The first anniversary of the pandemic: what has changed in the country and the world

What we learned about the virus and the disease and what we learned, "Novye Izvestia" tried to understand.

Yelena Ivanova, Natalia Seibil

During the year of the pandemic, people learned to wash their hands regularly, to distinguish operating masks from FFP-2 and 3, and learned a lot about microbiology and the structure of viruses. Many realized that life is finite, and that people die not only from wars, but also from an invisible enemy - a virus that originated from nowhere and conquered the entire planet. Also, people learned a lot about themselves, their health, society.

Virus

Anatoly Brunsburg is 91 years old. His considerable age does not prevent him from doing gymnastics every morning for an hour and a half. Anatoly Moiseevich has a wall bars and dumbbells in his apartment. And he looks much younger than his nine dozen. For the past 40 years, he has never had a fever, so when he felt unwell last April, he decided to measure it. It turned out to be 38 degrees. Anatoly Moiseyevich immediately suspected that something "extraordinary" had happened, got on a trolleybus and went to the clinic.

- At the entrance, my temperature was measured, the doctor listened to me and said: "You have pneumonia". She prescribed me a number of antibiotics without any CT scan. I ask her: "Maybe I have a coronavirus?" “No, it's just pneumonia, buy these antibiotics. If the temperature is over 38, call an ambulance". In from and the whole conversation.

Two days later, the temperature did not drop, so I had to call an ambulance. The doctor suggested that the pensioner go to the head clinic and have a CT scan. He got back on the trolleybus again and went to the examination. CT scan showed lung involvement. "You have a coronavirus". The doctor offered hospitalization, but Brunsburg refused. The doctor said to continue taking antibiotics and avoid contact. He got on the trolleybus again and returned home.

- In the end, the temperature rose above 39, the weakness is terrible. And so I did not feel anything special, except for the complete weakening of the body. I called an ambulance, they took me to the hospital. I ended up in hospital No.31, where I stayed for 10 days. Then they told me that they were being sent for rehabilitation outside the city to some hospital due to my age, since I had passed 90. I flatly refused, said that I could only go home from you or I would leave on foot. They told me that you will not go on foot, we will provide you with a car. In the evening, they brought me home by car, warning that no one was at home except me, says Anatoly Bransburg.

After covid, Anatoly Moiseevich had an affected Achilles tendon - there was no injury, and he could not step on his foot for a long time. And one more consequence - although almost a year has passed, the sense of smell has not been restored to this day. The pensioner restored his physical form in three months...

The fact that Anatoly Bransberg tolerated the covid quite easily borders on a miracle. In his age group over 80, the mortality rate reaches 15%, while men die twice as often as women. British scientists have calculated that the risk of dying from coronavirus infection for men over 65 is 50 times higher than from an accident.

Doctor of Medical Sciences, virologist Anatoly Altstein has been dealing with viruses all his life. Researchers have known about coronaviruses for a long time. Previously, the scientist says, they were studied by "Losers", since they were of little interest for study. The first human coronaviruses were described in the 1960s. But at the beginning of the 21st century, the attitude towards this group changed fundamentally. In 2002, SARS , a virus highly pathogenic for humans, was discovered in China. It killed 10% of those infected. In total, 80 thousand cases were registered - until the virus disappeared as suddenly as it appeared. Ten years later, a new MERS epidemic broke out in the Middle East with an even higher mortality rate - one in three died. At the end of 2019, another coronavirus infection arrived - COVID-19.

"Previous epidemics numbered thousands of cases and hundreds of deaths. Now about 115 million have fallen ill, about 2.5 million people have died. Such epidemics occur once every 100 years. The Spaniard was even scarier. In "Spanish flu" at least 20 million people died, much more than died on the fronts of the First World War. Then there were no drugs...", - says Altstein.

There are no drugs now, the expert adds. It takes decades of research to create a new drug. Covid is only one year old, and doctors are just starting to collect material about the anamnesis. The only thing they can say with certainty is not the flu. But it is necessary to treat the sick, so today large research groups are testing already developed drugs for action against covid - against influenza, Ebola, and malaria. No results yet.

"A lot of work is being done in this direction, more than 400 investigational drugs are in development. Research will continue for a long time. There are now important nonspecific drugs available to help with this disease. They are aimed at reducing blood clotting and suppressing unwanted hyperimmune reactions of the sick organism".

The situation with the vaccine is much better in the world.

Vaccine and covid

Since the days of Edward Jenner and Louis Pasteur, humanity has been fighting with vaccines against infectious diseases. With the help of a live vaccine from a weakened pathogen, it was possible to completely defeat smallpox, measles, yellow fever, chickenpox, and rubella. Against poliomyelitis - infantile paralysis - there are two vaccines - live and inactivated (when the pathogen is completely inactivated). The inactivated vaccine is used in the fight against rabies, influenza, tick-borne encephalitis.

