Editor-in-Chief: Janusz Ostrowski IAHN Bulletin is the official E-Newsletter of the International Association for the History of Nephrology
INTRODUCTION TIME OF PANDEMIC The second half of this year is, perhaps in line with the predicted dark scenario, overshadowed by the pandemic. After many governments relaxed the restrictions during the holiday season, a second wave of the pandemic appeared in the autumn, with double strength in some countries. In addition to the negative impact on the economies of all countries, this resulted in the cancellation of all cultural, sports and scientific events, including medical ones, especially those of greatest interest to us, nephrology. The latter were and still are carried out only on-line. May this not become the rule in the future! Direct, personal contact seems essential after all. The organisers of the 12th IAHN Congress in Turkey are considering postponing the next year's congress to 2022. An official announcement in the matter should be coming up soon. The first optimistic information about the possibilities of fighting the virus is starting to surface, though. Of those concerning a larger scale, there is information about the launch of vaccination campaign against Covid-19 in the UK, we are also waiting for the upcoming vaccination programme in other European countries and the US. A long process as it might be, it definitely offers hope for a breakthrough in the epidemic situation in the world, fewer complications in the course of the disease, and fewer deaths. A few weeks ago, an issue of the Archives of Hellenic Medicine was released with full coverage of the lectures presented during the 11th IAHN Congress in Larissa, Greece. An exclusive book version was also prepared as History of Nephrology 12. The material was prepared in an extremely professional and attractive way by prof. Athanasios Diamandopoulos and prof. Ioannis Stefanidis and will certainly be an excellent source for historians of nephrology and beyond. Some members of our society, as well as its supporters remain very active in this difficult period. It is certainly very much true of our dear Friend prof. Natale De Santo whose activities meet widespread admiration and respect. Due to the relatively un eventful season, I turned to many acclaimed representatives of our community from different countries to prepare a publication presenting their outlook on the reactions of societies in their respective countries to the course of the pandemic. I personally find it quite an interesting topic for now and in the future. My request met with a positive response from some. The materials I received made a great impression on me and confirmed my assumptions. Anyway, it is for you to judge, my friends. The upcoming Christmas looks like a great opportunity to read these accounts. The works were prepared by prof. Raymond Ardaillou from France, Ing. Katarina Derzsiova from Slovakia, prof. Athanasios Diamandopoulos from Greece, prof. Michał Kopczyński from Poland and prof. Natale De Santo from Italy. For the whole Christmas season and for the entire New Year 2021, I wish you all a lot of health, rest and peace, and come back to the life we know from before the pandemic as soon as possible so that we can meet again face to face shortly. Merry Christmas and Happy New Year Janusz Ostrowski
The Covid-19 pandemic has changed the life of our country as well as that of many others with, however, specific characteristics that I will try to identify. The majority of French people are used to criticizing the decisions of public authorities and of scientific experts, and are rarely unanimous in their opinions. Basically, some criticize the lack of preparation for the appearance of a new emerging disease, late decisions, contradictory assertions. Some French people have even gone so far as to launch legal proceedings against successive ministers of health who were guilty, according to them, of knowingly endangering the lives of others and being responsible for the deaths of dependent elderly subjects housed in establishments intended for them. Others, on the other hand, criticize the public authorities for giving priority to the fight against disease by imposing a 2-month period of almost total confinement, which has destabilized the economy and prevented schoolchildren and students from continuing their schooling, especially those whose parents are unable to help them.
No. 5, December 2020
Janusz Ostrowski Professor, Centre of Postgraduate Medical Education, Warsaw, Poland
Board of the International Association for the History of Nephrology Iwannis Stefanidis – President Janusz Ostrowski – Past President Ayse Balat – President Elect Vincenzo Savica – Treasurer Councillors:
The Covid-19 pandemic in the Slovak Republic The course of the first wave On January 20, the Chinese government officially announced the emergence of a new virus with human-to-human transmission. In March 2020, WHO finally decided to declare a pandemic. Despite the frightening news of the situation in China and even after the outbreak of the Covid-19 pandemic in Italy, medical authorities in Slovakia behaved as if it had had nothing do with us. In addition, at that time in Slovakia, elections were approaching and politicians were more involved in the political campaign. It was only in late February 2020 during the pre-election moratorium that they started to pay attention and took action. The first case of Covid-19 virus infection was recorded on March 6, 2020 in Bratislava region. With the situation deteriorating, Slovakia officially declared a state of emergency on March 15, 2020 when strict measures were taken. Borders with the neighbouring countries were closed, airline, international rail and bus transportation were cancelled. Based on a measure of the Public Health Office of the Slovak Republic, due to the threat to public health, all retail and service establishments, except those providing for vital needs, were closed. Compulsory wearing of masks covering the mouth and nose was ordered, and 2 meters distance from each other became a rule. The movement of people was limited to going to work, to the doctor or for necessary shopping. All mass events were prohibited, schools of all levels, as well as universities were closed and distance teaching began. Furthermore, free railway service for pensioners and students was put on hold. Visits to hospitals and social service facilities were prohibited. The Ministry of Foreign Affairs ensured the repatriation of our citizens from abroad, who had to undergo a 14-day quarantine in state facilities to prevent the spread of the infection. Although the outgoing government during the first weeks of the pandemic really took responsibility for what was to follow, the real burden remained on the new coalition that started to govern on March 21, 2020.
