Mis à jour : avr. 23
For more than thirty years, the Geneva anthropologist Jean-Dominique Michel has been studying health systems and health care policies. His article "Covid-19: fin de Partie" (Covid-19: the game is over?!) has caused a lot of reaction since it was published in mid-March on his blog hosted by the Tribune de Genève, especially in France where it has been massively read. The paper has now been translated into several languages. Having just recovered from the disease himself, after a treatment with hydroxychloroquine, the speaker answered my questions in the following interview.
You can find the french version of the article here
Amèle Debey for The Impertinent: As the epidemic gradually spread from China to the rest of the world, not all the governments reacted in the same way. In Europe, for example, there is a feeling that they tried to minimize the problem and then jumped to the other extreme, as if to avoid being accused of negligence.
But that is the problem: we have been aware for years that we have a pandemic hanging over our heads. Ebola now sounds like a warning. A warning that we have not been able to hear. What is the reason for this lack of preparation?
J.D.M.: It's hardly understandable!
Once we're out of the woods, we'll look into this question, and it is sure going to be interesting.
This is a major health risk that we have known for about 25 years. Just as we know the risk that sooner or later a major earthquake will occur in certain seismically unstable regions. We know the structural and operational measures that need to be taken, so we build accordingly; we train the population; we prepare the emergency services to respond; we anticipate the special logistical, health and vital (food) needs, etc., to ensure that we are well prepared when the problem occurs.
Since the 2000s, and even more so after the H1N1 episode (which was, thank God, just a wet firecracker), solid and, well-thought-out plans have been put in place to anticipate this threat. In France, for example, Professor Didier Raoult has unearthed a report from 2003 in which he predicted and described how a pandemic would unfold. Yet our governments give the impression that they have suddenly discovered this threat, as if they had never thought about it. They are also doing the opposite of what all the best experts recommend in such cases. So, yes, it does raise questions.
Do you think the Federal Council should have demanded containment?
No, not at all. I understand how difficult it is to assess health risks live, which is why it is of course important to be well prepared. The authorities in both Switzerland and France reacted as they did in the 19th century, when we had none of the means available to us today. Confinement is a very bad measure and is only necessary at the very end, or in the absence of any useful means!
Even if there was no containment as such, we still went in that direction in stages. With slightly different modalities, but it is the same logic.
However, what the best experts in infectious epidemiology tell us is that we need to do exactly the opposite to fight an epidemic of this kind: it is imperative to confine people at risk, to quarantine infected people, but not people who are not ill, have no risk profile or are already immune; then we need to test as many people as possible to find out the characteristics of the epidemic (and not work blindly) and allow people to know whether they are infected or not. Containment is therefore limited to what is useful, and other people continue to live normally without putting the economy on the ground... This is how territories such as Hong Kong and Singapore, which are both highly populated and have been at the forefront of the epidemic, have acted, with very few deaths!
Why, then, have our governments not been able to react in the same way?
I do not know. The plans were ready and they were good, the stockpiles (of masks in particular) were made. And making millions of tests available from our scientific and industrial resources would have been as easy as pie if we had made it an urgent strategic priority. This fascinates Raoult in Marseille, it fascinates the best experts and it fascinates me too. Our governments give the impression that they have been caught off guard, like 19th-century nations, or without scientific and technical resources.
The major damage we see today is not due to the dangerousness of the Covid-19. On the contrary, it is the poor health response that generates most of the mortality. In this case, the cost of this inexplicable lack of preparation and of this archaic fear reflex ("everybody to the shelters!"), which is exactly the opposite of what needs to be done in the 21st century to fight a pandemic, will have been the real cause of death for so many people. Confining sick people and those at risk together is the best way to have the greatest number of victims, alas!
"It is better to forget about all this and expose as many people without a particular risk profile to the virus as soon as possible."
What about the usefulness of masks?
This is again an interesting question: Asian countries have made very good use of them. Japan, Korea, Singapore, Hong Kong have protected themselves a lot with the masks and the impact is visible: it has not prevented them from moving while being protected.
