Putting the increase in covid cases and hospitalizations into perspective

This analysis is based on the Sciensano epidemiological report dated 17/11/2020. (1)

Below, we will analyze in A, the epidemiological graphs of covid published by Sciensano, in order: 1 the number of cases, 2 and 3 hospitalizations, 4 patients in intensive care, 5 mortality(2)(3).

  1. There continues to be a significant decrease in the number of positive tests from an average of 8,350 to 4,900 per day per week. They are not always « cases » in the clinical sense of the term and the majority have mild forms of the disease (95%). This peak of positives is in no way comparable to the one in March-April when only patients who arrived at the hospital in very advanced stages were tested. The testing policy is shrinking, 250,000 tests were performed the previous week (week 45) compared to twice that number two weeks earlier. The decision to retest asymptomatic patients is highly questionable in terms of relevance, as this untargeted testing policy detects mostly healthy carriers whose contagiousness is not established(4).

As the epidemic peak is now on the downward slope, we will be able to evaluate, later in this analysis, the different indicators since the beginning of this autumn episode.

  1. As for the curve of hospitalizations classified as « covid », it is also clearly decreasing. What we can say in numbers about the peak of this epidemic:
  • At the height of this episode, covid patients occupied 7500 beds, or about 20% of all available clinic beds nationwide (37,000) or 94% of the 8000 beds potentially available for covid cases(5).
  • The 880 hospitalizations classified as « covid » recorded during the November 3 peak in admissions represent about 70% of the approximately 1,200 daily hospital contacts typically recorded for respiratory complaints, according to 2017 data from FPS Public Health(6).
  • It should also be noted that the distribution of hospitalizations was not homogeneous: Brussels and Wallonia bore 2/3 of the « covid » hospitalizations.

The threat, as stated by the experts, which led the political authorities to tighten the health measures during the month of October, is that of the saturation of the hospitals. Although the situation was indeed very tense in the covid units, it is clear that the hospitals were not saturated! Attributing this inflection to health measures taken by the authorities is completely misleading. Indeed, the epidemic peak of this autumn episode seems to have been reached around October 23, as shown in the perspective of week 44 (see nbp 6).

This can be highlighted by the Sciensano graph in B where a major parameter of the quantification of the epidemic episode, namely the covid test positivity rate, peaks around October 25.

Graph of the number of daily tests performed and their positivity rate (1)

While it is commonly accepted that there is usually a 10 to 15 day delay between sanitary measures taken to limit the spread of Sars-Cov2 and its expected effects(7), the impact of this new containment on the evolution of the epidemic is highly debatable, if not absolutely null. At most, one could attribute a possible effect of the measures taken at the beginning of October, but this remains to be demonstrated. Nevertheless, the most coercive measures taken after the second half of October cannot be the cause of the inflection of the indicators observed at present. Most obviously, this autumn epidemic peak was expressed through the various indicators in the form of a banal bell curve on which the restrictions imposed on the population probably had little effect.

Moreover, the phenomenon of hospital saturation during periods of increased seasonal respiratory illnesses is unfortunately not new; there were episodes of winter saturation in 2017 as well as in 2019 during the influenza epidemics(8)(9). If we want to probe the reasons for this chronic saturation of hospitals, it is important to take into account the clear decrease in beds available for acute conditions in hospitals over the last 30 years, from more than 55,000 to 37,000, despite the increase in the population and its ageing (see nbp 5)!

  1. We probably had to face a new epidemic episode of covid. But what is its origin? One of the hypotheses that seems to be confirmed by various findings and epidemiological studies is that a new variant of Sars-Cov2 originating in Spain has spread throughout Western Europe(10)(11).

Another hypothesis that could be complementary to the first one and shared by Christophe de Brouwer, Professor at the School of Public Health of the ULB, would be a modification of the viral transmission (infectiousness) caused by NPIs (non-pharmaceutical intervention) measures, such as lock-down/confinement, closure of social places, etc.(12)

The latter would have left « virgin zones » in terms of immune susceptibility, which acted as « transmission nodes » conducive to the spread of the virus during this second epidemic episode.

But is this episode on the same scale as the first one? The peak of hospitalizations is higher than in March, but the mortality and case-fatality of this episode are much lower. In addition, the onset of seasonal respiratory illnesses (fall/winter) implies more suspected clinical cases of covid. PCR tests, with their very high sensitivity and non-absolute specificity, will not always distinguish covid from other seasonal respiratory infections.

It is important to note that depending on the sensitivity of PCR tests, up to 90% of positive tests for SARS-COV2 have no medical significance when systematized to this extent. Indeed, some studies show a very high proportion of clinically irrelevant positives when the number of PCR amplification cycles (CT) exceeds 30(13). And in Belgium, the number of PCR amplification cycles (CT) ranges from 30 to 35(14).

If the CT cycles of the PCRs performed are too high, the tests are hypersensitive and therefore cannot determine, even if positive, whether the patient is indeed sick with covid.

All these patients labelled « covid », whether they really have this disease or not, will in fact cause a rapid saturation of the hospital system because of the cumbersome protocol of their care.

