Scientific Courtesy - not like that, but like that!
Als je wil zeggen: "Die maatregelen van het RIVM raken kant noch wal"
then say:
"....misschien heeft het RIVM gelijk, en vindt de meeste verspreiding plaats via grote druppels en contact. Maar het zou goed zijn zulke uitspraken met wetenschappelijke publicaties te verbinden"
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.
Het gaat hem in het interview dus om het ontbreken van wetenschappelijke basis in het Nederlandse beleid. Dat is ook waar de woede onder de tegenstanders vandaan komt. Het RIVM heeft zelf iets bedacht, namelijk: "Omdat in maart de besmettingen zijn verlopen zoals ze zijn verlopen, kunnen aerosolen geen belangrijke rol spelen". Op basis van die koffietafelfantasie wordt het land ondoelmatig en catastrofaal beleid opgelegd. Als het wel aerogene transmissie was geweest, had de curve er "anders" uitgezien. Hoe dan? Geen idee. Nog steiler? Hoger? Hij zal in elk geval iets bedoelen als 'ernstiger'.
Als je snel moet handelen ontkom je niet aan gezondverstand-ingrepen. Goed onderbouwd, veel consensus, met afgewogen voors en tegens van alle kanten en nooit al zo waterdicht 'bewezen' als je graag zou willen. Zo refereert Lelieveld zelf ook aan interne “berekeningen“ waarmee hij het belang van mondkapjes beargumenteert. Hij zegt in elk geval dat ze in Duitsland een sommetje hebben bedacht waarbij mondkapjes er heel effectief uitkomen. Dat sommetje kennen we verder niet (zo'n sommetje kan iedereen bedenken) maar wat hij vooral zegt: "Neem het zekere voor het onzekere." Dat is Nederlands voor "Better safe than sorry". Klinkt bekend.
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Unpublished statement by Prof.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 yet addressed the negative side effects of ventilation, so you actually wonder what is against it. Van Dissel's counterarguments will be discussed shortly.
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 heeft geen onderbouwing voor hun druppelstandpunt. Hij past herhaaldelijk een cirkelredenatie toe: "we hebben dat destijds gezien en we weten dus dat dat zo is omdat we die ervaring hebben". Dit is drie keer hetzelfde zeggen en een causaal verband suggereren. Wat hij ook impliciet zegt: "Waar het niet nader is onderzocht hebben we gewoon druppeltransmissie aangenomen, dus dat blijven we zo doen."
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' weight. The points discussed one by one:
ad 1) Only highly contagious viruses are aerogenic
Comparatively, very little attention has always been paid to infectious diseases that pose little threat to public health. Annual flu waves of an average of 6,500 deaths were hardly reason for further investigation for virologists. There are viruses going around and that's a good thing, that's how it should be. But why couldn't they be aerogenous, since that has never been scientifically ruled out? In fact, influenza is indeed aerogenic, as several studies show. It's just not that high of a 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, therefore breathing-related) diseases. Virology was happy to finally have a scientific foundation. Until then, miasmas had been used: bad odors that would make you sick. During epidemics, doctors wore conical bags over their mouths and noses, filled with herbs and perfumes to counteract 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...
Ziektes met een extreme dodelijkheid, zoals SARS en MERS, brachten verandering. Die noopten tot onderzoek. Bij zulke ziektes overlijdt bijvoorbeeld 20% van de besmetten; dat is meer dan honderd keer zoveel als bij de griep dus daar moest ingegrepen worden. Wat bleek: al die onderzochte zeer dodelijke virussen werden vooral aerogeen verspreid. In plaats van het inzicht dat dat wel eens voor alle respiratoire ziektes zou kunnen gelden, leidden deze ontdekkingen tot de basishouding: "Besmetting gaat via druppels, behalve als het virus heel gevaarlijk is, dat zijn uitzonderingen". Dan snap je niet dat je door de scope van je onderzoek (zeer besmettelijke en dodelijke virussen) moet oppassen met hoe je generaliseert. Heb je misschien een generiek principe te pakken? Je hebt toevallig alleen maar ernstige virussen onderzocht. Er is geen reden om zomaar aan te nemen dat andere, minder dodelijke of besmettelijke respiratoire virussen zich anders zouden gedragen. Dan moet je dus open staan voor het feit dat je dat altijd verkeerd hebt gezien.
Dat van Dissel dit niet goed begrijpt, blijkt ook uit zijn opmerking over het fretten-onderzoek. Dat onderzoek is gedaan om de bewering te toetsen dat corona-besmettingen niet via de lucht kunnen plaatsvinden. Dat was ook een eerder RIVM-argument tegen ventilatie. Een onderzoek met fretten toonde aan dat besmettingen via aerosolen goed mogelijk zijn. Waarop van Dissel nu weer zegt "ja maar aerosolen is ook het enige waarop in dat onderzoek naar is gezocht". Hij ziet de samenhang gewoon niet. (Inmiddels is er trouwens ook 'levend' virus gesampled, dat onderzoek kent hij kennelijk niet.)
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 the circumstances are decisive. In the open air, respiratory viruses have little chance of causing serious infections. After all, you have to ingest a large dose of the 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, contagiousness, receptivity, humidity, air movement, air exchange. An IFR is no longer inherent to 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 somewhat to aerosol avoidance. With non-moving air, an aerosol cloud is formed around the head of the 'shedder'. The closer, the more contagious the air. If he is wearing a face mask, the center of the cloud is behind him, otherwise in front of him. 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, did you notice that?). In America, however, hospitals were indeed sources of infection, especially the waiting rooms. We have also seen outbreaks in the Netherlands. Covid patients are indeed kept separate. Staff do indeed take extra measures. 10% to 15% of hospital staff are nevertheless on sick leave due to corona. And all this while hospitals have good ventilation and anti-contamination protocols are observed. Van Dissel pretends as if Covid patients are receiving normal treatment...
ad 5) The overall picture...
Seems like a lot but is a repetition of the basic assumption.
In conclusion
The piles of scientific evidence, letters from renowned scientists and institutes, signals such as those from Lelieveld, Bosma or, more substantiated, from Maurice de Hond, are ignored on the basis of... Nothing.
Precies wat Lelieveld zegt in het AD:
