Christian Drosten: "The emergency regime may last about a year ..."
A famous German virologist, one of the main medical consultants of the German government in the fight against coronavirus infection, Christian Droosten was one of the creators of the test for the presence of COVID-19 in humans, which the World Health Organization recommended for use around the world.
In an interview with ZEIT Online, Drosten talks about the causes of low mortality in Germany; about the nature of the new coronavirus; how soon a vaccine for the new coronavirus will appear and how many people in Germany and Europe will have to wait for a normal life to return. Novye Izvestia cites the most interesting places from this interview.
About the benefits of quarantine
I hope that quarantine measures will decisively affect the dynamics of the spread of the virus. Perhaps this will be appreciated by Easter (that is, by mid-April, approx.ed). Maybe we will already see then that there are fewer infected people than can be expected based on the current exponential growth, and that this curve on the graph has become smoother. But this will not immediately affect the mortality rate. Because people who die from the virus before Easter are either infected right now or they will get infected in the coming days. In addition, the decisions made today will not change our life immediately, but only after a few days. Already, our daily routine is changing; parents gradually managed to organize childcare, more and more people began to realize that they should not meet with companies. It will take some time to get used to all this.
I think now a lot of things are changing in people's heads. Quarantine measures were introduced recently, but now it should become clear to the majority. We will always find some incorrigible people, unlike China - where even such people are corrected. But I am glad that we do not live in such a society as Chinese. And by the way, I’m not sure how important it is for the overall picture of the epidemic to identify all the "incorrigible" to one.
Closing bars and restaurants, canceling public events, closing kindergartens and schools is already very effective. It is important to prevent most personal contact.
I believe that Germany was able to recognize the outbreak at a very early stage: two to three weeks earlier than in some neighboring countries. This was possible thanks to large-scale diagnostics - we conducted many tests. Of course, we missed some cases during this first stage, this is inevitable. But I do not think that we have incorrectly estimated the scale of the flash. Of course, we record far from all cases, but still more than in other countries.
In Italy, those who go to hospitals are primarily tested. The population there knows that there are not enough tests, so even with symptoms, people stay at home, and if they feel worse, they go to the hospital. They arrive there already with difficulty breathing and, in fact, they have to be immediately put into intensive care. And only at that moment they are being tested. Therefore, the average age of registered patients in Italy is much higher than ours. I assume that a lot of young Italians are either infected or have already suffered an infection and have not been included in the statistics. This also explains the allegedly high mortality from the virus in Italy.
While we simply are not able to increase the power needed for diagnosis as fast as the number of infected people is growing. And then two factors will unite. One of the patients will die from COVID-19, but since we cannot test everyone, our statistics will become very incomplete. Then the percentage of deaths will increase with us. That is, outwardly it will seem as if the virus has become more dangerous, but this is exclusively a statistical distortion. It illustrates a trend that has already begun: we are missing more infections.
About urgent measures
You need to try to speed up. If a person has a virus, we can consider his whole family infected, without even having a test. Just because it is known: if one member of the family becomes infected, it infects households. If you immediately accept all family members as infected, you can save a large number of tests. Imagine that you became infected, and the next day your wife should stand in line for testing. And if suddenly the first test does not work, she will have to go to take it again. There is little sense in this. It is better to immediately leave the whole family in quarantine. The Netherlands has chosen just such a path, and I am going to offer it to representatives of the German health authorities.
At some point, a suspected infection will be reported only on the basis of symptoms, and statistics will focus on such cases. At the same time, the available tests will have to be redistributed in favor of risk groups. If any girl student who is in good health is quarantined at home and looks at Netflix, the doctor does not need to know the result of her test. Let him sit and recover. And a completely different case - if we are talking about a 70-year-old not very healthy person who became ill and isolated at home. I would like to check it, and then every couple of days to call and ask how he breathes. So that he was promptly admitted to the hospital, and did not arrive already with serious pulmonary disorders in the outpatient department, from where he would immediately be sent to intensive care.
It is necessary to wait for the appearance of tests to determine the antigen, which can quickly confirm the presence of viral protein. Outwardly, such a test is similar to a pregnancy test - and the result can be found out just as quickly. If these tests justify themselves, they will completely replace the current ones. Then the lines will disappear. I hope this can happen by May.
Regardless of any calculations, everyone with whom I speak is unanimous in the opinion that now it is necessary to reduce the incidence. Otherwise, we will miss the moment, and in a few weeks we will begin to have the same problems as in Italy. We have more beds and, perhaps, a slightly higher level of professional training of specialists - but even this, even a high, level of resuscitation assistance will still not be enough. Based on today's data, we need - even by the most conservative estimates - three times as many intensive care facilities to provide mechanical ventilation devices to anyone who might need it.
Right now we are ordering additional ventilators, preparing departments and hospital wards. This process will take a couple of weeks. It is for this - and not for the urgent development of a vaccine - that we need the time that we are winning now.
On the main surprise of coronavirus
Very simple: the virus actively multiplies in the larynx. The Severe Acute Respiratory Syndrome Virus (SARS), which caused the outbreak in 2002-2003, could not be isolated from the tissues of the larynx. Patients with SARS had fewer viruses in their bodies, and the pathogen was less contagious. In addition, this new coronavirus has an amazing biological feature: in its surface protein there is a site of protease cleavage. The presence of this area - for example, in the case of bird flu - usually depends on whether the pathogen causes a serious illness in the bird or not.
