Professor Ancha Baranova: "Everyone should have their own plan to fight the virus"

This time Ancha gave a detailed interview to Novye Izvestia.

Natalia Seibil

- Ancha, we have collected the questions that we think are of the greatest concern to the enlightened public in the fight against coronavirus. Let's start with the simplest: do masks protect people from infection?

- I’ll say right away: if you mean a “piece of clothing” that has become popular in the last year and a half (and this, as a rule, is a piece of ordinary material), then there is no need to talk about any protection against viruses. Most people choose these masks based on color and patterns, and not some biological indicator. And they also wear them for weeks without washing and disinfection. They do not fit snugly to the face, acting simply as a marker indicating compliance with general sanitary rules. If you mean disposable medical gauze masks, then there is no need to rely on effective protection either - they filter only 10 percent of the viral aerosol. The reason is the same - loose fit...

- Some wear masks, not masks, but respirators resembling "gas masks". Are they not good either?

- It is respirators that do not leave gaps between them and the person's face that fulfill their function. I have specially dealt with this issue and can confidently confirm: yes, this is an indispensable tool in public places.

- Sorry, but many people cannot wear respirators for a long time - they suffocate...

- People think they are uncomfortable because bad air has accumulated in the respirator. This is not true. A bunch of scientific articles have come out that refute this. The CO2 level was measured. It is not promoted. In fact, the question is much deeper. If people feel discomfort, then it is. The fact is that there are receptors in the area of the mouth and nose that sense heat. It is the most sensitive part of our body, like a dog's face. If you put hot food in a bowl for the dog, he will not eat it, it will wait until it cools down. The dog senses temperature with his muzzle much more accurately than with his paw. Humans have the same ability. We feel the gradient. If you are sitting near a fire or stove, you know which way you should not move - it is too hot there. You can guess the exact zone where you are comfortable to sit. If you move a centimeter, it will be uncomfortable, and a centimeter further, it will be cold. The area of our mouth and nose is the most sensitive to temperature changes. When you cover it with a mask, this zone is locally overheated, just a little, but our body feels that you are in a zone of discomfort. The body gives a signal - move away from the fire, and you suppress this signal. It turns out that while wearing a mask, you constantly suppress the signal of discomfort, your brain is busy trying to keep you in the chair.

- So what to do? Don't wear masks? As a result, they are all worn on the chin in order to follow rules that are not always reasonable. As in the situation with the gloves, canceled only a couple of weeks ago...

- I myself saw a girl in a respirator in a bank, and a pencil was inserted into it from below. She formally follows all the rules, she is comfortable, but she will infect clients if she turns out to be a carrier of the virus. This is definitely not the way to do it. But there is a way out. Masks have already been developed where this problem has been eliminated. They must be certified in each country separately, as they are considered medical equipment. These are plastic structures, lightweight, with filters that fit snugly to the face, but provide ventilation. There is no overheating problem. At Amazon you can buy masks with fans. They are large and take up a lot of space, but there is a built-in hood. You are protected, but your face is constantly cooling. Such respirators cannot be disposable, three-kopeck pieces, but in principle they are.

But if you can't buy a respirator at all, wear a medical mask. Because it's better than nothing. But you should control social distance with other people and definitely not sit in closed rooms with poor ventilation.

- By the way, about ventilation and airing of premises. You constantly repeat in your speeches that this is the easiest and most effective way to counter viruses.

- Of course! Together with the air from the office or school class, you also expel the virus into the street. The more often you ventilate, the less chance of catching the disease. Another thing is that in winter in Russia you will not be able to open all windows and doors every hour, otherwise you will have to sit in coats and hats. People who are in rooms with artificial ventilation through a single house system are also deprived of the same opportunity. They are even worse: the virus is transferred from one room of the house to all others. Therefore, there is really only one way out: either to close the offices and all public places, or to install viral air purification systems

- Do you mean the so-called air recirculators?

- Precisely them. More precisely, those devices that have ultraviolet lamps that kill the infection, and those that do not produce ozone harmful to the lungs. Many such devices are produced in many countries of the world, including Russia. The advantages of recirculators are that they come in very different capacities - from personal ones, which can be placed on a work table, to systems designed for cleaning large areas.