The quest for equity Michael J Sandel, Professor of Political Philosophy at the University of Harvard, asked, in April 2020, to remove present inequalities in America where the best colleges of the country still give access to the richest families, so they just care for students originating in the top 1% of families in the country (New York Times, April 13, 2020). The quest for equity is also very strong in Europe. By the end of 2019 Aldo Schiavone, in a book entitled “Eguaglianza” (equality), stressed that the concept of equality was born in Europe where it is considered a constitutive character, a principle of the world that has been lost before the turn of the 21st century. In Europe there is a minority of very rich, fortunate persons who are structured in a pyramidal fashion and embedded in a mass of persons who have difficulties to build a pension for age and cannot resist sudden needs due to disease or loss of work (1). Economy is a consequence of the history of science Thomas Piketty, in a recent interview (2), explained that our times favour l’économie des inégalités and that “the entire world shall be “rethinked” in a more equitable and sustainable way after the pandemic. Every society shall investigate its inequalities, find reasons for them; otherwise the political and social building will crush” (Capital and Ideology in the Twenty-first Century, 2017). However, Sandel, Schiavone and Piketty may be wrong, or at least too pessimistic. In fact, Claude Allègre, Professor of Geology at the University of Paris and Minister of Research in the Government of Lionel Jospin, in Dieu face à la science (1997) answered the question “Did science progress in the Western world since capitalism flourished there?” His answer was “science and capitalism developed in symbiosis and today we think that economy is relevant for the progress of science. However, in the early twenty years of the last century, in the world, there were less than two hundred physicists. Their discoveries did not depend on economy but by their imagination. History of science is not dependent on economy; economy has been a consequence of the history of scientific progress in the Western world since capitalism flourished.
Professor Raymond Ardaillou Academy of Medicine, Paris
History of the first containment to control the pandemic The first alerts in February 2020 were unexpected clusters in Mulhouse (Alsace) and Creil (North west of Paris). Their causes were rapidly found, a religious meeting of evangelists and the return of military from Wuhan (China) without any quarantine at their arrival, respectively. The extension of the epidemic was very fast in these two regions and then reached Paris, the main cities of the eastern part of the country, and also Lyon and its surroundings. Hospitals were overwhelmed, particularly intensive care units. Deaths of elderly, obese and chronically ill people increased and long stay institutions for elderly people were particularly affected. The decision of the government was a quasi-total containment extended to the entire country although the west and the sparsely populated areas of the centre were spared. A few months after the start of the pandemic, what were the results of this policy? We can separate the good from the bad. Among the first, the French hospital system coped with the disease and no patient who needed to enter an intensive care unit was excluded, even the elderly. The staff showed dedication and overcame fatigue with long working days and the suppression of public holidays. Retired doctors and students were also active to help. Patients requiring intensive care were transferred, when necessary, to hospitals in spared regions and even abroad (Germany, Luxembourg and Switzerland).The public was submitted to a series of constraints: physical distancing, outings outside the home for a limited time (1 hour) and a short distance (1 Km) with a signed certificate indicating the reason of the exit among those allowed, closure of restaurants, bars and all businesses considered non-essential, suppression of shows and religious ceremonies. Schools and universities were closed. The amounts spent on supporting the economy and helping unemployed persons or businesses without activity were considerable, the highest in the states of the European Union. Teleworking developed rapidly. The public observed the containment measures with discipline and application from March to May 2020. The bad aspects were the lack of masks in a sufficient amount, the psychological distress of students and unemployed staff, the isolation of elderly people living in long stay homes who were deprived of visits from their relatives. It was also difficult to find some private medical specialists and dentists who left the big cities to get to their country houses. This escape from the big cities just before the start of the confinement was often badly considered by country dwellers who feared being infected. Another shortcoming in controlling the epidemic by detecting and isolating virus carriers was the lack of machines and reagents to carry out nasopharyngeal swab and RT-PCR investigations, the first tests available being only the serological tests for diagnostic orientation to detect the antibodies following an infection. All hospital, private, university and veterinary school laboratories were involved in the detection by RT-PCR. It was planned that subjects who tested positive were to be isolated for 2 weeks and questioned about their contacts both retrospectively (who infected them) and prospectively (who may themselves have infected) in order to test these contacts and, if necessary, isolate them. The laboratory must inform the health insurance which was in charge of doing so. A mobile phone software was disseminated to learn more about the contacts. In fact, this system did not work well for at least two reasons: there were no coercive but only incentives measures for isolation, and the department responsible for notifying contact persons was quickly overwhelmed by the demands of the health insurance. The number of hospitalisations for covid-19 had alarming consequences on other pathologies. Many surgical operations were cancelled. Patients were reluctant to go to hospital for fear of being infected and many children missed the vaccination schedule. The outing of containment All these measures led to a gradual reduction in the number of positive cases, hospital admissions and transfers to intensive care units. Satisfied with this improvement, the government decided to end the confinement after 2 months (from March 10 to May 10) and to restore a normal economic activity and the freedom of transport. The wearing of masks, now in sufficient number, outside the home was still maintained as