Essay // Coronavirus II (COVID-19 / SARS-CoV-2): A wake up call to Human Civilization

Mis à jour le Dimanche, 12 Décembre 2021

Coronavirus Chinois COVID-19

What we now know about the ugly SARS-CoV-2 virus is that it is among a group of coronaviruses that causes diseases in animals and birds, and respiratory tract infections in humans. These infections tend to be mild, but in rarer forms such as the Middle East respiratory syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) they can be fatal. SARS-CoV-2 shares a similar sequencing identity with the infamous SARS coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), but SARS-CoV-2 is relatively more infectious in comparison to other CoV. SARS-CoV-2, SARS-CoV, and MERS-CoV are all suspected of being from animal reservoirs and then transmitted to humans.

The current outbreak declared by the World Health Organization (WHO) is caused by SARS-CoV-2 which has a close genetic similarity to bat coronaviruses and are thought to have been its likely origin. The virus primarily targets the respiratory system and causes flu-like symptoms upon exposure, although some patients may appear asymptomatic. In the early stages, the disease presents itself as a mild respiratory infection. However, as the disease progresses in severity, it may lead to acute respiratory failure, severe complications such as multiorgan failure, and ultimately death.


The wild tornado in the body: how the infection starts and kills

COVID-19 spreads in a similar way to cold and flu bugs; through droplets being left on surfaces after a person coughs or sneezes, which are then touched by other people and spread furtherThe Coronavirus (SARS-CoV-2 / CoVID-19) has been killing thousands of people every hour globally since it appeared. Clinicians and pathologists are still trying to fully understand how it inflicts such damage as it tears through the human body.

Although it well known that the lungs are ground zero (i.e. the main point of impact), the virus can extend to many other organs including the heart and blood vessels, kidneys, guts and brain. « Its ferocity is breathtaking and humbling », said Krumholz a cardiologist from Yale university.

The infection begins when an infected subject expels virus-laden droplets and another person inhales them, the SARS-CoV-2 coronavirus then enters the nose and throat and finds a comfortable home in the lining of the nose according to scientists from the Wellcome Sanger Institute. This region is lined with cell-surface receptor known as ACE2 (i.e. Angiotensin-converting enzyme 2) which are present throughout the body to help regulate blood pressure but it also marks tissues vulnerable to infectionThe virus requires this receptor to enter a cell, and once inside it hijacks the cell’s machinery, multiplies itself and takes over new cells.

During the period where the virus is multiplying itself, an infected person may shed copious amounts of it, especially during the first weekThere may not be any symptoms at this point, or the victim may develop a fever, dry cough, sore throat, loss of smell and taste, or head and body achesIf the immune system does not destroy the virus at this early stage, then it moves down the windpipe and starts to wreck havoc in the lungs where it can become deadly.

The thinner, distant branches of the lungs respiratory tree end in tiny air sacs called alveoli [alveolus (single)], each lined by a single layer of cells that are also rich in ACE2 receptors, the very same receptors that allows the virus to penetrate. When we are in good health, oxygen crosses the alveoli into the capillaries, which are tiny blood vessels that lie beside the air sacs (alveoli). That oxygen is then transported to the other regions of our bodyBut, when the immune system is stressed and fighting ardently against the virus, the battle disrupts the oxygen transferThe front-line white blood cells release inflammatory molecules called chemokines, which in turn create more immune cells that target and destroy virus-infected cellsWhen these infected cells are destroyed by the chemokines, they leave a stew of fluid and dead cells – pus – behindThis process is the scenario that takes places in pneumonia and the corresponding symptoms are: coughing; fever; and fast, shallow breathing. In some cases, we find COVID-19 patients who recover, sometimes simply with oxygen breathed in through nasal prongs.

However, in other unfortunate scenarios, patients often deteriorate suddenly to develop a condition referred to as acute respiratory distress syndrome (ARDS), where they struggle to breathe as the oxygen levels in their blood falls abruptly. On x-rays and computed tomography scans, the lungs of these patients are shown to be riddled with white opacities where instead healthy dark space [i.e. air] should beThese cases end up on ventilators and many dieAutopsies have shown their alveoli (air sacs) stuffed with fluid, white blood cells, mucus and the detritus of destroyed lung cells.

Coronavirus COVID-19 Breathing, lungs, alveoli, immune system

Image: The cross section shows immune cells crowding an inflamed alveolus (air sac) whose walls break down during attack by the virus causing reduced oxygen intake – patients cough, experience rising fever and breathing becomes difficult / Source: Wadman (2020)

Some clinicians found that the driving force that leads to severely ill patients’ downhill trajectory and death to be a disastrous overreaction of their own body’s immune system, a reaction referred to as a « cytokine storm » , which viral infections are known to trigger. Cytokines are chemical signaling molecules that guide a healthy immune response, however, in a cytokine storm, the level of cytokines rise beyond the level of what is needed, and hence this excessive rush [i.e. storm] of immune cells also start to attack and destroy healthy tissues – these individuals’ blood vessels leak, blood pressure drops, blood clots form, and catastrophic organ failure can follow.

Some studies (Chen et al., 2020) have demonstrated elevated levels of these inflammation-inducing cytokines (Huang et al., 2020) in the blood of hospitalised COVID-19 patients. Jamie Garfield, a pulmonologist who treats COVID-19 patients at the Temple University Hospital argues that the real morbidity and mortality of this disease is probably driven by this out of proportion inflammatory response of the human immune system to the virus. However, other medical professionals are not convinced. “There seems to have been a quick move to associate COVID-19 with these hyperinflammatory states. I haven’t really seen convincing data that that is the case,” said Joseph Levitt, a pulmonary critical care physician at the Stanford University School of Medicine. Levitt is also worried that efforts to develop several drugs to dampen the cytokine response could actually cause harm by suppressing the immune response that our body needs to fight off the virus.

We find different views among the academic community on this new virus. Others are viewing it from a completely different perspective, and are focusing on the heart and blood vessels, that they believe is playing a significant role in the rapid deterioration of some patients.


Tearing the heart

All the classic symptoms of a heart attack was observed in a 53-year-old Italian woman in Brescia along with signs in her electrocardiogram and high levels of blood marker suggesting damaged cardiac muscles. Further tests revealed cardiac swelling and scarring, and a left-ventricle – which is usually the powerhouse chamber of a human heart – so weak that only one-third of the normal amount of blood could be pumped. When doctors injected dye in her coronary arteries to look for what they believed to be a blockage that is usually associated with heart attacks, they found nothing. The next test carried out revealed that the culprit was in fact COVID-19.

It is still a mystery to academics how the virus attacks the heart and blood vessels but many preprints and scientific papers attest that such damage is common. A JAMA cardiology paper observed damages to the heart in nearly 20% of COVID-19 patients (Shi et al., 2020) out of 416 hospitalised patients in Wuhan, China. Another Wuhan study revealed that 44% of 36 patients admitted in ICU had arrhythmias, i.e. irregular heart beats (Wang et al., 2020).

What has been discovered, is that the disruption extends to blood itself. Among 184 COVID-19 patients in a Dutch ICU, 38% had blood that clotted abnormally, and about one-third already had clots (Klok et al., 2020). Blood clots are very dangerous since they can break apart and end up landing in the lungs, blocking vital arteries – a condition known as pulmonary embolism, which has killed many COVID-19 patients. Blood clots from arteries can also end up in the brain, causing stroke. Many COVID-19 patients have dramatically high levels of D-dimer, a byproduct of blood clots. Hence, it is very likely that blood clots have a major role in the disease severity and mortality with the COVID-19 pandemic.

Infection may also lead to the constriction of blood vessels. There are reports emerging of ischemia [i.e. an inadequate blood supply to an organ or part of the body, especially the heart muscles] in the fingers and toes – reduction in blood flow can cause swollen, painful digits and eventually tissue death. Blood vessels carry oxygen to various parts of our body, and when they become constricted problems will logically arise. In the lungs, the constriction of blood vessels may explain the reports of a very perplexing phenomenon seen in patients with pneumonia caused by COVID-19: some patients although having extremely low blood-oxygen levels are not gasping for breath. Since we are still uncovering the depths of the virus, one explanation may be that at some stages of the disease, the virus modifies the delicate balance of hormones that regulate blood pressure and constricts the blood vessels going to the lungs. Logically, constricted blood vessels will lead to oxygen uptake being impeded – this may be the cause of low blood-oxygen levels rather than clogged alveoli (air sacks) as explained above.

It is very important to take note that if COVID-19 targets blood vessels, it may explain why patients with pre-existing damage to those vessels, such as those with diabetes and high blood pressure, face a higher risk of serious disease. The recent data from the Centers for Disease Control and Prevention (CDC) on hospitalised patients in 14 US states found that bout one-third had chronic lung disease and nearly as many had diabetes and half had pre-existing high blood pressure (Garg et al., 2020). It has also been observed that there is a very low number of cases suffering from asthma and other respiratory diseases. The risk factors seem to be vascular: diabetes, obesity, age and hypertensionAcademics are still in the dark regarding the causes of cardiovascular damageSince the lining of the heart and blood vessels are rich in ACE2 receptors just like in the nose and the alveoli, it is possible that the virus may be directly targeting and attacking themAnother possibility for cardiovascular damage could be the lack of oxygen caused by a combination of factors: lack of oxygen, chaos in the lungs and damages to blood vesselsA cytokine storm unleashed by the immune system itself could also be responsible for damages to the heart as it does for other organs.


Destruction in multiple zones

While there is worldwide tension regarding the shortage of ventilators for failing lungsless attention has been given to dialysis machines. Jennifer Frontera, a neurologist from New York University’s Langone Medical Center who has treated thousands of COVID-19 patients pointed out that if patients are not dying from lung failure, they are dying from renal failure. Hence, her hospital is developing dialysis protocols with different machines to support additional patients. As usual, the ACE2 receptors, a favoured penetrating site for the virus, is abundantly present in kidneys. Going by a preprint, 27% of 85 hospitalised patients in Wuhan had kidney failure (Li et al., 2020). Another report read 59% of nearly 200 hospitalised COVID-19 patients in China’s Hubei and Sichuan provinces had protein in their urine (Diao et al., 2020), and 44% had blood clotboth suggest that kidney damage took placePatients with acute kidney injury (AKI), were more than five times as likely to die as COVID-19 patients without it, the same Chinese preprint reported.

“The lung is the primary battle zone. But a fraction of the virus possibly attacks the kidney. And as on the real battlefield, if two places are being attacked at the same time, each place gets worse,” says Hongbo Jia, a neuroscientist at the Chinese Academy of Sciences’s Suzhou Institute of Biomedical Engineering and Technology and a co-author of that study.

The electron micrographs from the autopsies of kidneys revealed viral particles (Diao et al., 2020), suggesting a direct viral attack. However, the kidney injury may also be a collateral damage caused by ventilators – that heighten the risk of kidney damage – as do some antiviral compounds such as remdesivir [which has been used experimentally in early COVID-19 patients]. The immune system’s cytokine storms may also severely reduce blood flow to the kidney and often causing fatal damage. Diabetes can also increase the chances of kidney injury. Hence people with chronic kidney diseases are at a higher risk for acute kidney injury.


Combo hits to the brain

Another range of symptoms in COVID-19 patients focus on the brain and the central nervous systems (Mao et al., 2020). Frontera says that neurologists are required to assess 5% to 10% of coronavirus patients at her hospital and believes that it may be a gross underestimate of the number of patients whose brains are struggling since many are sedated and on ventilatorsPatients have suffered from brain inflammation, encephalitis (Moriguchi et al., 2020), with seizures and with a sympathetic storm [i.e. a hyper reaction of the sympathetic nervous system that causes seizure-like symptoms and is mostly observed after a traumatic brain injury]. Some COVID-19 patients even lose consciousness for a short amount of time while others suffer strokes. The loss of the sense of smell has also been widely reported. Frontera and others are asking themselves whether in some cases, infection depresses the brain stem reflex that senses oxygen starvation; this may provide an explanation to why despite dangerously low blood oxygen levels, patients are not gasping for air.

The former coronavirus behind the 2003 severe acute respiratory syndrome (SARS) epidemic – a cousin of COVID-19 – could infiltrate neurons and at times caused encephalitisSince ACE2 receptors are present in the neural cortex and brain stem, the virus could interact with those receptors and penetrate the brain. In a case study in the International Journal of Infectious Diseases, a team of academics from Japan found traces of COVID-19 traces in the cerebrospinal fluid of a patient who developed meningitis and encephalitis, insinuating that COVID-19 can penetrate the central nervous system.

COVID-19 encephalitis tissue damage in the brain

Image: Tissue damage in the brain (milky white areas shown by the arrows) as a result of encephalitis developed by a 58-year-old woman infected with COVID-19 / Source: (Poyiadji et al., 2020)

However, other factors could also be damaging the brain, such as a cytokine storm triggered by patients’ immune system itself, leading to swelling, and the blood’s exaggerated tendency to clot could trigger strokes. The collection of neurological data from care patients received is ongoing at a worldwide consortium that now include 50 centers in order to identify the prevalence of neurological complications in hospitalised COVID-19 patients and document how they fare.

The aim of course is to better understand the virus’ impact on the nervous system, including the brain. Sherry Chou, a neurologist speculates about an invasion route for the virus: through the nose, then upward through the olfactory bulb which connects to the brain, which may explain the loss of smell.


To the gut

Diarrhea with blood, vomiting and abdominal pain was reported in early March 2020 from a 71-year-old woman from Michigan who returned from a Nile river cruise. Doctors suspected the common stomach bug, e.g. Salmonella. However, after she developed a cough, nasal swabs revealed that she was positive for COVID-19. Gastrointestinal (GI) infection was diagnosed after a stool sample was positive for viral RNA and an endoscopy revealed signs of colon injury according to a paper in The American Journal of Gastroenterology (AJG) (Click to see).

This case adds to a growing body of evidence suggesting that like the SARS, COVID-19 can infect the lining of the lower digestive tract where, once again, the ACE2 receptors needed for the virus to enter are abundant. As many as 53% of sampled patients’ stool samples have shown to contain viral RNA. The virus’ protein shell was also found in gastric, duodenal and rectal cells in biopsies by a Chinese team who reported it in a paper in Gastroenterology (Xiao et al., 2020). “I think it probably does replicate in the gastrointestinal tract,” said Mary Estes, a virologist at Baylor College of Medicine.

Up to 50% of patients, making up about 20% across studies experience diarrhea. Gastrointestinal Infection (GI) however is not on the CDC’s list of COVID-19 symptoms which could lead to some COVID-19 cases to go undetected. The co-editor of Gastroenterology, Douglas Corley of Kaiser Permanente, Northern California said: “If you mainly have fever and diarrhea, you won’t be tested for COVID.”

So, can COVID-19 be passed on through feces? We do not know if the stool contains active, intact, infectious virus or simply RNA and proteins, there is no evidence to date. Based on experiments with SARS and with the virus that causes Middle East respiratory syndrome, a cousin of COVID-19, the risk from fecal transmission is probably low. 

Finally, the virus also affects the eyes as one-third of hospitalised patients develop conjunctivitis – reddish, watery eyes – although it is not clear if the virus directly attacks the eyes (Wu et al., 2020). Some other reports have also suggested liver damage since more than 50% of COVID-19 (Zhang, Shi and Wang, 2020) patients hospitalised in two Chinese centers had elevated levels of enzymes (Fan et al., 2020) which suggest injury to the liver or bile ducts. However, many experts reportedly told Science that direct viral hits are unlikely, stating that other events in a failing body, like drugs or an immune system overdrive, are more likely driving the liver damage.

COVID-19 is a new virus and the academic community are only beginning to uncover its secrets and find answers to these questions:

Who is most vulnerable?

Why does it develop so rapidly and why it is so hard for some patients to recover?

Why does the infection spread so rapidly from people who are asymptomatic?

Why some patients are hardly affected while others are hit so severely?

The answers to those questions lie in the depths of our immune system. In the human body, immune cells are microscopic warriors that fight off invasive viruses in our body and we have 2 trillion of those. When viruses enter our body, immune cells instantly track them and devour the enemy, injecting toxins to destroy them and sometimes even release a sticky web to ensnare them. 

Latest scientific discoveries are beginning to uncover the enigmatic mechanism behind our immunity. We are now confident that the novel coronavirus has the ability to break down our immune defences with its formidable powers; COVID-19 slips through, suppresses and unleashes chaos. Research on the human immune system is continuing and is helping to find potential new treatments to fight off the novel coronavirus. As vaccines were being developed, scientific research revealed that blood from recovered COVID-19 patients can save the lives of those suffering from severe symptoms.

The COVID-19 virus spreads from tiny droplets released from an infected person’s mouth, and these are smaller than a 1000th of a millimeter in diameter; a droplet around 1mm across can contain as much as 7 million virus particles.

001 04-15 Next Gen Microscope Living Cells at work

Image: This next-generation microscope enables the observation of living cells at work, capturing cells in attack mode in 3D.

Nowadays, advanced technology has provided powerful microscopes that enable us to visualise the world within our bodies; we can even observe living cells at work and capture immune cells in attack mode in 3D. Other tools such as ultra-high 8K resolution microscopy, 3D reconstructions of electron microscope images, as well as the latest CGI techniques enable us to see the wars between viruses and the cells of our body.

The virus, SARS-CoV-2, belongs to a group of coronaviruses (CoVs) of the Coronaviridae family, namely, the β-CoVs, which infect mammals. Coronaviruses are pleomorphic enveloped particles with a single-stranded RNA genome. There are fringe projections known as spike (S) proteins on the virus’s surface, which are the main characteristic of these viruses. The virus uses the S protein to enter the host cell by interacting with the host cell receptor angiotensin-converting enzyme 2 (ACE2). The viral RNA is released in the host cells and triggers a cascade of events that replicate viral RNA and synthesize structural and non-structural proteins. These proteins are vital in the survival and propagation of the virus.

SARS-CoV-2 is mainly transmitted from human to human via respiratory droplets. When an infected person coughs, sneezes, or talks, another person could be infected if the droplets are inhaled or come into contact with their mucous membranes. The novel coronavirus gets into the body through droplets that carry the virus [e.g. through the mouth, or nose]. However, the virus cannot keep going, and the first barrier it meets is the respiratory tractthe airway that leads into our lungs. The image below shows the repiratory tract magnified more than 10,000 times by an electron microscope.

002 05-31 Image of Respiratory Tract

Image: Human respiratory tract magnified 10,000 times showing tiny hair-like structures called cilia [about a 100th of a strand of human hair] that make tiny rapid movements [over 1000 times per minute]. These movements cause foreign matter such as viruses to be pushed away. However, COVID-19 can infect cilia cells by stopping their sweeping movements in order to slip through and penetrate deep into the lungs.

002 05-31 Membrane-Cilia-Airway

The novel coronavirus has the potential to infect cilia cells by stopping their protective sweeping movements and slip through into the airways to finally work its way deep into the lungs. When that happens, the COVID-19 infection begins; the virus particules approaches a lung cell and targets an odd looking protrusion on the lung cell’s surface which is only about 1/100000 mm. The novel coronavirus attaches its spike onto that protrusion on the cell surface, then the COVID-19 virus gradually sinks itself into the cell – the infection is now complete! This method is a cunning trick unique to viruses.

003 06-39 COVID-19 attaches spike to cell protrusion

Animation: The novel coronavirus attaches its spike to the protrusion on the lung cell’s surface and burries itself into that cell to infect it.

The protrusions [shown in purple in the above animation] which are present on the surface of lung cells, act as a keyhole, only allowing essential substance such as cholesterol. Hence, only substances with the right “key” are allowed to enter the cell. The COVID-19 virus has a fake key that fits perfectly with the keyhole of the cells. So, COVID-19 tricks the lung cell into allowing an intruder inside. The image below was taken with an electron microscope; it shows the interior of a cell that has been infected by COVID-19 [all the red dots are COVID-19 virus particles].

004 07-43 Inside of Cell Infected with COVID-19

Image: Interior of a cell infected by COVID-19. All red dots are virus particles that once inside can replicate itself as much as a 1000 times before breaking out.

005 COVID-19 burst out of an infected cell

Image: Microscopic image showing the moment where COVID-19 particles [in red] have burst out of an infected cell. Vast amounts of viral particles scatter all around, looking for new cells to infect.

When the COVID-19 burst out and scatter all around from an infected cell while continuing the infection process, patients tend to suffer from more severe pneumonia.

In X-rays of COVID-19 patients, the areas that are inflamed due to the viral infection show up as white spots while the lungs are shown in black; and when the pneumonia intensifies and becomes critical, X-rays show vast amounts of white areas [i.e. vast areas affected by inflammation].

006 08-41 X-ray image of COVID-19 Pat

Image: X-ray image of a COVID-19 infected patient. Lungs are shown in black and areas of inflammation caused by the viral infection are shown in white [as these spread, pneumonia symptoms worsen]

In order to prevent such crisis, our body relies on immune cells, which are the defence unit of the human organism. A cell infected with COVID-19 starts to release large amounts of blue particles, a substance called interfera, which sends a warning to immune cells [i.e. our defence units] in order to alert them of a dangerous enemy; this alert [i.e. blue particles] is carried across the body through the bloodstream. Those alert messages are then received by round cells that roam in our blood vessels, known as phagocytes.

007 09-52 Phagocyte in patrol

Animation: The inside of a blood vessel showing phagocytes on patrol inside these blood vessels all around our body. When they receive the alert message [i.e. blue particles released by infected cells (interferons)] warning them of an enemy intrusion, they head out from the blood vessel to the site of infection

When phagocytes locate their target, i.e. foreign matter such as viruses, they move in and devour it whole, even if those targets happen to be larger than themelves. Patients infected with COVID-19 but who do not show any symptoms are thought to have incredibly active phagocytes in their bodies; those powerful defensive units which engulf the viral enemy are known as our innate immunity and it is part of a system that we have inherited since birth; it derives from our shared evolutionary history of encouters with viruses as human beings.

008 10-15 Phagocyte devours COVI-19

Animation: Phagocyte devouring the viral target which is larger than itself

009 Society and COVID-19

But why unlike others, do some people experience life threatening symptoms as their health deteriorates even though they are supposed to be protected by our innate immunity?

Latest research has revealed an intriguing possibility; the COVID-19 virus may have developed the ability to evade the defensive attacks of our innate immune system. This was uncovered by Dr. Kei Sato at the Tokyo University Medical Research Institute as the genetic information stored inside the COVID-19 virus was explored.

010 COVID-19 Gene ORF3b Dr Kei Sato

Image: ORF3b, the unique gene of the COVID-19 virus that gives it the ability to deceive the innate immunity of human beings. “The poor IFN responses in COVID-19 patients may be explained by the action of this viral product, ORF3b”, said the lead scientist, Kei Sato

When this genetic information was compared to those of other viruses, the COVID-19 virus was found to have a unique gene [ORF3b, as shown in the image above]. Further experiments revealed that the function of the unique gene discovered was to give the COVID-19 virus the ability to deceive our innate immunity.

Remember, as explained above, a COVID-19 infected cell will release masses of alert messages [i.e. blue particles known as interferons] to warn our immune cells about the presence of a viral enemy. However, when this unique gene [ORF3b] discovered in the COVID-19 virus is activated, those defensive alerts to our immune cells are supressed; only about 1/10 of those warnings are sent [90% blocked] from the infected cell.

011 12-10 ORF3b Gene COVID-19

Animation: When the unique ORF3b gene that is present in the COVID-19 virus is activated, it drastically reduces the amount of interferons (blue particles) sent by the infected cell [in dark red] to warn the immune cells to take action.

So, when this happens, the phagocytes do not receive any message of the impending danger and hence they cannot be mobilized to neutralise the COVID-19 virus, which is left to replicate itself at will. A further study has found that without the warning messages of the interferons to the phagocytes, the COVID-19 virus can replicate by as many as 10,000 times in only 2 days.

012 With or without interferons

Image: The ability of the COVID-10 virus to replicate and cause severe symptoms is largely related to the patient’s ability to release interferons. Left (with interferons); Right (without interferons); Virus particles replicating itself (in Red)

Now we know that people who experience severe symptoms produce lower levels of interferons, and it is very likely that this weakness in some people allows the novel coronavirus to spread throughout the body and replicate itself savagely, resulting in severe and life-threatening symptoms.

013 Lower interferons severe symptoms

Graph: The number of interferons produced are clearly poor in patients with severe symptoms (Konno et al., 2020)

So, supressing our body’s red alerts is one deadly weapon COVID-19 is using against us and this may be the reason why it has turned into such a global crisis and emergency. Countries around the world and their governments have been stunned by this pandemic and have been taking desperate measures such as complete lockdowns at the cost of their economy in a bid to halt this the spread of this ugly infection.

One of the greatest difficulties with COVID-19 is that there is a certain delay before any convincing symptoms appear and if people are unaware that they are infected, they eventually go on to infect others. Usually, when our body is infected by a virus, an alert substance is released within our bodies, which causes our body temperature to rise in order to activate the immune response. However, since the novel coronavirus is suppressing those warning signals, infected people show no signs such as fever, even thought the viral load within their bodies keeps increasing. That superficially asymptomatic state leads to people not knowing that they are infected and hence allows the virus to spread since those infectious hosts are going unchecked.

021 COVID-19 no symptoms virus unchecked

Another worrying news is that the virus’s ability to suppress those warning signals seems to be getting stronger with different genetic types of COVID-19 variants spreading throughout the planet. A strain found in Ecuador has a slight alteration in the gene that suppresses the alarm substance. Dr. Paul Cardenas who has been studying patients at the hospital in the capital of Quito said that it is abnormal to find young people developing severe symptoms that quickly. After virus samples of the new strain was collected and analysed, the gene that suppresses alarm signals (i.e. interferons) revealed a mutation; that change leads to the amount of interferons being reduced even further to 1/20. If this powerful variant continues to spread, the immune system’s defence will be forced to fight even tougher battles against the coronavirus.

We have also recently heard a lot about the B.1.1.7 variant [first detected in the UK], the B.1.351 variant [first detected in South Africa] and P.1 variant [detected in Manaus, Brazil]. Other variants continue to appear, such as the one in New York, named B.1.526 which contains the same E484K mutation that has caused so much concern in the UK’s B.1.351 (South Africa) variant; which allows the virus to escape some of the body’s immune response. There are many other variants of COVID-19 appearing around the planet due to genetic changes and these changes will lead to even more variants that could eventually become resistant to the vaccines developed and drugs used to treat patients with severe symptoms.

Vaccines may also have to be updated and modified to address the new variants since those developed for the original virus have been found to be less effective against the B.1.351 (South Africa) variant. The latter variant has been reported to be on the rise in the UK and patients affected by it were on average older and more frequently hospitalised. As for the B.1.526 (New York) variant, it appears to be scattered in the northeast of the US, and its unique set of spike mutations may also pose an antigenic challenge for current interventions. In Finland, The Fin-796H variant, identified by researchers from Vita laboratories and the Institute of Biotechnology at the University of Helsinki, is reported to have mutations similar to those seen in B.1.1.7 (UK) and B.1.351 (South Africa).

The B.1.1.7 variant identified in early October 2020 from genomic sequencing of samples from COVID-19 carriers in the south east of England has been classified as a variant of concern (VOC-202012/1). In December this variant spread from the south east to London and the rest of the UK and its growth coincided with the second national lockdown (5 November to 2 December 2020). Additional control measures had to be imposed after its increased rate of spread with international restrictions on travel from the UK shortly following, in particular to France and to the rest of Europe late in December 2020 to curb the contamination of other countries with this new variant, despite evidence that it had already been present outside the UK. Since then, the prevalence of B.1.1.7 (VOC-202012/01) has been increasing in both Europe and the US. Research conducted in the UK measured the possibility of death within 28 of the 1st positive test result and found that the risk of mortality with the B.1.1.7 (VOC-202012/01) variant is inreased and is high. Hence, as the research carried out by Robert Challen and his colleagues suggest in the British Medical Journal, the UK variant has the potential to raise the mortality rate significantly compared with previously circulating variants, and healthcare capacity planning and national and international control policies are all impacted by this finding as increased mortality lends weight to the argument that further coordinated and stringent measures are justified to reduce human deaths from COVID-19 (Challen et al., 2021).

As of the 30th of March 2021 in France, as predicted by epidemiologists and infectiologists , the UK variant B.1.1.7 identified as “anglais” by the French, has been found to be responsible for the majority of contaminations. Of the COVID-19 positive PCR tests screened to differentiate the original SARS-CoV-2 strain from a variant, 79% of the infections in France were found to be due to the much more contagious “English” mutant B.1.1.7. The share of the South African and Brazilian variants remains is still quite small as the chart below shows.

COVID-19 Représentation des variants dans les tests PCR criblés

Pink – UK Variant; Blue – SA Variant; Yellow – Unidentified Variant, and Grey – Original Wuhan Strain / Représentation des variants dans les tests PCR criblés. Source: Geodes, Santé publique France

If the COVID-19 virus manages to evade our innate immune system and keeps on multiplying, in most cases hosts (i.e. humans) remain asymptomatic for around 5 days after they are infected. But when the viral load in the body exceeds a certain limit, symptoms begin to appear in the shape of fever, cough and fatigue. As the virus breaks down our innate immunity and escapes our defences, it continues to replicate at will.

However, the immune system will not just give up. This is when our secondary defence force takes action; it is known as our “Adaptive Immune System” and that is deployed in the fight against the infectious viral invader. This scenario is still dependent on the phagocytes that had been fighting the virus, however now the phagocytes move to a different location and start to act as messengers seeking reinforcements. That messenger phagocyte will attach itself to a blue immune cell while holding a fragment of the novel coronavirus that it had devoured earlier in what looks like a clasp. The blue immune cell will accept this fragment from the clasp and process it as an enemy intel, and will then become activated – it is now a killer T cell ready to attack.

014 18-45 Killer T Cell

Animation: The messenger phagocyte attaches itself to a blue immune cell while holding a fragment of the novel coronavirus that it had devoured earlier in what looks like a clasp [shown in golden yellow]. The blue immune cell accepts that fragment from the clasp and processes it as an enemy intel, and becomes activated – it is now a killer T cell [shown in green]ready to attack.

These activated killer T cell with information about the virus will now target cells which are infected with the novel coronavirus – it knows what it is looking for. Infected cells have fragments of the COVID-19 virus protruding from its surfaces. The killer T cell will move in and compare those protruding fragments with the information they received from the messenger phagocyte, and if the target matches, it will be confirmed and the killer T cell will will commence their attack; the virus as well as the cell will then be completely obliterated.

015 20-05 Killer T Cell Attack

Animation: The Killer T cell attaches itself to the surface of the infected cell, compares the fragment in the protruding clasp on the surface with the information it received from the messenger phagocyte and launches its devastating attack once the target is confirmed – obliterating both virus and cell.


016 20-18 Killer T Cell Attack M

Video: We can see the live action from a cutting-edge microscope that has caught the moment of attack by a killer T cell [in green] once it attaches itself to its target cell [in blue]; a toxic substance [in red] is injected, destroying the infected cell along with the alien virus inside.

Unfortunately, it now also appears that the novel coronavirus is finding ways to evade the killer T cell attack. Recent findings from China suggest that the COVID-19 virus has a unique quality setting it apart from other viruses. The novel coronavirus is now targeting those protruding clasps [that hold viral fragments] on the surface of the cells it has infected, reducing their numbers by 60%.

017 21-16 Clasps broken

Animation: COVID-19 virus breaking down the clasps protruding from the surface of infected cells, making it much harder for killer T cells to locate them, and allowing the virus to continue multiplying unchecked.

That makes it much harder for the killer T cells to locate infected cells, hence, the infection remains unchecked and the virus continues to multiply in the hosts.

But this war is far from over, since in retaliation our immune system sends out another unit known as the B cells. B cells also get their enemy intel from viral fragments just like killer T cells, however they produce powerful projectile weapons.

023 21-54 B cells recInt AntiB

Animation: B cells receiving information about the viral target from the phagocyte, and releasing the appropriate antibodies (in Yellow)

B cells release small yellow particles and are shaped as the letter Y when viewed through a microscope; these amazing yellow particles are known as antibodies. These yellow projectile weapons released from B cells close in on the ugly COVID-19 virus and bind to the spikes on its surface [remember these spikes are the fake keys that the virus uses to invade human cells]. Once the virus’s surface is covered with those yellow antibodies, the virus is rendered uselss as it can no longer attach to cells, infect them or replicate. With nowhere to go and hide, they are devoured one by one by the phagocytes. When infected patients reach this stage, they are out of danger, since their bodies will now begin to recover slowly.

024 Antibody BndSpks DvPhgC

Animation: Yellow Y-shaped antibodies produced by the B cells close in on the virus and bind to its spikes. Covered with those amazing antibodies the virus can no longer bind to cells, infect or replicate. With nowhere to go, they are devoured by phagocytes.

Yet, the work of T cells and B cells are far from over, since these amazing defence units will retain their memories of the viral enemy and remain alert in our bodies and ready to fight back for future attacks. These special units study the viral enemy, launch  intensive attacks and even after repelling the virus, they will remain vigilant to protect our bodies from harm – it is our adaptive immune system in action.

Vaccines developed against COVID-19 attempt to enhance the power and effectiveness of our adaptive immune system by injecting fragments from an attenuated virus into the body so that information about the novel coronavirus can be passed on safely to T cells and B cells; in that way our adaptive immune system will learn about the enemy before any infection occurs and be ready to provide the necessary attack if infected.

Two studies available as preprints conducted in England found that middle aged women face higher risk of debilitating ongoing symptoms, such as fatigue, breathlessness, muscle pain, anxiety, depression, and “brain fog” after hospital treatment for COVID-19. 7 in 10 patients admitted experiencing “long covid” symptoms an average of 5 months after discharge and those symptoms were more prevalent among women aged 40-60.

Prevalence of medical conditions for people aged 40 to 60 in 1991 to 1993 and 2011 to 2013

Figure: Prevalence of medical conditions for males & females aged 40 to 60 [Change between 1991 to 1993 and 2011 to 2013 in England / Source: GOV.UK Public Health England

The study carried out in England is reported in the British Medical Journal, it found that among those who classify themselves ethnically as “White”, with 2 or more comorbidities at admission, and receiving invasive ventilation while in hospital the risk was increased; however the severity of acute COVID-19 disease did not affect the likelihood of experiencing long COVID symptoms. [Note: Ethnicity is a grouping of people who identify with each other on the basis of shared attributes that distinguish them from other groups such as a common set of traditions, ancestry, language, history, society, culture, nation, religion, or social treatment within their residing area(s). Ethnicity is sometimes used interchangeably with the term nation]

From the 1077 patients studied, only 29% felt fully recovered when followed up, on average 5 months after discharge. More than 1/4 had clinically significant symtoms of anxiety and depression, 12% had symptoms of post-traumatic stress disorder, 17% had at least mild cognitive impairment, 46% had lower physical performance than age and sex matched controls, and 20% had a new disability. Before being admitted to hospital for treatment, 68% had full time work, but 18% of those had not returned to work and 19% had had to change their working habits due to long-lasting effects. The patients were grouped into 4 clusters by researchers, according to the severity of their physical and mental symptoms post-COVID: Very Severe (17% of patients); Severe (21%); Moderate with Cognitive Impairment (17%) and Mild (46%)

Rachael Evans, a clinical scientist and reseacher from the National Institute of Health Research declared: “The symptoms are very real, but they don’t have a straightforward relationship with heart and lung damage, or certainly heart and lung damage can’t explain all the symptoms.”

A smaller second study, from the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), found that women under 50 were 5 times less likely to report feeling recovered, 2 times as likely to report worse fatigue, 7 times more likely to become more breathless, and more likely to have greater disability than men of the same age who had been admitted to hospital with COVID-19. Disability usually affected memory, mobility, communication, vision, or hearing. More than half of the 327 patients assessed did not report feeling fully recovered when followed up on average 7 months later, and persistent symptoms were reported by 93.3%, with fatigue and breathlessness the most common.

Chris Brightling, a professor of respiratory medicine at the University of Leicester and a study researcher, speculated that sex based differences in the immune response may be responsible for the higher prevalence of long COVID symptoms in women, noting that autoimmune diseases were more prevalent in women than in men aged 40-60.

Maybe there’s a difference in the immune response acutely, such that men are more likely to have a more severe condition at the time of the infection,” he told a press conference at the Science Media Centre on 24 March 2021. “It may be that the immune response is different in women, so you then have a continued inflammatory reaction that then leads to a higher likelihood of having long covid.”

Higher levels of C reactive protein, a marker of systemic inflammation were found in patients with the most severe long COVID symptoms. Brightling said that a number of immune and chronic inflammatory condition can also cause elevated C reactive protein. About 450,000 COVID-19 patients have been admitted to hospital in the UK, so a “very large” proportion of these would potentially be affected by long covid, Chris Brightling said, adding, “Clearly there’s an even larger number of people that have had covid in the community, and a portion of those will also have long covid.” (Evans et al., 2021; Sigfrid et al., 2021)

La préparation dune dose de vaccin - QUEMENER YVES-MARIE OUEST FRANCE

Image: La préparation d’une dose de vaccin. | Photo: Quemener Yves-Marie

Researchers and health departments are working as fast as they can to ensure the safety of treatments and maximise the effectiveness of vaccines. While vaccine campaigns have begun across the planet, many people have lost their lives since the COVID-19 virus appeared in late 2019 and many others are still being infected. 


But, what may have happened in the bodies of patients who became critical and ultimately lost their lives?

038 South Brooklyn Casket Co

Image: Casket manufacturing business, South Brooklyn Casket Co. in the U.S, sending a casket to a customer during the COVID-19 pandemic

More than 150 autopsies have been conducted at the University Medical Center Hamburgg-Eppendorf in Germany and something quite unusual was discovered in the lungs of those COVID-19 victims.

Dominic Wichmann: “From our past studies where we learned that with every new disease there are new findings when you do autopsy on a regular basis. We thought it might be very interesting from a scientific point of view to get more into detail in COVID-19. We were really really surprised about very very high incidents of venous thromboembolisms and pulmonary embolisms. We discover that within the first 12 patients, we had about one third of patients who died from pulmonary embolism (Wichmann et al., 2020).”

Pulmonary embolism is a disease where blood clots form in the lungs. Blood clots cause blood circulation to fail in the human body and the resulting lack of oxygen led to the death of those patients. A closer look showed many blue dots among the red clots of blood in those patients; those blue dots are the dead remains of a type of phagocyte called neutrophils that had caused the clots.

035 27-19 Blood clots

Video: Blue dots, which are the dead remains of neutrophils (a type of phagocyte) were found within the blood clots in the lungs of deceased COVID-19 patients

As already explained above clotting occurs when our immune system goes into overdrive, a phenomenon called a cytokine storm. To explain this phenomenon, it is important to understand that the immune cells in our bodies can become overly activated when faced with a virus that is replicating in huge numbers. It has long been suspected that the human body’s own hyperactive immune cells have been damaging the blood vessels, and in order to close those internal wounds, platelets in the blood come would come together to form clots; those grow larger and sometimes end up blocking circulation. The important point to note is that recent research has shed light on this very disturbing mechanism where cytokine storms trigger dangerous blood clot formation.

Yogen Kanthi from the University of Michigan explained: “When Neutrophils start to detect that there are pathogens circulating in the bloodstream, they will start to take their DNA inside of the cell and they expel it outside of the cell. They spit it out from something called a neutrophil extracellular trap (NET). We know that certain cytokines that are released in the setting of COVID-19 can prime the neutrophil and make the neutophil more likely to form NETs (Neutrophil Extracellular Trap).

What we need to understand is that NETs (Neutrophil Extracellular Traps) are essentially suicide attacks, and this phenomenon was only recently discovered by the academic community in 2004. In normal cases, those kinds of attack will not cause any clotting. But in a cytokine storm overly active phagocytes in our bloodstream self-detonate in excessive numbers – that is where the danger of clotting appears.

018 Phagocyte Suicide NET

Image: The moment of attack: the yellowish-orange phagocyte shown here is only a 100th of a millimeter wide and here it is captured as it self-detonates, hurling its contents (in green) towards the enemy virus (in red). This green weblike structure is the DNA of the phagocyte; the cell sacrifices itself by detonating in a desperate effort to trap the enemy harming the body with its DNA’s sticky texture. (Image courtesy: Max Planck Institute, Germany)


019 29-44 Phagocyte Detonating

Video: A phagocyte self-detonating and releasing its DNA (in orange), seen here bursting out of that cell. In normal cases, those kinds of protective and self-sacrificing attacks will not cause any clotting. But in a cytokine storm overly active phagocytes in our bloodstream self-detonate in excessive numbers – that is where the dangerous blood clot formation begins

When excessive numbers of DNA NETs (Neutrophil Extracellular Traps) have been cast from the excessive number of phagocytes sacrificing themselves by self-detonating, those can even scatter blood components in the vicinity, lumps from those blood components form clots and bind to each other to grow larger and larger, to the point where they have the potential to completely block blood vessels in the human body. So, despite the intention of the phagocyte to protect its organism, these extreme suicide attacks backfire by forming blood clots that lead to death.

020 30-13 Lumps Clotting

Video: Clots being formed by scattered blood components [formed due to the excessive self-detonations of phagocytes] in the vicinity, binding together and eventually blocking blood vessels

Yogen Kanthi further explains: “COVID-19 as you know, is caused by the SARS-2 coronavirus. And this is a normal virus that our bodies have not encountered before. As a result of that, the bodies don’t know how to respond to it. And so they are pulling out every tool that we have in the toolbox to try and fight this infection. What this means is the infection results in unregulated amounts of inflammation. And so inflammation can be very helpful in the beginning to try and fight off infection and help to repair organs. But if the inflammation is unregulated and continues at high levels for long periods of time that inflammation can be damaging to the body.

Autopsies carried out on victims of COVID-19 have revealed that blood clots were the direct cause of death for 1/3 of those who lost their lives (Wichmann et al., 2020). Hence, to prevent the formation of deadly blot clots deriving from cytokine storms [i.e. the excessive self-detonations of phagocytes], those cytokine storms must be supressed. This is why drugs to dampen the reactivity of the human immune system have been trialed and considered as potential life-saving treatments in the fight against COVID-19. We are now armed with a new strategy, and hope is on the horizon to help patients with the severest symptoms.


Understanding the Immune System: the legacy of the shared evolutionary history of human primates on planet Earth

In the fight against viruses and pathogens since the dawn of mankind on our tiny blue planet, our immune system has always been the ultimate weapon and its presence can be traced way back in the shared evolutionary history of life. About 550 million years ago, the Cambrian explosion lead to the creation of the wide range of living organisms.

022 The Cambrian Explosion

Viruses also existed at that time and are believed to have had spikes on their surfaces; those spikes are the fake keys modern viruses use to infect their hosts. Our evolutionary kin back then looked like a fish, since all life came from water.

027 Our Evolutionary Kin

Those incredible cells from our adaptive immune system such as T cells and B cells appeared as they endured viral attacks through the course of their evolution with the ability to remember the enemies they encountered and the protective and defensive strategies they used against viruses.

Even if the COVID-19 virus continues to cause panic worldwide, studies have shown that viruses and their hosts have not always been antagonistic towards each other in the course of the evolution of human life on Earth. There are occasions when those viruses and their hosts co-existed, mutually taking advantage of one another. Hence, some viruses are known to have embedded their genes into the DNA of our cells that they had infected. Our early ancestors have also been faced with viruses and were infected by many that permanently left their mark in our DNA; this is a fact of our shared evolutionary history as human primates on planet Earth. As much as 8% of the human genome comes from viruses; and our bodies may have taken advantage of the qualities of those viral genes in its own evolution to gain various important functions.

032 Virus DNA Legacy d'purb dpurb

The process of creating new life itself testifies as a great example. In the process of fertilisation where the sperm binds to an egg, the sperm carrying the father’s DNA has to enter the mother’s egg. Since the egg views the sperm as a foreign substance, the sperm has to use a key to gain entry into the egg. This process is remarkably similar to how a virus enters a cell [as already explained above]. Modern academics and researchers believe that this process comes from the evolutionary past of life on earth; the fertilisation process may have taken advantage of the techniques of viral genes that had infected our early ancestors thousands of years ago.

There are also other functions about humans that are thought to have evolved from viral genes picked up along the way throughout the our shared evolutionary history, such as the placenta, which enables babies inside the womb to receive nutrition and oxygen from the mother, and some brain functions related to long-term memory. Through our long evolution, our immune system became stronger, more efficient and sophisticated.

033 Evolution Immune System

In the 21st century, we have more than 40 different types of immune cells that are working together in our bodies, forming an elaborate defence network to maintain health and vital functions. While we are eternally evolving along with our cells, viruses too have been evolving, gaining more powerful and elaborate techniques to break through the defences of our bodies. The current war being waged between our immune network and COVID-19 is at its most intense in the shared evolutionary history of mankind. Luckily for us, new insights into the working of our immune system and viruses are providing effective measures to counter the novel coronavirus.

Before the vaccines were released, a patient was infected with COVID-19 and slipped in a coma for 8 days. The first signs were similar to the regular flu, however within 5 days the man had trouble breathing and had to be admitted to hospital and was later transferred to the ICU where he would be put on a ventilator. In these early days against COVID-19, three different drugs were administered to him as part of a clinical trial in a desperate attempt to prevent him from dying, however his condition did not improve – medical professionals were running out of options and time. Then, he was given a special treatment and miraculously regained consciousness within 4 days and a very quick recovery followed. That patient was saved with the blood of another individual who could be said to possess special powers as a COVID-19 survivor. The antibodies contained in the blood of the COVID-19 survivor were collected and injected in the critically ill patient’s body. This treatment is known as convalescent plasma therapy.

Remember! Earlier we explained that: (1) when the virus enters and infects cells, blue interferons are released to alert the phagocytes to take action and devour the viral cells, but since the COVID-19 virus has a mutated gene that supresses the blue interferons, phagocytes cannot be mobilized; (2) the immune system then uses the phagocytes as messenger to carry viral particles as information to the blue immune cell that becomes activated as a killer T cells which then locates protrusions on infected cells’ surfaces to inject toxin and destroy both virus and cell, however, since the virus uses another cunning technique to break down the clasps protruding through infected cells, the T cells fail to detect those infected cells; (3) those 2 solutions were part of our innate immune system, and when they fail the body relies on the adaptive immune system to pass information through phagocytes to the B cells that release the life-saving yellow particles known as antibodies, and when a COVID-19 patient reaches this stage they are out of danger.

That convalescent plasma therapy which saved the above patient’s life is about collecting those amazing Y-shaped yellow particles known as antibodies which are produced by patients who successfully fought the COVID-19 virus. As already explained those yellow antibodies are projectile weapons tailor-made by immune cells based on the information they received on the virus from the messenger phagocytes. We know that antibodies released by B cells engulf the viral cells disabling them and preventing them to replicate, hence these antibodies are powerful weapon that target the COVID-19 virus. Fortunately for the critically ill patient above, the donor’s body was able to produce vast amounts of antibodies from his B cells. When those antibodies were injected in the body of the patient, they successfully disabled and eliminated the virus.

Hence, convalescent plasma therapy treatment is a proven solution expected to save lives as the COVID-19 continues its devastating rampage across the planet. Vaccines may be available, but it will take some time to vaccinate the whole planet, and even if the world is vaccinated, some people may still develop severe symptoms. So, having a stock of convalescent plasma at hand will always be the safest bet in preventing deaths from COVID-19. It seems noble and reasonable for health authorities worldwide to ask COVID-19 survivors to donate their blood, as their antibodies will save lives.

025 Plasma collected for COVID-19 Patients

Image: Convalescent Plasma Therapy [Life-saving antibodies created by the B cells of a COVID-19 survivor are collected from his blood, ready to be injected in the body of a patient with severe symptoms]

Research has shown that some individuals have the incredible ability to produce vast amounts of antibodies, enough to save the lives of patients with life-threatening symptoms. Blood was collected from 149 COVID-19 survivors. The graph shows the levels of antibodies found in their blood samples and we can see that they vary from patient to patient; some are able to produce 10 times more antibodies than the average. (Robbiani et al., 2020)

026 Level of antibodies produced

Graph: Level of antibodies produced by the patients who recovered from COVID-19 in the study. (Robbiani et al., 2020)

So what is the difference between people who are able to produce large amounts of antibodies when infected by the novel coronavirus and those who don’t?

The answer to this question is remains a mystery but scientists have a theory. The answer may lie in the moment when antibody production is triggered, i.e. when immune cells holding viral fragments pass on the message [enemy intel] to the B cells of our adaptive immune system which then produce antibodies based on this information. The key here is the shape of the clasp that comes from the messenger immune cell. We know that there are more than 10 000 types of those clasps and they vary from one individual to another.

029 Different clasps COVID-19

Image: There are more than 10 000 differently shaped clasps and those vary from one individual to the next

Some clasps have a better grasp [i.e. they can hold on more firmly] to the fragment of the novel coronavirus, hence they keep sending out precise intel to allow large amounts of antibodies to be made. But some people who have differently shaped clasps [i.e. clasps that do not perfectly fit the shape of the viral fragment] lead to their messenger immune cell not being able to grip the viral fragment perfectly, this leads to a lack of precise information being passed on to the B cells, and hence lower amounts of antibodies are released.

Interestingly, we are beginning to understand that these differences may be associated with geography and ethnicity [Note: Ethnicity is a grouping of people who identify with each other on the basis of shared attributes that distinguish them from other groups such as a common set of traditions, ancestry, language, history, society, culture, nation, religion, or social treatment within their residing area(s). Ethnicity is sometimes used interchangeably with the term nation].

Evolution of clasps people world

People across the planet have inherited differently shaped clasps better suited to fight against the viruses in their area throughout evolution. This evolution is eternal as the human race evolves.

In Africa, for example, we can find many people with clasps that are better suited for holding to fragments of the malaria parasite, meanwhile in south-east Asia there are many people who have the most suitable types of clasps to grip fragments of the bacteria responsible for leprosy. Scientists believe that these differences from different groups from different locations across the planet come from variations in a particular gene known as HLA, which is responsible for shaping the clasps of the immune cells in our bodies.

Katsushi Tokunaga of the Genome Medical Science Project from the National Center for Global Health and Medicine explains: “Many types of pathogens have emerged throughout our history. In different regions at different ages. That is why mankind has acquired different HLA types to fight off different pathogens.

About 200,000 years ago, our ancestors, the early primates, left Africa and began to explore and migrate to different parts of the planet. Wherever they moved to, just like us today, they also had to face viruses and pathogens. After each attack, it is believed that their immune system and HLA gene adapted; so these clasps suitable to face new enemies have been passed on to us through the long journey of evolution.

030 Different shapes clasps

Image: Each individudual has inherited a uniquely shaped clasp from their individual evolutionary history

Katsushi Tokunaga: “The diversity of HLA’s is our defense against the range pathogens. So only those who excelled in the fight against them left their HLA types as a legacy to us.”

We still cannot know when or how some individuals have acquired the incredible ability to develop those amazing clasps that are so well adapted to fight off the COVID-19 virus; the most rational explanation seems to be that individuals in their evolutionary lineage in the past experienced infections from viruses that shared a great deal of structural similarity with the novel coronavirus, hence they have acquired clasps that just happen to perfectly fit the shape of the COVID-19 virus. Every individual on our planet has inherited different shapes of clasps within their immune cells to fight off viruses. This is our heritage from our shared evolutionary history as primates on earth and a testament to our primitive ancestors who had fought and survived an incredible variety of infections diseases throughout evolution.

Today, cutting-edge medicine is attempting to harness the immune super powers of the few incredible individuals so that lives all over the world can be saved by passing down their immunity [i.e. the antibodies created by their B cells ]to fellow humans.

At the Lilly Technology Center, scientists are culturing immune cells collected from those individuals with super powers who can produce large amounts of COVID-19 antibodies. They are hoping to produce antibodies in vast quantities so they can be used to save the lives of patients suffering from the severe life-threatening symptoms of COVID-19 worldwide. Clinical studies are already underway and the academic community is hopeful that convalescent therapy treatment will be widely available.

Pamela J. Bjorkman from the California Institute of Technology Eppendorf said: “I think we could make things in the laboratory that would work better than what people are making. And maybe those would work at very low concentrations and make a practical way of delivering to people to protect them or help them if they’re actually sick. This is definitely a possibility. And I think it’s a very hopeful one too. If anyone was sick and they were willing to donate their plasma to help other people and to help science, then yes, they are definitely heroes.”

