Editor’s
note: Dr. Bhakdi released a now-viral video in which he calmly
explained why nationwide lockdowns are “collective suicide”. Now he has written
an open letter to Chancellor Angela Merkel and it is fantastic
An Open Letter from Dr. Sucharit Bhakdi,
Professor Emeritus of Medical Microbiology at the Johannes Gutenberg University
Mainz, to the German Chancellor Dr. Angela Merkel. Professor Bhakdi calls for
an urgent reassessment of the response to Covid-19 and asks the Chancellor five
crucial questions. The letter is dated March 26. This is an inofficial
translation; see the original
letter in German as a PDF.
Open Letter
Dear Chancellor,
As Emeritus of the
Johannes-Gutenberg-University in Mainz and longtime director of the Institute
for Medical Microbiology, I feel obliged to critically question the
far-reaching restrictions on public life that we are currently taking on
ourselves in order to reduce the spread of the COVID-19 virus.
It is expressly not my
intention to play down the dangers of the virus or to spread a political
message. However, I feel it is my duty to make a scientific contribution to
putting the current data and facts into perspective – and, in addition, to ask
questions that are in danger of being lost in the heated debate.
The
reason for my concern lies above all in the truly unforeseeable socio-economic
consequences of the drastic containment measures which are currently being
applied in large parts of Europe and which are also already being practiced on
a large scale in Germany.
My wish is to discuss
critically – and with the necessary foresight – the advantages and
disadvantages of restricting public life and the resulting long-term effects.
To this end, I am confronted
with five questions which have not been answered sufficiently so far, but which
are indispensable for a balanced analysis.
I would like to ask you
to comment quickly and, at the same time, appeal to the Federal Government to
develop strategies that effectively protect risk groups without restricting
public life across the board and sow the seeds for an even more intensive
polarization of society than is already taking place.
With the utmost respect,
Prof. em. Dr. med.
Sucharit Bhakdi
1. Statistics
In infectiology –
founded by Robert Koch himself – a traditional distinction is made between
infection and disease. An illness requires a clinical manifestation. [1]
Therefore, only patients with symptoms such as fever or cough should be
included in the statistics as new cases.
In other
words, a new infection – as measured by the COVID-19 test – does not
necessarily mean that we are dealing with a newly ill patient who needs a
hospital bed. However,
it is currently assumed that five percent of all infected people become
seriously ill and require ventilation. Projections based on this estimate
suggest that the healthcare system could be overburdened.
My question: Did the
projections make a distinction between symptom-free infected people and actual,
sick patients – i.e. people who develop symptoms?
2. Dangerousness
A number of
coronaviruses have been circulating for a long time – largely unnoticed by the
media. [2] If it should turn out that the COVID-19 virus should not be ascribed
a significantly higher risk potential than the already circulating corona
viruses, all countermeasures would obviously become unnecessary.
The internationally
recognized International Journal of Antimicrobial Agents will soon
publish a paper that addresses exactly this question. Preliminary
results of the study can already be seen today and lead to the conclusion that
the new virus is NOT different from traditional corona viruses in terms of
dangerousness. The authors express this in the title of their paper
„SARS-CoV-2: Fear versus Data“. [3]
My question: How does
the current workload of intensive care units with patients with diagnosed
COVID-19 compare to other coronavirus infections, and to what extent will this
data be taken into account in further decision-making by the federal government?
In addition: Has the above study been taken into account in the planning so
far? Here too, of course, „diagnosed“ means that the virus plays a
decisive role in the patient’s state of illness, and not that previous
illnesses play a greater role.
3. Dissemination
According to a report in
the Süddeutsche Zeitung, not even the much-cited Robert Koch Institute knows
exactly how much is tested for COVID-19. It is a fact, however, that a rapid
increase in the number of cases has recently been observed in Germany as the
volume of tests increases. [4]
It is
therefore reasonable to suspect that the virus has already spread unnoticed in
the healthy population. This would have two consequences: firstly, it would
mean that the official death rate – on 26 March 2020, for example, there were
206 deaths from around 37,300 infections, or 0.55 percent [5] – is too high; and secondly, it would mean that it
would hardly be possible to prevent the virus from spreading in the healthy
population.
