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

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[Should the elderly be confined?]

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I'm 72 years old -

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

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

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

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So my answer is no.

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[Should people at risk be confined?]

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It all depends on how you look at that question.

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

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

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

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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

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and their quality of life, then we have won.

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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.

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

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

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[How about the balance between benefit and 
risk?]

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

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

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

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

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in comparison to the risk of serious complications.

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

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

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

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

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

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we also realise that it is transmitted sexually.

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

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

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[What about masks?]

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

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

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

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

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that would carry the virus if I myself was 
infected.

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

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However, we can stand in solidarity with 
people at risk

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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.

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

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

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

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

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

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

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

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

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

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that interfere with their education.

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

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

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

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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.

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[Should we trust the experts?]

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

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

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

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

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

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

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

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

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[A lack of debate?]

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

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

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

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

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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?

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

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

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

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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.

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

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

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

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

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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

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

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

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[After Covid?]

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

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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.

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

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

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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.

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And for that it requires a democratic debate.

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[Immunity? What immunity?]

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

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

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

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

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

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

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

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

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

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

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

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

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The ingredients are that of an effective 
response to viruses.

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

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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.

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

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

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

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

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

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

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

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

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

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

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

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

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and do they communicate with each other at 
all?

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

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

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

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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?

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

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

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

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[What are the epidemiological models worth?]

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

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

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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.

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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.

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

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

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

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

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no: AIDS was going to have a negative impact.

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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

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

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

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

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

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

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

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have Roberto Martinez in the panel of experts.

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

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

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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

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

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

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

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if you're going to capture individual behaviour 
and relationships

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

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

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

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If we look at the world in this mechanical 
way,

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

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[Your vision of the world?]

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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.

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

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

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with economic development being the absolute 
value,

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and messing around with it is 'KO'.

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

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

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

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

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And today, this is being questioned quite 
a lot.

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

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

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

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The alternative is the total loss of our 
free will,

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

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[What's your creed?]

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The reappropriation of public goods through 
the appreciation of forces.

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

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

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

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and I try to learn from them.

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

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

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

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

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

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

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

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without always going to the mayor.

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

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

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

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

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

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

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and that is obviously a big issue.

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[Health-care funding?]

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

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but also the mechanisms of health financing.

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Today it is private healthcare in the majority 
of cases,

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

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

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

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

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

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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.

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

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

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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.

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

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

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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.

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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.

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on what mechanisms will make individual care 
more efficient.

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

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

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

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maybe especially the funding mechanisms and 
leasing.

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

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