending the rules. The people’s compliance to the rules or even overfulfil the rules would be much higher given sufficient background information. There never was any since March. The government dictates the rules and issued threats to punish the people if the rules were not followed. It rather reminds me of an outdated instrument of behavorial therapy than encouraging people to show personal responsibility with common sense.

There is no glory in prevention

One lacking key information is the explanation of the prevention paradoxon. In an alpine country, a significant portion of the people should be familiar with avalanche warnings. The different warning levels depend on the possible degree of avalanches threatening not only individual persons but even infrastructure and villages in the worst case. In lots of cases, nothing will happen or big avalanches will go down in unpopulated areas leaving no damage. However, what would happen if the warning level was low but the damage high? The impact could be devastating, with lifes at stake and severe damage to houses.

The relationship of warning and impact is displayed in the so-called risk matrix:

It becomes clear that the case of unpredicted events actually happening has to be prevented because it could not only cost money but also lifes.

The Austrian Government has given a quick response to their own failure with serious consequences (spreading the virus to most parts of Europe), and declared a lockdown by mid of March. The number of social contacts rapidly declined and the degree of transmission shrinked significantly. Hence, the number of death could be hold low compared with other European countries. As a consequence of this hard response, lots of covid-associated damage could be prevented, such as triage in the hospital (less care for non-covid patients and deciding of who has better survival chances), lots of covid patients with possible longterm symptoms. So-called experts used to say, the elderly would have died anyway, if not covid, it would be influenza or just the age itself. In a NDR podcast episode however, Drosten reported that the “infection fatality rate in the 65-74 yr group rises to 2,2% which is 30 times influenza. With 75-84 yr group it’s 7,3% and above 85 yrs it’s nearly every third person. That’s comparable with smallpox during mediaeval times or some ebola outbreaks in Africa“. Sorry to say but your grandma could have lived a couple of years longer if she hadn’t get Covid19. Moreover, there is a yearly updated vaccine against the flu but it’s not the fault of the scientists when people largely refuse to get vaccined.

The Viennese neurologist Dr. Michael Stingl has already seen long covid patients with postviral fatigue. These symptoms can resemble ME/CFS, a fairly frequent and severe disease of unknown cause. In England some well-known physicians are affected by long covid which is why the subject obtains much more attention (e.g. many articles in the BMJ) than in Austria where the total number of patients has been low during the first wave and media reports are quite sparse. Another problem is that lots of physicians dismiss postviral fatigue as psychosomatic condition (the imagined disease).

My quite compelling database of studies, reports and anecdotal evidence about longcovid reveals that long covid is a serious issue in nearly all countries severely hit by the first wave. Even mid-term troubles could disrupt the lifes of thousands of people losing their job when their illness exceeds several weeks or even months. Thinking of the flu, even staying at home for one week seems to be too long for many employers and it is still the case, even now in the middle of a respiratory virus pandemic, that sick employees must go to work. Now add an unknown number of long covid patients and affected families and employers. Common sense would tell us to keep the number of infections low by all means as we don’t know for sure which proportion will make a full recovery. There is much more than dead or alive as the numbers seem to imply.

As long as so-called experts officially claim the virus is as harmless as the flu (which it is certainly not) and ignore the growing number of longcovid cases, people will not put much effort in following the basic set of rules. Younger people tend to see themselves as invincible as the rate of asymptomatic or mild disease is higher (which doesn’t rule out long covid, though). The elderly are either frightened or ignorant. Superstituous thinking is strong in Austria, maybe even more widespread than in the USA. Conspiracy myths fall on fruitful ground. No surprise in a country selling “Granderwasser” and advertising “Lichtnahrung“, not to mention big money made by “Schüsslersalze” and “Bachblüten“, or homeopathic globules. In addition to that nearly a third of the Austrian population regularly votes for right-wing “anti-scientific” politics. The media does their part to the damage, too, mainly dominated by boulevard newspapers and sparse scientific journalism.

