Virologist Margarita del Val, from the Severo Ochoa Molecular Biology Center (CBMSO-CSIC-UAM) and coordinator of the Interdisciplinary Thematic Platform of the CSIC in Global Health that investigates COVID-19, believes that there will be a vaccine for the coronavirus, but not it will be soon. In addition, it warns that the autumn wave that is reaching all of Europe has only just begun.
What do you think awaits us between now and Christmas?
The cold has reached the northern countries earlier and the case curve has started to rise. I think that is what we are beginning to see, with a small delay depending on whether the province is more or less cold. We are going to face an autumn surge. I see it because of what is happening in Europe and what happened in Spain in 2009 with the influenza A pandemic, another respiratory virus in a time of pandemic with too many people without immunity. Then he began to climb the curve slowly, especially with the cold of Madrid, as autumn began.
It is not exactly comparable [to influenza A] because now we have measures to protect ourselves, and if we apply them, we can stop it. The autumn surge is not an inevitable curse, we can avoid it. It can be stopped. Older people this summer did not have their surge because they retired and lowered the median age of cases from 60 to 38 years.
Very early prevention is already far, but it can be slowed down enough with public health prevention measures: hygiene, distance, masks, air control, be careful with closed places, restrict bubbles, telework who can, facilitate public transport so that there are no crowds, give masks to those who cannot spend so much, isolate those who cannot do it in medicalized hotels as there are already in Madrid …
How will we get to Christmas? It depends on us, it always depends on us. It’s not like when the storm comes, it doesn’t matter what we do. The storm of the pandemic can be controlled by us. It is true that it is more difficult in autumn than in summer and Europe is showing it: several countries that had practically no summer surge are now beginning to see more cases.
In the longer term, what scenario can we foresee, especially in the absence of a vaccine?
The other coronaviruses [that cause colds] have virulence genes, but they seem benign because an overwhelming majority of the population has immunity. Since we are strong, these viruses appear weak. Putting ourselves in the worst, SARS-CoV-2 could remain as another catarrhal coronavirus somewhat less mild than the others. Maybe like the flu, which causes deaths every year.
Are reinfections a cause for concern?
I expected them because they occur every couple of years in other coronaviruses, although with tremendous differences in each person, between 6 months and 5 years. Memory lymphocytes make cells that make antibodies, and then there are no symptoms or it turns into a cold. This is what we expect with SARS-CoV-2: although it is not so banal, it is softer than the first time.
That said, with reinfections you have to be very clear about two things. First, that it really is and the sequence of the virus is different in each episode. Quite a few of the proposed cases could not be done and it is still a relapse or a false negative, be careful not to call it reinfection.
Second, we cannot interpret reinfection if we do not know the difference in the immune system between the first and the second episode. In the first case of death due to reinfection, the patient, an 89-year-old woman, had lymphatic cancer. They were giving him a very aggressive chemotherapy and his immune system did not have the minimum capacity to react.
Will there be a vaccine?
I think so, because coronaviruses vary less than flu and there are more than a hundred vaccines in development. That the first ones will be the simplest and maybe they are not enough? It can, but in our current situation it will be a giant advance even if it only partially protects. From there they will improve, because what is required of a vaccine is that it be equal to or better than natural immunity.
In any case, I don’t think there will be a single first vaccine, because more will emerge and be produced in different countries. Nor do I trust that it will be too soon and, above all, that the responsibility of maintaining preventive measures will be completely removed from us. Of course, vaccines have to spread throughout the world, even from a selfish point of view, or the epidemic will return.
Ideally, in addition to avoiding symptoms and deaths, vaccines prevent infections. Those are the best. Otherwise, it will not be worthwhile to vaccinate millions of healthy young people who already have a very high probability of being contagious asymptomatic.
How do you ensure they are safe in such a short time frame?
Who we want to protect is people who have severe COVID-19 and die, and for that we have to use vaccines that work and are safe in them. To know that a vaccine is safe in risk groups, clinical trials have first had to be carried out in healthy people and then dared to recruit volunteers among those risk groups. We have not yet arrived at that. So I think there will be a vaccine, but not so soon.
What do you think of the provocation trials that the United Kingdom will initiate, in which it will infect healthy vaccinated volunteers?
It is an important ethical debate. Luis Enjuanes [from the National Center for Biotechnology-CSIC] commented that an alternative is to have a controlled infection with an attenuated SARS-CoV-2, and they are already preparing these viruses. The risk would go down and it could be seen if replication is controlled, which is already an advance even if the vision is not complete because it does not tell you anything about the disease.
In emergencies another possibility is to go to an area with high incidence, vaccinate half, give a placebo to the other party and then evaluate it. But it is also true that natural exposure can be avoided or forced. Do you tell the vaccinated to allow themselves to be infected and go without a mask and without respecting the distance? It’s complicated.
And what about drugs? Large trials to reuse existing treatments have been, so far and generally, a failure.
Testing a drug that is already used for another ailment and is known to be non-toxic, if previous trials are promising, is a strategy that makes drug development cheaper and faster. Is not new. But it is not a custom designed antiviral and you have to try many, you will not find one in ten. This was not desirable but it was expected. They are being tested more and still one comes up. In addition, so far many antibiotics and few antivirals have been sought, and respiratory viruses have not had a scope that has justified their investigation, hence there were none.
Recent studies assure that fatality has dropped in many countries because they compare March with June. Does this approach seem correct to you?
The circumstances do not seem the same to me, because in March we did not know the risk groups and the protection was different. It is not comparable and the mortality of the summer has been lower because it has affected much younger people. The change in the affected population makes the two waves very different. Two different moments of the pandemic cannot be compared so easily. In fact, Fernando Simón has said that the age of older ICU patients is starting to rise. Although they have protected themselves, it is reaching them.
Do you think the long-term effects are being talked about too safely? Some such as fatigue, stress, insomnia and headache could be attributed to the crisis itself.
Indeed, it will be necessary to see which part is caused by the anomalous situation that we live in. Stress, anxiety, depression from not seeing your family, not having a job … that causes real symptoms. In a tragedy like this it is normal to be destroyed.
The rest of the sequels we still don’t know. We have never seen him with an infection before, we do not know how many things are the aftermath of the flu. It is absolutely new for humanity because we have never seen an infection up close, with such advanced medicine and access to so much data. We didn’t know what the aftermath was.
In addition, we treat COVID-19 patients before the sequelae, which are a bit neglected. It is a cause of medical concern that must be clarified as soon as possible. Also clean a bit the string of symptoms, which includes practically everything. It is necessary to clarify, not to confuse.
Do you think this is the great pandemic that scientists have been waiting for years?
We were expecting a flu pandemic and this one has been worse precisely because of that. Large flu pandemics affect mainly young people, because the elderly have cellular immunity, difficult to measure but much more conserved over time, having been reinfecting themselves all their lives without realizing it. We thought that was a pandemic: the flu virus changes so much that a part of the population has no immunity at all. There have always been influenza A, but they affected young people.
What we did not expect is that this would affect one hundred percent of the population in this way, because we have a wrong concept of what immunity was. Only the antibodies were looked at, which is the easy thing to measure. I have spent my whole life saying that cellular immunity is important. Antibodies neutralize viruses, but cellular immunity destroys infected cells where they are made by the thousands. It is the great pandemic because nobody expected it to affect the elderly population in that way because it has not been like that with the flu, which is what we expected.
Sergio Ferrer Pérez, Science + Technology, The Conversation
This article was originally published on The Conversation. Read the original.
