The virologist Pablo Goldschmidt and a debate towards the future, did it make sense to lock ourselves up to stop a respiratory virus? (Chapter I)

From Monaco, the Argentine professor and researcher at the Faculty of Medicine of the Pierre et Marie Curie University in Paris, offered a disruptive and interesting vision on the treatment of the pandemic. Here, the first installment of a series of notes for reflection and analysis.

It is difficult not to be fascinated when listening to the Argentine virologist and researcher Pablo Goldschmidt because he is truly passionate about science. From his place as a professor and long-time researcher in France, his worldview seems to contrast with the academic status quo; but reading his own fine print and the scientific context from which he says it, they do not differ so much.

The pandemic from its perspective can be thought of from a great phrase by the writer Albert Camus, which he himself brought to this conversation: “Badly naming things increases the misfortunes of humanity.” During the COVID-19 pandemic, many things have been misnamed for Goldschmidt.

Four decades ago he left Argentina to settle in Europe—first in Paris and then in Monaco where he currently lives—; There he became a relevant scientist. Professor Goldschmidt is a Pharmacist and Biochemist from the Faculty of Pharmacy and Biochemistry of the National University of Buenos Aires (UBA); also a clinically oriented psychologist graduated from the Faculty of Philosophy and Letters of the UBA. In France he trained in Virology at the Pasteur Institute and specialized in Clinical Pharmacology, obtaining a doctorate in Molecular Pharmacology at the Pitié Salpetrière Faculty of Medicine of the Pierre et Marie Curie University in Paris.

Furthermore, he is a pilgrim of the world, he has visited and worked in the most remote places on the planet, always in pursuit of teaching how to prevent viruses and bacteria in vulnerable areas. For more than two decades he has been an ad-honorem volunteer coordinator of field training missions for medical teams in Pakistan (Islamabad and Rawalpindi), Ukraine (Kiev, Lviv and Odessa) and in African countries (Algeria, Morocco, Guinea-Conakry , Cameroon, Mali and Guinea-Bissau). He has written numerous books, including “People and Microbes”, “Approach to Social Microbiology”, “Hurt Americans”, “Les scars des Américains - Cahiers abandonnés”; and “Will they be mothers tomorrow? “Slavery pays homage to our speech.” That is to say, Goldschmidt is familiar with viruses and bacteria, and his contribution to the treatment and clinical approach is globalized.

With anguish, Goldschmidt asks himself among many ideas: How was the great experience gathered around the world on how respiratory viruses are treated not applied to the treatment of a respiratory virus - as SARS-COV-2 turned out to be? Among whose maxims are that not everyone should be confined with the same rod; but to prioritize care, primary care and confinements for older adults - those aged 60 and 65 and older - and for people vulnerable due to previous illnesses, comorbidities, groups of immunosuppressed people to prevent the new coronavirus from escalating to death. . And don't leave them at home, isolated, with ibuprofen and a blood pressure monitor.

Review the pandemic

This conversation arose from a very solid writing of more than 70 pages, with a scientific and powerful tone to which Infobae had access and which had to be decoded in a language accessible to all. Because that is what Goldschmidt deserves at this point in his life, for everyone to read it. Even those who don't agree with your vision of things.

Goldschmidt has extensive experience in research in the field of respiratory viruses, both in medical centers in the European Union and in his field work in emerging countries. That is why he is so revolted by those things that he points out, such as the errors of the pandemic, bureaucratic decisions by central powers and institutions that cost so many individuals and families dearly.

Three and a half years have passed since the declaration of a global pandemic that, like no other plague before, put the world on pause. A disruptive event that altered global public health and caused more than 6.9 million deaths (direct or associated) and 770 million accumulated infections globally, according to updated statistics from the World Health Organization (WHO), the international health organization that depends on the United Nations. The pandemic also triggered a series of scientific discoveries - vaccines, new platforms such as messenger RNA, treatments, associations - that resulted in safe and effective inoculants that managed to stop the exponential chain of infections. The same figures and facts that Goldschmidt objects to and puts under the magnifying glass.

Goldschmidt's views are not tied to interests, nor are they politically correct, they are the views of a scientist who seeks evidence for every comma of what he says. He accompanied his writing with more than 20 sheets of bibliographical citations *(N. de la R.).

In that sense, looking back at the COVID-19 pandemic through the prism of Monday's newspaper can help dismantle some scientific-theoretical-health constructions that were believed to be learned truths and can help problematize ideas for the pandemics that will come. The latter is what encourages Goldschmidt the most.