well as distancing measures in restaurants, bars, churches and theatres. The committee of experts advising the government and the Academy of Medicine expressed reservations, advocating a reduction, and not the virtual elimination of confinement. The public felt liberated and festive gatherings, family celebrations, crowdy exhibition visits or walks in commercial streets or parks occurred frequently. Consequences were rapid. As soon as the end of August, warning signs were noted: the presence of viral RNA in the waste water, and with the greatest ease of testing, the increase in positive cases, and the factor (number of people infected by a subject) began to rise again and far exceeded the unit. The second wave Faced with this upsurge, the government decided to start a second containment, in several stages. It first established a curfew from 9pm to 5am to avoid festive gatherings at home, and then a week later, again the closure of bars, restaurants and shops considered non-essential and the necessity of written attestations to indicate the reason for an exit out of home. It also made an update of the StopCovid application, “Tous anticovid” allows the user to be alerted or to alert others in the event of exposure to Covid-19. He/she can thus act directly for his/her own health and that of others by helping to break the chains of transmission and slow the spread of the virus. The immediate consequence of the new containment was a relapse in economic activity and the loss of income for shopkeepers, which the government sought to mitigate by extending the financial aid measures. In spite of them, the result was an impoverishment of the population, mainly of the middle classes and younger people, which is reflected in their demand for food aid, formerly reserved for the poorest classes. The distress of these people, who are often isolated and without family help, increases the number of suicides. The public followed these constraints, but with gloom and much criticism of government decisions that often appeared bureaucratic, ineffective in countering the epidemic, but deplorable for small-scale trade. A German newspaper “Die Zeit” proposed to rename France under the name of "Absurdistan". However, hospitals were better prepared to fight the epidemic with a sufficient number of intensive care beds, more effective treatments, resulting in lower mortality and shorter hospital stays. At the end of November, the government issued flexible measures such as the opening of small shops and the resumption of religious services, giving hope that transport would be back for Christmas and that the restaurants would open in January 2021. The new regulation retains its share of the absurdity inherent in the country's administrative services: only 30 people will be allowed to gather for a religious service, whether in a small chapel or a huge cathedral. Go and understand! This is where we are at present. A new hope has appeared with the arrival of vaccines considered effective and without side effects, in particular the 2 American mRNA vaccines from Pfizer and Moderna. In France, the Pasteur Institute and Sanofi are preparing new vaccines either of inactivated viruses or recombined viral proteins but still in phase 3. The European Union has placed orders of vaccine doses with several suppliers which should be distributed according to the population of the member states. Phase 4 evaluation of these vaccines in the population and over a long period of time will be essential for the choice of the vaccine(s) selected. The role of scientific experts The government at the onset of the epidemic appointed a committee of experts to guide the measures to be taken to contain the epidemic. This committee proposed measures based solely on epidemiological data, neglecting socio-economic and psychological aspects. Moreover, its recommendations were made known to the government alone, which drew conclusions from them. The Academy of Medicine filled this vacuum by publishing from March 2020 until now more than 60 press releases aimed at doctors and the public and often quoted by the press. It denounced mistakes made by health officials such as the uselessness of wearing masks in the street to hide the lack of masks at the beginning of the epidemic. It insisted on the necessary reorganisation of hospitals, the purchase of equipment and reagents, the setting up of additional resuscitation beds and the obligation to train and recruit specialised nursing staff by making their careers more attractive. Conclusions This pandemic will profoundly change the country. France had poorly anticipated the response to the pandemic because the successive ministries of health had not foreseen any predictive scenario, making it difficult to curb the disease. This pandemic also shows us that Pasteur's country is lagging behind others in the development of vaccines. French researchers are behind new vaccines, but they have preferred to work abroad for several reasons, the reluctance of French people to invest in venture capital and the meticulous regulation of manufacturing processes and authorisations. We have excellent researchers, but they work elsewhere. Concerning the economic crisis, France cannot cope with the mass of new public debts without the help of the European Union, itself subject to the dissensions between member states. Internally, the segmentation of society by the multiplicity of identity, community and sexual groups and the irruption of social networks often spreading false news and hatred of others makes the task of governing increasingly difficult. Moreover, a gap is widening between the regions and the state considered dictatorial. The public feels the burning need for a welfare state, but their often disappointed expectations maintain a perpetual contestation. The result is unkindness in social relations. Moreover, France is the target of Islamist terrorists, which adds to its problems that of preventing attacks. Of course, French society is complex and many people are aware of their individual responsibility, as shown by the dedication of the carers and of the "indispensable" people. Merchants have shown a great capacity to adapt to the restrictions imposed on them and the digitisation of commerce has been widely developed. The same was true of medical practice, which made an extensive use of telemedicine. At the same time, the rapid advances in science demonstrated by the rapid development of vaccines are making us reconsider our future. We are caught up in the need to prevent the current world from falling apart and to reconcile progress with the observation of what makes us human, i.e. the freedom to think and to confront our positions with respect for others and also to help the most deprived of us.