In 1972-1973, a revolution took place - in the United States, genetic engineering appeared - a set of methods that allow you to create molecular structures with properties useful for humans. For 50 years, genetic engineering has changed modern biology and biotechnology. Fundamentally new approaches have been developed to obtain vector vaccines, vaccines based on DNA, RNA and viral proteins, a new type of live vaccines.

But what happened with the development of vaccines in 2020 is unknown in research history.

"After the outbreak of the coronavirus pandemic, hundreds of scientific laboratories and groups around the world have become involved in the development of new vaccines, using both traditional and new molecular biotechnological approaches. About 200 different vaccines were proposed, being developed in different countries, of which less than ten have reached production so far. The coronavirus vaccines are being made on platforms, some of which have been created in the past 20-30 years", - says Altstein.

In Russia, the Sputnik V vector vaccine was the result of research carried out by Boris Naroditsky in the 1980s and 90s together with the vectors' father, Canadian virologist Frank Graham. Thanks to the director of the Scientific Research Center of EM them. N.F. Gamaleya, Academician of the RAS A.L. Ginzburg, a department of molecular biology was created at his institute under the leadership of Naroditsky. His student, RAS Corresponding Member Denis Logunov, was in charge of the development of the Sputnik V vaccine.

It will become the main weapon in the fight against coronavirus in Russia.

In Europe and the USA, anti-coronavirus vaccines based on viral RNA are used as the main one. Alstein calls them "highly innovative drugs" that have successfully completed three phases of clinical trials. Vaccines based on viral DNA, obtained in the form of plasmids in bacrethial cells, are on the way.

Traditional inactivated vaccines have been created in three countries - China, India and Russia, at the Scientific Center for Research and Development of Immunobiological Preparations named after M.P. Chumakov . In theory, this approach does not raise research concerns, but large-scale production will be challenging.

Anatoly Altstein was vaccinated with his wife and grandson back in August 2020 among the first two hundred people who received the Sputnik V vaccine. The antibody titer that Alstein tested in November, 42 days after the second shot, was high. People vaccinated with Sputnik can be re-vaccinated with any vaccine, including the same Sputnik. There are no exact results on vaccination for the third or fourth time yet, but it is very possible that it will work. The fact is that the Sputnik vaccine has a very high virus content, so high that antibodies may only partially suppress the activity of the vector, says Altstein:

"At the Research Center named after Gamaleya they are doing this research, but they are more optimistic about it than I am. I think that antibodies with adenovirus may interfere. But there is such a thing - the vaccine is not required to protect by 90%. If it protects 50% - 60% - 70%, it is a perfectly working vaccine. When people report they have 66% protection, that's not bad at all for a vaccine".

It is difficult to say now how good vector vaccines will be for booster vaccinations - antibodies against the vector itself are developing, and the drug may become less effective.

RNA vaccines are good because there is no immunity against RNA, but they have another drawback - they are expensive. One dose of Moderna costs $ 37, a dose of Pfizer - $ 20. Over time, they will cost less.

The cheapest vaccine is the Oxford vaccine produced by Astra-Zeneca, it costs $ 4, Sputnik and the Johnson & Johnson vaccine are sold at the same price - $ 10. The Chinese Sinovac vaccine costs $ 30 per dose.

Most likely, in the future, people will be vaccinated with not one vaccine, but two:

"The existing vaccines have performed well, but I think that a live vaccine will be needed for the future control of the coronavirus. This is the same approach as for polio. The inactivated vaccine will be used widely enough, and against this background, immunity will be supported by a live vaccine, which will be done without fail. But it takes much longer than making such molecular biotechnological vaccines as they do now. A live vaccine is more difficult to make, and difficult to implement, but a combination of such vaccines, a molecular biotechnological vaccine and a live vaccine will give an optimal result".

As for the peptide preparation EpiVacCorona (FNTS Vector), the researchers have great doubts about its effectiveness. Anatoly Altstein says:

- The vaccine does not induce antibodies to protein S, the main protein responsible for immunity to coronavirus in any type of vaccine. This drug is most likely safe enough, but its effectiveness is questionable. No clinical trial data have been reported yet, although a vaccine is being used.

Health care system and covid

Photos and videos of hospitals in different countries, which have bypassed the world's media and social networks, cannot leave anyone indifferent. Staples of coffins in Bergamo, Italy, refrigerators in New York, where the dead from covid lay, corridors of Russian hospitals where sick people were housed.

