While the COVID-19 outbreak is hitting Indonesia, it seems some important pieces of information are missing.

The coronavirus comes from the ribovirus family, that of the common cold virus. There are several variants of coronavirus, which can cause anything from a common cold to more severe pneumonia. However, COVID-19 – which is caused by the SARS CoV2 virus – has more dramatic consequences.

Nevertheless, this relation with the cold virus will be interesting to study. As a matter of fact, scientists all around the world are debating over the potential impact of climate on the spread of COVID-19. While there is no strong evidence at the moment, it is important to note that it might not diffuse well in tropical areas.

Colds are more common in winter because of the tropism of the virus for cold mucous membranes, which is at 33 degree Celsius.

Also worthy of note is that, according to Pascal Crépey, an epidemiologist at the École des Hautes Études en Santé Publique, Rennes, France, influenza progression depends on seasonality, both in the northern and southern hemispheres, and this could very well be the case as well for the COVID-19 coronavirus.

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The fact is that currently the epicenter of the epidemic has shifted from China to Europe, with a significant impact in Italy, where there were already 3,405 deaths and 41,035 cases of contamination as of March 20. The death rate seems even higher than in Wuhan, China.

It should be borne in mind that 25 percent of the Italian population is aged above 60, which might be an important factor, as it seems that the mortality rate is much higher for the elderly. Comorbidity factors are also essential to take into account: diabetes, obesity, hypertension, smoking, asthma, pulmonary weakness and other factors involving weakness of the immune system.

Second, about the lethality percentage: To what extent will the coronavirus overcome the impact of a "super flu" like the epidemic that ravaged the south of France in 1720, exterminating a quarter of the population (100,000 dead out of a total population of 400,000!)?

Be careful not to confuse the death rate reported for the number of cases identified, with the rate reported for the total population. The discrepancy is huge, and yet the amalgam is often made, giving a sensational effect.

We forget that a very large part of the infected are "healthy carriers", that is to say asymptomatic: The virus has passed through them and they will develop immunity, but will not be sick. People without symptoms have to be taken into account and that's half of the people infected.

Only of a portion of the global population will be infected, far from the total, which also lowers the lethality percentage. Overall, far less than 1 per thousand people can be expected to die from this disease.

Still on the subject of this mortality rate, seeing deaths on TV is impressive. Hospitals are under pressure in Italy, but it must be borne in mind that the simple flu also kills hundreds of thousands every year, without any lines on front pages. Its impact is spread over six months in winter, while this coronavirus made its blitzkrieg in just two months.

Does it deserve extreme panic to the point of paralyzing the entire planet?

This is still an open question because the COVID-19 pandemic is not over yet. But still, the figures from China, Taiwan and South Korea show that the order of magnitude is a few thousand dead, not tens of thousands, let alone hundreds of thousands.

The question deserves to be asked because an extreme economic impact also means casualties, directly through famine in the most fragile countries, or indirectly through a reduction in the quality of health care for populations impoverished by bankruptcies.

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How useful is it to drastically confine populations? According to epidemiological simulations, it makes a significant impact if undertaken very early. In Italy and France, the drastic measures arrived far too late to change the situation. 

But with the enormous advantage of smoothing the number of cases requiring hospitalization over time, the flow of patients will be slowed down. This is a good measure in order to avoid overloading the capacity of the health services. The number of respirators is limited (5,000 in France).

What lessons can Indonesia learn?

Again, it should be remembered that the usual flu kills tens of thousands of people annually. Even if COVID-19 is two or three times worse, it does not seem that the order of magnitude would be radically greater.

Indonesia is a tropical country and it seems that the climate might have an impact, making the extent of this virus becoming widespread less likely. Its population is young, so the vast majority of infected people will resist well. Physical distancing is important and slows the progression of the virus, but it will in any case contaminate a large part of the population.

The measures taken by the government are good and the people should not panic, since it is not a modern plague. Much more drastic measures would have other equally deadly side effects: the impoverishment of the little people and a significant increase in the prices of essential materials.

A final point, last but not least, is very important: French biologist Claude Bernard said: “The microbe is nothing, the ground is everything.” No matter the virus, it is how the immune system will be able to manage that matters.

How to strengthen your immune system and greatly increase your chances of resisting COVID-19 and all other possible infections? This is the essential question that should be asked.

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Graduate of Department of Virology, School of Medicine, Pierre and Marie Curie University Paris V

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