«That the Covid-19 mute constantly does not mean that it becomes more virulent»

Antoni Trilla is head of the Preventive Medicine and Epidemiology Service of the Hospital Clínic de Barcelona and dean of the Faculty of Medicine of the University of Barcelona. And not only does he know what he is talking about, he also expresses it in a bluntly clear way. And vice versa. In the midst of a whirlwind of appointments, meetings and patients we have interrupted him to clarify any doubts.

– COVID-19 is compared with the flu and we pretend to know if it is successful.

– I think it is a situation in which it is possible to compare them, but it has advantages and disadvantages. It can be compared by clarifying similarities and differences. The flu is an extended disease that everyone has internalized and is associated with low mortality. But we also don’t know how Covid-19 will evolve and if it will make it to a flu. It is true that the World Health Organization (WHO) has always used the word pandemic, or, at least, when it has been used has been in relation to influenza and therefore the instructions given have to do with something similar. Therefore, if differences and similarities are well explained, it can be a resource. What is not appropriate is to compare this coronavirus with SARS (Severe acute respiratory syndrome) or MERS (Middle East Respiratory Syndrome). They are all coronaviruses but they behave differently.

– WHO has raised the global alert to very high around the world, what are the risks?

– It must be made clear that WHO is talking about the risk of spread, that is what the alert level refers to. It is not that the virus is more aggressive, it is simply that there are more countries that are showing cases and that makes more people infected and spread. But their level of virulence is the same as until now: about 80% of patients are mild and only 15% need hospital admissions.

– Can the virus mutate towards more aggressive characteristics?

– By definition, viruses, and even more so, are constantly mutating. But contrary to what people think, it does not mean that they are more virulent. Most of the time, viruses mutate to adapt to a better situation and that means infecting many people, but not something serious. If you infect something serious it is a bad deal for the virus. If he kills the patient it is difficult to transmit. Coronaviruses that produce colds are best adapted in this regard, infect millions of people and perhaps several times a year. Right now there is no evidence of a mutation that involves more seriousness or concern.

– Should we be afraid of him?

– What we have to have is fear of panicking. Fear is legitimate, I have it too, otherwise I would be unconscious. But it must make me adopt precautionary behaviors to avoid danger, that’s what fear is for. The problem is when we panic and we are paralyzed and have irrational or opposite behavior to what we must do to guarantee life. It is good to be alert to avoid danger, but not reach irrational attitudes.

– The irrational attitudes you talk about have to do with the use of the mask? S

– It is one of those situations in which fear or fear has led to an attitude without scientific basis for most people. In Wuhan you can wear a mask on the street, but in Barcelona or Madrid, wearing them thinking that everything will change in a few days makes no sense. Because the masks do work for certain people: for medical staff, for immunosuppressed patients … and if we exhaust them and the production situation in the world is compromised precisely by the virus, we will end up with those who need it will not have them. It is a good example of entering a situation that is not rational at all.

–Is WHO managing this epidemic well?

– I would say that WHO has had and has many criticisms. It can be criticized as bureaucratized, but it has learned from previous situations in which it has been fairly or unfairly criticized. Despite the size of the problem, it has a very good technical staff, there are people of reference to try to control an epidemic that has been in a thousand battles. That sometimes they have a spokesman who makes a less fortunate statement … they should be asked to convey that experience in a calm way. There is something that is complicated, which is that WHO has to speak all over the world, and it is not the same to send the message to Tanzania, Argentina, Switzerland or Canada. It is as if I had to send a weather report for everyone and that is impossible. WHO has to modulate that message. One thing is to say that we are very concerned about the arrival of the virus in Africa and another to speak of the number one public enemy. There are some messages that the ball could have been adjusted more.

– What are the stages through which Covid could go in the future?

– I’d like to know and get it right. You can’t talk about a single cycle. We contemplate different scenarios: what would happen if we contain it in a few months? What would happen if the number of infected people rises? You have to see all the indicators and go making decisions as the facts are presented, it is not known where each of these phases will go. Spain will have to make decisions at the national level and then it can implement measures in certain areas, as is the case right now in Italy. Where will it go? When the movie is over we’ll see. I would be unconscious if I said something right now. We move through facts, not opinions.


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