My question: Has there
already been a random sample of the healthy general population to validate the
real spread of the virus, or is this planned in the near future?
4. Mortality
The fear of a rise in
the death rate in Germany (currently 0.55 percent) is currently the subject of particularly
intense media attention. Many people are worried that it could shoot up like in
Italy (10 percent) and Spain (7 percent) if action is not taken in time.
At the same time, the
mistake is being made worldwide to report virus-related deaths as soon as it is
established that the virus was present at the time of death – regardless of
other factors. This violates a basic principle of infectiology: only when it is
certain that an agent has played a significant role in the disease or death may
a diagnosis be made. The Association of the Scientific Medical Societies
of Germany expressly writes in its guidelines: „In addition to the cause
of death, a causal chain must be stated, with the corresponding underlying
disease in third place on the death certificate. Occasionally, four-linked
causal chains must also be stated.“ [6]
At
present there is no official information on whether, at least in retrospect,
more critical analyses of medical records have been undertaken to determine how
many deaths were actually caused by the virus.
My question: Has Germany
simply followed this trend of a COVID-19 general suspicion? And: is it intended
to continue this categorisation uncritically as in other countries? How, then,
is a distinction to be made between genuine corona-related deaths and
accidental virus presence at the time of death?
5. Comparability
The appalling situation
in Italy is repeatedly used as a reference scenario. However, the true role of
the virus in that country is completely unclear for many reasons – not only
because points 3 and 4 above also apply here, but also because exceptional external
factors exist which make these regions particularly vulnerable.
One of these factors is the increased
air pollution in the north of Italy. According to WHO estimates,
this situation, even without the virus, led to over 8,000 additional deaths per
year in 2006 in the 13 largest cities in Italy alone. [7] The situation has not
changed significantly since then. [8] Finally, it has also been shown that air pollution
greatly increases the risk of viral lung diseases in very young and elderly
people. [9]
Moreover, 27.4 percent
of the particularly vulnerable population in this country live with young
people, and in Spain as many as 33.5 percent. In Germany, the figure is only
seven percent [10]. In addition, according to Prof. Dr. Reinhard Busse, head of
the Department of Management in Health Care at the TU Berlin, Germany is
significantly better equipped than Italy in terms of intensive care units – by
a factor of about 2.5 [11].
My question: What
efforts are being made to make the population aware of these elementary
differences and to make people understand that scenarios like those in Italy or
Spain are not realistic here?
References:
[1] Fachwörterbuch Infektionsschutz und
Infektionsepidemiologie. Fachwörter
– Definitionen – Interpretationen. Robert Koch-Institut, Berlin
2015. (abgerufen am 26.3.2020)
[2] Killerby et al.,
Human Coronavirus Circulation in the United States 2014–2017. J Clin Virol.
2018, 101, 52-56
[3] Roussel et al.
SARS-CoV-2: Fear Versus Data. Int. J. Antimicrob. Agents 2020, 105947
[4] Charisius, H. Covid-19:
Wie gut testet Deutschland? Süddeutsche Zeitung. (abgerufen am
27.3.2020)
[5] Johns Hopkins University, Coronavirus Resource Center.
2020. (abgerufen am 26.3.2020)
[6] S1-Leitlinie 054-001, Regeln
zur Durchführung der ärztlichen Leichenschau. AWMF Online (abgerufen
am 26.3.2020)
[7] Martuzzi et al.
Health Impact of PM10 and Ozone in 13 Italian Cities. World Health Organization
Regional Office for Europe. WHOLIS number E88700 2006
[8] European Environment Agency, Air
Pollution Country Fact Sheets 2019, (abgerufen am 26.3.2020)
[9] Croft et al. The
Association between Respiratory Infection and Air Pollution in the Setting of
Air Quality Policy and Economic Change. Ann. Am. Thorac. Soc. 2019, 16,
321–330.
[10] United Nations,
Department of Economic and Social Affairs, Population Division. Living Arrangements
of Older Persons: A Report on an Expanded International Dataset
(ST/ESA/SER.A/407). 2017
[11] Deutsches Ärzteblatt, Überlastung
deutscher Krankenhäuser durch COVID-19 laut Experten unwahrscheinlich,
(abgerufen am 26.3.2020)
Translation
generously provided by SPR