When the spokesman for the French government (the FOPH in our country said the same nonsense) said that the masks were useless, this was a state lie aimed at covering up in a dishonest way that the strategic stocks that had been made had in fact been liquidated and that we no longer had the necessary reserves, even to protect health care workers. Rather than admit this lack and take responsibility for having miscalculated, those responsible preferred to pretend that the masks were useless.
That said, I am quite sensitive to the argument of epidemiologists who say that, except for at-risk groups and professions in need of protection (such as caregivers, emergency room attendants, cashiers, and shopkeepers), it is better to forget about all this and expose as many people without a particular risk profile to the virus as soon as possible, since it is not dangerous for almost the entire population and is the only way to protect ourselves by building up group immunity.
But don't you think that this kind of speech is not audible in societies like ours, which are much more individualistic than some Asian societies?
I hear that. But we also have to realize that there has been a manipulation of numbers that is problematic in terms of intellectual honesty. I am thinking in particular of the study published by Professor Neil Fergusson at Imperial College in London, which states that there could be as many as 500,000 deaths in England. This was an absurd figure, totally false, and was put forward in order to get Boris Johnson to react and push him to change his health option. But epidemiologically, it wasn't worth anything! Since then, they have revised their forecasts by saying that there would be 20,000 deaths in the worst-case scenario. These are normal figures, corresponding to what we know about winter viruses in general.
This is what is really extraordinary: we are, in the unanimous opinion of the best specialists, in a normal epidemic event! There are simply no more deaths this year than in other years due to the usual respiratory pathologies, of which this new coronavirus (we already have several in circulation among the ten seasonal respiratory viruses) will be only another virus.
This would explain why we do not mention the mortality figures for seasonal flu, for example?
Precisely! If you lead people to believe that 100,000 or even 200,000 deaths worldwide represent a catastrophe, while every year respiratory infections cause 2,600,000 deaths on all continents, the exceptional measures put in place to fight a disease that causes 100,000 deaths no longer hold water.
So in your opinion, all the current measures are only used to justify their initial bad reaction?
Absolutely. It's a misdirection of attention, misinformation. We can see how the information we're given is manipulated (or at least oriented) to drown the fish. But in the end, there will have to be some accountability for the reality of what has been done. I have often shared my conviction on this subject: the State's responsibilities, both civil and undoubtedly also criminal, will be heavy. Destroying the economy, making hundreds of thousands of people (especially the most economically fragile) precarious and putting people at risk with the wrong health responses to a virus of no particular epidemic seriousness will have to be resumed without complacency.
But don't you think that the media are failing in their task by participating in the collective hysteria? Who will hold our leaders to account?
For the most part, it's true. But it's a little easy to engage in press-bashing. I think we've seen, on one hand, real quality journalistic work, especially in Switzerland. On the other hand, we have indeed fallen into an absurd emotional drama. As I have already said, if we were to give the same media treatment to any major health problem, such as cancer or even the annual flu, we would be just as terrified as we are today. And that is not ethical. You can't take a mini epidemic (basically no more serious than any other) and turn it into an apocalyptic catastrophe. But there is a collective responsibility here.
With the subsidiary question of freedom of the press, at a time when almost all the media (except those of public service-which are state-owned-and the Canard enchaîné and Mediapart in France) belong either to billionaires or to major industrial or financial groups.
"Fine particles exposure is one of the biggest real health disasters today."
Perhaps this fear also comes from the fact that not all hospitalized patients were at risk? Today we realize that overweight people are more vulnerable, for example.
Yes, but we have to analyze the information we are given very carefully. I have looked at the reliable data: there is no serious indication, apart from individual cases which may of course exist and be exceptions, that there is significant mortality outside the risk categories (age + pre-existing chronic diseases). To put it another way, less than 1-2% of deaths concern people outside these two risk factors - with, moreover, checks to be made (by autopsy) to confirm the absence of pre-existing pathology.
Younger people have indeed needed respiratory assistance (there have been many testimonies of this in different countries), but with a probability of survival teasing 100%.
And then there is something else: studies have correlated the impact of Covid with exposure to the famous fine particles, for example. This exposure is one of the biggest real health disasters today. Fine particles are those products of the degradation of hydrocarbons (especially diesel), which enter the bronchial tubes and which the body is unable to eliminate. This disaster causes 550'000 deaths a year in Europe, but governments have never put anything serious in place to deal with the problem.
