“Variants may continue to appear that give us some fright”



In addition to being a professor of Microbiology at the University of Navarra, Ignacio López-Goñi is a multi-award-winning disseminator, author of several books and head of one of the best virology blogs, ‘microBIO’, from which his definition of viruses as “Clouds of mutants.” His explanation of the parts of the coronavirus using a Ferrero Rocher chocolate went viral – worth the redundancy.

A sign of his intellectual humility is having recognized that, until March 6, 2020, when he saw an interview with the British epidemiologist Richard Hatchettt, he thought that the coronavirus was not going to be that bad. Days before, at the end of February, he said on Twitter that it produced “mass hysteria” that the media broadcast almost live every new case of coronavirus that was detected. But he soon changed his mind because of that interview on the British public channel Channel Four in which Hatchett said that the coronavirus was the most terrifying disease he had seen in his career, being highly infectious and having a lethality several times higher than that of the flu.

Why was that message not only spread in Spain?

I must admit, and I have said it publicly, that I was confused in the first weeks, until I saw that video. Not that I was skeptical, but our obsession was that the next pandemic was going to be a flu virus, because it spreads so easily and is the champion of variability. We know that there are flu viruses in birds that occasionally give us problems. It was what we were all hoping was a pandemic virus. Although there had been problems with SARS and MERS, it was seen that it did not transmit very well between people. The other reason is that, as of mid-February, 95 percent of all cases and deaths were in China, and the draconian measures that China had imposed and that we never imagined would reach our doorstep seemed that were effective for the coronavirus. So I thought I was going to get a big scare in China, like SARS and MERS.

Sure.

But when I saw that video, especially because of the prestige of that epidemiologist, who is not a mindundi, but a man who knows viruses and epidemiology, I changed the chip and thought: “This is more serious than what many of us are thinking” . Why was it not spread? The truth is that I do not know. The other day I reread the WHO report of March 5, in which it said that it was not a drill, that you had to take it seriously and take action. You read it now, a year or so later, and you wonder: “Damn, why didn’t we pay attention?” Well I do not know. It is also true that the WHO had already issued other alerts, such as the flu pandemic [2009] and that in the end it did not reach that much.

He spoke of the draconian measures applied in China to contain the virus. Now, in the light of various studies, some scientists estimate that the epidemic started well before what has been officially said from China, before the outbreak of the Wuhan seafood market.

Now there are not many doubts. The thing about the Wuhan market was that they saw such a big outbreak and realized they had a problem, but the virus was probably circulating months before. Had the Chinese authorities detected it? This already depends on the transparency of the Chinese government. But, indeed, the sequencing data indicates that at least in October or November the virus was already circulating.

In Spain, in February, PCR was not performed on patients with symptoms compatible with COVID-19 who did not have an epidemiological link with China or Italy. Perhaps many cases crept in there.

Probably yes. In those weeks, cases could be sneaked in because there was a very strict protocol of who and how to carry out the PCR. The samples had to be sent to the National Microbiology Center in Madrid … The protocol had not been activated because it was not estimated that it would be that strong.

Can the coronavirus vary so much as to totally avoid vaccines and at the same time remain infectious? There are experts who suggest that, if the S protein varied so much that our immune system was not able to recognize it, these changes would have altered that “key” of the virus so much that the pathogen would lose its tool to enter cells and harm us.

That is the discussion. We have never had a coronavirus pandemic. And we have learned that it is very difficult to make predictions. In general we say that coronaviruses mutate less than the champions of mutation and variability, which are the influenza virus and HIV. Additionally, coronaviruses have a system to rectify mutations. But that doesn’t mean they don’t change. They can mutate and recombine. The frequency and probability is lower than in the influenza virus, in which we clearly speak of strains, and in coronavirus it has not gone beyond the variant category. A variant has small mutations that do not affect biological changes in a very significant way, but when there is already a very large difference in biological changes, we start talking about strains. For now, in the coronavirus we are talking about variants, small mutations that make the virus more transmissible.

What will happen?

I don’t think anyone knows. I would hope, perhaps also out of optimism, that the virus will change and attenuate more, because it will adapt to the new host, which is us. It is no longer a new virus for our immune system, because many people are infected or vaccinated, and it ends up becoming endemic. It will cause us problems and perhaps deaths, but not in a pandemic way, collapsing the health system. A death toll that is – this is a bit harsh – socially acceptable.

In what sense?

Every year ten or fifteen thousand people die from the flu in Spain, but the system does not collapse. One hundred deaths in one day collapse everything. One hundred dead in a hundred days are the same dead, but the effect is totally different. With the evolution of the virus and with vaccines, what we are going to achieve is that this is attenuated. Not that it disappears. The objective of the vaccines is not that there are no infected, but that the disease is milder, that there is no income, ucis and deaths. And it is being achieved. Can the virus vary so much that a variant appears and gives us problems? Might. We cannot rule out that there are souvenir doses, perhaps for the oldest ones. But that would be in the post-pandemic phase, which is much more manageable. The urgent thing now is to stop the pandemic.

Does a slow vaccination process, especially in countries where vaccines barely reach, coupled with natural immunity after infection, increase the selective pressure on the virus and the chances of escape variants emerging?

Yes, because the more infected people there are, the more viruses there are. And if there are more viruses, then there are more variants, because there are more viral particles. It is a matter of statistics and evolution. This moment, with many half-vaccinated people, is delicate, because variants may continue to appear that give us some fright. There are two aspects: in the hypothetical case that a very dangerous variant appears, what we should do is what we are already doing: vaccinate as soon as possible with the full doses and avoid contagion. And the other idea is that this is a global problem: until we get vaccines to also reach countries with fewer resources and that have less access to vaccines, we will continue to have a problem, that new variants may emerge.

Why did the SARS and MERS coronaviruses disappear?

-In the case of SARS, I believe that it was not sufficiently adapted for an effective transmission between people and it disappeared as soon as measures were put in place. As for MERS, the virus continues to have its biological cycle, especially in dromedaries, and from time to time it continues to give scares in people who deal with these animals. What happens is that as the lesson has been learned, many measures are taken, and it is a virus that is not very adapted to being transmitted between people.

Could a “supervirus”, a coronavirus or an influenza virus emerge in nature that is both airborne, highly contagious, with 20% or more fatality, with a very long incubation period? and with a large percentage of asymptomatic?

I do not know. This SARS-CoV-2 is very bloody, because it has some of these characteristics: very transmissible, asymptomatic, with a long presymptomatic period … Imagine that it had the same fatality in children as in people over 80 years old. Could occur? Might. But in the end a balance is reached: transmissibility and lethality do not always go together. If it is very lethal, the virus quickly ends with its host and the cycle is closed, which is what happens to Ebola.

A few weeks ago, human cases of monkeypox were reported in the UK. Four decades have passed since smallpox was eradicated and we are not vaccinated against it. Could monkeypox give us a scare if it is “humanized”?

That is one of the reasons why there is still discussion about whether smallpox stocks should be totally destroyed. There is a laboratory in the United States and another in Russia that are investigating this virus. There is a stock of vaccines and specific antivirals against smallpox are being developed. One of the reasons is because there are smallpox viruses similar to human smallpox in other animals and, given the history of virology, we cannot rule out that a smallpox virus will reappear, in this case monkeypox. to be humanized. We have to be vigilant.

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