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March 31, 2020
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‘The virus is circulating. It is almost certainly everywhere’

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‘You can only see it when you look for it. Seek and you shall find.’

Workers prepare beds to set up a quarantine facility amid concerns about the spread of coronavirus in Howrah on the outskirts of Kolkata, March 19, 2020. Photograph: Rupak De Chowdhuri/Reuters 

IMAGE: Workers prepare beds to set up a quarantine facility amid concerns about the spread of coronavirus in Howrah on the outskirts of Kolkata, March 19, 2020. Photograph: Rupak De Chowdhuri/Reuters

 

Professor Tom Jefferson is a physician, researcher and campaigner for access to randomised controlled trial data at the Cochrane Institute in Rome.

The review lead by him deduced that respiratory virus spread can be reduced by handwashing. The study found no evidence that the more expensive, irritating and uncomfortable N95 respirators were superior to simple surgical masks.

It also reported that there is insufficient evidence to support screening at entry ports and social distancing (spatial separation of at least one metre between those infected and those non‐infected) as a method to reduce spread during epidemics.

The Cochrane Collaboration is a global independent network of researchers, health professionals, patients, carers, and other people interested in health.

“There is evidence from a trial carried out in India in 2005 that washing hands and personal hygiene works for all respiratory illnesses,” Dr Jefferson tells Archana Masih/KhabriBaba.com in a telephone interview from Rome.

Do you think we know enough about the coronavirus to battle its effect on the human body?

I am an epidemiologist and a medical practitioner. I can’t speak about the clinical features of the virus. It is unclear and the situation is evolving, we know more about it than a month ago, but I am personally unclear.

A vast majority of respiratory viruses have not been studied, or they haven’t been studied sufficiently.

Most researchers have been concentrating on influenza which is a non-serious cause of influenza-like illness. There is really no exact number of how many people does influenza kill every year, there are just models and guesses.

People concentrate on influenza because that is where the money is — all the rest is being left to its own devices. That is why we know so little about these coronaviruses and other agents.

Do lockdowns stop the infection from spreading?

We are busy updating the Cochrane review about physical interventions to interrupt or delay the spread of respiratory viruses. It is called physical interventions to interrupt the spread, we are updating it, but the 2011 version couldn’t show any evidence that distancing had any effect.

That does not mean that it doesn’t work, it means it has not been studied and does not have enough evidence.

In your opinion, why are the fatalities in Italy so high?

I am perplexed as you are. There are lots of theories, but very few facts.

We simply do not know if it is environmental, age-related, or the particular type of virus which appears to be different from the one in China or Iran — I simply don’t know.

How is this virus going to change the world as we know it?

First of all, for a little while governments will stop cutting back on healthcare. Italy has undergone years of underfunding and cuts, political interference and appointees. I hope that changes.

Maybe people will stop going on about influenza and start taking the other agents more seriously.

These are the two things I hope will happen.

I also feel there will be a backlash on some of the decisions that were taken like the 2009 influenza pandemic.

What disturbs me is that people who voice a view which is not the majority view are persecuted on that dreadful social media. Two scientists were attacked for their interviews given in Germany and America. That kind of behaviour cannot be tolerated in a democratic society.

How far do you think we are from a cure for Covid-19?

I would not pin my hopes on that. No one has produced an effective vaccine against respiratory viruses.

The only effective vaccines that have been produced are bacterial vaccines for respiratory bacteria, and those were done at the end of the First World War during the Spanish Flu.

There is lots of interest and the media is going crazy. Every day there is a cure ranging from green tea to miracle vaccines and miracle antivirals.

Do you think it will get worse before it gets better? When will it become better?

I am afraid somebody has stolen my crystal ball!

How did it spread in Italy? In India tests show that travellers are bringing the virus.

No. There were two Chinese tourists who recovered and were discharged, but they didn’t have any contact with the index case in Normandy, so where the index case got infected remains a mystery as we know now.

The index case is out of intensive care and my colleagues are asking him a few questions.

Is a person safe after the 14-day period has expired after return from abroad or after being exposed to a contact?

The virus is circulating. It is almost certainly everywhere. You can only see it when you look for it. Seek and you shall find.

I wouldn’t worry if you are this side of 75 and have no obvious pathologies, especially if you are a female.

A 75+ male with heart disease, diabetes, cancer, bronchial disease, then it appears they are at high risk of the infection.

How it is different from a yearly influenza wave is unclear.

What is making women more resistant to the virus in your opinion?

I don’t know. Maybe women wash their hands more. (laughs) Maybe their physical and mental make-up makes them more resistant.

On an average, there is a 3:1 ratio — out of 3 cases, especially severe cases, two who die are male.

What are your thoughts and advice when people are anxious about the disease?

There is evidence from a trial carried out in India in 2005 that washing hands and personal hygiene works for all respiratory illnesses.

This trial was carried out in poor areas and it was found that it protected pregnant women and children.

This is the most important and basic point. Clean water, sanitation and personal hygiene. If there is no water, use sand or anything that causes attrition and cleanses the hand.

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