What we are seeing here is that the more fine particles people have ingested, the more their lungs are damaged, the more they are exposed to the consequences of Covid. The same goes for "chronic pathologies" (cardiovascular, diabetes, cancer, metabolic syndrome, obesity, autoimmune, neurogenerative and even psychiatric diseases), of which at least 50% of the causality is linked to exposure to junk food, chemical and atmospheric pollution, sedentary lifestyle, stress or lack of sleep (now endemic).
The authorities and the federal parliament have never done anything worthy of the name to protect the population from these real risk and damage factors - the lack of knowledge of the FDP and the SVP, in particular, is abysmal in this field. Yet it is those people who are already suffering from these "social diseases" who are now also the first victims of Covid, along with the elderly.
Infectious diseases, we must bear in mind, are always ecosystem diseases. In other words, you have no malaria at the North Pole and few colds in our latitudes in summer. If, in this case, a naturally benign virus such as the Covid does or seems to do so much damage, it is because it comes to strike at the health fragilities within the population caused by phenomena in the face of which States have never done anything serious.
The weather is getting better and better... will the heat have an impact on the virus?
Everyone's hoping so. The good news is that the data now strongly suggests that we are in all probability past the epidemic stage in Europe. So we would now be on the right side, at least according to the best infectious epidemiologists in the world (which you don't hear on the mainstream media, but whose analyses are easily found if you know how to navigate the medical and public health search engines). The bad decisions of our governments will probably have only prolonged the agony, but despite this (and not because of it, as they are falsely tried to make us believe) we are on the right track.
I know and understand how uncomfortable and even possibly shocking this notion is for people who only have access to official information and the cognitive distortions produced by the media (magnifying glass effect): this epidemic is a non-event from an infectious point of view, except for very serious, but statistically rare, cases of pneumonia which lead some people to need respiratory assistance. This situation is of course dramatic, and is what (somewhat) distinguishes the Covid from the (more deadly) episodes of seasonal influenza. With the Covid, people are hospitalized and it is very spectacular and painful, both for the patients and their entourage and for the health care teams. The question that arises here is the risk of saturation of intensive care units, knowing that this situation is approached (in Switzerland or Germany) or reached (in Italy or France) several times each winter due to common viral infections. The fact that we are now on the other side of the epidemic cape is in any case not due to what we have done, but to the natural movement of any epidemic.
Doesn't the containment expose us to a second wave once the measures are lifted?
Yes, it is a huge risk, and this is a major criticism made by epidemiologists when deciding whether containment should be imposed or recommended. They tell us that the repercussions to be feared are the inevitable consequence of having (at least partially) defeated the emergence of herd immunity. This will be a further damaging consequence of the bad decisions that have been made.
The virus is in fact (fortunately!) much more contagious than previously thought - Prof. Gupta's research at Oxford University, for example, estimates that 50% of the population may have been infected and therefore, logically, immune. So we could in fact already be at the end of this famous group immunity, which is the only real protection against an epidemic of any kind. The coronavirus has been transmitted and spread widely, according to the genius of viruses in this respect. The latest data suggest that 90% of people who contract it do not even notice that they have been infected, as the symptoms are so subtle or even non-existent in most people. The other good news is that combined treatment with hydroxychloroquine and azythromycin can still protect people at risk.
A treatment that is currently controversial...
We have experts who are, for the most part, either ignorant of the infectious disease clinic (they are statisticians or theorists) or (the two are not mutually exclusive) under the direct influence of large pharmaceutical groups, from whom they make money year after year. These people decide that a treatment that works, but costs nothing, should be blocked in favor of other drugs developed urgently by the groups that pay them: Remédisivir, for example, developed by Gilead, could be sold (if the hopes placed in it are confirmed) at $1,000 per patient treated. As opposed to 15 euros for the treatment developed in Marseilles. This is a case in point for future ethicists who will look into these absurd and dishonest denigrations in the aftermath, in my opinion.