France at the time of coronavirus
Katarina Derzsiova Ing. Dipl., Former Head of the Laboratory, IV Internal Clinic, University Hospital of. L. Pasteur, Košice, Slovak Republic
Lessons from the pandemics
Natale G. De Santo, MD Emeritus Professor, University of Campania Luigi Vanvitelli, Naples, Italy
A world of foxes or hedgehogs? We do not yet know the outcome. In Fragment XXIV of Archilochus, we read “The fox knows many things, but the hedgehog one big thing”, meaning that the fox uses many tricks to escape hunters and dogs, while the hedgehog only one, but at this it is the best of all. Archilochus had many followers, among them Erasmsus of Rotterdam (1470-1530) who translated the above passage in Latin “multa novit vulpes, verum echinus unum magnum” in Adagiorum collectanea, and Isaiah Berlin (1909–1997) who in the tale The hedgehog and the fox (1953) described writers and thinkers either as hedgehogs (one principle to explain everything), or foxes (utilising many possibilities) (3). Watson and Crick celebrated reductionism in biology in 1953 by defining the structure of DNA. The peak of reductionism was, however, achieved with the demonstration of the Higgs mechanism and Higgs boson -hypothesised in 1964, when the “God particle“ was detected at CERN in 2012-2013 (3). At the beginning of the 13th century, universities in Europe were based on the trivium (literally the place where three roads meet), which included Grammar, Rhetoric and Dialectic and on quadrivium (the place where four roads meet), which included Arithmetic, Geometry, Music and Astronomy, as described in the seventh book of Plato’s Republic and represented the so-called liberal arts. These disciplines represented the basic curriculum for the study of Theology, Medicine and Philosophy (4). According to Nicholescu and Ertas (), there was a “big bang” and the number of disciplines rocketed to 8,000 in 2012. The decision for fragmentation is wrong, as the rapid advance of communications means that a connected world is driven by complexity. “The new education has to invent new methods of teaching, founded on logics. The old classical binary logic, that of “yes” and “no”, i.e. the logic of the excluded middle, is no more valid in the context of complexity” (4).5 A new role for university Jean Claude Allègre (born 1937), highly cited scientist, Emeritus Professor of Geophysics in Paris, and former Minister for Research in the Government of Lionel Jospin in Dieu face a la science. Comment peut-on être croyant aujourd'hui ? ( 1997), answered a seminal question. “Has science developed in the West due to the fact that capitalism took roots in the West”? He answered Science and capitalism developed in symbiosis and now we know that economy is important for the development of science. However, we have to bear in mind that in the twenties of the last century there were less than 200 physicists in the world. Their discoveries did not depend on the availability of means at their disposal, but on their imagination. History of science does not depend on economy, but economy is a consequence of history of science. Progress of science and capitalism appear linked , but the link is impalpable”. He prophesied. In Europe of diversity, in Europe of homelands, federalism, and place of effervescent exchanges, universities and their professors will have a role of primary importance since they drive the operational platforms where new knowledge will be acquired in a critical atmosphere. Nobody minds that Galilei was university professor as were Newton, Boyle Lyell. People trust University”. Umberto Eco (1932-2016) was very confident of the role and creativity of the university. On occasion of his 70th birthday he explained to the students of the University of Bologna that ”university is irreplaceable since it is the origin of the ideas that will came of age twenty years later. All things that are in the media nowadays have been generated in the university 20 years ago, and all topics that are now on the agenda of our universities will have a place in the media twenty years from now”. Edgar Morin pointed out that because of its nature university saves, memorizes, integrates, ritualizes the heredity of knowledge, ideas, values and regenerates it and by reviewing it makes it actual, transfers it , generates new knowledge, ideas, and values that in turn re-enter in the heredity. Thus university is conservative, regenerative and generative. Its function is transnational, and this main characteristic has been maintained despite the nationalism of modern nations. Autonomy allows to achieve its goals (6). Adopting complexity as a method For Edgar Morin, we have to learn how to learn, that is learning by separation while linking at the same time, through a process of contemporary analysis and synthesis. We have to learn to overcome linear causality (cause–effect) by learning reciprocal, relational, circular causality–the latter encompassing feedback and recursion. Furthermore, we should be aware of the uncertainty of causality. Causes do not always lead to identical effects since the reaction of systems may be different. Last but not least, different causes may be conducive to identical effects. Thus, we have to rise to the challenge of complexity arising from all fields of knowledge and action. To meet the challenge we have to create a new thought” (Edgar Morin, Einsegner a vivre. Manifeste pour changer l’education, 2017). Building sand castles Nicholas A. Christakis, Professor of Social and Natural Sciences and of Medicine at Yale has explained his attraction to the towers made of minute silica crystals. “Some people like to build sand castles, and some like to tear them apart. There can be much joy in the latter. But it is the former that interests me. You can take a bunch of minute silica crystals, pounded for thousands of years by the waves, use your hands, and make an ornate tower. Tiny physical forces govern how each particle interacts with its neighbours, keeping the castle together; at least until the force majeure of a foot appears. But having built the castle this is part that I like the most: you step back and look at it. Across the expanse of beach, here is something new, something not present before among the endless sand grains, something raised from the ground, something that reflects the scientific principle of holism”. He is aware that “[T]he properties arise because of the connections between the parts. I think grasping this insight is crucial for a proper scientific perspective on the world. You could know everything about isolated neurons and not be able to say how memory works, or where desire originates. It is also