I’m still fighting …though I don’t know for what ….

Prevention Paradox: © Martin Perscheid – a cartoonist who died a few months ago – I’ve known his cartoons since my childhood.

I’m getting somewhat more personal here and I prefer the english language in that case. Letting the world know what is happening here in Austria.

Last week I intendend to take part in an international conference of the World Health Network (WHN) whose basic statement on 30th October 2021 I signed as a private person. Main topic would have been No Covid Strategies in Germany but my intention was to add some facts about the dire situation in Austria. However, as the day came I didn’t feel like I could say something useful since the pandemic situation escalated quickly. I felt anger, frustration, depression. Austria is heading into the wrong direction for more than a year. We accidently act with the right decision during the first wave – with a hard lockdown, and got through with nearly Zero COVID. Even the former chancellor Kurz admitted the rightfulness and legitimacy of this strategy in an interview in June 2020.

Unfortunately, Austria fell victim to its own successfull combat against the virus: Prevention Paradox (see above). No crowded hospitals except for Tyrol, no large number of COVID deaths. Long COVID hasn’t been known in this time, not before April or May at least. Due to the small number of infections overall, we – the government, most physicians and the majority of advising scientists and the general population as well – didn’t recognize Long COVID as a possible disabling outcome of severe AND mild COVID disease, and although the awareness has rosen this year, Long COVID still doesn’t count when the politicians have to decide how much infections they tolerate before the health care system will collapse. Now Austria has reached the worst outcome of the pandemic – the health care system WILL collapse in a few weeks and stays that way for several weeks. The amount of people dying will rapidly rise due to hard triage and the basic treatment of non COVID and Long COVID patients will suffer, too, which will cause serious collateral damage. The federal government as well as the government of the federal provinces refuse to acknowledge they fucked up and blame the virologists and physicians instead for not telling them a big fourth wave would come. Yes, some so-called experts actually downplayed a big fourth wave, even a few weeks ago.

„The blame lies far less with individual scientists who were wrong than with an administration that sought out fringe viewpoints that echoed its own wishes, and elevated these above the overwhelming consensus of the public health
community.”
(Carl T. Bergstrom, 17th December 2020)

I feel lost. I tried to conduct scientific journalism for nearly 20 months, filling the gap most of the Austrian media left since the beginning of the pandemic. Recently I have been asked WHY I am so committed to do something about it. Honestly I hesitated to answer. It just feels right not to remain silent. I believe in justice. I believe in science. That’s a very short answer – maybe I will elaborate it later if I survive this madness.

The course of the pandemic, not only in Austria, but also in Germany where I originate from, is so sad because we had another choice. We could have continued the way of ZERO COVID as a result of the first lockdown where Austria responded very early compared to the other European States. We could have been a role model for science-based and effective pandemic management in Europe, mimicing successfull strategies of Asian and Pacific countries.

Infectiologist Richard Greil said something very very important during his interview with Isabelle Daniel (08.11.21, Ö24) but also recently with Armin Wolf (zib2, 09.11.21):

“People want to see effectivity and that’s the greatest healing factor also against polarisation: Success. Success must come as fast as possible. Collateral damage will remain the least then.”

However, in order to continue strict measures we should have explained them properly. One of the key mistakes in the early pandemic has been the claim that masks wouldn’t work for the general population – as an excuse for supply difficulties. We could have compensated for that mistake in April 2020 when face masks were introduced for the general population. As the infection rate started declining as a result of the effective contact and mobility restrictions, great barrington advocates doubted the necessity of face masks in public – as soon as May 2020 (Infectiologist Günter Weiss, advising Land Tyrol). The Great Barrington Declaration has not been invented before 4th October 2020 but great barrington thinking with major supporters like Tegnell, Kulldorf, Allerberger, etc. already existed early in the pandemic. In fact, face mask mandates have been lifted by July 2020 – annonced in Mid-June by Chancellor Kurz. I also remember Kurz’s words when face masks have been introduced that we have to learn to adopt useful measures from Asia helping us to stop the spread. Obviously, the reluctance to wear face masks has been greater than the belief in its usefulness, and false claims of so-called experts fortified the disbelief in its effectivity. There have been some serious mistakes in communication about transmission and how to protect against it, and they were never corrected until now. The AGES recently updated their F.A.Q. about COVID – after I sent an email with my FAQ-fact-check from March 2021 (!) – but one point is still not accurately described: COVID IS AIRBORNE.

Look…if the virus wasn’t airborne but spreads through large droplets and fomites…. superspread events couldn’t happen as well as infections several metres away from the index person, or infections in an empty room where an index person stepped out recently. People were made to feel safe INDOOR WITHOUT A MASK in a distance of one or two metres to another person. Don’t fuck around with fomite transmission. Frequent disinfection and hand washing may be helpful for other viruses like the norovirus but it plays a very minor role for COVID19. In my opinion, adressing the transmission route is one of the key factors to appeal to the people’s cooperativeness to follow (simple) measures: Wear a tight (!) face mask, better a tight surgery/cloth mask than a too big FFP2 mask with lots of gaps all over the face – as long as you meet other people indoors. Stop talking or screaming whenever possible. Oddly enough I don’t read THIS advice, e.g. for public transport. In one of my early blog entries in April 2020 I’ve written that keeping your mouth shut is the most effective way not to spread the virus. Speaking, yelling, singing emits much more aerosols than breathing. Remaining silent AND wearing a tight FFP2 mask cuts the risk of transmission to nearly zero.

