Scientific Courtesy – not so, but so!
If you want to say: "Those measures of the RIVM do not go either way"
"...maybe RIVM is right, and most of the spread takes place via large droplets and contact. But it would be good to link such statements with scientific publications."Prof. Dr. Jos Lelieveld
Jos Lelieveld is affiliated with the Max Planck Institute, various universities and a member of Leopoldina, the German Institute of Sciences. A heavyweight in the scientific world. His field of expertise is atmospheric chemistry, including the text of this article, also as a Dutch version.
In the interview, he is therefore concerned with the lack of scientific basis in Dutch policy. That's also where the anger among the opponents comes from. RIVM has come up with something itself, namely: "Because in March the infections proceeded as they did, aerosols cannot play an important role". On the basis of this coffee table fantasy, the country is being imposed on ineffective and catastrophic policies. If it had been aerogenic transmission, the curve would have looked "different". How? No idea. Even steeper? Higher? In any case, he will mean something like "more serious."
If you have to act quickly, you cannot escape common sense interventions. Well-founded, lots of consensus, with balanced pros and cons from all sides and never as watertight as you would like. Lelieveld himself also refers to internal "calculations" with which he argues the importance of face masks. In any case, he says that in Germany they have come up with a sum in which face masks come out very effectively. We don't know that sum (everyone can think of such a sum) but what he mainly says: "Be on the safe side." That's Dutch for "Better safe than sorry". Sounds familiar.
How face masks can be so effective after ventilation (according to Lelieveld) has already reduced 50% of infections is not entirely clear. In any case, he lays the foundation for ventilation with other measures on top of that, such as mouth masks:
Calculations show that regular ventilation reduces the risk of infection by 50 percent, while wearing a mask on top of that makes the risk even five to ten times smaller.Unpublished statement by Prof. Dr. Jos Lelieveld
Again not published of course: science is developing carefully but too slowly. We must act now. Common sense, the precautionary principle, proportionality... No one has thrown negative side effects of ventilation into the fray yet, so you actually wonder what is against it. Van Dissel's counterarguments will be presented in this way.
What Lelieveld says: of the 100 people who would normally become infected, only fifty would become infected thanks to ventilation. If they all wear masks, just five or ten. Five or ten? That is also a factor of 200%, while in epidemics we worry about tenths of a percent. 200% can also mean 10,000 deaths or 20,000 deaths. It's all just estimates, best guesses, just like those 50% less contaminated by ventilation. So let's leave the numbers for what they are.
In any case, Lelieveld states that face masks are useful in an environment where the aerosols have been effectively combated with ventilation. Against aerosols, those face masks do not help and that estimated 50 percent of him can also be 80% or 40%.
The fact that ventilation in the Netherlands is not a top priority is reprehensible, culpable and indicates that scientific insights are handled carelessly (because they have indeed been published about this) in which the importance of Public Health does not outweigh the stubbornness of the advising physicians. One wonders why they are so obstinate.
Where does rivm's fallacy come from?
Jaap van Dissel has no substantiation for their drip position. He repeatedly applies a circular reasoning: "we saw that at the time and we know that it is because we have that experience". This is saying the same thing three times and suggesting a causal relationship. What he also implicitly says: "Where it hasn't been further investigated, we've just assumed droplet transmission, so we'll continue to do so."
He explains how RIVM came up with it:
- In March, relatively few people were infected. In tested viruses (i.e. with proven air transmission), the infection curve looked different, with a different R0.
- The measures have obviously helped
- The measures did not focus on aerogenic transmission and thus had no effect on the aerogenic transmission
- In hospitals, there should have been many more infections in aerogenic transmission
- So the overall picture doesn't fit with aerogenic transmission
(If in doubt, watch the video of about 2m)
Argumentatively, this makes no sense, let alone 'scientific' wood. The points dealt with one by one:
ad 1) Only highly contagious viruses are aerogenic
Comparatively very little attention has always been paid to infectious diseases that posed little danger to public health. Annual flu waves of an average of 6,500 deaths were hardly grounds for further investigation by virologists. There are viruses going around and that's a good thing, that's how it should be. But why couldn't they be aerogenic, that's never scientifically out of the question? In fact, influenza is indeed aerogenic, according to several studies. It's just not such a high priority.