the case that the whole has a complexity that rises faster than the number of its parts” (Christakis, force majeure of a foot appears. But, having built the castle, ).www.edge.org “Universities are the places where we do things that will be discussed in the media twenty years from now” stated Umberto Eco to the students of the University of Bologna on the day he celebrated his 70th birthday. We have to be aware that our universities have the talents and the skills to maximise the effects of education. However, at the time when the economy of knowledge flourishes, we have to support them more than in the past. In “post-pandemic university” a crucial effort is required to achieve a diffuse status of excellency, not just for few and not just in a few places and not just in a few disciplines. In addition, students should be empowered to give solutions for the present but receive a dual education for the short and long period of time. There they should also learn how to achieve another peak of development in their field after having achieved a peak. This means that they will also learn how to walk the valley between peaks that have downward and upward routes (7). 219 Italian physicians died because Covid-19 From March 11 to November 27 219 physicians have died because of covid-19. Such a huge list of deaths is displayed daily and commented on the portal of the Federation of Italian Physicians and Dentists. The list was preceded by a comment of our President, Filippo Anelli. “Dead do not make noise”, wrote the poet Ungaretti - however the names of our friends and colleagues make a deafening noise. We cannot tolerate it that our physicians and health workers have been sent to fight with naked hands against the virus. An unequal struggle that hurts us, the citizens and the whole country Curing non-Covid patients As written by Lis Rosenbaum in N Engl J med on June 11, there is an untold toll about treatment of nonCovid-19 patients( 9). All resources have been destined to Covid patients. The other patients do not receive enough treatment and care. The number of myocardial infaction decreased by 51%, the number of patients who received cardiac surgery is less than 50% , the number of undiagnosed cancer patients is increasing. A newspaper calls non-Covid patients a lower category. There is a need to “Cure well, cure all” as discussed at a congress on November 30, 2020 in Naples. It was a congress organised by the Fraternity of Pilgrims, an association that has assissted migrants, pilgrims, patients, young people needing schooling for the past 442 years. Southern Italy has the worst healthcare system in our country due to negligence of previous governments. They imposed commissars who balanced the budget by reducing hospital beds, nurses and physicians to a level that does not grant function. The Campania region life expectation at birth, 65 and 75 years is the lowest in Italy. A woman at 65 can expect to live for the next 20.5 years in Campania and 22.9 years in Trentino Alto Adige. Who Can Put, Who Cannot Take This short message, just six words, appeared on a basket suspended from a balcony in an alley in Naples, during the pandemic on March 29, 2020. In Italian the words are: “Chi può metta, chi non ha prenda”. More fully this meant that those who have (the means) may add to the basket whilst those who have nothing can take from it. It was a strong message of solidarity. Passers-by, inhabitants in the neighbourhood, in anonymity, could take or add safely-packed food and other items such as soap, diapers, sanitary pads etc. Subsequently, special baskets were prepared containing cooked foods (Figure). References 1. Schiavone A. Eguaglianza. Einaudi, Torino, 2019. 2. Ciccarelli R. Thomas Piketti: il socialismo partecipativo per la crisi che verrà. Il Manifesto, Rome, 2020 June 9. 3. De Santo NG. Nephrology between Reductionism and Complex Systems: the Role of Philosophy Review of Evidence and Opinion. Eur J Mol Clin Med 2020; 7(1): 38-45 4. Martins PN. Descartes and the paradigm of Western medicine. An essay, Int J Rec Adv Sci Tech 2018; 5(3). 5. Nicholescu, B, Ertas, A. The Need for Transdisciplinarity in Higher Education in a Globalized World. Transdisciplinary Journal of Engineering & Science 2012; 3: 118. DOI: 10.22545/2012/00031 6. Morin E. La testa ben fatta. Cortina, Milano, 2000. 7. Ceruti M. Il tempo della complessità, Cortina, Milano, 2018, p.144. 8. Rosenbaum L. The Untold Toll The Pandemic’s Effects on Patients without Covid-19”. N Engl J Med 2020; 382:2368-2371, DOI: 10.1056/NEJMms2009984
Reaction of the population to the Covid-19 pandemic When the Covid-19 pandemic broke out, we were all surprised and frightened by the news of what was happening in Italy, how many people were dying there every day and that the healthcare system was in collapse. At that time, it was all new to us, unknown and we had a lot of energy and perseverance to fight the infection with the hope to defeat it. Thanks to compliance with restrictive measures, our discipline and responsibility towards each other and especially towards our seniors, we managed to slow down the growth of infection cases and prevent deaths. Several times our President Zuzana Čaputová made a TV appearance to address the nation in a very nicsupportivee and encouraging way. She rganized that no government in the history of Slovakia had faced such a difficult situation as the present one, and, therefore, asked all the citizens for their support and compliance with regulations. On June 13, 2020 the state of emergency came to an end, preceded by 4-tier relaxing measures. The total number of infected patients with Covid-19 from March 6 to June 30, 2020, i.e. during the first wave of the pandemic was 1,687 and the total number of deaths was 28 (Table 1). Impact of Covid-19 on the Slovak economy In all European countries, including Slovakia, the coronavirus has had a very negative impact on the economy. According to the Statistical Office of the Slovak Republic, it was manifested mainly in the second quarter of 2020 with a decrease in the average salary by 1.02%, the inflation rate up to 3%, an increase in unemployment to 7.7-8.0% and a decrease in gross domestic product (GDP) by 7-8%. The soaring figures of unemployment were mostly fuelled by a huge decline in industrial production. Slovakia, with its robust automotive industry, is dependent on the economy of other countries, especially Germany. People who lost their jobs or had their businesses temporarily closed or worked in emergency mode needed financial assistance from the state. Although the state aid has helped save a lot of jobs, the poverty risk rate jumped from 11.9% to 