A different look

—Dr. Goldschmidt, in 2020, a until then unknown virus, SARS-CoV-2 of the coronavirus family, put the world on edge and paralyzed it. Something similar has never happened with the global outbreak of a respiratory virus. You point out that pre-existing knowledge about the treatment of a respiratory infection was omitted, why?

— Pablo Goldschmidt: Of course humanity was facing a new virus; and precisely this disruptive idea was perhaps what caused many patients to arrive at the wards with lung tissues destroyed by inflammation not treated in a timely manner, that is, with a severe compromise in lung function and with hemostatic complications (blood clots) with repercussions on cardiac function.

I found no echo when I considered it incongruous that due to a respiratory virus the use of public roads is regulated for all ages and physical conditions, or in the name of a severe respiratory condition, the distances in meters are set depending on the day and the place. limit viral transmissibility outside the home with and without masks.

It was hardly justifiable to establish municipal provisions on the distance outside the home that guaranteed the limitation of its spread, to establish the hours in which there was or were not a risk of obtaining food supplies, among other measures. The denial of virological knowledge and infectious risk determined the type of activity that could be carried out and what essential products the population could acquire.

Good ventilation, air treatment and less occupancy of closed spaces can also reduce viral transmission in some environments. However, these measures could not be isolated from others either, making it difficult to determine their impact. Similarly, it was not possible to evaluate the effect of physical distancing (i.e., 1.5 m, 2 m or 3 m) as a preventive strategy, nor has it yet been demonstrated that the transmission of this virus has occurred through superficial contact.

It is curious that numerous trials have been carried out with vaccines (N. of the R.: which Goldschmidt calls Prophylactic Pharmaceutical Preparations (PFP), understood for him as preventive serums) with pharmacological treatments. And very little has been investigated in other therapeutic approaches.

Little research has been done to validate the relevance of social measures known as non-pharmacological interventions (NPIs) or behavioral, environmental, social and systems interventions. A meta-analysis of multiple public health measures (taken as a package of interventions) demonstrated a reduction in the incidence of COVID-19, when hand washing, use of effective masks and physical distancing were associated.

The strict implementation of not one, but the sum of the INPs reduced the transmission of CoVID-19; if they were adapted to each culture and environment, without throwing overboard the human contexts in which they are applied, and especially if they were applied in times of low intensity of transmission; because as the number of infections progressed, that is, as the transmissibility values ​​increased, the INPs became less effective.

For its part, the use of masks, effective against Influenzaviruses, showed a reduction in the incidence of CoVID-19, but the heterogeneity between the studies did not allow definitive conclusions to be established at a global level (there was data bias).

Lessons learned from COVID

—You think very differently from the network of scientists that makes up what is usually known as “the consensus of experts” and you question many of the ideas that the world of science usually calls “the lessons learned from COVID.” Could you identify them and confront some?

—Pablo Goldschmidt: The first major objection to the global health policies that were adopted to address COVID-19 lies in the adoption of universal health protocols that triggered the closure of borders, schools, mandatory social distancing and the medical neglect of other pathologies, in the face of a respiratory virus that fiercely attacked vulnerable groups, but did not have the same potential severity for the entire population. This was already known in 2020.

Let us again keep in mind that the severity and prognosis for all viral respiratory infections (I repeat, not only for SARS CoV2) differ for all physical conditions, for all ages, and for all professions. From the beginning of the pandemic, I insisted that it was urgent to train personnel capable of treating vulnerable people, since the number of specialists was (and continues to be) scarce.

— You call many of your objections about the handling and global management of the pandemic “naming errors”, something that you already mentioned in 2020. What do you mean by that concept?

— Goldschmidt: The COVID-19 pandemic highlighted social fragility and our individual vulnerability, and what our society has experienced cannot be interpreted as an isolated infectious phenomenon outside of the study of the behavior of individuals and the community. Faced with what happened and its consequences, absurd situations are perceived that can arise from the confrontation between our search for truths and the irrational silence of the world.

It is worth emphasizing what is meant by misnaming things. Let us remember that in December 2019, a virus from the coronavirus family was detected, called SARS-CoV-2, which from a certain date infected populations in more than 10 countries and is the agent responsible for the disease called COVID-19. The word pandemic refers to the number of States (countries) that detect a new health event (data from a period that is compared with previous ones).

But the term pandemic does not qualify either the virulence, the morbidity (proportion of people who become ill in a given space and time in relation to the total population of that place) or the mortality caused by that infectious agent.

