<nettime> Marcel Salathé: I fear we will need stronger measures

[William Waites <ww@styx.org>]

Marcel Salathé: I fear we will need stronger measures

    Interview by Sylvie Logean for Le Temps
    Original: https://www.letemps.ch/sciences/marcel-salathe-crains-ne-devions-aller-vers-mesures-plus-strictes
    Translation by William Waites
    2020/03/25

EPFL professor expresses his frustration about the authorities'
management of the COVID-19 crisis. Despite the appeals of experts as
early as January, the Swiss authorities were slow to act, losing
precious time. 

  [photograph of Marcel Salathé]
  Marcel Salathé, professor at EPFL, believes that, when it comes to the
  authorities, "we are dealing with a kind of magical thinking, a kind
  of hope that the situation will spontaneously improve".

The director of the Digital Epidemiology Laboratory at the Biotech
Campus in Geneva and professor at the École Polytechnique Fédérale de
Lausanne closely follows the COVID-19 pandemic across the world with
machine learning tools. For him, it was clear several weeks ago that we
would be facing a dramatic situation. He doesn't hide his frustration
with the authorities who, despite the appeals of experts, have been slow
to act. 

    Le Temps: several scientists tried to alert the authorities very
    early about the health emergency, in Switzerland and elsewhere, that
    the exponential growth of the COVID-19 epidemic would represent. Why
    did they take so long to react? 

Marcel Salathé: I think that's an eminently political question. We were
working on these questions already in January and we were able to
predict what was going to happen. Based on what happened in Wuhan, we
could see, in effect, that the number of infected people was following a
nearly perfectly exponential curve. At the same time, given our
vulnerability to this virus and a lack of preventative or therapeutic
treatments for it, we knew that the situation would be very difficult to
manage, even more so when the epidemic spread to Iran and Italy despite
the confinement measures taken in China. 

These were the observations that made us raise the alarm at the end of
January. Unfortunately, we were not taken seriously then and received no
support from the political class. In the eyes of many, we were simply
being alarmist. 

    On your Twitter account, you recently expressed your loss of
    confidence in the political arena... 

I understand that it's difficult to reconcile all the different existing
interests, to find the right equilibrium. But I was particularly shocked
by the lack of appreciation for the work of Swiss scientific experts
that weren't, at any time, involved in the decision-making process. I
expected the political actors to take the threat seriously, that the
authorities would strongly attack the situation from the beginning, but
this was not the case, which is terribly frustrating. 

Our objective is still not, today, to point the finger, but to face this
crisis together. This is why we have created, with a team of scientists,
a volunteer task force with the goal of producing studies that can be
useful for the authorities. Happily, in the past few days, a
communication channel seems to have been opened. It is a narrow channel,
but at least it exists. 

    In your opinion, did the the Federal Council try to appear too
    reassuring to the population? 

I think rather that part of our leaders did not, at that time, grasp the
true gravity of the situation. This observation, valid for Switzerland,
is also true for nearly all European countries as well as the United
States, which, unlike the Asian countries, haven't lived through the
trauma linked to the preceding SARS-CoV-1 and MERS epidemics. 

We also need to mention that, among the countries which reacted
inadequately, Switzerland nevertheless rapidly decided to impose
courageous measures, forbidding, for example, gatherings of more than
1000 people. Despite this, we lost precious time. 

    Seen from outside, the strategy of the Federal Council still doesn't
    seem clear. What model are they working from to face this pandemic? 

That's a question for which I don't have a precise answer. For now, the
Federal Council seems to be applying what I call the "salami technique",
which consists of cutting a certain number of measures into fine slices,
stronger and stronger, with the goal of obtaining more acceptance from
the population. Globally these are good measures, but are they really
sufficient? 

My impression is that the authorities seem to believe that it will still
be possible to manage the situation by compromise. We are faced with a
sort of magical thinking, a form of hope in the possibility of a
spontaneous improvement in the situation, like we observe with seasonal
flu. We don't know yet if this is really possible, but the example of
Italy shows us that it certainly won't happen. That's the reason why I
fear that we will need a much stricter lock-down.

    To some experts, the Swiss authorities seem to be acting as if
    they've already lost the war with this virus. Is this also your
    impression? 

Sadly, that's also my feeling when I hear the Federal Council compare
this pandemic to a wave against which we cannot struggle, that it would
be impossible to contain. We see a kind of resignation, which is even
less acceptable given that Switzerland is one of the countries with the
greatest per-capita number of COVID-19 cases in the world. 

The only way to manage this health crisis, in the absence of treatments
and while we wait for an effective and safe vaccine - which we know we
won't have before 9-18 months - is to attack the problem as the Asian
countries have done: with large-scale testing, isolating the sick, and
tracing people who have been in contact with infected people and
isolating them in turn if necessary. This strategy, recommended by the
World Health Organisation and which we could accomplish in Switzerland
while protecting personal data, has the immense advantage of enabling a
rapid and active extinction of local outbreaks, while avoiding strict
confinement for a long period of time. 

    That approach needs tests to be widely available, but we understand
    that they are still reserved, in Switzerland, for those who are
    vulnerable or have symptoms... 

Today, we still have a lack of reagent required for screening tests, but
the situation is starting to improve. Once this is solved, it is
imperative to change the guidelines to facilitate access to screening
with installations outside hospitals, as has been done in the
Bâle-Campagne and Berne cantons. These mobile units avoid overburdening
hospital resources and at the same time reduce the risk of iatrogenic
transmission to other patients or health professionals.

It is also clear that tests alone won't stop the propagation of
SARS-CoV-2; however,it seems evident that we won't be able to contain
the epidemic if they are only done in hospital for people who are
already sick. 

    The flu kills 650 000 people each year worldwide. Why don't we take
    similar measures? 

As epidemiologists, we would take measures against all infectious
diseases, including the flu. The situation is different, though, with
COVID-19. Even if they aren't perfect, flu vaccines exist. Numerous
people are immunised against the flu, and this is not yet the case with
SARS-CoV-2.

Despite this, 1 person in 1000 dies each year from the seasonal flu,
without the population really realising it. This epidemic will certainly
have opened numerous eyes to this reality. 

    The COVID-19 epidemic has shone a light on important gaps in
    countries' preparation for a pandemic. What lessons should we take
    from this health catastrophe?

Today, the whole world is under massive stress. I am nevertheless
persuaded that we will find a good path to learn from this situation and
keep it from happening again. To do this, it is imperative that we put
in place strong and lasting collaborations between the public health,
financial, and political communities. 

This is even more important because of the major health challenges that
await us. Beyond future pandemics, we risk being confronted by the
painful question of antibiotic resistance. There too, we imagine that a
solution will fall from the sky, without taking specific measures. But
the risk that one day we find ourselves face-to-face with a
super-resistant bacteria against which we won't have an antibiotic is
very real. And this new crisis will cause multitudes of deaths in its
turn.





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