The planetary war agains COVID-19 continues with no end in sight. However, it is important to note that our immune networks have been supporting us since birth and will do so until we take our last breath.

From birth, the moment we leave the vagina and take our first gasp of air on this planet as infants we are exposed to many different pathogens like viruses and bacteria. But the immune cells of babies are not yet ready to fight back. The first protection for the baby comes from the mother’s breast milk, which contains large amounts of immune cells and antibodies belonging to the mother; those help the baby’s own immune cells to develop while also providing protection from various bacteria and viruses.

Mères allaitant leur bébé d'purb dpurb site web

Image: Des mères allaitant leur bébés / Mothers breasfeeding their babies


After several months, the baby’s own immune networks begin to kick in, and in the years that follow through exposure to various types of viruses and bacteria our immune system continues to develop and grow stronger. It had previously been thought that the immunity of human beings reaches its peak around 20 years of age and then flattens out, gradually declining at around the age of 70.

031 Evolution of immune system

But during the current COVID-19 pandemic incredible recoveries have been observed across the planet from individuals in the 70s, 80s and even some centenarians. Studies suggest that these incredible individuals have something “special” in their bodies that is keeping their immune cells young.

037 Old COVID-19 Survivors

3 COVID-19 survivors who are above 90 years of age: (i) Connie Titchen (106, from the UK); (ii) Albert Chambers (100, from the UK); and Maria Branyas (113, from Spain)

The mystery of the human body remains and we know that it is a remarkable system supported by specialist cells that protect our lives with their unique skills honed over 4 billion years of evolution. The keys to overcoming this pandemic and future ones might just be locked away in our own bodies and it could be hidden in some incredible individuals out there.

It is important to note that these findings are just the beginning, and it will take years of serious research to fully understand COVID-19 along with the range of cardiovascular and immune effects it might trigger as new variants continue to evolve. We can only hope to find a way to stop this ugly virus in its track through the combined efforts of planet Earth’s scientific force and medical geniuses.

At present, whilst COVID-19 appears to be more contagious than SARS or MERS, the fatality rate is relatively low (around 3%) when compared with MERS (34%) and SARS (10%), with early data suggesting the elderly and those with underlying health conditions are at a higher risk.

In France, if Mentonians are concerned about coronavirus, it is in fact mainly for their elders. « Menton is a town of old people. If the epidemic spreads, they’ll all be dropping like flies. It’s going to be no man’s land, » said Denis, arm in arm with his 88-year-old mother. « I’m not afraid for myself: I know the virus won’t kill me. But I’ve told my mother, ‘you’re not going out of the house any more,’ » explained Véronique, in her fifties, as she folded a tablecloth from her shop in the centre of town.

By advocating the use of chloroquine to treat people suffering from Covid-19, the brave maverick, Professor Didier Raoult became the target of criticism in a very short time. Raoult did, however, receive some support, notably from Jean-Marie Bigard, who recounted one of his telephone conversations with the much-scorned professor. « We talked about how he thanked me for supporting him (…) And then he said something funny to me, saying: ‘All the time I was thinking about this story, I only thought about one thing, and that was your sketch about the bat,’ » the comedian said. Furthermore, even if it is not a miracle cure, a range of other medical professionals claim to have successfully treated a range of COVID-19 sufferers with hydroxychloroquine, while some studies have shown its ability to inhibit the virus in vitro.

Didier Raoult au micro d'Apolline de Malherbe sur BFM TV d'purb dpurb site web

Image: Didier Raoult au micro d’Apolline de Malherbe

Didier Sicard a professor from Sorbonne University also a specialist in infectious diseases who has a long experience in scientific work on the HIV, argued that researchers should go back on the field and inquire on the animal origin of the epidemic. Professor Sicard noted that the abrupt transformation of primary forests has brought humans closer to bats and hence a reservoir of viruses that has not yet been closely studied.

While China has only recently, on the 24th of February 2020, immediately and completely banned all traffic and consumption of wild animals, conscious of its dietary culture of eating practically anything that moves, it is important to note that such a legislation exists since 2003 without it being strictly respected by Beijing. Hence, Professor Sicard reasonably argues for an international health court. The former Chair of the Advisory Committee on Ethics from 1999 to 2008 emphasizes the extent to which, in this epidemic, the issue of contact is paramount – everyone must behave like a model.

les dermatologues alertent sur de nouveaux symptômes cutanés d'purb dpurb site web

Image: Femme consultant son médecin / Woman consulting her doctor Source: AFP – B. BOISSONNET

Sicard also points out that the starting point of this pandemic is an open market in Wuhan where wild animals, snakes, bats, pangolins, preserved in wicker crates, accumulate. In China, these animals are bought for the Rat Festival and are quite expensive and considered as food of choice. In this wild meat market, these animals are obviously touched and handled by the vendors throughout the day, skinned, while they are stained with urine; ticks and mosquitoes also make a kind of cloud around these poor animals by the thousands.

These conditions have meant that a few infected animals have inevitably infected other animals within a few daysOne can hypothesize that a vendor injured himself or touched contaminated urine before putting his hand to his face. Here we go! What strikes Sicard is the indifference at the starting point of this ugly virus. As if society was only interested in the point of arrival: the vaccine, the treatments, the resuscitation. But for this not to happen again, the starting point should be considered vital. And it’s impressive to see how it’s being neglected. The indifference to wildlife markets around the world is dramatic. It is said that these markets bring in as much money as the drug market. In Mexico, there is such a traffic that customs officers even find pangolins in suitcases.

Wildlife Alliance Pangolin Rescue (South America)

Image: Un pangolin sauvé au Mexique par la Wildlife Alliance / A pangolin being rescued in Mexico by the Wildlife Alliance


Estimated number of Asian pangolins in international trade between 1977 and 2012 as reported to CITES

Chart: Estimated number of Asian pangolins in international trade between 1977 and 2012 as reported to CITES, and estimated number of pangolins in illegal trade in Asia between July 2000 and 2013. Illegal trade is based on seizures made in or trade recorded in Cambodia, China, Hong Kong SAR, India, Indonesia, Lao PDR, Malaysia, Myanmar, Nepal, Pakistan, Philippines, Singapore, Sri Lanka, Taiwan (P.R. China), Thailand and Vietnam. Source: CITES trade database (UNEP World Conservation Monitoring Centre, Cambridge, UK), and for illegal trade, various sources / Source: (Challender, Harrop and MacMillan, 2015)

Jean-Christophe Ruffin, a doctor, diplomat and writer from the Académie Française said: “Now is not the time to burden anyone and sue, it will come. But they’ll have to be done. We’ll have to learn from this. This proves one thing: when we get out of this terrible crisis, as infectious disease specialists say, there will be others. And we can’t be in a situation like that again.”

« It is of course not the first time that animals are at the origin of sanitary crises, in fact they are responsible for the majority of epidemic crises: HIV, H5N1 avian flu, Ebola. These viral diseases always come from a reservoir of animal viruses », Sicard pointed out, and there’s almost no interest in them. It’s the same with dengue fever. “I have a very close relationship with Laos, and when the disease appears, the local people there say, ‘We have to control the mosquitoes’. But in reality, it is during the dry season, when there are only larvae, that a policy of exterminating mosquito larvae should be implemented. But nobody does it because people say ‘oh, there are no mosquitoes, why do you want us to use insecticides? And the Pasteur Institute of Laos is sputtering in vain, asking local people to make the effort before the disease bursts”, Sicard explained to France Culture, saying “It is exactly like the work that’s left to be done on the bats. They are themselves carriers of about 30 coronaviruses! We need to do some work on these animals. »

Pangolin sauvé des mains d'un trafiquant local, Uganda. 9 avril 2020.

Image: Pangolin sauvé des mains d’un trafiquant local, Uganda. 9 avril 2020 • Crédits : Isaak Kasamani – AFP

The latter also added: « Obviously, it is not very easy: going into caves, well protected, taking vipers, pangolins, ants, looking at the viruses they harbour, this is ungrateful work and often despised by laboratories. Researchers say: ‘We prefer to work in the molecular biology laboratory with our cosmonaut hoods. Going into the jungle, bringing in mosquitoes, is dangerous. Yet, these are by far the most important routes.

Moreover, we know that these epidemics will start again in the years to come repeatedly if we don’t definitively ban the traffic of wild animalsThis should be criminalized as an open-air sale of cocaineThis crime should be punishable by imprisonmentI am also thinking of those battery farms for chicken or pork that are found in ChinaEvery year they give new flu outbreaks from viruses of avian origin. Gathering animals like that is not seriousIt is as if veterinary art and human medical art had nothing to do with each other. The origin of the epidemic should be the subject of a major international mobilisation.

Prof Sicard argued that we need to reconstruct the epidemiological pathway by which bats have tolerated coronaviruses for millions of years, but have also dispersed them. It contaminates other animals.

MERS coronavirus evolves to infect different species

Letko, M., Miazgowicz, K., McMinn, R., Seifert, S., Sola, I., Enjuanes, L., Carmody, A., van Doremalen, N. and Munster, V., 2018. Adaptive Evolution of MERS-CoV to Species Variation in DPP4. Cell Reports, 24(7), pp.1730-1737.

When bats hang in caves and die, they fall to the ground. Then the snakes, vipers in particular, who love their corpses, eat them. Just like the young bats that fall down and are immediately eaten by these snakes which are therefore probably intermediate hosts for viruses. In addition, there are clouds of mosquitoes and ticks in these caves and we should try to see which insects are also possible transmitters of the virus. Another hypothesis concerns the transmission that occurs when bats go out at night to eat fruit. Bats have an almost automatic reflex; as soon as they swallow, they urinate, explained Sicard. They will therefore contaminate the fruits of these trees and the civets, which love the same fruits, hence contaminating themselves by eating them. The ants participate in the agape and the pangolins – for which the most wonderful food is ants – devour the ants and become infected in their turn. It is this whole chain of contamination that needs to be explored. Probably the most dangerous reservoirs of viruses are snakes, because they are the ones that are constantly feeding on bats, which are themselves carriers of coronavirusesSnakes could therefore be a permanent host for these viruses, and obviously eating them is not only disgusting but dangerous. But that is exactly what we need to know and check. Researchers should therefore capture bats, but also do the same work on ants, civets, pangolins and try to understand their tolerance to the virus. It’s a bit ungrateful, but essential.

Didier Sicard also elaborated on the relation between the local Eastern Asian population and the bats, saying “What struck me in Laos, where I often go, is that the primary forest is regressing because the Chinese are building stations and trains there. These trains, which cross the jungle without any health precautions, can become the vector of parasitic or viral diseases and carry them through China, Laos, Thailand, Malaysia and even Singapore. The Silk Road, which the Chinese are in the process of completing, may also become the route for the spread of serious diseases. Caves are becoming more and more accessible there. As a result, humans tend to get closer to where the bats live, and bats are also a highly sought-after food source. Humans are now also building fruit tree parks close to these caves because there are no more trees due to deforestation. The inhabitants feel that they can gain territory, like in the Amazon. And so, they are building agricultural areas very close to extremely dangerous virus reservoir areas. I don’t have the answer to all these questions, but I just know that the starting point is not well known. And that it’s totally ignored. It’s being turned into folksy conference speeches. They talk about bats and the curse of the pharaohs.”

Sicard also said that there must be some serious studies about the ability of bats to harbour coronaviruses, saying “but when I go to the Pasteur Institute in Laos which is run by an exceptional man, Paul Brey, this director has the fibre of a Louis Pasteur, he has been passionate for twenty years about transmission issues, but he is extremely lonely. Even the study of mosquitoes, which is fundamental to understanding the transmission of diseases in Laos, is almost abandoned. And Paul Brey keeps telling me that there are about thirty species of coronavirus in bats. So, the scientific effort is not up to the task.” Sicard added, “When the French Ministry of Foreign Affairs removes the virologist’s post at the Pasteur Institute, which is a few hundred kilometres from the Chinese border, we are finished. This happened in November 2019. We are going to try to get that post back, but it is still frightening to think that even at the very gates where viral infectious diseases come from, it is hard to put all the effort into it. The Pasteur Institute of Laos is supported very moderately by France, it is supported by the Japanese, the Americans and the Luxembourgers. France contributes to it, but it does not make it a major research tool.”

The role of this Pasteur Institute according to Professor Sicard is to train local researchers, “To carry out epidemiological studies on the existing viruses chikungunya, dengue fever and now coronavirus, to be a place for high-level biological scientific studies in a remote, tropical territory, but with a high-security laboratory. To be as close as possible to where epidemics occur and to have laboratories that are up to the task. It is very difficult for relatively poor countries to have high level scientific equipment. The network of Pasteur Institutes – which exist in several countries – is a structure that the world envies. But institutes like the one in Laos need much more help than they do now. These laboratories are struggling to make ends meet and they are also having difficulty recruiting researchers. Most of them prefer to be in their laboratory at the Pasteur Institute in Paris or in a Sanofi laboratory or at Merieux, but to become an explorer in the jungle, there aren’t many people who do that. But that’s what Louis Pasteur did, he went to see the farmers in the vineyards, he went to see the shepherds and their sheep.»

La science n'a pas de patrie, parce que le savoir est le patrimoine de l'humanité, le flambeau qui éclaire le monde d'purb dpurb site web

Traduction(EN): « Science has no homeland, because knowledge is the heritage of humanity, the torch that lights up the world. » – Louis Pasteur


Les vaccins les plus répandus / The most common vaccines (Source: Statista France)


Science is an integral part of human culture and has played a huge part in the construction of the modern societies that humanity lives in today, and I believe the essay, “History on Western Philosophy, Religious cultures, Science, Medicine & Secularisation” gives a decent picture of where we came, where we have come and where we are going as a civilisation. « Louis Pasteur would come out of his laboratory. Just like Alexandre Yersin who was in the field in Vietnam when he discovered the plague bacillus », Sicard declared, « so, entomological research and research on transmitting animals is not up to the challenge. Of course, it exists, but it must account for perhaps 1% of research. Because what fascinates the candidates for the Nobel Prize is to find a treatment or a new virus in molecular biology and not to reconstitute the epidemiological chains. And yet the great infectious discoveries were born this way: the agent of malaria, Plasmodium, was discovered by a Frenchman, Alphonse Laveran, in the field in Tunisia. And this is fundamental research that is carried out on a scale that has been somewhat forgotten. »

Is the study of animal really crucial? Sicard said: “The plague remains an exciting example. The reservoir of the plague are rats. There are populations of rats that are very resistant and that transmit the plague bacillus, but they don’t care. And then there are populations of rats that are very susceptible. All it takes is a few individuals from the susceptible rat population meeting the resistant rat population one day to get infected. The susceptible rats die. At that point, the fleas that feed on the blood of the rats, desperate not to have more live rats, will start biting humans. Reconstructing this very beginning of the chain of transmission makes it possible to act.

In places where the plague is still rife, in California, Madagascar, Iran or China, when we see that a few rats start to die, that is exactly the time to intervene: it is extremely dangerous because that is when the fleas will start to want to bite humans. In plague areas, when we see hundreds of dead rats, it is a real bomb.

Le Triomphe de la Mort par Pieter Brueghel 1562 d'purb dpurb

Tableau: Le Triomphe de la Mort, par Pieter Brueghel l’Ancien, 1562 (Huile sur bois). Ce tableau est une allégorie mettant en scène diverses formes relatives à la mort : crime, exécution, maladie, combat, suicide.

Fortunately, the plague is a disease of the past. There must still be 4,000 or 5,000 cases of plague in the world. That is not a huge number and then the antibiotics are effective. But this is an example, to show that the animal origin is fundamental and always difficult to apprehend. It is nevertheless essential for understanding and makes it possible to put in place prevention policies. Today, if we continue to sell wild animals on a market, we are in a delirious situation. The precautionary principle must be applied.”

While wild animal traffic is prohibited and there is an international convention that monitors all sales, in China this international convention is not respected, declared Sicard, adding “It is clear that if we ask each country to organise itself nationally, nothing will change. China initially put pressure on the WHO not to call it a pandemic. It tried to block it because it is a major contributor to the funding of the WHO.


Les plus gros contributeurs au budget de l’OMS / Source: Statista France

It would therefore be important for it to be a totally independent health tribunal, like an international war crimes tribunal, with independent inspectors who verify what is happening on the ground. In Laos, in the countryside, there are many markets where wild animals are sold like chickens or rabbits. There is general indifference because it is the local culture. And culture is the most difficult thing to change in a country,” observed Didier Sicard. Indeed, rightly concluded, since culture, which is a mode of behaviour passed down by individual groups to other generations unfortunately is also sometimes constitutive of a range of atrociously bad and unproductive habits [e.g. medical, dietary, physical (health), linguistic, educational, artistic, perceptive, emotional, managerial and political patterns].

« Avant, avec mes amis, on avait peur des Chinois. Maintenant, on voit sur Twitter qu’on a peur de nous, les Italiens ! »

Alicia à franceinfo

Sicard also commented on what struck him on the attitude of the French population, stating, “the gap between a kind of indifferent casualness, hardly any critical look at Italy and China and the brutal discovery of the health disaster. We have gone from recklessness to extreme anxiety and both are equally toxicrecklessness creates contamination and extreme anxiety leads to irrational behaviour. The proof of this is the flight of Parisians, Lyonnais and inhabitants of large cities to their second homes. This seemed to me at first to testify to a very short-sighted vision, as if one could escape, in war, from the arrival of the German armies. And then an extraordinarily individualistic behaviour, in the wrong sense of the word: ‘Save whoever you can, I shut myself up in my countryside and then it’s too bad for the others, I protect myself’. Of course, I imagine that if you can protect the elderly and keep them safe, that’s fine. But when we see young couples or groups of friends who are now saying to each other, we’re going to go on holiday! This is all the more shocking because this epidemic is about something completely different from just saving someone. On the contrary, it’s a question of asking how each can be seen by the other as a role model.”

Professor Didier Raoult also pointed out in 2009, that human civilization is still savage and prehistoric when it comes to a culture of medical hygiene because most of us do not know how to handle viruses due a lack of knowledge and social organisation, i.e. it is a pattern of behaviour that is still not firmly embedded in culture of the non-scientific majority. Raoult even pointed out 11 years ago that if a mutant respiratory virus was to appear we would be facing a considerable disaster, and here we are.

Didier Raoult « On ne sait pas lutter contre la contagion d’un virus respiratoire » | Archive INA (2009)

A similar argument was also recently brought forward by Bill Gates in 2018 who suggested that a new diseases could kill 30 millions in 6 months, while his foundation published a simulation showing an epidemic spreading from China, which is coincidentally now facing a « serious situation » to deal with the accelerating deadly coronavirus epidemic that has put the world on its knees. « In the case of biological threats, that sense of urgency is lacking, » Gates said, adding that countries need to prepare for pandemics in the same serious way they prepare for war; he asserted that a small non-state actor even had the ability to construct a deadly form of smallpox in a laboratory environment. The philanthropist explained in an interview on Virtual TED Interview that if the United States enacts such a strict isolation law, positive results could be seen within the first 20 days. According to Gates, the United States was too late to react. If they had started testing people who might have had the virus as early as February, they could have escaped total isolation. « There are no half measures. It’s not right to say « keep going to restaurants and buying houses, ignore the pile of dead bodies in the corner. It’s irresponsible to tell people not to worry, » said Bill Gates, also adding that the public must, at all costs, maintain the law of isolation for as long as it is necessary to save lives and prevent the situation from becoming similar to that in Wuhan and Northern Italy.


#COVID19 : en se basant sur des modèles prédictifs, des chercheurs de l’UCL ont estimé que l’ensemble des mesures de #confinement ont déjà permis de sauver plusieurs dizaines de milliers de vies en Europe / Source: Statista France

In an essay written on the Oxford Martin School website at the University of Oxford Ian Goldin and co-authored by Robert Muggah, a similar orientation is suggested, i.e. for the world to become more interdependent since our world has become more connectedHowever, globalisation must be managed efficiently in order to fight systemic risks such as the COVID-19.

We saw how the growing complexities of the global financial system was badly managed by public authorities controlled by politicians, and supposedly financial « experts », people who were supposed to have graduated from the supposed best institutions, simple parvenus turned mechanical thinkers, and what did they do? Together, as a pack of ruthless & cannibalistic great white sharks, they took the whole world into the financial crash in 2008; it is not even the first time in history and nothing tells us that they will not do it again. The full blame can be attributed to the dangerous negligence and overconfidence of this very special and particular breed.

Banker sitting on the street

Image: Un banquier assis dans la rue / A banker sitting on the street

This has led to mediocre, cheap, uncharismatic and atavistic populists politicians without any sophisticated outlook about a connected world to storm to power since the world’s political and economic « elites » were held responsible for the 2008 financial crisis. But we now see how these populists lack the sophistication to lead a new modern and interconnected world as we are living through this crucial phase in human history where civilisation is changing era with the post-modern technological revolution [The sincere, realist, punching, unhypocritical, genre-defying, barrier-smashing, universal and mind-blowing documentary by fellow Frenchman Nicolas Hulot about the impact of humans on environmental change released in 2009, « Le Syndrome du Titanic »  portrays this change of era magnificiently – unfortunately those types of production seem far too honest, scary, deep, profound and intellectually stimulating to get the publicity and attention they deserve among the mainstream consumers and the industries who have everything to gain in them remaning naive and atavistic, but remains an iconic piece in the collection of the wise, avant-garde & insightful chosen few – facts that can never be hidden]

The atavistic minds who grabbed power in the US are following an ancient tradition that does not have its place anymore in our modern world, i.e. blaming foreigners for everything and turning their back to the outside world, and hence also making themselves insignificant among noble world leading societies, i.e. those who together set an example to civilisation and shape the human civilisation of the future.


Une majorité de 80% des citoyens français se méfient des Etats-Unis et n’approuvent pas leur politique / Source: Le Figaro

The grotesque US president, Donald Trump spurned scientific thinking about a range of serious issues such as climate change, spread fake news through petty news agencies and twitter ogres and even shunned traditional allies and international institutions such as the World Health Organization and the Paris Climate Agreement, decisions that have not been met with approval by many sensible Americans; for example, Melinda Gates sees Trump’s decision as absurd, and with the evidence of infections rising fast, most extremist nationalist politicians are compelled to recognise the traumatic human and economic costs of COVID-19. Hence, it is also not surprising that in France, a literary, intellectually hungry and constantly evolving nation of voracious and sophisticated self & world-cultivating book readers & writers, Trump is viewed as one of the greatest disasters of the modern world, compared to the pigs of George Orwell’s « Animal Farm », and has even been paraded as a clown along with Macron in Nice.

Trump le clown avec Macron la marionnette au carnaval de Nice

« Complice du pire » / Trump le clown et Macron la marionnette au carnaval de Nice, 2019 / Source: 20minutes

« Do me a favor, speed it up, speed it up. », this is what the naive Trump told the National Association of Counties Legislative Conference, because the ignorant, infantile, insensitive and obese politician believed that if he repeated it a couple of times the vaccine would have suddenly appeared. A vaccine takes longer to be safe and ready, and most people with some scientific foundation know this. As the American chemist, inventor, musician, professor, entrepreneur and former chancellor of the University of North Carolina, Herbert Holden Thorp wrote for ScienceMag, China has rightfully taken criticism for blocking attempts by scientists to report the truth about the coronavirus, the US under Trump and his circus have been doing the same thing. To inform Fauci and other government scientists that all public comments must be cleared with Pence is bordering on dictatorship and an assault on individual freedom and dignity.

It is clearly not a time for a mediocre, disconnected, unsophisticated and atavistic American politician who does not fear ridicule by making an absolute ass of himself through his denial of evolution, climate change and the dangers of cigarette smoking to come around and tell people how to live, what to believe in and shape the public messagethis is dangerous to every single person who lives in the US. It is however encouraging to see that Fauci, Francis Collins [director of the U.S. National Insitutes of Health (NIH)], and their colleagues across federal agencies ignored these instructions and gradually spread the message, because transmission rates and death are not measurements that can be changed with Trump’s will and an extroverted presentation. The Trump administration repeatedly lied, saying that the virus spread in the US was contained, when it was very clear from genomic evidence that community spread was occurring in Washington State and beyondThis kind of distortion during such a deadly pandemic is unacceptable and contributed to the federal government’s slow response. Although the words of the Trump administration have never mattered to or registered in the brain of learned individuals, these words are now clearly a matter of life and death in the US during the pandemic.

Most intellectually cultivated, smart and refined individuals do not expect politicians or mediocre gossip journalists to know much about philosophical discourse, the foundations of scientific reasoning, objectivity, statistics, to be able to read and fully understand a scientific paper, let alone understand brain physiology, the laws of evolution and gravity, p-value, logical reasoning or know what ostinato and legato are; and that is perhaps why most of the finest intellectuals remain in their league and keep their distance from street politicians and the common crowd, because they likely know that it would be like trying to communicate with non-receptive, indifferent and inanimate objects such as pebbles or truffles.

Some White Truffles

Image: Truffes blanches / White truffles

Hence, it is very likely that to most sensible and intellectually cultivated individualsattempting to have a conversation with those objects would be a waste of time, neuronal activity and calorie; while also having to leave the noble realm of philosophical discourse, their library with names such as Darwin, Voltaire, Balzac, Descartes, Rousseau, Lacan, Satie and Debussy, and sometimes even their piano or violin, to then have to jump into a world of slimy reptilian characters and see weird and untrustworthy faces of brains inferior to their own trying to tell them how to live, and also having to endure mockery of the lowest, most infantile and animalistic kind from some of the vilest and most frustrated peasant-like parvenus in politics with severe inferiority complexes. So these cultured intellectuals keep quiet in the distance and focus on writing books instead.

mona_lisa_pic_d'purb dpurb site web french embassy ambassade de france usa

Source: Services culturels – Ambassade de France aux États-Unis / Cultural Services – French Embassy in the US

As a bilingual Franco-British intellectual, in the French speaking world for me, it would be like attempting to have a sophisticated discussion about « les métaphores artistiques d’Eugène Delacroixla structure du psychisme, la philosophie du désir, la motivation chez le sujet cartésien, l’héritage voltairien, et la dialectique Lacanienne » with « simplets » [i.e. simple minds] like Bécassine, Nabilla, Bamboula, Darmanin, Hollande, Pompili and Morano in a small village bistrot; and in the Anglo-Saxon sphere with Postman Pat, Nigel Farage, Harry Potter or Mr.Bean in an ancient and derelict pub in England, or Homer Simpson, Forest Gump, Joe Biden and Donald Trump in the US – so, what I mean and what most intellectually superior individuals understand is that it would be useless and unproductive because of the unsynchronised psyches caused by different levels of intellectual cultivation and heritage.

If the majority of humans read, manage to grasp and fully understand the essay, « Psychoanalysis: History, Foundations, Legacy, Impact & Evolution », they should realise that the human psyche, its development, cultivation and construction are composed of many layers, while the essay, « The Concept of Self » would also guide individuals about self-conception and identity. After studying intellectual humility, psychologists have found that individuals with this personality trait have superior general knowledge (Krumrei-Mancuso, Haggard, LaBouff and Rowatt, 2019). Intellectual humility has consequences for learning and styles of thinking; the process of learning itself requires intellectual humility to acknowledge that one lacks a particular knowledge and hence has something to learn in order to continue evolving. In the same study in the Journal of Positive Psychology, Krumrei-Mancuso and her colleagues found that intellectual humility was associated with less claiming of knowledge that one does not have, indicating a more accurate assessment of one’s own knowledge. In the study, intellectual humility was also correlated with being more inclined to reflective thinking, and also possessing more “need for cognition” [i.e. enjoying thinking hard and problem solving], greater curiosity, and open-minded thinking.

In the journal Self and Identity, the results from a study by Porter and Schumann (2017) suggest that intellectual humility can be increased in individuals through a growth mindset of intelligence; hence we could all benefit from intellectual humility in our lifetime development. The authors concluded that “teaching people a malleable view of intelligence may be one promising way to foster intellectual humility and its associated benefits.”

Les métiers qui inspirent le plus (et le moins) confiance d'purb dpurb site web

Les métiers qui inspirent le plus (et le moins) confiance / Source: Statista France

Many uncharismatic, simple-minded, grotesque and mediocre politicians need to acknowledge that their lack of knowledge, creativity and cultivation makes their ambitions of leadership impossible, and also understand that the ancient and stagnant political structure with parties and group agendas as it is nowadays can be considered as a discipline that is dead-alive and on its last leg; that hardly elicits the passionate interest of the civilised crowd anymore. The politics of parties and division is ongoing for the simple reason that civilised society has not yet implemented an organised and sophisticated concept to replace it and use it to manage our modern and interconnected human civilisation.

Regarding the degraded and cheap form of politics around the world in the 21st centurypeople at large need to firmly understand that every time typical, plain and ignorant office workers stack enough money aside to be able to afford quitting their day job in order to join a group of politicians in a movement, it does NOT suddenly transform them into a superior authority that requires everyone to stand in line to listen to everything that comes out of their mouths; they cannot and will never win a noble and sophisticated philosophical debate by insulting and disrespecting intellect and science simply because it does not always conform to their wishes and is often against their disconnected and backward outlook, while also at times being too challenging for most of their average, limited, naive, unproductive, boring and uncreative brains.

Un théoricien de la psychologie d'élite d'purb dpurb site web

Traduction(EN): « An elite psychology theorist who deals with brain behaviour and sculpture at the granular level will not listen to the absurdities of a simple mind, even if the partners of this simple mind can pay all the advertisers in the world to publish their nonsense on toilet paper, cereal boxes, the cheap animal press to bus stops. We are above that! Every time a drugged out publisher of an obscure corner of the Internet creates a title with an image he considers degrading, it has no effect on us, none, zero; with his sweaty, sticky fingers slamming on a dirty keyboard on the 10th floor of an old building in a crowded corner of a polluted urban jungle? we are above these little defamation campaigns organized by childish politicians and the Jewish media they love so much. It cannot be anti-semitic to simply state that the majority of the press is owned, and hence controlled by Jews. My message to these people is this: « Try to grow up! Not a single intelligent person in the world is defined by your impulses… you are worse than children. People define themselves… simple….. your opinions, they’re just simple opinions as simple as your mind! » -Danny J. D’Purb

So, these simple animalistic minds and parvenus in the media along with those who hold their leash in politics need to seriously understand that no matter how many rotten tomatoes they throw at the wall of reason, these bricks were built on science, philosophy and intellect, and they will NEVER go down; to explain this logic, we can use the example, of the scientific facts that alcohol consumption and smoking cause cancer, and that flesh in a state of decomposition is a breeding place for maggots. Quite clearly, no amount of headlines, photo editing or covers will ever change those facts and convince any intellectually cultivated mind otherwise – although that does not seem to stop some cheap, corrupt and deluded media businesses and journalists from trying – the marketing of Trump by the media is an equivalent example. We all know that some people are hired to do so, but they would make their own lives easier and less stressful by knowing the limits of rational possibility, that is, by understanding the simple logic that covering gold with manure and swine scum will never transform it into those.

Alcool Alcohol Addiction Culture Société Society

Image: Un alcoolique / An alcoholic

During the CoVID-19 pandemic, these haters of intellect and science then insisted on something as serious as a vaccine – that science cannot provide on demand – as if it was as simple as feeding or mass breeding pigs on a farm. As Holden Thorp also noted, for the past 4 years the obese Trump and his circus made deep cuts in the scientific budget including cuts to funding for the Centers for Disease Control and Prevention and the NIH. For their selfish political goals, the grotesque administration’s disregard for the science of the Environmental Protection Agency and the National Oceanic and Atmospheric Administration, and stalled naming of a knowledgeable director for the Office of Science and Technology Policy has caused a lot of harm over 4 years to US residents and the credibility of the US itself on the world scene.

Then, with the devastation caused by CoVID-19, Trump suddenly needed the discipline he disrespected and ignored, i.e. science. Yet, to cite Thorp, « the centuries spent elucidating fundamental principles that govern the natural world—evolution, gravity, quantum mechanics—involved laying the groundwork for knowing what we can and cannot do. The ways that scientists accumulate and analyze evidence, apply inductive reasoning, and subject findings to scrutiny by peers have been proven over the years to give rise to robust knowledge. These processes are being applied to the COVID-19 crisis through international collaboration at breakneck, unprecedented speed […] the same concepts that are used to describe nature are used to create new toolsSo, asking for a vaccine and distorting the science at the same time are shockingly dissonant. »

The website allows users to comment on scientific articles in post-publication, but also to report suspicions of breaches of scientific ethics. The site highlighted gaps in several high-profile articles, which in some cases led to retractions and accusations of scientific fraud as noted by the blog, which analyzes retractions of scientific articles and comments on issues related to scientific integrity. PubPeer exists because of the inability of some hard empirical science to sometimes replicate its results and effectively self-correct itself.

A reliable vaccine must have a strong scientific foundation and will have to be manufacturable and safe. To achieve this, it has taken some time, and although the top scientists have been working as fast as they can to deliver this life changing vaccine, we could not have expected a miracle in instantly [e.g. in 3 weeks]. The business executives from those giant pharmaceutical companies who see life in terms of bank notes, had every thing to gain in getting the vaccine fast but luckily for people, even they also understand that we could not have used magic to get there in a week. However, we can perhaps take a positive note from this tragedy, since a couple of years ago Trump declared his skepticism about vaccines and even tried to launch an antivaccine task, but then crippled with COVID-19, he suddenly now loves vaccines.

Herbert Holden Thorp beautifully said it: « If you want something, start treating science and its principles with respect. »

The Centers for Disease Control’s worst-case scenario suggested that about 160 million to 210 million Americans will be infected by December 2020; as many as 21 million will need hospitalisation and between 200,000 and 1.7 million people could die within a year. Harvard University researchers believe that 20% to 60% of the world’s population could become infected, and estimated that 14 million to 42 million people could lose their lives.

Une disparité qui pose question les hommes meurent plus du #COVID19 que les femmes malgré le fait qu'ils aient été contaminés

Une disparité qui pose question : les hommes meurent plus du #COVID19 que les femmes malgré le fait qu’ils aient été contaminés à part à peu près égale. Dans certains pays, cette différence est particulièrement marquée / Source: Statista France

As Ian Goldin also suggested, the extent to which excess mortality can be prevented depends on how quickly societies can organise itself medically and culturally to reduce new infections, isolate the sick and manage health services and resources humanly and efficiently, and also on how long relapses can be prevented and contained.


La France compte rattraper son retard sur les #tests et a fait du #dépistage massif son fer de lance pour lutter contre le #covid19. Voici un état des lieux du nombre de tests réalisés par habitant dans une sélection de pays / Source: Statista France

While intelligent campaigns that teach and reshape human cultures on hygienic habits to deal with viruses may help, without a reliable and effective vaccine and an intelligent vaccination campaign along with systematic organisation, rapid manufacture and delivery, COVID-19 will remain as a hugely disruptive force for years, the pandemic will inflict more suffering and damage on poorer and most vulnerable communities within many countries, highlighting the risks associated with rising inequality.


COVID-19 : quel est le statut des cas identifiés ? / Statista France

In the US, over 60% of the adult population suffers from chronic disease, around 1 in 8 Americans live below the poverty line, and more than 75% of them live from paycheque to paycheque, and over 44 millions in the US have no health coverage at all; and to make matters even worse, they also constitute the largest culture of obesity and community of fat people on the planet.

Un gros obesity obésité

Speaking with the Conversation France, Frédéric Altare, the director of the département d’immunologie at the Centre de Recherche en Cancérologie et Immunologie Nantes-Angers confirmed that being overweight is the major comorbidity associated with severe forms of Covid-19, which require admission to resuscitation in hospital. It can be estimated that, in some places, up to 80% of these may be related to obesity and that if we take a national average, obesity certainly accounts for more than half of the proportion of people admitted to intensive care. The fact that obesity creates a bias in favour of worsening the disease is also confirmed by the outbreak of the epidemic in the United States, a culture of hot dogs and big bellies where almost 40% of the population is severely obese. Since we are on the topic of hot dogs, a review of evidence in the British Medical Journal found that all processed meats [e.g. sausages, bacon, ham, and corned beef] are highly carcinogenic, i.e. they cause cancer, those foods all now appear in the same risk group for cancer (group 1) as asbestos, cigarettes and alcohol (Kmietowicz, 2015).


Le graphique présente les taux d’obésité (IMC>30kg.m-2). La moyenne des pays de l’OCDE est de 19,5% d’obèses. Les Etats-Unis, le Mexique, la Nouvelle Zélande et la Hongrie sont les pays les plus touchés avec respectivement 38,2, 32, 4, 30,7 et 30% d’obèses. Le Japon, la Corée, l’Italie et la Suisse sont les pays les moins touchés avec 3,7, 5,3, 9,8 et 10,3% d’obèses. La France est à 15,3% de taux d’obésité (donnée OCDE basée sur du déclaratif légèrement inférieure aux résultats d’ESTEBAN, basé sur des mesures) / Source: Centre de recherche et d’information nutritionnelles (Cerin)

This association between obesity and severe forms was already well-known for other respiratory infections such as the avian flu. The people at higher risk are those who have passed the morbid obesity milestone. Whether an individual is overweight is assessed using the famous « body mass index« , or BMI [You can check your BMI here], which is the ratio of weight to height squared. A person with a BMI above 25 is considered to be slightly overweight. From 30, we speak of proven overweight with the onset of obesity, at 35 we begin to speak of severe obesity, and from 40 we enter into what is called « morbid » obesity. Morbid, because the people concerned are considered to be at risk of developing pathologies, mainly cardiovascular and atherosclerosis, but also type 2 diabetes, liver diseases, certain forms of cancer.

The challenges to deal with the COVID-19 epidemic are also dramatic in Latin America, Africa and South Asia, where health systems are weaker and governments are less able to respond, risks caused by the failure of politicians such as Bolsonaro and Modi to take the issue seriously enough, argued Ian Goldin of Oxford University and Robert Muggah from the University of Rio de Janeiro.

In poor communities where many individuals share a single room and depend on day to day work to feed themselves, social isolation is difficult and around the world as individuals lose their income, we should expect rapidly rising homelessness and hungerIn the US, a record of 3.3 million people have already filed for unemployment benefit, and across Europe unemployment is also reaching record levels. Yet, in richer countries some safety nets exist even if they are struggling to organise themselves, but poor countries simply do not have the capacity to ensure that no-one dies of hunger.

Homelessness in the USA

Image: Une femme sans-abri tient dans ses bras son fils de 2 ans dans l’une des villes de tentes de Seattle / A homeless woman holds her 2-year-old son at one of Seattle’s tent cities Source: Business Insider (France)

All responsible and realistic governments around the world should therefore ensure that all people in need have a basic income to ensure that no-one starves as a result of this crisis. Goldin rightly observes that the COVID-19 pandemic provides a turning point in national and global affairs, it shows our interdependence and also that the general public tends to rely on governments to protect and save them and not the private sector, thus badly organised governments lead to human disasters… a song that most people are already familiar with.

In agreement with my own suggestions, Goldin and Muggah also argue that at a time when faith in democracy is at its lowest point in decades, deteriorating economic conditions will contribute to even more political and social instabilityThere is already a tremendous trust gap between politicians and citizens.

Some politicians are sending mixed signals and citizens are receiving conflicting messages; this reinforces their lack of trust in public authorities controlled by politiciansDue to a shortage of international leadership from the US government, cities, businesses and philanthropies are stepping up.

Bill Gates Delivers A Speech At The Fundraising Day At The Sixth World Fund Conference In Lyon

Bill Gates delivers a speech at the fundraising day at the Sixth World Fund Conference in Lyon, France, on October 10, 2019. At the head of his foundation, Microsoft’s founder, wisely advocates international cooperation against the virus. (Photo by Nicolas Liponne/NurPhoto)

With the range of serious viral infections that have blighted the world during the last decades, it was only a matter of time for others to appear; most perceptive minds probably knew, but unfortunately these minds are a minority on our planet. « What’s to stop some form of SARS showing up? » Bill Gates asked in 2014, referring to the 2002-2003 epidemic of severe acute respiratory syndrome, caused by another coronavirus. Next, he said, could be « SARS II. » Bill and Melinda Gates established their foundation in 2000 and have always focused on biomedical innovations against disease and ways to deliver them. In 2014, during the Ebola epidemic that killed thousands worldwide, the Foundation was active in helping to stamp out the virus.

Governments should also take notice that the way a society cares for and treats its residents reveals a lot about their philosophy and their values about human life and dignityAs a modern civilisation, free high standard healthcare for all should be one of the priorities for all sophisticated and civilised societies, because people do not go to the hospital for fun, freebies or to collect free candies but end up there in situations of distress. Whether the public hospital has a homeless person, a high-earning lawyer, a student or a child at their doorstep, the quality of medical care should be at the highest standards for all, and societies who want to set an example to the world should certainly start with healthcare, because caring for the population is not spending but investing – a population in good health leads to progress at multiple levels [i.e. physical and brain development, educational achievement, psychological health, professional performance, etc]. Research and medical advancement are sectors that no government should discriminate because it ensures a healthy and progressive society.

Bill Gates in 2016 met Trump in the Manhattan skyscraper where the Trump Organisation is based and wanted to discuss « science and innovation ». Gates who co-chairs Bill and Melinda Gates Foundation – which is focused on infectious disease research and treatments – told Trump before he took office that he ought to make preparedness for the danger posed by viral pandemics a priority of his administration. But, of course, with Trump’s ignorance and lack of sophistication these words probably did not register on his brain who now says that « nobody could have predicted » the CoVID-19 virus » when Bill Gates did warn him. The only horribly stupid question that a scientifically illiterate Trump asked Bill Gates during that meeting was whether there’s « a difference between HIV and HPV ». Gates later recounted: « I was able to explain that those are things that are rarely confused with each other.”

“I feel terrible,” Bill Gates says now. And, “I wish I had done more to call attention to the danger,” even if it is the government’s responsibility to keep itself well informed and protect its population. Gates and his charitable organisation have so far committed more than $300 million to various coronavirus relief efforts, which is about 3 times the contribution of the whole of the US to the World Health Organisation.

Gates Foundation spending on pandemic preparedness

Gates Foundation direct spending on pandemic preparedness / Source: Bill & Melinda Gates Foundation

The point he made to Trump back then is more or less the same one he’s been stressing for years, including during a much-touted 2015 TED Talk in which he described viruses as posing the “greatest risk of global catastrophe.” “If anything kills over 10 million people over the next few decades, it’s most likely to be a highly infectious virus rather than a war,” Gates said at the time. “Not missiles, but microbes.” As of now the US is the global epicentre of the COVID-19 pandemic with more than 29 millions cases confirmed and 543, 000 deaths according to the Johns Hopkins COVID-19 resource center, exceeding the 58,220 lives lost over nearly 2 decades in the Vietnam war.

The Bill & Melinda Gates Foundation have invested $100 million to fight the new coronavirus in China; Twenty million will go to institutions including the World Health Organization (WHO), the American and Chinese Centers for Disease Control and Prevention, and the National Health Commission in China. Twenty million will be allocated to public health authorities in sub-Saharan Africa and Southeast Asia, areas that have been disproportionately affected by recent epidemics including the H1N1 pandemic in 2009. Up to $60 million will be spent on research into vaccines, treatments and diagnostic tools. Other groups such as the Wellcome Trust, Skoll, the Open Society Foundations, the UN Foundation, and are also scaling up assistance.

It is clearly not the appeals to atavistic and extremist nationalism and closed borders that will trigger solutions and make the most out of the complexities of our interconnected global civilisation in times of crisis where coming together as one planetary civilisation with a unified economic, scientific and medical force is key to destroying this virus and also prepare for the next epidemicthe solution is not about closing the borders or opening the borders, but to create a strong, safe, reliable and intelligent filtration system that is also flexible, reasonable and humane to people and allows movement in and out that contributes to the multi-layered forms of development of a country and civilisation as a whole (e.g. intellectual, academic, educational, linguistic, literary, artistic, cultural, scientific, medical, technological, economic, etc), through the transmission of connaissance (knowledge) and savoir-faire (know-how).

If those who feel that they have the responsibility to shape our human civilisation read and fully understand the essay, “Psychological Explanations of Prejudice & Discrimination“, they should come to realise what the theory of evolution is about; scientifically there is no such thing as a « pure » race [because all human primates on earth are the product of migration, breeding and evolution]. The theory of evolution formulated by Charles Darwin revealed to mankind that there is no stable and eternal essence, and that any idea of an exceptionally pure entity that would be beyond evolution does not exist – everything on our planet is in a constant state of flux/change [so from a scientific, evolutionary and organic standpoint, racism is a totally archaic absurdity since we are all simply organic matter on a small blue planet in the vast universe being recycled, recreated and reshaped in a continuous process]. Darwin stated very clearly that he honestly thought that evolution is accepting the idea that there is no end to evolution and it goes in all directions. The French philosopher Barbara Stiegler wisely suggested that the task of creating the consent of the masses should be left in the hands of experts in psychology [i.e. those who understand the psychic structure and philosophies of how humans and societies operate, develop and evolve].

Ian Goldin and Robert Muggah agree on the idea that the spread of COVID-19 must be met with a coordinated international effort to find vaccines, mobilise medical supplies and, when the volcanic dust settles, to ensure that we never again face what could be an even deadlier disease. They write on the University of Oxford’s Oxford Martin School website : « Now is not the time for recriminations: it is the time for action. National and city governments, businesses, and ordinary citizens around the world must do everything they can to flatten the epidemic curve immediately, following the examples set by Singapore, South Korea, Hong Kong, Hangzhou and Taiwan. »

Bill Gates remains optimistic about the crisis, since COVID-19 will allow the world to accumulate experience and prepare for the next pandemic. The modern and forward-thinking philantropist believes that the innovation shown by countries in the northern hemisphere could be of great help to countries in the south that are likely to be affected by the virus in the coming seasons, Gates is convinced that the fight against the virus requires a more realistic count of the number of proven cases, the Microsoft founder will finance the free distribution of testing tests in his city of Seattle. For him, the coronavirus could be the epidemic of the century. In practice, as soon as the tests are available, they will be distributed on demand in Seattle. The aim is that anyone with symptoms will be able to make the diagnosis themselves, by rubbing a cotton stick into the back of their nostrilsThe Foundation says it can quickly process thousands of tests every day and deliver results within 48 hours maximumPositive screenings will be notified to the patients, as well as to public health authorities. Positive patients will then be asked to complete an online questionnaire to detail their recent travels and the people they may have been in contact with. The aim is to better monitor the epidemic and to ensure that potential patients do not travel to hospitals or doctors’ offices.

“You can’t get ‘outside », said Professor Didier Sicard, who also argues for a universal attitude, which comes at a right time to educate world culture on medical hygiene, « We must not consider that we are 30 years old and in good health and that we are not going to be fooled by all this talk. » Everyone must realize that they may be unknowingly contaminating others. The epidemic has passed through people who have returned from China or Italy. Didier Sicard says: « I know the example of an Italian woman who went to Argentina. She attended a wedding and kissed everyone. This woman infected 56 people! Irresponsibility in times of epidemics does immense damage. On the contrary, we have to respect the measures. Like waiting, for example, in front of the supermarket before entering if you see that there are people. »


Quelle est l’efficacité des masques de protection ? / Source: Statista France


Où les masques sont déjà omniprésents

Où les masques sont déjà omniprésents: le gouvernement a annoncé que des masques seraient distribués aux Français / Source: Statista France

Surgical face masks have been proven to significantly reduce the detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets, hence surgical masks have the potential to prevent the transmission of human coronaviruses and influenza viruses from symptomatic individuals (Leung et al., 2020).

Until the world population is immunised, the face mask will become the indispensable and essential accessory for us all at all times, when we are in environments frequented by others. Most popular among lay people, the cloth mask is already being widely used and it is re-usable; this accessory will be the key to ease us all out of lockdown and offer some temporary protection to us and the people around us. THE MASK IS NOT A MIRACLE PROTECTION, SO INDIVIDUALS MUST REMAIN VIGILANT AND NEVER LOWER THEIR GUARD and are advised to seriously take notice of where their hands and fingers are going and ensure that it does not get in contact with their face [i.e. mouth, eyes, ears], carry a hand-sanitiser with at least 60% alcohol with them at all times and use it properly, maintain a safe distance of about 1 metre minimum from all other individuals at all times, and also stay away from those who are not wearing masks as micro droplets from their breath and mouth may contaminate others.

Safety Goggles Coronavirus CoVID-19

A study published in the PNAS using highly sensitive laser light scattering showed that micro droplets generated by asymptomatic carriers of COVID-19 during speech can emit thousands of oral fluid droplets per second and these can remain in the stagnant air of confined environments for up to about 15 minutes. This confirms that there is probability that normal speaking causes airborne COVID-19 virus transmission in confined environments (Stadnytskyi, Bax, Bax and Anfinrud, 2020).

People should also not be ashamed about their appearance due to protective measures, nothing is enough for a deadly virus, and I would personally recommend using safety goggles that completely seal the eyes when outdoor in highly frequented public places such as shopping areas. People should also never lose their focus about the possible sources of contamination indoors, such as shoes and clothes worn outside. It may be life-saving to organise a specific routine such as leaving shoes worn outside in a corner, sanitise hands when touching themPerhaps as soon as one gets home, instantly remove and place all clothes worn outside in a basket far from people in the house, outside in a sheltered place may be convenient for washing then disinfect oneself and shower.

We must NEVER FORGET that there is a deadly virus circulating and any minor slip or even a small reflex [e.g. scratching the eyelids] can mean death. The Académie de Médecine recommends the facial mask for all.

How to maintain your cloth mask

Coronavirus CoVID-19 Scorpion Face Mask

Image: Scorpion of Mortal Kombat may motivate the younger generations to wear their masks and maybe even the more mature generations

There are many people who do not know that the cloth mask MUST COVER THE NOSE AND THE MOUTH otherwise it would be pointless, hence it is advisable to tell any person not wearing their mask properly to do so; the mask should also not be used for more than 4 hours. Generally, the cloth mask must be washed every time that it has been used, taking into consideration that usage should not exceed 4 hours. Hence, it is obvious that every individual will need to have a few in order to rotate them during the day appropriately.

The Association Française de normalisation (Afnor) also advises to wash this protection every time it is dirty or wet or badly positioned on the face. To be worn properly, the mask must cover the nose and the mouth and should not be placed in waiting position on the forehead or around the neck. The Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM) also stated that all mask makers must give details on how to wash and disinfect their masks. Here is a list of some helpful advices for an optimal maintenance:

  • Wash at 60 degrees celcius with your usual laundry for at least 30 minutes preferably in the machine, or if not available, by hand
  • Dry the mask in the 2 hours that follow the washing in a dryer, or if not available, with a hair dryer
  • At the slightest sign of wear (e.g. hole or deformation) the mask must be discarded.

Here are also a few things that you MUST NOT DO:

  • Place it in a microwave
  • Iron it without washing it
  • Use bleach or alcohol
  • Dry it in open air

Coronavirus Putting Your Mask On

Before the wash

Before the washing process, the Afnor precisely explained in its FAQ that it is not necessary to systematically disinfect the inner tube [i.e. the area that holds the laundry] before washing your masks. However, Afnor recommends to run an empty wash if you have accidentally added a used mask with other clothes during a wash at a temperature lower than 60 degrees celcius. In this case, we must proceed, before the wash, with a cold rince of the inner tube with bleach, or run an empty wash in the machine at 60 degrees celcius or 95 degrees celcius without spin.

During the wash

Masks should be washed with your usual detergent at a temperature of 60°C for at least 30 minutes in the washing machine or, if this is not possible, by hand. The use of fabric softener is not recommended. It is best not to use any product other than your usual detergent, as any other product could degrade the mask fabric. Furthermore, the Afnor specifies that you can wash your masks with sheets or towels, in order to « ensure the mechanical aspect of the wash ».

The Drying Process

The Afnor believes that « the mask should be completely dried within the two hours that follows the washing« . Whenever possible, the mask should therefore be tumble dried after cleaning the filters. Drying in the open air is slower, but it can be an alternative, » we find on the Afnor website.

Can the mask also be blown dry? The option is mentioned in a standard notice for fabric/cloth masks put online by the Direction générale des Enterprises. But Afnor does not recommend this method, because of the « poor control of the temperature level », which can lead to damage to the fabric. If you nevertheless choose this option, for lack of any other solution, it is therefore essential to pay attention to the temperature supported by the mask. The ANSM also recommends, if possible, steam ironing the mask. This can help to complete the drying process, adds the Afnor. Here again, be careful with the temperature so as not to damage the fabric or the elastics.

