[The Covid-19 Crisis: An Interview with Dr Jean-Louis Lamboray, 22 June 2020]

[Should the elderly be confined?]

I'm 72 years old -

don't tell me to stay at home until we get a vaccine.

You will find me on the street because I am an active citizen:

I am capable of judgement, I am capable of protecting myself and I am capable of solidarity with others.

So my answer is no.

[Should people at risk be confined?]

It all depends on how you look at that question.

Do we see the world as a set of problems? Do we see people as entities that can be manipulated at will?

This is when we must see people as actors in their own right.

If we do indeed see the person at risk as being in the best position

to decide what they can do to protect themselves from becoming ill, in an environment where they can see the balance between the preventative actions they take

and their quality of life, then we have won.

So if we stay at home until a vaccine is developed, then you're looking at a 72-year-old guy who's going to demonstrate. It's simple.

That we're being taken for victims, we are not. We are already quite capable of participating in the discussion,

and can act to reduce risk in the same way that we do in all kinds of public health crises

[How about the balance between benefit and risk?]

Here, it looks like we have made an exception to good public health practice

I'll give an example: during the flu season, we don't tell children to get flu shots.

But yes, they will likely get the flu and I don't have a problem with that.

We will, however, reccommend people at risk to vaccinate against the flu, because the cost of the vaccination is worthwhile

in comparison to the risk of serious complications.

Another example: we don't tell young girls to get mammograms.

Mammograms are done on women who are at risk of breast cancer.

Therefore, this risk-based approach makes perfect logical sense.

If I may draw a parallel - a little daringly so- let's go back to the 80s when a virus was also circulating.

After we realise that it is a retrovirus, and even more, hides in cells,

we also realise that it is transmitted sexually.

But we didn't say "attention: stop having sex, there is this sexually-trasmitted virus".

We instead said "listen, if you take risks in your sexual behaviour, protect yourself". So the parallel is having a risk-based approach.

[What about masks?]

Masks or no masks? The first thing is to know how to properly remove a mask, especially without touching it,

as we are not used to wearing masks. It really is a lot of work and can't be learned automatically.

Outdoors, it's not necessary, but when sharing confined spaces with those at risk - why should we wear a mask here?

In these cases it is precisely because wearing a mask will prevent me from possibly spreading saliva droplets

that would carry the virus if I myself was infected.

And so if you do not know whether you are infected or not, wearing a mask is useful.

However, we can stand in solidarity with people at risk

if we all wear a mask in public spaces where there is likely to be people at risk, such as in hospitals, on buses and the metro.

So let's talk for a few minutes about the loss to the person at risk.

A quarter of the Belgian population is at risk of developing serious symptoms of Covid.

This is a combination of coronavirus and an underlying condition. So who are these people?

These are those over the age of 65, and those younger who suffer from diabetes, obesity or lung disease.

That's basically it. Those are the people at risk.

It's because you have to separate the probability of contagion from the risk serious complications,

and I think that it is incredibly important to make this distinction. How come?

Because, for example, in schools, children can catch the coronavirus, but it will not become a serious disease that leads to death.

And so there is no reason to subject children, for example, to all kinds of extraordinary measures

that interfere with their education.

Even at this stage, there is no reason to stop them from going to school.

There is no reason to stop children from going on camp, nor is there any reason to protect teenagers from the coronavirus.

But the probability that they will suffer from serious covid that may lead to death is not zero.

So let's keep the extraordinary measures - wearing a mask, social distancing - for cases where we find ourselves having to take special measures because we are with people at risk.

[Should we trust the experts?]

Today the predominant vision is that of mechanics: inputs are put in and are tranformed by a process that gives results.

And in this context, of course, the experts - the public authorities - see a problem.

And so they try to solve this problem, through measures that they assign to a party or the population.

But I will say: where is the debate at several levels?

Where is the debate between experts? Who are these experts?

Yes, the results of their deliberations are being published today, but what is the sum total of their experience in managing epidemics?

For example, why do they simplify what they say? They have epidemiological models. What is the capacity to make decisions based on these models?

These questions need to be debated, and personally, I don't see that debate happening.

[A lack of debate?]

The citizens point of view must be formulated for virus to be managed locally.

It is - I would say -mayors who can be facilitators of joint action of all the living forces of the nation.

I do not see where, for example, elderly people have been able to express themselves as elderly people.

I have 12 grandchildren. It has been sad to see how they've been confined.

But if we asked the grandparents: in order to protect you, do you wish to impose such a long period of confinement on your grandchildren?

Before their grandchildren, I would be very surprised if some grandparents were to speak in favour of this.

I can't imagine this. It would be the opposite if we explain to the young people:

"there was a time where we had to confine you to the house, because frankly, the country wasn't ready.