Add to that the fact that some patients admitted for anything other than covid, undergo PCR tests, and if they are positive, they are listed as « covid hospital admission »!

  1. The number of intensive care unit (ICU) patients is also declining. The number of « covid » patients in the ICU reached a peak of 1475 throughout the country. This is about 70% of the intensive care bed capacity in Belgium (about 2000) (15). As for the saturation of the intensive care units in Belgium, unfortunately this is not an exceptional situation either. According to Dr. Philippe Devos, intensivist at the CHC Liège, during the peak of the flu epidemic in January/February 2020, the ICU bed occupancy rate was over 90%! This was done by patients who developed complications from severe influenza (see nbp 15).

It is also imperative to highlight the fact that covid clinical pictures are significantly less bleak than in March/April. The proportion of ventilated patients has clearly decreased, intubations are only done as a last resort and now constitute only 60% of the management of patients in ICU compared to more than 80% in March/April. This improvement in terms of the « severity » of cases is most certainly due to better management of patients upstream thanks to a more thorough knowledge of the disease as well as the introduction of treatments such as anticoagulants, corticosteroids or oxygen therapy which reduce ICU visits and their severity (see nbp 16). And this is confirmed by a lower covid mortality at the present time.

  1. The « covid » mortality is stabilizing and reached the peak of 206 deaths on November 6, the intensity of this peak is 33% less than the previous one.

Fortunately, the covid mortality rate was rather low compared to the previous epidemic, which is a major proof of the lesser severity of this episode. So I refer you to graph C which is the general mortality data: there is, until November1, a notable general excess mortality compared to the previous three years with respect to this fall 2020 epidemic episode, but much less than in March/April.

Graph of 2020 global mortality data from Statbel (2)

There is no doubt that this episode caused a significant excess of mortality in Belgium. But what about our neighbors where the same Sars-Cov2 was in circulation? It is deplorable to note in Graph D, which represents the « Z‑score » (a standardized indicator, measuring the excess of deaths) of all our neighboring countries, that Belgium has the highest score after France, on which, moreover, our leaders are often quick to copy health policy decisions.

Excess mortality graphs (z‑score) for Belgium and its neighbors for the year 2020 published by the Euromomo website (3)

The apparent case-fatality rate (deaths over cases) for covid in Belgium is 2.8%, compared to 1.6% for Germany, 1.9% for the Netherlands and 0.86% for Luxembourg. Only France has a rate close to Belgium’s with 2.35%(16). In doing so, it would be a good time to question the strategies for managing this health crisis, given the dramatically disastrous results displayed by the Kingdom in comparison with its neighbors. The latter having a comparable sociology, standard of living and demography

Summary of the key indicators of this epidemic episode* :

  • Hospitalization rate (number of hospitalizations per identified case): 4.4
  • Proportion of hospitalized patients admitted to intensive care: 20%(0.88% of cases)
  • Proportion of resuscitation patients on ventilators: 60%(0.53% of cases)
  • Apparent case fatality rate for the fall episode (since September 15): 1.07%.
  • Median age of death: 82 years

*From 15/09/2020 to 18/11/2020

In conclusion, it seems very likely that SARS-Cov2 takes on a seasonal pattern and that a particular variant of SARS-Cov2 is responsible for this fall epidemic peak. Contrary to what the media-political doxa would like to distill, this upsurge of the epidemic is not due to a « relaxation of the citizen’s behavior » but to a classic, identifiable and quantifiable evolution of the dynamics of the viral epidemic.

To date, the peak of the Sars-Cov2 epidemic in Belgium is clearly over and probably took place during week 43 (around October 25), i.e. before the most coercive measures taken by the authorities at the end of October, which raises a huge doubt about their efficiency and legitimacy.

In a reckless headlong rush, our government, supported by a unanimous and dogmatic expertocracy, has plunged the people into a new confinement with heavy consequences, without really analyzing the situation or waiting for the evolution of the epidemiological situation. Not to mention that restrictive measures taken in the past may even have contributed to this situation!

It should be remembered that the effectiveness of containment has not been proven: the countries that have applied this measure drastically are among those with the most catastrophic mortality rates per capita in Europe: Belgium, Spain, Italy, the United Kingdom and France. Add to this the fact that a seroprevalence study conducted by the Spanish authorities on more than 60,000 subjects showed that confined persons were more contaminated than persons who continued their professional activities in the essential sectors. Data, confirmed by another Italian study, which may legitimately cast doubt on the containment strategy as a solution to the epidemic(17)(18).

Furthermore, the evidence for the ineffectiveness of confinement on overall mortality seems to be confirmed by the French study of IRMES in collaboration with the University of Toulouse. Researchers analyzing data from 188 countries around the world over 9 months found no correlation between harsh health measures and reduced mortality, with some evidence pointing to the opposite(19). The collateral damage of the most restrictive health strategies, such as containment, seems to tip the balance in favor of risks rather than benefits. As shown by several British studies which highlight an unprecedented increase in late diagnosed cancers and heavy consequences on untreated pathologies such as cardiovascular accidents. Not to mention suicides, depression and the resurgence of domestic violence(20).