I receive hundreds of messages from doctors telling me that they share my analysis and that they are deeply shocked by the troubled game of the health authorities, who favor the economic interests of some over the needs of the population. Prohibiting, as is currently the case, city doctors from prescribing the hydroxychloroquine treatment that hospitals such as the CHUV and the HUG have adopted on a massive scale to treat patients suffering from Covid is not only indefensible but also constitutes an act of health dictatorship: banning general practitioners from practicing their art in their soul and conscience, thereby violating their inalienable freedom as doctors, is an abuse of power that must be reversed. So is depriving citizens of the right to receive the best treatment chosen by their doctor.
The exploitation of authorities and institutions to serve private interests is not a new phenomenon in the health sector: all the best ethics centers and medical journals have been denouncing it for 15 years, without any real action being taken on the matter. For example, the Swiss parliament (led by the PLR and the SVP, of course) has refrained from requiring doctors and hospitals to list their links of interest with industry. Whereas even in France (that is to say!) transparency has finally been guaranteed by a search engine that makes it possible to see who has received what amounts from whom.
This has, for example, enabled journalists and the public to discover that the main opponents of the treatment proposed by Professor Raoult (I am thinking of Karine Lacombe and almost all the members of the two "scientific" committees set up by Emmanuel Macron) receive large sums of money and various benefits in kind, year after year, from Gilead but also from a dozen pharmaceutical companies. What Harvard University's Edmon J. Safra Center for Ethics calls "systemic corruption" is not illegal, but it distorts the purpose of health care systems by subordinating them to private interests that take precedence over the public interest. It is a problem that is well known to all... and that makes our authorities instantly deaf, dumb and blind when we talk about it.
What should we think of the German philosopher Sloterdijk's view that "the Western system will prove to be as authoritarian as China's"?
Unfortunately, it seems a good point to me. The ongoing attacks (explicit or implicit) on fundamental freedoms are extremely worrying. To give you an insignificant example, I have launched a petition on Avaaz to ask Alain Berset to authorize town doctors to prescribe hydroxychloroquine. It collected 2,400 signatures. Avaaz censored my petition because it had been flagged as "inaccurate". This had already happened to me on Mediapart's blog: I had put forward analyses that differed from the official discourse, but that was perfectly justified epidemiologically (confirmed the following days by the world's leading specialist in medical data processing). However, the Mediapart people considered it as fake news (since it was far from the official discourse) and deleted it.
So the French government is lying to its people, and when informed specialists like me try to nuance, or even correct things, we fall on the fallacious motive that we're throwing out fake news. What an age!
Philosophically speaking, do you think that Western countries are today paying for their liberal and individualistic policy?
Yes, of course, but they are paying more than that. They are paying for an obvious form of intellectual and ethical decadence. When it comes to science, the Asians are now ten years ahead of us.
The French-speaking authorities in our country are completely lacking. We have experts - Prof. Raoult is one of the world's most respected experts in infectiology, a potential Nobel Prize winner and one of the researchers most often cited by his peers! He knows his field like no one else, he and his teams have experience in the use of hydroxychloroquine against viruses and even intracellular bacteria that no other laboratory in the world has. He knows exactly what he's doing - but we don't listen to him. While we listen to pseudo-authorities of the third zone who don't have a tenth of his knowledge and experience, who, moreover, have understood nothing about epistemology (Edgar Morin stressed their scientific lack of culture) and who allow themselves to come and criticize, with arguments that don't hold water, his research methodologies.
You will recall that the main criticism of the trials he published is that he did not use the method known as a "randomized double-blind trial"). If you read the scientific literature, you will find the demonstration that this method does not offer any real advantage over the observational trials chosen in Marseille.
Most methodologists are unaware of this subtlety. But the HUG have thus written an absurd position paper on the subject of hydroxychloroquine based on this fundamental ignorance. It is reminiscent of the late Umberto Eco, who said that the Internet era had led to a race to the bottom, where the word of a fool is put on the same level as a Nobel Prize winner. Here we are.
What are the psychological and social consequences that we can imagine?
I fear they will be enormous. We are currently in a state lie, and obviously the authorities will fight tooth and nail to assert (even against all evidence) that they have taken the right decisions. The end result will be a phenomenal loss of confidence in the authorities. In France even more than in Switzerland.
