For a number of weeks in a row as coronavirus infections, hospitalizations and deaths spiraled upwards exponentially, the broad population in Belgium and many other European countries came out at specified times in the evening to collectively celebrate the heroism of their medical cadres on the front lines of the pandemic. For a while I joined in, but then as it became clear that Belgium has the world’s highest number of deaths per capita in the world, and that the explanations for this given by the authorities are utterly unconvincing, my feelings towards our medical profession changed from admiration to pity for their risking their lives only to produce miserable results. Clearly the foot soldiers had been let down by their generals.
As of today, more than 9,500 patients have died in this country of 11.5 million, half in hospital and half in old age and care homes. To put this in proper perspective, in the United States, where the chaotic response of the federal government under President Trump has been exposed to scathing ridicule both domestically and by observers abroad, today was marked with solemnity as the country crossed the threshold of 100,000 Covid -19 deaths. If the official Belgian mortality rate per million were to be projected onto the United States, which is 28 times more populous, we should be marking 270,000 deaths there today. Of course, given the unruly de-confinement now going in many U.S. states with the active encouragement of the White House, the numbers there may reach and exceed that level in the coming weeks. But they also may not.
If we use another yardstick which has been promoted by the Financial Times, namely the total excess deaths in a given country in 2020 during the months of the pandemic compared to the normal mortality in the same country in the same period over the past several years, Belgium once again comes out at the top of the list of shame, just behind the UK and Italy.
Most of the Covid-19 deaths in Belgium could have been spared had the right decisions been taken at the outset. And I do not mean earlier imposition of confinement. I will explain myself below. Many other unnecessary deaths have continued even up to the present day because of critical errors that are not being corrected due to pure incompetence, aided and abetted by a dysfunctional political system of power sharing, placing political ideology above pragmatism, and being penny wise and pound foolish in the spending to combat the epidemic. In this regard, it is relevant to note that the daily death toll in Belgium this past week has persistently exceeded that in neighboring France, a country with 5 times the population.
In this brief essay, I will ask some of the tough questions that our lame print media seem unable or unwilling to do during the thrice weekly press conferences held by officials of the federal health ministry.
As recently as a few days ago I hesitated to come out with accusations since I am not a health professional and can base my doubts only on the inconsistencies I have remarked between how the epidemic has been handled in other countries including South Korea and Russia where deaths per million are vastly lower, and what is being done and said from high offices in Belgium. However, the very sharp criticism reported on 26 May in the middle-of-the-road French language newspaper La Libre Belgique directed against the Sciensano institute at the center of the Government’s Covid 19 management has brought starkly into the open some of the weaknesses we in lay society had observed among ourselves in kitchen talk. A breach in the Government’s defenses of its policies has opened up and it is high time to march through.
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La Libre Belgique assigned to the article mentioned above a title sure to attract the attention it merits: “Coronavirus: the Royal Academies castigate the ‘opaque decisions of Sciensano’ which ‘put our country in danger.’” The Royal Academy of Medicine and the Royal Academy of Sciences, Letters and Fine Arts denounce in particular the monopoly of power exercised by the Scientific Institute of Public Health (Sciensano) with respect to management of the health crisis and the way their own advice has not been taken into account. They call for ‘rethinking the strategy for developing the Belgian medical plan.’ They note that the oncoming pandemic provoked panic in the country. Decisions were taken precipitously and without any well thought out plan despite the fact that the viral outbreak had occurred in China already in December. They insist that Belgium must learn from its errors if it is to face up to the likely second wave of viral infections ahead.
The one specific charge the Royal Academies raise is over the flip-flop on public policy with respect to wearing masks. We are told that “They point their finger at the ‘denial of the interest in the population wearing masks to cover up the shortage [of masks] and a lack of foresight, as well as the ‘restrictions on use of diagnostic tests’ for the asymptomatic or pre-symptomatic cases of persons having been in contact with a contaminated person.’”
The net result of the démarche is the following: “The two Academies ask Sciensano to collaborate with them in order to ensure transparency, independence and coherence of the decisions taken. They emphasize that they are composed of ‘internationally recognized experts in numerous disciplines concerned by the problem at hand.’”
Finally we are told that the two Academies point to the mistrust which the population is showing with regard to the management of the health crisis, saying ‘’It is urgent that we reestablish confidence and credibility between the decision-making authorities and civil society.”
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For little Belgium, the open conflict among elites that we see in the article I have summarized above is quite remarkable. We read that the public has lost trust in the authorities, and we read that internationally recognized experts have been sidelined.
Neither phenomenon is particularly unusual in this country where the flip side of the advanced democratic solutions for holding the kingdom together, given the rivalries of the French-speaking and Dutch-speaking regions, is power sharing. This power sharing broadly equates to institutionalized corruption and incompetence. Ministers receive their portfolios by back-room deals among the parties forming the governing coalition of the day. The coronavirus is the sharp end that has driven these abuses out into the open for public scrutiny, particularly as regards the reviled minister of public health Maggie de Bock.
The remarks about government lies about the usefulness of masks when there were none for the hospitals let alone for the general public hit at the most talked about and grating abuses of the Minister of Health. Moreover, she had a year earlier overseen the destruction of millions of masks purchased for the feared ‘bird flu’ H5N1 ten years ago, thereby leaving the country totally exposed in case of some new viral epidemic. On these grounds alone, the Belgian doctors’ association had called for her to be stripped of her license to practice medicine. That may not seem more than a tap on the wrist, but the notion of hauling her into court for dereliction of duty was too improbable of success to be contemplated.