12.55%. Impact of Covid-19 on elderly people Strict measures, in particular quarantine, have had a major impact on the quality of last days survival of the country‘s elderly citizens. Isolation, minimal contact with relatives or friends have had a negative impact on the mental health of all of us, but especially on the psyche of seniors. Covid -19 has been fearsome for the elderly living alone or in social homes. They were most worried that they would never see their loved ones again, and that they would remain bedridden served by staff wearing masks. As it is around the world, and so in our country, adults, old and very old patients affected by Covid-19 have been dying in loneliness without the presence of their relatives, without tenderness, religious help and farewell. Covid-19 pandemic has left a negative mark on the population of all age groups and in all sectors of our economy whether it is education, science, health, culture or industry. After the strict measures were relaxed people wanted to indulge in freedom. Summer came and many of us went on holiday abroad. Borders opened up and people, trusting that the worst was already behind us, ceased being disciplined and responsible. However, In July and August the number of new cases of infected people began to increase. The second wave of the pandemic The second wave of the pandemic was in full swing in September, and gradually, the whole Slovakia turned red. The daily number of new cases, the number of hospitalized patients, as well as the number of deaths were rocketing (Table 1). On October 1, a state of emergency was declared again. It was between 31 October and 1 November 2020 that the government, with the support of the President of the Slovak Republic, rganized a nationwide testing (people aged 10 – 65+) of Covid-19, using Antigen tests. The testing covered 3,625,332 people (95% of those who should be tested), of which 38,359 (1.06%) were positive, but asymptomatic. The following the testing was repeated in the most critical districts. 2,048,555 people were tested, of which 13,509 (0,66%) were positive. Both actions were declared very successful and Slovakia was the only European country to carry out such an undertaking. From 9 November, mobile sampling points were set up for antigen testing. By November 20, 10,790 cases had been positive. Table 1 shows only positive cases confirmed by a PCR test. Table 1 Occurrence of Covid-19 in the Slovak population
Total cases   cases per 10 5   population    1,687   31/10 5   668   12.2/10 5   95,257   1,750/10 5     1.75%/10 5   Total recovered   1,466   86.9%   409   61.2%   43,188   45.3%   Total  deaths     (total death - to - case)   28     1.66%   6     0.9%   644   11.9/10 5   0.68%
Table 2 Occurrence of Covid-19 in nephrology patients
1st wave                      March  – November 20 Total cases      CKD/PD/HD patients     6 / 0 /7     11 / 2 / 201 (6.3%)   Total recovered   5 / 0 /7   9 / 0 / 84 (41.8%)   Total deaths    1 / 0 /0   2 / 0 / 41 (20.4%)   Total cases of transplanted (Tx)  patients      1     48  (3.0%)   Total recovered   1   42 (87.5%)   Total deaths    0   3 (6.25%)
\% of recovered and death/total cases % of total HD cases resp. Tx/total number of HD resp. Tx patients Average age of patients dying: on HD 69.5 and Tx: 67.3 How do I perceive the pandemic? Of course, I have been disciplined, I have followed all the regulations. What I have been missing most are the scientific events that have been cancelled due to the prohibition of public assembly. Although I am retired, my lifelong interest in scientific work still persists, and also the urge to participate in national and international congresses. Acknowledgements I am thankful to the medical directors of dialysis companies, the main expert for transplantation in the Slovak Republic as well as the heads of transplant centres for the obtained patients‘ data.
COVID-19 in Greece The cov-19 pandemic is severe. Globally, as of 9:54am CET, 26 November 2020, there have been 59,816,510 confirmed cases of COVID-19, including 1,410,378 deaths, reported by WHO. Even if we allow for the fact that the number of cases depends on the number of tests done and the number of deaths include patients who would anyway have died soon due to comorbidities, the burden on the global population is heavy. But it is lighter than that of the great epidemics of the past like the Athens’ Plague reported by Thucydides, the Black Death or the “Spanish” flu which killed one third to half of the then known population. Still a climate of panic and terror is felt by many and is spread by the media. Why does this happen? In my opinion it is the shattering of the established certainties of the Western World. The pandemics in the past shattered the strong beliefs about the God’s or gods’ omnipotence to prevent or cure any disease. Thus, scenes of sacrilege and breakdown of the social order followed. Nowadays the strong belief of a modern citizen is the total capacity of himself to control his life, health, finance, desires and the State’s and Science’s omnipotence to provide for it. Hence, the industrialized world was taken by surprise and reacted either with disobedience and uncontrolled entertainment like the period before Halley’s Comet, or with depression and acceptance of all measures imposed. There are some indications of this assumed failure of the Western World. The number of deaths by covid-19 in Eastern Europe reached almost 90.000 compared with 350.000 in Western Europe and 256.000 in USA both having roughly equal population. Moreover, the ratio of positive cases to deaths is 4: 1 in favor for the East. A surprising finding comes from Africa. Most of the countries there have a very low number of covid deaths. Indicatively, South Africa where statistics are more reliable reports 765.00 positive cases and 21.000 deaths having a population of 57.000.000, almost half the incidence than in the USA. There is wide speculation about the reasons of this discrepancy. The compulsory vaccination with the BCG vaccine in the countries of the Eastern Block, the younger population in Africa (in South Africa the median age is 30 years) thus there are not very many old people to succumb to the disease, the overcrowded domestic situations which lead to several other virus infections resulting to a kind of natural cross-resistance to cov-19 as well and the hectic travelling from and to the West due either to tourism, commerce, cultural events or to immigration are some of the suggested factors. While writing this article everyday revisions were made as new data became available continuously. Thus our conclusions may soon become obsolete.