Here, the Federal Council has been very Swiss, slow, outdated, neither reactive nor clever. It was also somehow restful and reassuring. The members of the French government, for their part, lied like through their teeth, denying everything. I am convinced that the French authorities will end up in the box of the accused in a court of law, probably in Assizes. Not only have they lied, but above all they have taken hostages and endangered the population. There will also be a deplorable stab in the political contract.
In Switzerland, it is more complicated. Our parliamentary commissions of inquiry usually resemble more a carnotzet where we drink a toast to good intelligence (?!) and avoid asking the questions that make people angry. The civil and criminal characterization of government actions also augurs well for intervention by the Third Estate, which is another matter.
As for the rest, the Federal Council reacted as it did in the 1950s: "We get the Cénovis and the Rivella out of the rucksack, we call 22 in Anières and we hope that someone will answer. And if nothing happens, we'll try again tomorrow." It's flat-out and reassuring, but we'll never have seen the agility and responsiveness required, for example, to set up the necessary screening tests as quickly as possible, or even to accept from Novartis the millions of doses of hydroxychloroquine that the drug company is proposing.
Then there is the question of the impact on our model of society. Over the past few weeks, we've realized that we can live very well without being addicted to shopping and without being completely bogged down in the money-making machine (for some). The planet is breathing, there is less pollution. The question is: "What are we going to do next?" Are we going to be able to stay the course to revise the societal choices that have been made, locking in the unsustainable and even the untenable? Or will we be able to be more intelligent and thus fundamentally question some of our collective choices?
Do you think we've fallen into psychosis as a population?
Yes, in the true sense of the word: a state characterized by emotional and cognitive distortions, depriving us of the means to take account of reality as it is. With a complicated emotional stake for the authorities, which I had summarized in the following formula to illustrate the squaring of the circle in which the Federal Council (as well as the cantonal authorities, by the way) was caught: "how to make people panic without making them panic, while still making them panic enough, but without making them panic too much either"?
They weren't bad, but they made the wrong decisions. And they're going to have to explain that. Because it's just not acceptable that the state services, with civil servants who are paid a lot of money year after year to make plans to anticipate this kind of danger, should have done their job so badly.
What are the differences between countries, in Europe for example? In Germany and Great Britain, neither the reactions nor the consequences have been the same. What does that say politically?
The implications are enormous because we can see the results at the end of the day. Some countries reacted well because they were intelligently prepared, like the Germans, with a remarkable health response. They had it all planned: they had the masks, the screening tests, the hospital beds...and the result was a very low mortality rate. This opens the door to trouble for countries that made the wrong (and stubborn) choices. I wonder how they will justify, in the end, the fact that they have caused a mortality rate (per million inhabitants) on 5 April of the order of plus or minus 250 (Spain or Italy), plus or minus 115 (France, Switzerland, Belgium), whereas, in the countries that have renounced containment, we have death rates of the order of 17, 21 or 15 per million inhabitants (Germany, Sweden).
Any epidemiologist worthy of the name will confirm that the difference in these mortality rates is primarily a direct consequence of poor health decisions, such as the decision to confine contagious carriers and people at risk together. We have also seen here again a demonstration of the difference between Latin and Nordic countries.
Does this also mean, at the end of this crisis, that the European Union is being called into question?
Without a doubt, this is a wonderful example of the tragic failure of this construction, which had everything to be right, with many good aspects. But we still see this total inability to show solidarity and, above all, to co-construct something intelligent. How Italy has been neglected is monstrous.
Anthropologically speaking, a probability doesn't mean anything to our brain. Things are binary.
In Switzerland, the healthcare system is neglected to the benefit of the economy, right?
Of course. I've been working on the subject for 30 years. That's an understatement. For years I've been explaining everywhere I went that 5,000 people die every year in Switzerland because of fine particles, and I've got a polite ear at best. And when the Geneva government wants to limit the circulation of the most polluting vehicles in the event of major air pollution, the TCS and the PKR are quick to rise to the occasion to denounce this intolerable attack on the freedom to damage others in certain economic sectors!
I have been talking about this corruption of research and medical practice for years at just about every conference I attend. I am listened to politely and then: great embarrassed silence. The only exception was when an eminent professor from the Centre for Evidence-Based Medicine at Oxford University said, in the wake of an intervention I had just made on this subject, and with this very British art of euphemism, that he "unfortunately had to agree with everything I had just said".