Desaster at schools

Sorry that I’m unable to choose comforting words here. I don’t have children and I’m blunt because I’m autistic. Schools in Austria are open since September and big surprise: There are quite a lot positively tested students and teachers. Dogs and cats can be infected, too, but only cats can infect humans. Children are treated like dogs: Physicians admit that children can be infected but they are supposed to rarely infected other children or adults. A huge study in India destroys the most frequent argument of “children are not an important player in transmitting SARS-CoV-2” experts. That’s far away from a surprise, either. Since July it is well-known that children possess similar amounts of virus in the upper respiratory tract than adults and asymptomatic childen can be quite infectious as well. Thankfully children are better protected against severe disease than adults but otherwise children are not like dogs but rather like cats.

If you do not want to accept truth, what is the best strategy? Correct, we simply test lesser children than before! We completely ignore, however, that parents and teachers are at risk here, too. Is this forward-looking thinking? Shouldn’t we do everything possible to protect the elderly and people with pre-existing illness? During the first wave, the leading politicians themselves pointed out that it was not a good idea to let the children play with their grandparents.

It’s the economy, stupid!

Due to the lack of understanding for the prevention paradoxon, a significant part of the population thinks the measurements were exaggerated and the damage to the economy and non-covid illness too high. I strongly disagree for several reasons. First, a large number of covid patients would have bonded much capacity missing for non-covid patients. Second, the right-wing leading politicians did not address psychologic consquences (chancellor Kurz wanted a total curfew but the green party managed to include going outside for physical and psychological well-being) and some fear could have been taken away finding appropriate words instead of only punishments when someone walks too close near other people in the park. A large number of infected people would have shutdown the economy anyway as a result of severe illness, quarantine and isolation.

The notorious Swedish Strategy to achieve herd immunity seems to be a role model for the current course of the Austrian government. Prof. Allerberger, Head of the health office AGES, invited the swedish chief epidemioligist Tegnell to Vienna in early 2021. Austria already copied some of their (misleading) strategies: Few tests for children, ignoring people at risk and the elderly. Moreover, schools were re-opened during a time with rapid increasing transmission (community spread).

Economy first! Keep the schools open even if we put (a few) children and teachers at risk. Main purpose is to let the parents remain at their working place. The doctor’s note by phone call vanished by end of August although it served well separating covid-ill patients and non-covid patients. The number of sick notes even decreased in contrast to the prejudice of employers leading to the decision to abolish this fine instrument. All the “system key workers” maintaining the basic services for the public (energy supply, supermarket, health care professionals, cleaning workers, public transport, etc.) never received appropriate appreciation for keeping up throughout the lockdown (and thereafter). The government didn’t raise unemployment pay despite rapidly rising number of unemployed (especially tourism, gastronomy in the beginning) and in order to feed the economy with increased spending capacity. Moreover, the severely disappointing vice chancellor of the green party, Kogler, publicly sympathized with ideas for a degressive unemployment pay, enhancing the pressure for every worker to keep the job even with more shitty circumstances. The catastrophic management of the financial crisis caused by the pandemic and the abolishment of the former epidemic act without adequate substitute could be a separate blog entry. Let’s just say a leftist government would probably have chosen a more appreciating and reassuring communication strategy to manage the crisis, not to mention we would have an epidemiologist as female chancellor (Rendi-Wagner).

Second wave …

The rapid increase by the end of August doesn’t come by surprise. Slack measures, returning vacationers and increased mobility of the younger population resulted in high community spread infiltrating the schools. It’s especially frustrating to see such high humbers well before the autumn started. The majority of September and several days of October remained above-average warm and sunny. Despite favorable conditions for outdoor activities, numberous clusters formed indoor (marriage, birthday, club meetings, private partys, etc. ).

Age cohort and number of new infections over time,

The grim part of the autumn and winter season is still ahead. A number of cold days with few sunshine. I would not recommend indoor dining but rather take-away or ordering at home. Thanks to climate change, we surely can expected a couple of relatively warm days even in winter and the remaining restaurants (i.e., those which are not broke by the end of the year) should be allowed to serve outside all the time.

I personally decided to take the bicycle as often as possible, even when it means to be in the dark in the next months. I hope to get the opportunity to take some hiking tours to open mountain huts where I can sit outside on the terrace. Being outside as often as possible, in the forest, on the mountain, will be my strategy to survive.

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