Professor Athanasios Diamandopoulos Louros Foundation for the History of Medicine Athens, Greece
There are however collateral damages by this obsessive lamentation on the pandemic. That is the hiding of other real catastrophic situations the global population is threatened by. The most severe is the global debt. According to IIF it has now reached 227 trillion dollars corresponding to 360% of the global gross income, the pandemic having increased it only by 45%. The sum is impossible to be paid back. It leads to bankruptcy most of the developing countries, Zambia being the recent victim. As this article is not a Financial Forum we would not elaborate on the causes of the phenomenon. However, the result causes directly and indirectly much more human losses than the pandemic. A second damage is the avoidance of contemplating about the sharp rise of the death of old people in Europe, most characteristically in Sweden. The Swedish Public Health Agency told the BBC that 48.9% of deaths were care home residents up to and including 14 May. The reasons there were the great number of senior citizens “stored” in private or public institutions, the poor measures for preventions, the guidelines not to transfer to hospitals or even giving oxygen by the nurses to the aged victims of the disease. "We did not manage to protect the most vulnerable people, the most elderly, despite our best intentions," Prime Minister Stefan Löfven admitted last week. This was a statement rounding corners. The “progressive” line of thought in Northwestern Europe even before the pandemic was that the aged are a burden to the societies, they should understand their duty to die and thus to ask for euthanasia and even to install special booths in the streets where those people could enter, enjoy some music and drink a tasty lethal cocktail. Hence, according to this line, covid-19 is making a favor to society. Focusing on Greece a few remarks would be helpful. The country, in contrast to the whole of Europe, had an outstanding low incidence of the pandemic during the first wave in March - April. The very austere measures imposed early by the government were acclaimed as the reason for it and public opinion overwhelmingly supported the government. With the second wave the data worsened. We have roughly 98.000 positive cases and 2000 deaths reaching 1.96% of them. Still, much lower than in the West. The median age of the deceased was 80 years and the 97% of them had an underlying disease. It is evident here the very humane approach of the Health System towards the elderly. However, this success came with a heavy price both on the financial and the cultural level. Greece, alone in Europe, emerged in 2019 from a financial catastrophe after ten years of strict supervision of its economy by its borrowers via complex legal agreements nicknamed “memoranda”. The rationale was to lift the burden of a non sustainable national loan equating to 120% of GDP. After this ten years’ austerity and giving away a good part of the state’s property the percentage increased (!) instead of falling, to 180%. In spite of that some hopes started to appear that we could escape bankruptcy. By imposing a limitation to markets, communications and travel in an attempt to hold the virus within a country who’s a greater part of income was tourism, the percentage of the National Loan to GNP reached 210%!! This is really unstainable and a catastrophe is pending. Future aid by the European Union is planned but for the present it does not affect the population. On the cultural level the measures shattered the three main pillars of the Greek life. Christian faith, invocation for unbound democracy and outdoor entertainment. The suppression of all three institutions was explained by the need of avoiding contamination via huge gatherings and the urgency of the situation. Although this was partially true, in reality these were old animosities that resurfaced. Holy Services and litanies for the Easter, the Assumption of Mary and for Christmas were banned and the Holy Communion was devaluated as a simple mixture of wine and bread transferring the virus to the faithful without any Eucharistic mystery. Governmental degrees were issued without parliamentary enhancement and demonstrations were banned. Sunbathing with company, picnics, café shops, taverns, restaurants, all the outlets for the hardest working people in the EU according to Euro statistics were prohibited. Even working per se was strictly regulated. The damage is not so much the temporarily loss of all these but the danger for the people to become used to this loss for ever. In favor of the government’s handling of the pandemic’s second wave some sound arguments should be stressed. That is the till now efficiency of the National Health System, a bet that richer states lost, the heavy direct or indirect subsidy of the private sector, the great upgrading of the e- teaching, e-government, e-business and the keeping of public order up to a point. Against these successes we notice a rising wave of disappointment and disobedience. Recent surveys by international University and Media agencies report on a higher degree of anger and depression than in many other European countries but also mention a very high degree of altruism. The reasons for the first two negative feelings is the campaign of terror issued by the government and the media in order to make people obedient, the discrepancies between the pandemic’s lethal potency and the small number of deaths, the scorn with which “specialists” and politicians respond to any reservations about the measures either from the general public or other parts of the scientific community and the blind eye the police turn when dealing with the violation of the measures by politically strong bodies. All these are alienating the population but acts of extreme depression like suicides are not reported. The altruism is enhanced by the strong family links, the charitable institutions and the feeling of the risk to the community. Narrowing further our survey, we focus on the renal patients. Apart of the death of 18 patients on RRT in a private clinic in Athens during the first wave there were not any other accidents. Strong guidelines were issued by the Ministry of Health, the Scientific Societies and the Patients Associations and were more or less observed. No covid-19 renal patient was refused dialysis. Naturally, a greater degree of anxiety and depression is noted in this group of patients that in the general population. These feelings are limited in the wards where there is a great degree of warm patients/staff personal relations. The article finishes with the final stage of the covid-19 patients in Greece, i.e. their last hours and their funerals. These issues are bound to any pandemic in the past and in any country at present. Patients hospitalized in covid-19 wards are absolutely isolated from their family and friends. They cannot speak or even see them. And they die lonely without someone to hold their hand. And they are buried enwrapped in many layers of plastic, without friends or several family members as only nine persons are permitted to attend any funeral. And this handful of close relatives cannot kiss the corpse as it is the custom in the Orthodox Churches. It is a very Cold Good Bye. Still better than the en bloc undignified burials in Italy, the States and other countries with hecatombs of victims. There are hopes that the rising 2021 will bring a solution to the problems. Is it wishful thinking? *The opinions expressed in this article reflect the author’s thoughts on the social impact of the covid-19 pandemic mainly in Greece and the renal patients and it is not a strictly scientific approach to the disease. Thus, citations are omitted but if any reader is interested he/she is welcomed to ask from the author
People and Epidemics Then and Now Epidemics that had been haunting mankind in the past can be traced back to numerous historical sources. Historians of medicine have dealt mainly with medical doctors activities, illness symptom descriptions, demographic outcomes assessment. A historian of culture is rather focused on the types of behavior showed by people suffering from the epidemics. The then records are dominated with human fear of a sudden death, anonymous burial, lack of an opportunity to account for one’s earthly life, and by the same token, eternal damnation. Dread deeply infiltrated culture as a result of the recurrent cycles of epidemic. It was scare that drove the flagellators into the streets and made them birch themselves to beg the grace of the Almighty for the whole community. It was scare that made ever growing numbers of pilgrims attempt to store good deeds “in advance” to secure salvation during the Final Judgment. Demand for the “in advance” absolution resulted in trade with indulgences. As a response, an open- minded concept emerged that the path to salvation leads through faith itself, and not through penances. This brought about first the devotio moderna, and next the Reformation followed. Dread, however, conditioned more mundane behaviors. The fall of public baths in the late Middle Ages was one of the symptoms of a new approach to the body hygiene. The trend was to take rare and sparse baths, so as not to risk that the contaminated air penetrates the open skin pores. Soap was replaced with a frequently changed white shirt a symbol of cleanliness. A discomforting smell was neutralized by a scented handkerchief.