Our government knows it very well, but they don't want to hear it: 80% of the diseases that people suffer from in Switzerland today are preventable. They are due to anthropogenic causes and are therefore a direct consequence of our lifestyles and our collective choices. The health of the population is being sacrificed to big industrial interests. Pesticides, junk food, stress, pollution, etc... I hope you understand what we are talking about: if we could reduce this morbidity by even half (in a few years, with good measures it would be possible), our health insurance premiums would drop by 40%. The truth (excuse my French) is that almost nobody cares!
Yet today we are reacting? Why now?
Because of this famous question of risk perception. Anthropologically speaking, a probability doesn't mean anything to our brain. Things are binary for our brain: either I am in danger (which is serious) or I am safe. Knowing that I have a 1 in 100, 1,000 or 10,000 chances of experiencing this or that means next to nothing. Either I am in danger and then "help" or I am not and then everything is fine.
When you explain to people that 550,000 Europeans die every year with their lungs damaged by fine particles, it doesn't mean anything to them. They don't feel in danger. On the other hand, if a virus or an epidemic comes along reminiscent of the plague of past centuries, we all feel in danger.
So it's a chicken and egg story: is it the people’s fear that made the governments react or the governments’ actions that instilled that fear in people?
I think it is a co-construction. This visceral fear of the epidemic resonates with a heavy historical past and is therefore transgenerational for all of us: we cannot fail to have had (far back) victims in our families killed young by the plague, cholera or even Spanish flu.
You also have a fantasy dimension, a bit like the shark attacks that kill an average of four people a year around the world, but of which everyone is afraid. You are a million times more likely to die on an electric scooter, but nobody is afraid of electric scooters?
We all have visceral images and fears. When you add to that the media intoxication that's all about that, counting the dead, it's a nightmare guaranteed! Especially since we don't know if the deaths counted died with the Covid or because of the Covid.
So what about the future?
I think everything will be over in a few weeks, unless of course the containment leads (that's the risk) to aftershocks at each attempt to deconflict. I'm rather optimistic about the risk of a second wave, because I think that herd immunity is already much more developed than we imagine. The epidemic is in all likelihood already passing. Our screening capacities are increasing (at last!), and it will probably come to the point (which should have been done from the start) of testing as many people as possible to identify sick people by asking them to stay at home without locking everyone in. Once this transition is made, we'll be out of the hostel.
Can we imagine seeing a vaccine coming out from behind the bundles soon?
I don't think so. It's the big, juicy fantasy of the industry (and probably one of the reasons for the war on hydroxychloroquine), but the facts are there: vaccines against viruses don't generally work very well. There are safety issues that are not obvious, with the potential for significant deleterious effects. As with the famous dengue fever vaccine, which promised wonders and had to be withdrawn in a hurry because of the damage it caused to the vaccinated people. The vaccine against Influenza, for example, offers very little protection. But it is true that, in the collective imagination, vaccines and antibiotics are in some ways the saviors of humanity.
So there's going to be a lot of energy put into going in that direction. Above all, I think Gilead will do everything possible to ensure that Remdesivir becomes the reference treatment. We've just seen it: a clinical trial alongside which Prof. Raoult's trials almost resemble summits of methodological conformity, so biased is it, has just affirmed a "cure rate" of 60%) with quite a few deaths at the end of the day all the same).
The blocking of hydroxychloroquine in France as in Switzerland, in my opinion, cannot be explained otherwise. All the "scientists" who are in Macron's government and who oppose hydroxychloroquine feel the generous bills released (philanthropically no doubt) by this laboratory. As for Switzerland, I do not doubt that the parliamentary commissions of inquiry will ask those in charge of the FOPH and our hospitals about the reality of their links (and therefore potential conflicts of interest). In 2011, a survey carried out by the RTS and published in the Swiss Medical Journal evaluated "that two out of three experts working for Swissmedic declare relations with the pharmaceutical industry - mandates, boards of directors, shareholdings, etc. - as being of interest to them. "The independence of the experts is one of the key problems in the area of drug safety." The survey also stated that "conflicts of interest between the regulator of the drugs market and the major pharmaceutical companies are permanent.