Whichever option you choose, all layers of the mask must be completely dry. As a final step, before storing it in a clean, airtight package, visually inspect the mask. If you notice any deterioration (wear, deformation, holes, etc.), discard the mask.

If Washing Is Not Possible

It is not recommended to microwave the mask. Steam ironing or hair drying is not a substitute for washing either. Finally, it is absolutely not recommended to use bleach or alcohol to disinfect a mask. Not only can these two products alter the quality of the mask by degrading the fabric, but bleach is also dangerous to your health (with risks of skin irritation or respiratory problems).

The Stop-postillons site, created by doctors, nevertheless gives this advice, if one cannot disinfect one’s mask right away: « keep it in an airtight box (for example a plastic box disinfected with bleach) », then « wait a week ». You can also find a simple method to make your own mask that does not require any additional material except a pair of scissors and a t-shirt.

On masks, Didier Sicard declared: « …they are psychological protectors for walkers and not virological protectorsEvery French person has to say to themselves: I do everything so that others can’t blame me for anything. We need an attitude where we look for the other’s gaze before our ownThat alone will bring efficiencyMasks are obviously protective for doctors and caregivers in an environment where the virus circulates. But when you have people walking down the street wearing masks, it’s paradoxical. They think they’re protecting themselves from others, but there’s a huge gap between the uselessness of masks on the street and the vital usefulness of masks in hospitals. I myself was at the pharmacy on Saturday morning and I showed my doctor’s card to see if I could buy masks. The pharmacist told me there were none left. So, if I needed them to treat a patient, I wouldn’t have been able to go see him, or I might have contaminated him. We have seen too many people walking down the street wearing masks as a kind of panoply. There is a major political drama in this absence of masks.”

Sicard pointed out that masks should be reserved for carers, stating: “To anyone who works around the virus. When you see cashiers at the supermarket who don’t have masks while customers have masks, there is something completely counterproductive. Those who don’t need them have got them, and those who really need them are missing them. This is directly related to individual behaviour. I would never have dared to walk down the street with a mask until the caregivers had masks. It’s something that would have frightened me. It basically shows people’s blindness and ignorance. If you walk around without meeting anyone, there is no point in wearing a mask.”

Didier Sicard

Didier Sicard

From an ethical standpoint, the attitude of carers who are now on the front line when they were on strike a few weeks back struck Sicard, who said: “That’s their duty. A doctor is mobilized in his inner self to do his job. Cowards don’t come at the beginning. So, it seems both admirable and normal to me. The suffering of the hospital body, I’ve been seeing it for ten or fifteen years. The number of my colleagues who have told me, you are so lucky to be retired! We suffer, it’s terrible, the hospital has become a business. And I totally agree with what they said: the hospital has been martyred. With purely economic decisions that ignored the interests of patients and doctors. The number of doctors who took early retirement should be measured by explaining that their profession no longer had any interest and that they felt they were spending their time filling in forms and boxes. There has been a real ransacking of the public hospital over the last decade. The last Minister of Health who was still really aware of his role and who respected health care workers was Xavier Bertrand. After that, it was a disaster.”

Sicard also did not think that this broken health system had any repercussions today faced with the current sanitary crisis in France, adding: “All the measures that made the hospital non-functional have temporarily disappeared. The administrators are terrified in their offices and do nothing. The doctors are doing everythingThey have regained all their power.


There is a certain happiness for them in finding the job they always wanted to do. The administration has packed up its bags, or more precisely, it is in charge. The balance of power has been reversed: a year ago, doctors were at the orders of the administration; now, it is the administration that is at the orders of the doctors. This is a very interesting phenomenon. Doctors themselves are no longer hindered by being forced to fill the beds with patients who bring in money, which was the principle until then. Now they’re going back to their core business. Which is the fight against death. Deep down, they find the deep DNA of their craft. It’s almost a paradox: there is less distress in the medical profession now at peak activity, than there was six months ago when they were desperate and depressed because they felt that their profession had lost its meaning.”

Sicard seems to rightly observe and believe that the politicians will remember this period and that civilisation is changing era: “I can give you an example for which I’ve been fighting for two years. I won’t name the hospital, but I know a woman who specializes in burn surgery. At the hospital, her department was closed and she didn’t have a position anymore. Nevertheless, she wanted to continue working with children with burns. However, her burn unit was transformed into a plastic surgery unit for buttocks and breasts. Because it brings in a lot of money. But she always tells me that if there was a fire in a school with forty or fifty burned children, we would no longer have the capacity to take them in because we consider that burns are not profitable enough and that it is better to focus on surgery for the stars. »


Où perd-on foi dans le capitalisme ? / Source: Statista France

« This economic vision of medicine, which has been introduced over the last ten years, is an absolute disaster, » declared the experienced medical professional This was of course a public hospital, “In the private sector, institutions do what they want. However, it is not normal for the public sector to destroy an activity that is not profitable – because burns are very expensive and bring in very little money and there is no private activity capable of dealing with them – and to dismiss it in favour of profitable activities. Basically, the public was anguished at the idea that it had to invest heavily in top-of-the-range equipment to match the private sector. The public will never have as much money as the private sector and will never be able to keep up. And by spending money on highly specialized sectors, we end up neglecting the most vulnerable people, be they the elderly, alcoholics or people in precarious situations. The public hospital has ended up forgetting its hospital function, as I have said on several occasions. Ninety per cent of doctors have been aware of this and it has been a terrible suffering for them. Just as it was for nurses and other care workers to do a job that was linked to money.”

Macron le clown

La majorité des Français pensent que le Macron banquier est inutile comme leur président / Source: Odoxa

Professor Sicard believes that we have no assurance that politicians will change their views on health care, however he thinks that the French will remember and will hold them to account, saying: “President Macron had promised to stop activity-based pricing, the current system of hospital financing. Economists have been pushing the envelope, saying that we would no longer be able to measure the cost of this or that operation. And the head of state gave up. I think that after this crisis, the President of the Republic will modify this activity-based pricing. The hospital will ask to be reimbursed on what it achieves and what it considers its priority. We have to trust the hospital not to treat patients unnecessarily and fill beds as if we were at the club méditerranée. The hospital will regain its true public care function.

pas-assez-medecins-scolaires-dans-les-ecoles-francaises d'purb dpurb site web

Image: Médecin scolaire au travail en France / School doctor at work in France

In the UK, at Oxford University, researchers have been working with Oxford University Hospitals NHS Foundation Trust to reduce clinical research activity to allow researchers to prioritise research on COVID-19 and to support the pressing clinical needs of the NHS. The academic community will have to work together with governments, funders and healthcare providers to combat this ugly COVID-19 virus and Oxford has a long history of responding to health emergencies, e.g. during the 2014 Ebola crisis among negro communities in Africa, Oxford scientists lead the way in undertaking human vaccine studies, and Oxford’s strength in research around infectious diseases and international health, alongside its leading work in emergency vaccine development places it in a great position to contribute to better comprehension around the effective control of this horrific epidemic.

Coronavirus Researchers at Oxford

Source: Oxford University Research

The Oxford team had already tested a potential coronavirus vaccine successfully on several animal species. The World Health Organisation (WHO) had reported that over 70 vaccines were being developed globally for the COVID-19. The Oxford team joined 3 other groups of researchers, 2 in the US and 1 in China for the start of human trials. Professor Sarah Gilbert, a vaccinologist at Oxford University said she was « 80 per cent » confident it will be a success. Patrick Vallance, the UK’s chief scientific adviser said that it would be « very lucky » if a coronavirus vaccine was available widely within a year.

Exscientia Oxford Science Park

Image: Researchers at the laboratory of British pharmatech company Exscientia at Oxford Science Park in Oxford, part of an initiative to develop coronavirus treatments. Source: Adrian Dennis/AFP via Getty Images

The Oxford group are among the most advanced viral vaccine group in the world and have been working on vaccine preparedness for several years which means that they have been able to test and evaluate Covid-19 vaccine candidates rapidly.  The group have unique unique viral vector delivery and expression systems combined with diverse expertise from basic virology to vaccine production scale-up.

The UK has no current vaccine manufacture however, and may have to rely on its Western European neighbours (e.g. France, Belgium and Germany) that have industrial level manufacturing capabilitiesThe Jenner Institute and Oxford Vaccine Group, could develop a jab that would be ready as early as September, almost a miracle in speed for such a demanding task as people are dying by the thousands every couple of hours globally.

Worldometers Coronavirus (COVID-19) Cases Count

COVID-19 CORONAVIRUS PANDEMIC Live Counter (here last updated on March 24, 2021) / Source: Worldometer (Click to see the live counter)

So, we are going to need  a technology that allows us to deliver billions of doses over a year. The team at the University of Oxford said that they expect to produce a million doses of their experimental vaccine as early as September; months ahead of the official 12-to-18 month timeline quoted by experts around the world. “Then we’ll move even faster from there, because it’s pretty clear that the world is going to need 100s of millions of doses ideally by the end of the year to end this pandemic and let us out of lockdown safely”, said Professor Adrian HillDirector of the Jenner Institute, University of Oxford.

Part des Français prêts à accepter des mesures de quarantaine afin d'endiguer la propagation du nouveau coronavirus d'purb dpurb site web

Part des Français prêts à accepter des mesures de quarantaine afin d’endiguer la propagation du nouveau coronavirus (COVID-19) en France en 2020 / Source: Statista France



Pourquoi la distanciation sociale est primordiale / Source: Statista France

The Oxford University team’s experimental product, called « ChAdOx1 nCoV-19 », is a type of immunisation known as a recombinant viral vector vaccine and was just one of at least 70 potential Covid-19 candidate shots under development by biotech and research teams around the world. The vaccine had been chosen as the most suitable vaccine technology for the virus as it can generate a strong immune response from one dose, said the team. When they were asked how they managed to move the usually lengthy process of vaccine approval along so quickly, Professor Sarah Gilbert, lead the study, said it had been their ongoing research into Disease X – an as yet unknown infectious agent earmarked as a potential pandemic in the making – which has allowed them to pivot so quickly to COVID-19.

Collaboration and cooperation sarh gilbert d'purb dpurb site web

Traduction(EN): « I am in no doubt that we will see an unprecedented spirit of collaboration and cooperation. » – Sarah Gilbert

We should be looking into creating a planetary medical organisation that is minutely planned and efficiently organised around the latest and finest technological advancements. All vaccine researchers and developers worldwide have a responsibility towards mankind to synchronise their knowledge and findings in the development of the ultimate vaccine.

The World Health Organization will also have to prioritise works on the linguistic synchronisation of planet Earth’s medical worlds since this unification of the medical talents and expertise worldwide is of upmost importance for the future of mankind and civilisation. What we mean by linguistic synchronisation is that the whole medical community will need to work in one language as it will speed up development, and will also be one fundamental cornerstone towards building a united planetary civilisation, even if individuals are free to learn or study other tertiary languages if that is what they desire, such as being a member of particular societies [e.g. book clubs, ancient languages of civilisation, etc]

It is important to emphasise that in this essay, my usage of the terms “united planetary civilisation” is very different to “globalisation”, since the latter term is vague and generally refers to labour, migratory movement and financial motives, whereas the “building of a united planetary civilisation” is about getting humans of earth to genuinely agree on values and goals, feel, understand and synchronise their lives with each other as a truly united planetary community that is helping, working and building harmoniously together at every level and not only economically.

Literacy-Rate-by-Generation-World-Map d'purb dpurb site web

Carte montrant la différence des niveaux de littératie entre la génération plus âgée et la plus jeune / Map showing the difference in literacy levels between the older and the younger generation / Source: OurWorldinData

We are after all living in pivotal times where the human civilisation is evolving at breakneck speed and changing era right before our eyes in the 21st century with a generation that has the chance of having access to the wide range of accelerated learning technologies available; the world’s societies have evolved beyond recognition from their « primitive » past, and are today interconnected and inspire and influence each other in so many ways [e.g. science, sport, medicine, cuisine, arts, literature, philosophy & education].


It is also to be noted that with all the difficulties that the delicate intellectual responsibility and duty to shape and structure the construction of a modern civilisation involve due to the lack of sophistication, open-mindedness, personality along with the persistent culture of atavism of many rigid, naive, ignorant, infantile and petty little minds, especially in the Anglo-Saxon sphere, reminding me of a comedic post about the 29 things French people love about Britain, but more particularly in the even more savage industrial and mechanical wild west of the US.

As a bilingual Franco-British individual with native mastery of French and English, I have always invested my time and energy in the cause of mankind’s evolution and tried my best to act as a cultural bridge between the academic, medical, scientific, intellectual, psychological, philosophical, and psycholinguistic realms of the 2 most widely spoken languages in the so called « developed world » – that sometimes unfortunately still feels like concrete jungles through the savage behaviour, actions and reasoning of some passionless and unsophisticated creatures that are supposed to set an example, inspire, motivate, guide a civilisation and create a humane and harmonious society where « le dépassement de soi » is a realistic pursuit and where individuals can grow in multiple ways, truly « live » in the full sense of the term and not simply have a plain and meaningless existence where achievement is purposeless and devoid of sense.

In our times, however, there are still many regions of the world that are linguistically « undeveloped »; where the majority cannot even master simple communication in English, let alone grasp the finesse, artistry, romanticism, emotional sensibility, humane values of the enlightenment, sophisticated philosophy, and depth of the psychical realm of literary French.

Les politiciens en manque d'éducation linguistique et littéraire d'purb dpurb site web

Traduction(EN): « Can anyone tell me how a simple female monkey with electrodes, let alone a (so-called) minister of culture, can talk without dying of shame about a « learning » summer?
I repeat: a learning summer.
A summer, therefore, that learns.
That learns what? 
To write French, no doubt. » / Source: Twitter (Juan Asensio)

Indeed, just like the great majority of useless, cheap, uncultivated and frustrated street politicians in France, the great majority of their political counterparts in other parts of the world also fail to do so, unconsciously suffering from a lack of literature, self-cultivation, artistic exposure, self-respect and dignity combined with a constant complexe d’infériorité towards those who are wiser, smarter, nobler in spirit, more intelligent, creative, charismatic and sophisticated than them; I would recommend them to sit down and listen to the university lectures of Prof. Michel Butor [E.g. Les récits philosophiques de Balzac], it may help towards their cultural evolution, but also ease the pain on those forced to endure them, such as their wife and children.

Honoré de Balzac d'purb dpurb site web

Honoré de Balzac (1799 – 1850)

It is time for them to firmly understand that we still have some « adultes surdoués » as Monique de Kermadec » phrases it, or « Overmen » as Friedrich Nietzsche puts it i.e. highly talented and skilled individuals who live and exist out there, especially in the psyches of the French speaking world and heritage [e.g. Napoléon, of whom even the great German Georg Wilhelm Friedrich Hegel himself described seeing as follows: « I saw the Emperor – this world-soul – riding out of the city on reconnaissance. It is indeed a wonderful sensation to see such an individual, who, concentrated here at a single point, astride a horse, reaches out over the world and masters it. »]; individuals who have the savoir-faire and creative power to manage dozens of governments worldwide, a film/video/music/media production company, a publishing house, who could also give a lesson in professional artistic photography, post-production and presentation, and even train a whole generation of original, sophisticated, witty, poetic, literary and noble writers, and not just in Oscar Wilde’s granular Oxford English, although flat compared to French, but also « la langue Française de Balzac » in all its precise articulations, depth, style and literary artistry.

City of Words - Vito Acconci - 1999 dpurb d'purb RS

Image : La Cité des Mots (City of Words), par Vito Acconci (1999)

Logically, to  such individuals, running a press/publishing/media business would be a piece of cake, something achievable half-asleep with superior values, style, efficiency and impact than the mass of mediocre newspapers and their usually obese owners and political sympathisers out there; if such a direction was a career choice and goal for those gifted individuals at a particular point of their life – of course!

Besides, my whole life I have questioned my own sanity because I have always felt misunderstood and different from the rest of the crowd and highly sensible and receptive to what most primates around me could not even hear, sense, feel, see, perceive or understand, and also never found anyone in the Anglo-Saxon realm with a mastery of French similar to mine, and nobody in the French realm with a mastery of English as mine, thinking that I could be fake, I then realised that linguistic discourse and speech are not fake, but are very real and alive, as Jacques Lacan also concluded.

Luckily, I recently read Monique de Kermadec’s book « L’Adulte Surdoué » and found out that humanity has a minority of individuals out there in the world who also feel misunderstood and are hard to classify, because just like myself, these « weird fools » and misunderstood individuals have an IQ of above 145 [which I only recently found out myself from a small IQ test on the MENSA website that only measured up to 145, which is sufficient for me to know without an exact number since this is a statement of fact not an exercise of arrogance – delivering me from my torment to confirm that the weird ones are not us, but the mediocre majority that surrounds us and cannot follow our discourse or understand our lightning speed judgements because of their lower IQ – valuable things in nature are rare, that is why they are valuable]. That is genuinely valuable knowledge for individuals out there among the human population who may also have felt or feel the same way. It is known that around 2.5% of the human population fit the classification of “Surdoué” or “Haut Potentiel”.

Intelligence IQ Surdoué Haut Potentiel Gifted dpurb

Graphique montrant la répartition de la population humaine en fonction du QI // Chart showing the distribution of the human population according to IQ

While 2.5% may not seem a great proportion, it still amounts to around 197 million [196 874 145] people on earth from a population of 7.9 Billion [7 874 965 825]. It is highly recommended for those individuals to learn about their singularity and channel their talent appropriately because human civilisation needs the contribution of those amazing individuals for its betterment. There are books written by some experts who have dedicated their career to these amazing individuals. Intellectuals such as Nathalie Clobert who studied individuals who fit the description of “Haut Potentiel”, who also tend to come with the trait of “hypersensibility” [i.e. they are more receptive to almost any stimuli and so, they feel more, sense more, understand more and are more reactive]. Clobert’s book “Psychologie du haut potentiel: Comprendre, identifier, accompagner” responds to the need for training and information of professionals by offering a reference book on the subject. The book covers the major aspects of the theme of the “Haut potential”: from the reference models of giftedness to the accompaniment of children and adults, including current scientific research, identification and differential diagnosis issues. She made an appearance on France Inter in 2021 to discuss the HPI (Haut Potentiel Intellectuel), in a discussion entitled “Comment fonctionne le cerveau des enfants et des adultes surdoués, à haut potentiel intellectuel ?

Jeanne Siaud-Facchin is also another trusted name in the study of those particularly gifted individuals; her books “L’enfant surdoué, l’aider à grandir, l’aider à reussir (2002)“, “Les Surdoués (2004)“, and “Trop intelligent pour être heureux ? L’adulte surdoué (2008)” provide some essential reading on the matter for individuals out there who may be looking for some light in the dark tunnel of the amazing “Haut Potentiel” or as parents to gifted children. Jeanne Siaud-Facchin founded the Cogito’Z centres and dedicated her career to understand the particularities of these singular profiles who are the scouts of tomorrow’s world, giving particular attention to their power of thought, their sharp analysis, their exacerbated lucidity, their intuition and creativity, their hyper-connected brain, their hypersensibility, their exacerbated emotions, explaining that those are strengths to which these incredible individuals can relate to in order to shine and feel at home in the face of the complexity of a disoriented world.

Siaud-Facchin also posts videos online and educates employers and professionals about the need to understand those particular indiviuduals and their superior abilities in order to make the most of such potential in the professional world and also to allow those individuals to succeed at multiple levels; a more direct way to word it, is that those readings will give employers and professionals a better understanding of the ways to manage, deal and/or interact with individuals who are more intelligent, smarter, faster and more creative than them.

Chef d'orchestre

Hence, from the perspective of someone who fits the category, it comes across as a responsibility to other gifted individuals and civilisation to point out that most superior individuals with superior intellect will not see the majority constituted of cold-blooded, cannibalistic, reptilian political primates as a model to follow, as an inspiration, as a source of comfort, safety, hope or stability, as a spiritual guide or as an ultimate authority, but instead just see them as a bunch of other boring, cold, disconnected and mechanical bureaucrats; artistically, culturally and philosophically poor souls, and divisive money-minded & party-oriented politicians with simple minds, passing by, like the thousands of mediocrities who have lived and died before them and who have been responsible for some of the most castastrophic human disasters in history without ever being able to accept their mistakes.

CITATION Voltaire - les grands hommes avouent qu'ils se trompent

Traduction [EN]: “Men make mistakes, great men confess that they have made mistakes.” – Voltaire

When we look back, we also find that those unscrupulous party-oriented bureaucrats have not had any major positive impact on the world; and are at this minute rotting in a forgotten grave with maggots sliding through their bones. While, my self-respect and moral fibre prevents me from doing such a disgraceful and disrespectful act, it comes across as hard for me not to think of the title of Boris Vian’s book, “J’irai cracher sur vos tombes”.

Benoit Ferreux lisant « J'irai cracher sur vos tombes » de Boris Vian dans le film Le Souffle au cœur (1971)

Image: Benoit Ferreux lisant « J’irai cracher sur vos tombes » de Boris Vian dans le film Le Souffle au cœur, réalisé par Louis Malle, sorti en 1971.

We could even ask ourselves whether some of those disconnected bureaucrats – who mostly spent a few years amassing money in some mundane office, chatting in front of a coffee machine before joining a group of people who all see life though the same lens [i.e. left, centre or right] known as a political party – have green blood? It may be a sensitive and humane gesture of compassion to simply try and imagine the horror and agony it must be for any woman, who for whatever reason, has had to, or is having to wake up next to one of those reptilian primates every morning, with its eye lids slapped on a greasy face and in the centre of it, a mouth half open drooling on a pillow with its « haleine de boudin ».

Le gouvernement du clown macron

Le gouvernement a-t-il été à la hauteur de la situation ? / Source: Odoxa

And to stress the point that most of the mediocre politicians nowadays cannot be trusted with the heart of the people, the historical and legendary verbal whipping from the great Napoleon himself to the evil, lying, sly, dishonest, disloyal and backstabbing politician, Talleyrand, who was plotting against the emperor with Fouché in 1834, comes to mind; looking at the untrustworthy face and straight in the eyes of the unscrupulous man, the emperor Napoléon said:

« Vous êtes un voleur, un lâche, un homme sans foi. Vous ne croyez pas à Dieu ; vous avez toute votre vie manqué à tous vos devoirs, vous avez trompé, trahi tout le monde […] Tenez, Monsieur, vous n’êtes que de la merde dans un bas de soie. »

Napoléon à Talleyrand - de la merde dans un bas de soie d'purb dpurb site web

Traduction(EN): « You’re a thief, a coward, a man of no faith. You do not believe in God; all your life you have failed in all your duties, you have deceived, betrayed everyone […] Here, sir, you are nothing but shit in a silk stocking. » – Napoléon (to Talleyrand, during the Council of Ministers convened at the Château des Tuileries) / Source: L’Histoire en Citations

Nowadays with the adaptive and dynamic technology and skilled software engineers available, we should be creating a sophisticated planetary medical system where the latest findings, empirical studies, analysis and statistics of the medical experts of the whole world are instantly synchronised and available in one place [with instant full-access to all medical journals worldwide], while respecting the personal and non-medical details of patients by a tested and proven system of indexing that does not allow for personal details to be input but only strict medical/scientific details. It may also be useful to note that when it comes to health problems, we are all equal on our small and interconnected planet Earth, and in the essay on clinical psychology, « Learning Disabilities, Anxiety, Depression & Schizophrenia and the Effectiveness of Psychotherapy », the global statistics portray this fact.

We should be focusing on specialised and highly encrypted [an encryption specially devised for this system that is 100% safe so that even if there are hacks and data breaches, the data will never be usable due to the powerful encryption] servers only accessible through highly controlled card systems, only available to the medical departments of hospitals and universities from all around the globe.

Such a system would speed up development for both medical professionals and patients. For example, If a patient suffering from cervical, skin, ovarian, testicular or lung cancer in any part of the world (e.g. Rio de JaneiroNew York, Moscow, Port-Louis, Mumbai, Tokyo, Alabama, Berlin, Jerusalem, Ottawa, Cape Town, Zurich, London, Grenoble or Paris) has a CT scan, that scan would be instantly uploaded and classified in the medical database on the specialised and encrypted servers and made available to all medical departments and professionals in the world connected to the system, who would then have the options to add comments or questions, with their involvements being rewarded by points.

The heads of medical faculties at universities could even have the option to use these live data and cases to train medical students, and in doing do, provide a revision to the diagnosis and treatments of patients while also subjecting the cases to constructive criticism and/or new treatments being developed.

Infirmière avec les personnes âgées d'purb dpurb site web

Image: Étudiante en médecine en formation / Medical student in training

A similar scenario could also apply for all diseases and all types of treatment that would be minutely and systematically classified while remaining intuitive to browse, sort by a range of variables and access for medical professionals; the age, blood group, weight, height, sex and other medical details only would be made available on the specialised server, not private non-medical information. Such an advanced system would not only connect the medical community, stamp  out medical negligence and raise medical standards, but also provide a massive dataset from which a range of institutions could carry medical research and have a more precise conclusion from statistical tests. From the essay on clinical psychology, “Controversies that surround modern day mental health practice“, we clearly pointed out a range of different views among the medical community on a range of controversial treatments; such a system would lead to a more open-minded debate among the academic community on ethics and methods of treatments while considering individual patient characteristics across different fields of medicine and treatment.

This system with a well organised database could also be used to manage a global blood bank and ensure that it is evenly distributed internationally so that even those with rare blood groups can be treated efficiently when health problems arise;

Serrurier d'Amiens

Image: Un serrurier au travail / Locksmith at work

for example, if the daughter of a motel owner, fried chicken and hot dog seller in Illinois happens to be of a very rare blood type and she finds herself in desperate need of it to remain alive, she could instantly have access to the rare blood which could have been collected from the other side of the globe and extracted from the veins of a locksmith in Amiens, an aborigine in New Zealand, a noodle seller in China, a dwarf circus-performer from an English village, a banker in India, an Eastern European stripper in Las Vegas, a heavy truck driver in Madagascar, a kangaroo keeper in Australia, a potato farmer in Germany, a gay bouncer and bodybuilder in Austria, an old and bald Breton who edits a low class « plouc » newspaper in Northern France, a retired, frustrated, useless and senile politician in Brazil, a peasant with a limited vocabulary and a strong « Marseillais » accent, or a globally known elite, bilingual French writer, intellectual, philosopher, thinker, speaker and creative artist – because such an efficient and sophisticated system would allow for a systematic management of blood banks globally.

la collecte de sang d'purb dpurb site web

Image: Don de sang / Blood donation

That system would also include the profiles of medical professionals accessible between them along with a system of forums, awards, points and chats where any medical department and expert could post messages regarding the recruitment of patients for studies, the latest findings of particular medicines and treatments from the wide range of departments and specialities; and also the top articles from scientific journals made available by different departments – until we work on such a sophisticated system, humanity will continue to suffer from a lack of organisation and management.

A system as sophisticated and organised as that would lead to the world being up-to-date and synchronised medically, with patients also receiving the latest treatments or having the option to travel to different parts of the world for new treatments against deadly diseases or terminal stages that are still in the trial phase and also doctors remaining focused and sharp through the latest updates in their specific fields while also giving them the ability to instantly ask questions on the forum/chat to other experts in their fields right from the operating table if they are unsure or would like some words of support or confirmation.

An Example of collaborative software Microsoft Teams d'purb dpurb site web

Image: Microsoft Teams, un exemple de modèle pour une application collaborative / Confinement: le nombre d’utilisateurs quotidiens a augmenté de 12 millions en l’espace d’une semaine. Le 11 mars, Microsoft Teams comptait 32 millions d’utilisateurs quotidiens, pour ensuite voir ce chiffre passer à 44 millions le 18 mars / Source: Statista France

They may even have a live camera streaming system on their foreheads or face while conducting surgery so that it can be seen by all those connected to the system in private clinics, hospitals and the medical faculties of universities worldwide. Such a system could be regulated by an independent global medical authority that would also deliver certifications to all institutions and professionals who apply for it, patients could also see a particular logo on their treatment locations to see that they are part of such a system; if this is implemented even minor hospitals in small villages will suddenly have the boost and expertise of the top medical experts behind them. This would lead to an instant rise in medical standards worldwide.

Femme-et-son-médecin_france d'purb dpurb site web

Image: Une femme en France discutant avec son médecin / A woman discussing with her doctor in France

In the 21st century with the affordability of powerful multi-core processors, high-definition audiovisual equipment and high speed broadband it is a scenario that is very realistic and not a far-fetch scene from one of the infantile mass produced science-fiction fantasies of the Hollywood industry.

We need to apply the technological ingenuity of mankind appropriately to make the most of our lives in this world and allow our fellow humans to live more and stress less, and not simply focus all that technological prowess into creating brain numbing and absurd entertainment media and other petty devices and apps that lead humanity to a culture of mundane, mediocre, meaningless and useless social blogging and nonsense, where bored and pathetic people share photos of their sandwiches, drinks, breakfast and make-up tips with the world.

From an article in the Lancet, Sarah Gilbert said: « WHO is in the process of creating a forum for everyone who is developing COVID-19 vaccines to come together and present their plans and initial findings. It is essential that we all measure immunological responses to the various vaccines in the same way, to ensure comparability and generalisability of our collective findings. Work is continuing at a very fast pace, and I am in no doubt that we will see an unprecedented spirit of collaboration and cooperation, convened by WHO, as we move towards a shared global goal of COVID-19 prevention through vaccination”.

The twelve SARS-CoV-2 vaccine candidates dpurb site

Chart: The twelve SARS-CoV-2 vaccine candidates reaching/announcing Phase III clinical trials by mid-November 2020. Shown in pie-chart configuration are the companies responsible for the development of the vaccines, the technology each vaccine uses, their reported efficacy in Phase III trials. *, efficacy not yet available. Due to variability in reporting criteria for cases of COVID-19, efficacy results may not be directly comparable. (Funk et al., 2021)

Advantages & Disadvantages of Vac Platforms

Table: Avantages et désavantages des différentes plateformes vaccinales / Advantages and disadvantages of various vaccine platforms (Loo et al., 2021)

I also take the opportunity to salute all the medical teams and healthcare workers operating all over the world for the courageous task they are undertaking and also express all my gratitude and support to my local NHS GP surgery in West London who have always been there when I needed them and who are still texting their patients to show their concern and support in these difficult times affecting the entire human civilisation.

NHS UK Message

« This is a snapshot of the message I received from my local GP surgery in West London on Friday, 10th of April at about midnight (UK time) even if I am out of the UK at the moment after more than 14 years without taking any holiday or leave of absence from the country. My plans to return in January with a trip to Oxford has been ruined by this ugly Coronavirus pandemic, and now all the flights have been frozen… my heart remains and will forever be in Western Europe. » -Danny D’Purb

On this note, the British psychoanalytical Society have set up “With You in Mind”, a consultation in times of crisis to support NHS and social care staff who are working and are under immense pressure while being exposed to risk during the COVID-19 pandemic. Members of the Institute of Psychoanalysis, who are all mental healthcare specialists are volunteering their time to offer support sessions. These volunteers are hoping that the opportunity to talk may offer some relief and support – whether about professional or personal matters, or the situation at work, they are hoping to help in any way they possibly can.

With You In Mind IOPA British Psychoanalytical Society d'purb dpurb site web

With You in Mind: Consultations in Crisis

Psychoanalysts can also support reflective practice activities [they can be contacted by CLICKING HERE or if you are a member and would like to find out more, email:]


Steps to prevent infection are vital:

There are many things we can do to protect ourselves and the people we interact with. As with a cold, a flu vaccine won’t protect people from developing COVID-19. The best thing we can do at this point is to follow the same preventive measures as we would against the flu. It is widely known that individual can catch the flu when people sneeze and/or cough on them, or when they touch a dirty [infected] doorknob. We should wash our hands thoroughly especially before eating or touching the facial area and cavities and also after using the bathroom, while also avoiding others with flu-like symptoms – these are the best strategies for the time being.

Officer worker having lunch in London

Déjeuner d’un employé de bureau âgé à Londres / Elderly office worker in London having lunch

The following preventive actions are also recommended:

  • Wash hands with soap and water for at least 20 seconds. Dry them thoroughly with an air dryer or clean towel. If soap isn’t available, use a hand sanitizer with at least 60% alcohol.
  • Stay at home if sick.
  • Avoid touching nose, eyes, and mouthUse a tissue to cover a cough or sneeze, then dispose of it in the trash.
  • Use a household wipe or spray to disinfect doorknobs, light switches, desks, keyboards, sinks, toilets, cell phones, and other objects and surfaces that are frequently touched.
  • It may also be important to create a household plan of action. You should talk with people who need to be included in your plan, plan ways to care for those who might be at greater risk for serious complications, get to know your neighbours, and make sure you and your family have a household plan that includes ways to care for loved ones if they get sick. This includes planning a way to separate a family member who gets sick from those who are healthy, if the need arises.
  • Medical professionals recommend that people voluntarily wear cloth face masks in public settings where other social distancing measures are difficult to maintain, including grocery stores and pharmacies, especially if they live in an area of significant community-based transmission. It should be noted that the cloth mask is not meant to protect the wearer from infection. It is instead meant to slow the spread of the virus (if people who have the virus and do not know it wear masks, they help prevent transmitting it unknowingly to others). Health experts advise making face coverings at home from simple materials, and reserving surgical masks and N95 respirators for health care workers and other medical first responders.

While everyone should take precautions, measures may be critical for adults over 65 years old (the risk seems to gradually increase with age starting at age 40, according to the World Health Organization) and those with chronic conditions (such as diabetes, heart disease, and lung disease).

Les plus de 70 ans, principales victimes du #COVID19 pourraient être confinés plus longtemps

Les plus de 70 ans, principales victimes du #COVID19 pourraient être confinés plus longtemps / Source: Le Parisien

People in these higher risk categories especially should stock up on household items, groceries, medications, and other supplies in case they need to stay home for an extended period of time. The world also faces another crisis, which is the risk of a toilet paper shortage as the COVID-19 crisis has slowed down the delivery of goods, and most notably those of paper pulp.


#Consommation : les Français se seraient-ils montrés plus raisonnables que les autres face à l’achat-panique ? On peut se poser la question au regard de cette estimation de la hausse des ventes de #papiertoilette par pays en mars / Source: Statista France

Steps to follow if you become infected and fall ill:

Until now, information available shows that the severity of COVID-19 infection ranges from very mild (sometimes with no reported symptoms at all) to severe to the point of requiring hospitalisation. Symptoms can appear anywhere between 2 to 14 days after exposure, and may include:

  • Fever
  • Cough
  • Difficulty breathing

Getting in touch with one’s medical provider for advice in the eventuality of experiencing these symptoms, especially if you have been in close contact with a person known to have COVID-19 or live in an area with ongoing spread of the disease is recommended.

Most people will have a mild illness and will usually be able recover at home without medical care. Seek medical attention immediately if you are at home and experience emergency warning signs, including difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse, or bluish lips or face. This list is not final, so consulting your medical provider if other concerning symptoms are noticed is vital.

François Sureau : « Les Français ne sont pas un troupeau de moutons ou une garderie d’enfants »

To conclude, just like Goldin and Muggah, I also believe that the major Western European players, China, Japan and especially France, a world leading and cultivating nation, must set an example for history by stepping up and leading a global effort, forcing the deteriorated and unstable US government and the uncharismatic politicians controlling it into a global response, which includes accelerating vaccine trials and ensuring free distribution to the world once the ultimate vaccine and antivirals are perfected and finalised. Governments and financial institutions around the world will also need to take dramatic action toward massive investments in health, sanitation and basic income and also provide financial support to both struggling employers and employees.


Potential treatment for those infected with COVID-19

For those who have been infected, as already explained above, we have some studies suggesting that convalescent plasma [i.e. donated blood from people who have recovered since this donor blood has antibodies to COVID-19lead to shorter hospital stays and lower mortality for patients who received the treatment while no severe adverse effects were observed (Chen, Xiong, Bao and Shi, 2020). It has also been shown that chloroquine, hydroxychloroquine and tocilizumab have the potential to act as a potential cure in « some » patients but they are not guaranteed to function in all cases of COVID-19. Remdesivir was approved in the US to treat COVID-19 in patients who are ≥12 years old and weigh at least 40 kg. This antiviral drug is able to prevent the viral genome of SARS-CoV-2 from replicating. TOCILIZUMAB has even recently shown to cure COVID-19 patients with severe underlying medical conditions; it has cured a patient who recently had a kidney transplant (Fontana, et al. 2020), and others with asthma (Schleicher, Lowman and Richards, 2020), systemic sclerosis (Distler, 2020), multiple myeloma (Zhang, et al. 2020) and sickle cell (De Luna, et al. 2020).

Some doctors in France are claiming to have healed patients infected with CoVID-19 through the use of antihistaminesa well-known and easily accessible medication against seasonal allergies, and some patients are claiming that in 24 hours their symptoms disappeared [i.e. blocked nose, runny nose, aches and pains]. Although no empirical studies have been carried out yet, these French doctors are claiming that since antihistamines can reduce inflammation in its early stages it can prevent progression towards dangerous stagesDr Hélène Rezeau-Frantz prescribed antihistamines to 18 patients who were symptomatic but untested and after a couple of hours they all started feeling better. These doctors are claiming that antihistamines carry no risk of serious adverse effects and genuinely believe that we may be on an interesting trail towards treatment and are asking for serious studies to be carried out on antihistamines.

All these recent advances have been referenced below in the « Références (Études Scientifiques) » section, and academics & medical professionals are kindly urged to read, analyse and continue further research in this direction and the world can also help by spreading this information as far and wide as they can without wasting a single second.


Potential Protection against COVID-19: Vaccines

For those who are not infected and suffering from the severe symptoms of the COVID-19 virus, the best form of protection is vaccination. Throughout humankind’s history, vaccinations have played a significant role in eradicating diseases and improving public health since the discovery of the smallpox vaccine by Edward Jenner in 1796. Vaccines are administered to a host [a patient] to produce an immune response similar to that produced by a natural infection without resulting in a diseased state. The purpose of introducing a vaccine to the host is to produce immunity and an immunologic memory like that of a natural infection. Hence, if the host is exposed to a natural infection in the future, their immune system will be able to elicit an immune response to fight against that infection.

As mentioned earlier, the S protein on the SARS-CoV-2 virus plays an essential role in allowing the virus to bind to and enter the host cell. It enables the virus to attach to host cells via receptor recognition and triggers a cascade of events contributing to its pathogenesis. The S protein has vital functions that makes it a target in developing a vaccine. A range of vaccines have been released and vaccination campaigns have started around the planet with at-risk age groups being given priority. Researchers have developed various types of vaccines with the release of the genetic sequence of the SARS-CoV-2 virus in January, and all those vaccines reach their optimal efficiency after 2 doses; these include inactivated viral vaccines, protein sub-unit vaccines, mRNA vaccines, and recombinant viral vector vaccines, with the 6 most popular ones being:

(i) ChAdOx1 nCOV-2019 Vaxzevria produced by the University of Oxford/AstraZeneca

(ii) Gam-COVID-Vac Sputnik V produced by Gamaleya Scientific Research Institute

(iii) mRNA-1273 produced by Moderna

(iv) BNT162b2 produced by Pfizer & BioNTech

(v) NVX-CoV2373 produced by Novavax

(vi) BBV152 Covaxin produced by Bharat Biotech

6 Major Vaccines COVID-19

6 Pricipaux Vaccins: (i) ChAdOx1 nCOV-2019 Vaxzevria produced by the University of Oxford/AstraZeneca; (ii) Gam-COVID-Vac Sputnik V produced by Gamaleya Scientific Research Institute; (iii) mRNA-1273 produced by Moderna; (iv) BNT162b2 produced by Pfizer & BioNTech, & (v) NVX-CoV2373 produced by Novavax (vi) BBV152 Covaxin produced by Bharat Biotech

(i) ChAdOx1 nCOV-2019 Vaxzevria Vaccine produced by the University of Oxford/AstraZeneca

The ChAdOx1 nCOV-2019 Vaccine produced by the University of Oxford/AstraZeneca uses adenovirus-vectored technology [i.e. recombinant viral vector technology], a harmless, modified version of a common cold virus that usually spreads among chimpanzees. This altered virus may cause a person to become ill, but it carries a gene from the novel coronavirus’s spike protein, the portion of the virus that triggers an immune response; this allows the immune system to manufacture antibodies that works against COVID-19, hence teaching the body how to respond should it become infected with COVID-19. Recombinant viral vector vaccines are generally built upon a non-replicative virus or an attenuated replication-competent virus, which is bioengineered to express antigens from the target pathogen. Although various viral vectors are being studied in vaccine development, only a few recombinant viral vector vaccines have been approved for human use. (Loo et al., 2021)

The original strategy for the Oxford/AstraZeneca vaccine was to deliver a single-dose vaccine. However, it was found that two doses provided much better immune responses. It has been found that those who had a longer interval actually developed much better immune responses after the second dose; this has also been noticed with other vaccines, such as the one against cervical cancer. Longer intervals between the 2 doses provide better immune responses because the immune response matures after the first dose is administered. When it is given enough time to mature, a very good memory booster response is obtained when the 2nd dose is administered. If the 2nd dose is administered too early, the immune response will not have matured fully, so there is some negative feedback, and so it does not overshoot the mark, hence we obtain a smaller response to the 2nd dose (Mahase, 2021).

For the ChAdOx1 nCOV-2019 Vaccine produced by the University of Oxford/AstraZeneca, recent data backs a 12 week [3 months / 84 days] interval between the 1st and 2nd dose. That decision is based on an analysis from 3 single-blind randomised controlled trials involving 17 178 participants in the UK, Brazil and South Africa. The study found vaccine efficacy reached 81.3% after a second dose in those with a dosing interval of 12 weeks or more (95% confidence interval 60.3% to 91.2%). If those doses were given less than 6 weeks apart the efficacy would have been reduced to only 55.1% (CI 33.0% to 69.9%). These observations are supported by immunogenicity data that showed binding antibody responses more than two-fold higher after an interval of 12 weeks or more compared to an interval of less than 6 weeks. These findings confirm that the vaccine is efficacious with outcomes varying by dose interval with a 3-month interval being advantageous over a programme with a short dose interval for a pandemic vaccine to protect the largest number of individuals in the population as early as possible while also improving protection after the 2nd dose. A single standard dose of vaccine was found to provide 76% protection overall against symptomatic COVID-19 starting from day 22 to day 90 after vaccination, with protection not falling in this time frame. We cannot tell how long this protective first dose could last since too few cases were available after 90 days to reach any meaningful judgement. However, it is important to note that analyses suggest that it is the dosing interval and not the dosing level which has the greatest impact on the efficacy of the vaccine (Voysey et al., 2021). This is in line with previous research supporting a greater efficacy with longer intervals with other vaccines such as influenza and Ebola. Researchers found that the vaccine however appears quite poor at preventing asymptomatic infection although its efficacy increased with a longer gap between the 1st and 2nd doses (Wise, 2021).

In an earlier interim primary efficacy analysis conducted with 11,636 (7548 in the UK, 4088 in Brazil), a group of participants were not given the usual 2 standard doses, but were instead given a low-dose (2·2 × 1010 viral particles) as their 1st dose and were then boosted with a standard dose (5 × 1010 viral particles) as their second. An incredible efficacy of 90% was noted in those who received a low dose as prime, this was intriguingly high compared with other findings in the study. The researchers declared that this might be chance at play, however, exploratory subgroup analyses, included at the request of reviewers and editors, that were restricted to participants aged 18-55 years old, or aligned with an dosing interval of more than 8 weeks showed similar findings. Hence, the use of a low dose (LD) for priming could provide more vaccine for distribution at a time of constrained supply while, according to the data, also not compromising the protective effects. However, wide confidence intervals around those estimates conclude that further data will be required to confirm those preliminary findings (Voysey et al., 2021).

There has been some worldwide unfounded controversy regarding ChAdOx1 nCOV-2019 Vaccine produced by the University of Oxford/AstraZeneca where many citizens and healthcare workers have been rejecting it. This irrational hesitancy came after a German newspaper caused international upset when it claimed that the vaccine was ineffective in older people basing itself on just one single anonymised source without any evidence. The European Medicines Agency and many other countries however have ignored this claim and approved the vaccine for over 65s, including most recently, Canada. The Canadian drug regulator said that the vaccine’s efficacy in this age group was supported by factors outside clinical trials. Evidence came from a vaccine rollout to healthcare workers and elderly people in Scotland that showed how the vaccine reduced the risk of admission to hospital by up to 94%, four weeks after the first dose was administered (Torjesen, 2021). These findings may have prompted a change to the recommendations in France, where the ChAdOx1 nCOV-2019 Vaccine is now approved for adults up to 75, after originally being restricted to those under 65.

As it has proven to be effective and has an acceptable safety profile, ChAdOx1 nCOV-2019 Vaccine became the second vaccine to be approved in the UK and has been administered to prioritised groups first. The vaccine was also later approved for use in Europe and India [the Oxford-AstraZeneca vaccine is being produced under licence by Serum Institute India under the commercial name Covishield].

The adenoviral vector vaccine, ChAdOx1 nCoV-19 has also demonstrated efficacy against the B.1.1.7 (UK) variant which similar to the efficacy of the vaccine against other lineages. Vaccination with the ChAdOx1 nCoV-19 leads to a reduction in the duration of shedding and viral load, which may translate into a considerable impact in the reduction of disease transmission (Emary et al., 2021).

Other studies, released in a preprint, to further investigate the vaccine’s efficacy against the B.1.351 (South Africa) variant and the B.1.1.7 (UK) variant have been conducted on Syrian hamsters, which have been successfully used for the preclinical development of several vaccines including Ad26 vaccine by Janssen and mRNA-1273 vaccine by Moderna since those specific rodents have a SARS-CoV-2 infection model that is characterised by natural susceptibility to SARS-CoV-2 and the development of a robust upper and lower respiratory tract infection (Muñoz-Fontela et al., 2020). Animal models such as the Syrian hamster play an important part in science, for example, in the development and evaluation of potential chemotherapeutic agents against leishmaniasis; Syrian hamsters infected with Leishmania species lead to visceral leishmaniasis (VL) that closely mimic the disease in natural hosts, including target organs, lesions, and clinical course (Jiménez-Antón, Grau, Olías-Molero and Alunda, 2019).

Image: Le hamster syrien comme modèle expérimental avancé en médecine / Syrian Hamster as an Advanced Experimental Model in Medicine

With the ongoing evolution of SARS-CoV-2, the readily available and cost-effective Syrian hamster model allows rapid evaluation of the protective efficacy of novel VOCs (Variants of Concern). In addition, it will allow rapid preclinical benchmarking of existing vaccines against preclinical vaccines with updated antigen designs.

Those studies showed that ChAdOx1 nCoV-19 vaccine may be less effective at reducing upper respiratory tract infection caused by the B.1.351 (South Africa) than the B.1.1.7 (UK) along with reduced efficacy against mild disease; however complete protection against lower respiratory tract disease was observed, which is consistent with protection against severe disease. So, based on those results, the researchers hypothesise that the currently available vaccines will likely still protect against severe disease and hospitalisation caused by the B.1.351 (South Africa) variant. ChAdOx1 nCoV-19 vaccination resulted in complete protection against disease in hamsters and hence, viral vectored vaccines may provide substantial protection against lower respiratory tract infection caused by the B.1.351 variant and subsequent hospitalization and death (Fischer et al., 2021).

A study assessing the efficacy of the ChAdOx1 nCoV-19 Vaxzevria vaccine against the B.1351 (South Africa) variant published in the well known New England Journal of Medicine made a major mistake, which seems to suggest that researchers out there are missing some of the advances being made in vaccine efficacy or not exploring the wide range of journals. The study was carried out on 2026 participants and they were given 2 standard doses 21 to 35 days apart, and we know that the vaccine does not reach maximum efficacy if given less than 6 weeks apart, in fact with new data dosing gap must be at least 12 weeks. So, we can assume that the methods were wrong and the results have reflected the mistake (Madhi et al., 2021).


(ii) Gam-COVID-Vac Sputnik V Vaccine produced by Gamaleya Scientific Research Institute

The Russian vaccine known as Gam-COVID-Vac Sputnik V produced by Gamaleya Scientific Research Institute was developed and produced entirely domestically in Russia. In March 2020 when the COVID-19 had already been declared as a world pandemic by the World Health Organization, the Gamaleya National Center of Epidemiology and Microbiology in Moscow was already working on a protype of Sputnik V, funded by the Russian Direct Investment Fund (RDIF), the country’s sovereign wealth fund.

It is a recombinant viral vector DNA vaccine (i.e. the similar viral technology used by the ChAdOx1 nCOV-2019 Vaccine produced by the University of Oxford/AstraZeneca), except instead of using chimpanzee viruses, 2 common human cold viruses were used in the vaccine prototype; the vaccinologists opted for 2 different human adenovirus vectors (rAd26 and rAd5) delivered separately in 2 doses, 21 days (3 weeks) apart. Since using the same adenovirus for the 2 doses could lead to the body’s immune response to act against the vector and destroy it when the 2nd dose is administered, 2 different vectors reduces the likelihood of such a scenario.

The results of both Phase I and Phase II were published in the Lancet based on 76 participants, and according to the paper all participants developed SARS-COV-2 antibodies and no serious adverse effects were observed, at the exception of some mild ones [such as half experiencing pain at injection site] (Logunov et al., 2020). The interim phase III data for the Gam-COVID-Vac Sputnik V vaccine was published in early February 2021 which included 22,000 adults aged 18 years or older. The results indicate that the vaccine is 91.6% effective based on its ability to prevent symptomatic infection. Some 94% reported very mild side effects, and 4 deaths were recorded during the study which were not related to the vaccine (Logunov et al., 2021). The phase III data have been met warmly by the academic community. Russia has gone to great lengths to promote Sputnik V beyond its borders in a vaccine diplomacy drive, promising that it will cost les than $ 10 (£ 7.20; 8.40 Euros) per dose for international buyers.

The University of Oxford and AstraZeneca have even launched a trial to be held in Russia to assess whether mixing doses of their own ChAdOx1 nCOV-2019 Vaxzevria with the Gam-COVID-Vac Sputnik V may yield more benefits to patients worldwide. This initiative in based on the fact that effective vaccines usually require more than one time immunisation in the form of a prime-boost. Traditionally, the same vaccines are given several times as homologous boosts. Findings have suggested the prime-boost against a particular virus can be done with different types of vaccines containing the same antigens; in many cases such heterologous prime-boost can be more immunogenic than homologous prime-boost (Lu, 2009).

Scientists in Russia are also working on 2 versions of the initial Sputnik V vaccine: one that needs to be stored at -18°C, freezer temperature, and another that uses dried (lyophilised) material that can be stored at 2 to 8°C in a range of standard refrigerators, which would aid transport and distribution. Yet more versions of the vaccine are also in the works, including a single dose alternative.

While the vaccine seems to have a high efficacy, one of the main concerns about the safety of the product is the use of the Ad5 vector. According so some researchers who published an article in the Lancet, the use of a recombinant adenovirus type-5 (Ad5) vector may lead to an increased susceptibility to HIV infection among some men, hence they are suggesting to be cautious in using recombinant viral vector vaccines with Ad5 in areas of high HIV prevalence. It is important to clear out the confusion and prevent unecessary panic; the vaccine will not give the recipient HIV, since it is a virus that is transmitted from others. However, these researchers who worked with an Ad5 vectored HIV-1 vaccine (Moodie et al., 2015) about a decade ago are only suggesting to be cautious with the use of Ad5 vector since, if exposed to the HIV virus, it may increase the risk of developing HIV in some men [especially uncircumcised males] by lowering the immune response towards the HIV virus. According to the hypothesis put forward by those researchers, the immune response towards Ad5 induces a lowered activity of the CD4 and CD8 T cells which are specific to HIV. There is no solid data or studies to ascertain that the Russian Gam-COVID-Vac Sputnik V vaccine will lead to increased risk of HIV, but since only a few recombinant viral vector vaccines have been approved for human use, caution is being advised! Further research to dispel this risk would be most welcomed by all (Buchbinder, McElrath, Dieffenbach and Corey, 2020). South Africa, besides being the most severely affected country in Africa with COVID-19, is also a region where the prevalence of HIV is high [19% among adults 15 – 49 years of age], hence the Russian Gam-COVID-Vac Sputnik V vaccine has been placed under close observation there.


