Margarita del Val: "It seems that ómicron is as virulent as the original strain from Wuhan"

With a sixth wave in the making, the chemist and virologist Margarita del Val (1959) warns that it is still early to consider it "the beginning of the end". Whether SARS-CoV-2 becomes an endemic virus depends on "our immunity", which is acquired through vaccination. However, before defining a new vaccination schedule, hospitalization data after the winter should be analyzed.

In view of some messages and political decisions that are being transferred, howDo you think it is time to endemize the virus?

On political decisions I have no training to give an opinion. In this wave we have little data about the omicron variant and, furthermore, it has to be contrasted. That is why it is still difficult to make decisions beyond controlling the virus as we have always done.

The lack of knowledge we have about the effects that it can have in the long term, in the form of persistent covid for example, this massive contagion.

The fundamental thing and what worries us now is the short-term effect, that is, deaths. When the long-term effects occur, they will be something else.

A few days ago he declared that, to contain the virus, we must bet on ventilation, masks and vaccination. We have the latest, but ventilation seems to be the pending issue.

We have delved too little into ventilation. In June 2021, a group of 100 scientists, including myself, wrote a request for such action. We were in time to provide air quality meters, filters and teach air conditioning with the maximum renewal that energy consumption allows. Nothing has been done. Therefore, these three things must be done, and the sooner the better. It must be taken into account that they will not only protect us from this infection, but also from other respiratory diseases, bearing in mind that the next most likely pandemics will also be of respiratory transmission.

Why do you think that a measure, which a priori seems simple to implement, has not caught on as much as masks or vaccines?

Because the World Health Organization (WHO) did not recognize it and even called it a hoax. When they recognized it, they simply posted it on their website without notifying anyone. In the end, if the highest health authority gives it little publicity and does not take this form of transmission into account, it is very difficult for other media to launch it. It is a problem, the WHO is weighed down by a false understanding of what aerosol transmission is since the 19th century.

What do you mean by this "false understanding" of what aerosols are?

It has had a very bad reputation because there was someone who said that the outside air was full of miasma and polluted. That, in the 19th century, raised a great alarm because it was stated that cholera was not transmitted by sewage but by the air. That was bullshit and the information that was provided to disprove it at the time is still with us a century later. It is a very important problem, because it has allied itself with bad fame and the scientific evidence has been ignored. Now the WHO emphasizes the importance of ventilation, but it does not look further and it is clear that in cold places, for example, it is not only possible to ventilate.

Given the importance that ventilation has acquired, should we discard contagion through surfaces?

Right now, having the habit of wearing masks, this form of contagion is less important. The mask protects us from dirtying surfaces with our hands. By having it on, even if it is poorly adjusted, we do not touch our mouths and noses. So the mask performs many functions and is one of the great aces up our sleeve that we have in Spain because we use it a lot indoors, except when we eat and drink. That has been a great success.

In October, the message was given that the pandemic seemed to be ending, but ómicron has given us a scare again. Could this high incidence have been avoided?

Ómicron expands much better. It spreads more than Delta among those who have been vaccinated and those who already have immunity from infection. With delta we already knew that vaccinated people could become infected and transmit the virus, but with this variant it was one in five more or less. With omicron this ratio is much higher. Therefore, while everyone was already vaccinated with Delta, almost no one could become infected and transmit it, with omicron, all of a sudden, those susceptible to infecting us have become all Spaniards. We could not foresee that characteristic because it was a very abrupt jump. So we haven't done anything wrong. In fact, we were being very cautious because before this sixth wave, third doses were being administered, which was an excess of caution. But look, it's been good for us.

Is ómicron milder or is its lesser damage a reflection of the population's vaccination status?

It is milder because we are vaccinated and there are more people who have had the infection, but above all because we are vaccinated. It is not known if the variant itself is dimmed or not. At the moment it appears that omicron is as virulent as the original Wuhan strain, and perhaps slightly less so than delta, although the latter is unconsolidated data. As I mentioned, the only certainty is that it has an advantage over delta in people who have immunity from vaccination or infection. In addition, this information that we have only contemplates young people, because there have been too few infections among adults over 65 years of age to draw conclusions. That is why we must be very cautious, have patience to have data with which to carry out rigorous analysis and not just cling to the good news. Lax testing can lead people to make decisions that are the exact opposite of what to do, such as deciding to get infected and die from it.