Professor Michał Kopczyński Faculty of History University of Warsaw, Poland
Nonetheless, the epidemics had caused not only fear. The sources mention also completely opposite types of behavior. Medical doctors advised a stoical attitude, arguing that - in their opinion - fear might disturb the balance of moods, and thus make one an easier pray for disease. Stoicism, however, was an elite approach. The less sophisticated would rather pursue risky behaviors, convinced that life is fragile and short anyway, so one should make the best of it. Against the background of fear, liquor was flowing freely, and promiscuity followed in tow. This aspect is present in all descriptions of the epidemics, including the “Decamerone” by Boccaccio. Possibly it was really like that, though Cezary Kuklo a demographer recording births and deaths in the 18th century in Warsaw is quite skeptical. As his calculations show, the number of births in the year following the epidemic, was lower than in the years with no epidemic. Clearly, the external threat does not create favorable conditions for a marital intercourse. I remembered the conclusions by Kuklo, when in the spring I was reading a blog written by a certain frustrated lady, who had hoped that lockdown would bring back the earlier romantic infatuation, candlelit dinners, etc. Meanwhile, the reality turned completely different, quite mundane: Netlix, youtube, home office. Psychologists sound a warning that the numbers of domestic abuse have been growing, though this might not be true. The attitudes towards epidemic, recorded in historical sources not so long ago, seemed to be a merely faded evidence of the former era. The mankind of the 21st century was convinced that with the help of science and technology one can fully control nature. The year 2020 sobered up even the most overconfident of human power. Poland suffered one after the other: Covid, drought, numerous floods, national park fire and a series of violent climatic phenomena. The environment control proved to be an illusion. The old attitudes came back, though assumed a new form. In Poland, fear worked from March to June, when the majority obeyed the lockdown rules, while the then Health Minister enjoyed high public trust. This did not take long. Envious politicians and their media henchmen blackened his reputation with strong charges, putting him off civil service. In the summer, when the number of infections visibly dropped down, people did not observe restrictions anymore. Beaches and mountain routes got crowded too much. A contemporary human, for whom to live means to consume, is not ready to give up his nice holidays. The autumn saw a second wave of infections, much stronger than the one in the spring, accompanied by a crisis of confidence in all types of authorities. Protesters of various types hit the streets; some politically motivated, others objecting the sanitary regime. Disregard for restrictions, avoidance of Covid tests and resultant potential home quarantine, reluctance to contact a doctor in case of mild disease symptoms; all these were less spectacular, nevertheless clearly visible. In November family doctors were alerting to this dangerous phenomenon but it seems that it was of no avail. Patients lost their faith not only in the public authorities but also in the power of reason. The medicalization of social problems, or in other words, the public life colonization by health care system representatives described by Michel Foucault in the “Naissance de la clinique” (1963) as an unavoidable outcome of the process of modernization – this time faced public resistance. Fear and inclinations towards risky types of behavior, witnessed today, only seemingly bring to mind the responses to epidemics from the old times. The underlying causes of their manifestations and origins are rooted elsewhere. Fortunately, fear is not translated into the quest for the alleged culprits, witch- hunting or persecution of aliens. Defiance of the sanitary restrictions is more than simple “playing around”. A contemporary human is completely different than before, though not necessarily wiser. As pertinently observed in the “La rebelión de las masas” (1929) by Jose Ortega de Gasset, a modern man, in politics, in art, in social usages, in other sciences, will adopt the attitude of primitive, ignorant man; but he will adpot them forcefully and with self- sufficiency […]. By specializing him, civilization has made him hermetic and self-satisfied within his limitations; but this very inner feeling of dominance and worth will induce him to wish to predominate outside his speciality. Reason has been confronting anti-reason. It is hard to predict what their future struggle will be like. *To supplement the publication by prof. Michał Kopczyński, I give you a handful of statistical data on the pandemic in Poland. The first case of Covid-19 was recorded on March 4, 2020. Until now, there have been 1102096 cases. Covid19-related deaths stand at 21630, no. of recovered patients: 792119.(J. O.) (data on December 10th, 2020)
Maria Kalientzidou Biagio Ricciardi Davide Viggiano Achmet Aciduman   Sylvie Opatrna        Przemysław Rutkowski
1st w ave
July - August
March - Nove m b er 20
1st wave: March 6 - June 30, 2020