(iii) mRNA-1273 Vaccine made by Moderna

The mRNA-1273 Vaccine made by Moderna and the BNT162b2 Vaccine produced by Pfizer & BioNTech use a different technique to fight against COVID-19 than the ChAdOx1 nCOV-2019 Vaccine produced by the University of Oxford/AstraZeneca. These 2 former vaccines use a technology known as mRNA which does not use a virus DNA, but instead introduces a piece of genetic code (mRNA) that tricks the body into producing COVID-19 antibodies. mRNA vaccines had never been used therapeutically in human beings, this is the first time in human history!

Reseach has found that mRNA vaccines allow transient expression and accumulation of the target viral antigens, thus leading to a profound effect on the magnitude and affinity maturation of antibody responses, providing a longer duration of protection. mRNA vaccines are also non-infectious and non-integrating, this means a significantly lower risk of infection or insertational mutagenesis. mRNA is degraded in the body through normal cellular processes, and the 2 vaccines that use this technology [Moderna and BioNTech] rely on intramuscular injections to administer the vaccines since this prevents rapid digestion of the mRNA and avoids stimulation of the innate immune system which could lead to a reduced vaccine efficacy. (Loo et al., 2021)

The mRNA-1273 Vaccine made by Moderna data shows that a delay of at least 28 days between the 2 doses could maximise vaccination program effectiveness and prevent additional infections, hospitalisations and deaths. The interim analysis of Moderna phase III trial reported that the vaccine was 94.5% effective 14 days after the 2nd dose. The Moderna mRNA-1273 Vaccine can be stored at −20°C rather than the −75°C needed for the Pfizer/BioNTech vaccine, which makes handling it much easier. Moderna has announced that the vaccine can be kept in a conventional freezer for up to six months and that once thawed can be kept for up to 30 days in a standard refrigerator. This makes the vaccine much easier to deliver.

The most frequently reported adverse reactions to the Moderna vaccine were injection site pain, fatigue, and headache. Adverse reactions were usually mild or moderate and resolved within a few days after vaccination. The US Centres for Disease Control have reported that 29 people have so far developed anaphylaxis in response to being vaccinated with the Pfizer BioNTech and Moderna vaccines. It said the rate of anaphylaxis cases is currently around 5.5 cases per 1 million vaccine doses given [incredibly low]. In the decision documents, the MHRA tackled potential anaphylactic reactions. It said that “close observation for at least 15 minutes is recommended following vaccination” and advised healthcare professionals to ensure that “appropriate medical treatment and supervision to manage immediate allergic reactions” are readily available. (Mahase, 2021)

Regarding the B.1.1.7 (UK) variant of COVID-19, the preprints of a studies using the mRNA-1273 Vaccine that there was no significant impact on the vaccine’s neutralising ability against B.1.1.7 (UK) lineage. It has been found that both infection- and vaccine-induced antibodies were effective at neutralising the B.1.1.7 (UK) variant. However, reduced neutralisation was measured against the mutation present in the B.1.351 (South Africa) variant. The data resumed demonstrate that there was a reduced but still significant neutralisation against the full B.1.351 (South Africa) following mRNA-1273 vaccination (Wu et al., 2021; Edara et al., 2021).


(iv) BNT162b2 Vaccine produced by Pfizer & BioNTech

While very slightly inferior to Moderna’s performance, the BNT162b2 Vaccine produced by Pfizer & BioNTech is also mRNA based and succesfully averted more hospitalizations and deaths in the UK. The BNT162b2 Vaccine was found to have a 94% efficacy with a 3-week (21 days) dosing schedule between the 1st and 2nd dose. A published study assessing Israel’s vaccination rollout between 20 December 2020 and 1 February 2021 showed that 2 doses of the Pfizer-BioNTech vaccine reduced symptomatic cases by 94%, hospital admissions by 87% and severe COVID-19 by 92%. The paper also suggested that the vaccine was effective against the B.1.1.7 variant [the UK COVID-19 virus variant] (Wise, 2021).

However, the UK is the only country to have adopted a 12-week delay between the 2 doses of the mRNA based BNT162b2 Vaccine produced by Pfizer & BioNTech after recommendations by the Joint Committee on Vaccination and Immunisation (JCVI). This strategy is not in line with what the World Health Organization or the US Centers for Disease Control and Prevention who have both opted for the recommended 21 days (3-week) dosing delay (94% efficacy) and no more than a 6-week to the second dose in exceptional circumstances.

For the mRNA based BNT162b2 Vaccine produced by Pfizer & BioNTech, the 3-week dosing schedule was found highly effective in the phase 3 randomised clinical trial – regarded as gold standard. No clear advantage was found in delaying the 2nd dose of the BNT162b2 Vaccine produced by Pfizer & BioNTech in the reduction of infections, unless the efficacy of the 1st dose did not wane over time. An article in the Lancet questions the UK’s decision to go against the 3-week dosing schedule which is considered as gold standard. The UK’s Chief Medical Officers’ decision to adopt a 12-week delay is not supported by clinical data or efficacy generated from real-life clinical observational data from Israel (Chodick et al., 2021; Aran, 2021).

In the case of the ChAdOx1 nCOV-2019 Vaccine produced by the University of Oxford/AstraZeneca, the 12-week dosing strategy seems like a good decision since that vaccine is different, being DNA based and there is sufficient evidence to back the 12-week gap, but this is not the case for the mRNA based vaccins such as the BNT162b2 Vaccine produced by Pfizer & BioNTech. The JCVI made an assumption that the 89% effectiveness efficacy is obtained after the 1st dose. This estimate of 89% was obtained from an unplanned, retrospective analysis of the randomised clinical trial data, comparing COVID-19 cases in the vaccine group vs the control group from a 6-day window (15-21 days), selected retrospectively after examining the data; hence the 89% was based on about 20 events. Retrospective analyses in therapeutic trials can be used to generate hypotheses but should not be used to treat patients. So, without any solid empirical evidence, the JCVI made the major assumption that 89% effectiveness persists after the 1st dose from day 21 to day 85 in the absence of the 2nd dose [See: Chapter 14a & The Independent report of the Department of Health & Social Care]. In a further major incorrect assumption, the JCVI stated: “There is currently no strong evidence to expect that the immune response from the Pfizer-BioNTech and AstraZeneca vaccines differ substantially from each other. The Pfizer-BioNTech vaccine is an mRNA vaccine different to the AstraZeneca DNA vaccine, and no scientific data on mRNA vaccines exists to support the JCVI’s assumption. The available quality peer-reviewed, published immunology data would refute the assumptions documented by the JCVI and Public Health England.

As already explained, mRNA vaccines have never been used before therapeutically in humans. The assumption made by the JCVI that the 2 mRNA vaccines, i.e. BNT162b2 (produced by Pfizer & BioNTech) & mRNA-1273 (made by Moderna) would have a similar behaviour to the ChAdOx1 nCOV-2019 Vaccine (produced by the University of Oxford/AstraZeneca) is not supported by published empirical evidence (Folegatti et al., 2020; Widge et al., 2021; Walsh et al., 2020).

Recent findings point out to the importance of quantifying the characteristics and durability of vaccine-induce protection after the 1st dose in order to determine the optimal time interval between the 2 doses (Moghadas et al., 2021). The data from the Phase 1/2 of the ChAdOx1 nCOV-2019 Vaccine (the viral vector DNA vaccine produced by the University of Oxford/AstraZeneca) revealed a substantial specific anti-virus spike protein T-cell response at day 7, which then peaks at day 14 (Folegatti et al., 2020); this response is not seen in the BNT162b2 (the mRNA vaccine produced by Pfizer & BioNTech).

Furthermore, there are marked quantitative differences in the production and duration of neutralising antibodies (NAbs). The two mRNA vaccines i.e. BNT162b2 (produced by Pfizer & BioNTech) & mRNA-1273 (made by Moderna), show marked falls in NAb titres (compared with the Oxford/AstraZeneca viral vector DNA vaccine) in the period before the scheduled second dose [day 22 for BNT162b2 by Pfizer & BioNTech (Mulligan et al., 2020; Collier et al., 2021) & day 29 for mRNA-1273 by Moderna (Widge et al., 2021)], something that has been highlighted as occurring in all age groups. Neutralisation titers are correlated with protection against viral infections post vaccination. It is quite clear that neutralising antibodies (NAbs) titres will continue to fall during days 21-85 [if a 12-week delay is implemented between the 2 doses], leading to very reduced immunity and increased risk to individuals of infection, especially in frail older people. A low efficacy of 52.4% was reported out to day 22 after the 1st dose for BNT162b2 (produced by Pfizer & BioNTech) (Polack et al., 2020), and efficacy of 50-60% has been reported in observational cohort studies from Israel covering the same period (Chodick et al., 2021; Aran, 2021).

Hence, it seems that the UK’s decision for a delayed 2nd dose strategy for the BNT162b2 (produced by Pfizer & BioNTech) is a misguided step; it will provide some protection for patients after a 1st dose, but how much and for how long, is unknown and without patient consent. The main risk is that UK’s 12-week delayed 2nd dose could lead to the emergence of COVID-19 variants resulting from sub-optimal or partial immunity. The Government’s Scientific Advisory Group for Emergencies has also documented concern about emergence of variants as a result of delayed 2nd dose; yet this will not be an issue for the ChAdOx1 nCOV-2019 Vaccine (the viral vector DNA vaccine produced by the University of Oxford/AstraZeneca) but rather for the mRNA vaccines [BNT162b2 (the mRNA vaccine produced by Pfizer & BioNTech) & mRNA-1273 (made by Moderna)]. Sub-optimal vaccination with the 2 mRNA vaccines will lead to selective pressure favouring the emergence of vaccine-resistant variants, which could result in a persisting pandemic. New updated vaccines to target the variants is a possibility, but this will require time for testing, mass production, and distribution; human lives will also be lost.

As already said, in the case of the ChAdOx1 nCOV-2019 Vaccine produced by the University of Oxford/AstraZeneca, the 12-week dosing strategy seems like an excellent decision since that vaccine is different, being a viral vector DNA vaccine, and there is sufficient evidence to back the 12-week gap, but this is not the case for the mRNA based vaccines such as the BNT162b2 Vaccine produced by Pfizer & BioNTech. If escape variants arise due to sub-optimal dosing with BNT162b2, they will likely be resistant to other vaccines that target the same viral spike protein.

To conclude, the 3-week dosing schedule as gold standard (94% efficacy) should be respected for the mRNA based vaccine BNT162b2 produced by Pfizer & BioNTech as supported by the World Health Organisation and adopted by the US Centers for Disease Control and Prevention and there should be no more than a 6-week (42 days) gap between the 2 doses (for exceptional circumstances) as advised by the European Medicines Agency. (Robertson et al., 2021)

A study published in Nature explored the antibody and memory B cell responses of a small cohort of 20 volunteers who received the 2 messenger RNA vaccines Moderna (mRNA-1273) or Pfizer-BioNTech (BNT162b2) and found that 8 weeks after receving their 2nd dose, the plasma neutralising activity and relative number of RBD-specific memory B cells were equivalent to those of individuals who had recovered from natural infection. However, activity against SARS-CoV-2 variants that encode E484K-, N501Y- or K417N/E484K/N501-mutant S was reduced by a small—but significant—margin. Together, these results suggest that the monoclonal antibodies in clinical use should be tested against newly arising variants, and that mRNA vaccines may need to be updated periodically to avoid a potential loss of clinical efficacy (Wang et al., 2021).

Recent research, investigating the neutralisation of viruses with European, South African, and United States SARS-CoV-2 variants with the BNT162b2 mRNA vaccine found that the antibodies elicited by primary infection and by the vaccine are likely to maintain protective efficacy against B.1.1.7 variant (UK) (Muik et al., 2021) and most other variants but the partial resistance of the spike protein found in the B.1.351 (South Africa) variant could lead to some individuals being less well protected (Tada et al., 2021)Further studies showed that the neutralisation of the B.1.351 (South Africa) lineage/variant was robust but lower than the neutralisation of B.1.1.7 (UK) lineage and P.1 (Brazil) lineage (Liu et al., 2021; Xie et al., 2021)


(v) NVX-CoV2373 produced by Novavax

The NVX-CoV2373 produced by Novavax is a protein-based vaccine. Protein subunit vaccines use smaller components of the target pathogen to minimise the risk of unintended allergenic or reactogenic effects [Note: Reactogenicity refers to adverse reactions, especially excessive immunological responses and associated signs and symptoms, including fever and sore arm at the injection site] caused by introducing the whole organism into the host. The protein subunit vaccine used to fight against COVID-19 makes use of the S protein of the SARS-CoV-2 virus as it can trigger the release of neutralizing antibodies and T cells. Similar to killed vaccines, subunit vaccines are not alive and so cannot penetrate host cells. (Loo et al., 2021)

The NVX-CoV2373 vaccine by Novavax uses the coronavirus S protein to generate an antigen using recombinant nanoparticle technology coupled with Novavax’s Matrix-MTM adjuvant to produce their vaccine. Preliminary studies for the vaccine produced promising results whereby it demonstrated high immunogenicity in animal models. High levels of S protein-specific antibodies and SARS-CoV-2 wild-type virus-neutralising bodies were detected after a single immunisation. Upon administering the second dose with adjuvant, the microneutralisation titers further increased 8-fold over responses seen with the first vaccination. As explained above, neutralisation titers are correlated with protection against viral infections post vaccination. Vaccines against viral infections induce protective neutralising antibodies which are markers of protective immunity against reinfections after an initial infection. This suggested that the vaccine would be protective when used in humans.

The NVX-CoV2373 vaccine  produced by Novavax has been found to be effective at 95.6% against the original variant of SARS-CoV-2 but also provides protection against newer variants, the UK’s B.1.1.7 variant (85.65% efficacy) and South Africa’s B.1.351 variant (60% efficacy) as preliminary data from clinical trials show. The interim results have been released from a phase III trial carried out in the UK with more than 15,000 participants aged between 18 – 84, including 27% over the age of 65.

The trial tested 2 doses of the vaccine administered 21 days (3 weeks) apart. 62 symptomatic cases of COVID-19 were reported of which 56 were in the placebo group (saline) and 6 in the vaccine group; only 1 case out of the 62 cases of symptomatic COVID-19 was considered as severe and it was in the placebo group, while 32 were in the UK B.1.1.7 variant group of COVID-19. A phase II trial is also ongoing in South Africa with 4400 volunteers, in which 29 cases of COVID-19 have been seen in the placebo group (only 1 severe) and 15 in the vaccine group. Preliminary sequencing data of 27 of these cases found that 93% of them (25) involved the South African COVID-19 variant B.1.351.

Funded in part by the Coalition for Epidemic Preparedness Innovations and the Bill and Melinda Gates Foundation, both the South Africa and UK trial are continuing and further analysis is expected to be shared as more data becomes available. Another phase III trial in the US and Mexico is under way and has randomised more than 16 000 participants; it was expected to hit its 30 000 target by February 2021.

The NVX-CoV2373 vaccine can be stored at 2°C to 8°C and has been found to be safe. An interim analysis of clinical trial data reported that severe, serious, and medically attended adverse events occurred in very low numbers and were balanced between the vaccine and placebo groups. (Mahase, 2021)


Chart: Quelle est l’efficacité des vaccins Covid-19 ? / How Effective Are The Covid-19 Vaccines? / Source: Statista


(vi) BBV152 Covaxin produced by Bharat Biotech

While Covishield (i.e. the Indian version of Oxford/AstraZeneca’s ChAdOx1 nCOV-2019) uses a weakened version of chimpanzee adenovirusBBV152 Covaxin uses a human inactivated SARS-CoV-2 virus extracted from an asymptomatic patient. In an inactivated viral vaccine, the target virus has lost the ability to replicate, and it can thus be safely used in a vaccine to trigger an immune response. Inactivated vaccines such as BBV152 Covaxin trigger hymoral responses that release neutralising antibodies. The inactivated viruses cannot penetrate the host cells actively; they can only rely on endocytosis to be taken up into the cells. Inactivated viral vaccines exhibit lesser immunogenicity and have a shorter duration of protection than live vaccine. Therefore, repeat doses or co-administration with an adjuvant or delivery vehicle are needed to overcome weak immune responses after vaccination. The addition of an adjuvant enhances local inflammation by activating the innate immune response, which increases the vaccine’s ability to provoke an adaptive response. (Loo et al., 2021)

In January 2021, the Lancet published the phase I trial data for BBV152 Covaxin, giving it a green light for safety, stating that it generates “adequate” immune response and induced high neutralising antibody responses that remained elevated in all participants 3 months after the second vaccination but said further efficacy trials were needed (Ella et al., 2021). In the phase II trial, the BBV152 Covaxin was given in a 2-dose regimen over 4 weeks (28 days apart) and showed better reactogenicity [Note: Reactogenicity refers to adverse reactions, especially excessive immunological responses and associated signs and symptoms, including fever and sore arm at the injection site] than reported with BNT162b2 and mRNA-1273 and safety outcomes, and was able to induce robust humoral and cell-mediated immune responses compared with phase I trial while no serious adverse events were observed (Ella et al., 2021). The Phase III results of BBV152 Covaxin based on a trial involving 25,800 participants aged between 18 – 98 years old, including 2,433 who were over the age of 60 and 4,500 with comorbidities [the largest ever conducted in India], showed that the vaccine was well tolerated and demonstrated 81% efficacy in preventing COVID-19 in those without prior infection after the 2nd dose. Analysis from the National Institute of Virology also found that the vaccine-induced antibodies can neutralise the UK variant and other heterologous strains.

The BBV152 Covaxin is stable at 2 to 8 degrees celcius and comes in a ready-to-use liquid formulation. Clinical trial is ongoing to the final analysis at 130 confirmed cases in order to gather further data and evaluate the BBV152 Covaxin in additional secondary study endpoints.

A hurried approval of India’s own BBV152 Covaxin, manufactured by Bharat Biotech in collaboration with the Indian Council of Medical Research and National Institute of Virology has undermined public trust among its own citizens. Activists in India are mainly criticising the way in which BBV152 Covaxin’s phase III clinical trials have been conducted. 700 people were recruited by the People’s University, a privately run medical college and hospital, who paid 750 Indian Rupees (£ 7.50; 8 Euros; $ 10.30) to each. However, there are no records of informed consent, despite audiovisual recording of consent from people who cannot read or write being mandatory since 2013. Hence, many participants did not understand they were taking part in a trial and thought the jab was simply COVID-19 protection, while the follow-up was also inadequate since they could not describe their reactions in written form adequately, many family members share one phone and not every participant was available for such monitoring. Hence, the major confusion arose due to the lack of transparency. Anant Bhan, an adjunct professor at Yenepoya University pointed out: “As the number of participants in a trial increases, there’s a higher chance you will catch adverse events, which would be relatively rarer in smaller groups,” he says. “This is why efficacy data is important to knowsafety is an ongoing process even in phase 4, as you market the vaccine.“, adding “It’s concerning, because all this could have an impact on public trust in the vaccine, undermining such a critical public health intervention.”

As already mentioned, Covishield is the better known out of the 2 vaccines produced in India, it is an Indian version of the Oxford University-AstraZeneca vaccine made by the world’s largest vaccines manufacturer, the Serum Institute of India, and we know that in India, people feel safer with the Covishield vaccine instead of India’s own BBV152 Covaxin. This has been confirmed in a nationwide survey in India among undergraduate medical students through an online questionnaire completed by 1068 medical students across 22 states. Choosing between the well-known Covishield (developed by Oxford-AstraZeneca) and India’s BBV152 Covaxin was considered as important by medical students both for themselves and their future patients, where Covishield was preferred to Covaxin (Jain et al., 2021).

A survey has also been conducted in India regarding the adverse effects and symptoms following COVID-19 vaccination where 5396 people responded. Among those who responded the majority were doctors (85.8%), followed by nurses (6.2%), technicians (1.1%) and others. 56% of the respondents were male and 44% female.

Among the respondents, 5128 (95%) received Covishield (which the Oxford-AstraZeneca vaccine manufactured by Serum Institute in India), 180 (3.3 %) received BBV152 Covaxin (manufactured by Bharat Biotech in India), while 44 (0.8%) had received Pfizer-BioNTech and Sinopharm vaccines from other nations.

Type of Vaccine received

Chart showing type of vaccine received by the 5396 respondents. (Jayadevan et al., 2021)

Overall, 65.9% of respondents reported experiencing at least one post-vaccination symptom such as:

Tiredness (45%), myalgia (44%), fever (34%), headache (28%), local pain at injection site (27%), joint pain (12%), nausea (8%) and diarrhoea (3%) were the most prevalent symptoms. All other symptoms were 1% or less (See the chart below).

Post Vaccination Symtoms COVID-19

Chart showing post-vaccination symptoms among 5396 respondents. (Jayadevan et al., 2021)

To conclude, two-thirds of healthcare professionals who completed the survey reported mild and short-lived post-vaccination symptoms. Tiredness, myalgia and fever were most commonly reported. These symptoms were consistent with an immune response commonly associated with vaccines, and correlated with the findings from previously published phase 2/3 trials.

In 90% of the cases, the symptoms were either milder than expected or meeting the expectation of the vaccine recipient. No serious events were reported. Symptoms were more common among younger individuals and there was no difference in symptoms among those who had a past history of COVID-19 (Jayadevan et al., 2021).

Percentage symptoms by age

Chart showing % chance of experiencing adverse symptoms of post-vaccination among 5396 respondents by age group (Jayadevan et al., 2021)

There are also a range of other vaccines worldwide, however those 6 vaccines presented and discussed above are the most popular ones with data and real world deployment to support their efficacy.

The first COVID-19 vaccine to be approved in the western world, BNT162b2 (Pfizer), was closely followed by mRNA-1273 (Moderna), and the chimpanzee-adenovirus vectored AZD1222 (AstraZeneca–Oxford). Unfortunately, cold-chain requirements, finite global manufacturing capacity, and insufficient supply are likely to disproportinately affect low-income and middle-income countries (LMICs). Mathematical models indicate that there will not be an adequate supply of vaccines available to cover the global population until 2023, further exacerbating health and other disparities in LMICs.

India’s own vaccine, BBV152 Covaxin, produced by Bharat Biotech, is a welcome addition since the company is experienced in the development of a wide range of vaccines [influenza H1N1, Rotavirus, Japanese Encephalitis, Rabies, Chikungunya, Zika and the world’s first tetanus-toxoid conjugated vaccine for Typhoid] and distribution to low-income and middle-income countries (LMICs), and is poised to bridge vaccine disparity gap using its BBV152 Covaxin which has an almost similar efficacy to the Oxford/AstraZeneca’s ChAdOx1 nCOV-2019 [81% efficacy from Phase III clinical trials] hence slightly inferior compared to the 2 mRNA vaccines, BNT162b21 [94% efficacy] and mRNA-1273 [94.5% efficacy], the NVX-CoV2373 vaccine [95.6% efficacy] and the Gam-COVID-Vac Sputnik V Vaccine [91.6% efficacy]. However, while vaccinated people may still become infected with COVID-19, all those vaccines should prevent severe and life-threatening symptoms.

In India, Covishield (i.e. the Indian version of Oxford/AstraZeneca’s ChAdOx1 nCOV-2019) & BBV152 Covaxin are being provided for free to frontline workers, with no choice as to which one a recipient receive. Both vaccines require the usual two doses and work by priming the immune system with a SARS-CoV-2 spike protein. The vaccines are paid for by the Indian government, who declared that the 2 vaccines cost them a quarter of the price on the global market, making them the cheapest in the world. The Oxford-AstraZeneca Covishield is priced at £ 2.01 (200 Indian Rupees) and Bharat Biotech’s BBV152 Covaxin will cost £ 2.97 (295 Indian Rupees) for a single dose. However, when India’s vaccines reach the private market, those prices are expected to be much higher. Covishield is expected to increase by 5 times, reaching around £ 10.05 (1000 Indian Rupees) per dose and at this moment there are no measure in place to keep them affordable for those who desperately need it. With the world’s second largest population, at 1.36 billion, there is a huge potential market in India where more than 160 000 COVID-19 deaths have so far been recorded while also being the country with the second highest number of infections worldwide; it also has one of the largest pharmaceutical manufacturing capacities in the world, so the Asian country seems well placed to deal as both importer and exporter, and has a central role to play in the planetary immunisation efforts against the COVID-19 pandemic.

In December 2020, the US pharmaceutical company Ocugen signed a letter of intent to codevelop Bharat Biotech’s vaccine, BBV152 Covaxin, for the American market. And in the wake of mixed efficacy results for the Chinese Sinovac, Brazil has also looked to India for both BBV152 Covaxin and Covishield stocks. By 23 January 2021, 2 million doses of Covishield had already been delivered to Brazil, while a memorandum has been signed by private Brazilian clinics for 5 million doses of BBV152 Covaxin to be delivered by March 2021.

Biotech companies in India are also expected to produce 300 million doses of Russia’s Sputnik V vaccine. This may come as crucial since the powdered version of the Sputnik V vaccine can be stored at refrigerator temperatures, making it more suitable for warmer climates. Novavax is also expected to have 2 billion doses of its NVX-CoV2371 produced per year by the Serum Institute of India. All this puts India in a prime position to both benefit from the world’s vaccine need and provide for its own gigantic population.

Pfizer and Oxford-AstraZeneca are reported to be in discussions regarding updating their vaccines to target new variants. The Oxford AstraZeneca team announced that the updated vaccine could be available by autumn 2021. It is possible it could take the form of a one dose booster which is updated and rolled out every year.


Maintaining vigilance after vaccination

It is also important to note that being vaccinated is not a guarantee of instant and/or absolute protection. Like all medicines, no vaccine is completely effective, so individuals should continue to take precautions to avoid infection. Some people may still be infected with COVID-19 despite being vaccinated, however their symptoms should be less severe and not life-threatening once the vaccine’s immunity has fully developped after the completed 2 doses with the perfectly timed interval [depending on the vaccine type].

Vaccines do not provide instant immunity; people have little or no immunity at all to the coronavirus immediately after their first jab. Full immunity can take as long as 3 weeks to develop!

Experts have called for stronger health warnings for people vaccinated against COVID-19 after observing a rise in infections shortly after vaccination, suggesting that many people are unaware of the danger and are letting their guard down before the vaccine has taken effect.

A study conducted by Public Health England in the over 70s found a “notable” rise in COVID-19 infections in people immediately after they received the AstraZeneca vaccine (Bernal et al., 2021). Similary another study on Israel’s vaccination programme, found a similar spike in cases among people who had just been jabbed; it was observed that the daily incidence approximately doubled after vaccination until about day 8 (Hunter and Brainard, 2021). A survey conducted in the UK by the Office for National Statistics, investigating COVID-19 and vaccine attitudes and behaviours in England, explains why those spikes may be taking place. Among over 80s who had received their 1st dose of vaccine in the previous 3 weeks, a staggering 41% reported having met up with someone other than a household member, care worker, or member of their support bubble indoors since vaccination, thereby breaking lockdown regulations.

Survey Over 80s UK Attitudes Behaviours

Percentage of over 80s, by who they had met indoors, since being vaccinated against COVID-19, by how many doses of vaccine they have received, England, 15 February to 20 February 2021 / Source: ONS


Survey Over 80s UK Attitudes Behaviours2

Percentage of all over 80s, by how much they perceived the coronavirus (COVID-19) to be a risk to them personally, after hypothetically receiving each dose of vaccine, England, 15 February to 20 February 2021 / Source: ONS

Hence, a group of health psychologists from King’s College, London, University College London and the University of East Anglia have written in the British Medical Journal that the studies, considered together, suggest that there is an urgent need to ramp up health warnings. “Looking at both strands of research—from Israel and the UK—it’s reasonable to suggest people are letting their guard down after they have their first dose,” said James Rubin, professor of psychology of emerging health risks at King’s. “The research has shown that immediately after a first jab people are more likely to be flouting social distancing, meeting people outside their household or bubble—and meeting them indoors.”

A YouGov survey conducted in December 2020 revealed that 29% of people would follow pandemic related rules and restrictions less strictly once they were vaccinated. Paul Hunter, professor of health protection at the University of East Anglia, who reviewed the Israeli data, drew similar conclusions. “While it is not possible to know for certain why this [the spike in cases soon after vaccination] may be the case, there have been concerns that people may believe they are protected as soon as they have had . . . their first injection and so start engaging in risky behaviour more than previously,” he said.

James Rubin said that authorities needed to ram home the message that people have little or no immunity to the coronavirus immediately after their first jab. Full immunity can take as long as three weeks to develop. This message must be clarified and made very clear to publics worldwide. The British Medical Journal asked Public Health England to comment on the suggestion that health leaflets should give greater emphasis to the fact that vaccines do not provide immediate immunity. Rubin said that the NHS should also consider hammering home the message verbally. He said, “I do think that this one-to-one situation, when the person is getting jabbed, is a perfect opportunity for the person giving the vaccine to say that the recipient won’t be protected for a few weeks—and to remind them that they need to continue sticking to the rules on social distancing and not meeting people outside their household or bubbles.”


Vaccines must be monitored for future side-effects & the safest vaccine selected

The rapid increase in morbidity and mortality of the COVID-19 pandemic has led to a drastic shift in the conventional vaccine development paradigm and timelines from a time frame of 10–15 years to 1–2 years (Lurie, Saville, Hatchett and Halton, 2020). The change in the development time frame could mean researchers cannot ascertain the vaccine-induced protective immunity’s longevity and quality. In an ideal world, a vaccine should have high efficacy, with minimum adverse reactions. It should stimulate both humoral and cell-mediated immune responses while being able to induce life-long immunity in the recipients.

It is important to understand that different vaccine platforms’ have been deeply studied and each one has its benefits and limitations [as the table above shows].

In order to overcome the limitations of particular vacccine platforms [technology] a range of techniques have been developed to modify the vaccine platforms to ensure the safety and efficacy of the vaccines before they are distributed and administered. In the case of inactivated viral vaccines [such as BBV152 Covaxin] and protein subunit vaccines [such as NVX-CoV2373 vaccine by Novavax], the antigens in the vaccine by itself may have inadequate immunostimulatory capabilities, hence to compensate for this weakness, additional adjuvants have to be added. Adjuvants generally trigger the innate immune response to recognise the components of the vaccine as a threat to the host [patient’s body], leading to the activation of the antigen-presenting cells, resulting in adaptive immune activities (Coffman, Sher and Seder, 2010). This leads to an increased vaccinal efficacy and extends the duration of the vaccine; it could also lead to a lower dosing frequency to achieve immunity towards the pathogen. However, one of the side effects of adjuvants is that it may increase reactions such as pain, redness, and swelling at the injection site and a few other symptoms such as fever, fatigue, and myalgia (Garçon, Segal, Tavares and Van Mechelen, 2011) due to enhanced activation of the immune response, resulting in inflammation at the injection site.

Currently, the 2 mRNA vaccines developed by Pfizer and Moderna do not use adjuvants. Prime-boost techniques have also been utilised to develop higher immunity levels compared to immune responses obtained by a single vaccination. This method aims to induce both humoral and cellular immune responses to provide long-lasting immunity. An example would be the use of a heterologous prime-boost method involving a viral vector for priming a protein-based vaccine as the booster, which allows for the induction of a strong cellular immune response and a higher specificity of antibodies produced against the target of the vaccine.

Studies have shown that the modifications made to vaccines could lead to other side effects even though they may increase the vaccine’s effectiveness. There have been instances in the past where licensed vaccines have been withdrawn from the market due to newly discovered adverse events associated with them. Hence, a strict assessment of the benefit-to-risk ratio is vital to ensure that the continued use of a particular vaccine provides more benefits than harm to the public.

As the COVID-19 pandemic comes under control or new information regarding the vaccine surfaces, assessments of the benefits of the vaccines may change. Hence, health authorities should assess which vaccine will be the most suitable and effective in our planetary fight against the COVID-19 pandemic. Each vaccine has demonstrated that it can elicit an immune response and has a relatively good safety profile even if all the vaccine platforms used have advantages and disadvantages.

The choice of the best and ultimate vaccine ultimately depends on the knowledge of the pathophysiology of SARS-CoV-2 [i.e. the COVID-19 virus] and the exact immune response required for protection. The ultimate vaccine should be confirmed as one that can be used without severe complications in the patient post immunisation. Relentless monitoring of recipients of the vaccine is essential to detect any severe adverse reactions to ensure the vaccine is safe for the long term health of future generations.

A good and reliable vaccine must be easily administered and remain stable during transport and storage [one of the disadvantages of the 2 mRNA COVID-19 baccines is the extreme low temperature storage requirement]. From an economic standpoint, the manufacturing process of a good vaccine should be reproducible and inexpensive to be easily translated to developing countries. Once an effective vaccine is developed, it is crucial that there is equitable access and distribution of vaccines across all nations to protect the public’s health. Demographics at a higher risk should also be prioritised in receiving the vaccine to prevent further spread and fatalities, because no country will be safe until the whole world is.


Understanding the importance of strategy for successful vaccination campaigns

Vaccination campaigns to control the COVID-19 pandemic on the planet is not simply dependent on the vaccine efficacy and safety. The acceptance of the vaccine among the publics worldwide and healthcare workers has a decisive role in the successful immunisation of the human population and the control of this pandemic. A systematic review has been conducted in order to provide an assessment of COVID-19 vaccination acceptance rates worldwide. The results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates rates, found from 33 different countries. Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%). Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel. In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%. Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries.

This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy. Such studies are particularly needed in the Middle East and North Africa, Sub-Saharan Africa, Eastern Europe, Central Asia, Middle and South America. Addressing the scope of COVID-19 vaccine hesitancy in various countries is recommended as an initial step for building trust in COVID-19 vaccination efforts (Sallam, 2021).

COVID-19 Vaccine Acceptance Rate 2021 dpurb d'purb

Map: COVID-19 vaccine acceptance rates worldwide (Sallam, 2021)

In order to encourage people to get vaccinated, one of the most important persuasive factor remains the safety of the vaccine. A study conducted found that people who perceive COVID-19 as a severe disease were more intent on taking a COVID-19 vaccine. Hence, informing publics worldwide about the safety of the COVID-19 vaccine(s) should be the focus for health authorities aiming to achieve a high vaccine uptake in the course to immunise the human population on the planet (Karlsson et al., 2021). In the UK 4 in 5 adults (86%) who were reluctant or intending to refuse a COVID-19 vaccine in December 2020 had changed their mind by February 2021 and planned on getting vaccinated or had already been vaccinated, as a UCL cohort study on trends, patterns and psychological influences on COVID-19 vaccination intention shows.

In the Middle East, 3 countries, Israel, the United Arab Emirates (UAE), and Bahrain, have successfully administered the vaccine to a high percentage of their populations compared to the rest of the world. These Middle Eastern states have put continuous effort into reassuring the public that the vaccine is safe and effective. Through its universal healthcare system, within days, Israel vaccinated almost 11.0 doses per 100 population and the next highest rate was 3.5 in Bahrain. The vaccination in these countries was higher compared to that in the United Kingdom, the United States of America, and even China (Rosen, Waitzberg and Israeli, 2021).

Another study confirmed that factors related to the implementation will contribute more to the success of vaccination programs than a vaccine’s efficacy itself. The benefits of a vaccine will decline substantially if we face manufacturing or deployment delays, significant vaccine hesitancy or greater epidemic severity.


Chart: Comment les vaccins ont éradiqué des maladies courantes / How Vaccines Eradicated Common Diseases Source: Statista

Hence, it is fundamental for health authorities and officials to invest greater financial resources and attention to vaccine production and distribution programs, to redouble efforts to promote public confidence in COVID-19 vaccines and to encourage continued adherence to other mitigation approaches (Paltiel et al., 2021).


The planetary urgency for equitable distribution of COVID-19 vaccines and treatments

COVAX, launched in April 2020 is an initiative led by 3 global organisations [GAVI, CEPI & The World Health Organisation] that supports the research, development, manufacturing, and price negotiation of the COVID-19 vaccines. COVAX has been established to accelerate the successful development of a vaccine for COVID-19 and initiatives have been implemented to ensure that nations with lower incomes will also be able to receive the vaccines.

However, reports have surfaced that the larger industrial economies, countries such as Canada, the US and the UK have purchased enough doses of vaccines to vaccinate their population multiple times over (Dogra et al., 2021). It is important to note that as the big industrial economies place excessive vaccine orders, the ability of other countries to procure COVID-19 vaccines could be severely undermined and could lead to more deaths and continued contamination globally from various types of travel – no country is safe until the whole human population is immunised against COVID-19. Wealthier countries with only 14% of the world’s population have purchased 53% of the 8 most promising vaccines, the People’s Vaccine Alliance said, this includes all of the doses of the mRNA-1273 vaccine [made by Moderna] to be produced over 2021 and 96% of the BNT162b2 vaccine [made by Pfizer & BioNTech] doses. When the pandemic is ravaging mankind across the planet, this voracious and unnecessary hoarding of vaccines is simply the kind of scenario that could have only been triggered by the collective neuronal activity of irrational imbeciles.

The People’s Vaccine Alliance, that has gained strong support among a wide range of public figures worldwide declared that AstraZeneca-Oxford, Moderna, Pfizer-BioNTech had received more than 5 billion USD of public funding in the development of their vaccines. Significant supply deals have been struck with national governments for those 8 vaccines: Pfizer-BioNTech, Moderna, AstraZeneca-Oxford, Novavax, Johnson & Johnson, Sanofi-GSK, Gamaleya-Sputnik, and Sinovac. While on the other side, some 67 low income countries have made no purchases on their own and are completely dependent on the World Health Organisation’s COVAX programme – a collaboration involving WHO, UNICEF, the World Bank, and the Bill & Melinda Gates Foundation, among others. That programme has managed to secured only about 700 million doses, which is just enough to immunise about 10% of the population in 67 low-income countries.

As a goodwill diplomatic gesture, the Asian vaccine-manufacturing giant, India, is donating 800,000 doses of Covishield. In the same noble path, Oxford University and AstraZeneca have pledged to distribute 64% of their ChAdOx1 nCOV-2019 Vaccine in developing nations, yet, this will only reach 18% of the world’s population in 2021, the Alliance said. The world’s population count is around 8 billion, for those who are not specifically gifted with numbers, this means 8000 million [8000 000 000], and it is on the rise with predictions pointing to almost 10 billion by 2050.

World Population Density dpurb

Densité de la population mondiale / World Population Density (personnes/km2) (Source: Worldometer)

A spokesman for Health Canada upon being querried about the excessive vaccine orders, noted that the country had invested £262 million in the COVAX initiative, most of which would be used towards the vaccinal needs of other countries. Experts believe that rich countries will eventually donate their unneeded stocks of vaccines directly to COVAX, but that was not how the programme was supposed to work. However, those countries will first wait to find out about each vaccine’s performance and durability, and the likely consequence will be that we will not be able to reach complete human immunisation on the planet as citizens of poor countries will not be vaccinated until 2022 or 2023.

The People’s Vaccine Alliance have declared that at least 90% of the population in 67 low income countries stand little chance of getting vaccinated against COVID-19 in 2021 because wealthy nations have reserved more than what they require. Selfish and greedy vaccine developers are also refusing to share their intellectual property [which is the vaccine technology used], making it impossible for the vaccines to be produced elsewhere. If the situation remains static, billions of people all over the planet may not be vaccinated for years to come, Oxfam’s health policy manager, Anna Marriott observed. Wealthier nations have enough doses of COVID-19 vaccines to jab their populations almost 3 times over, whilst poor countries do not even have enough to reach health workers and people at risk.

The current system where pharmaceutical corporations use government funding for research, and then retain exclusive rights whilst also keeping their technology secret to boost their profits could cost many lives. Pharmaceutical companies like any other business need financial revenue to cover their costs and develop vaccines and treatments, and in normal circumstances, most people do not have anything against buying their multi-vitamins, toothpastes, mouthwash, pain-relieving pills, pet shampoo or flea-repellent and other drugs at a pharmacie (drug store). However, we are facing a historical pandemic and most of the research and development (R&D) costs to finding a vaccine were financed by public money, hence many humanitarian organisations find it unscrupulous for pharmaceutical giants to charge exorbitant amounts as is the case for other medicines. Pfizer, is selling its COVID-19 BNT162b2 Vaccine for around 39 USD for 2 doses, this works out at an 80% profit margin and puts it beyond the reach of all but the wealthier countries.

Pharmaceutical corporations and research institutions working on COVID-19 vaccines must act with dignity in this global humanitarian crisis; vaccines are not as straightforward as many other medicines to copy since many are composed of very specific biological material. The People’s Vaccine movement argue that since most of the treatments and vaccines have been funded by taxpayer money, governments should impose conditions on their pricing and request corporations and research institutions to share the science, technological know-how, and intellectual property related to the vaccines to maximise production by other quality producers across the planet. Besides, we already have a global mechanism that facilitates this sharing, which is the World Health Organization COVID-19 Technology Access Pool (C-TAP). This would allow enough safe and effective doses to be supplied at a faster rate to all those who also urgently need them; it would also speed up our planetary goal of immunising the world’s population. In the past, the creation of the Medicine Patent Pool for HIV medication resulted in the production of millions of affordable doses of antiretroviral drugs that are today accessible and still being used to save lives in developing countries; this is something that should inspire contribution to the C-TAP (COVID-19 Technology Access Pool).

In those times of crisis, the world’s governments should be focusing on waging a war against death by maximising vaccine production and supplies instead of maximising profits for pharmaceutical giants. For example, Oxford University & Astra Zeneca have licensed production of their ChAdOx1 nCOV-2019 Vaccine to companies in India, Brazil and in Argentina, other vaccine developers should take notice and follow a similar path. The University of Oxford and Vaccitech, having joint rights in the vaccine, entered into a partnership with AstraZeneca in April 2020 for further development, large-scale manufacture and global supply of the vaccine. Equitable access to the vaccine is a key component of the partnership. Neither Oxford University nor Vaccitech will receive any royalties during the pandemic period or from any sales of the vaccine in developing countries.

Vaccine development has progressed impressively fast, however the efforts to provide access to vaccination globally are disgustingly slow. A proposal has been made by South Africa and India to the World Trade Organisation to waive intellectual property rights on COVID-19 vaccines, tests and treatments until the whole human population is protected from COVID-19. Hence, this is an initiative that governments worldwide must support and do everything that is required to ensure that quality COVID-19 vaccines and treatments are made a global public good, freely accessible and distributed simultaneously and quickly across the planet to all its inhabitants in order to eradicate COVID-19 as fast as possible and focus on putting civilisation back on track.

The People’s Vaccine Alliance argued that if COVAX is considering a tiered pricing model, many low and middle-income countries, already faced with economic instability and with under-resourced health systems, will not be able to afford the vaccine or would have to do so at the expense of being even more indebted. COVAX will only succeed if they speed up and maximise production of vaccines by pressuring phamaceutical companies and research institutions to share the science, technology and know-how behind the vaccines with the World Health Organization COVID-19 Technology Access Pool (C-TAP), secure low and transparent vaccine prices and ensure equitable distribution according to the WHO’s equitable allocation framework.

Où sont produits les vaccins contre le COVID-19

Nombre total de doses de vaccins contre le COVID-19 produit par pays / Total number of doses of COVID-19 vaccine produced per country (Source: Statista France)

The People’s Vaccine Alliance declared that donors should contribute towards vaccine purchases through the global mechanism COVAX.

COVAX should strongly consider the fact that governments have funded much of the research and development costs of vaccines and treatments when they are negotiating the prices. The governments of lower and middle-income countries must also increase and prioritise financing for health services so that vaccines can be acquired as soon as they are available. We are facing a global pandemic with intolerable economic costs for all nations, but this is even worse for the poorest nations. Vaccines, tests and treatments should be supplied at transparent affordable prices so that donors, governments and other charitable associations can afford enough for everyone and provide them free of charge to everyone. Using the HIV treatment as an example, when the price was high people in developing countries were denied life-saving treatment, which resulted in millions of needless death. This changed when generic competition forced the prices down, allowing donors to buy millions of treatments with over 20 million people today benefiting.

The fundamental urgency is to scale up vaccine production across the planet; every manufacturer with the possibility to produce vaccines should be doing so, since it seems barbaric and embarrassing for wealthier nations to be openly vying with each other to secure exclusive access to vaccines while the majority of the human population are left in the cold to watch and wonder about their fate.

Les Politiciens de très grands enfants dpurb

Image: Des politiciens dans une démonstration d’agression primitive / Politicians in a display of primitive aggression [Plus d’informations ici / More here: Essay // Psychology: Causes of Aggressive Behaviour in Human Primates]

The People’s Vaccine Alliance believe in an equitable system for prioritising access to those most at risk across the globe, i.e. health and care workers, senior citizens above the age of 60 and all those with chronic conditions – vaccine distribution should be distributed according to necessity rather than being auctioned to the highest bidder. COVAX is currently the only global mechanism for pooling demand for COVID-19 vaccines for lower-income countries and it is encouraging to see that 194 countries have agreed to work together, but the larger industrial economies continue to cut bilateral supply deals with pharmaceutical companies, hence undermining a synchronised worldwide effort towards a systematic and simultaneous vaccine distribution based on an equitable system of distribution to cover the globe.

It is fundamental for everyone on this small over-populated and depleting blue planet to understand no country will truly be safe until all countries are. This is not simply a catch phrase to play good samaritan, but to sensible thinkers it is simply insightful reasoning; because we are not living in the 1950s anymore, the world, its inhabitants, mentalities and human culture has drastically changed. Nowadays, with the post-modern economic development of the 21st century, standards of living have risen worldwide and with the competition in the transportation industries, air tickets have become more affordable; that simply brings forward the fact that no one on Earth is far from one another, since it only takes an address, a phone number, about 20 hours of flight, few hours of driving and a phone call to meet anyone, anywhere & anytime on this small planet.

Décollage d'un avion dpurb

Image: Décollage d’un avion / Plane taking off

The world is more interconnected as it never was before and this means that if the human population is not immunised as fast as possible, this deadly COVID-19 virus will continue to circulate and be passed around across borders from the wide range of interactions, transactions and exchanges that take place across the planet.

Many groups worldwide are advocating for a people’s vaccine [#PeoplesVaccine] and not a profit vaccine since the COVID-19 is an alarming planetary situation – probably the major pandemic that will be studied and remembered in the centuries to come as part of the history of the 21st century; the campaign is gaining momentum worldwide. Researchers are hopeful that once a greater percentage of the general population receives the vaccine, herd immunity across the planet can be achieved, and humanity can finally turn the page on this ugly pandemic and focus on other matters, for e.g. progressive and meaningful development, standards of education and teaching, enhanced living experience, shared values in a unified civilisation, among others.



This is a very stressful and testing time for not only the academic community but also to the rest of the human population and until the planet is immunised and reliable treatments made accessible to all, we cannot lower our guards or act recklessly towards this dangerous and deadly virus.

035 Coffins COVID-19 Victims


We must NEVER FORGET that there is a deadly virus circulating and any minor slip or even a small reflex [e.g. scratching the eyelids] can mean death. We must follow the barrier moves at all times and be incredibly conscious of our every move and actions while also constantly maintaining a strict clinical hygiene. Those who are not following these protective rules are not only playing with their own life but with those of others and a good suggestion for these dangerous, irresponsible and immature people would be to imagine 2,700,000 human corpses stacked in a heap in front of them and ask themselves whether they would like to be part of it, because this is the number of lives the CoVID-19 epidemic has claimed in a few months which includes many highly trained and experienced doctors.

Skulls in the Opdas Mass Burial Cave

Image: Skulls in the Opdas mass burial cave (for illustrative purposes only)

We have also heard and read some rumours in the media regarding the impact of weather and climate on the COVID-19 pandemic. What a recent study in Science (Baker et al., 2020) found is that humid climates tend to favour stronger outbreaks, however summer and sunshine will not limit the pandemic growth substantiallyThe only things that will give us all our life back are effective antivirals and a reliable and safe vaccine with proven long-term efficacy successfully distributed and administered as fast as possible to immunise the human population.

It is also understandable that many people are also eager to get back to resuming their normal lives and having been confined for so long many want to travel or go on holidays, especially confined couples.

Lady in Red - ALLoyd d'purb dpurb site web

Image: Lady in red / A.Lloyd

However, it is imperative to understand that as long as effective antivirals are not made accessible worldwide and vaccination campaigns are not completed, this incredibly dangerous virus will continue circulating among human populations on the planet. Hence, as matters currently stand the wisest behaviour for the time being is to wait and be patient while also minimising unimportant social interactions and travel and only focus on what is truly important. We should only leave the house for essential and vital reasons such as for work [if impossible to work from home] and for food provisions. The severe acute respiratory syndrome COVID-19 / Coronavirus II (SARS-CoV-2) pandemic is a powerful reminder of the ability of infectious diseases to sicken, kill and disrupt, even in the most technologically advanced generation.

Video: Une note sur le COVID 19 et la gestion de la civilisation [En Francais & in English (Starts at 13:00)]

I would also like to thank all my readers, followers and supporters for their kindness, time, loyalty and trust. It will soon be almost a decade since was launched and we have been through so much together, in many cases all of us behind our screens but travelling the universe, living, experiencing so much within our minds.

Since launching in 2012 I have met so many people from England, France and other places, from all walks of life (in offices, universities, libraries, on the internet, in art galleries, on the streets, etc) who have sometimes asked me some great questions to which I have most of the time answered by speeches that have always been well received and admired; so I recently decided to put all those answers in writing so that the whole world can understand, feel and connect with our line of thought, values, philosophy and goals [These can be found in the essay « Top XV Questions asked by French & English people over the years »].

I shall end this essay by emphasising on the fact that was launched with the firm intention to touch, inspire and motivate individuals from all walks of life that make up our human civilisation on our little planet Earth, from the small to the immense.


Danny d’Purb

Note: We can also be followed on Twitter: @DannyDPurb

Le Boléro de Ravel par l’Orchestre national de France en #confinement #ensembleàlamaison

(FR) Vous trouverez ci-dessous une liste des principaux articles relatifs à la crise COVID-19 en cours. La liste ci-dessous sera continuellement mise à jour comme tous nos articles sur le siteVeuillez visiter ce poste périodiquement pour plus d’informations pendant que nous luttons ensemble contre cet horrible virus en tant qu’une civilisation des créatures les plus intelligentes de la Terre.

(EN) Below is a list of the top articles related to the ongoing COVID-19 crisis. The list below will be continuously updated as all of our posts on the website. Please visit this post periodically for more information as we fight this ugly virus together as a civilisation of the smartest creatures on Earth.