The indiscriminate use and abuse of this term meant that in a few weeks the entire planet was under a massive restriction of individual freedoms, with mass media around the world overwhelmed by infectologists, epidemiologists, microbiologists and biostatisticians.

Skip prior knowledge

“The defects inherent in the management (approach) of this respiratory infection have reduced life expectancy, especially in people with comorbidities and in people over 80 years of age. It has also had negative consequences on the use of medical services, an increase in sedentary lifestyle and gender violence,” Goldschmidt pointed out and does not lose sight of another devastating consequence. In general, workers who faced the front line of COVID - especially health professions - increased the risks of developing mental pathologies.

According to the virologist, “since 2020 the world seems to have withdrawn from past experiences, since it did not take into consideration that all infections due to viruses, bacteria or respiratory tropism fungi can be complicated in vulnerable people, and not in the entire population.” .

Goldschmidt emphasizes this aspect today but he also did so at the hot moment of the emergence of COVID-19, when he stressed that guidelines aimed at the general - and global - population were applied when the respiratory pathogen cruelly targeted a specific group.

That is why Goldschmidt stated forcefully: “Precisely for this reason, since the declaration of the pandemic I maintained that it was necessary to train health agents with the capacity to protect vulnerable people. From clinical virology, there was no doubt at that time that effective therapeutic management of symptomatic people infected by respiratory viruses and not hospitalized would limit the risks of severe complications and sometimes fatal superinfections. Unfortunately, the instructions that were arriving for months at the Ministries of Health caused, on the one hand, the confinement of millions of non-vulnerable people (healthy, sad, depressed and without work for months) and on the other, vulnerable people who did become infected. They had limited medical assistance.”

— It is important to return to a topic proven by clinical virology that you have insisted on since the beginning of the pandemic: all viral respiratory infections (not only for SARS-CoV-2) differ according to physical conditions, ages, and the professions. Therefore, it is difficult to standardize a public health intervention against COVID, however all the WHO guidelines downwards followed that line...

— Goldschmidt: The idea was stirred that absolutely everything was new, that we were facing the unknown, and that there were no known therapeutic attitudes to limit complications. These were times when any disagreement was rejected. The entire planet became a spectator of a dominant passion in which for months the authorities did not modulate the impact of their statements and ignored the implementation of early treatments for respiratory viruses.

It is pertinent here to reiterate that severe complications were already known before 2020, especially in those over 65 years of age, in people with uncontrolled diabetes, in patients with obesity or with antineoplastic therapies, with cardiorespiratory conditions and in people with altered immune functions. However, we live together impregnated by a single thought, clouded by panic and without applying known strategies for the initial management of these respiratory infections.

The empty office syndrome

—The emergence of COVID-19 gave rise to a very complex phenomenon called “empty office syndrome”, that is, patients who were being treated for various pathologies, and who suddenly, due to the disruption of the pandemic, cut off their consultations. It is easy today to talk to Monday's newspaper, but what other situations for you were compromised by the management of the pandemic and could have been avoided?

— Doctor Pablo Goldschmidt: For long months we witnessed empty hallways in hospitals, without patients carrying out cardiovascular risk controls. The fear of a respiratory virus meant that cardiovascular, respiratory and tumor diseases that could have been prevented or controlled did not find appropriate medical assistance. There were practically no consultations in the area of ​​degenerative conditions of the nervous system, and with certain exceptions, public health institutions could not be accessed without a confirmed prior appointment, which was attended without a companion and sometimes with a QR code that had to be obtained through the intervention of computer algorithms.

People with motor disorders or unfamiliar with the use of these computer tools to arrange a consultation felt hostage to procedures that had little to do with the morbidity of respiratory viruses and mechanical protection against their transmission.

Faced with the total passivity of political and union forces and almost the entire terrorized civil society, every act of daily life was subject to supervision by security forces, who, occupying the space, carried out repetitive controls on documents, certified for circulation. on the street, in the neighborhood, in the city, in the country, among others.

The paralysis that was born from fear

— Fear of contagion, transmission to vulnerable family members, and also fear of death. An intrinsic reaction to human nature. So, do you believe that fear around the pandemic was a determining factor. Was there excess fear?

— Pablo Goldschmidt: There is no doubt that the experience around the globe in the last 3 years has revealed health harassment beyond the real pathogenic power (morbidity and mortality risks) of all respiratory viruses and bacteria in people at risk. .