But now that we have things under control and are more prepared, what if you have a party to celebrate? There is no danger for you.

But please do this in solidarity with your grandparents and your aunts and uncles

in the areas that you meet by wearing a mask and practicing social distancing".

I also think of these young entrepreneurs. They had just began their start-up, and then they are told to stay at home.

But it's possible that their start-up needs physical interaction,

but they are all young people. What are we going to do with all kinds of me he liked to bet and put people at risk and therefore has a need for local conversations

in families, in workplaces and in neighbourhoods. We need to be talking to each other.

If we don't talk and think together, then we cannot act together.

[After Covid?]

We are talking about pre-Covid. There is no post-covid.

Post-covid is now. It is the way we manage ourselves, that is to say, how all of us manage the crisis, which prefigures the way that we will live in the future.

And that's why it's very important that we open a dialogue and revive solidarity.

That we build on the solid gestures of solidarity that have been there following the lockdown.

So let's be solid in the way that we address covid so that when there is a 'covid-25' or 'covid-35', we are ready.

And for that it requires a democratic debate.

[Immunity? What immunity?]

So we're talking about immunity. How do you get immunity?

The first way is by becoming infected and thereby letting the body develop a resistance to the virus.

So that's the first way. The second way is by administering a vaccine,

which of course artificially stimulates the person's resistance to the virus.

So, all right, if a vaccine comes that is effective with no side effects and is not too expensive - hallelujah!

We are not going to be ungrateful to this; we will welcome it!

But don't let them tell us that this is the solution.

Why? Well because, what is effective against Covid-19, will not be effective against 'Covid-21' or 'Covid-35'.

We'll get caught again in this situation, so there is a third dimension which is social unity.

If you would like, I'll give an example. It was during AIDS. The representative to the general assembly of Eastern Thailand

said there is no AIDS vaccine, amd there is still no AIDS vaccine to do this day.

This was pronounced 15 years ago. But there is a social vaccine. What are the ingredients?

The ingredients are that of an effective response to viruses.

The first dimension is political authorities. Are they clear from the outset in what they warn and what they say,

as the Prime Minister of Singapore said, "here we have this case, but what says afterwards, but are we quite capable of dealing with it?" What does it say attention is serious or he says no no no, together we can get out of this.

That's the first dimension. Now, the health care systems.

Are they able to detect the sick? Are they able to treat them?

By the way, are they capable of sending messages to seem in such a way that people can take responsibility.

Has enough been invested in public health, not the health of individuals?

So that we can make strategic stocks of masks, tests and also be able to track cases

in such a way that we can inform, in particular, those at risk if they or someone in their family has been exposed.

Third is us - the citizens. We know that basic barrier measures include washing your hands in all kinds of circumstances,

not touching your face except after washing your hands and probably avoiding contact when greeting each other.

Let's say that those three elements are probably the basic elements,

which already allow us to have some effectiveness in avoiding transmission of the infection and to avoid becoming infected.

In the case of Covid, our morals make us more vulnerable than perhaps in other cases.

And so, if we can get past all the countries I'd say the authorities, the health authorities, the public - what do they do,

and do they communicate with each other at all?

A little earlier I was on the phone with the faculty of sociology at the University of Potsdam,

I said to them: I'm interested in how you are living. A young women said: listen, we had a party

but before the party we told each other that we were still being responsible.

What did we do? We went to the local health authorities. And we said yes, but what can we do to reduce the risks here, what can we do intelligently?

The authorities told us that they've been following it. Obviously the police didn't come because everyone acted responsibly

and when you go through their analysis grids of the different places you can see Thailand, Singapore, Sweden, and us.

And in this way we see how far we are to having social immunity from the beginning and how we can expand up it.

[What are the epidemiological models worth?]

When I was working at the World Bank, during the first study on the economic impact of AIDS a country - it was on Tanzania.

So of course the team's economists, epidemiologists and I were in charge of the interventions

of what could be done, and they were able to build a model. We went to Tanzania several times and we did a lot of work.

All the data from the epidemic and the impact of AIDS on the economy by the ton made the model work and the result was that AIDS boosted the Tanzanian economy.

Why? It lowers population growth and so it's going to have a positive effect on per capita economic growth

and moreover health care expenses increase and that's a beneficial effect,

so what do the economists and epidemiologists do? They opened the hood of the model, they turned a few carburetor screws,

they closed the model and we don't have to go the government anymore,

no: AIDS was going to have a negative impact.

The models that I know of are not capable of conceiving people in relation to each other, nor from the outset conceive of individual motivation

and the willingness to connect as a factor. Models, if you like - I'll make a daring parallel with Fifa.