Moreover, the phenomenon of saturation of public hospitals seems to be more attributable to the chronic lack of hospital resources as well as to the choice of health strategies of our authorities, such as the absence of a policy of outpatient care, which is a probable factor of aggravation of the pathology in many patients. Faced with the same virus, our Dutch, German and Luxembourg neighbors fared much better than we did, which undoubtedly reflects a problem of consistent management of the crisis. As Belgium is a very poor performer in terms of mortality and lethality, it seems legitimate to question the validity of sanitary measures that have little effect. However, the political and media apparatus, not content with not questioning these measures, shamelessly continues to use a dialectic that makes the citizen feel guilty, tacitly making the latter the only person responsible for the evolution of the epidemic as well as for the tensions in the hospitals.

One of the many questions to be asked about this health crisis is why Belgium has such a catastrophic mortality record compared to its neighbors.

This question deserves more than ever reflections and answers!

See https://www.transparence -coronavirus.be, of which the author is a member. 

Notes et références
  1. https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_Daily%20report_20201117%20-%20FR.pdf
  2. https://statbel.fgov.be/fr/visuals/mortalite?fbclid=IwAR0_8aNxz_F2Zc0E7wgdNjIRMLsn6qOei4_K477I8Bw2qxRR55Lokm-BVEQ
  3. https://www.euromomo.eu/graphs-and-maps/
  4. https://www.industrie-techno.com/article/les-tests-rt-pcr-du-covid-19-se-revelent-etre-de-tres-mauvais-tests-de-contagiosite.61389?fbclid=IwAR2xqlwHywpMsjf_wFKarck6HuuJQxDXegak29k8EstFZ2waDJHkF6g1Xg8
  5. https://www.healthybelgium.be/images/Donne%CC%81es_Phares_Soins_de_sante%CC%81_2019_pdf.pdf?fbclid=IwAR2JmEdwq5MvPWteuh7_1MZiTbiGr1rOdv8oaKcPxveQfTZWgw-zyVnH2eA
  6. https://www.kairospresse.be/article/mise-en-perspective-au-sujet-de-laugmentation-des-cas-covid-et-des-hospitalisations/
  7. 24. https://www.rtbf.be/info/belgique/detail_le-premier-ministre-a-la-chambre-adapter-les-protocoles-sanitaires-et-attendre-l-effet-des-mesures-prises-la-semaine-derniere?id=10615023
  8. https://www.rtbf.be/info/regions/detail_grippe-et-chutes-les-hopitaux-du-hainaut-sont-pleins-a-craquer?id=9506451&fbclid=IwAR1k2fDJ7cwbAakMDmE8iuJH0VG4jG2zaSULBwp6nt4rMQ7igyf7E1WETP0
  9. https://bx1.be/news/nombre-de-cas-de-grippe-continue-daugmenter/
  10. https://www.medrxiv.org/content/10.1101/2020.10.25.20219063v1
  11. https://www.france24.com/fr/europe/20201030-covid-19-sur-la-piste-de-la-folle-propagation-d-une-souche-espagnole-du-virus
  12. https://www.medrxiv.org/content/10.1101/2020.02.28.20029272v2?fbclid=IwAR3pU9qwfPCcn3Lu07w8XeSVeJOvAIGZV_MZ-LY7TQ3kr1mWL3WAFciJLf8
  13. https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html
  14. https://www.rtbf.be/info/societe/detail_coronavirus-vous-avez-un-test-pcr-positif-et-vous-ne-l-etes-peut-etre-pas-ou-vous-n-etes-pas-contagieux?id=10578123
  15. https://www.lalibre.be/debats/opinions/coronavirus-sans-mesures-de-precaution-drastiques-on-risque-d-avoir-850–000-personnes-infectees-et-50–000-morts-en-belgique-5e5cf60f9978e23106a0bfd9
  16. https://www.europe1.fr/sante/coronavirus-la-prise-en-charge-des-patients-sameliore-chaque-jour-un-peu-plus-3987417
  17. https://www.worldometers.info/coronavirus/
  18. https://www.mediterranee-infection.com/efficacite-du-confinement-et-etude-de-prevalence-serologique-en-espagne/#:~:text=Efficacit%C3%A9%20du%20confinement%20et%20%C3%A9tude%20de%20pr%C3%A9valence%20s%C3%A9rologique%20en%20Espagne,-Accueil%20Efficacit%C3%A9%20du&text=Une%20%C3%A9tude%20a%20%C3%A9t%C3%A9%20men%C3%A9e,anticorps%20contre%20le%20COVID%2D19.&text=Source%20%3A%20Estudio%20nacional%20de%20sero,%2DCOV%2D2%20en%20Espana
  19. https://www.istat.it/it/files//2020/08/ReportPrimiRisultatiIndagineSiero.pdf
  20. https://www.frontiersin.org/articles/10.3389/fpubh.2020.604339/full
  21. https://www.spectator.co.uk/article/the-growing-evidence-on-lockdown-deaths?fbclid=IwAR3v_Dng9pU3hFR-X-c8kSXzjzZJzS_TTiwDuJHctn4cLHytnP_nO3DY4WU
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