In order for the virus to develop and invade the next cell, the surface protein must be incised. And thanks to this incision site, the virus is probably ready for cleavage immediately after isolation from the previous infected cell. Imagine a piece of paper that is easy to tear out of a notebook because it has a perforated line to tear off. So the Sars-CoV-2 virus has such a perforation.
Perhaps this leads to the fact that the virus is released from the cell already in a mature state, ready for penetration into the next cell. Maybe that is why Sars-CoV-2 reproduces so actively in the throat and is so easily transmitted. All this remains to be seen.
About the mortality rate
In fact, now another indicator is more important: Infection Fatality Rate, that is, the proportion of deaths among those infected - including those who do not have pronounced or generally no symptoms, and therefore do not fall into the statistics. Thanks to this indicator, we can roughly estimate the number of unregistered cases. How many people did not feel anything at all? How many got away with just a sore throat? Among the first infected in Germany, which we carefully examined for scientific purposes, there were many. I often hear that in 80% of cases the infection is mild. But I get the impression that this proportion is even much higher. And it would be important to know this for sure.
In young people, habitual respiratory diseases sometimes also go very hard. However, often we have very little data about these people. Media in such cases write: "A 35-year-old man was in intensive care." But a 35-year-old person can also have severe background illnesses. It is known, for example, that a high risk of body mass index, as well as coronary heart disease, i.e. narrowing of the coronary arteries due to atherosclerosis. Pneumonia creates a huge burden on the cardiovascular system. And if the cardiovascular system is initially not in order, then the additional load leads to damage. Many people between the ages of 35-50 live with these risk factors. Another hypothesis is that some could breathe a huge dose of the virus directly into the lungs. Then the virus begins to multiply immediately in the deep airways, without first causing an immune reaction in the throat. Perhaps, in this case, the person immediately falls ill very seriously - the body has not yet managed to develop any means of protection. But all this, I repeat, is only a hypothesis.
About the rush
Perhaps the situation will be so serious that some rules and procedures will be canceled and simplified. Theoretically, one can imagine that the existing protocols will have to be simplified, given the emergency situation, and that vaccines that do not pass all the required clinical tests will be used. All this is still very speculative. But if you really squeeze it - until I exclude this - you can imagine such a scenario. In any case, some biotech companies have long had vaccine options in development.
Rather, it may be about launching into mass production a surface protein of the virus against which the immune system will actively produce antibodies. Some companies take this approach. A vaccine of this kind could be specifically used for vaccination to people at risk. With a critical scenario, one can imagine that something similar will happen. .
About existing drugs
The best option seems to me is the substance "Remdesivir". It was developed to fight the Ebola virus. Research is already underway, but the manufacturer so far allows its use only according to a special protocol for patients with a severe course of the disease and only in a short period of time. Of course, I would like to prescribe it at an earlier stage, but for this, the drug should become more accessible. We need to wait for the first results.
I do not see other real options. Neither the anti-malarial drug Chloroquine nor the drugs for HIV therapy Ritonavir / Opinavir are suitable. Both drugs are in clinical trials, but the results are inconclusive.
In addition, there are many healthy young patients who are ideal plasma donors. With a disease, their body produces optimal antibodies. If they are promptly administered to other patients, this can be a very real therapy. I can imagine that in two months we will collect a small amount of analytics on such cases for Germany. But to expect instant results, especially on a large scale, from all these attempts is impossible.
Warm weather will not stop the flash, but it may be useful. And I fully expect that a summer temperature increase - combined with insulation measures - will bring a definite result.
About the prospects
It may take about a year for society to live in an emergency. But I don’t think the same as now. The situation can and will need to be corrected. Some prohibitions will be canceled. But at the initial stage, from today until the first week after Easter (April 13–20), it is necessary to act very consistently, carefully observing the development of the incidence.
Certain measures can be developed specifically for risk groups. For example, organize early diagnosis for the elderly and patients at risk, as well as hospitalize them first. To provide for such people the opportunity to work from home, and for long periods. You can figure out how to organize home quarantine for the elderly, provide for them transport services, provide them with food. Volunteers, or possibly soldiers, can help. It is necessary to divide children and risk groups in everyday life as consistently as possible.
Probably, you have to come up with something: for example, half of the classes use some corridors, the other half use others ... Refuse from big changes, and even from small ones ... Do not use public premises, close them. Perhaps this will reduce the real size of groups in schools. This needs to be properly planned, but the time is up to the first week after Easter. Most importantly, now we need scientific models, analytics on the situation in the school.
Grandchildren may have to take a test before visiting grandparents to make sure they don’t infect them. These details must be worked out. The decisions taken by the authorities have so far put an end to all social life. But I hope that with the help of scientific models and calculations analyzing the situation in Germany, the authorities will correct the situation.
For doctors, the question of special testing is already being considered so that people can normally go to work. If we already had antigen tests, this principle could be extended to other professions. In addition, if we assume that 10-15 million people will fall ill in Germany by the fall, then soon we will have a lot of people whose antibodies have already been developed in their bodies, which means immunity. Then there will be nurses and doctors working without masks, as well as representatives of other professions who will be able to say: "I was ill." And there will be more and more.
For someone who has been ill, immunity is likely to persist until the end of the pandemic - I think for several years. And even with repeated infection, the disease will proceed in the form of a harmless cold. The next infection will no longer be severe. At least today I see it this way.
Most likely, this virus will be the same as with other coronaviruses, which now cause only a cold. We will have to live with him, but after we survive this outbreak, he will no longer be so dangerous for us.