According to the latest data released by the Chinese National Health Agency, the number of people who died in the outbreak of the Coronavirus has increased to 563. The number of those identified as infected has exceeded 28 thousand. Out of China, 258 cases were detected in 31 countries. In Wuhan, located in Hubei province, where the virus first appeared, nearly a health care for around 20 thousand cases is tried to be provided. Outside China, only two people have died, one in the Philippines and one in Hong Kong so far, while the Japanese Ministry of Health has announced that the number of the infected cases have increased to 20 on the Diamond Princess ship, which has 3,700 passengers under quarantine.

 

Another passenger ship carrying 3,600 passengers is also under quarantine in Hong Kong. 350 US citizens, who are evacuated from the center of the epidemic-Wuhan, are also kept under quarantine in their homeland.

 

A medical solution has not yet been found for the Coronavirus outbreak, which has become a global threat. The World Health Organization has declared the "Global Emergency" regarding the Coronavirus. Secretary-General of the WMA, Dr. Otmar Kloiber answered the questions of the Mezopotamya Agency (MA) regarding the quarantine measure and the responsibilities of the states applied to prevent the spread of the Coronavirus epidemic.

 

People in China live under strict life conditions due to quarantine. What is your opinion on this strict quarantine and how efficient do you think quarantine applications are god to prevent a plea.

 

First of all, for those diseases that can spread, the infectious diseases, which we have no other measures and when we know that they spread rapidly and freely among populations, quarantine is the only measure, which we really have.  So quarantine is a very extreme measure because of the restricts in the freedom of the individual person or patient, quite clearly. However, in order to protect other people from the same disease, it is certainly necessary. Quite frankly, this would only be done if the disease itself bears some severe consequences, like severe illness or death like in this case. You would not do this for common cold, which you likewise cannot stop to spread, but clearly for those cases where you have no other measures and which are really threatening, the quarantine is a valuable measure. Whether it works with whole population, I am not sure whether we have enough evidence for that in cases like this, so it will show how good this measure is good to help to contain the disease or at least to reduce spreading. It is quite obvious that the disease has spread already and the quarantine of Wuhan could not prevent the disease going out. Maybe because measures were taken too late. It is something that is just too early to say in order to be fully based on evidence. However, from public health’s point of view, mass quarantines are extreme measures, but in some cases, they are the only measures we have. 

 

In general, how do you evaluate the application of quarantine in terms of human rights in terms of social health? Would you consider it to be threatening also for the human psychology, the conditions of isolation brought by quarantine? 

 

Yes, again, quarantine is an extreme measure and a measure of last resort. You do not put somebody in quarantine when you have other measures, which are likewise efficient like the treatment. So the quarantine is of course the restriction of individual freedom and of course produces psychological stress to those who are in quarantine that maybe even a severe stress if you are isolated alone without direct contact to other human beings. Maybe a little bit less dramatic If you are quarantined in-group and you still can socially intact, no doubt. On the other hand, our freedoms are always freedoms in a society. They are freedoms together with other people and our freedoms have to be always balanced with the freedoms of others. And if others have also the freedom not to be infected by you they have a right to be protected. So there must always be a balance of such course of measures and individual rights that have to be protected also for other people not to be ill, not to be infected and not to be even endangered which is obviously the case of such a severe disease here.  

 

The news of death due to Coronavirus comes from other countries than China. The last time the news came from Philippines. What does this show? Are we really in danger? Can we talk about an increasing danger of Coronavirus from your perspective?

 

Well, let us have a look on the figures. So right now as of yesterday, we had around 60-70 thousand infected people. Out of this, we have about 360 deaths. As far as I see it correctly, roughly a relation of 2% of people who have been dying. This figure may change. So this is a preliminary figure. Now we have about 180 cases, no I am sorry we have about 2% of death, but we have about 180 cases  of the disease outside the country, outside of China and 1 death only so far which we see the person has unfortunately died in the Philippines. This means that is certainly less than 2%, but the numbers are so small that right now it is completely impossible to make any prediction of the fatalities will be outside China. So I only can caution to take any conclusion from the law number of death outside China. This is far too early to say anything about the fatality rate, the mortality outside China. It may turn out the same, it may turn it lower, and it may even turn out higher. We simply do not know yet and I only can caution to speculate that this disease will be milder outside China. We do not know this yet. 