In Russia, the health care system faced a war and was left alone with it, says Nikolay Prokhorenko, first vice-rector of the Higher School of Health Organization and Management:

"The health care system, for many years, or maybe decades, not receiving adequate funding and governed not by scientifically based decisions, but by anything other than them, could not be fully prepared for the epidemic and was not ready for it either organizationally, neither resourcefully nor psychologically".

The system could not, from the point of view of the organization of treatment, make it not dangerous for patients, says Nikolai Prokhorenko. As a result, people crowded in queues, went to get sick leaves, there was no clear division of streams anywhere and there was no understanding that people were getting infected there.

Several countries have dealt with the pandemic very well. Southeast Asia performed well, Australia and New Zealand showed a drop in overall mortality amid the pandemic. In Germany, the increase in overall mortality was 3%. In Russia, mortality increased by 18% - 19%. Prokhorenko calls this a political and managerial mistake when the authorities decided not to show the death rate from covid:

“I have spoken to many regional health ministers explaining to them that they are making a huge mistake. The ministers understood this, but the epidemic is the governor's area of responsibility. And the health care of the region is the minister's area of responsibility. So, the governors did not allow ministers to show the increase in mortality from covid. Because they did not want to show that they had organizationally failed to cope with anti-emidemic measures. Everything fell on the health care system, which worked about the same everywhere, in Moscow - better because of the resource endowment.

All over the world, the percentage of mortality from covid is approximately the same - less than one percent. It all depends on how many people got sick. In Russia, the number of excess deaths was 320 thousand people. This means that about 35 million people in Russia have been ill with covid. Many suffered from the disease asymptomatically and did not go to doctors".

The main problem of the country is that the population does not trust the authorities. In the absence of clear information, people rushed to buy lemons, ginger, garlic, antibiotics, vitamins. The price for ginger went up from 200 rubles to 6 thousand, and in Irkutsk people were queuing up for an antibiotic.

Data on the number of infected have not been opened, according to what principles the testing was carried out, it is still unknown.

"Who is to be tested? Maybe the employees who served the State Duma were given tests every other day? Therefore, we have a huge number of analyzes at the expense of those to whom they were done endlessly again. Who are we isolating? One family member has confirmed covid, the rest do not, and are not in quarantine. Who lives together or does not live was determined by registration, and not by actual residence".

Doctors

The verdict of the scientists involved in Russian healthcare is harsh: the system is exhausted, disorganized, and the vertical of command has been virtually destroyed due to fear of responsibility. In the US, they write that the number of "burnt out" employees has grown to 70%. If you read the comments on social networks or on the Vrachi.RF website, we have 90% of them, says Prokhorenko. The population began to treat doctors and medical staff more respectfully and with greater attention. In words, the authorities have also repeatedly confirmed that they will provide everyone and everything. As a result, funding in the budget was reduced for three years.

Medical staff who worked directly with covid patients received a salary increase due to supplements. But the fact is that absolutely all employees of medical organizations contacted them. Nikolay Prokhorenko says:

- Here is my daughter, a student at the St. Petersburg Medical University. They were mobilized. But they were not given any means of protection, arguing that they did not work in a covid hospital.

Exactly two weeks after the patient was transported to a CT scan, who later became diagnosed with covid, seven out of 11 working students fell ill, including my daughter. Has anyone paid even a penny to the students? They were generally not taken into account in regulatory documents. Nowhere.

Like any crisis, a pandemic is a chance. Unless a public consensus is reached on the financing of medicine, health care will continue to deteriorate. The whole country should understand that a lot of money needs to be allocated for health.

What's next

In the meantime, the pandemic continues. Recently, the director of the WHO European office, Hans Kluge, said that the pandemic will end in a few months. After heated discussions and excuses, it turned out that Kluge wanted to say: in a few months, lockdowns and other harsh restrictive measures may disappear. The head of the Charité Institute of Virology, Christina Dorsten, tweeted that none of the known mutations and new strains gives reason to talk about weakening.

However, in some countries, such as Brazil or the United States, so many people have been ill that one can even assume the emergence of herd immunity.

Some countries have advanced with vaccinations as well. In Israel, more than 90% of the population is vaccinated, in America - 50 million people, by June there will be 100 million. 4 million people were vaccinated in Russia.

Anatoly Altstein is optimistic:

"I do not exclude that in a year or two it will be possible to take control of this infection. The vaccine is a very important anti-epidemic tool. This is not only the private protection of a given person, but also the protection of society. This is an important measure against the epidemic. If it does not protect one person 100%, then it protects society".

Nikolay Prokhorenko reminds:

"The epidemic does not read our newspapers. The virus is an objective, not a controllable object, so the epidemic behaves unpredictably... The covid virus will become one of the causative agents of seasonal SARS".

So there is no great reason for optimism yet. For nobody and nowhere.