Références (Études Scientifiques) – Cliquez sur les liens

  1. Ahmed, S., Quadeer, A. and McKay, M., (2020). Preliminary Identification of Potential Vaccine Targets for the COVID-19 Coronavirus (SARS-CoV-2) Based on SARS-CoV Immunological StudiesViruses, 12(3), p.254.
  2. Akatsu, T., (2020). The Body Vs. Coronavirus. The battle inside us (Documentary). NHK. Japan.
  3. Aljofan, M. and Gaipov, A., (2020). COVID-19 Treatment: The Race Against TimeElectronic Journal of General Medicine, 17(6).
  4. Amuasi, J., Walzer, C., Heymann, D., Carabin, H., Huong, L., Haines, A. and Winkler, A., (2020). Calling for a COVID-19 One Health Research CoalitionThe Lancet.
  5. Aran, D. (2021). Estimating real-world COVID-19 vaccine effectiveness in Israel using aggregated counts.
  6. Asian Pacific Journal of Allergy and Immunology, (2020). Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic.
  7. Baker, R., Yang, W., Vecchi, G., Metcalf, C. and Grenfell, B., (2020). Susceptible supply limits the role of climate in the early SARS-CoV-2 pandemicScience, p.eabc2535.
  8. Bennardo, F., Buffone, C. and Giudice, A., (2020). New therapeutic opportunities for COVID-19 patients with Tocilizumab: Possible correlation of interleukin-6 receptor inhibitors with osteonecrosis of the jawsOral Oncology, p.104659.
  9. Bergin, C., Browne, P., Murray, P., O’Dwyer, M., Conlon, N., Kane, D., Laffey, J., Ní Choitir, C., Adams, R., O’Leary, A., King, F. and Gilvarry, P., (2020). Interim Guidance For The Use Of Tocilizumab In The Management Of Patients Who Have Severe COVID-19 With Suspected Hyperinflammation [V3.0]. The Irish Health Repository.
  10. Bernal, J., Andrews, N., Gower, C., Stowe, J., Robertson, C., and Tessier, E. et al. (2021). Early effectiveness of COVID-19 vaccination with BNT162b2 mRNA vaccine and ChAdOx1 adenovirus vector vaccine on symptomatic disease, hospitalisations and mortality in older adults in England.
  11. Bi, Q., Wu, Y., Mei, S., Ye, C., Zou, X., Zhang, Z., Liu, X., Wei, L., Truelove, S., Zhang, T., Gao, W., Cheng, C., Tang, X., Wu, X., Wu, Y., Sun, B., Huang, S., Sun, Y., Zhang, J., Ma, T., Lessler, J. and Feng, T., (2020). Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort studyThe Lancet Infectious Diseases,.
  12. Boytchev, H. (2021). Why did a German newspaper insist the Oxford AstraZeneca vaccine was inefficacious for older people—without evidence?. BMJ n414.
  13. Buchbinder, S., McElrath, M., Dieffenbach, C. and Corey, L., (2020). Use of adenovirus type-5 vectored vaccines: a cautionary tale. The Lancet, 396(10260), pp.e68-e69.
  14. Carsetti, R., Quintarelli, C., Quinti, I., Piano Mortari, E., Zumla, A., Ippolito, G. and Locatelli, F., (2020). The immune system of children: the key to understanding SARS-CoV-2 susceptibility?The Lancet Child & Adolescent Health,.
  15. Cellina, M., Orsi, M., Bombaci, F., Sala, M., Marino, P. and Oliva, G., (2020). Favorable changes of CT findings in a patient with COVID-19 pneumonia after treatment with tocilizumabDiagnostic and Interventional Imaging,.
  16. Challen, R., Brooks-Pollock, E., Read, J., Dyson, L., Tsaneva-Atanasova, K. and Danon, L., (2021). Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study. BMJ, p.n579.
  17. Challender, D., Harrop, S. and MacMillan, D., (2015). Understanding markets to conserve trade-threatened species in CITESBiological Conservation, 187, pp.249-259.
  18. Chang, R. and Sun, W., (2020). Repositioning Chloroquine as Ideal Antiviral Prophylactic against COVID-19 – Time is Now.
  19. Chen, L., Liu, H., Liu, W., Liu, J., Liu, K., Shang, J., Deng, Y. and Wei, S., (2020). [Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia]Chinese Journal of Tuberculosis and Respiratory, 43(0):E005.
  20. Chen, L., Xiong, J., Bao, L. and Shi, Y., (2020). Convalescent plasma as a potential therapy for COVID-19The Lancet Infectious Diseases, 20(4), pp.398-400.
  21. Chodick, G., Tene, L., Patalon, T., Gazit, S., Tov, A., and Cohen, D. et al. (2021). The effectiveness of the first dose of BNT162b2 vaccine in reducing SARS-CoV-2 infection 13-24 days after immunization: real-world evidence.
  22. Coffman, R., Sher, A. and Seder, R., (2010). Vaccine Adjuvants: Putting Innate Immunity to Work. Immunity, 33(4), pp.492-503.
  23. Collier, D., Ferreira, I., Datir, R., Meng, B., Bergamaschi, L., and Lim, E. et al. (2021). Age-related heterogeneity in neutralising antibody responses to SARS-CoV-2 following BNT162b2 vaccination.
  24. Colson, P., Rolain, J., Lagier, J., Brouqui, P. and Raoult, D., (2020). Chloroquine and hydroxychloroquine as available weapons to fight COVID-19International Journal of Antimicrobial Agents, p.105932.
  25. Cortegiani, A., Ingoglia, G., Ippolito, M., Giarratano, A. and Einav, S., (2020). A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19Journal of Critical Care.
  26. Day, M., (2020). Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientistsBMJ, p.m1086.
  27. Day, M. (2021). Covid-19: Stronger warnings are needed to curb socialising after vaccination, say doctors and behavioural scientists. BMJ n783.
  28. De Luna, G., Habibi, A., Deux, J., Colard, M., d’Alexandry d’Orengiani, A., Schlemmer, F., Joher, N., Kassasseya, C., Pawlotsky, J., Ourghanlian, C., Michel, M., Mekontso-Dessap, A. and Bartolucci, P., (2020). Rapid and Severe Covid-19 Pneumonia with Severe Acute Chest Syndrome in a Sickle Cell Patient Successfully Treated with TocilizumabAmerican Journal of Hematology,.
  29. Diao, B., Wang, C., Wang, R., Feng, Z., Tan, Y., Wang, H., Wang, C., Liu, L., Liu, Y., Liu, Y., Wang, G., Yuan, Z., Ren, L., Wu, Y. and Chen, Y., (2020). Human Kidney is a Target for Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.
  30. Dong, L., Hu, S. and Gao, J., (2020). Discovering drugs to treat coronavirus disease 2019 (COVID-19)Drug Discoveries & Therapeutics, 14(1), pp.58-60.
  31. Dyer, O., (2020). Covid-19: Many poor countries will see almost no vaccine next year, aid groups warn. BMJ, p.m4809.
  32. D’purb, D.,(2016). Clinical Psychology: Controversies that surround modern day mental health practice. essais
  33. D’purb, D., (2018). Clinical Psychology: Learning Disabilities, Anxiety, Depression & Schizophrenia and the Effectiveness of Psychotherapy. essais
  34. D’purb, D., (2016). History on Western Philosophy, Religious cultures, Science, Medicine & Secularisation. essais
  35. D’purb, D., (2018). Psychoanalysis: History, Foundations, Legacy, Impact & Evolution. essais
  36. D’purb, D., (2016). Psychology: The Concept of Self. essais
  37. Dogra, P., Koay, E., Wang, Z., Vahidy, F., Ferrari, M., Pasqualini, R., Arap, W., Boom, M., Sostman, H. and Cristini, V., (2021). Do Pandemics Obey the Elliott Wave Principle of Financial Markets?.
  38. Edara, V., Floyd, K., Lai, L., Gardner, M., Hudson, W., Piantadosi, A., Waggoner, J., Babiker, A., Ahmed, R., Xie, X., Lokugamage, K., Menachery, V., Shi, P. and Suthar, M., (2021). Infection and mRNA-1273 vaccine antibodies neutralize SARS-CoV-2 UK variant.
  39. Ella, R., Vadrevu, K., Jogdand, H., Prasad, S., Reddy, S., Sarangi, V., Ganneru, B., Sapkal, G., Yadav, P., Abraham, P., Panda, S., Gupta, N., Reddy, P., Verma, S., Kumar Rai, S., Singh, C., Redkar, S., Gillurkar, C., Kushwaha, J., Mohapatra, S., Rao, V., Guleria, R., Ella, K. and Bhargava, B., (2021). Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: a double-blind, randomised, phase 1 trial. The Lancet Infectious Diseases,.
  40. Ella, R., Reddy, S., Jogdand, H., Sarangi, V., Ganneru, B., Prasad, S., Das, D., Raju, D., Praturi, U., Sapkal, G., Yadav, P., Reddy, P., Verma, S., Singh, C., Redkar, S., Gillurkar, C., Kushwaha, J., Mohapatra, S., Bhate, A., Rai, S., Panda, S., Abraham, P., Gupta, N., Ella, K., Bhargava, B. and Vadrevu, K., 2021. Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: interim results from a double-blind, randomised, multicentre, phase 2 trial, and 3-month follow-up of a double-blind, randomised phase 1 trialThe Lancet Infectious Diseases,.
  41. Emary, K., Golubchik, T., Aley, P., Ariani, C., Angus, B., Bibi, S., Blane, B., Bonsall, D., Cicconi, P., Charlton, S., Clutterbuck, E., Collins, A., Cox, T., Darton, T., Dold, C., Douglas, A., Duncan, C., Ewer, K., Flaxman, A., Faust, S., Ferreira, D., Feng, S., Finn, A., Folegatti, P., Fuskova, M., Galiza, E., Goodman, A., Green, C., Green, C., Greenland, M., Hallis, B., Heath, P., Hay, J., Hill, H., Jenkin, D., Kerridge, S., Lazarus, R., Libri, V., Lillie, P., Ludden, C., Marchevsky, N., Minassian, A., McGregor, A., Farooq Mujadidi, Y., Phillips, D., Plested, E., Pollock, K., Robinson, H., Smith, A., Song, R., Snape, M., Sutherland, R., Thomson, E., Toshner, M., Turner, D., Vekemans, J., Villafana, T., Williams, C., Hill, A., Lambe, T., Gilbert, S., Voysey, M., Ramasamy, M., Pollard, A. and Group, O., (2021). Efficacy of ChAdOx1 nCoV-19 (AZD1222) Vaccine Against SARS-CoV-2 VOC 202012/01 (B.1.1.7). SSRN Electronic Journal,.
  42. Evans, R., McAuley, H., Harrison, E., Shikotra, A., Singapuri, A., Sereno, M., Elneima, O., Docherty, A., Lone, N., Leavy, O., Daines, L., Baillie, J., Brown, J., Chalder, T., De Soyza, A., Diar Bakerly, N., Easom, N., Geddes, J., Greening, N., Hart, N., Heaney, L., Heller, S., Howard, L., Jacob, J., Jenkins, R., Jolley, C., Kerr, S., Kon, O., Lewis, K., Lord, J., McCann, G., Neubauer, S., Openshaw, P., Pfeffer, P., Rowland, M., Semple, M., Singh, S., Sheikh, A., Thomas, D., Toshner, M., Chalmers, J., Ho, L., Horsley, A., Marks, M., Poinasamy, K., Wain, L. and Brightling, C., (2021). Physical, cognitive and mental health impacts of COVID-19 following hospitalisation – a multi-centre prospective cohort study.
  43. Fan, Z., Chen, L., Li, J., Tian, C., Zhang, Y., Huang, S., Liu, Z. and Cheng, J., (2020). Clinical Features of COVID-19 Related Liver Damage.
  44. Fazzi, E. and Galli, J., (2020). New clinical needs and strategies for care in children with neurodisability during COVID‐19Developmental Medicine & Child Neurology,.
  45. Fischer, R., van Doremalen, N., Adney, D., Yinda, C., Port, J., Holbrook, M., Schulz, J., Williamson, B., Thomas, T., Barbian, K., Anzick, S., Ricklefs, S., Smith, B., Long, D., Martens, C., Saturday, G., de Wit, E., Gilbert, S., Lambe, T. and Munster, V., (2021). ChAdOx1 nCoV-19 (AZD1222) protects hamsters against SARS-CoV-2 B.1.351 and B.1.1.7 disease.
  46. Folegatti, P., Ewer, K., Aley, P., Angus, B., Becker, S., and Belij-Rammerstorfer, S. et al. (2020). Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial. The Lancet 396: 467-478.
  47. Fontana, F., Alfano, G., Mori, G., Amurri, A., Lorenzo, T., Ballestri, M., Leonelli, M., Facchini, F., Damiano, F., Magistroni, R. and Cappelli, G., (2020). Covid‐19 pneumonia in a kidney transplant recipient successfully treated with Tocilizumab and HydroxychloroquineAmerican Journal of Transplantation,.
  48. Fu, B., Xu, X. and Wei, H., (2020). Why tocilizumab could be an effective treatment for severe COVID-19?Journal of Translational Medicine, 18(1).
  49. Funk, C., Laferrière, C., and Ardakani, A. (2021). Target Product Profile Analysis of COVID-19 Vaccines in Phase III Clinical Trials and Beyond: An Early 2021 Perspective. Viruses 13: 418.
  50. Garçon, N., Segal, L., Tavares, F. and Van Mechelen, M., (2011). The safety evaluation of adjuvants during vaccine development: The AS04 experience. Vaccine, 29(27), pp.4453-4459.
  51. Gao, J., Tian, Z. and Yang, X., (2020). Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studiesBioScience Trends, 14(1), pp.72-73.
  52. Gao, Q., Bao, L., Mao, H., Wang, L., Xu, K., Yang, M., Li, Y., Zhu, L., Wang, N., Lv, Z., Gao, H., Ge, X., Kan, B., Hu, Y., Liu, J., Cai, F., Jiang, D., Yin, Y., Qin, C., Li, J., Gong, X., Lou, X., Shi, W., Wu, D., Zhang, H., Zhu, L., Deng, W., Li, Y., Lu, J., Li, C., Wang, X., Yin, W., Zhang, Y. and Qin, C., (2020). Development of an inactivated vaccine candidate for SARS-CoV-2Science, p.eabc1932.
  53. Garg, S., Kim, L., Whitaker, M., O’Halloran, A., Cummings, C., Holstein, R., Prill, M., Chai, S., Kirley, P., Alden, N., Kawasaki, B., Yousey-Hindes, K., Niccolai, L., Anderson, E., Openo, K., Weigel, A., Monroe, M., Ryan, P., Henderson, J., Kim, S., Como-Sabetti, K., Lynfield, R., Sosin, D., Torres, S., Muse, A., Bennett, N., Billing, L., Sutton, M., West, N., Schaffner, W., Talbot, H., Aquino, C., George, A., Budd, A., Brammer, L., Langley, G., Hall, A. and Fry, A., (2020). Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020 Morbidity and Mortality Weekly Report, 69(15), pp.458-464.
  54. Guo, C., Li, B., Ma, H., Wang, X., Cai, P., Yu, Q., Zhu, L., Jin, L., Jiang, C., Fang, J., Liu, Q., Zong, D., Zhang, W., Lu, Y., Li, K., Gao, X., Fu, B., Liu, L., Ma, X., Weng, J., Wei, H., Jin, T., Lin, J. and Qu, K., (2020). Tocilizumab treatment in severe COVID-19 patients attenuates the inflammatory storm incited by monocyte centric immune interactions revealed by single-cell analysis.
  55. Hamzavi, I., Lyons, A., Kohli, I., Narla, S., Parks-Miller, A., Gelfand, J., Lim, H. and Ozog, D., 2020. Ultraviolet germicidal irradiation: Possible method for respirator disinfection to facilitate reuse during the COVID-19 pandemicJournal of the American Academy of Dermatology, 82(6), pp.1511-1512.
  56. Hu, Z., Song, C., Xu, C., Jin, G., Chen, Y., Xu, X., Ma, H., Chen, W., Lin, Y., Zheng, Y., Wang, J., Hu, Z., Yi, Y. and Shen, H., (2020). Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, ChinaScience China Life Sciences.
  57. Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., Xiao, Y., Gao, H., Guo, L., Xie, J., Wang, G., Jiang, R., Gao, Z., Jin, Q., Wang, J. and Cao, B., (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, ChinaThe Lancet, 395(10223), pp.497-506.
  58. Hunter, P., and Brainard, J. (2021). Estimating the effectiveness of the Pfizer COVID-19 BNT162b2 vaccine after a single dose. A reanalysis of a study of ‘real-world’ vaccination outcomes from Israel.
  59. Iacobucci, G., and Mahase, E. (2021). Covid-19 vaccination: What’s the evidence for extending the dosing interval?. BMJ n18.
  60. Jain, J., Saurabh, S., Goel, A., Gupta, M., Bhardwaj, P., and Raghav, P. (2021). COVID-19 vaccine hesitancy among undergraduate medical students: results from a nationwide survey in India.
  61. Jiménez-Antón, M., Grau, M., Olías-Molero, A. and Alunda, J., (2019). Syrian Hamster as an Advanced Experimental Model for Visceral Leishmaniasis. Methods in Molecular Biology, pp.303-314.
  62. Jayadevan, R., Shenoy, R., and TS, A. (2021). Survey of symptoms following COVID-19 vaccination in India.
  63. Jin, Z., Zhao, Y., Sun, Y., Zhang, B., Wang, H., Wu, Y., Zhu, Y., Zhu, C., Hu, T., Du, X., Duan, Y., Yu, J., Yang, X., Yang, X., Yang, K., Liu, X., Guddat, L., Xiao, G., Zhang, L., Yang, H. and Rao, Z., (2020). Structural basis for the inhibition of SARS-CoV-2 main protease by antineoplastic drug carmofurNature Structural & Molecular Biology,.
  64. Juan, J., Gil, M., Rong, Z., Zhang, Y., Yang, H. and Poon, L., (2020). Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies.
  65. Karlsson, L., Soveri, A., Lewandowsky, S., Karlsson, L., Karlsson, H., and Nolvi, S. et al. (2021). Fearing the disease or the vaccine: The case of COVID-19. Personality And Individual Differences 172: 110590.
  66. Kearney, J., (2020). Chloroquine as a Potential Treatment and Prevention Measure for the 2019 Novel Coronavirus: A Review.
  67. Kim, Y., Dema, B. and Reyes-Sandoval, A., (2020). COVID-19 vaccines: breaking record times to first-in-human trialsnpj Vaccines, 5(1).
  68. Klok, F., Kruip, M., van der Meer, N., Arbous, M., Gommers, D., Kant, K., Kaptein, F., van Paassen, J., Stals, M., Huisman, M. and Endeman, H., (2020). Incidence of thrombotic complications in critically ill ICU patients with COVID-19Thrombosis Research,.
  69. Kmietowicz, Z., (2015). Processed meats are carcinogenic, says new review of evidenceBMJ, p.h5729.
  70. Kim, J., Marks, F. and Clemens, J., (2021). Looking beyond COVID-19 vaccine phase 3 trials. Nature Medicine, 27(2), pp.205-211.
  71. Kong, W., Li, Y., Peng, M., Kong, D., Yang, X., Wang, L. and Liu, M., (2020). SARS-CoV-2 detection in patients with influenza-like illness. Nature Microbiology, 5(5), pp.675-678.
  72. Konno, Y., Kimura, I., Uriu, K., Fukushi, M., Irie, T., and Koyanagi, Y. et al. (2020). SARS-CoV-2 ORF3b Is a Potent Interferon Antagonist Whose Activity Is Increased by a Naturally Occurring Elongation Variant. Cell Reports 32: 108185.
  73. Krumrei-Mancuso, E., Haggard, M., LaBouff, J. and Rowatt, W. (2019). Links between intellectual humility and acquiring knowledge. The Journal of Positive Psychology, 15(2), pp.155-170.
  74. Lamers, M., Beumer, J., van der Vaart, J., Knoops, K., Puschhof, J., Breugem, T., Ravelli, R., Paul van Schayck, J., Mykytyn, A., Duimel, H., van Donselaar, E., Riesebosch, S., Kuijpers, H., Schippers, D., van de Wetering, W., de Graaf, M., Koopmans, M., Cuppen, E., Peters, P., Haagmans, B. and Clevers, H., (2020). SARS-CoV-2 productively infects human gut enterocytesScience, p.eabc1669.
  75. Letko, M., Miazgowicz, K., McMinn, R., Seifert, S., Sola, I., Enjuanes, L., Carmody, A., van Doremalen, N. and Munster, V., (2018). Adaptive Evolution of MERS-CoV to Species Variation in DPP4Cell Reports, 24(7), pp.1730-1737.
  76. Leung, N., Chu, D., Shiu, E., Chan, K., McDevitt, J., Hau, B., Yen, H., Li, Y., Ip, D., Peiris, J., Seto, W., Leung, G., Milton, D. and Cowling, B., (2020). Respiratory virus shedding in exhaled breath and efficacy of face masksNature Medicine,.
  77. Li, Z., Wu, M., Yao, J., Guo, J., Liao, X., Song, S., Li, J., Duan, G., Zhou, Y., Wu, X., Zhou, Z., Wang, T., Hu, M., Chen, X., Fu, Y., Lei, C., Dong, H., Xu, C., Hu, Y., Han, M., Zhou, Y., Jia, H., Chen, X. and Yan, J., (2020). Caution on Kidney Dysfunctions of COVID-19 Patients.
  78. Liu, J., Cao, R., Xu, M., Wang, X., Zhang, H., Hu, H., Li, Y., Hu, Z., Zhong, W. and Wang, M., (2020). Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitroCell Discovery, 6(1).
  79. Liu, Y., Liu, J., Xia, H., Zhang, X., Fontes-Garfias, C., Swanson, K., Cai, H., Sarkar, R., Chen, W., Cutler, M., Cooper, D., Weaver, S., Muik, A., Sahin, U., Jansen, K., Xie, X., Dormitzer, P. and Shi, P., (2021). Neutralizing Activity of BNT162b2-Elicited Serum. New England Journal of Medicine,.
  80. Logunov, D., Dolzhikova, I., Zubkova, O., Tukhvatulin, A., Shcheblyakov, D., and Dzharullaeva, A. et al. (2020). Safety and immunogenicity of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine in two formulations: two open, non-randomised phase 1/2 studies from Russia. The Lancet 396: 887-897.
  81. Logunov, D., Dolzhikova, I., Shcheblyakov, D., Tukhvatulin, A., Zubkova, O., and Dzharullaeva, A. et al. (2021). Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in Russia. The Lancet 397: 671-681.
  82. Loo, K., Letchumanan, V., Ser, H., Teoh, S., Law, J., Tan, L., Ab Mutalib, N., Chan, K. and Lee, L., (2021). COVID-19: Insights into Potential Vaccines. Microorganisms, 9(3), p.605.
  83. Lu, S. (2009). Heterologous prime–boost vaccination. Current Opinion In Immunology 21: 346-351.
  84. Lu, C., Chen, M. and Chang, Y., (2020). Potential therapeutic agents against COVID-19Journal of the Chinese Medical Association, p.1.
  85. Lurie, N., Saville, M., Hatchett, R. and Halton, J., (2020). Developing Covid-19 Vaccines at Pandemic SpeedNew England Journal of Medicine.
  86. Madhi, S., Baillie, V., Cutland, C., Voysey, M., Koen, A., Fairlie, L., Padayachee, S., Dheda, K., Barnabas, S., Bhorat, Q., Briner, C., Kwatra, G., Ahmed, K., Aley, P., Bhikha, S., Bhiman, J., Bhorat, A., du Plessis, J., Esmail, A., Groenewald, M., Horne, E., Hwa, S., Jose, A., Lambe, T., Laubscher, M., Malahleha, M., Masenya, M., Masilela, M., McKenzie, S., Molapo, K., Moultrie, A., Oelofse, S., Patel, F., Pillay, S., Rhead, S., Rodel, H., Rossouw, L., Taoushanis, C., Tegally, H., Thombrayil, A., van Eck, S., Wibmer, C., Durham, N., Kelly, E., Villafana, T., Gilbert, S., Pollard, A., de Oliveira, T., Moore, P., Sigal, A. and Izu, A., (2021). Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant. New England Journal of Medicine,.
  87. Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q., Chang, J., Hong, C., Zhou, Y., Wang, D., Miao, X., Li, Y. and Hu, B., (2020). Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, ChinaJAMA Neurology.
  88. Mahase, E., (2020). Covid-19: what treatments are being investigated?BMJ, p.m1252.
  89. Mahase, E. (2021). Covid-19: UK approves Moderna vaccine to be given as two doses 28 days apart. BMJ n74.
  90. Mahase, E. (2021). How the Oxford-AstraZeneca covid-19 vaccine was made. BMJ n86.
  91. Mahase, E. (2021). Covid-19: Novavax vaccine efficacy is 86% against UK variant and 60% against South African variant. BMJ n296.
  92. Mihai, C., Dobrota, R., Schröder, M., Garaiman, A., Jordan, S., Becker, M., Maurer, B. and Distler, O., (2020). COVID-19 In A Patient With Systemic Sclerosis Treated With Tocilizumab For Ssc-ILD. Annals of Rheumatic Diseases, 79(5).
  93. Miller, A., Reandelar, M., Fasciglione, K., Roumenova, V., Li, Y. and Otazu, G., (2020). Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study.
  94. Moazzen, N., Imani, B., Aelami, M., Motevali, N., Kianifar, H., Khoushkhui, M. and Ahancian, H., (2020). How to boost your immune system against Coronavirus infection?Arch Bone Jt Surg, 8(1).
  95. Moghadas, S., Vilches, T., Zhang, K., Nourbakhsh, S., Sah, P., and Fitzpatrick, M. et al. (2021). Evaluation of COVID-19 vaccination strategies with a delayed second dose.
  96. Moodie, Z., Metch, B., Bekker, L., Churchyard, G., Nchabeleng, M., Mlisana, K., Laher, F., Roux, S., Mngadi, K., Innes, C., Mathebula, M., Allen, M., Bentley, C., Gilbert, P., Robertson, M., Kublin, J., Corey, L. and Gray, G., (2015). Continued Follow-Up of Phambili Phase 2b Randomized HIV-1 Vaccine Trial Participants Supports Increased HIV-1 Acquisition among Vaccinated Men. PLOS ONE, 10(9), p.e0137666.
  97. Moriguchi, T., Harii, N., Goto, J., Harada, D., Sugawara, H., Takamino, J., Ueno, M., Sakata, H., Kondo, K., Myose, N., Nakao, A., Takeda, M., Haro, H., Inoue, O., Suzuki-Inoue, K., Kubokawa, K., Ogihara, S., Sasaki, T., Kinouchi, H., Kojin, H., Ito, M., Onishi, H., Shimizu, T., Sasaki, Y., Enomoto, N., Ishihara, H., Furuya, S., Yamamoto, T. and Shimada, S., (2020). A first case of meningitis/encephalitis associated with SARS-Coronavirus-2International Journal of Infectious Diseases, 94, pp.55-58.
  98. Muik, A., Wallisch, A., Sänger, B., Swanson, K., Mühl, J., Chen, W., Cai, H., Maurus, D., Sarkar, R., Türeci, Ö., Dormitzer, P. and Şahin, U., (2021). Neutralization of SARS-CoV-2 lineage B.1.1.7 pseudovirus by BNT162b2 vaccine–elicited human sera. Science, 371(6534), pp.1152-1153.
  99. Mulligan, M., Lyke, K., Kitchin, N., Absalon, J., Gurtman, A., and Lockhart, S. et al. (2020). Phase I/II study of COVID-19 RNA vaccine BNT162b1 in adults. Nature 586: 589-593.
  100. Muñoz-Fontela, C., Dowling, W., Funnell, S., Gsell, P., Riveros-Balta, A., Albrecht, R., Andersen, H., Baric, R., Carroll, M., Cavaleri, M., Qin, C., Crozier, I., Dallmeier, K., de Waal, L., de Wit, E., Delang, L., Dohm, E., Duprex, W., Falzarano, D., Finch, C., Frieman, M., Graham, B., Gralinski, L., Guilfoyle, K., Haagmans, B., Hamilton, G., Hartman, A., Herfst, S., Kaptein, S., Klimstra, W., Knezevic, I., Krause, P., Kuhn, J., Le Grand, R., Lewis, M., Liu, W., Maisonnasse, P., McElroy, A., Munster, V., Oreshkova, N., Rasmussen, A., Rocha-Pereira, J., Rockx, B., Rodríguez, E., Rogers, T., Salguero, F., Schotsaert, M., Stittelaar, K., Thibaut, H., Tseng, C., Vergara-Alert, J., Beer, M., Brasel, T., Chan, J., García-Sastre, A., Neyts, J., Perlman, S., Reed, D., Richt, J., Roy, C., Segalés, J., Vasan, S., Henao-Restrepo, A. and Barouch, D., (2020). Animal models for COVID-19. Nature, 586(7830), pp.509-515.
  101. Oberemok, V., Laikova, K., Yurchenko, K., Fomochkina, I. and Kubyshkin, A., (2020). SARS-CoV-2 will continue to circulate in the human population: an opinion from the point of view of the virus-host relationship. Inflammation Research,.
  102. Paltiel, A., Schwartz, J., Zheng, A., and Walensky, R. (2021). Clinical Outcomes Of A COVID-19 Vaccine: Implementation Over Efficacy. Health Affairs 40: 42-52.
  103. Parvin, F., Islam, S., Urmy, Z., & Ahmed, S. (2020). THE SYMPTOMS, CONTAGIOUS PROCESS, PREVENTION AND POST TREATMENT OF COVID-19. European Journal of Physiotherapy and Rehabilitation Studies, 0. Retrieved from
  104. Patel SK, Pathak M, Tiwari R, Yatoo MI, Malik YS, Sah R, Rabaan AA, Sharun K, Dhama K, Bonilla-Aldana DK, Rodriguez-Morales AJ. (2020). A vaccine is not too far for COVID-19J Infect Dev Ctries
  105. Patruno, C., Stingeni, L., Fabbrocini, G., Hansel, K. and Napolitano, M., (2020). Dupilumab and COVID ‐19: what should we expect?Dermatologic Therapy,.
  106. Polack, F., Thomas, S., Kitchin, N., Absalon, J., Gurtman, A., and Lockhart, S. et al. (2020). Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. New England Journal Of Medicine 383: 2603-2615.
  107. Porter, T. and Schumann, K. (2017). Intellectual humility and openness to the opposing view. Self and Identity, 17(2), pp.139-162.
  108. Robbiani, D., Gaebler, C., Muecksch, F., Lorenzi, J., Wang, Z., and Cho, A. et al. (2020). Convergent antibody responses to SARS-CoV-2 in convalescent individuals. Nature 584: 437-442.
  109. Robertson, J., Sewell, H., and Stewart, M. (2021). Delayed second dose of the BNT162b2 vaccine: innovation or misguided conjecture?. The Lancet 397: 879-880.
  110. Rosen, B., Waitzberg, R. and Israeli, A., (2021). Israel’s rapid rollout of vaccinations for COVID-19. Israel Journal of Health Policy Research, 10(1).
  111. Rosenbloom, D. and Markard, J., (2020). A COVID-19 recovery for climateScience, 368(6490), pp.447-447.
  112. Rostad, C. and Anderson, E., (2021). Optimism and caution for an inactivated COVID-19 vaccine. The Lancet Infectious Diseases,.
  113. SaifAddin, B., Almogbel, A., Zollner, C., Wu, F., Bonef, B., Iza, M., Nakamura, S., DenBaars, S. and Speck, J., (2020). AlGaN Deep-Ultraviolet Light-Emitting Diodes Grown on SiC SubstratesACS Photonics, 7(3), pp.554-561.
  114. Sallam, M. (2021). COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates. Vaccines 9: 160.
  115. Santos, I., Grosche, V., Sabino-Silva, R. and Jardim, A., (2020). Antivirals against human and animal Coronaviruses: different approach in SARS-CoV-2 treatment.
  116. Schleicher, G., Lowman, W. and Richards, G., (2020). Case Study: A Patient with Asthma, Covid-19 Pneumonia and Cytokine Release Syndrome Treated with Corticosteroids and TocilizumabWits Journal of Clinical Medicine, 2(SI), p.47.
  117. Schrack, J., Wanigatunga, A. and Juraschek, S., (2020). After the COVID-19 Pandemic: The Next Wave of Health Challenges for Older AdultsThe Journals of Gerontology: Series A,.
  118. Shenker, N., Aprigio, J., Arslanoglu, S., Aye, N., Bærug, A., Bar Yam, N., Barnett, D., Bellad, R., Bertino, E., Bethou, A., Bharadva, K., Olin, A., Billeaud, C., Buffin, R., Cassidy, T., Chugh Sachdeva, R., Clifford, V., Coutsoudis, A., Deb, S., Domjan, A., Fang, L., Festival, J., Franks, A., Garcia-Lara, N., Gaya, A., Golubiú-Úepuliú, B., Groff, L., Grøvslien, A., Hamilton Spence, E., Heidarzadeh, M., Hosseini, M., Hughes, J., Israel-Ballard, K., Jain, K., Jain, S., Jayaraman, S., Jones, F., Kale, P., Kasar, J., Kithua, A., Klein, L., Klotz, D., Lin, Y., Liu, X., Lockhart Borman, L., Lundstrom, J., Malzacher, A., Mansen, K., Mathisen, R., Mileusnic-Milenovic, R., Moe, Z., Moro, G., Mukherjee, S., Myint, S., Nangia, S., Ngerncham, S., Njeru, F., Olonan-Jusi, E., Opie, G., Palmquist, A., Reimers, P., Saboute, M., Sakamoto, P., Sanchez, S., Shenker, N., Singh, H., Singh, J., Singh, P., Staff, M., Sulfaro, C., Thi Hoang, T., Tiit-Vesingi, A., Tiwari, S., van Goudoever, J., Vickers, A., Waiyego, M., Weaver, G., Wesolowska, A. and Wright, J., (2020). Maintaining safety and service provision in human milk banking: a call to action in response to the COVID-19 pandemicThe Lancet Child & Adolescent Health,.
  119. Shi, J., Wen, Z., Zhong, G., Yang, H., Wang, C., Huang, B., Liu, R., He, X., Shuai, L., Sun, Z., Zhao, Y., Liu, P., Liang, L., Cui, P., Wang, J., Zhang, X., Guan, Y., Tan, W., Wu, G., Chen, H. and Bu, Z., (2020). Susceptibility of ferrets, cats, dogs, and other domesticated animals to SARS–coronavirus 2Science, p.eabb7015.
  120. Shi, S., Qin, M., Shen, B., Cai, Y., Liu, T., Yang, F., Gong, W., Liu, X., Liang, J., Zhao, Q., Huang, H., Yang, B. and Huang, C., (2020). Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, ChinaJAMA Cardiology,.
  121. Sigfrid, L., Drake, T., Pauley, E., Jesudason, E., Olliaro, P., Lim, W., Gillesen, A., Berry, C., Lowe, D., McPeake, J., Lone, N., Cevik, M., Munblit, D., Casey, A., Bannister, P., Russell, C., Goodwin, L., Ho, A., Turtle, L., O’Hara, M., Hastie, C., Donohue, C., Spencer, R., Harrison, J., Donegan, C., Gummery, A., Hardwick, H., Hastie, C., Merson, L., Carson, G., Kenneth Baillie, J., Openshaw, P., Harrison, E., Docherty, A., Semple, M. and Scott, J., (2021). Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol.
  122. Srivastava, N. and Saxena, S., (2020). Prevention and Control Strategies for SARS-CoV-2 InfectionMedical Virology: From Pathogenesis to Disease Control, pp.127-140.
  123. Stadnytskyi, V., Bax, C., Bax, A. and Anfinrud, P., (2020). The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmissionProceedings of the National Academy of Sciences, p.202006874.
  124. Sun, P., Lu, X., Xu, C., Sun, W. and Pan, B., (2020). Understanding of COVID‐19 based on current evidenceJournal of Medical Virology.
  125. Tada, T., Dcosta, B., Samanovic-Golden, M., Herati, R., Cornelius, A., Mulligan, M. and Landau, N., (2021). Neutralization of viruses with European, South African, and United States SARS-CoV-2 variant spike proteins by convalescent sera and BNT162b2 mRNA vaccine-elicited antibodies.
  126. Taipale, J., Romer, P. and Linnarsson, S., (2020). Population-scale testing can suppress the spread of COVID-19.
  127. Thiagarajan, K. (2021). Covid-19: India is at centre of global vaccine manufacturing, but opacity threatens public trust. BMJ n196.
  128. Thorp, H., (2020). Do us a favorScience, 367(6483), pp.1169-1169.
  129. Thorp, H., (2020). Time to pull togetherScience, 367(6484), pp.1282-1282.
  130. Tinari, S., (2021). The EMA covid-19 data leak, and what it tells us about mRNA instability. BMJ, p.n627.
  131. Torjesen, I. (2021). Covid-19: First doses of vaccines in Scotland led to a substantial fall in hospital admissions. BMJ n523.
  132. van Kraaij, T., Mostard, R., Ramiro, S., Magro Checa, C., van Dongen, C., van Haren, E., Buijs, J., & Landewé, R. (2020). Tocilizumab in Severe COVID-19 Pneumonia and Concomitant Cytokine Release SyndromeEuropean Journal of Case Reports in Internal Medicine, 2.
  133. Vidyasagar, V. and Nithish, C., (2020). Convalescentplasma as potential therapy for recently emerged novel CoVID-19EPRA International Journal of Research & Development (IJRD), 5(4).
  134. Voysey, M., Clemens, S., Madhi, S., Weckx, L., Folegatti, P., Aley, P., Angus, B., Baillie, V., Barnabas, S., Bhorat, Q., Bibi, S., Briner, C., Cicconi, P., Collins, A., Colin-Jones, R., Cutland, C., Darton, T., Dheda, K., Duncan, C., Emary, K., Ewer, K., Fairlie, L., Faust, S., Feng, S., Ferreira, D., Finn, A., Goodman, A., Green, C., Green, C., Heath, P., Hill, C., Hill, H., Hirsch, I., Hodgson, S., Izu, A., Jackson, S., Jenkin, D., Joe, C., Kerridge, S., Koen, A., Kwatra, G., Lazarus, R., Lawrie, A., Lelliott, A., Libri, V., Lillie, P., Mallory, R., Mendes, A., Milan, E., Minassian, A., McGregor, A., Morrison, H., Mujadidi, Y., Nana, A., O’Reilly, P., Padayachee, S., Pittella, A., Plested, E., Pollock, K., Ramasamy, M., Rhead, S., Schwarzbold, A., Singh, N., Smith, A., Song, R., Snape, M., Sprinz, E., Sutherland, R., Tarrant, R., Thomson, E., Török, M., Toshner, M., Turner, D., Vekemans, J., Villafana, T., Watson, M., Williams, C., Douglas, A., Hill, A., Lambe, T., Gilbert, S., Pollard, A., Aban, M., Abayomi, F., Abeyskera, K., Aboagye, J., Adam, M., Adams, K., Adamson, J., Adelaja, Y., Adewetan, G., Adlou, S., Ahmed, K., Akhalwaya, Y., Akhalwaya, S., Alcock, A., Ali, A., Allen, E., Allen, L., Almeida, T., Alves, M., Amorim, F., Andritsou, F., Anslow, R., Appleby, M., Arbe-Barnes, E., Ariaans, M., Arns, B., Arruda, L., Azi, P., Azi, L., Babbage, G., Bailey, C., Baker, K., Baker, M., Baker, N., Baker, P., Baldwin, L., Baleanu, I., Bandeira, D., Bara, A., Barbosa, M., Barker, D., Barlow, G., Barnes, E., Barr, A., Barrett, J., Barrett, J., Bates, L., Batten, A., Beadon, K., Beales, E., Beckley, R., Belij-Rammerstorfer, S., Bell, J., Bellamy, D., Bellei, N., Belton, S., Berg, A., Bermejo, L., Berrie, E., Berry, L., Berzenyi, D., Beveridge, A., Bewley, K., Bexhell, H., Bhikha, S., Bhorat, A., Bhorat, Z., Bijker, E., Birch, G., Birch, S., Bird, A., Bird, O., Bisnauthsing, K., Bittaye, M., Blackstone, K., Blackwell, L., Bletchly, H., Blundell, C., Blundell, S., Bodalia, P., Boettger, B., Bolam, E., Boland, E., Bormans, D., Borthwick, N., Bowring, F., Boyd, A., Bradley, P., Brenner, T., Brown, P., Brown, C., Brown-O’Sullivan, C., Bruce, S., Brunt, E., Buchan, R., Budd, W., Bulbulia, Y., Bull, M., Burbage, J., Burhan, H., Burn, A., Buttigieg, K., Byard, N., Cabera Puig, I., Calderon, G., Calvert, A., Camara, S., Cao, M., Cappuccini, F., Cardoso, J., Carr, M., Carroll, M., Carson-Stevens, A., Carvalho, Y., Carvalho, J., Casey, H., Cashen, P., Castro, T., Castro, L., Cathie, K., Cavey, A., Cerbino-Neto, J., Chadwick, J., Chapman, D., Charlton, S., Chelysheva, I., Chester, O., Chita, S., Cho, J., Cifuentes, L., Clark, E., Clark, M., Clarke, A., Clutterbuck, E., Collins, S., Conlon, C., Connarty, S., Coombes, N., Cooper, C., Cooper, R., Cornelissen, L., Corrah, T., Cosgrove, C., Cox, T., Crocker, W., Crosbie, S., Cullen, L., Cullen, D., Cunha, D., Cunningham, C., Cuthbertson, F., Da Guarda, S., da Silva, L., Damratoski, B., Danos, Z., Dantas, M., Darroch, P., Datoo, M., Datta, C., Davids, M., Davies, S., Davies, H., Davis, E., Davis, J., Davis, J., De Nobrega, M., De Oliveira Kalid, L., Dearlove, D., Demissie, T., Desai, A., Di Marco, S., Di Maso, C., Dinelli, M., Dinesh, T., Docksey, C., Dold, C., Dong, T., Donnellan, F., Dos Santos, T., dos Santos, T., Dos Santos, E., Douglas, N., Downing, C., Drake, J., Drake-Brockman, R., Driver, K., Drury, R., Dunachie, S., Durham, B., Dutra, L., Easom, N., van Eck, S., Edwards, M., Edwards, N., El Muhanna, O., Elias, S., Elmore, M., English, M., Esmail, A., Essack, Y., Farmer, E., Farooq, M., Farrar, M., Farrugia, L., Faulkner, B., Fedosyuk, S., Felle, S., Feng, S., Ferreira Da Silva, C., Field, S., Fisher, R., Flaxman, A., Fletcher, J., Fofie, H., Fok, H., Ford, K., Fowler, J., Fraiman, P., Francis, E., Franco, M., Frater, J., Freire, M., Fry, S., Fudge, S., Furze, J., Fuskova, M., Galian-Rubio, P., Galiza, E., Garlant, H., Gavrila, M., Geddes, A., Gibbons, K., Gilbride, C., Gill, H., Glynn, S., Godwin, K., Gokani, K., Goldoni, U., Goncalves, M., Gonzalez, I., Goodwin, J., Goondiwala, A., Gordon-Quayle, K., Gorini, G., Grab, J., Gracie, L., Greenland, M., Greenwood, N., Greffrath, J., Groenewald, M., Grossi, L., Gupta, G., Hackett, M., Hallis, B., Hamaluba, M., Hamilton, E., Hamlyn, J., Hammersley, D., Hanrath, A., Hanumunthadu, B., Harris, S., Harris, C., Harris, T., Harrison, T., Harrison, D., Hart, T., Hartnell, B., Hassan, S., Haughney, J., Hawkins, S., Hay, J., Head, I., Henry, J., Hermosin Herrera, M., Hettle, D., Hill, J., Hodges, G., Horne, E., Hou, M., Houlihan, C., Howe, E., Howell, N., Humphreys, J., Humphries, H., Hurley, K., Huson, C., Hyder-Wright, A., Hyams, C., Ikram, S., Ishwarbhai, A., Ivan, M., Iveson, P., Iyer, V., Jackson, F., De Jager, J., Jaumdally, S., Jeffers, H., Jesudason, N., Jones, B., Jones, K., Jones, E., Jones, C., Jorge, M., Jose, A., Joshi, A., Júnior, E., Kadziola, J., Kailath, R., Kana, F., Karampatsas, K., Kasanyinga, M., Keen, J., Kelly, E., Kelly, D., Kelly, D., Kelly, S., Kerr, D., Kfouri, R., Khan, L., Khozoee, B., Kidd, S., Killen, A., Kinch, J., Kinch, P., King, L., King, T., Kingham, L., Klenerman, P., Knapper, F., Knight, J., Knott, D., Koleva, S., Lang, M., Lang, G., Larkworthy, C., Larwood, J., Law, R., Lazarus, E., Leach, A., Lees, E., Lemm, N., Lessa, A., Leung, S., Li, Y., Lias, A., Liatsikos, K., Linder, A., Lipworth, S., Liu, S., Liu, X., Lloyd, A., Lloyd, S., Loew, L., Lopez Ramon, R., Lora, L., Lowthorpe, V., Luz, K., MacDonald, J., MacGregor, G., Madhavan, M., Mainwaring, D., Makambwa, E., Makinson, R., Malahleha, M., Malamatsho, R., Mallett, G., Mansatta, K., Maoko, T., Mapetla, K., Marchevsky, N., Marinou, S., Marlow, E., Marques, G., Marriott, P., Marshall, R., Marshall, J., Martins, F., Masenya, M., Masilela, M., Masters, S., Mathew, M., Matlebjane, H., Matshidiso, K., Mazur, O., Mazzella, A., McCaughan, H., McEwan, J., McGlashan, J., McInroy, L., McIntyre, Z., McLenaghan, D., McRobert, N., McSwiggan, S., Megson, C., Mehdipour, S., Meijs, W., Mendonça, R., Mentzer, A., Mirtorabi, N., Mitton, C., Mnyakeni, S., Moghaddas, F., Molapo, K., Moloi, M., Moore, M., Moraes-Pinto, M., Moran, M., Morey, E., Morgans, R., Morris, S., Morris, S., Morris, H., Morselli, F., Morshead, G., Morter, R., Mottal, L., Moultrie, A., Moya, N., Mpelembue, M., Msomi, S., Mugodi, Y., Mukhopadhyay, E., Muller, J., Munro, A., Munro, C., Murphy, S., Mweu, P., Myasaki, C., Naik, G., Naker, K., Nastouli, E., Nazir, A., Ndlovu, B., Neffa, F., Njenga, C., Noal, H., Noé, A., Novaes, G., Nugent, F., Nunes, G., O’Brien, K., O’Connor, D., Odam, M., Oelofse, S., Oguti, B., Olchawski, V., Oldfield, N., Oliveira, M., Oliveira, C., Oosthuizen, A., O’Reilly, P., Osborne, P., Owen, D., Owen, L., Owens, D., Owino, N., Pacurar, M., Paiva, B., Palhares, E., Palmer, S., Parkinson, S., Parracho, H., Parsons, K., Patel, D., Patel, B., Patel, F., Patel, K., Patrick-Smith, M., Payne, R., Peng, Y., Penn, E., Pennington, A., Peralta Alvarez, M., Perring, J., Perry, N., Perumal, R., Petkar, S., Philip, T., Phillips, D., Phillips, J., Phohu, M., Pickup, L., Pieterse, S., Piper, J., Pipini, D., Plank, M., Du Plessis, J., Pollard, S., Pooley, J., Pooran, A., Poulton, I., Powers, C., Presa, F., Price, D., Price, V., Primeira, M., Proud, P., Provstgaard-Morys, S., Pueschel, S., Pulido, D., Quaid, S., Rabara, R., Radford, A., Radia, K., Rajapaska, D., Rajeswaran, T., Ramos, A., Ramos Lopez, F., Rampling, T., Rand, J., Ratcliffe, H., Rawlinson, T., Rea, D., Rees, B., Reiné, J., Resuello-Dauti, M., Reyes Pabon, E., Ribiero, C., Ricamara, M., Richter, A., Ritchie, N., Ritchie, A., Robbins, A., Roberts, H., Robinson, R., Robinson, H., Rocchetti, T., Rocha, B., Roche, S., Rollier, C., Rose, L., Ross Russell, A., Rossouw, L., Royal, S., Rudiansyah, I., Ruiz, S., Saich, S., Sala, C., Sale, J., Salman, A., Salvador, N., Salvador, S., Sampaio, M., Samson, A., Sanchez-Gonzalez, A., Sanders, H., Sanders, K., Santos, E., Santos Guerra, M., Satti, I., Saunders, J., Saunders, C., Sayed, A., Schim van der Loeff, I., Schmid, A., Schofield, E., Screaton, G., Seddiqi, S., Segireddy, R., Senger, R., Serrano, S., Shah, R., Shaik, I., Sharpe, H., Sharrocks, K., Shaw, R., Shea, A., Shepherd, A., Shepherd, J., Shiham, F., Sidhom, E., Silk, S., da Silva Moraes, A., Silva-Junior, G., Silva-Reyes, L., Silveira, A., Silveira, M., Sinha, J., Skelly, D., Smith, D., Smith, N., Smith, H., Smith, D., Smith, C., Soares, A., Soares, T., Solórzano, C., Sorio, G., Sorley, K., Sosa-Rodriguez, T., Souza, C., Souza, B., Souza, A., Spencer, A., Spina, F., Spoors, L., Stafford, L., Stamford, I., Starinskij, I., Stein, R., Steven, J., Stockdale, L., Stockwell, L., Strickland, L., Stuart, A., Sturdy, A., Sutton, N., Szigeti, A., Tahiri-Alaoui, A., Tanner, R., Taoushanis, C., Tarr, A., Taylor, K., Taylor, U., Taylor, I., Taylor, J., te Water Naude, R., Themistocleous, Y., Themistocleous, A., Thomas, M., Thomas, K., Thomas, T., Thombrayil, A., Thompson, F., Thompson, A., Thompson, K., Thompson, A., Thomson, J., Thornton-Jones, V., Tighe, P., Tinoco, L., Tiongson, G., Tladinyane, B., Tomasicchio, M., Tomic, A., Tonks, S., Towner, J., Tran, N., Tree, J., Trillana, G., Trinham, C., Trivett, R., Truby, A., Tsheko, B., Turabi, A., Turner, R., Turner, C., Ulaszewska, M., Underwood, B., Varughese, R., Verbart, D., Verheul, M., Vichos, I., Vieira, T., Waddington, C., Walker, L., Wallis, E., Wand, M., Warbick, D., Wardell, T., Warimwe, G., Warren, S., Watkins, B., Watson, E., Webb, S., Webb-Bridges, A., Webster, A., Welch, J., Wells, J., West, A., White, C., White, R., Williams, P., Williams, R., Winslow, R., Woodyer, M., Worth, A., Wright, D., Wroblewska, M., Yao, A., Zimmer, R., Zizi, D. and Zuidewind, P., (2021). Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. The Lancet, 397(10269), pp.99-111.
  135. Voysey, M., Costa Clemens, S., Madhi, S., Weckx, L., Folegatti, P., Aley, P., Angus, B., Baillie, V., Barnabas, S., Bhorat, Q., Bibi, S., Briner, C., Cicconi, P., Clutterbuck, E., Collins, A., Cutland, C., Darton, T., Dheda, K., Dold, C., Duncan, C., Emary, K., Ewer, K., Flaxman, A., Fairlie, L., Faust, S., Feng, S., Ferreira, D., Finn, A., Galiza, E., Goodman, A., Green, C., Green, C., Greenland, M., Hill, C., Hill, H., Hirsch, I., Izu, A., Jenkin, D., Joe, C., Kerridge, S., Koen, A., Kwatra, G., Lazarus, R., Libri, V., Lillie, P., Marchevsky, N., Marshall, R., Mendes, A., Milan, E., Minassian, A., McGregor, A., Mujadidi, Y., Nana, A., Padayachee, S., Phillips, D., Pittella, A., Plested, E., Pollock, K., Ramasamy, M., Ritchie, A., Robinson, H., Schwarzbold, A., Smith, A., Song, R., Snape, M., Sprinz, E., Sutherland, R., Thomson, E., Török, M., Toshner, M., Turner, D., Vekemans, J., Villafana, T., White, T., Williams, C., Douglas, A., Hill, A., Lambe, T., Gilbert, S., Pollard, A., Aban, M., Abeyskera, K., Aboagye, J., Adam, M., Adams, K., Adamson, J., Adewatan, G., Adlou, S., Ahmed, K., Akhalwaya, Y., Akhalwaya, S., Alcock, A., Ali, A., Allen, E., Allen, L., Alvernaz, F., Amorim, F., Andrade, C., Andritsou, F., Anslow, R., Arbe-Barnes, E., Ariaans, M., Arns, B., Arruda, L., Assad, L., Azi, P., Azi, L., Babbage, G., Bailey, C., Baker, K., Baker, M., Baker, N., Baker, P., Baleanu, I., Bandeira, D., Bara, A., Barbosa, M., Barker, D., Barlow, G., Barnes, E., Barr, A., Barrett, J., Barrett, J., Barrett, K., Bates, L., Batten, A., Beadon, K., Beales, E., Beckley, R., Belij-Rammerstorfer, S., Bell, J., Bellamy, D., Belton, S., Berg, A., Bermejo, L., Berrie, E., Berry, L., Berzenyi, D., Beveridge, A., Bewley, K., Bharaj, I., Bhikha, S., Bhorat, A., Bhorat, Z., Bijker, E., Birch, S., Birch, G., Birchall, K., Bird, A., Bird, O., Bisnauthsing, K., Bittaye, M., Blackwell, L., Blacow, R., Bletchly, H., Blundell, C., Blundell, S., Bodalia, P., Bolam, E., Boland, E., Bormans, D., Borthwick, N., Bowring, F., Boyd, A., Bradley, P., Brenner, T., Bridges-Webb, A., Brown, P., Brown, C., Brown-O’Sullivan, C., Bruce, S., Brunt, E., Budd, W., Bulbulia, Y., Bull, M., Burbage, J., Burn, A., Buttigieg, K., Byard, N., Cabrera Puig, I., Calvert, A., Camara, S., Cao, M., Cappuccini, F., Cardona, R., Cardoso, J., Carr, M., Carroll, M., Carson-Stevens, A., Carvalho, Y., Casey, H., Cashen, P., Castro, T., Castro, L., Cathie, K., Cavey, A., Cerbino-Neto, J., Cezar, L., Chadwick, J., Chanice, C., Chapman, D., Charlton, S., Cheliotis, K., Chelysheva, I., Chester, O., Chiplin, E., Chita, S., Cho, J., Cifuentes, L., Clark, E., Clark, M., Colin-Jones, R., Collins, S., Colton, H., Conlon, C., Connarty, S., Coombes, N., Cooper, C., Cooper, R., Cornelissen, L., Corrah, T., Cosgrove, C., Costa, F., Cox, T., Crocker, W., Crosbie, S., Cullen, D., Cunha, D., Cunningham, C., Cuthbertson, F., da Costa, D., Da Guarda, S., da Silva, L., da Silva Moraes, A., Damratoski, B., Danos, Z., Dantas, M., Datoo, M., Datta, C., Davids, M., Davies, S., Davies, K., Davies, H., Davies, S., Davies, J., Davis, E., Davis, J., de Carvalho, J., De Jager, J., de Jesus Jnr, S., De Oliveira Kalid, L., Dearlove, D., Demissie, T., Desai, A., Di Marco, S., Di Maso, C., Dinesh, T., Docksey, C., Dong, T., Donnellan, F., Dos Santos, T., Dos Santos, T., Dos Santos, E., Douglas, N., Downing, C., Drake, J., Drake-Brockman, R., Drury, R., Du Plessis, J., Dunachie, S., Duncan, A., Easom, N., Edwards, M., Edwards, N., Edwards, F., El Muhanna, O., Elias, S., Ellison-Handley, B., Elmore, M., English, M., Esmail, A., Essack, Y., Farooq, M., Fedosyuk, S., Felle, S., Ferguson, S., Ferreira Da Silva, C., Field, S., Fisher, R., Fletcher, J., Fofie, H., Fok, H., Ford, K., Fothergill, R., Fowler, J., Fraiman, P., Francis, E., Franco, M., Frater, J., Freire, M., Fry, S., Fudge, S., Furlan Filho, R., Furze, J., Fuskova, M., Galian-Rubio, P., Garlant, H., Gavrila, M., Gibbons, K., Gilbride, C., Gill, H., Godwin, K., Gokani, K., Gonçalves, M., Gonzalez, I., Goodall, J., Goodwin, J., Goondiwala, A., Gordon-Quayle, K., Gorini, G., Goyanna, A., Grab, J., Gracie, L., Green, J., Greenwood, N., Greffrath, J., Groenewald, M., Gunawardene, A., Gupta, G., Hackett, M., Hallis, B., Hamaluba, M., Hamilton, E., Hamlyn, J., Hammersley, D., Hanrath, A., Hanumunthadu, B., Harris, S., Harris, C., Harrison, T., Harrison, D., Harris-Wright, T., Hart, T., Hartnell, B., Haughney, J., Hawkins, S., Hayano, L., Head, I., Heath, P., Henry, J., Hermosin Herrera, M., Hettle, D., Higa, C., Hill, J., Hodges, G., Hodgson, S., Horne, E., Hou, M., Houlihan, C., Howe, E., Howell, N., Humphreys, J., Humphries, H., Hurley, K., Huson, C., Hyams, C., Hyder-Wright, A., Ikram, S., Ishwarbhai, A., Iveson, P., Iyer, V., Jackson, F., Jackson, S., Jaumdally, S., Jeffers, H., Jesudason, N., Jones, C., Jones, C., Jones, K., Jones, E., Jorge, M., Joshi, A., Júnior, E., Kailath, R., Kana, F., Kar, A., Karampatsas, K., Kasanyinga, M., Kay, L., Keen, J., Kellett Wright, J., Kelly, E., Kelly, D., Kelly, D., Kelly, S., Kerr, D., Khan, L., Khozoee, B., Khurana, A., Kidd, S., Killen, A., Kinch, J., Kinch, P., King, L., King, T., Kingham, L., Klenerman, P., Kluczna, D., Knapper, F., Knight, J., Knott, D., Koleva, S., Lages, P., Lang, M., Lang, G., Larkworthy, C., Larwood, J., Law, R., Lawrie, A., Lazarus, E., Leach, A., Lees, E., Lelliott, A., Lemm, N., Lessa, A., Leung, S., Li, Y., Lias, A., Liatsikos, K., Linder, A., Lipworth, S., Liu, S., Liu, X., Lloyd, A., Lloyd, S., Loew, L., Lopez Ramon, R., Lora, L., Luz, K., MacDonald, J., MacGregor, G., Madhavan, M., Mainwaring, D., Makambwa, E., Makinson, R., Malahleha, M., Malamatsho, R., Mallett, G., Manning, N., Mansatta, K., Maoko, T., Marinou, S., Marlow, E., Marques, G., Marriott, P., Marshall, R., Marshall, J., Masenya, M., Masilela, M., Masters, S., Mathew, M., Matlebjane, H., Matshidiso, K., Mazur, O., Mazzella, A., McCaughan, H., McEwan, J., McGlashan, J., McInroy, L., McRobert, N., McSwiggan, S., Megson, C., Mehdipour, S., Meijs, W., Mendonça, R., Mentzer, A., Mesquita, A., Miralhes, P., Mirtorabi, N., Mitton, C., Mnyakeni, S., Moghaddas, F., Molapo, K., Moloi, M., Moore, M., Moran, M., Morey, E., Morgans, R., Morris, S., Morris, S., Morrison, H., Morselli, F., Morshead, G., Morter, R., Mottay, L., Moultrie, A., Moyo, N., Mpelembue, M., Msomi, S., Mugodi, Y., Mukhopadhyay, E., Muller, J., Munro, A., Murphy, S., Mweu, P., Myerscough, C., Naik, G., Naker, K., Nastouli, E., Ndlovu, B., Nikolaou, E., Njenga, C., Noal, H., Noé, A., Novaes, G., Nugent, F., Nunes, G., O’Brien, K., O’Connor, D., Oelofse, S., Oguti, B., Olchawski, V., Oldfield, N., Oliveira, M., Oliveira, C., Oliveira, I., Oommen-Jose, A., Oosthuizen, A., O’Reilly, P., O’Reilly, P., Osborne, P., Owen, D., Owen, L., Owens, D., Owino, N., Pacurar, M., Paiva, B., Palhares, E., Palmer, S., Parracho, H., Parsons, K., Patel, D., Patel, B., Patel, F., Patrick-Smith, M., Payne, R., Peng, Y., Penn, E., Pennington, A., Peralta Alvarez, M., Pereira Stuchi, B., Perez, A., Perinpanathan, T., Perring, J., Perumal, R., Petkar, S., Philip, T., Phillips, J., Phohu, M., Pickup, L., Pieterse, S., Pinheiro, J., Piper, J., Pipini, D., Plank, M., Plant, S., Pollard, S., Pooley, J., Pooran, A., Poulton, I., Powers, C., Presa, F., Price, D., Price, V., Primeira, M., Proud, P., Provstgaard-Morys, S., Pueschel, S., Pulido, D., Quaid, S., Rabara, R., Radia, K., Rajapaska, D., Rajeswaran, T., Ramos, L., Ramos, A., Ramos Lopez, F., Rampling, T., Rand, J., Ratcliffe, H., Rawlinson, T., Rea, D., Rees, B., Resuello-Dauti, M., Reyes Pabon, E., Rhead, S., Riaz, T., Ricamara, M., Richards, A., Richter, A., Ritchie, N., Ritchie, A., Robbins, A., Roberts, H., Robinson, R., Roche, S., Rollier, C., Rose, L., Ross Russell, A., Rossouw, L., Royal, S., Rudiansyah, I., Ryalls, K., Sabine, C., Saich, S., Sale, J., Salman, A., Salvador, N., Salvador, S., Sampaio, M., Samson, A., Sanchez-Gonzalez, A., Sanders, H., Sanders, K., Santos, E., Santos Guerra, M., Satti, I., Saunders, J., Saunders, C., Sayed, A., Schim van der Loeff, I., Schmid, A., Schofield, E., Screaton, G., Seddiqi, S., Segireddy, R., Senger, R., Serrano, S., Shaik, I., Sharpe, H., Sharrocks, K., Shaw, R., Shea, A., Sheehan, E., Shepherd, A., Shiham, F., Silk, S., Silva-Reyes, L., Silveira, L., Silveira, M., Singh, N., Sinha, J., Skelly, D., Smith, D., Smith, N., Smith, H., Smith, D., Smith, C., Soares, A., Solórzano, C., Sorio, G., Sorley, K., Sosa-Rodriguez, T., Souza, C., Souza, B., Souza, A., Souza Lopez, T., Sowole, L., Spencer, A., Spoors, L., Stafford, L., Stamford, I., Stein, R., Stockdale, L., Stockwell, L., Strickland, L., Stuart, A., Sturdy, A., Sutton, N., Szigeti, A., Tahiri-Alaoui, A., Tanner, R., Taoushanis, C., Tarr, A., Tarrant, R., Taylor, K., Taylor, U., Taylor, I., Taylor, J., te Water Naude, R., Templeton, K., Themistocleous, Y., Themistocleous, A., Thomas, M., Thomas, K., Thomas, T., Thombrayil, A., Thompson, J., Thompson, F., Thompson, A., Thompson, A., Thompson, K., Thornton-Jones, V., Thotusi, L., Tighe, P., Tinoco, L., Tiongson, G., Tladinyane, B., Tomasicchio, M., Tomic, A., Tonks, S., Towner, J., Tran, N., Tree, J., Trillana, G., Trinham, C., Trivett, R., Truby, A., Tsheko, B., Tubb, P., Turabi, A., Turner, R., Turner, C., Turner, N., Tyagi, B., Ulaszewska, M., Underwood, B., van Eck, S., Varughese, R., Verbart, D., Verheul, M., Vichos, I., Vieira, T., Walker, G., Walker, L., Wand, M., Wardell, T., Warimwe, G., Warren, S., Watkins, B., Watson, M., Watson, E., Webb, S., Webster, A., Welch, J., Wellbelove, Z., Wells, J., West, A., White, B., White, C., White, R., Williams, P., Williams, R., Willingham, S., Winslow, R., Woods, D., Woodyer, M., Worth, A., Wright, D., Wroblewska, M., Yao, A., Yim, Y., Zambrano, M., Zimmer, R., Zizi, D. and Zuidewind, P., (2021). Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised trials. The Lancet, 397(10277), pp.881-891.
  136. Wadman, M., (2020). How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toesScience,.
  137. Walsh, E., Frenck, R., Falsey, A., Kitchin, N., Absalon, J., and Gurtman, A. et al. (2020). Safety and Immunogenicity of Two RNA-Based Covid-19 Vaccine Candidates. New England Journal Of Medicine 383: 2439-2450.
  138. Wang, C., Li, W., Drabek, D., Okba, N., van Haperen, R., Osterhaus, A., van Kuppeveld, F., Haagmans, B., Grosveld, F. and Bosch, B., (2020). A human monoclonal antibody blocking SARS-CoV-2 infectionNature Communications, 11(1).
  139. Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y., Zhao, Y., Li, Y., Wang, X. and Peng, Z., (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, ChinaJAMA, 323(11), p.1061.
  140. Wang, M., Cao, R., Zhang, L., Yang, X., Liu, J., Xu, M., Shi, Z., Hu, Z., Zhong, W. and Xiao, G., (2020). Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitroCell Research, 30(3), pp.269-271.
  141. Wang, Z., Schmidt, F., Weisblum, Y., Muecksch, F., Barnes, C., Finkin, S., Schaefer-Babajew, D., Cipolla, M., Gaebler, C., Lieberman, J., Oliveira, T., Yang, Z., Abernathy, M., Huey-Tubman, K., Hurley, A., Turroja, M., West, K., Gordon, K., Millard, K., Ramos, V., Da Silva, J., Xu, J., Colbert, R., Patel, R., Dizon, J., Unson-O’Brien, C., Shimeliovich, I., Gazumyan, A., Caskey, M., Bjorkman, P., Casellas, R., Hatziioannou, T., Bieniasz, P. and Nussenzweig, M., (2021). mRNA vaccine-elicited antibodies to SARS-CoV-2 and circulating variants. Nature,.
  142. Wichmann, D., Sperhake, J., Lütgehetmann, M., Steurer, S., Edler, C., and Heinemann, A. et al. (2020). Autopsy Findings and Venous Thromboembolism in Patients With COVID-19. Annals Of Internal Medicine 173: 268-277.
  143. Widge, A., Rouphael, N., Jackson, L., Anderson, E., Roberts, P., and Makhene, M. et al. (2021). Durability of Responses after SARS-CoV-2 mRNA-1273 Vaccination. New England Journal Of Medicine 384: 80-82.
  144. Williamson, E., Walker, A., Bhaskaran, K., Bacon, S., Bates, C., Morton, C., Curtis, H., Mehrkar, A., Evans, D., Inglesby, P., Cockburn, J., Mcdonald, H., MacKenna, B., Tomlinson, L., Douglas, I., Rentsch, C., Mathur, R., Wong, A., Grieve, R., Harrison, D., Forbes, H., Schultze, A., Croker, R., Parry, J., Hester, F., Harper, S., Perera, R., Evans, S., Smeeth, L. and Goldacre, B., (2020). OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients.
  145. Wise, J. (2021). Covid-19: New data on Oxford AstraZeneca vaccine backs 12 week dosing interval. BMJ n326.
  146. Wise, J. (2021). Covid-19: Pfizer BioNTech vaccine reduced cases by 94% in Israel, shows peer reviewed study. BMJ n567.
  147. Wu, K., Werner, A., Moliva, J., Koch, M., Choi, A., Stewart-Jones, G., Bennett, H., Boyoglu-Barnum, S., Shi, W., Graham, B., Carfi, A., Corbett, K., Seder, R. and Edwards, D., (2021). mRNA-1273 vaccine induces neutralizing antibodies against spike mutants from global SARS-CoV-2 variants.
  148. Wu, P., Duan, F., Luo, C., Liu, Q., Qu, X., Liang, L. and Wu, K., (2020). Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, ChinaJAMA Ophthalmology,.
  149. Xiao, F., Tang, M., Zheng, X., Liu, Y., Li, X. and Shan, H., (2020). Evidence for Gastrointestinal Infection of SARS-CoV-2Gastroenterology, 158(6), pp.1831-1833.e3.
  150. Xie, X., Liu, Y., Liu, J., Zhang, X., Zou, J., Fontes-Garfias, C., Xia, H., Swanson, K., Cutler, M., Cooper, D., Menachery, V., Weaver, S., Dormitzer, P. and Shi, P., (2021). Neutralization of SARS-CoV-2 spike 69/70 deletion, E484K and N501Y variants by BNT162b2 vaccine-elicited sera. Nature Medicine,.
  151. Xu, X., Han, M., Li, T., Sun, W., Wang, D., Fu, B., Zhou, Y., Zheng, X., Yang, Y., Li, X., Zhang, X., Pan, A. and Wei, H., (2020). Effective Treatment of Severe COVID-19 Patients with Tocilizumab
  152. Yang, L., Tian, D. and Liu, W. (2020). Strategies for Vaccine Development of COVID-19Sheng wu gong cheng xue bao (Chinese journal of biotechnology)
  153. Yonesi, M. and Rezazadeh, A., (2020). Plants as a Prospective Source of Natural Anti-viral Compounds and Oral Vaccines Against COVID-19 Coronavirus.
  154. Zhang, C., Shi, L. and Wang, F., (2020). Liver injury in COVID-19: management and challengesThe Lancet Gastroenterology & Hepatology, 5(5), pp.428-430.
  155. Zhang, C., Wu, Z., Li, J., Zhao, H. and Wang, G., (2020). The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL-6R) antagonist Tocilizumab may be the key to reduce the mortalityInternational Journal of Antimicrobial Agents, p.105954.
  156. Zhang, W., Zhao, Y., Zhang, F., Wang, Q., Li, T., Liu, Z., Wang, J., Qin, Y., Zhang, X., Yan, X., Zeng, X. and Zhang, S., (2020). The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from ChinaClinical Immunology, 214, p.108393.
  157. Zhang, X., Song, K., Tong, F., Fei, M., Guo, H., Lu, Z., Wang, J. and Zheng, C., (2020). First case of COVID-19 in a patient with multiple myeloma successfully treated with tocilizumabBlood Advances, 4(7), pp.1307-1310.
  158. Zhou, P., Yang, X., Wang, X., Hu, B., Zhang, L., Zhang, W., Si, H., Zhu, Y., Li, B., Huang, C., Chen, H., Chen, J., Luo, Y., Guo, H., Jiang, R., Liu, M., Chen, Y., Shen, X., Wang, X., Zheng, X., Zhao, K., Chen, Q., Deng, F., Liu, L., Yan, B., Zhan, F., Wang, Y., Xiao, G. and Shi, Z., (2020). A pneumonia outbreak associated with a new coronavirus of probable bat originNature, 579(7798), pp.270-273.