Back to ZeroCovid. I already explained the idea behind zeroCovid oftentimes and feel no need to explain it one more time. ZeroCovid is an approach to AVOID lockdowns as an ultimate measure to regain control of the spread. Lockdowns are always a sign for failure, adhering to the false reference numbers like intensive care unit capacities. “Define a capacity and you will reach it.” (Eran Segal, Weizmann institute Israel). In contrast,

“Either you set this goal [elimination] and you don’t achieve it, but in the process, you certainly are reducing the number of lives lost. The alternative is to set a lesser goal and then still misfire.” (Jacinda Ardern, Prime Minister of Nea Zealand)

New Zealand’s approach works for every country in the world. You mave have to adapt some of the measures to country specifics but following a strict timeline, with milestones, as called by Greil, and having continuous measures increases the committment of the people to stick to the rules until the goal is reached. The goal is a low incidence and not a date by when all measures will be lifted to return into an illusional old normality with high background incidence and resurging waves, full of sickness, deaths and collateral damage.

I’m sad and shocked at the same time about the egoistic behavior of so many people. I try hard not to condemn unvaccinated people without (!) a medical reason for it. I know a person who got her vaccine late because of that. It IS rare but it does exist. The government, the media, so-called experts failed explaining or deliberately spread misinformation about the threat covid19 poses to the longterm health. Formerly healthy people can become very sick and die. Children can become very sick – fortunately much more infrequent – and die, too. The vast number of already affected persons with long COVID is disheartening – and with daily new infections of about 10000, 15000 – 10-20% will follow, without a chance for appropriate treatment because of the overwhelmed health care system. Yesterday I waited nearly 2 hours in front of the doctor’s office and overheared that the following surgery hours were all full. Another key mistake was to downplay and even silence the risk for longcovid in the general population. I deeply believe we could have raised the vaccination rate especially in the younger healthy population where the risk of severe covid19 is somewhat diminished compared to the older population but longcovid risk is real and can affect the entire life when not treated rapidly and with pacing.

So many people actually believed the politicians and the media when they were told that the pandemic would be over after two vaccinations. We didn’t know the longterm effect of immune protection at this time but we already have known then that waning immunity will be a problem especially for the older population and immunocompromised people. And virologists always said they didn’t expect a robust transmission protection at all and were surprised it was much stronger with mRNA than expected. However, it has always been clear that transmission protection will be waning too with increasing distance to the second vaccination. All of this has never been clarified for the public and to a necessary extent. It is even worse. I experienced that a lot of people with JJ or double vaccination resumed their old party, event and family reunion life – as if the pandemic was really over. Hoehl et al. (06/21) warned that people after the first vaccination could behave incautiously thinking they were fully protected against symptomatic infection and disease. For DELTA it is, however, necessary to obtain both vaccinations and to finish the immunization by the third vaccination after 6 months. So… although that paper was written for people after one dose, it is also applicable for people after two doses and after a certain time thereafter. It also strongly depends on the amount of virus during exposure. The greater the viral exposure, the greater the probability of symptomatic and severe infection.

Herein lies the great danger of the current national approach:

The pandemic is out of control. Public communication solely focusses on the vaccination instead of contact and mobility restriction measures. The remaining unvaccinated people are children and people rejecting the vaccines – either they don’t believe there even is a pandemic or they have reservations against the vaccines safety or they honestly believe they were healthy and do not need a vaccine. Either way, lots of them will resume their “old life” as soon as they have two vaccinations, i.e. attracting the kind of cluster situations which are responsible for extending the length of the pandemic: restaurants, parties, festivals, night clubs, etc. As long as there is high incidence with DELTA, there will be spread among unvaccinated and vaccinated people. People receiving their first dose now, will have certain protection at the beginning of January 2022, and they will loose it again in summer 2022. It is very likely we will reach “booster immunity” in the general population not before the end of 2022 – and then only with the help of vaccination mandates.

I don’t expect any thoughts and ideas to bridge these gaps of lacking immunization between surging waves and waning immunity accounting for it. Hopefully three vaccine doses will be sufficient to finish the basic immunization.

Until then…. how will my life look like? I was looking forward to see my parents at Christmas. I took leave over Christmas (working in shifts means I have no day off by default). Still – even in the worst scenarios, triple vaccinated people should be able to travel without restrictions between the countries. As the situation in Bavaria and soon entire Germany is shattering, too., and will stay that way for months – I (we) have get used to the fact that medical treatment will be strongly limited. If there is an accident or medical complications (gallstone, acute appendicitis, etc.), you could end up in a triage situation. So traveling will be especially a risk for mobility accidents (car, train, etc…), defying the odds.

I’m not sure how we will come out of this mess. The entire political and economical system is rotten and completely inept to manage a health crisis like this one. The society is rotten, too – selfish and unempathic. The media is interspersed with false balance thinking and treating the pandemic like a political crisis, or even worse, a lifestyle crisis. The vehicles of communication are rotten, too. Facebook and WhatsApp groups with conspiracy fans aggravated the dire situation we’re in altogether.

Maybe I should stop here before I become depressed.

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