Fifa is based on money, it's a database of the people who play.

But Robert Martinez, he doesn't manage his team of the basis of Fifa.

He knows that each one of his players are capable of decision,

so even if the models can inform him from time to time, he knows that there are other elements at play in achieving victory.

It is the same for Covid. So I too have a recommendation:

have Roberto Martinez in the panel of experts.

[Are policy-makers too much influenced by the models?]

As I'm not in the head of the political decision-makers, I can only make a hypothesis

That is to say that like all of us we would like to be assured. So here my model says that's it's reassuring to read so the science wafik

You have to know that when we make up the model, we are obliged to make a hypothesis,

then these hypotheses, they are the possible meshes - we respect that.

But they are only hypotheses, and all these models have this inability again to understand

if you're going to capture individual behaviour and relationships

between people. So why are we discounting it? Again, it depends on the worldview.

If you look at the world as a set of cogs and wheels,

which are fertilizer is in a way that Newtonian style only ten years ago.

If we look at the world in this mechanical way,

well yes, we can more or less change the terms of the model.

[Your vision of the world?]

Here, too, we need to understand that we in the midst of nature, in a relationship between the human person, the natural environment and the universe.

Until we recognise that we're in this relationship, as long as we aren't acknowledging this,

we're going to remain in a mechanistic, unfortunately often at the service of the production and economic process,

with economic development being the absolute value,

and messing around with it is 'KO'.

The organic vision, the holistic vision - this is a vision that is centered on nature.

In this vision, we are part of nature, we aren't exploiting it - we aren't apart of that.

Us Westerners thought that we were a few steps more rational than the others,

and thus entitled to exploit the rest of our structures and resources including people.

And today, this is being questioned quite a lot.

It is being questioned in the same way as a mechanistic vision of the response to Covid - .

this is also being called into question. This is the parallel and the answer lies in the discussion,

in the co-creation of what we want as citizens of the world.

The alternative is the total loss of our free will,

it is our progressive lobotomization where we will be good citizens for a dictatorial power.

[What's your creed?]

The reappropriation of public goods through the appreciation of forces.

This is what we have been doing at Constellation for at least 15 years.

That is to say, when I come into contact with another person, I am there to learn from that person.

I don't see them as a problem, I see them as someone who has gifts

and I try to learn from them.

Whoever they are, whatever their characteristics - whether poor or rich, a sex worker

or a nun. It's not important. I'm looking to take from each and every person.

From every person but also from every human group and therefore from each person.

We are working in an agora, and in the agora, we are all neighbours -

elected or not, expert or not - we come together as neighbours.

And we start from our experience as neighbours and we recreate the world, that is to say,

we recrease our dream for and from birds, starting from what we can do ourselves

without always going to the mayor.

The mayor will only come when we cannot act on our own.

This calls for a complete review of the role of the political authority.

Are we ready to let go of the space for citizen dicussion so that we complement where we are useful?

But where indeed citizens are getting away with doing things amongst themselves - hallelujah!

It will be a lot less tax - that's a win-win situation!

But for that to happen, we have to let ago of the political authority,

and that is obviously a big issue.

[Health-care funding?]

One of the elements that will need to be debated is not only the level of health financing,

but also the mechanisms of health financing.

Today it is private healthcare in the majority of cases,

except for in medical centres, which use a different system.

In private healthcare, it is obvious that the income comes from the procedures.

The more procedures I perform, the faster I can pay back my loan.

The hospital's revenue is also sustained by elective examinations.

[Sarcastically] "Listen madam, we might as well try - you never know".

So we avoid in the world never knows. And therefore it must be the case that these incentives are not necessarily a source of deficiency, it must be said.

And we can see that today. It's my hypothesis that more and more young people are saying:

I don't want to work like my father or grandfather who were doctors,

who worked 10 - 12 hours and we saw him arrive exhausted at 10 in the evening and leave for work at 6 in the morning.

I don't want that life. I'm ready to work on a fixed price basis, in other words, I have clientele

of as many people nd I get as much per person and my goal is to maintain good health.

I'm ready for that, and I can work three-quarters of te time because I am a woman and I also want to take care of my children with my husband.

Okay, I don't want to be just a slave to medicine. And so you can see that there's a lot of thought on this.

on what mechanisms will make individual care more efficient.

The big bang vat fraud now there's something else there's that but there's all the funding for public health.

Although, education for health, I think I've seen a figure - 73% of the total budget.

So there is really a need to review - deeply review - not only the level but I would say

maybe especially the funding mechanisms and leasing.

Voila. I'm exhausted - thank you so much.

[Directed by Bernard Crutzen] [2nd Camera: Diego Crutzen Diaz] [Music: Christophe Monthieux]