 

 You said that there are other measures other than quarantine in order to prevent a plea.  Are there the other measures that could be developed other than quarantine for Wuhan?

 

Let me be quite clear. If there are any other measures that could be applied, then they should be applied. But there are cases like this one where we do not know if there are any other measures.  We, for instance, do not know whether physical barriers, like wearing masks, certainly not those paper masks, paper masks are pretty much useless, at least in order to prevent the infection. But if there are ever other measures that are effective, if those are effective than the question has to be answered: is this enough in order to limit the spread of the disease? These can be physical barriers. Like, for instance, masks as protective gears that may be possible. This may be a medication that can be taken or if available, that may be a vaccination.  All of these, right now, does not seem neither available nor to give enough protection.  In such a case, then, a quarantine is the method of last resort that can be justified. 

 

 How would you evaluate the responsivity of state? What could the state has done to stop Coronavirus? 

 

In Germany, we have a saying: “Afterwards you are always more clever.” And then it is true for any of such situation. So, when this is over, we certainly will have to do a resume of what has happened, how communication has worked, where the communication was sufficient or where the communication was insufficient, or even totally appropriate or totally inappropriate. We have already seen that there are rumors spreading while theories of conspiracy. All of these has to be evaluated, as if they were helpful or not helpful in order to react properly to his crisis. There will be the question on how the first response of state bodies of the public health service and how politicians has reacted, but those are the questions which has to be answered afterwards. Now, in the time of the crisis, at the emergency, this is not the time to go into this discussion. 

 

Whenever it comes to the question what we have done right and what we have done wrong, it is important to do this without blaming and shaming.  We need to look in what it is we want to achieve, the protection and to heal people. And the question of what we have done the right way and what we have done the wrong way is something that has to be done in the time when this first crisis is over, when we can sit down and see what have been the right measures and what have been the wrong measures. We will not only have to look on the first response around this, we will also have to look into the questions that how well we all are prepared for this. 

 

And I see big deficiencies, not only in China, ,where the very supplies run short, but I see them likewise in our countries in Europe and probably also in other parts of the world, where we already find that supplies, protective supplies for instance, like masks, like gaunts and so on come short in supply. And there are the questions, which we have to answer: Is it correct how we deal economically with those problems of emergency preparedness? I have my doubts if we were correct in the past, but again this is not a question for this moment. This will be a question, which we have to answer afterwards. This will be something, which we will have to discuss and take the consequences from what we have learnt during this crisis and during the previous crisis. And again, in all parts of the world, there is a lot of homework, which we have to do.

 

As the World Medical Association how is your work and studies on Coronavirus? How do you evaluate Coronavirus?

 

As the World Medical Association, we, in the first place look on the questions of how we can be better prepared and better counteract to such a crisis. Now, of course, from a scientific point of view, the most interesting thing would be to have a vaccine in order to prevent all of this, but we know that the next disease will come. Because the development of these viruses is a very rapid, steadily ongoing process in nature. So there will be other pathogens that are coming and the question is: what can we learn? Now what I see is that already many interesting things have happened. The exchange of the virus into motion has been much better than before. There are groups all over the world already working on treatment questions, on preparation questions, on what information they got from China about this virus. This is, of course, very interesting. 

 

But then there are other questions for us as well: How can we better prepare? Like, for instance, stock piling of medicines and making the supply chain better than what it is now. And for us the matter is to convince politicians to invest more in the emergency preparedness. What we have done before and now it turns out that just-in-time delivery for hospitals, for medicines, is not really the best way of dealing with those questions especially when you look into the question of emergency preparedness. Because what we need is, we need in times when we have the situation to isolate people of populations; we have an immediate need of local stockpiles, which quite obviously are not there in the sufficient manner. And that is something, which we certainly will look into how we can in this process together with politicians and those in charge for equipping the public health services have to react in the future and what we have to change. So that will be something which we knew. And of course we are certainly also looking very much to our scientific community of what would be the results of the best treatment for infections we have, but also the best ways to prevent those infections, for instance, the new vaccines. 

 

Dr. Kloiber thank you so much for your valuable answers. Is there anything you would like to add as a final message?

 

I think I have said the most important things. We now first have to solve this crisis and I think everybody has to concentrate on serving the patients and we have to prevent the further spread as far as that is possible.  Afterwards we will look into the learnings for the future. 

 

MA/ Zemo Ağgöz- Eylül Deniz Yaşar