Coronavirus: the letter from the Spanish doctor that has gone viral

In a letter that has gone viral, Margarita del Val, a researcher at the "Severo Ochoa" Molecular Biology Center, a Spanish immunologist and virologist, explains the importance of drastic measures against the coronavirus (COVID-19).

The text, which has been disseminated in the main world media, highlights the importance of moving from thinking on an individual level, to considering ourselves as part of a society and working as a team with more empathy.

You can read it below!

The letter that has gone viral


I am a virologist and an immunologist, but not an epidemiologist.

In my opinion, the key to understanding it is move from the level of the individual to the level of the epidemic, which suffers from it is society.

I understand your amazement because I agree that it is not said why these unusual measures are taken, and I really do not understand why it is not said. Soon, for those who do not want to read more: these measures are taken not only to protect each one of us, but especially to protect the vulnerable and especially those who heal us, so that the toilets do not become saturated or become mass sick and can heal us to all. I also understand that you do not want to alarm the population so that they do not go to the doctor unnecessarily. Still, like you, I miss an explanation for the drastic measures.

Some points to understand it, IMHO:

First, Mortality appears to be somewhat higher than that of the flu, but the most vulnerable group is similar and speaking of the flu is not far from what it is. The flu, by the way, is not as banal as we think. Every year 6,300 Spaniards die of influenza. Many more than from traffic accidents. Special attention must be paid to people with previous pathologies of various types and to older people: mortality in China approximately doubles with each decade (look for exact data if you want), reaching 14.8% for those over 80 years of age .


BUT: (and I don't want to alarm): At the collective level, there are several differences that justify this care, these quarantines, this social and economic impact. This is what the full content of the word epidemic is: that the impact is at the collective level, at the societal level, not just the individual one:

It is a new virus and science knows very little about it. And therefore it can predict very little. But scientists do well to work hard and try to understand everything possible

We have neither an antiviral nor a vaccine, while against the flu we have vaccines, which can be improved, but we have. Nor do we know if all science will succeed in producing vaccines; It is possible, but until we have them, we don't know. We have vaccines against few infectious diseases, do not forget that there are infections that resist despite tremendous worldwide scientific efforts, such as HIV or dengue, malaria or tuberculosis, and many more.

It is much more contagious than the flu, Among other things, perhaps because we have some past immunity against the flu, but against this virus we are totally helpless, naive.

The flu is sick (that is, with symptoms like going to the doctor) 1% of the population every year in the winter season. Which means that maybe we do not know what a flu is in our lives – we may not have more than one in 100 years – not to confuse a good flu with other milder infections with very similar symptoms. And about 30,000 are hospitalized each year.

From coronavirus we can infect, theoretically and without quarantines or barriers, 100% of the population in a few months, in the worst case. Well, only 20-25% will have symptoms, in the worst case.


We cannot allow the free circulation of the coronavirus because it would make 17% of the population sick (severe or critical) (current Chinese data), a number of patients that is unabsorbable by the health system.

Therefore, quarantines, contact tracing, and any measure that manages to reduce the speed at which we will slowly infect almost all are necessary. You have to win as much time as possible so that everyone's infection will hopefully take 100 years. You have to buy time for a vaccine or treatment. You have to buy time to see if you are lucky and it fades in the summer. Or it disappears, like SARS, with containment measures similar to the current ones. You have to buy time for an antiviral. You have to buy time to see if I live longer and don't die prematurely.

But above all, our healthcare system must not collapse. Because it is a disease that, with health care, is much less harmful and much less deadly than without it: oxygen, hydration, antipyretics, anti-inflammatories, antibiotics if complicated, life support … doctors know this for other pneumonias, but perhaps this virus has its own pathologies and sequelae.

In China, in "ground zero" mortality has been 8 to 30 times higher than in other provinces of China: "Asked why (in) Wuhan (the fatality ratio) was so much higher than the national level, the National Health Commission of China official replied that it was for lack of resources "(NHCC and WHO meeting, Feb 20, 2020).

Because the epidemic must be stopped, it is protocolized that the health workers are quarantined when they have been exposed without knowing it and without protecting a sick person. This is already done for pneumonia, measles, for example, and also now for coronavirus. If they become infected, even slightly, and they have to be quarantined, in order to avoid infecting very vulnerable patients, the health human resources will decrease.

Because the epidemic must be stopped, it is protocolized that the patients be isolated, in hospital or at home according to severity and according to the available resources. But in this way, with the necessary isolation measures, they will not even be able to attend to us if 1% of the population becomes ill in a few months, if it becomes the usual level that influenza reaches in winter, or if it becomes a year of hard flu. Lombardy has reached this past weekend of International Women's Day to levels close to the health emergency with about 350 cases per million inhabitants, far from 1% (which is 10,000 cases per million). That is why it has been necessary to adopt drastic measures for the movement of people. And the Italian Healthcare is the fifth in the world, with the Spanish the third, with all its shortcomings and greatness that we know, In Hubei they have reached a maximum of 1,200 cases / million. That is why they have had to build 16 hospitals in a few days and recruit tens of thousands of toilets from other provinces.

The epidemic must be stopped because the observation of Italy, of Spain, shows us that every week or ten days the number of cases is multiplied by 10. Make numbers in the short term, estimate how we reached the end of the month only if we remain reluctant to adopt or follow the recommended measures.

That is why we must respect all the containment, quarantine, and isolation measures recommended by the health authorities. Because even doing so, and being more prepared than ever in history to fight a pandemic, we are also more globalized than ever to expand and enhance a pandemic.

That is why, in addition to strictly following all the recommended measures, you must be sensible and limit your contacts. Because what is in question is not only if I am infected or not, but especially if I can infect other people or not, just the opposite. Remember, it is an epidemic. Therefore, cancel health congresses. Therefore, avoid unnecessary trips and in which we are exposed and exposing many people of diverse origins. So avoid crowds and large gatherings. That is why, when the company is closed because there is a case of coronavirus in your apartment, you should not go for a drink or visit your mother or make the purchase in a moment: they send you home not to protect you, who You are strong, young and healthy, but so that you are not a vehicle of contagion that could lead to the death of more vulnerable people in a couple of jumps of contagion, and even to you if you unexpectedly suffer from appendicitis and cannot be cured.

Not to mention if the same thing happens in a few weeks in countries with fewer resources.

Hopefully in the future it will become just a seasonal disease like the flu and the multiple respiratory infections that we suffer regularly. But to get there we have to go through the wave of the epidemic. And it has to be as slowly as possible. You have to buy time, any delay in the spread of the virus and the spread of the epidemic is important. Yes, it is possible to do it and the delays are in everyone's hands (never better said, wash them) even with simple measures,

In addition to an attempt to explain, this is a call to good sense and responsibility, once we have the data, the few data we know about this virus. The responsibility is not only not to panic, but also to think of others, who are always, always, the closest.

Well, this is my opinion. Greetings"

Marga del Val


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Complutense University of Madrid – Faculty of Chemical Sciences