The director of the Institute of Pharmacological Research Mario Negri lists five reasons to be optimistic and three reasons for concern about the evolution of Covid
Giuseppe Remuzzidirector of the Mario Negri Institute of Pharmacological Research and professor of Nephrology at the University of Milan for «clear fame», it seems that we cannot yet put the word «end» to the story of the pandemic.
Have we at least reached the last chapters?
“We have five reasons to be optimistic and three reasons for concern. The first source of hope comes from a distant past: in 1889, in St. Petersburg, what was called the “Russian flu” broke out, a real pandemic spread all over the world, with one million confirmed deaths. It has not been stressed enough that the similarities with the current situation are remarkable: the alleged culprit is a coronavirus (OC43), the infection caused severe pneumonia and killed mainly the elderly. Even without vaccines and drugs to combat it, the virus remained aggressive for some years (and three waves) and then “died down”. The health authorities recommended ventilation and disinfection of the rooms, spacing and isolation of the infected. All activities, including schools, have been closed. The comparison with Sars-CoV-2 is impressive. OC43 still circulates and is one of the many cold pathogens. We can hope that this is the ending of the story. But it won’t happen tomorrow ».
What other factors may suggest an improvement in the situation?
“According to the Global burden of disease (Gbd), an international program that evaluates the impact of the main diseases in terms of mortality and disability, in Italy a peak of infections, hospitalizations and deaths from Covid occurred between January and February of this year. year, followed by a decline and a small recovery. A more significant descent should begin in mid-April and then continue until July, also thanks to the summer. The forecasts of the Gbd, developed however before the advent of Omicron BA.2, indicate zero cases of Covid in Italy between June and August. An important prospect, even if we have learned that this virus can hold us many surprises. There are also three other elements in our favor. The first is that the population is almost completely infected or vaccinated and therefore there is widespread immunity that allows us to face any new mutations with a protective base that we did not have in 2020. The second is that Omicron, despite its very high diffusion capacity , generally tends to be located in the upper respiratory tract, sparing the bronchi and lungs. Finally, crucially, today we have not only vaccines, but also antivirals and monoclonal antibodies. Pharmaceutical companies are working on drugs that are able to counter the possible variants of Sars-CoV-2. And there is the prospect of a vaccine that covers all coronaviruses: a project by Duke University in Brigham and the Women’s Hospital in Boston that has shown efficacy close to 100% in monkeys. ”
What are the reasons for concern?
“First of all, what is happening in Hong Kong: a very heavy wave that unequivocally demonstrates how Omicron is not a little dangerous in a poorly vaccinated population, especially the elderly. Only the full course with three doses can protect us from this and other variants. In Italy we have one million and 200 thousand over 70 who have not completed the vaccination cycle: a large circulation reservoir for the virus, to which is added the range between 5 and 12 years where coverage is still 34% and those more children for which a vaccine does not yet exist. Without forgetting that in countries close to us, such as the African ones, the vaccination rates are very low ».
Should the appearance of the XE variant worry us?
«Yes, because it is a recombinant variant, that is, it has combined parts of Omicron BA.1 and Omicron BA.2. Unlike other recombinant strains, such as Xd and Xf (mix between Delta and Omicron), which are not very popular, Xe is gaining ground in England (where sequencing activity is very intense) and we expect it to be already present. Also in Italy”.
How are these mixes born?
“It is possible that a subject was infected at the same time by two different variants and that the viruses, during replication, underwent a mixing of the genetic material. If the recombinant variant has an evolutionary advantage in transmission capacity it will become predominant over the previous ones and that is what could happen with Xe. The only defense weapon we have is to upgrade the sequencing systems so as not to be caught unprepared. Let us remember, however, that when we “see” something, it is because diffusion has already begun ».
The pressure on the health system remains stable. Is this a good sign?
“We actually have a big problem on this point and it is the third cause for concern. Between 5 and 10% of patients recovered from Covid have sequelae of various kinds, a condition erroneously defined as “Long Covid”: we therefore have an audience of people who are neither sick nor healthy and who will weigh on the health system in the coming years. But there is good news: according to the latest studies, cited in an editorial in Nature, vaccination with three doses reduces the risk of complications in the long term after infection by 50% ».
Do masks still protect us?
“Yes, it is essential to keep this simple security guard, considering that the scenario is undergoing strong evolution”.
April 6, 2022 (change April 6, 2022 | 07:45 am)
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