The following document was published at the website of Charles University in Prague. We owe Xanthippa a debt of gratitude for translating it from the original Czech. The translator also recommends an English-language analysis of it by a highly respected physicist and formal presidential advisor.
This is one of the most sensible things I’ve read about the coronavirus. It’s good to see something like this put out by fully credentialed academic experts (as opposed to TV talking head experts). It’s like a formal text version of the video by the two California doctors that went viral before YouTube took it down:
April 21, 2020
Challenge from 11 doctors of Charles University to the public
The Czech Republic has been on lockdown for almost six weeks under restrictive measures introduced in connection with the protection of citizens’ health during the COVID-19 epidemic. The government needs to be commended for the first swift and comprehensive measures, which have undoubtedly helped to manage the risks. At present, in light of current epidemiological data and the development of the epidemic, it is necessary to significantly accelerate the dismantling of these measures — for the sake of the health of citizens, economic and social stability and the prosperity of the country.
The common motivation for the emergence of this challenge is the protection of the health of the citizens of the Czech Republic, which is threatened by long-term restrictions, fears for our future, whether health-related or economic, as well as efforts to dispel the untruths and myths which are being spread about the epidemic. These blanket measures will not lead to the eradication of COVID-19 . Above all, it is necessary to create an immune response in the majority of the population, which will also protect vulnerable groups of the population, as defined by their diagnosis, not by their age.
In order to maintain the health and prosperity of our country, it is essential to:
- end the state of emergency by 30 April 2020;
- restore full access to healthcare for all citizens;
- resume classes at primary, secondary and higher learning institutions during May 2020;
- remove obstacles to the functioning of the economy, prevent the collapse that threatens significant parts of small and medium-sized enterprises and sole proprietors;
- gradually loosen state borders in coordination with neighboring countries, and especially with our neighbors and those with a similar epidemiological situation, such as Germany or Austria;
- adopt well-thought-out solutions instead of chaotic and contradictory measures.
Our conclusion is drawn from current epidemiological data, knowledge, facts, expertise and also from our professional and practical experience and knowledge.
1. IT IS NECESSARY TO RESUME FULL MEDICAL CARE FOR ALL CITIZENS
Since the beginning of March, there has been a service outage in healthcare facilities for seriously ill patients who are not COVID-19 positive. Preventive programs in cardiovascular care and oncology have been stopped. For example, the removal of transplant organs and a number of surgical procedures have been reduced.
Other casualties are caused both by postponing planned interventions and by patients’ fear of going to hospital in time. There are increasing cases of neglected abdominal pain (ruptured appendix and other sudden abdominal events), minor movement or speaking disorders (stroke) or shoulder or back pain (acute myocardial infarction), all due to patients’ fear of infection during treatment or hospitalization.
The reduction in the choice of health insurance — even with the proposed increase in payments for state insured persons — will lead to a deepening of underfunding of the entire health care system, and thus, in its consequences, to worsened care for patients with other, often more serious diseases than COVID-19. Unfortunately, victims of this lack of care will have been caused by anti-epidemic measures against the coronavirus.
2. THE HEALTHCARE SYSTEM DID NOT AND SHALL NOT COLLAPSE UNDER THE PRESSURE OF SUPPORTING COVID-19 PATIENTS
From Italy, we know that 80% of the population infected with COVID-19 present with mild symptoms that do not require hospitalization. Of the 20% experiencing more severe symptoms, 5% required intensive care. Here, proponents of a full quarantine of the nation and the closure of the world are basing their calculations on 50% mortality rate and three weeks’ hospitalization in intensive care units [per patient]. These figures only apply to the most severe forms of pneumonia and respiratory distress. However, we find these in only 25%-30% of intensive care patients, while overall, the most common length of stay of a patient with COVID-19 is between 8-10 days. This more than doubles the estimated capacity of the availability of intensive care units. In addition, up until today (April 21, 2020) we have not filled more than 45% of the capacity of intensive care units in the Czech Republic, so we have more than half of them in reserve!
3. THE CORONAVIRUS HAS NOT INCREASED NATURAL [NET] MORTALITY IN THE CZECH REPUBLIC
The loss of every human life is always irreplaceable and distressing.
Every year in the Czech Republic, approximately 110,000 people die a natural death, i.e. on average about 300 people die every day. The average number of deaths of patients for whom COVID-19 was identified is 5 per day — but at least half of these are not directly related to COVID-19, but are deaths from other serious diseases.
When comparing deaths from respiratory diseases in 2019, we do not find a difference from 2020 (source: SZÚ data). From a statistical point of view, it should be objectively noted that coronavirus did not increase natural [net] mortality in the Czech Republic .
4. (NOT) GAINING COLLECTIVE IMMUNITY
At the moment, much attention is being paid to testing for immunity in society, which should show how many people have recovered from the disease and how many of these have antibodies. However, it is not yet clear whether anyone infected with the coronavirus will necessarily have antibodies. Cellular immunity, which cannot be detected by routine laboratory tests, plays an important role in the defense against the virus.
Once generated, antibodies can persist for several weeks to months, but the memory of them stored in lymphocytes (cellular immunity) may even persist for life. Following a contact with the same virus, the antibodies again begin to be manufactured.