The panic produced a degradation of the living conditions of many humans and left the entire space to be occupied by a monster that could not be contained with reason, the confusion grew with social networks that on numerous occasions were more virulent and toxic than the person himself. virus. The panic did not serve to strengthen medical care systems, nor to significantly increase national or international solidarity funds.

The pandemic once again highlighted that access to medical care in countries without state social protection was dependent on the purchasing power of each individual, showing that getting sick was not the same in regions that were difficult to access. Here, it seems pertinent to integrate the idea that, according to psychology and evolutionary anthropology, considers that if humans were phylogenetically more successful than other species, it was because they cooperated in crisis situations.

The fear of dying - typical of humans -, associated with powers granted to national, regional and municipal forces, were constant to control movements of citizens inside and outside of countries in a state of internal peace and without war declared against any foreign country. I reiterate that with the passage of time, faced with scientifically unjustifiable decisions, citizens deserve explanations.

— So, confinements and movement restrictions as a unified global response should be considered as a future strategy or should be discarded based on their cost/benefit for the general population: neglect of severe pathologies, lack of attendance at medical centers for those infected due to COVID, having received painkillers as the only treatment, resulting in severe symptoms

— Doctor Goldschmidt: There is still no convincing evidence of the significant benefit of confinement for society. Aware that health budgets were deficient, confinement was decided on premises that assumed that viruses would continue until herd immunity was achieved, that individuals would never change their behavior in the face of a viral threat, and that the risk of becoming ill and Dying was independent of the vulnerability of the people.

The confinements led to telephone medical consultations and strict home isolation being imposed, limiting the therapeutic arsenal for those infected to paracetamol and discouraging them from going to health centers. As indicated, these measures influenced the increase in severe complications and deaths from diseases linked or not directly to SARS-CoV-2 infection.

Rethinking the lethality of COVID

“It has not yet been proven that SARS-CoV-2 has greater intrinsic virulence than expected for respiratory viruses responsible for epidemics. Now, knowing that for all respiratory viruses there is no zero case, a future with zero COVID cannot be predicted (there is no zero flu and there is no zero cold),” Goldschmidt describes to Infobae.

And he points out that it is also not expected that the application of vaccines – which the Argentine virologist prefers to call Prophylactic Pharmaceutical Preparations (PFP) – will eliminate diseases caused by respiratory viruses.

In more than three and a half years, the COVID pandemic caused 6.9 million deaths in the world according to WHO data, but Goldschmidt questions that in many countries these statistics do not reflect the real clinical cause of death of each patient: “ It should be remembered that respiratory ailments prior to the 2020 pandemic caused more than 2,600,000 deaths annually around the world.”

—To date, the debate on the complex analysis models to evaluate the real increase in mortality caused locally and globally by the SARS-CoV-2 virus is open. What do you think about this?

— Doctor Goldschmidt: The increase in global mortality from the COVID-19 disease requires validation and cannot be isolated from other health injustices. In 2020, calculations and forecasts - based on models that contradicted each other - caused the entire planet to reach a point of no return since the appearance of SARS-CoV-2, since every death with a laboratory test ( when available) positive or with a mere clinical suspicion, it would be recorded as a death due to CoVID-19. Almost all other causes of death disappeared, for example, respiratory failure, broncho-obstructive pathologies with febrile episodes or severe pneumonia of bacterial or viral origin.

According to estimates published this year 2023 by the American Heart Association, in 2020, the first year of the COVID-19 pandemic, more people died from causes related to the cardiovascular system than in any other year since 2003. The figures continue under permanent review and no conclusive data is known.

Everything suggests that the declared figures excluded people whose laboratory tests were not performed or did not show positive virological results before death, which may represent a deficit in the mass of data (in territories with little capacity to perform the tests). ). On the other hand, it should be emphasized that it was not always reported whether the clinical elements in the cause of death were confirmed with reliable tests for SARS-CoV-2 and/or with pathognomonic images. There could be cases directly associated with COVID-19 that were not included in regions lacking infrastructure (deficit in cases or false negatives) or, on the contrary, deaths may have been reported due to clinical suspicion without confirmation by laboratories or with incorrect tests (excess). or false positives).

*(N. of R.1) The bibliographic citations that support the statements and scientific assertions of Dr. Pablo Goldschmidt in this note are available through my email dablanco@infobae.com and were provided by him himself. Por Daniela Blanco

LINK AL ARTICULO ORIGINAL (SPANISH)