Traditionally, since the advent of microscopic examination, it has been assumed that the larger droplets, studyable under the microscope, are the source of contamination. The discovery was a eureka moment: the perpetrator had been caught red-handed. Just look through the microscope: that's it!
This remained the starting point for infectious (also respiratory, i.e. respiratory-related) diseases. Virology was happy to finally have a scientific foundation. Until then, miasmas had been used: bad smells that would make you sick. During epidemics, doctors walked with cone bags in front of their mouths and noses, filled with herbs and perfumes to combat those toxic fumes.
So drops. Even when Wells demonstrated otherwise in the 1930s, it wasn't picked up: too slippery ice because how on earth do you investigate a gas? The urgency just wasn't there to answer those questions.
Hey! SARS and MERS are aerogenic...
Diseases with extreme lethality, such as SARS and MERS, brought change. They called for an investigation. In such diseases, for example, 20% of those infected die; That is more than a hundred times as much as with the flu, so intervention had to be taken there. It turned out that all those highly deadly viruses were mainly spread aerogenously. Instead of the insight that this could apply to all respiratory diseases, these discoveries led to the basic attitude: "Infection is via droplets, unless the virus is very dangerous, those are exceptions". Then you don't understand that because of the scope of your research (highly contagious and deadly viruses) you have to be careful with how you generalize. Do you have a generic principle? You just happened to have examined serious viruses. There is no reason to simply assume that other, less lethal or contagious respiratory viruses would behave differently. Then you have to be open to the fact that you have always seen that wrong.
That van Dissel does not understand this well is also evident from his comment about the ferret research. That research was done to test the claim that corona infections cannot take place via the air. That was also an earlier RIVM argument against ventilation. A study with ferrets showed that contamination via aerosols is quite possible. To which van Dissel now says again: "yes, but aerosols are also the only thing that was searched for in that research". He just doesn't see the connection. (By the way, 'live' virus has also been sampled, which he apparently does not know.)
In addition: Influenza is also aerogenic, that is scientifically established. Influenza is not so terribly deadly after all. You just don't get those statements.
Virologists apparently cannot deal with the fact that circumstances are decisive. In the open air, respiratory viruses have little chance of causing serious infections. After all, you have to get a large dose of virus for that. It becomes a lot more complex than 'touching something' or 'getting a drop in your nose'. It is then suddenly about temperature, infectiousness, comprehensibility, humidity, air movement, air exchange. An IFR is no longer inherent in a virus. It also depends on the circumstances.
re 2) The measures have obviously helped
Whether the measures have helped so much is debatable. Countries with heavy lockdowns and countries with lighter measures show little correlation with the course of the disease. (less than countries with/without the drug HCQ). You can read and watch a lot about that. For example this video by Ivor Cummins.
re 3) Air transmission was not included in the measures and yet they worked
Some measures against droplet transmission also happen to have included air transmission. The most important measure in this regard was the banning of events and other group gatherings. It is plausible that this measure alone would have been sufficient, given the deplorable indoor climate in our country. This measure reduces large outbreaks in standard indoor environments. Because of the neglected ventilation, these are the drivers of the epidemic.
The one-and-a-half-meter rule also contributes to aerosol avoidance. With non-moving air, an aerosol cloud is formed around the head of the 'shedder'. The closer, the more infectious the air. If he wears a face mask, the center of the cloud is behind him, otherwise in front of it. Poor ventilation can move or spread the contaminated air in a room, then distance makes little difference.
re 4) There should have been many more infections in hospitals
In hospitals there would have been more infections with aerogenic properties (again nothing is quantified, do you notice that?). In America, however, hospitals were sources of infection, especially waiting rooms. We have also seen outbreaks in the Netherlands. Covid patients are indeed kept separate. Staff do take extra measures. 10% to 15% of hospital staff are nevertheless on sick leave due to corona. And that while hospitals are well ventilated and anti-contamination protocols are observed. Van Dissel pretends that covid patients are receiving normal treatment...
ad 5) The overall picture...
Seems like a lot but is a repetition of the basic assumption.
De stapels wetenschappelijk bewijs, brandbrieven van gerenommeerde wetenschappers en instituten, signalen zoals die van Lelieveld, Bosma of, zwaarder onderbouwd, van Maurice de Hond, worden in de wind geslagen op basis van… Niets.
Precies wat Lelieveld zegt in het AD: