Prof Emmanuel André, former spokesman of the federal crisis centre, has supported Belgian citizens since the beginning of the lockdown by informing them daily on the evolution of the pandemic. He is now responsible for organising the tracing to help eradicate the propagation of the pandemic and devotes his energy to the community during this critical phase of unlockdown.
What lessons can we learn from this pandemic?
Emmanuel André: It is premature to draw all the lessons because the epidemic will last for several more months or even years. However, at present we can see that, despite very efficient health and social security systems, Europe has shown itself to be very vulnerable to this new disease. The old country has probably forgotten the importance of preparing itself for infectious diseases, whereas it has been able to eradicate the epidemics that have marked its history one by one, through hygiene, vaccination, antibiotic therapy, etc…
Europe was very badly affected because it was not sufficiently prepared. “Pandemic” plans are not up to date with the risks, in terms of protection systems and communication of information between countries. The carnival holidays, a time of great migration, were one of the key moments in the start of the epidemic. Better and more fluid information systems and information exchange between countries could probably have made it possible to better assist each other in this preparation. Without laying the blame on any one country in particular, it is the overall information flow system that will probably need to be improved.
Are you worried about a second wave?
Emmanuel André: The second wave will probably be much less strong but it will be much longer. As countries open up, with economic and social recovery, the virus will start to circulate again, more slowly and in different circumstances, with the protective measures that everyone knows. If the epidemic were to resume, containment measures would once again be in place. It will be necessary to monitor, to have effective systems for monitoring the epidemic. Communication between European countries will be crucial.
What will be the biggest challenges in the future? What are the expectations at European level?
Emmanuel André: The biggest challenge at European level will be to reopen borders and to build trust between countries to allow the flow of people. If we see a resurgence of the virus in any one place, then people going or coming from that place will be more exposed than the rest of the population. All European countries must be able to keep the circulation of the virus as low as possible. In order to do this, it is much more effective to act on preventive measures to avoid contamination such as social distancing, wearing masks, hand hygiene, adaptation of infrastructures, office architecture, work spaces, etc. Second, it will be necessary to be able to identify cases of infection and to provide universal access to diagnosis for anyone suspected of being infected, and for all their contacts. It is essential to include every person, foreign workers, homeless people, migrants, etc., in the health system from the outset.
This will make it possible to act very quickly and avoid the emergence of new outbreaks at the national and international level and thus extinguish fires as soon as they are detected. There is therefore a role in coordinating recommendations between countries but also cross-border control systems. Countries were concerned about what was happening intramuros, managing the health emergency on their territories. Today, we are entering a second phase of communication and preparation for the future, particularly in terms of applications that must be interconnectable between countries.
Do you think that vaccination will help to protect the citizens, even though the virus seems to be mutating rapidly?
Emmanuel André: A virus mutates by definition every time it replicates. This is not something that will prevent the development of a vaccine because it will target the stable and essential parts of the virus, not those that mutate. If the virus mutates on its main functions, it will no longer be viable, it will no longer be able to infect and will disappear on its own.
Belgium was one of the hardest hit countries. Why are there so many deaths in Belgium?
Emmanuel André: The death surveillance system in Belgium has been one of the most effective compared to other countries. All deaths in hospitals and nursing homes were recorded. We knew from information from China that the elderly were the most vulnerable. This component is starting to be taken into account in other countries, which will reduce the differences, even though Belgium was severely affected.
How long do patients stay in the intensive care units on average?
Emmanuel André: The length of stay in the intensive care unit varies greatly. It all depends on the severity of the illness and the fragility of the person. It ranges from a few days to several weeks.
As the person in charge for the tracing, could you explain what the tracing refers to exactly? Tracing has also its limits concerning the private life. What is your opinion?
Emmanuel André: Tracing is a method of accompanying people who have come into contact with an individual diagnosed as Covid-19-positive and are therefore potentially infected. This small high-risk group must be able to receive special support, remain in quarantine for 14 days, obtain answers to their questions and be cared for by their doctor for medical follow-up. Inevitably, this raises questions about privacy. Medicine is by definition people’s private life, but it is covered by medical secrecy. The fundamental principles of balance between health and privacy are inherent in all medical activity.
Should we prepare for other pandemics in the future?
Emmanuel André: This type of new virus that emerges from the animal world and is accidentally transmitted to humans is a phenomenon that is continually observed. Indeed, we can expect to have new diseases. We do not know when or which virus will arrive. But if we take the family of coronaviruses, between SARS and now Covid-19, we have seen the emergence of 3 viruses in the space of 15 years from the same family. The animal world is a huge reservoir of viruses, some of which may one day be transmitted to humans.