Thus, each individual produces antibodies in varying amounts and at different times. There may be many individuals in the population who have successfully recovered from coronavirus and do not have an increased, or detectable, level of antibodies. This fact supports the estimate that of the number of potential convalescent plasma donors (i.e. plasma from a person who had recovered from the coronavirus infection), only about one in eight to ten of those who have recovered from the coronavirus have sufficiently high amount of antibodies to be suitable donors.
The prevalence of antibodies in the population can be estimated in terms of percentages.
Currently, it turns out that isolating non-risk groups, which in practice means preventing the whole population from living and working normally, will not lead to the acquisition of immunity. On the contrary, further prolongation of the quarantine will have widespread consequences and will lead to societal trauma.
The argument that if widespread testing does not detect a sufficiently high rate of antibody positive cases in the population, then we must continue with quarantine measures and restrictions, is faulty.
5. ELDERLY CITIZENS NEED SAFE SOCIAL CONTACT, NOT ABSOLUTE QUARANTINE
The stigmatization and imposition of limitations on older people in the “fight against COVID-19” is baseless and unjustified and establishes age discrimination in public sentiment.
As part of the solution to the COVID-19 crisis, the public is being massively persuaded by fear of the extraordinary danger of infection for “older” people and the necessity of implementing identical emergency measures for this very heterogeneous group, including not leaving their apartments or having specific shopping times. At the same time, the public is finding out that it is precisely these seniors affected by COVID-19 that could overwhelm the health care system. Suggestions were even raised to classify patients based only on age. Defining “endangered old age” at 65+ has led to an unprecedented stigmatization of 20% of the population of the republic, including people who are healthy and not particularly endangered. Some became uncertain of themselves or had to suffer the manipulative behavior of their environment. Many of them suffer from exaggerated fear of infection, from reduced contact with families, isolation, loneliness, deprivation of communication, disruption of daily routines with serious psychological consequences, disproportionate to the risk and the potential for reducing it. Several weeks without going outside has endangered fragile people through loss of stability, mobility, and thus self-sufficiency. However, there is no reason for them not to move freely in open spaces while keeping a distance from other people.
It appears that worsening of the COVID-19 prognosis is mainly related to associated illnesses, not age as such. These include nutritional disorders, oncological and cardiovascular diseases, diabetes, possibly some medications. It is not primarily “the elderly” who are affected, but those who are “fragile and severely ill”. In this, COVID-19 is no different from any other stress factor, including disease, as we know from influenza epidemics, heat waves or freezing weather.
Particularly problematic are residential social service facilities (senior residences, assisted living homes) and long-term care facilities. This is an instance of risky concentration of exceptionally fragile people with a number of serious illnesses. Experience from other countries as well as the initial data from the Czech Republic show that these people probably make up the majority of all COVID-19 victims. This shows that one’s health potential (fitness, resilience, adaptability) is a much stronger predictor than age as such. Many frail patients succumbed to this infection as a non-specific stress factor, just as they would have succumbed to the flu or a major injury.
On the contrary, even in the Czech Republic, not enough has been done to protect this most endangered group — residents of residential social services facilities. These include the quality of preventive measures, personnel training, quarantine training, sufficient protective and hygiene products, frequent staff testing, the main source of its [the pathogen’s] introduction, testing in case of suspicious symptoms and the immediate transport of infected clients to high-quality quarantine facilities with the necessary care available should difficulties develop, and so on.
6. THIS IS NOT JUST ABOUT PHYSICAL AND INTELLECTUAL HEALTH BUT ALSO A HEALTHY ECONOMY AND DEMOCRACY
It is necessary to emphasize that physical health goes hand in hand with mental health, socio-economic health and the health of Czech democracy . It will not improve anyone’s health when they have to dismantle their hard-built and well-running business, lay off qualified employees and register the whole family with the welfare office. There is a proven link between cardiovascular mortality, the incidence of cancer and psychiatric illness in relation to job losses.
Long-term isolation is devastating for the whole society. Isolation and restrictions on activity increase the consumption of alcohol and other addictive substances, computer reliance and gambling. Isolation leads to an increase in domestic violence, divorce, social tensions and aggression.
We are convinced that the media-saturated emotional charge of the current situation needs to be corrected based on substantiated facts and, with regard to them and to the possible societal consequences and impacts of these crisis measures, it is necessary to act as soon as possible and accelerate the state’s plan to return to normal life. All this should be done with reasonable observance of hygiene measures, i.e. wearing a mask when in contact with other people, washing hands and maintaining social distancing. Citizens have shown not only great solidarity and national unity during the coronavirus crisis, but also discipline in adhering to these rules, so there is no doubt that they will continue to practice these basic measures.
In this difficult time we need more optimism and sensible solutions; we must not give into fear, panic and despair. We believe that our challenge will contribute to this.
In Prague on April 21, 2020
Signed (in alphabetical order):
doc. MUDr. Martin Balík, Ph.D.
prof. MUDr. Jirina Bartunkova, DrSc., MBA
prof. MUDr. Cyril Höschl, DrSc.
MUDr. Zdenek Kalvach, CSc.
prof. PaedDr. Pavel Kolar, Ph.D.
prof. MUDr. Robert Lischke, PhD.
prof. MUDr. Jiří Neuwirth, CSc., MBA
prof. MUDr. Jan Pirk, DrSc.
MUDr. Jaroslav Svoboda
prof. MUDr. Julius Spicak, CSc.
prof. MUDr. Tomas Zima, DrSc., MBA