Références (Générales) – Cliquez sur les liens

  1. Statista France: Nombre de personnes guéries du coronavirus (COVID-19) dans le monde au 23 avril 2020, selon le pays (2 Avril 2020)
  2. Quotidien Présent:  Un virus qui n’aime pas les politiciens (16 Mars 2020)
  3. Confinement et agressivité : 1 mois pour maitriser ses pulsions et ne pas tuer son conjoint (21 Mars 2020)
  4. France Info: « Les vieux vont tomber comme des mouches » : à Menton, près de la frontière italienne, le coronavirus est sur toutes les lèvres (28 Fevrier 2020)
  5. QueFaire: Préparer sa mort, transmettre, organiser ses obsèques (14 Octobre 2014)
  6. France Info: Un homme de 101 ans est parvenu à vaincre la maladie. (2 Avril 2020)
  7. SudOuest: Gironde : à 105 ans, elle a vécu deux guerres et guéri du Covid-19 (19 Mai 2020)
  8. Los Angeles Times: If I become infected with the coronavirus, what are my odds of survival? (19 Mars 2020)
  9. France Culture: Coronavirus chinois : plus mystérieux que la peste, le paludisme, le choléra (25 Janvier 2020)
  10. France Info: Réaction tardive, complaisance envers la Chine… Pourquoi la gestion de la pandémie de Covid-19 par l’OMS est autant critiquée (15 Avril 2020)
  11. France Info: Coronavirus : visualisez l’évolution du nombre de morts dans le monde en un graphique animé (7 Avril 2020)
  12. Paris Match: Coronavirus : ce professeur à la Sorbonne annonçait la catastrophe (6 Avril 2020)
  13. France Inter: PORTRAIT – Didier Raoult, chercheur disruptif (24 Mars 2020)
  14. France Inter: Coronavirus : 10 façons de se dire bonjour sans se faire la bise ou se serrer la main (2 Mars 2020)
  15. Yale University Medicine: 5 Things Everyone Should Know About the Coronavirus Outbreak (15 Avril 2020)
  16. Harvard T.H. Chan School of Public Health: Coronavirus (COVID-19): Press Conference with Marc Lipsitch (4 Mars 2020)
  17. RTL: Coronavirus : Trump suspend sa contribution à l’OMS, une décision « absurde », selon Melinda Gates (16 Avril 2020)
  18. Financial Times: Donald Trump has poured fuel on the flames of coronavirus (12 Mars 2020)
  19. France Culture: Pourquoi le système de santé américain n’est pas solidaire (1 Avril 2020)
  20. Le Figaro: Aux Etats-Unis, l’épidémie semble frapper démesurément les Noirs (8 Avril 2020)
  21. Le Figaro: Coronavirus :  pourquoi New York est-elle si durement touchée? (13 Avril 2020)
  22. YouTube (New York Times): ‘People Are Dying’: Battling Coronavirus Inside a N.Y.C. Hospital (26 Mars 2020)
  23. BFMTV: Davantage d’Américains sont désormais morts du coronavirus qu’à la guerre du Vietnam (29 Avril 2020)
  24. L’Express: Le chômage, l’autre tragédie américaine (28 Avril 2020)
  25. Oxford University Press: Breaking the Two-Party Doom Loop (24 Janvier 2020)
  26. Oxford University Press: Do Morals Matter? (23 Mars 2020)
  27. Usbek & Rica: Quand Bill Gates prédisait l’apparition d’une pandémie (17 Mars 2020)
  28. Red Action: Bill Gates avait averti en 2018 qu’une nouvelle maladie pourrait tuer 30 millions de personnes en 6 mois (27 Janvier 2020)
  29. Forbes France: Covid-19 : Pourquoi Bill Gates Reste Optimiste (1 Avril 2020)
  30. Ouest France:  Bill Gates s’engage dans le développement de sept vaccins (7 Avril 2020)
  31. Oxford University Research: Covid-19 bears out the research: Music brings people together* (27 Mars 2020)
  32. Le Figaro: À réécouter : notre sélection de disques pour s’évader du confinement (19 Mars 2020)
  33. France Musique: Musique émoi de confinement 2 (3 Mai 2020)
  34. France Inter: Philo : Penser le confinement, cette « expérience commune » de Nietzsche qui constitue un peuple (25 Mars 2020)
  35. France Inter: Du plasma de patients guéris pour traiter les malades du Covid-19 : un essai clinique commence lundi (3 Avril 2020)
  36. France Culture: Didier Sicard : « Il est urgent d’enquêter sur l’origine animale de l’épidémie de Covid-19 » (27 Mars 2020)
  37. France Culture: Covid-19 : sur la piste de l’origine animale (10 Mai 2020)
  38. Oxford University / Oxford Martin School: China’s Announcement on Wildlife Trade – What’s New and What Does It Mean? (12 Mars 2020)
  39. France Bleu: Le Limousin Quentin Bontemps nous raconte le début du déconfinement à Wuhan en Chine (9 Avril 2020)
  40. France Inter: Comment la Corée du Sud a réussi, jusqu’ici, à dompter l’épidémie de coronavirus (1 Avril 2020)
  41. Oxford University Research: Digital contact tracing can slow or even stop coronavirus transmission and ease us out of lockdown (16 Avril 2020)
  42. Oxford University Research:Oxford scientist develop rapid testing technology for COVID-19 (18 Mars 2020)
  43. Oxford University Research:Coronavirus (COVID-19) Research Priorities (13 Mars 2020)
  44. Oxford University Research: First patients enrolled in new clinical trial of possible COVID-19 treatments (23 Mars 2020)
  45. Oxford University Research: Oxford COVID-19 vaccine programme opens for clinical trial recruitment (27 Mars 2020)
  46. Twitter (Didier Raoult): Nouveaux résultats de l’IHU Méditerranée Infection : 80 patients traités par une association hydroxychloroquine/azithromycine. (27 Mars 2020)
  47. Caducee: #COVID19 : Un médecin américain aurait traité avec succès plus de 500 patients avec l’hydroxychloroquine (26 Mars 2020)
  48. News Coronavirus UK: Un médecin décrit les symptômes comme «rien de tel que la grippe» (17 Mars 2020)
  49. Guardian: Coronavirus: UK will have Europe’s worst death toll, says study(8 Avril 2020)
  50. Guardian: UK failures over Covid-19 will increase death toll, says leading doctor, Richard Horton, editor-in-chief of the Lancet (18 Mars 2020)
  51. Financial Times: Coronavirus may have infected half of UK population – Oxford study  (24 Mars 2020)
  52. University College London (UCL): COVID-19: UCL academics mobilise to provide critical advice and expert comment (16 Avril 2020)
  53. University College London (UCL): UCL, UCLH and Formula One develop life-saving breathing aids for the NHS
  54. Oxford University Research: Ventilator project given the green light by UK government to proceed next stage of testing (31 Mars 2020)
  55. Statista France: COVID-19 : quel est le statut des cas identifiés ? (24 Avril 2020)
  56. YouTube (L’Express): Coronavirus : pourquoi l’Allemagne s’en sort mieux que la France ? (10 Avril 2020)
  57. France Inter: William Dab : « Plus on retarde le travail de terrain, plus il va falloir prolonger le confinement » (11 Avril 2020)
  58. Oxford University Research: Universities into the breach (9 Avril 2020)
  59. France Culture: Jean-Christophe Rufin : « Le coronavirus méritait discussion, mais elle n’a pas eu lieu faute de moyens » (1 Avril 2020)
  60. Oxford University / Oxford Martin School: The world before this coronavirus and after cannot be the same: « Now is the time to start building the necessary bridges at home and abroad. » (30 Mars 2020)
  61. France Inter: Le confinement fait drastiquement baisser les émissions de CO2 dans le monde(mais ça ne va pas durer) (11 Avril 2020)
  62. Le Parisien: Coronavirus : le coup de gueule du président des médecins, contaminé à son tour (19 Mars 2020)
  63. Le Figaro: Masques: Macron le grand bouffon frustré souhaite «l’indépendance pleine et entière» de la France «d’ici la fin de l’année» (31 Mars 2020)
  64. Twitter (Nicolas Chung): Bonjour Twitter, je ne fais jamais ça mais nécessité fait loi : une amie médecin en hôpital en IdF cherche imprimantes 3D pour fabriquer les dispositifs d’adaptation pour les masques Decathlon. Merci pour votre aide et vos RT. (1 Avril 2020)
  65. Oxford University Research: Infectious disease experts provide evidence for a coronavirus mobile app for instant contact tracing (17 Mars 2020)
  66. Oxford University Research: Coronavirus Researchers at Oxford (18 Mars 2020)
  67. Clinical Trials Arena: Coronavirus treatment: Vaccines/drugs in the pipeline for COVID-19 (16 Avril 2020)
  68. l’Opinion: Coronavirus: l’Afrique suit la prescription de chloroquine du Pr Raoult (30 Mars 2020)
  69. Le Point: Coronavirus : une nouvelle étude de Didier Raoult sur la chloroquine (28 Mars 2020)
  70. Les malades chroniques traités à la chloroquine sont-ils immunisés contre le coronavirus ? (3 Avril 2020)
  71. L’internaute: Vaccin et médicaments contre le coronavirus : le point sur les avancées (16 Avril 2020)
  72. La La Chine commence à tester sur les êtres humains un vaccin « efficace » contre le nouveau coronavirus, a indiqué mercredi le ministère de la Défense à Pékin. Il est développé sous la direction de l’épidémiologiste Chen Wei. Le vaccin a été approuvé après de premiers tests. Il peut désormais être testé sur les êtres humains. Le ministère de la Défense le décrit comme sûr et efficace, et a précisé que les préparations pour sa production en masse sont en cours, rapporte l’agence de presse espagnole Europa Press. (18 Mars 2020)
  73. Xinhuanews: (COVID-19) La Chine approuve trois vaccins de COVID-19 pour des essais cliniques (14 Avril 2020)
  74. UK Research and Innovation: Coronavirus: the science explained
  75. Confédération Suisse: Federal Office of Public Health FOPH: New coronavirus (14 Avril 2020)
  76. France Inter: « L’État ne va pas pouvoir continuer à soutenir l’économie à ce niveau-là pendant longtemps », selon le Medef (11 Avril 2020)
  77. France Culture: Youtube: Coronavirus : crise économique ou changement de modèle ? (12 Mars 2020)
  78. Le Figaro: Coronavirus : Cristiano Ronaldo transformerait ses hôtels en hôpitaux (15 Mars 2020)
  79. Gala: VIDEO – Didier Raoult : ce surprenant aveu fait à Jean-Marie Bigard (1 Avril 2020)
  80. Sputnik France: Un pilote de la compagnie aérienne AirAsia a quitté son avion par la fenêtre du cockpit en apprenant que plusieurs passagers pourraient être porteurs du nouveau coronavirus (23 Mars 2020)
  81. Le Figaro: Aides-soignants, caissiers, camionneurs… Les gilets jaunes sont devenus les «premiers de tranchée» (9 Avril 2020)
  82. France Bleu: Confinement : qui a gagné ou perdu le plus de population en Auvergne-Rhône-Alpes ? (9 Avril 2020)
  83. Statista France: Ces produits qu’on s’arrache en plein confinement (8 Avril 2020)
  84. Oxford University Research: The economic impact of COVID-19 (7 Avril 2020)
  85. The Conversation France: Conversation avec Frédéric Altare : l’obésité, facteur très aggravant du Covid-19 (2020)
  86. Science Media Centre: Expert reaction to Times Interview about vaccines with Prof Sarah Gilbert (11 Avril 2020)
  87. The Lancet: Sarah Gilbert: carving a path towards a COVID-19 vaccine (18 Avril 2020)
  88. The Telegraph: A vaccine for Covid-19 could be ready by the end of summer (17 Avril 2020)
  89. France Inter: Coronavirus : voici des sources fiables pour vous informer en évitant les fake news (17 Mars 2020)
  90. Le Point: Coignard – Covid-19 sur le « Charles de Gaulle » : une allégorie française (20 Avril 2020)
  91. France Bleu: Coronavirus : les dermatologues alertent sur de nouveaux symptômes cutanés (7 Avril 2020)
  92. Ouest France: Pour Anne Soupa, journaliste, théologienne et bibliste, le confinement ces dernières semaines a accentué notre inventivité sur la manière d’être présent (28 Avril 2020)
  93. Paris Match: Edgar Morin, paroles de sage (16 Avril 2020)
  94. Guardian: Priti Patel has said removing coronavirus restrictions in the UK will not be a binary choice and the government would not give a date for the end of lockdown. The home secretary added that five tests will have to be met before schools can reopen but said giving a date ‘would be irresponsible and get hopes up’, saying: « We want to prevent a second wave of this horrendous virus. To do that we have to ensure that we continue with the measures we have put in place. » (25 Avril 2020)
  95. YouTube (Telegraph): Priti Patel: « We know people are frustrated but we are not out of danger yet. It is imperative that people continue to follow the rules designed to protect their families, their friends and their loved ones; this will continue to save lives. We all want to return to living our lives as normally and as soon as safely as we can… but the 5 tests we have laid out must be met…» (25 Avril 2020)
  96. Le Figaro: Hervé Morin: «La reprise des cours aurait pu attendre septembre» (27 Avril 2020)
  97. RTL: Coronavirus : l’université d’Oxford promet un vaccin pour septembre (28 Avril 2020)
  98. RFI: Déconfinement en France: Martine Wonner (LaREM) : «Ce plan va être bancal faute de thérapeutique adaptée» (28 Avril 2020)
  99. Le Point: Déconfinement : ce qui attend les Français le 11 mai (28 Avril 2020)
  100. Le Point: Masque, visière, gants… Les coiffeurs ainsi que de nombreux commerces, sont autorisés à rouvrir en Suisse, où le déconfinement se fait en plusieurs étapes. (27 Avril 2020)
  101. Science Daily: Ultraviolet LEDs prove effective in eliminating coronavirus from surfaces and, potentially, air and water (14 Avril 2020)
  102. France Info: Le coronavirus vaincu par des antihistaminiques ? Certains médecins généralistes français assurent avoir guéri des patients du CoVID-19 avec des antihistaminiques. (7 Mai 2020)
  103. Le Figaro: Rebond de Coronavirus: Plusieurs quartiers de Pékin confinés (13 Juin 2020)
  104. France Inter: Karine Lacombe : “Le virus ne va pas disparaître et risque de ressurgir par clusters” (17 Juin 2020)
  105. Sciences et Avenir: Covid-19 : le tocilizumab efficace pour les patients dans un état grave (28 Avril 2020)
  106. APHP: Le tocilizumab améliore significativement le pronostic des patients avec pneumonie COVID moyenne ou sévère (27 Avril 2020)
  107. VOX EU: The Mauritian response to COVID-19: Rapid bold actions in the right direction [The Nobel Prize Laureate Joseph E. Stiglitz stated that the accomplishments of Mauritius are admirable and many nations should learn from them, The Mauritius Miracle (Stiglitz, 2011)] (9 Mai 2020)
  108. Ouest France: TÉMOIGNAGE. Des mesures « draconiennes » pour séjourner sur l’île Maurice. Jean-François Soulard, ancien élu, s’envole pour retrouver sa fille, il va devoir vivre à l’isolement total pendant 14 jours. Les contraintes peuvent surprendre mais l’île est aujourd’hui à l’abri de l’épidémie de COVID-19 (10 Janvier 2021)
  109. Le Figaro: «Partir quoi qu’il en coûte», les Français souhaitent s’échapper pour Pâques malgré les restrictions sanitaires (25 Mars 2021)
  110. Emeral Insight: Only vaccines or drugs will end social distancing (29 Avril 2020)
  111. Twitter (Edward Leigh): “We (UK) are an island. Why didn’t we introduce travel quarantines earlier? (9 Février 2021)
  112. The Conversation: Until a coronavirus vaccine is ready, pneumonia vaccines may reduce deaths from COVID-19 (14 Octobre 2020)
  113. Daily Mercato: “J’ai battu le Covid, mais tu n’es pas Zlatan” : le message de prévention d’Ibrahimovic (29 Octobre 2020)
  114. Neuroscience News: Loss of Sense of Smell and Taste May Last up to 5 Months after COVID-19 (23 Février 2021)
  115. New York Times: With First Dibs on Vaccines, Rich Countries Have ‘Cleared the Shelves’: The U.S., Britain, Canada and others are hedging their bets, reserving doses that far outnumber their populations, as many poorer nations struggle to secure enough (15 Décembre 2020)
  116. Reuters: Canada approves AstraZeneca’s COVID-19 shot, 500,000 doses to arrive next week (26 Février 2021)
  117. BBC: Covid vaccine: PM to have AstraZeneca jab as he urges public to do the same (19 Mars 2021)
  118. Politico: French government opens door to AstraZeneca vaccine for the elderly (25 Férier 2021)
  119. Le Point: Nicolas Sarkozy, vacciné et agacé par Emmanuel Macron (18 Février 2021)
  120. France Culture: Covid-19: la course contre les variants (3 Mars 2021)
  121. France Culture: La vaccination bat son plein dans les départements sous surveillance renforcée (3 Mars 2021)
  122. Le Figaro: Covid : vaccination en pharmacie «à compter de la semaine du 15 mars» (4 Mars 2021)
  123. Le Figaro: Covid-19: les habitants de Washington peuvent se faire vacciner directement en pharmacie (18 Février 2021)
  124. BBC: Covishield and Covaxin (by Bharat Biotech): What we know about India’s Covid-19 vaccines (9 Mars 2021)
  125. Pharmaceutical Technology: Bharat Biotech’s Covid-19 vaccine COVAXIN shows interim efficacy of 81% (4 Mars 2021)
  126. BFMTV: Patrick Bruel sur le Covid-19: “Faites gaffe, ce truc est une saleté” (13 Décembre 2020)
  127. France Culture: Covid-19 : un troisième vaccin “efficace” à plus de 90% (16 November 2020)
  128. Le Figaro: Le vaccin BioNTech/Pfizer peut être stocké à des températures plus élevées pendant deux semaines, selon les laboratoires (19 Février 2021)
  129. France Info: Covid-19 : le vaccin russe Spoutnik V est efficace à plus de 91%, selon une étude de la revue médicale “The Lancet” validée par des experts indépendants (2 Février 2021)
  130. Caducee: 96,4 % d’efficacité pour le vaccin anti COVID-19 NVX–CoV2373 de Novavax (14 Mars 2021)
  131. Doctissimo: Vaccin Novavax Covid-19 : principe, efficacité, effets secondaires (12 Mars 2021)
  132. Le Figaro: Vaccins Pfizer et Moderna: pas de cas suspects de troubles de la coagulation en France (19 Mars 2021)
  133. Le Figaro: AstraZeneca affirme que son vaccin est efficace à 79% et sans risque de caillots après des tests américains (22 Mars 2021)
  134. The Conversation: Vaccin d’Oxford: voici comment il a été développé en un temps record (13 Janvier 2021)
  135. France Culture: Covid-19 : l’Agence européenne des médicaments souligne les bénéfices du vaccin AstraZeneca (16 Mars 2021)
  136. Developing versatile immunisation programmes against COVID-19 through potential vaccine combinations (11 Décembre 2020)
  137. l’Usine Nouvelle: “Les vaccins d’AstraZeneca, J&J et Spoutnik sont des vaccins OGM”, explique Axel Kahn (27 Novembre 2020)
  138. Vidal: COVID-19: Mutations, Variants, Lignées, N501Y, E484K… de quoi parle-t-on? (18 Février 2021)
  139. Nouvel Obs: Des scientifiques appellent à une enquête indépendante sur les origines du Covid-19 (4 Mars 2021)
  140. Organisation Mondiale de la Santé: Dernières nouvelles de la part du Mécanisme COVAX à l’intention des participants concernant les retards de livraison de vaccins par le Serum Institute of India (SII) et AstraZeneca (25 Mars 2021)
  141. ReliefWeb: Two-thirds of epidemiologists warn mutations could render current COVID vaccines ineffective in a year or less; New survey from People’s Vaccine Alliance shows urgency of vaccinating all countries (30 Mars 2021)
  142. Le Figaro: Le risque d’une pénurie de papier toilette plane sur le monde (29 Mars 2021)
  143. France Inter: Covid-19 : 10 cartes et graphiques à avoir en tête avant le conseil de défense de mercredi (30 Mars 2021)
  144. Le Monde (Le blog de Marc Gozlan, journaliste médico-scientifique): Covid-19 : vaccins et nouveaux variants, quel impact ? (22 Janvier 2021)
  145. Our World in Data: Coronavirus Disease (COVID-19) – Statistics and Research

Danny J. D’Purb |


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Essay // Developmental Psychology: The 3 Major Theories of Childhood Development

Mis à jour le Mercredi, 14 Avril 2021

TheoriesOfDevelopment danny d'purb dpurb

Source: An Introduction to Developmental Psychology by Slater & Bremner (Blackwell:Oxford, 2nd Edn, 2011)

It is fundamental to undertstand that as human beings, whatever stage of our lives we are, in order to be able to function fully in our daily lives and in any other activity we first of all need to have a strong foundation. That foundation is our brain, and hence, if our brain [i.e. the hardware] is not physiologically within the limits of what is deemed fit and healthy, every aspect of our mind will be affected and also of our lives. There is no psyche [mind] without a brain, because this biological hardware given to us by nature throughout the course of the shared evolutionary history of primates on planet Earth, allows us to experience every aspect of our lives, both physical and psychical [i.e. mental].

So, before diving deeper into the depth of children’s development, we are going to explore this link between brain and behaviour in order to get a foundation of the importance or a healthy brain, for a healthy development and a healthy and fulfulling life, by starting with how brain damage can affect our personalities and mental abilities; we are going to look at the Frontal lobe, which is the part of the brain behind our forehead responsible for problem solving, strategic planning, use of environmental instructions to shift procedures, and the inhibition of impulsivity.


(Photo: Jez C Self / Frontal Lobe Gone)


Frontal Lobes (& Frontal Lobe Damage)

The Wisconsin Card Sorting Test (WCST; Grant & Berg, 1948; Heaton, Chelune,Talley, & Curtis, 1993) has long been used in Neuropsychology and is among the most frequently administered neuropsychological instruments (Butler, Retzlaff, & Vanderploeg, 1991).

The test was specifically devised to assess executive functions mediated by the frontal lobes such as problem solving, strategic planning, use of environmental instructions to shift procedures, and the inhibition of impulsivity. Some neuropsychologists however, have questioned whether the test can measure complex cognitive processes believed to be mediated by the Frontal lobes (Bigler, 1988; Costa, 1988).

The WCST test, until this day remains widely used in clinical settings as frontal lobe injuries are common worldwide. Performance on the WCST test is believed to be particular sensitive in reflecting the possibilities of patients having frontal lobe damage (Eling, Derckx, & Maes, 2008). On each Wisconsin card, patterns composed of either one, two, three or four identical symbols are printed. Symbols are either stars, triangle, crosses or circles; and are either red, blue, yellow or green.

At the start of the test, the patient has to deal with four stimulus cards that are different from one another in the colour, form and number of symbols they display. The aim of the participant would be to correctly sort cards from a deck into piles in front of the stimulus cards. However, the participant is not aware whether to sort by form, colour or by number. The participant generally starts guessing and is told after each card has been sorted whether it was correct or incorrect.

Firstly they are generally instructed to sort by colour; however as soon as several correct responses are registered, the sorting rule is changed to either shape or number without any notice, besides the fact that responses based on colour suddenly become incorrect. As the process continues, the sorting principle is changed as the participant learns a new sorting principle.

potbIt has been noted that those with frontal lobe area damage often continue to sort according to only one particular sorting principle for 100 or more trials even after the principle has been deemed as incorrect (Demakis, 2003). The ability to correctly remember new instructions with for effective behaviour is near impossible for those with brain damage: a problem known as ‘perseveration’.

Another widely used test is the ‘Stroop Task’ which sets out to test a patient’s ability to respond to colours of the ink of words displayed with alternating instructions. Frontal patients are known for badly performing to new instructions. As the central executive is part of the frontal lobe, other problems such as catatonia – a condition where patients remain motionless and speechless for hours while unable to initiate – can arise. Distractibility has also been observed, where sufferers are easily distracted by external or internal stimuli. Lhermite (1983) also observed the ‘Utilisation Syndrome’ in some patients with Dysexecutive Syndrome (Normal & Shallice, 1986), who would grab and use random objects available to them pathologically.


Incomplete Frontal Lobe Development & Impulsiveness in Children

Image: PsyBlog

The Frontal lobe, responsible for most executive functions and attention, has shown to take years [at least 20] to fully develop. The Frontal lobe [located behind the forehead] is responsible for all thoughts and voluntary behaviour such as motor skills, emotions, problem-solving and speech.

In childhood, as the frontal lobe develops, new functions are constantly added; the brain’s activity in childhood is so intense that it uses nearly half of the calories consumed by the child in its development.

As the Pre-Frontal Lobe/Cortex is believed to take a considerable amount of at least 20 years to reach maturity (Diamond, 2002), children’s impulsiveness seem to be linked to neurological factors with the Pre-Frontal Lobe/Cortex; particularly, their [sometimes] inability to inhibit response(s).

The idea was supported by developmental psychologist and philosopher Jean Piaget‘s  Theory of Cognitive Development of Children [known for his epistemological studies] where he showed the A-not-B error [also known as the “stage 4 error” or “perseverative error”] is mostly made by infants during the substage 4 of their sensorimotor stage.

Researchers used 2 boxes, marked A and B, where the experimenter had repeatedly hid a visually attractive toy under the Box A within the infant’s reach [for the latter to find]. After the infant had been conditioned to look under Box A, the critical trial had the experimenter move the toy under Box B.

Children of 10 months or younger make the “perseveration error” [looked under Box A although fully seeing experimenter move the toy under Box B]; demonstrating a lack of schema of object permanence [unlike adults with fully developed Frontal lobes].


Frontal lobe development in adults was compared with that in adolescents, e.g. Sowell et al (1999); Giedd et all (1999); who noted differences in Grey matter volume; and differences in White matter connections. Adolescents are likely to have their response inhibition and executive attention performing less intensely than adults’. There has also been a growing & ongoing interest in researching the adolescent brain; where great differences in some areas are being discovered.

The Pre-Frontal Lobe/Cortex [located behind the forehead] is essential for ‘mentalising’ complex social and cognitive tasks. Wang et al (2006) and Blakemore et al (2007) provided more evidence between the difference in Pre-Frontal Lobe activity when ‘mentalising’ between adolescents and adults. Anderson, Damasio et al (1999) also noted that patients with very early damage to their frontal lobes suffered throughout their adult lives.


2 subjects with Frontal Lobe damage were studied:

1) Subject A: Female patient of 20 years old who suffered damages to her Frontal lobe at 15 months old was observed as being disruptive through adult life; also lied, stole, was verbally and physically abusive to others; had no career plans and was unable to remain in employment.

2) Subject B was a male of 23 years of age who had sustained damages to his Frontal lobe at 3 months of age; he turned out to be unmotivated, flat with bursts of anger, slacked in front of the television while comfort eating, and ended up obese in poor hygiene and could not maintain employment. [However…]


While research and tests have proven the link between personality traits & mental abilities and frontal brain damage, the physiological defects of the frontal lobe would likely be linked to certain traits deemed negative by a subject willing to be a functional member of society [generally Western societies].

However, personality traits similar to the above Subjects [A & B] may in fact not always be linked to deficiency and/or damage to the frontal lobes; as many other factors are to be considered when assessing the behaviour & personality traits of subjects; where [for example] violence and short temper may [at times] be linked to a range of factors and environmental events during development, or other mental strains such as sustained stress, emotional deficiencies due to abnormal brain neurochemistry, genetics, or other factors that may lead to intense emotional reactivity [such as provocation or certain themes/topics that have high emotional salience to particular subjects, ‘passion‘]



In 1984, Nicholas Humphrey described us as “nature’s psychologists’” or homo psychologicus. What he meant was that as intelligent social beings, we tend to use our knowledge of our own thoughts and feelings – “introspection” – as a guide for understanding how others are likely to think, feel and hence, behave. He also argued that we are conscious [i.e. we have self-awareness] precisely because such an attribute is useful in the process of understanding others and having a successful social existence – consciousness is a biological adaptation that enables us to perform introspective psychology. Today, we are confident in the knowledge that the process of understanding others’ thoughts, feelings and behaviour is an ability that develops through childhood and most likely throughout our lives; and according to the greatest child psychologist of all time, Jean Piaget, a crucial phase of this process occurs in middle childhood.

Developmental psychology can be characterised as the field that attempts to understand and explain the changes that happen over time in the thought, behaviour, reasoning and functioning of a person due to biological, individual and environmental influences. Developmental psychologists study children’s development, and the development of human behaviour across the organism’s lifetime from a variety of different perspectives. Hence, if we are studying different areas of development, different theoretical perspectives will be fundamental and may influence the ways psychologists and scholars think about and study development.

Through the systematic collection of knowledge and experiments, we can develop a greater understanding and awareness of ourselves than would otherwise be possible.


Focussing on changes with time

The new born infant is a helpless creature, with communications skills that are limited along with few abilities. By 18 – 24 months, the end of the period of infancy – this scenario changes. The child has now formed relationships with others, has gained knowledge about the aspects of the physical world, and is about to undergo a vocabulary explosion as language development leaps ahead. At the time of adolescence, the child has turned into a mature, thinking individual actively striving to come to terms with a fast changing and complex society.

The important contribution to development, is maturation and the changes resulting from experience that intervene between the different ages and stages of childhood: the term maturation refers to those aspects of development that are primarily under genetic control, and which are relatively uninfluenced by the environment. An example would be puberty, and although its onset can be affected by environmental factors such as diet, the changes that occur are genetically determined.


Development Observed

The biologist, Charles Darwin, notable for his theory of evolution, made one of the earliest contributions to our understanding of child psychology in his article “A biographical sketch of an infant” (1877), which was based on observations of his own son’s development. By the early 20th century, most of our understanding of psychological development was not based on scientific methodology as much was still based on anecdotes and opinions of qualitative analysis, a method that strict empiricists have never managed to grasp or like. Nevertheless, knowledge was still being organised through both observation and experiment and during the 1920s and 1930s the study of child development started to grow as a movement, particularly in the USA with the founding of Institutes of Child Study or Child Welfare in university centres such as Iowa and Minnesota. Minute observations were made of young children in their developmental phase along with normal and abnormal behaviour and adjustment. In the 1920s Jean Piaget started his long and passionate career in child psychology, blending observation and experiment in his studies of children’s thinking.

The observations carried out in naturalistic settings was soon criticised by the empiricists of the behavioural movement in the 1940s and 1950s [although it continued to be the method of choice in the study of animal behaviour by zoologists]. This led to many psychologist carrying their experiments under laboratory conditions with statistical methods, and such experiments although come with some advantages from the perspective of empirical statistics, they do have limitations and drawbacks [e.g. on measuring qualitative aspects of personality such as emotions, values, etc]. It should be noted that much of the laboratory work on child development from the 1950s and 1960s has been described by Urie Bronfenbrenner (1979) as “the science of the behaviour of children in strange situations with strange adults”.

Schaffer (1996, pp. xiv – xvii) notes other changes in the methods in which psychologists now approach child development, such as the importance in understanding the processes of how children grow and develop rather than simply outcomes, and to integrate findings from a range of sources at different levels of analysis – for example meaningful others, community [geography, socio-linguistics, arts, etc] and culture [religion, nationality(ies), education, class, etc).

In the course of this essay, we will be integrating perspectives to make the most of the findings in distinguishing differences in personality, by reflecting on the links to be made by psychologists between the concept of the child’s “internal working model of relationships” and discoveries about the “theory of mind”.

It is fundamental to acknowledge that psychology itself is mostly based on accurate approximations due to the statistical methods used and the problematic nature of the qualitative variables measured, and not precision. And with this in mind, we should accept the complementary virtues of various different methods of investigation and gain a sense that the child’s process of development and the socio-behavioural context in which they exist are closely intertwined, each having an influence on the other.


Defining development according to world views

Intellectuals and researchers who study development also have different views on the topic, that is, the way in which development is defined, and the areas of development that are of interest to individual researchers generally orients them towards specific methodologies and philosophy when studying development.

We are now going to look at the 2 main views in the study of development given by psychologists who hold different views or sometimes combine elements of both, like ourselves, being firmly on the organic perspective of development and construction.

A world view [also known as paradigm, model, or world hypothesis] can be characterised as “a philosophical system of thinking, perceiving and feeling [ideas and more] that serves to organise a set or family of scientific theories and associated scientific methods” (1986, p. 42).

They are beliefs we adopt because it aligns with our values, and these are qualitative and often not open to common reductive empirical tests – that is precisely why we believe them!

Lerner and others note that many developmental theories appear to fall under one or two world views: organismic and mechanistic.


Organismic World View

The organismic world view which is the main view that we adopted to be the foundation of the Organic Theory, is one that sees a human being on earth as a biological organism that is inherently active and continually interacting with the environment [all aspects and dimensions], and therefore helping to shape its own development. The organismic worldview emphasises the interaction between maturation and experience that leads to the development of new internal, psychological structures for processing environmental input (e.g. Getsdottir & Lerner, 2008).

As Lerner states: “The Organismic model stresses the integrated structural features of the organism. If the parts making up the whole become reorganised as a consequence of the organism’s active construction of its own functioning, the structure of the organism may take on a new meaning; thus qualitatively distinct principles may be involved in human functioning at different points in life. These distinct, or new, levels of organisation are termed stages…” (p.57). A good analogy would be qualitative changes that take place when the molecules of two gasses hydrogen and oxygen, combine to form a liquid, water. Many other qualitative changes happen to water when it changes from frozen (ice) to liquid (water) to steam (vapour). Depending on the temperature, these qualitative changes in the state of water are easily reversed, BUT in human development the qualitative changes that take place are very rarely, if ever, reversible – that is, each new stage represents an advance on the previous stage, and the organism [human being] does not regress to former stages.


The main argument is that the new stage is not simply reducible to components of the previous stage; it represents new characteristics that were not present in the previous stage.

For example, the organism appears to pass through structural changes during foetal development [See Picture A].

PA Development of the human foetal brain_A_v2.jpg

PICTURE A. Development of the human foetal brain / Source: Adapted from J.H.Martin (2003), Neuroanatomy Text and Atlas (3rd ed., p.51). Stamford, CT:Appleton & Lange.

In the initial stage [Period of the Ovumfirst few weeks after conception] cells multiply and form clusters; in the second stage [Period of the Embryo – 2 – 8 weeks] the major body parts are formed by cell multiplication, specialisation and migration as well as cell death; in the last stage [Period of the Foetus] the body parts mature and begin to operate as an integrated system [e.g. head orientation towards and away from stimulation, arm extensions and grasping, thumb sucking, startles to loud noises, and so on (Fifer, 2010; Hepper, 2007)]. It is important to understand that similar stages of psychological development are postulated to happen after birth also, and the individual from one stage to another is different with new abilities that cannot be reversed.

Jean Piaget is perhaps the greatest and best example of a successful organismic theorist. Piaget suggested that cognitive development occurs in stages and that the reasoning of the child at one stage is qualitatively different from that of the earlier or later stages.

Partir en Livre BNF Bibliothèque nationale de France dpurb d'purb site web

“Chaque civilisation se forge un mythe destiné à expliquer son apparition et construit sa tradition écrite autour d’un support privilégié” / Découvrez (Liens): (i) l’aventure des écritures et (ii) l’aventure du livre | Source: La Bibliothèque Nationale de France (BNF)

The main job of the developmental psychologist who believes in the organismic worldview [like ourselves] is to determine when [i.e., at what age?] different psychological stages operate and what variables and processes represent the different between stages and determine the transition between them.