Now, in fact, it is not uncommon to hear that the sixth wave is the beginning of the end.

That is not true. It is not based on anything. The beginning of the end is how well vaccinated we are and we have to wait to see how we spend this winter to draw any conclusions.

Seeing what has happened this winter, it is not ruled out that other variants can give us new 'scares'.

New variants will emerge, for sure. With omicron, people have begun to say that it is the beginning of the end, believing that it is attenuated, but we do not know it yet. People have wanted to see it attenuated, but it was the illusion that those who were infected were young and vaccinated people.

What can we expect in the short-term future after this sixth wave?

I do not know. We have to observe. Now we should not look at the number of cases because it is a value full of errors, given that in many places the saturation does not allow diagnosing or because the decision to prioritize is made. Besides, there are many people who do an antigen test and do not communicate their diagnosis. The data that should replace it is that of hospitals, which should be much clearer. We need to know which people admitted are vaccinated, how old they are and their evolution. We need to know which people admitted are vaccinated, how old they are and their evolution. The point is no longer knowing if a hospital is saturated or not –although also–, but who is entering and under what conditions. And with those observations we will have enough data to conclude how we are doing this winter and if the pandemic is near its end or not.

The pneumococcal vaccine in the elderly, an example to follow

The pneumococcal vaccine, which is prescribed for those over 65, could be the example to follow in the vaccination campaign against the coronavirus. This is how the CSIC virologist Margarita del Val considers it, who highlights that this vaccine is only given once because "it is so powerful" that it does not need second or third doses, and allows the elderly population to be protected against various subtypes of this bacterium.

“These vaccines that we have against the coronavirus are very good,” explains Del Val. In this way, the virologist emphasizes that the massive revaccination policies against the coronavirus have to be rethought for the coming months. Although the scientist agrees that a fourth dose should be inoculated to the immunosuppressed population, she understands that this protection should not be proposed until "the clinical data are not evaluated" because, with current knowledge, "it makes no sense to put a fourth vaccine shortly after the third.

The expert also affirms "not understanding" the decision to vaccinate people who have just been infected in just four weeks. “It doesn't make immunological sense because the system is reinforced by the infection,” he points out.

Del Val makes this comparison to distance the coronavirus from the "false analogies" that are usually made with the common flu. A parallelism that, in the eyes of the virologist, is "ridiculous", given that the coronavirus varies less than the flu virus, it has effective treatments -something that the flu does not-, it has a "much better" vaccine and the coronavirus "We know how to defend ourselves."

For this reason, the virologist considers that it is time to start relating it to other types of viruses and vaccines, so that a different message can be spread. In the case of pneumococcus, as he explains, "the vaccine is so powerful that it is only necessary to vaccinate them once from the age of 65." From other viruses, such as rubella, mumps, whooping cough, tetanus or hepatitis, they only require protection in the childhood stage.

Why then has the flu virus been linked to the one that causes covid-19 throughout the pandemic? The answer is that the flu virus is the one we talk about the most. "It is the only respiratory disease whose name we remember," insists the virologist, who emphasizes that this happens because it is an "easy" name. In addition, we tend to confuse all types of viruses with the flu. "Everyone says they had the flu when the reality is that there are 8 viruses that can cause the same symptoms," he stresses.

We also remember it more because vaccination campaigns force us to do so. And it is that the flu vaccine is the only one that is inoculated every year for the population over 65 and for people with the highest risk of contagion.

At the moment, the vaccine is the best way to acquire immunity against the virus, with a view to one day "we have enough to consider that the pandemic is over." But to get there, as Del Val points out, "we have to analyze the data from this winter." In any case, the scientist rules out that we can end the virus. "The virus will continue to circulate and mutate," he highlights.

In this sense, he insists that it is of the utmost importance to vaccinate the entire population of the planet, "for humanity and for selfishness." "When there's a country that's a bottleneck for anything we need - humanitarian, economic or even supply-wise - if they're not well vaccinated, at some point it's going to bounce back to us."

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