In the meantime, two months into the pandemic, Belgium has stocked up on masks and latex gloves. In my own commune of Ixelles, one of the boroughs in central Brussels, we received a knock on the door a couple of weeks ago, from a communal official delivering for me and my wife individually packaged double layer cloth masks. A very nice gesture, if somewhat late. In Brussels, it is now mandatory to wear masks on public transit and in stores. However, the damage to public trust from the prevarication of the minister was substantial.
What we see in the allegations of the two Academies is that the rot goes much further than one incompetent minister. The Institute advising the ministry, Sciensano, is itself a concoction of political interests rather than a serious center of expertise. It serves two very different administrations: Public Health and Agriculture. Wikipedia tells us that “its core business is scientific research in the fields of public health, animal health and food safety.” The same source spells out the ideology which Sciensanto promotes: “that the areas of human health, animal health and the environment are inherently connected with each other.” Given this ‘green agenda,’ is it any wonder that early on in the pandemic we heard that the high levels of infection and mortality in Belgium might be explained by the high levels of industrial pollution in its cities. I would suggest that this irrelevancy blinded officials to the mortal threat posed by a vicious and uniquely contagious viral infection, full stop.
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There is no question but that lockdown everywhere has been effective in “flattening the curve” and bringing the daily admissions into hospital, and more particularly into Intensive Care Units, down to manageable levels and so avoiding the kind of pandemonium that we all saw to our horror hit Lombardy in early March.
It is also beyond dispute that imposition of draconian lockdown rules in democratic societies could come only after the existential threat to society was made plain by the kind of disaster that hit Italy. During an interview with the BBC, Italian Prime Minister Conte said as much to justify his foot-dragging in the early days of the epidemic: “Had I imposed lockdown then, all the political classes would have said I was crazy.”
In this respect, we have to give credit to the government of Belgium, and to its Acting Prime Minister Sophie Wilmès for its breaking the political logjam and imposing lockdown in time to avoid the tragedy of Northern Italy. However, it also has to be said that this very rich country did not do what could have changed the game in favor of both saving lives and saving the economy: it did not reach into its wallet to do what China had done so impressively, namely to urgently construct one or more large scale dedicated hospitals to isolate and treat Covid 19 patients. Removing the flow of patients from the normal hospital infrastructure could have maintained essential services to the public., so important to dialysis patients, oncology patients undergoing chemotherapy, those suffering from cardio-vascular events, and the like. Equally importantly, the concentration of fire power in a very few facilities would have helped to ensure proper training and availability of proper protective equipment for those dealing with the Covid-19 patients. Instead, Belgium chose the cheap and dirty solution, distributing the daily influx of Covid-19 patients among more than 100 hospitals around the country, most of which were very poorly prepared for the daunting challenges ahead.
The second, very important strategic failure of the Belgian health profession was to advise all those who were reporting Covid-19 symptoms to remain at home as long as possible and merely consult with their ‘family physicians’ (which a great many people do not have) by remote. The net result of this practice is that Belgian patients came to hospital by ambulance in advanced and often untreatable condition. Yes, they may have been placed on respirators in ICU’s. Indeed, Belgium never fell short of respirators. We can have no doubt that failure by the health authorities to inform us about the fatality rate of those placed on respirators is simply that the figures are too shocking.
So what do other countries that have been more successful both in patient outcomes and in damage to the economy show us? First, that those exhibiting or complaining of Covid-19 symptoms should be isolated by the authorities, not by self-quarantine, and that they should be observed closely and given drugs now known to inhibit the reproduction of the virus, among which we find the Gilead substance remdesivir. This is what is being done with great effect in South Korea. It is what is being done in Russia, where another virus-inhibitor discovered in China during the Wuhan treatments is now undergoing massive production in Moscow for widespread distribution to treat the virus. Russian authorities claim that the Chinese pills shorten the Covid-19 recovery time and lessen the damage from the infection by a factor of two compared to remdesivir.
As we all know, Western media have focused on the high incidence of Covid-19 infections in Russia, said to be third in the world after the United States and China, and the very low mortality, with death toll less than 4,000 at last count. The first fact results directly from the massive testing going on in Russia, far greater than in any other country now experiencing this plague.
The reasons for the relative benign outcomes in Russia are simple if you make an effort to understand what is being done. First, the Russians have copied directly the Chinese approach to urgent construction of dedicated Covid-19 field and permanent hospitals. These are state of the art facilities with $60,000 allocated for each bed. Second, the Russians followed the draconian lockdown on the most vulnerable populations, namely those over age 65. In Russia, seniors are directed, not merely advised to stay at home. No walking the dog, no visits to pharmacies or food stores. As regards the urban population, volunteers bring food and other essentials directly to the apartments of the seniors. This is precisely what the Chinese were doing in Wuhan for the entire population.
Unfortunately, in Belgium as in most of Western Europe and in the USA, China is today viewed only as the source of the Covid-19 pandemic. Yes, they are paid suppliers of our masks and other protective gear. But we do not see in them solutions to medical management that are proving very effective in Russia and which have parallel, home developed solutions elsewhere in Asia.
Despite all the talk of globalization, the reality here in Belgium with respect to handling the Covid-19 pandemic has been insular and, quite plainly, ignorant. Let us hope that now, when the first wave of the pandemic is receding, we will stop rallying around the interim government and start exercising our minds by challenging the authorities on the points above and many further points which I am sure our medical experts in the Academies are aware of.
Postscript, Friday, 29 May 2020
©Gilbert Doctorow, 2020
[If you found value in this article, you should be interested to read my latest collection of essays entitled A Belgian Perspective on International Affairs, published in November 2019 and available in e-book, paperback and hardbound formats from amazon, barnes & noble, bol.com, fnac, Waterstones and other online retailers. Use the “View Inside” tab on the book’s webpages to browse.]