Mechanistic World View

From the mechanistic world view, it is assumed that a person can be broken down into components and can be represented as being like a machine [such as a computer], which is inherently passive until stimulated by the environment [this view seems to be more in line with the early British thinkers about the brain]. Human behaviour is reducible to the operation of fundamental behavioural units [e.g. habits] that are acquired in a progressive, cumulative manner. The mechanistic view assumes that the frequency of behaviours can increase with age due to various learning processes and they can decrease with age when they no longer have any functional consequence, or lead to negative consequences [such as punishment]. The developmental psychologists job here is to study environmental factors, or principles of learning, which determine the way organisms respond to stimulation, and which results in increases, decreases, and changes in behaviour.

Quite unlike the organismic world view, the mechanistic world view sees development as reflected by a more continuous growth function, rather than occurring in qualitatively different stages, and the child is believed to be passive rather than active in shaping its own development and its environment. This mechanistic view is generally embraced by behaviourists and cognitive-behaviourists who function on a reductionist philosophy based on the limitations of the scientific method when faced with understanding psychology and the mechanism of mind; instead they tend to focus on measurable behaviour and treat the brain as an information processing centre with a highly similar logic to a computer. The mechanistic view while being fairly grotesque due to its reductionist values, has revealed to be very practical in the study of human-machine interaction and along with new cognitive methods, it has helped to enhance the design of technological equipment to improve human experience in a wide range of areas.

As for us, we are mostly on the perspective of the organismic school of thought but refuse to completely dismiss all the mechanistic world view’s elements, because some of it can be embedded as secondary cognitive processes carried out by the conscious or preconscious areas of the mind when appraising stimuli from an organism’s environment. Hence, some elements can be embedded in understanding interaction with basic objects and elements of an organism’s “external” [not internal] environment, but to fully base our thoughts and behaviour on a mechanistic world view would arguably be irrationally reductionist.


Theories of Development


“Es gibt nichts Praktischeres al seine gute Theorie.”

–Emmanuel Kant (1724 – 1804)


“There is nothing so practical as a good theory.”

-Kurt Lewin (1944, p. 195)


Human development is complex and it would be irrational to expect a single universal theory of development that could do justice to this complexity, and indeed no theory of development attempts to do so. Each theory attempts to account for only a limited range of development and it is often the case that within each area of development there are competing theoretical views, each attempting to account for the same aspects of development. We shall see below some of this complexity and conflict in our account of different theoretical views.

First of all, it would be helpful to understand what is implied by a “Theory” in the field of developmental psychology. A theory of development is a scheme or system of ideas that is generally based on evidence and attempts to explain, describe and predict behaviour and development. So, from this account, it is quite clear that a theory aims to bring order to what might otherwise be a chaotic mass of information – and hence why there may indeed not be anything more practical than a good theory.

We usually deal with at least 2 kinds of theory in every area of development, we have the minor theories [that are generally concerned with very specific and narrow areas of development such as eye movements, the origins of pointing and so on], and we have the major theories which are the ones we are primarily interested in as they attempt to explain large areas of development.

They have been divided in 3 groups for the purpose of this essay, with cognition, emotion and motivation in focus:

(I) The Theory of Cognitive Development of Jean Piaget

(II) The Theory of Attachment in Emotional Development by John Bowlby

(III) The Genetic/Psychosexual Model of Development by Sigmund Freud




(I) The Theory of Cognitive Development (Jean Piaget)

The theory of cognitive development we are interested in is that of Jean Piaget who saw children as active agents in shaping their own development,  and not simply blank slates who passively and unthinkingly responds to whatever the environment throws at them or treats them to [an assumption that is insulting to human intelligence, hence why we do not subscribe blindly to the passive school of thought but only consider some elements related to very basic cognitive processes].

This suggests that children’s behaviour and development is motivated largely intrinsically (internally) rather than extrinsically (externally).

For Piaget and intellectuals with a firm belief in the mind as an active entity, children learn to adapt to their environment and as a result of their cognitive adaptations they are now better able to understand their world. Adaptation is an act that all living organisms have evolved to do and as children adapt, they also gradually construct more advanced understanding [internal working models] of their worlds.

These more advanced understanding of the world reflect themselves in the appearance of new stages of development. Piaget’s theory is the best and most accomplished example of the organismic world view, and it portrays children as inherently active, continually interacting with various dimensions of their environments, in such a way as to shape their own development.

With this assumption in mind, Piaget’s theory is also often referred to the Constructivist Theory.


Piaget’s Theory of Cognitive Development (0 – 12 yrs)

Jean Piaget’s theory developed out of his early interest in observing animals in their natural environment. Piaget published his first article at the age of 10 about the description of an albino sparrow that he had observed in the park, and before the age of 18, journals had accepted several of his papers about molluscs. During his adolescent years, the young theorist developed a keen interest in philosophy, particularly “epistemology” [the branch of philosophy focused on knowledge and the acquisition of it]. However, his undergraduate studies were in the field of biology and his doctoral dissertation was once again, on molluscs.

For a short while, Piaget then worked at Bleuler’s psychiatric clinic where his interest in psychoanalysis grew. As a results, he moved to France and attended the Sorbonne university, in 1919 to study clinical psychology and also pursued his interest in philosophy. In Paris, he worked in the Binet Laboratory with Theodore Simon on the standardisation of intelligence tests. Piaget’s task was to monitor children’s correct response to test times, but instead, he became much more interested in the mistakes that children made, and developed the idea that the study of children’s errors could provide an insight into their cognitive processes.

Piaget came to realise that through the process and discipline of psychology, he had an opportunity to create links between epistemology and biology. Through the integration of the disciplines of psychology, biology and epistemology, Piaget aimed to develop a scientific approach to the understanding of knowledge – the nature of knowledge and the ways in which an organism acquires knowledge. As a man who valued richness and detail, Piaget was not at all impressed by the reductionist quantitative methods used by the empiricists of the time, however, he was influenced by the work on developmental psychology by Binet, a French psychologist who had pioneered studies of children’s thinking [his method of observing children in their natural setting was one that Piaget followed himself when he left the Binet laboratory].

Piaget later integrated his own experience of psychiatric work in Bleuler’s clinic with the observational and questioning strategies that he had learned from Binet. Out of this fusion of techniques emerged the “Clinical Interview” [an open-ended, conversational technique for eliciting children’s thinking (cognitive) processes]. It was the child’s own subjective judgement and explanation that was of interest to Piaget, as he was not testing a particular hypothesis, but rather looking for an explanation of how the child comes to understand his or her world. The method is not simple, and the team of Piaget’s researchers had to be trained for 1 year before they actually started collecting data. They were trained and educated about the “art” of asking the right questions and testing the truth of what the children said.

Piaget’s career was devoted to the quest for the mechanisms guiding biological adaptation, and also the analysis of logical thought [that derives from these adaptations and interaction with the exterior environment] (Boden, 1979). He wrote more than 50 books and hundreds of articles, correcting many of his earlier ideas in later life. At its core, the theory of Jean Piaget is concerned with the human need to discover and acquire deeper understanding and knowledge.

Piaget’s incredible output of concepts and ideas characterises his attitude towards constant construction and reconstruction of his theoretical system, which was quite consistent with his philosophy of knowledge, and perhaps indirectly to the school of thought of the mind as an “active” entity.

This section will explore the model of cognitive structure developed by Piaget along with the modifications and some of the re-interpretations that subsequent Piagetian researchers have made to the master’s initial ideas. Although many details have been questioned, it is undeniable that Piaget’s contribution to the understanding of thinking processes [cognitive] of both children and adults.

One great argument made by the theorist suggested that if we are to understand how children think we ought to look at the qualitative development of their problem-solving abilities.

Two famous examples from Piaget’s experiments will be considered that explore the thinking processes in children, showing how they develop more sophisticated problem-solving skills.

Example 1 – One of Piaget’s dialogue with a 7-year-old

Adult:    Does the moon move or not?
Child:    When we go, it goes.
Adult:    What makes it move?
Child:    We do.
Adult:    How?
Child:    When we walk. It goes by itself.

(Piaget, 1929, pp. 146-7)

From this example and other observations based on the similar theme, Piaget described a particular period in childhood which is marked by egocentrism. Since the moon appears to move with the child, she concluded that it does indeed do so. But as the child grows and her sense of logic follows, there is a shift from her own egocentric perspective where the child starts to learn to differentiate between what she sees and she “knows”. Gruber and Vonèche (1977) provide a good example of how an older child used her sense of logic to investigate the movement of the moon. This particular child had sent his younger brother for a walk down the garden while he himself remained immobile. The younger child reported that the moon moved with him, but the older boy realised from his observation that the moon did not move and could then disprove this wrong information with his brother.

Example 2 – Estimating the Quantity of a Liquid

FA Piaget Liquid Quantity

FIGURE A. Estimating a quantity of liquid

This example is taken from Piaget’s research into children’s understanding of quantity. Let us assume that John [aged 4] and Mary [aged 7] are given a problem; two glasses, A and B, are of equal capacity [volume] but glass A is short and wide and glass B is tall and narrow [See Figure A]. Glass A is filled to a particular height and the children would then be asked, separately, to pour liquid into glass B [tall and narrow] so that it would contain the same amount as glass A. Despite the striking proportional differences of the 2 containers, John could not grasp that the smaller diameter of glass B requires a higher level of liquid. To Mary, John’s response is incredibly senseless and stupid: of course one would have to add more to glass B. Piaget interestingly saw the depth of the argument that was in the responses of those children. John could not “see” that the liquid in A and the liquid in B are not equal, because his thought processes are using a mechanism that is qualitatively different in terms of reasoning and that is not yet developed [perhaps due to physiological/hardware limitations] and lacks the mental operations that would have allowed him to solve the problem. Mary, the 7 year old girl finds it hard to understand 4 year old John’s stupidity and why he could not perceive his error.

Facing this situation, Piaget brilliantly proposed that the essence of knowledge is “activity” – a line of thought and perspective adopted by many psychologists and intellectuals from the German and French school of Lacan quite opposite to the early British thoughts that assumed the mind to be “passive” and mostly shaped by the effects of the outside environment.  This argument is not only one that embraces human ingenuity and creativity and acknowledges our instinctual drives to thrive and succeed but also characterises the mind as an entity with high creative power instead of simple junction of neurons conditioned to react to stimuli from its environment almost helplessly as the “passive” school assumed it to be. Hence, to Piaget and ourselves, the essence of knowledge is “activity”, he could be referring to the infant directly manipulating objects and in doing so also learning about their properties. It may also refer to a child pouring liquid from one glass to another to find out which has more in it. Or it may refer to the adolescent forming hypotheses to solve a scientific dilemma. In the examples mentioned, it is important to note that the learning process of the child is taking place through “action”, whether physical (e.g. exploring a ball of clay) or mental (e.g. thinking of various outcomes and reflecting on what they mean). Piaget’s emphasis on activity was important in stimulating the child-centred approach to education, because he firmly believed that for lasting learning to occur, children would not only have to manipulate objects but also manipulate and define ideas. The major educational implications of Piaget will be discussed later in this section.


Assumptions of Piaget’s Theory of Development: Structure & Organisation

Through his carefully devised techniques, and using observations, dialogues and small-scale experiments, Piaget suggested that children progress through a series of stages in their thinking, each of which synchronises with major changes in the structure or logic of their intelligence. [See Table A]

TA Piaget - Stages of Intellectual Development

TABLE A. The Stages of Intellectual Development in Piaget’s Theory

Piaget named the main stages of development and the order in which the occurred as:

I. The Sensori-Motor Stage [0 – 2 years]
II. The Pre-Operational Stage [2 – 7 years]
III. The Concrete Operational Stage [7 – 12 years]
IV. The Formal Operational Stages [12 years but may vary from one child to the other]

Piaget’s structures are sets of mental operations, which can be applied to objects, beliefs, ideas or anything in the child’s world, and these mental operations are known as “schemas”. The schemas are characterised as being evolving structures, in other words, structures that grow and change from one stage to the next.

The details of each section of the 4 stages will be explored below, however it is fundamental that we first understand Piaget’s concept of the unchanging or “invariant” [to use his own term – this may be related to temperament but here it involves another set of abilities] aspects of thought, which refers to the broad characteristics of intelligent activity that remains constant throughout the human organism’s life.

These are the organisation of schemas and their adaptation through assimilation and accommodation.

Organisation: Piaget used this term to explain the innate ability to coordinate existing cognitive structures, or schemas, and combine them into more complex systems [e.g. a baby of 3 months old has gained the ability to combine looking and grasping, with the earlier reflex of sucking]. The baby is able to perform all three actions together when feeding from her mother’s breast or a feeding bottle, an ability that the new born child did not originally have in his/her repertoire. A further example would be Ben who at the age of 2 had learned to climb downstairs while carrying objects without dropping them, and also to open doors. This means that he could then combine all three operations to deliver newspaper to his grandmother in the basement flat. To note, each separate operation combines into a new action more complex than the sum of the parts.

The complexity of the organisation also grows as the schemas become more elaborate. Piaget described the development of a particular action schema in his son Laurent as he attempted to strike a hanging object. Initially, Laurent only made random movement towards the object, but at the age of 6 months the movements had evolved and were now deliberate, focused and well directed. As Piaget put it in his description, at 6 months old, Laurent possessed the mental structure that guided the action involved in hitting a toy. Laurent had also gained the ability to accommodate his actions to the weight, size and shape of the toy and its distance from him.

The next invariant function, adaptation is characterised by the striving of the organism for balance [or equilibrium] with the environment, and is achieved through the further processes of “assimilation” and “accommodation”. During the process of assimilation, the child’s repertoire of knowledge expands and he/she takes in [learns about] a new experience [and the knowledge acquired with it] and fits it into an existing schema. For example, a child may learn the words “dog” and “car”, and following this enigmatic event, the child may call all animals “dogs” [i.e. different animals taken into a schema related to the child’s understanding of dog], or all vehicles with four wheels are called “cars”. The process of accommodation balances this erroneous process, where the child adjusts an existing schema to fit in with the nature of the environment [i.e. from experience, the child begins to perceive that cats can be distinguished from dogs, and may develop schemas for these 2 different animals – also that cars can be distinguished from other vehicles such as trucks or lorries.

By these two processes, namely assimilation and accommodation, the child achieves a new state of equilibrium which is however not permanent as this balance is generally soon upset as the child assimilates further new experiences or accommodates her existing schemas to another new idea.

Equilibrium only seems to prepare the child for more disequilibrium through further learning and adaptation; these two processes occur together and cannot be thought of separately. Assimilation provides the child with consolidation for mental structures; and accommodation results in growth and change. All adaptations contains the components of both processes and striving for balance between assimilation and accommodation [Remember: Organisation  Adaptation + (Assimilation & Accommodation)] leads to the child’s intrinsic motivation to learn [This is also reminiscent of the psychodynamic school of thought as several processes colliding to find balance in its model of the mental life of the individual mind]. When new experiences are within the child’s response range in terms of abilities, then conditions are said to be at their best for change and growth to occur.

The Stages of Cognitive Development

To adepts of Piaget’s outlook, intellectual development is a continuous process of assimilation and accommodation. We will not describe the four stages identified in the development of cognition from birth to about 12 years old [in normal children]. This order is similar for all children but the age these milestones are achieved may vary from one child to another – with the stages being:

I. The Sensori-Motor Stage [0 – 2 years]
II. The Pre-Operational Stage [2 – 7 years]
III. The Concrete Operational Stage [7 – 12 years]
IV. The Formal Operational Stages [12 years but may vary from one child to the other]

I. The Sensori-Motor Stage (about 0 – 2 years) | Stage 1 of 4

During the sensori-motor stage the child changes from a newborn, who focuses almost entirely on immediate sensory and motor experiences, to a toddler who possesses a rudimentary capacity for thinking. Piaget described in detail the process by which this occurs, by documenting his own children’s behaviour. On the basis of such observations, carried over the first 2 years of life, Piaget divided the sensori-motor stage into 6 sub-stages. [See Table B]

TB Sub-stages of the sensori-motor period

TABLE B. Substages of the sensori-motor period according to Piaget

The first substage, reflex activity, included the reflexive behaviours and spontaneous rhythmic activity with which the infant is born. Piaget called the second substage primary circular reactions. He used the term “circular” to emphasise how children tend to repeat an activity, especially those that are pleasing or satisfying (e.g. thumb sucking). The term “primary” refers to simple behaviours that are derived from the reflexes of the first period [e.g. thumb sucking develops as the thumb is assimilated into a schema based on the innate suckling reflex].

Secondary circular reactions refer to the child’s willingness to repeat actions, but the word “secondary” is used here to point out the behaviours that are the child’s very own. In other words, she is not limited to just repeating actions based on early reflexes, but having initiated new actions, she can now repeat these if they are satisfying. However, at the same time, these actions tend to be directed outside the child (unlike simple actions like thumb sucking) and are aimed at influencing the environment around her.

This is Piaget’s description of his own daughter Jacqueline at 5 months old, kicking her legs (in itself a primary circular reaction) in what gradually ascends to a secondary circular reaction as the leg movement is repeated not just for itself, but is initiated in the presence of a doll.

Jacqueline looks at a doll attached to a string which is stretched from the hood to the handle of the cradle. The doll is approximately the same level as the child’s feet. Jacqueline moves her feet and finally strikes the doll, whose movement she immediately notices… The activity of the feet grows increasingly regular whereas Jacqueline’s eyes are fixed on the doll. Moreover, when I remove the doll Jacqueline occupies herself quite differently; when I replace it, after a moment, she immediately starts to move her legs again.

(Piaget, 1936, p. 182)

In displaying such behaviours, Jacqueline seemed to have established a general relation between her movement and the doll’s, and was also engaged in a secondary circular reaction.

Coordination of Secondary Circular Reactions, being substage 4 of the Sensori-motor period, and as the word “coordination” implies, it is particularly at this substage that children begin to combine different behavioural schema. In the following extracted section, Piaget described how his daughter (aged 8 months) combined several schemas, such as “sucking an object” and “grasping an object” in a series of coordinated actions when playing with a new object:

Jacqueline grasps an unfamiliar cigarette case which I present to her. At first she examines it very attentively, turns it over, then holds it in both hands while making the sound apff (a kind of hiss which she usually makes in the presence of people). After than she rubs it against the wicker of her cradle then draws herself up while looking at it, then swings it above her and finally puts it in her mouth.

(Piaget, 1936, p. 284)

Jacqueline’s behaviour illustrates how a new object is assimilated to various existing schema in the fourth substage. In the following stage, that of tertiary circular reactions children’s behaviours become more flexible and when they repeat actions they may do so with variations, which can lead to new results. By repeating actions with variations, children are, in effect, accommodating established schema to new contexts and needs.

The final sub-stage of the sensori-motor period is known as the substage of Internal Representations and it refers to the child’s achievement of mental representation. The previous substages the child has interacted with the world through her physical motor schema, another way of phrasing it would be that, she has acted directly on the world. In this final substage, she can now act “indirectly” on the world because she has developed the capacity to hold mental representations of the world – that is, she can now think and plan.

As evidence for children attaining the level of mental representation, Piaget pointed out that by this substage children have a full concept of object permanence. Piaget noticed that very young infants ignored even highly attractive objects once they were out of sight [e.g. a child reaching for a toy, but then the toy is suddenly covered with a cloth and it immediately leads to the child losing all interest in it and would not attempt to search for it, and might even just look away]. According to Piaget it was only after the later substages that children demonstrated an awareness [by searching and trying to retrieve the object] that the object was “permanently” present even if it was temporarily out of sight. Searching for an object that cannot be seen directly implies that the child has a memory of the object, i.e. a mental representation of it.

It is only towards the end of the sensori-motor period that children demonstrated novel patterns of behaviour in response to a problem. For example, if a child wants to reach for a toy and comes across an object between herself and the desired toy, younger children might just try and reach for the toy directly and it is possible that the child knocks over the object while reaching for the target toy – this is best described as “Trial and Error” performance. In the later substages, the child might solve the problem by instead first removing the object out of the way before reaching for the desired toy. Such structured behaviour suggests that the child was able to plan ahead, which indicates that he/she had a mental representation of what she was going to do.

An example of planned behaviour by Jacqueline was given where she was trying to solve the problem of opening a door while carrying two blades of grass at the same time:

She stretches out her right hand towards the knob but sees that she is cannot turn it without letting go of the grass. She puts the grass on the floor, opens the door, picks up the grass again and enters. But when she wants to leave the room things become complicated. She put the grass on the floor and grasps the door knob but then she realises that in pulling the door towards her she will simultaneously chase away the grass which she placed between the door and the threshold. She therefore picks it up in order to put it outside of the door’s zone of movement.

(Piaget, 1936, pp. 376-7)

Jacqueline solved the problem of the grass and the door before she opened the door. It is assumed that she would have had a mental representation of the problem, which permitted her to work out the solution, before she acted.

A third line of evidence for mental representations comes from Piaget’s observation of deferred imitation, that is when children carry out a behaviour that is a reflection of copied behaviour that was previously taken in by the developing child. Piaget provides a good example of this:

At 16 months old Jacqueline had a visit from a little boy of 18 months who she used to see from time to time, and who, in the course of the afternoon got into a terrible temper. He screamed and he tried to get out of a playpen and pushed it backward, stamping his feet. Jacqueline stood observing him in amazement, having never witnessed such a scene before. The following day, she herself screamed in her playpen and tried to move it, stamping her foot lightly several times in succession.

(Piaget, 1951, p. 63)

This suggests that if the little boy’s behaviour was repeated by Jacqueline a day later, she would have had to have retained an image of his behaviour, i.e. she had a mental representation of what she had seen from the day before, and that representation provided the basis for her own copy of the temper tantrum.

To conclude, during the sensori-motor period, the child advances from very simple and limited reflex behaviours at birth, to complex behaviours at the end of the period. The more complex behaviours depend on the progressive combination and elaboration of the schema, but are, at the beginning, limited to direct interactions with the world – thus, the name Piaget gave to this period because he thought of the child developing through her sensori-motor interaction with the environment. It is only towards the end of that period that the child is not limited to immediate interaction anymore because she has now developed the ability to mentally represent her world [mental representation], and with this ability the child can manipulate her mental images (or symbols) of her world, in other words, she can now act on her thoughts about the world as well as on the world itself.

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Revisions of the Sensori-motor Stage

Jean Piaget’s observations of babies during this first stage lasting until 2 years of age, have been largely confirmed by subsequent reseachers, however Piaget may have underestimated children’s mental capacity to organize the sensory and motor information they take in. Several investigators have shown that children have abilities and concepts earlier than Piaget thought.

Bower (1982) examined Piaget’s hypothesis that young children did not have an appreciation of objects if they were not in sight. For this experiment, children a few months old were recruited and shown an object, and shortly after a screen was moved across in front of the object [so that it would be hidden/unseen from the child’s visual field], to then finally be moved back to its original position. This scenario was presented with 2 slight changes: in Condition 1 the object was still in place and hence seen again by the child when the screen was moved back to its original location; and in Condition 2, the object was removed so the child would perceive the object to have disappeared when the screen was moved back. After monitoring the children’s heart rate to measure changes [which reflect surprise]. To go back to Piaget’s assumptions from his qualitative observations, it would be assumed that children of a few months old do not retain information about objects that are no longer present, and if this was the case, we would not register any heart rate change because as there should be no element of surprise [i.e. the child would not expect an object to be there once the screen was moved back to its original location], thus in Condition 2, no reaction should be displayed by the children, however it was found that children displayed more surprise in Condition 2 and Bower inferred that the children would have had an expectation of the object to still be in its position or “re-appear” after the screen was moved back – this would be the evidence that young children must retain a mental representation of the object in their mind [could be interpreted as young children having some basic form of object permanence even if not properly developed at an earlier age than the assumptions of Piaget based on the results of his experimental methods].

In a further experiment, Baillargeon and DeVos (1991) showed 3-month-old children objects that moved behind a screen and then re-appeared from the other side of the screen. The upper half of the screen had a window and in one condition the children saw a short object move behind the screen [the object was small and below the level of the window and hence when it passed behind the screen it was completely out of sight / not visible, until it appeared at the other side of the screen].

In a second condition a taller object was passed behind the screen, and it was high enough to be seen through the window as it passed from one side to the other. Furthermore, Baillargeon and DeVos created an “impossible event” by passing the tall object through the screen without it appearing through the window, and it lead to the children displaying more interest by looking longer at the scenario than that with the small object. This lead to the argument that children reacted so, due to their expectation of the taller object to appear through the window, and hence this would suggest that young children early in the sensori-motor stage have an awareness of the continued existence of objects even when they are out of view. These results along with that of Bower (1982) seem to suggest that young children to have “some” understanding of object permanence earlier than assumed.

Another one of Piaget’s conclusion was also investigated further by another group of researchers who wanted to find out if children only developed planned action [which demonstrated their ability to form mental representations] at the end of the sensori-motor stage. Willatts (1989) placed an attractive toy on a cloth, out of the reach of 9-month-old children; the children could pull the cloth to access the attractive toy. However, the children could not reach the cloth directly since it was not accessible as Willatts placed a light barrier between the child and the cloth [the child had to move the barrier to reach the cloth]. The experiment showed that children were able to access the toy by carrying out appropriate the series of actions [i.e. first moving the barrier, then pulling the cloth to bring the toy within reach]. Most importantly, many of the children carried out the correct actions within the first occasion of being presented with the problem without the need of going through a “trial and error” phase. Willatts argued that for such young children to demonstrate novel planned actions, it may be inferred from such behaviour that they are operating on a mental representation of the world which they can make use of to organise their behaviour before carrying it out [This is also earlier than assumed by Piaget’s experiments].

Another point made by Piaget was that deferred imitation was an evidence that children should have a memory representation of what they had seen earlier. Soon after birth however it was found that babies are able to imitate the facial expression of an adult or the head movement (Meltzoff and Moore, 1983, 1989), however such imitation is performed in the presence of the stimulus being imitated. From Piaget’s experiments, it was initially deduced that stored representations are only achieved by children towards the end of the sensori-motor stage, however, Meltzoff and Moore (1994) showed that 6-week old infants could imitate a behaviour a day after they had seen the original behaviour. In Meltzoff and Moore’s study some children saw an adult make a facial gesture [e.g. sticking out her tongue] and others just saw the adult’s face while she maintained a neutral expression. The next day, all the children in the experiment saw the same adult, however this time, she kept a passive face. Compared to the children who had not seen any gesture, the children who had seen the tongue protrusion gesture the day before were more likely to make tongue protrusions to the adult the second time they saw her. Meltzoff and Moore argued that for the children to be able to perform those actions they would have had to have a mental representation of the action at a much earlier age than Piaget’s experiments concluded


II. The Pre-operational Stage (about 2 – 7 years) | Stage 2 of 4

This stage will be divided in 2 periods: (a) The Pre-conceptual Period (2 – 4 years) and (b) the Intuitive Period (4 – 7 years)

(a) The Pre-Conceptual Period (2 – 4 years)

The pre-conceptual period builds on the ability for internal, or symbolic thought to develop based on the latest advancements during the final stages of the sensori-motor period. During the pre-conceptual period [2 – 4 years old], we can observe a rapid increase in children’s language which, in Piaget’s view, results from the development of symbolic thought. Piaget unlike other theorists of language [who suggested that thought emerges from linguistic competence] argued that thought arises out of action and this idea is supported by research into cognitive abilities of deaf children who, despite limitations in language, have the abilities for reasoning and problem solving. Piaget argued that thought shapes language far more than language shapes thought [at least during the pre-conceptual period], and symbolic thought is also expressed in imaginative play.

However there are some limitations in the child’s abilities at the pre-conceptual period (2-4 years) of the pre-operational stage. The pre-operational child is still centred in her own perspective and finds it difficult to understand that other people can look at things differently. Piaget called this the “self-centred” view of the world and used the term egocentrism.

Egocentric thinking occurs due to the child’s belief that the universe is centred on herself, and thus finds it hard to “decentre”, that is, to take the perspective of another individual. The dialogue below gives an example of a 3-year-old’s difficulty in taking the perspective of another person:

Adult: Have you any brothers or sisters?
John: Yes, a brother.
Adult: What is his name?
John: Sammy.
Adult: Does Sammy have a brother?
John: No.

It is quite clear here that 3-year old John’s inability to decentre makes it hard for the child to realise that from Sammy’s perspective, he himself is a brother.

The egocentric trait at this particular period of development is apparent in their flawed perspective taking tasks. One of the most famous experiments carried out by Piaget is the three mountains experiment tasks, and it involves exploring children’s ability to see things from the perspective of another. In 1956, Piaget and Inhelder asked children between the ages of four and twelve [4 – 12 years old] to say how a doll would perceive an array of three mountains from different perspectives [i.e. by placing the doll at different locations].

FJ Piaget III Mountain Task.jpg

FIGURE J. Model of the mountain range used by Piaget and Inhelder viewed from 4 different sides

For example in Figure J, a child might be asked to sit at position A, and a doll would be placed at one of the other positions (B, C or D), then the child would be made to choose from a set of different views of the model, the view that the doll could see. When four and five year old children [4 and 5 years old] were asked to do this task, they often chose the view that they themselves could see (rather than the doll’s view) and it was not until 8 or 9 years of age that children could confidently work out the doll’s view. Piaget argued that this should be convincing in asserting that young children were still learning to manage their egocentricity and could not decentre from their own perspective to work out the perspective / view of the doll.

However, several criticisms have been made regarding the 3 mountain tasks, and one researcher, Donaldson (1978) pointed out that the tasks were unusual to use with young children who might not have a good familiarity with model mountains or be used to working out other people’s views of landscapes. Borke (1975) carried out a similar task to Piaget, but instead of using model mountains, he used the layout of toys that young children typically spend time with in play. She also altered the way that children were asked to respond to the question about what a different person’s view would be, and found that children as young as 3 or 4 years of age had some basic understanding of how another person’s perspective would be different from another position. This was much earlier than previously deduced from Piaget’s experiments, and shows that the type of objects and procedures used in a task can have a huge impact on the performance of the children. By using mountains, Piaget may have selected a far too complex content for such young children’s perspective-taking abilities to be demonstrated optimally.

Borke’s Experiment: Piaget’s Mountains Revised & Changes in the Egocentric Landscape

Borke’s main inquisition was about the appropriateness of Piaget’s three mountain tasks for such young children, and was concerned with the aspects of the task that were not related to perspective-taking and whether this might have adversely affected the children’s performance. These aspects were:

(i) the mountain from a different angle or not may not have sparked any interest or motivation in the children
(ii) the pictures of the doll’s views that Piaget had asked the children to select may have been too taxing for their intelligence
(iii) due to the task being unusual in nature, children may have performed poorly because they were unfamiliar with such a task

Borke considered if some initial practice and familiarity with the task would improve the children’s performance, and with those points in mind, Borke repeated the basic design of Piaget and Inhelder’s experiment but changed the content of the task, avoided the use of pictures and gave children some initial practice. She also used 4 three-dimensional  displays: there were a practice display and three experimental displays [see FIGURE B].

FB Borke's 4 three-dimensional displays

FIGURE B. A schematic view of Borke’s four three-dimensional displays viewed from above.

Borke’s participants were 8 three-year-old children and 14 four-year-old children attending a day nursery. Grover, a character from the popular children’s television show, “Sesame Street” was used for the experiment as a substitute for Piaget’s doll. There we 2 identical versions of each display (A and B), and Display A was for Grover and the child to look at, and Display B was on a turntable next to the child.

The children were tested individually and were first shown a practice display which consisted of a large toy fire engine. Borke placed Grover at one of the sides of the practice Display A so that Grover could view the fire engine from a point of view [perspective] that was different from the child’s own view of this display.

A duplicate of the fire engine [practice Display B] appeared on a revolving turntable, and Borke briefed the children, explaining that the table could be turned so that the child could look at the fire engine from ANY side. Children were then prompted to turn the table until their view of the Display B matched the exact perspective that Grover had while looking at Display A. If necessary, Borke even helped the children to move the turntable to the correct position or walked the children round Display A to show them the exact view [perspective] that Grover had in view

Once the practice session was over, the child was ready to take part in the experiment itself. This time, the procedures were similar, except no help was provided by the experimenter. Every single child was shown three dimensional displays, one at a time [see FIGURE B].

Display 1 included a toy house, lake and animals
Display 2 was based in Piaget’s model of three mountains
Display 3 included several scenes with figures and animals
Note: There were 2 identical copies of each display, and of course, children had to rotate the second  copy which was on a turntable to match the perspective [view] that Grover had in sight [as prepared in the practice session].

What Borke found was that most of the children in the experiment were able to work out Grover’s perspective for Display 1 [three and four-year-olds were correct in 80% of trials] and for Display 3 [three-year-olds were correct in 79% of trials and four-year-olds, in 93% of trials. However, for Display 2 [Piaget’s mountains], the three-year-olds were correct in only 42% of trials and four-year-olds in 67% of trials. Borke calculated an analysis of variance, and found that the difference between Displays 1 & 3 and Display 2 was significant at p < 0.001. As for errors, there were no significant differences in the children’s responses for any of the 3 positions – 31% of errors were egocentric [i.e. child rotated Display B to show their OWN view/perspective of Display A, rather than Grover’s view].

Borke successfully demonstrated that the task had a major influence on the perspective-taking performances of young children. When the display included toys that the children were familiar with and hence recognisable, and when the response involved rotating a turntable to work out Grover’s perspective, even the comparatively complex Display 3 task was successfully achieved by the children.

This seems to suggest that the poor performance by the children in Piaget’s original experiment involving three mountains was due in part to the unfamiliar nature of the objects that the children were shown.

Borke concluded that the potential for understanding the viewpoint of another was already present in children as young as 3 and 4 years of age, and this seems to be a reliable addition and revision to Piaget’s original assumption that children of this age are egocentric and incapable to taking the viewpoint of others. It now seems clear that although their perspective taking abilities may not be fully developed, they tend to make egocentric responses when they misunderstood the task, but when given the appropriate conditions, they show that they are capable of working out another’s viewpoint.

However, on a final note, it is important to also consider that Borke’s finding that children as young as three years can perform correctly in perspective-taking tasks stands in firm contrast to other researchers who have found that three-year-olds have difficulty realising another person’s perspective when the child and the other person are both looking at the same picture from different point of view [e.g. at the Louvres museum] (e.g., Masangkay et al, 1974).


(a) The Pre-Conceptual Period (2 – 4 years)… continued from above

Piaget use the three mountains task to investigate visual perspective taking and it was on the basis of this task that he concluded that young children were egocentric. There are also a variety of other perspective taking scenarios, and these include the ability to empathise with other people’s emotions, and the ability to know what other people are or may be thinking depending on the scene, setting and scenario (Wimmer and Perner, 1983). In other words, young children are less egocentric than Piaget initially assumed.


(b) The Intuitive Period (4 – 7 years)

At about the age of four, there is a further shift in thinking where the child begins to develop the mental operation of ordering, classifying and quantifying in a more systematic way. The term “intuitive” was particularly chosen by Piaget because the child is largely unaware of the principles that underlie the operations she completes and cannot explain why she has done them, nor can she carry them out in a fully satisfactory way, although she is able to carry out such operations involving ordering, classifying and quantifying.

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Difficulties can be observed if a pre-operational child is asked to arrange sticks in a particular order. 10 sticks of different sizes from A (the shortest) to J (the longest), arranged randomly on a table were given to the children. The child was asked to arrange them in ascending order [order of length]. Some pre-operational children could not complete the task at all. Some other children arrange a few sticks correctly, but could not complete the task properly. And some put all the smaller ones in one and all the longer one in another. A more advance response was to arrange the sticks so that tops of the sticks when order even though the bottoms were not [See FIGURE C].

FC Pre-operational ordering different-sized sticks

FIGURE C. The pre-operational child’s ordering of different-sized sticks. An arrangement in which the child has solved the problem of seriation by ignoring the length of the sticks.

To sum up, the pre-operational child is not capable of arranging more than a very few objects in the appropriate order.

It was also discovered that pre-operational children also have difficulty with class inclusion tasks – those that involve part-whole relations. Let us assume that a child is given a box that contains 18 brown beads and 2 white beads; all the beads are wooden. When asked “Are there more brown beads than wooden beads?” [note that the question does not make sense since all the beads are made of wood but some are brown and some are white], the pre-operational child tends to say that there are “more brown beads”. The child at the intuitive-period of the pre-operational stage finds it hard to consider the class of “all beads” [wooden] and at the same time considering the subset of beads, the class of “brown beads”[wooden + brown].

This findings is generally true for all children in the pre-operational stage, irrespective of their cultural background. Investigators further found that Thai and Malaysian children gave responses that were very similar to those of Swiss children at this stage of life [4 – 7 years old] and in the same sequence od development [the intuitive period].

Here, a Thai boy who was shown a bunch of 7 roses and 2 lotus [all are in the class of flowers], states that there are more roses than flowers [problem with class of all flowers] when prompted by the standard Piagetian questions:

Child: More roses.
Experimenter: More than what?
Child: More than flowers.
Experimenter: What are the flowers?
Child: Roses.
Experimenter: Are there any others?
Child: There are.
Experimenter: What?
Child: Lotus
Experimenter: So in this bunch which is more roses or flowers?
Child: More roses.

(Ginsburg and Opper, 1979, pp. 130-1)

One of the most extensively investigated aspects of the pre-operational child’s thinking processes is what Piaget called “conservation”. Conservation refers to the understanding that superficial changes in the appearance of a quantity do not mean that there has been any real change in the quantity. For example, if we had 10 dolls placed in line, and then they were re-arranged in a circle, it would not mean that the quantity has been altered [i.e. if nothing is added or subtracted from a quantity then it remains the same – conservation].

Piaget’s experiments revealed that children in the pre-operational stage generally find it hard to grasp the concept that an object’s qualities remain intact even if it is changed in shape and appearance. A series of conservation tasks were used in the investigations and examples are given in FIGURE D and PLATE A.

FD Piaget - Tests de Conservation

FIGURE D. Some tests of conservation: (a) two tests of conservation of number (rows of sweets and coins; and flowers in vases); (b) conservation of mass (two balls of clay); (c) conservation of quantity (liquid in glasses). In each case illustration A shows the material when the child is first asked if the two items or sets of items are the same and illustration B shows the way that one item or set of items is transformed before the child is asked a second time if they are still similar.

PA Piaget - Conservation of Number

PLATE A. A 4-year-old puzzles over Piaget’s conservation of number experiments; he says that the rows are equal in number in arrangement (a), but not in arrangement (b) “because they’re all bunched together here”.

If 2 perfectly identical balls of clay are given to a child and if questioned about whether the quantity of clay being similar in both balls, the child will generally agree that it is. However, if one of the balls of clay is rolled and shaped into a sausage [see FIGURE D(b)], and the child is questioned again about whether the amount are similar, he/she is more likely to say that one is larger than the other. When asked about the reasons for the answer, they are generally unable to give an explanation, but simply say “because it is larger”.

Piaget suggested that a child has difficulty in a task such as this because she could only focus on one attribute at a time [e.g. if length is being focussed on, then she may think that the sausage shaped clay, being longer, has more clay it it. According to Piaget, for a child to appreciate that the sausage of clay has the same amount of clay as the ball would require an understanding that the greater length of the sausage is compensated for by the smaller cross section of the sausage. Piaget said that pre-operational children cannot apply principles such as compensation.

A further example to demonstrate this weakness in the child’s reasoning about conservation is through the sweets task [see FIGURE D(a)]. In this scenario, a child is shown 2 rows of sweets with a similar number of sweets in each row [presented with one to one layout] and when asked if the numbers match in each row, she will usually agree. Shortly after, one row of sweets is made longer by spreading them out, and the child is once again asked whether the number of sweets in similar in each row; the pre-operational child usually makes a choice between the rows suggesting that one has more sweets in it. He/she may for example think that the longer row means more objects [logic of the pre-operational child]. At this stage, the child does not realise that the greater length of the row of sweets is compensated for by the greater distance between the sweets.

Compensation is only one of several processes that can help children overcome changes in appearance; another process is known as “reversibility”. This is where the children could think of literally “reversing” the change; for example if the children imagine the sausage of clay being rolled back and reshaped into a ball of clay, or the row of sweets being pushed back together, they may realise that once the change has been reversed the quantity of an object or the number of items in the row remains similar to before. Pre-operational children lack the thought processes needed to apply principles like “compensation” and “reversibility”, and therefore they have difficulty in conservation tasks.

In the next stage, which is the third stage of development known as the “Concrete Operational Stage”, children will have achieved the necessary logical thought processes that give them the ability to use the required principles and handle conservation techniques and other problem-solving tasks easily.


Revisions of the Pre-Operational Stage

While Piaget claimed that the pre-operational child cannot cope with tasks like part-whole relations or conservations, because they lack the logical thought processes to apply principles like compensation. Other researchers have pointed out that children’s lack of success in some tasks may be due to factors other than ones associated with logical processes.

The pre-operational child seems to lack the ability to grasp the concept of the relationship between the whole and the part in class inclusion tasks, and will happily state that there are more brown beads than wooden beads in a box of brown and white wooden beads “because there are only two white ones”. Some other researchers have focussed their attention on the questions that children are asked during such studies and found them to be unusual [e.g. it is not often in every day conversation that we ask questions such as “Are there more brown beads or more wooden beads?”]

Minor variations in the wording of the questions that enhances and clarifies meaning can have positive effects on the child’s performance. McGarrigle (quoted Donaldson, 1978) showed children 4 toy cows, 3 black and 1 white, all were lying asleep on their sides. If the children were asked “Are there more black cows or more cows?” [as in a standard Piagetian experiment with a meaningless trap wording of the question] they tended not to answer correctly. McGarrigle found that in a group of children aged 6 years old, 25% answered the standard Piagetian question correctly, and when it was rephrased, 48% of the children answered correctly – a significant increase. From such an observation it was deduced that some of the difficulty of the task was in the wording of the question rather than just an inability to understand part-whole relations.

Donaldson (1978) put forward a different reason from Piaget as a cause for children’s poor performance in conservation tasks, he argued that children have a build in model of the world by formulating hypotheses that help them anticipate future events based on their past experiences. Hence, in the case of the child there is an expectation about any situation, and his/her interpretation of the words she hears will be influenced by the expectations she brings to the situation. When in a conservation experiment, for example, the experimenter asks a child if there are the same number of sweets in two rows [FIGURE D(a)]. Then one of the rows is changed by the experimenter while emphasising that it is being altered. Donaldson suggested that it is quite fair to assume that a child may be compelled to deduce that there would be a link between the change that occurred [the display change] and the following question [about the number of sweets in each row]; otherwise why would such a precise question come from an adult if there had not been any change? If the child is of the belief that adults only carry actions when they desire a change, then he/she might assume that a change has occurred.

McGarrigle and Donaldson (1974) explored this idea in an experiment with a character known as “Naughty Teddy”, and it was this character rather than the experimenter who changed the display layout and the modification was explained to the children as an “accident” [in such a context the child might have less expectation that a deliberate treatment had been applied to the objects, and there would be no reason to believe a change had taken place]. This procedure was setup in such a way because McGarrigle and Donaldson found that children were more likely to give the correct answer [that the objects remained the same after being messed up by Naughty Teddy] in this new context than in the classical Piagetian context.

Piaget was correct to point out the problems that pre-operational children face with conservation and other reasoning tasks. However, other researchers since Piaget have found out that, given the appropriate wording and context, young children seem capable of demonstrating at least some of the abilities that Piaget thought only developed later [even if these abilities are not well developed at such a stage].

Piaget also found that pre-operational children had difficulties when faced with tasks requiring “transitive inferences”. In this case, the children were showed 2 rods, A and B. Rod A was longer than Rod B, and then Rod A was taken out of sight of the children, who were then showed only Rod B and Rod C [B was longer than C]. When the children were then asked which rod was longer, Rod A or Rod C? Young children on the pre-operational stage find such questions hard and Piaget provided the explanation that these children cannot make logical inferences such as: if A is longer than B and B is longer than C, then A must be longer than C.

Bryant and Trabasso (1971) also considered transitive inference tasks and wondered whether children’s difficulties had more to do with remembering all the specific information about the objects rather than making an inference [i.e. for children to respond correctly they would not only have to make an inference but also remember the lengths of all the rods they had seen]. Bryant and Trabasso proposed that it was possible that young children [with brains still growing and developing physiologically] who have limited working memory capacity, were unable to retain in memory all the information they needed for the task.

In another scenario, children were faced with the similar task in an investigation of transitive inferences, however this time they were trained to remember the lengths of the rods [they were trained on the comparisons they needed to remember, i.e., that A was longer than B, and B was longer than C]. It is only when Bryant and Trabasson were satisfied that the children could remember all the information were they asked the test question [i.e. which rod was longer? A or C?]. The experimenters found that children could now answer correctly. So, the difficulty that Piaget noted in those tasks was more to do with forgetting some of the information needed to make the necessary comparisons, rather than a failure in making logical inferences.


III. The Concrete Operational Stage (about 7 – 12 years) | Stage 3 of 4

Mikail Akar Art Education Jan 2020 dpurb site web

Image: Mikail Akar, the 7-year-old being crowned the “Mini Picasso” (2020)

At the age of about 7 years old, the thinking processes of children change once again as they develop a new set of strategies which Piaget called “concrete operations”. These strategies are considered concrete because children can only apply them to immediately present objects. However, thinking becomes much more flexible during the concrete operational period because children lose their tendency to simply focus on one aspect of the problem, rather now, they are able to consider different aspects of a task at the same time. They now have processes like compensation and reversibility [as explained earlier in understanding volume], and they now succeed on conservation tasks. For example, when a round ball of clay is transformed into a sausage shape, children in the concrete operational stage will say, “It’s longer but it’s thinner” or “If you change it back, it will be the same.”

Conservation of number is achieved first [about 5 or 6 years], then this is followed by the conservation of weight [around 7 or 8], and the conservation of volume is fully understood at about 10 or 11 years old. Operations like addition and subtraction, multiplication and division become easier at this stage. Another major shift comes with the concrete operational child’s ability to classify and order, and to understand the principle of class inclusion. The ability to consider different aspects of a situation at the same time enables a child to perform successfully in perspective taking tasks [e.g. in the three mountains task of Piaget, a child can consider that she has one view of the model and that someone else may have a different view].

However, there are still some limitations on thinking, because children are reliant on the immediate environment and have difficulty with abstract ideas. Take the following question: “Edith is fairer than Susan. Edith is darker than Lily. Who is the darkest and who is the fairest?” Such a problem is quite difficult for concrete operational children who may not be able to answer it correctly. However, if children instead are given a set of dolls representing Susan, Edith and Lily, they are able to answer the question quickly. Hence, when the task is made a “concrete” one, in this case with physical representations, children can deal with the problem, but when it is presented verbally, as an abstract task, children have difficulty. Abstract reasoning is not found within the repertoire of the child’s skills until the latter has reached the stage of formal operations.


Revisions of the Concrete Operational Stage

A great amount of Piaget’s observations and conclusions about the concrete operational stage have been broadly confirmed by subsequent research. Tomlinson-Keasey (1978) found that conservation of number, weight and volume are acquired in the order stated by Piaget.

As in the previous stage, the performance of children in the concrete operational period may be influenced by the context of the task. In some context, children in concrete operational period may display more advanced reasoning that would typically be expected of children in that stage. Jahoda (1983) showed that 9-year-olds in Harare, Zimbabwe, had more advanced understanding of economic principles than British 9-year-olds. The Harare children, who were involved in the small business of their parents, had strong motivation to understand the principles of profit and loss. Jahoda set up a mock shop and played a shopping game with the children. The British 9-year-olds could not provide any explanation about the functioning of the shop, did not understand that a shopkeeper buys for less than he sells, and did not know that some of the profit has to be set aside for the purchase of new goods. The Harare children, by contrast, had mastered the concept of profit and could understand trading strategies. These principles had been grasped by the children as a direct outcome of their own active participation in running a business. Jahoda’s experiment, like Donaldson’s studies (1978), indicated the important function of context in the cognitive development of children.


IV. The Formal Operational Stage (12 years old) | Stage 4 of 4

During the third period of development, the Concrete operations stage, we have seen that the child is able to reason in terms of objects [e.g., classes of objects, relations between objects) when the objects are present. Piaget argued that only during the period of Formal Operations that young people are able to reason hypothetically, now they no longer depend on the “concrete” existence of objects in the real world, instead they now reason with verbally stated hypotheses to consider logical relations among several possibilities or to deduce conclusions from abstract statements [e.g. consider the syllogistic statement, “all blue birds have two hearts”; “I have a blue bird at home called Adornia”; “How many hearts does Adornia have?” The young person who has now reached formal operational thinking will give the correct answer by abstract logic, which is: “Two hearts!” Children within the previous stage will generally not get past complaining about the absurdity of the scenario.

Young people are now also better at solving problems by considering all possible solutions systematically. If requested to formulate as many combinations of grammatically correct words from the letters A, C, E, N, E, V, A, a young person at the formal operational stage could first consider all combination of letters AC, AE, AN, etc., verifying if such combinations are words, and then going on to consider all three letter combinations, and so on. In the earlier stages, children would attend to such tasks in a disorganised and unsystematic fashion.

Inhelder and Piaget (1958) explained the process of logical reasoning used by young people when presented with a number of natural science experiments. An example of one of their task, “The Pendulum Task” can be seen in Figure E.

FE Piaget - Pendulum Prob

FIGURE E. The pendulum problem. The child is given a pendulum, different lengths of string, and different weights. She is asked to use these to work out what determines the speed of the swing of the pendulum (from Inhelder and Piaget, 1958).

The young person as the participant here is given a string [that can be shortened or lengthened], and a set of weights, and then asked to figure out what determines the speed of the swing of the pendulum. The possible factors are the length of the string, the weight at the end of the string, the height of the release point and the force of the push. In this particular scenario the solutions to the solving the problem are all in front of the participant, however the successful reasoning involves formal operations that would also have to incorporate a systematic consideration of various possibilities, the formulation of hypotheses (e.g., “What could happen if I tried a heavier weight?”) and logical deductions from the results of trials with different combinations of materials.

The other tasks investigated by Inhelder and Piaget (1958) included determining the flexibility of metal rods, balancing different weights around a fulcrum, and predicting chemical reactions. These tasks mimic the steps required for scientific inquiry, and Piaget argued that formal scientific reasoning is one of the most important characteristic of formal operational thinking. From his original work, carried out in schools in Geneva, Piaget claimed that formal operational thinking was a characteristic stage that children or young people reached between the ages of 11 and 15 years – having previously gone through the earlier stages of development.


Revision of the Formal Operational Stage

Piaget’s claim has been rectified by recent research, more researchers have found that the achievement of formal operational thinking is more gradual and haphazard than Piaget assumed – it may be dependent on the nature of the task and is often limited to certain domains.

FF Piaget - Proportion of boys at different Piagetian stg

FIGURE F. Proportion of boys at different Piagetian stages as assessed by three tasks (from Shayer and Wylam, 1978).

Shayer et al. (1976; Shayer and Wylam 1978) gave problems such as the pendulum task [FIGURE E] to school children in the UK. Their results [see FIGURE F] showed that by 16 years of age only about 30% of young people had achieved “early formal operations” [Is this shocking compared to French speaking Europe where Piaget implemented his theory? Could this provide a partial explanation to the lack of personality, emotion, creativity, openness, depth and sophistication in some populations? Interesting questions…]. Martorano (1977) gave ten of Piaget’s formal operational tasks to girls and young woman aged 12 – 18 years in the USA. At 18 years of age success on the different tasks varied from 15% to 95%; but only 2 children out of 20 succeeded on all ten tasks. Young people’s success on one or two tasks might indicate some formal operational reasoning, but their failure on other tasks demonstrated that such reasoning might be limited to certain tasks or contexts. It is highly likely that young people only manage to achieve and apply formal reasoning across a range of problem tasks much later during their adolescence.

Formal thinking has been shown by some researchers as an ability that can be achieved through training, FIGURE G shows the results of such a study by Danner and Day (1977), where they mentored students aged 10 years, 13 years and 17 years in 3 formal operational tasks. As expected, training had a limited effect on the 10-year-olds, but it had marked effects at 17 years old. In summary, it seems that the period from 11 – 15 years signals the beginning of the potential for formal operational thought, rather than its achievement. Formal operational thought may only be used some of the time, in the domains we are generally familiar with, are trained in, or which have a great significance to us – in most cases formal thinking is not used. After all, we tend to know areas of life where we should have thought things out logically, but in retrospect realise we did not do so [without any regrets sometimes].

FG Piaget - LvL of availability of formal thought

FIGURE G. Levels of availability of formal thought. Percentage of adolescents showing formal thought, with and without coaching (from Danner and Day, 1977).

The Educational Implications of Jean Piaget’s Theory of Cognitive Development

Piaget’s theory was planned and developed over many decades throughout his long life, and at first, it was slow to make any productive impact in the UK and the USA, but from the 1950s its ambitious, embracing framework for understanding cognitive growth was becoming the accepted and dominant paradigm in cognitive development.

Whatever the shortcomings are with Piaget’s theory, it impossible to deny his ingenious contributions, as his approach provided the most comprehensive description of cognitive growth ever put forward on earth. It has had considerable impact in the domains of education, most notably for child-centred learning methods in nursery and infant schools, for mathematics curricula in the primary school, and for science curricula at the secondary school level.

Piaget argued that young children’s thinking processes are quite different from that of an adult, and they also view he world from a qualitatively different perspective. It goes with the logic that a teacher must make a firm effort to adapt to the child and never assume that what may be appropriate for adults should necessarily be right for the child. The idea of “active learning” is what lies at the heart of this child-centre approach to education. From the Piagetian perspective, children learn better from actions rather than from passive observations [e.g., telling a child about the properties of a particular material is less effective than creating an environment in which the child is free to explore, touch, manipulate and experiment with different materials]. A good teacher should recognise that each child needs to construct knowledge for him or herself, and active learning results in deeper understanding.


“Our real problem is: what is the goal of education? Are we forming children who are only capable of learning what is already known? Or should we try to develop creative and innovative minds capable of discovery from the preschool age through life?” – Jean Piaget (1896 – 1980)

So, how can a teacher promote active learning on the part of the pupil? First, it should be the child rather than the teacher who initiates the activity. This should not lead us to allow the child a complete freedom to do anything they want to do, but rather a teacher should set tasks which are finely adjusted to the needs of their pupils and which, as a result, are intrinsically motivating to young learners. For example, nursery school classrooms can provide children with play materials that encourage their learning; set of toys that encourage the practice of sorting, grading and counting; play areas, like the Wendy House, where children can develop role-taking skills through imaginative and explorative play; and materials like water, sand, bricks and crayons that help children make their own constructions and create symbolic representations of the objects and people in their lives. From this range of experiences, the child develops knowledge and understanding for herself, and a good teacher’s role is to create the conditions in which learning may best take place, since the aim of education is to encourage the child to ask questions, try out experiments and speculate, rather than accept information and routine conventions unthinkingly – this also allows the child to learn and be creative about her subjective experience which is unique and different to any other child.

(1919) Jaroslava &amp; Jiri by Alphonse Mucha (1860 - 1939)

(1919) Jaroslava & Jiri, The Artist’s Children by Alphonse Mucha (1860 – 1939)

Secondly, a teacher should be concerned with the process rather that the end-product. This is in line with the belief that a teacher should be interested in the reasoning behind the answer that a child gives to a question rather than just in the correct answer. Conversely, mistakes should not be penalised, but treated as responses that can give a teacher insight into the child’s thinking processes at that time.

The whole idea of active learning resulted in changed attitudes towards education in all its domains. A teacher’s role is not to impart information, because in Piaget’s view, knowledge is not something to be transmitted from an expert master teacher to an inexpert pupil. It should be the child, according to Piaget, who sets the pace, where the teacher’s role is to create situations that challenge the child [creatively] to ask questions, to form hypotheses and to discover new concepts. A teacher is the guide in the child’s process of discovery, and the curriculum should be adapted to each child’s individual needs and intellectual level.

In mathematics and science lessons at primary school, children are helped to make the transition from pre-operational thinking to concrete operations through carefully arranged sequences of experiences which develop an understanding for example of class inclusion, conservation and perspective-taking. At a later period, a teacher can also encourage practical and experimental work before moving on to abstract deductive reasoning. Through this process, a teacher can provide the conditions that are appropriate for the transition from concrete operational thinking to the stage of formal operations.

The post-Piagetian research into formal operational thought also has strong implications for teaching, especially science teaching in secondary schools. The tasks that are used in teaching can be analysed for the logical abilities that are required to fulfil them, and the tasks can then be adjusted to the age and expected abilities of the children who will attempt them.

Considering the wide range of activities and interests that appear in any class of children, learning should be individualised, so that tasks are appropriate to individual children’s level of understanding. Piaget did not ignore the importance of social interaction in the process of learning, he recognised the social value of interaction and viewed it as an important factor in cognitive growth. Piaget pointed out that through interaction with peers, a child can move out of the egocentric viewpoint. This generally occurs through cooperation with others, arguments and discussions. By listening to the opinion of others, having one’s own view challenged and experiencing through others’ reactions the illogicality of certain concepts, a child can learn about perspectives other than her own [egocentric]. Communication of ideas to others also helps a child to sharpen concepts by finding the appropriate words.



“Everyone knows that Piaget was the most important figure the field has ever known… [he] transformed the field of developmental psychology.”

(Flavell, 1996, p.200)

“Once psychologists looked at development through Piaget’s eyes, they never saw children in quite the same way.”

(Miller, 1993, p.81)

“A towering figure internationally.”

(Bliss, 2010, p.446)




(II) The Theory of Attachment in Emotional Development (John Bowlby)

If we pick up a new born baby , he/she will respond without any difference to us or to any other person. However, after 9 months, the same baby will have developed one or more selective attachments and will discriminate familiar faces to unfamiliar ones. So, if we were to pick up the baby again, we may face scenarios where he/she displays anxiety or cries, but if the mother or father picks her/him up, the baby will be reassured and pacified.

This section will explore and give an account of the development of attachment relationships between infants, parents, and other close primary caregivers. The significance of such attachments for development in adult life will also be considered, with its implication for the philosophy of education in sculpting the minds of tomorrow, along with some research on parenting styles analysing some of the factors affecting successful and less successful parenting.


The Development of Attachment Relationships: Attachment as an innate drive

The infant’s expression of emotions and the caregiver’s response to these emotions is the fundamental foundation of John Bowlby’s Theory of Attachment. Bowlby’s (1958, 1969 / 1982, 1973, 1980) theory was inspired and influenced by an exciting and creative range of disciplines including psychoanalysis, ethology and the biological sciences. Before Bowlby, the main assumption and view of the infant-mother attachment was that it was a “secondary drive” or a side-product of the infant associating the mother with the provision of physiological needs, such as hunger [Picture B – breast feeding image].

Breastfeeding Mother

PICTURE B. Early theories of infant-mother attachment suggested that it was a secondary drive resulting from the mother satisfying the infant’s primary drives, such as hunger. / Photography:  Jo Frances

Bowlby defied this logic, and argued convincingly that attachment was an innate primary drive in all infants, and while his theory went through many revisions over the years, this argument remained fundamental.

In Bowlby’s first version of his theory of attachment (Bowlby, 1958), the emphasis was on the role of behaviours resulting from our instincts [on how behaviours such as crying, clinging and smiling served the purpose of eliciting a reciprocal attachment response from the caregiver]:

There matures in the early months of life of the human infant a complex and nicely balanced equipment of instinctual responses, the function of which is to ensure that he obtains parental care sufficient for his survival. To this end the equipment includes responses which promote his close proximity to a parent and… evoke parental activity.

(Bowlby, 1958, p. 346)

However, in the 1969 version of his theory (1st volume of his trilogy, Attachment and Loss),  Bowlby focussed on highlighting the dynamics of attachment behaviour, and switched to explaining the infant-mother tie in terms of a goal-corrected system which was triggered by environmental cues rather than innate instinctual behaviours. Whether attachment is instinctual or goal-corrected, we know that it eventually leads to the infant maintaining proximity to the primary caregiver.

Bowlby acknowledged that the development of an attachment relationship was not dependent purely upon the social and emotional interplay between infant and caregiver. Since we can only observe attachment behaviour primarily when the infant is separated from the caregiver, it is logically dependent upon the infant’s level of cognitive development in the ability for object permanence [i.e. the ability to represent an object (living or non-living) that is not physically present within the child’s proximity].

This seems to synchronise partly with Piaget’s outlook and theory of cognitive development, and indeed Bowlby was inspired by Jean Piaget, and based his argument on Piaget’s (1955) contention that this level of object permanence is not attained until the infant is approximately 8 months old. Furthermore, while children would be able to recognise familiar people before such age, they would still not miss the attachment figure and thus display attachment behaviour until they have reached the level of cognitive sophistication that comes with the ability to represent absent objects [and people, who are in the same class].


The Phases of Attachment: Development of Attachment Relationships

Let us imagine a classic example of a mother and child [about 1 – 2 year-old] in a park. What we might observe is that the mother is seated on a bench while the infant runs off to explore the area. Periodically, the child may be seen to stop and look back at the mother, and every once in a while may even return close to her, or make physical contact, staying close for a while before venturing off again. In most cases, the infant rarely goes beyond about 60 metres from the mother or primary caregiver, who may however have to go and retrieve the child if the distance gets too great or if the need to leave is imminent.

The scenario here from a developmental psychologist’s perspective is fairly simple; the infant is exploring the environment it is being exposed to inquisitively, and is using the mother as a “secure base” to which to return periodically for reassurance. This is one of the hallmarks of an “attachment relationship”. These observations of children in parks were made by a student of John Bowlby, Anderson (1972) in London, and the development of attachment has been described in detail by John Bowlby (1969).

Bowlby (1969, p. 79) described 4 phases in the development of attachment and subsequently extended it to a 5th.

The phases are:

I. The pre-attachment phase (0 – 2 months) is characterised by the infant showing hardly any differentiation in their responses to familiar or unfamiliar faces.

II. During the second phase (2 – 7 months), the foundations of attachment are being laid. Here infants start to recognise their caregivers, even if they still do not possess the ability to show attachment behaviours upon separation. The infant is also more likely to smile at the mother or important caregivers and to be comforted by them if distressed.


III. Clear cut attachment behaviours only start to appear after 7 months. At this phase, infants start to protest at being separated from their caregivers and become very wary of strangers [so called stranger anxiety] – this is often taken as a definition of attachment to caregiver and this onset of attachment happens from 7 – 9 months.

IV. When the attachment relationship has evolved into a goal-corrected partnership (from around 24 months / 2 years of age), [i.e. when the child also begins to accommodate to the mother’s needs, e.g. being prepared to wait alone if requested until the mother returns]. This is an important change because before this phase, the infant only saw the mother as a resource that had to be available when needed. Bowlby saw this as characterising the child at 3 years of age, although as mentioned from 2 years old babies can partly accommodate to verbal requests by mothers to await for her return (Weinraub and Lewis, 1977). From this phase onwards, the child relies on representation or internal working models of attachment relationships to guide their future social interactions.

V. The lessening of attachment is noticed as measured by the child maintaining proximity. The characteristics of a school-age child, and older, is the idea of a relationship based more on abstract considerations such as affection, trust, loyalty and approval, exemplified by an internal working model of the relationship.

Bowlby viewed attachment as a canalized developmental process where both the mainly instinctive repertoire of the new born and certain forms of learning are important in early social interactions. Certain aspects of cognitive sensori-motor development [as supported by Jean Piaget] are also fundamental for attachment. Until the developing infant can master the concept of cause-effect relations, and of the continued existence of objects [incl. persons] when out of sight, he or she cannot protest at separation and attempt to maintain proximity [note the importance of object permanence in emotional development and internal working models]. Hence, sensori-motor development is also a canalised process, and it should not be in opposition to an ethological and a cognitive-learning approach to attachment development.


Attachments: Between whom?

Many articles and textbooks have characterised the attachment relationship as mainly focussed on the mother (e.g. Sylvia and Lunt, 1981), and this may not be completely true, since many studies have suggested that early attachments are usually multiple, and although the strongest attachment is often to the mother, this need not always be so.

In a study conducted in Scotland, mothers were interviewed and asked to whom their toddlers showed separation protest (Schaffer and Emerson, 1964), the proportion of babies with more than 1 attachment figure increased from 29% when separation protest first appeared [about 7 – 9 months] to 87% at 18 months [1 and half year old]. It was also found that for about one third of babies, the strongest attachment seemed to be to someone other than the mother, such as father, or other trusted primary caregivers. In most cases, attachment were formed to responsive persons who interacted and played a lot with the infant; basic caregiving such as nappy changing was clearly not in itself such an important factor; and similar results were obtained by Cohen and Campos (1974).


Peinture: Sandrine Arbon

Studies in other cultures also support this conclusion, for example in the Israeli kibbutzim, young children spend the majority of their waking hours in small communal nurseries, in the charge of a nurse or metapelet. In a study of 1- and 2- year-olds reared in this way, it was found that the infants were very strongly attached to both the mother, and the metapelet; either could serve as a base for exploration, and provide reassurance when the infant felt insecure (Fox, 1977). In many agricultural societies, mothers tend to work in the fields, and often leave infants in the village, in the care of grandparents, or older siblings, returning periodically to breastfeed. In a survey of 186 non-industrial societies, it was found that the mother was rated as the “almost exclusive” caretaker in infancy in only 5 of them; hence other persons had important caregiving roles in 40% of societies during the infancy period, and in 80% of societies during early childhood (Weisner and Gallimore, 1977).


The Security of Attachment

Early infant-caregiver attachment relationships and the internal working models are the main aspects of Bowlby’s theory of attachment and have been given the greatest attention, with researchers developing 2 of the most widely used measuring instruments in developmental psychology to investigate Bowlby’s theoretical claims: the strange situation procedure to assess the goal-corrected system that evolved from the early attachment relationship, and the Adult Attachment Interview to assess internal working models.

Bowlby’s theory was focussed and interested with the making and breaking of attachment ties, probably because his experiences of working as a child psychologist exposed him to the negative consequences for emotional development of severe maternal deprivation [such as long term separation or being orphaned].

Nowadays, researchers and intellectuals are generally less concerned with whether a child has formed an attachment [since any child who experiences any degree of continuous care will become attached to the caregiver], but are rather more interested in the quality or security of the attachment relationship. This important shift in emphasis was due to the empirical work of Mary Ainsworth.

Ainsworth interest in the concept of attachment grew after working with Bowlby in London during the 1950s. Later, she moved to Uganda to live with the Ganda people where she made systematic observations of infant-mother interactions in order to investigate Bowlby’s goal-corrected attachment systems in action.

One factor that struck Mary Ainsworth (1963; 1967), was the lack of uniformity in infant’s attachment behaviour, in terms of its frequency, strength, and degree of organisation. Furthermore, these differences were not specific to Gandan infants, since she replicated these findings in a sample of children in the USA when she moved to Baltimore. These variations in attachment type had not been accounted for by John Bowlby’s Theory and hence, this led Ainsworth to investigate the question of individual differences in attachment.

Mary Ainsworth experience of working with Bowlby, along with her rich collection of data harvested over a period of many years, put her in a unique position in the development of attachment as an empirical field of research. Her contribution led to attachment issues becoming part of mainstream developmental psychology, rather than being simply confined to child psychiatry, and behind this achievement was an investigation of the development of attachment under normal family conditions and by developing a quick and effective way of assessing attachment patterns in the developmental laboratory.

Although the strange situation procedure (Ainsworth & Wittig, 1969) circumvented [found a way around] the need for researchers to conduct lengthy observations in the home, it was not developed simply for research convenience, but because there are problems in trying to evaluate attachment type in the child’s own home environment. For example, if a child becomes extremely distressed upon the mother moving to another room in their own home environment, this may be an indication of a less than optimal attachment achieved, because if a child feels secure then such a separation should not trigger any distress. The extensive experience of Ainsworth in observing infant-mother interactions enabled her to identify the situations that we most crucial in attachment terms, and therefore formed the basis of the strange situation procedure.


The Strange Situation Procedure

Ainsworth and her colleagues then developed a method for assessing the attachment strength of an individual infant towards her mother or caregiver (Ainsworth et al., 1978). The method is known as the Strange Situation, and has been widely used with 12 – 24 months old infants in many countries worldwide. To sum up, it is a method for checking in a standardised way, how well the infant uses the caregiver as a secure base for exploration, and is comforted by the caregiver after a lightly stressful experience.

The strange situation assesses infants’ responses to separations from and subsequent reunions with, the caregiver [mother here], and their reactions to an unfamiliar woman [the so-called “stranger”]. In the testing room, there are only 2 chairs [one for the mother and one for the stranger] and a range of toys with which the infant can play.

TA - The Strange Situation Procedure

Table A. The Strange Situation Procedure

As Table A shows, the episodes are ordered so that the infant’s attention should shift from the exploration of the environment to attachment behaviour towards the caregiver as the Strange Situation proceeds. The most crucial points are the infant’s responses to the 2 reunion episodes, and form the basis for assessing an infant’s security of attachment. The coding scheme for security attachment was developed by Ainsworth et al. (1978) and describes infant behaviour according to 4 indices:

1) Proximity-seeking
2) Contact-maintenance
3) Resistance
4) Avoidance

Referring to Table A, in a well-functioning attachment relationship, it would generally assumed that the infant would use the mother as a base to explore [Episodes 2, 3 and the end of Episode 5], but be stressed by the mother’s absence (Episodes 4, 6 and 7;  these episodes are cancelled if the infant is overly distressed or the mother wants to return sooner]. Special attention is also given to the infant’s behaviour in the reunion episodes (5 and 8), to see if her or she is effectively comforted by the mother. Based on those measures, Ainsworth and others distinguished a number of different attachment types.

The 4 primary ones are:

Type A – Insecure Avoidant Attachment

Insecure-Avoidant (Type A) infants display high levels of environment-directed behaviour to the detriment of attachment behaviour towards the caregiver [i.e. Avoidant (A) – avoids caregiver and explores environment]. The Insecure Avoidant Types display little if any proximity-seeking behaviour, and even tend to avoid the caregiver, by averting gaze or turning or moving away, if the caregiver attempts to make contact. Throughout the whole process of the Strange Situation, Insecure Avoidant infants appear completely indifferent toward the caregiver, and treat both the latter and the stranger is very similar ways; hence, these infants may show less avoidance of the stranger than of the caregiver.

Note that conversely, the (Type C) Insecure Resistant / Ambivalent Attached infants show high levels of environmental-directed behaviour to the detriment of the caregiver [the complete opposite to Type A].

Type B – Secure Attachment

When the dynamics of the attachment relationship is a balance between environmental exploration and attachment behaviour directed towards the caregiver [See PICTURE C], then the securely attached infants are considered as having the right balance.

PC Attachment as a balance of behaviour TA

PICTURE C. Attachment as a balance of behaviour directed toward mother and the environment. Source: Adapted from Meins (1997).

The presence of the caregiver in the pre-separation episodes affords them the security to turn their attention to exploration and play, with the confident knowledge that the caregiver will be available for comfort or support should it be required. However, attachment behaviour is triggered in securely-attached infants during the separation episodes, leading to seek contact, comfort, proximity or interaction with the caregiver when they return. Securely attached infants may or may not become distressed upon separation from caregivers, and this makes the infants’ response to separation a relatively unreliable and poor indicator of attachment security. However, regardless of their response to separation, securely attached children are marked by their positive and quick response to the caregiver’s return, displayed generally by their readiness to approach, greet and interact with the caregiver.

It important to note that Type B [Secure] Attachment is the only “secure” attachment in the group, all the rest are insecure attachment types, and in contrast to Type B, they have their balance of infant attachment tipped to either extreme [i.e. Avoidant (A) – avoids caregiver and explores environment / Resistant (C) – avoids environment and exhausts caregiver]

Type C- Insecure Resistance / Ambivalent

Insecure-resistant infants are over-involved with [to the point of exhausting] the caregiver, showing attachment behaviour even during the pre-separation episodes, with little or no interest in exploring the environment. The Insecure Resistant (Type C) infants tend to become extremely distressed upon separation, however, the over-activation of their attachment system hampers their ability to be comforted by the caregiver upon reunion – this leads to angry or petulant behaviour, with the infant resisting contact with and from the caregiver [in extreme cases this manifests itself as tantrum behaviour where the caregiver may sometimes be hit or kicked by the infant].

Type D – Insecure Disorganised

Besides the original 3 categories mentioned above distinguished by Ainsworth et al. (1978), Main and Solomon (1986, 1990) established a fourth category, Type D [Insecure Disorganised Attachment] for infants whose behaviours appeared not to match any of the A [Avoidant], B [Secure] and C [Resistant/Ambivalent] categories. These insecure-disorganised infants look disoriented during the strange situation procedure, and display no clear strategy for coping with separations from and reunion with their caregivers. Infants classified as insecure-disorganised may simultaneously display contradictory behaviour during the reunion episodes, such as seeking proximity while also displaying obvious avoidance [e.g. backing to which the caregiver or approaching with head sharply averted]. Insecure-disorganised infants (Type D) may also react to reunion with fearful, stereotypical or odd behaviours [e.g. rocking themselves, ear pulling, or freezing]. Main and Hesse (1990) argued that, although the classification criteria for insecure-disorganised attachment are diverse, the characteristic disorganised behaviours all include a lack of coherence in the infant’s response to attachment distress and betray the “contradiction or inhibition of action as it is being undertaken” (p.173).

Main and her colleagues (1985) believe the Type D [Insecure-disorganised ] is a useful extension of the original Ainsworth classification.

There are many subtypes of these main types, however most studies do not refer to them, and in older studies, type D babies [who are often difficult to classify as they do not show a clear pattern] were ‘forced’ into 3-way and 4-way classifications.

In most cases, type B babies (secure – considered as most desired, i.e. “normal” / although debated] are compared with types A and C [inscure-avoidant and insecure-resistant/ambivalent], and the type B [secure-attachment] tends to be seen as developmentally normal, or advantageous. Many criticisms have been made of the attachment typing resulting from the Strange Situation procedure (Lamb et al., 1984), particularly of the earlier work that was based on small samples, and of the normative assumption that “B is best”. They also pointed out the procedure only measures the relationship between mother and infant, and not the characteristics of the infant. Since attachment security is the dyadic measure, infant-mother attachment type is not necessarily the same as infant-father attachment type. In fact, many studies have found that the attachment type to father is not related to that with the mother; meta-analyses (Fox et al., 1991; van Ijzendoorn and De Wolff, 1997) found a very modest association between the two.

However, the strange situation procedure is today a commonly and internationally used technique. One of the most important test of utility of attachment types is that it should allow us to predict other aspects of development, and we now have considerable evidence for this (see Bretherton and Waters, 1985 and Waters et al., 1995, for reviews).

Kochanska (2001) followed infants longitudinally from 9 to 33 months and observe their emotions in standard laboratory episodes designed to elicit fear, anger or joy. Over time, type A (Avoidant – towards caregiver) infants became more fearful, type C (Resistant/Ambivalent – exhausts caregiver) infants became less joyful, type D (Disorganised – does not fit in A, B or C behavioural categories) infants became more angry; whereas type B (Secure) infants showed less fear, anger or distress. Using the strange situation procedure, secure attachment to mother at 12 months has been found to predict curiosity and problem solving at age 2, social confidence at nursery school at age 3, and empathy and independence at age 5 (Oppenheim et al., 1988), and a lack of behaviour problems (in boys) at age 6 (Lewis et al., 1984).

Is the Strange Situation valid across populations worldwide?

Van Ijzendoorn and Kroonenberg (1988) provided a cross-cultural comparison of strange situation studies in a variety of different countries. In American studies, some 70% of infants were classified as securely attached to their mothers (type B), some 20% as Type A, and some 10% as Type C. However, German investigators found that some 40-50% of infants were of Type A (Grossman et al., 1981), while a Japanese study found 35% to be of Type C (Miyake et al., 1985). These percentages do raise the question about the nature of “insecure attachment”: is it a less satisfactory mode of development or are these just different styles of interaction?

Takahashi (1990) argued that the Strange Situation must be interpreted carefully when it is applied across cultures. He found that Japanese were excessively distressed by infant alone episode (episode 6 – Table A), because generally in Japanese culture babies are never left alone at 12 months. This is the reason why fewer Japanese babies scored B (Secure). It is also important to note, that there was no chance for them to show avoidance (and score A – insecure avoidant), since the mother seeing the level of distress went straight on without hesitation to pick up the baby. This may also be possible explanation as to why many Japanese babies were C (Insecure Resistant/Ambivalent) at 12 months [still they are not at 24 months, nor are adverse consequences apparent]. This distortion can be avoided by virtually omitting episode 6 (see Table A) for such babies. Rothbaum et al. (2000) do take a more radical stance, in comparing the assessment security in the USA and Japan. They argue that these two cultures put different cultural values on constructs such as independence, autonomy, social competence and sensitivity; such that some fundamental tenets of attachment theory are called into question as cross-cultural universals.

Cole (1998) suggested that we need information of the geographical trends in socio-behavioural patterns [culture, heritage, language, arts, etc] under study if we are to understand the nature of the everyday interactions that shape the development of young children in relation to their caregivers. The strange situation may be a valid indicator but we at least need to redefine the meaning of the categories “avoidant, secure and resistant / ambivalent” according to the geographical socio-behavioural patterns [culture]. He also argued that although it is a standardised test, strange situation is really a different situation in different environmental circumstances. However for successful use of the strange situation in a non-western culture [one that is not of Western European heritage], we can take a look at the Dogon people of Mali.

Infant-mother attachment among the Dogon of Mali

The study we are about to discuss is a very rare one among its kind which took place among the Dogon people of Eastern Mali, a primarily agrarian people living by subsistence farming of millet and other crops, as well as cash economy in towns [see PICTURE D].

PD - Dogon mother spinning cotton with child on her lap

PICTURE D. Dogon mother spinning cotton with child on her lap

The study was carried out in 2 villages with a total population of about 400, and one town population of 9000, with the researchers attempting to get a complete coverage of infants born between mid-July and mid-September 1989. Not all infants could take part, due to relocation or refusal, and the researchers excluded 2 infants who had birth defects, and 8 suffering from severe malnutrition. In addition, after recruitment two infants die before or during the two-month testing period. Finally, 42 mother-infant pairs took part and provide a good quality data. The infants were 10 to 12 months old at the time of testing.

The Dogon are a polyamorous society, and mothers typically live in a compound with an open courtyard, often shared with co-wives. There was some degree of shared care of infants, about one half were cared for primarily or exclusively by the mother, about one third primarily by the maternal grandmother with a mother however being responsible for breastfeeding (see PICTURE E).

PE - Dogon mother breastfeeding her child

PICTURE E. Dogon mother breastfeeding her child.

Breastfeeding is a normative response by the mother to signs of distress in in the Dogon infants. Three related features of infant care in the Dogon – frequent breastfeeding on demand, quick response to infant distress, and constant proximity to the mother or caregiver – are seen as adaptive and there is high infant mortality [as in some other traditional African cultures].

The researchers have several objectives in mind, they wish to see if the strange situation could be used successfully in Dogon culture; one distribution of attachment types was obtained; whether infant security correlated with maternal sensitivity – a test of the Maternal Sensitivity Hypothesis; whether infant attachment type related to patterns of attachment-related communications in mother-infant interaction – the test of what the authors call the Communication Hypothesis; and to see if frightened or frightening behaviour by the mother predicted disorganised infant attachment.

Three situations were used to obtain relevant data, the behaviour being recorded on videotape in each case. One was rather new – the Weigh-In, part of the regular well-infant examination, in which the mother handed over the infant to be weighed on a scale – and mildly stressful separation for the in, especially in Dogon culture. The other two were more standard – the strange situation, carried out in an area of courtyard separated off by hanging mats; and two 15 minute observations in the infant’s home, and the mother was cooking, bathing/caring for the infant.

The following data were obtained:

  • Infant attachment classification (from the strange situation)
  • A rating of infant security on a 9-point scale (from the strange situation)
  • Mother and infant communication related to attachment, coded by 5-point Communications Violations Rating scales (from the Weigh-in)
  • Maternal sensitivity, rated in terms of promptness, appropriateness and completeness of response to infant signals (from the home observations)
  • Frightened or frightening behaviours by the mother, such as aggressive approach, disorientation, trance state, rough handling as if baby is an object, on a 5-point scale (from the home observations and the Weigh-In).

[REMEMBER!!!! [although we are quite sure you know this already] : “r” is known as the correlation coefficient and tells us 2 things: (i) Direction of Relationship + or – & (ii) Strength of Relationship : +or- .1 is a small effect / +or- .3 is a medium effect / +or- .5 is a large effect | and p-value is the critical decider of whether to reject Null Hypothesis( i.e. the scenario we rightly thought would be opposite to our predictions) if p small enough (if p < .05 we say results were statistically significant, if p < .01 we say it is HIGHLY statistically significant) we reject the Null Hypothesis [both cases].

The strange situation was found to be feasible, following quite standard procedures. The distribution of attachment types was 67% B (Secure), 0% A (Avoidant), 8% C (Resistant/Ambivalent), and 25% D (or on a forced 3-way classification, 87% B, 0% A and 13% C). This is quite unusual in having no avoidant (A) classifications; D is high but not significantly greater than Western norms.

The Maternal Sensitivity Hypothesis only received weak support. The correlation between infant security and maternal sensitivity was r = 0.28, and with p < .10; the difference in means between attachment classifications was not statistically significant (B=5.26, C=5.00, D=4.20).

The Communications Hypothesis did get support. Infant security correlated -.54 with Communications Violations (p < .001), and the attachment classifications differed significantly (B=2.66, C = 3.50, D = 3.89; p < .01).

Finally, frightened or frightening behaviour by the mother correlated r = -.40 (p < .01) with infant security, and was particularly high in children with disorganised attachment (B= 1.23, C = 1.33, D = 2.35; p < .01).

Besides demonstrating the general application of the strange situation procedure in a nonwestern group with socio-behavioural patterns very different to our own, the findings provides support for the Communication Hypothesis. The case here would have been stronger if the different kinds of communication patterns for each attachment classification had been described in more detail. For example, that insecure resistant / ambivalent (C) attachment type infants would be inconsistent and often unable to convey their intent, or to terminate their own or another’s arousal, whereas insecure disorganised (D) attachment type infants would “manifest contextually irrational behaviours and dysfluent communication” (p. 1451). As it is, the main findings show that insecure infants show more communications violations, do not describe the detailed typology. Indeed, since some of the Communications Violations rating scales were of “avoidance, resistance and disorganisation” (p. 1456), there is a possible danger of conceptual overlap between this scale and the attachment classifications.

Although support for the Maternal Sensitivity Hypothesis was we, the correlation of r = .28 is in line with the average of r = .24 found in the meta-analysis by De Wolff and Van Ijzendoorn (1997) on mainly Western samples. The researchers used a multiple regression analysis to examine the contributions of both maternal sensitivity and mothers frightened/frightening behaviour, to attachment security. They found that the contribution of maternal sensitivity remain modest, whereas the contribution of mothers frightened/frightening behaviour was substantial and significant; ratings of maternal sensitivity do not normally take account of mothers frightened/frightening behaviour, and the researchers suggest that this might explain the modest effects found for maternal sensitivity to date.

The absence of avoidant (A – avoids caregiver and favours exploration) type infants is interesting and the researchers argue that, given the close contact mothers maintained with the Dogon infants, and the normal use of breastfeeding as a comforting activity, it would be very difficult for it Dogon infant to develop an avoidant strategy [this may have some similarity with the low proportion of A-type in Japanese infants). If avoidant (A) attachment is a rare or absent when infants nursed on demand (which probably characterises much of human evolution), this might suggest that A type attachment was and is a rare except in Western samples in which infants tend to be fed on schedule, and often by bottle rather than breast, so that the attachment and feeding systems are effectively separated.

Most Dogon infants showed secure (B) attachment, but 25% scored as disorganised (D) [though mostly with secure as the forced 3-way classification]. The researchers comment that the frightened or frightening behaviours were mild to moderate, and did not constitute physical abuse. But why should mothers show these sorts of behaviour at all? An intriguing possibility is that it is related to the high level of infant mortality prevalent in the Dogon. About one third of infants died before five years of age, and most mothers will have experience in early bereavement. Unresolved loss experienced by a mother is hypothesised to disorganised (D) attachment; perhaps, frightened behaviours are more rational or expected, when the risk for infants are so much higher.

This study to great efforts to be sensitive to the geographically specific socio-behavioural patterns (culture) of the venue, when using procedures and instruments derive mainly from Western samples. A Malian researcher assisted in developing the maternal sensitivity coding, and Dogon women acted as strangers in the strange situation procedure. The Weigh-In and home observations were natural settings. The authors comment, however, that future work might make more effort to tap the perceptions of mothering and attachment held by the Dogon people themselves, in addition to the constructs coming from Western psychology.

(True, M. M., et al, 2001)


Back Home in the West: Why do infants develop certain attachment types?

Enfant en train de lire

Individual differences in the caregiver’s sensitivity to infant’s cues were the earliest reported predictors of attachment security. Ainsworth and colleagues (Ainsworth, Bell & Stayton, 1971, 1974; Ainsworth et al., 1978) found that mothers who responded most sensitively to their infants’ cues during the first year of life tended subsequently to have securely attached infants. The insecure-avoidant (Type A) pattern of attachment was associated with mothers who tended to reject or ignore their infants’ cues, and inconsistent patterns of mothering were related insecure-resistant/ambivalent (Type C) pattern of attachment. Although further research has largely supported this link between early caregiver sensitivity and later attachment security, the strength of the relation between these factors has not been replicated. For example, De Wolff and van Ijzendoorn (1997) conducted a meta-analysis to explore the parental antecedents of attachment security using data from 21 studies involving over 1000 infant-mother says, and reported a moderate effect size for the relation between sensitivity and attachment security (r = 0.24), compared with the large effect (r = 0.85) in Ainsworth et al.’s (1978) study. This led De Wolff and van Ijzendoorn to come to the conclusion that “sensitivity cannot be considered to be the exclusive and most important factor in the development of attachment” (p. 585).

It seemed that the construct of sensitivity might have been responsible for the result, so we return to Ainsworth et al.’s (1971, 1974) original definitions in order to have a better understanding of predictors of attachment security. In this research, we were particularly influenced by Ainsworth’s focus on the caregiver’s ability not merely to respond to the infant, but to respond in a way that was consistent with the infants cue. For example, Ainsworth et al., (1971) describe how mothers of securely attached infants appeared “capable of perceiving things from the child’s point of view” (p. 43), whereas maternal insensitivity involve the mother attempting to “socialise with the baby when he is hungry, play with him when he is tired, and feed him when he is trying to initiate social interaction” (Ainsworth et al., 1974, p. 129). Meins et al. (2001) verse argued that the critical aspect of sensitivity was the caregiver’s ability to “read” the infant’s signals accurately so that the response could be matched to this passive cue from the child.

baby-bebe-d'purb dpurb site web.jpg

In order to test this proposal, Meins et al. (2001) obtain measures of mothers’ ability to read their 6-month-olds’ signals appropriately (so called mind-mindedness), and investigated the comparative strength of mind-mindedness versus general maternal sensitivity in predicting subsequent infant-mother attachment security. Meins et al. reported that maternal mind-mindedness was a better predictor of attachment security 6 months later than was maternal sensitivity, with mind-mindedness accounting for almost twice the variance in attachment security than that accounted for by sensitivity.

This seems like a strong conclusion, since the genetic factors have been accounted for and do not contribute to attachment type as van Ijzendoorn et al. (2000) argued that it has a modest if any influence on attachment type. This can be confirmed from a twin study conducted by O’Connor and Croft (2001) when they assessed 110 twin pairs in the strange situation and found concordance of 70% in monozygotic twins and 64% in dizygotic twins – not significantly different. The model suggested estimates of only 14% of variance in attachment type due to genetics, 32% to shared environment, and 53% in non-shared environment.

A study of attachments formed by babies to foster mothers (Dozier et al., 2001) found as good a concordance between mothers’ attachment state of mind (from the Adult Attachment Interview, see below) and infant attachment type from the strange situation, as for biological mother-infant pairs, once again suggesting little genetic influence on attachment type.

So, it is fairly accepted today that mothers’ mind-mindedness is an important construct and it is defined as the mother treating her infant as an individual with a mind, instead of just an organism or small creature with needs to be satisfied. The emphasis should be on responding to the infant’s inferred state of mind, rather than simply their behaviour. In a longitudinal study of 71 mother-infant pairs, they found that maternal sensitivity (responding to infant cues) and some aspects of mind-mindedness, especially appropriate mind-related comments by the mother, measured at six months, both independently predicted security of attachment at 12 months. True et al., (2001) also found evidence that mothers’ frightened or frightening behaviour may also contribute independently to attachment security (Refer to Dogon Study above – Picture D and Picture E).

We should also take note that a huge amount of variance in attachment type appears to be related non-shared environment, and this cannot be explained by generalised maternal sensitivity. It is highly probable that, mothers are more sensitive and behave differently to some infants than others, depending on birth order, gender and infant characteristics, suggesting the need for family systems on these issues (van Ijzendoorn et al., 2000).


Attachment Beyond Infancy & The Internal Working Model

The attachment theory proposes that children use their early experiences with their caregivers to form internal working models (Bowlby, 1969 /1982, 1980) which incorporate representations of themselves, their caregivers, and their relationships with others. These internal working models will then be used by the child as templates for interacting with others. Consequently, because of the sensitive, loving support that securely attached children’s caregivers have supplied, these children are self-confident and have a model of themselves as being worthy; they therefore expect others to behave in a sensitive and supportive fashion. Conversely, given the patterns of interaction typically experienced by avoidant and resistant infants, insecurely attached children expect people to be rejecting, or inconsistent and ambivalent when interacting with them.

The strange situation measures security of attachment in terms of behaviours; especially how the infant behaves at a reunion of the separation. The strange situation procedure is generally used with infants between the ages of 12-24 months old. For 3 – 6 year-olds, variants of the strange situation, such as a reunion episodes after separation, have been used with some success (Main and Cassidy, 1988).

Research during the last 10 years has seen attachment become a life-span construct with corresponding attempts to measure it at different developmental stages (see Melhuish, 1993, for a review). It has been revealed that as infants grow older, in Bowlby’s 4th and 5th stages, attachment relationships become less dependent on physical proximity and overt behaviour, and more dependent on abstract qualities of the relationship such as affection, trust, approval, internalised in the child and also in the adult.

Research has revealed that it is useful to think of internal representations of the relationship in the child’s mind; the child is thought of as having an internal working model of his or her relationship with the mother, and with other attachment figures (Bowlby, 1988; Main et al., 1985). These are characterised as cognitive structures embodying the memories of day-to-day interactions with the attachment figure. They may be ‘schemas’ or ‘event scripts’ that guide the child’s action with the attachment figure, based on their previous interactions and the expectations and affective experiences associated with them.

Different attachment type would be expected to have differing working models of the relationship. Secure (Type B) attachment would be based on models of trust and affection [and a Type B infant would be able to communicate openly and directly about attachment-related circumstances, such as how they felt if left alone for a while]. By contrast, a boy or girl with an Insecure Avoidant (Type A) attachment may have an internal model of his/her mother that leaves the child without any expectancy of secure comforting from the latter when he/she is distressed [the mother may in fact reject his/her approaches]. The child’s action rules then become focused on avoiding her, thus inhibiting approaches to her that could be ineffective and instead lead to further distress; and this can be problematic, as there is less open communication between mother and son, and their respective internal working models of each other are not being accurately updated.

Insecure Resistant / Ambivalent (Type C) infants might not know what to expect from their mother, and they in turn would be inconsistent in their communication with the latter and often unable to convey their intent.

PF - Boy by Land Rover - from Separation Anxiety Test

PICTURE F. Boy by Land Rover: A picture from the Separation Anxiety Test

Over the last 15 years, researchers have attempted to measure attachment quality in older children [as much as the empirical methods allowed them to do in terms of construct validity and internal consistency], by trying to tap in to their internal working models (Stevenson-Hinde and Verschueren, 2002). One of the methods used involved narrative tasks, often using doll-play; children use a doll family and some props and complete a set of standardised attachment related story beginnings. Another method used has been the Separation Anxiety Test, in which children or adolescents respond to photographs showing separation experiences [see Picture G for an example]. The child is questioned about how the child in the photograph would “feel and act”, and then how he/she [the participating child] would feel and act if in that situation (Main et al., 1985). This test was found to have a good rater reliability and consistency for 8 to 12-year-olds. Large differences in responses between children having clinical treatment for behaviour disturbance and a normal control group was found (See Table B)

TB - Two Protocols from the Separation Anxiety Test

TABLE B. Two protocols from the Separation Anxiety Test

Securely attached children generally acknowledge the anxiety due to the separation but come up with feasible coping responses; insecurely attached children generally deny the anxiety, or give inappropriate or bizarre coping responses.


The Adult Attachment Interview

The internal working models of relationships can normally be updated or modified as new interactions develop. It is likely possibility that for younger children, these changes must be based on actual physical encounters. However, the Main et al. (1985) suggested that in adolescents or adults who have achieved formal operational thinking [Jean Piaget’s 4th and final stage at around the age of 12 as explained in our essay], it is possible to change / modify their internal working models without the need for such direct interaction. In order to measure attachment in older adolescents and adults, they developed the Adult Attachment Interview. This is a semi-structured interview that proves memories of one’s own early childhood experiences. The transcripts are coded, not on the basis of experiences themselves, so much as on how the person reflects on and evaluate them, and how coherent total account is [Adults’ attachment classifications are not based on the nature of their actual childhood experiences, but on the way they represent these experiences, be they good or bad]. They are also generally asked to describe their childhood relationships with mother and father, and to recall times when they were separated from their parents or felt upset or rejected. There are specific questions that also deal with experiences of loss and abuse. According to their responses during the AAI, Allsopp placed into one of the 4 attachment categories: (i) Autononous, (ii) Dismissing, (iii) Preoccupied [Or Enmeshed] and (iv) Unresolved


(i) Autonomous Attachment

Autonomous adults are able to give coherent, well-balanced accounts of their attachment experiences, showing clear valuing of close personal and meaningful relationships [note meaningful subjectively to the individual]. These adults classified as autonomous may have experience problems in childhood, or even had a very difficult or abusive upbringings, but they can generally have an open conversation and talk openly about the negative experiences and most seem to have managed to resolve any early difficulties and conflicts. In contrast to the open and balanced way in which autonomous adults talk about childhood experiences, adults in the remaining three categories have incredible difficulties in talking about attachment relationships.


 (ii) Dismissing Attachment

Dismissing adults deny the importance of attachment experiences and insist they cannot recall childhood events and emotions, or provide idealised representations of the attachment relationship that they are unable to corroborate the real-life events. [i.e. dismiss attachment relationship as of little importance, concern or influence


(iii) Preoccupied [or Enmeshed] Attachment

Preoccupied adults lack the ability to move on from the childhood experiences, and are still overinvolved with issues relating to the early attachment relationship [generally preoccupied with dependency on their own parents and still struggle to please them].


(iv) Unresolved Attachment

The final category is reserved for adults who are unable to resolve feelings relating to the death of a loved one or to abuse they may have suffered [people who have not come to terms with a traumatic experience, or work through the mourning process]

It is to be noted that, people from lower socio-economic groups are slightly more likely to score as Dismissing. However the large difference is in people receiving clinical treat, the great majority of whom do not score as Autonomous on the AAI.


Are attachments stable over time? From Infancy to Adult Attachment Type

The main question should be asking ourselves is does the security of attachment change the life, or does infant-parent attachment set the pattern not only for later attachment in childhood, but even for one’s own future parenting? As attachment has become lifespan construct, these questions have generated considerable research and debate.

Many studies have now spanned a period of some 20 years to examine whether strange situation classification in infancy predicts Adult Attachment Interview (AAI) classification as young adults (Lewis et al., 2000; Waters et al., 2000). The outcome is varied, but some of these studies have found significant continuity of the 3 main attachment types; that is, from Secure to Autonomous; Avoidant to Dismissive, and Resistant (Ambivalent) to Enmeshed. Several studies have also found relationships between discontinuities in attachment classification, and negative life events such as the experience of parent divorce.


Relationship between Adult Attachment Interview (AAI) and Infant-Parent Attachments

Adult Attachment Interview (AAI) and classifications have been found to relate systematically to the security of the infant-parent attachment relationship. Autonomous parents are more likely to have securely attached infants, and parents in the 3 non-autonomous group. Dismissing, Preoccupied and Unresolved are much more likely to form insecure attachment relationships with their infants. This relationship has been identified for both patterns of infant-mother (e.g. Fonagy et al., 1991; Levine et al., 1991) and infant-father (Steele et al., 1996) attachment. Furthermore, unresolved maternal AAI classification has been identified as a predictor of insecure-disorganised attachment (Main & Hesse, 1990; van Ijzendoorn, 1995). Thus, the way in which a parent represents their own childhood attachment experiences is related to the types of relationship formed with their children.


Are attachment stable over generations?

On top of the degree of continuity over time for an individual’s attachment typing, there is also evidence for the transmission of attachment type across generations; specially from the parent’s AAI (Adult Attachment Interview) Coding and their infant’s strange situation coding. Main et al. (1985) had reported some evidence for such a link, and indeed the AAI coding system is based on it; it was argued that Autonomous adults would end up with Secure infants; Dismissing adults with Avoidant infants, Enmeshed adults with Resistant (Ambivalent) infants; and Unresolved adults would have Disorganised infants. [See Table C].

TC - Hypothesized relationships between maternal stage of mind (AAI), maternal behaviour, and child attachment type

TABLE C. Hypothesised relationships between maternal stage of mind (from the AAI – Adult Attachment Interview), maternal behaviour, and child attachment type

Van Ijzendoorn (1995) looked at a large number of available studies in the decade since Main’s work and found considerable linkage between adult AAI (Adult Attachment Interview) and infant Strange Situation coding; Van Ijzendoorn argued that this “intergenerational transmission” of attachment may be via parent responsiveness and sensitivity. We discussed above how this is only a partial explanation, and other aspects of maternal behaviour and of the home environment may also be involved.

We have considerable evidence for some degree of continuity of attachment security through life, and onto the next generation; but considerable evidence that this can be affected by life events. An adult’s attachment security can also be influenced by counselling, clinical treatment, or simply by reflection [self mind-mindedness].

Some insight into this matter comes from a study by Fonagy et al. (1994). In a longitudinal study with 100 mothers and 100 fathers in London, who are given the AAI and other measures shortly before their child was born. The strange situation was used subsequently to measure security of attachment, to mother at 12 months and the father at 18 months. As many other studies have discovered, the parent’s AAI scores predicted the Strange Situation scores of the infants. The researchers also calculated the estimates of the amount of disrupted parenting and deprivation which the parents had experienced themselves, and use the measures to find out if these influenced infant attachment, which they did. However, the amount of disrupted parenting and deprivation the parents had experienced interacted strongly with the way in which the parents had dealt with their own representations of their experiences of being parented. Coding the AAI (Adult Attachment Interview), the researchers developed a Reflective Self-function scale to assess the ability parents had to reflect on conscious and unconscious psychological states, and conflicting beliefs and desires. Of 17 mothers with deprived parenting and low reflecting self-function scores, 16 had insecurely attached infants, as might have been expected. Completely opposite to this scenario 10 mothers who had experienced deprived but had high reflective self-function scores, all had securely infants. It was argued that reflective self-function could have the saliency to change the internal working models of people, and also demonstrate resilience to adversity and a way of breaking the inter-generational transmission of insecure attachment.

Adults who experienced difficult childhoods but have overcome early adversity and insecure attachment by a process of reflection, counselling or clinical help, are known as “earned secures”, and could be distinguished from “continuous secures”, who had a positive upbringing and what most might quality as “normal” childhood. Phelps et al. (1998) made home observations of mothers and their 27-month-old children, and found that earned-secures, like continuous secures, showed positive parenting; under conditions of stress, both these groups showed more positive parenting than insecure mothers.

Another fascinating perspective on this issue of inter-generational transmission of insecure attachments would be the Holocaust study (Bar-On et al., 1998; van Ijzendoorn et al., 1999). The Holocaust refers to the experiences of Jews and other persecuted unwanted & unassimilated minorities [who did not want to be Germans] in the concentration camps of World War II to be securely offloaded/deported when Adolf Hitler’s Germany became the Third Reich and when the policies changed to focus on National Socialism and Imperial Intentions of Expansion and Conquest (1939-45).


Jew Children: Here we see Jew school children in 1942. They look like younger children who are just beginning school. Notice that at least 2 teachers are with them. By this time the Jewish children had been forced out of public schools. For a short time however, they we allowed to attend schools set up by the Jewish community. At the time this photograph was taken, the transports to the deportation camps had already begun. Often children under 10-years of age were not required to wear the badges, but some of these children look much younger.

Although many revisionist such as the English historian, David Irving, of this dark part of human history are finding out inaccuracies regarding the true people responsible for those massacres [since no evidence has been found of Hitler giving any extermination order] along with other atrocities as evil if not worse than the deaths in concentration camps [for a section of a population that was causing instability to the proper functioning of a nation during times of revolt and huge global conflicts involving economic treaties, Jewish propaganda and ultra-liberal communist migration agendas fused with policies based on business & banking motives] committed by many of the “supposed good guys of the Allies” that involved the rape and murder of innocent children and women, fuelled by pure hate, Bolshevism and Jewish Communism against the native aryans of Germany [i.e. the German Volk/People].

A documentary extract from the diary of Dr. Joseph Goebbels who decided to take a firm stance against the national destruction of Germany (and Western Europe), Christianity, and whom many Nationally oriented thinkers consider to be among the bravest of the last great Christian Aryan men to have walked the earth. [See Aryan Race et aussi Race Aryenne / Also to be noted perhaps quite surprisingly that there were strong ancient Aryan religious & mythological warrior values embedded in the mind of Heinrich Himmler (the Reichsführer of the SS), the person believed to have taken the decision to exterminate the jews (remember the term itself originated from human sacrifices by Jews to their god, Baal), as he told his personal masseur & physician Felix Kersten that he always carried with him a copy of the ancient Aryan scripture, the Bhagavad Gita because it relieved him of guilt about what he was doing – he felt that like the sacred warrior Arjuna, who was simply doing his duty for his people and their future without attachment to his actions]

But, since the majority on this planet have been made to believe one version where all the Jews and the alien army of the allies are the good guys, and all the Germans [including Adolf Hitler] were the blood-sucking vampires who also turned into cannibals on the week ends, we are going to base our comments on this politically correct version that the history books and mainstream publishers prefer. [Politics too nowadays is in serious need of revision; are people really divided into 3 main categories? Left, Centre and Right? I tend to believe that we are above all this and have elements of all 3 embedded in us as modern human beings of the 21st century]

But getting back to the Bedouin cultured civilisation’s distinguished members, i.e. Jews as an example of victims in those concentration camps [that many people have begun to question the evidence used to claims of gas chambers (with a great amount found on territories occupied by Stalin) with many camp detainees reporting being kept in facilities with swimming pools, orchestras and kitchens, the number of casualties, and the true perpetrator of the crimes]. It is believed by most people of the 21st century who have had no other options but to take in their news from mainstream Jewish-owned media, that besides being treated like despicable rats, degraded and tortured, many of the Jews to be deported kept in those camps were killed [some shot like parasitic animals as they tried to escape], leaving behind them orphaned children in traumatic circumstances.

Our question here however in regards to the focal point of this section, i.e. “insecure attachments”, is whether such traumatic experiences could have an impact on attachment, and could this also have been transmitted inter-generationally to the Jewish children scattered around the globe today like modern gypsies? This issue of inter-generational transmission of insecure attachments is the focus of the Holocaust study (Bar-On et al., 1998; van Ijzendoorn et al., 1999). The study we are looking at encompasses 3 generations of Jews, now grandparents, who went through the Holocaust [note that the name Holocaust itself comes from an event involving human sacrifices to the Jewish god, Baal], typically as children themselves who had lost their parents; their children, now parents; and their grandchildren. These generations are compared here with comparable 3-generation families who had not experienced the Holocaust.

It was found that the effects of the Holocaust were evident in the grandparent generations, who showed distinctive patterns on the AAI (Adult Attachment Interview), scoring high on Unresolved, as would have been predicted, and high on unusual beliefs – another predicted effect of trauma and unresolved attachment issues. They also displayed avoidance of the Holocaust topic; a very common finding was that the experiences ha