The likelihood of getting covid is directly proportional to the amount of viral particles that are in the room, the time you spend in this room, plus multiplied by your luck. In one corner, a cloud can hang (this is due to the configuration of the room), but in the other corner this cloud is not. You walked in and walked right or left - the likelihood of getting sick will depend on this. Recirculators with ultraviolet lamps reliably reduce the amount of live virus in the room. How much they reduce depends on the amount of this very virus in the air, the volume of air and the speed of its pumping through the device. The device will not instantly reduce 1000 viruses per cube to zero - it takes time. He'll do it overnight. And during the day it will just help. Imagine - you are in the bank, you need to get an extract. This takes 15 minutes. So, with a recirculator in a room with the same initial concentration of the virus for infection, you need to stay there for 25 minutes, and without a recirculator - five. There is no one hundred percent protection. But for you, for you personally, a recirculator turns out to be quite useful and saves you from infection.

- In the near future, elections will be held in Russia. Do you think it wise to equip polling stations with air recirculators?

- That would be a powerful solution! Moreover, I believe that at the polling stations it is necessary to put devices inside the voting booths!

Now a work has come out that clearly shows that when we have an internal division of the room, then these same dividers interfere with air circulation and increase the possibility of infection, and not vice versa.

Both polling stations and hairdressing salons in America function in the same way. There are booths in each of the rooms. At the polling station - real ones, and in the beauty salon - artificial ones, they were piled up simply by hanging transparent plastic sheets, as if for safety. A person enters them as in a booth. Only the hairdresser is with him. At first glance, this decision seems reasonable - one hairdresser, one client. But the fact is that if they were in a common room, the virus would be diluted. And so it turns out that if a super-spreader entered one of the booths and breathed, then a huge concentration of the virus remained there, since there was no circulation. And all other clients who come there are guaranteed to receive a viral dose.

Therefore, I believe that it is necessary to supply recirculators. Not big, small. But in every booth, at the level of the face! In order for the volume of air that the client breathed in, the device would quickly drive out and disinfect. However, I'm not sure how it will be in terms of fire hazard. There may be limitations. But from the point of view of biology, this would be absolutely the right decision.

-What about public transport, elevators?

- It would be very useful to put recirculators in buses, since there are many people in them at the same time, high density. In the subway, during the movement of the train, the carriages are well ventilated. When the train travels, the carriages are blown through. But on the bus, there is nothing to breathe very often. Even worse - in minibuses, which in your country are called "route taxis". They have only one door at all, and the salon is usually full of people. There is such a rule - if you feel that you are suffocating, there is nothing to breathe, then there is no air circulation, a large amount of CO2 accumulates. Where it is impossible to ventilate, it is necessary to install recirculators everywhere. In all schools and so on. I think this is a really important topic. I wrote a couple of posts about this. But I was immediately answered by people who wanted to buy a recirculator and install it in kindergarten. It turned out that there are requirements, if you install a recirculator for sanitary purposes, it is considered medical equipment and must be registered in a special way. Some can be installed, some cannot, otherwise the kindergarten will be closed. This is not the case in America. There are regulations, but they are not spelled out in such detail as in Russia.

- Recently, Russia has begun to produce elevators with built-in recirculators for air purification...

- This is a great innovation! And let no one be upset by the thought that the coronavirus pandemic will end sooner or later, and the devices will be useless. It is not true. They will also fight any other viruses, which are more than enough without covid. I hope that this idea will be supported by the relevant laws and instructions emanating from the sanitary authorities.

- Is it even possible to talk about 100% protection against the virus?

- I think everyone should have an individual strategy for identifying risks. Here, an important role is played by the protective antibody titer or its absence in a particular person. An older person has a very different safety and risk differential than a younger person. A person who gave two shots of the Sputnik vaccine, and then underwent revaccination, but his revaccination did not raise his titer, is also at risk. Previously, he calmly rode the bus without a mask, but now he cannot do that. And he should know about it.

Recirculators, masks, social distance are protective measures, none of which is 100% guaranteed. Of course, they should be used. And many people think like this: since you do not give one hundred percent guarantee on your bridge, then I will not go on it. I'd rather swim across the river with crocodiles.

- Why does vaccination against covid not provide complete protection? Is there an increase in the number of people infected in Israel, the UK, the USA, despite the high percentage of vaccinated? Why is herd immunity not formed?

- These are different situations in time, and the virus is different. Another type of spread, another type of disease. Coronavirus can be compared to polio or smallpox, for example, like a wolf and a hawk - they, of course, are both predators, but this is where the similarities end. Traditionally, covid is compared to the flu, because both of these diseases are respiratory. But there are also many problems here, because influenza has more variability than covid, and this variability is of a completely different type. Moreover, the influenza virus is not species-specific at all, it constantly exchanges with animal populations - and therefore the comparison with the coronavirus is also incorrect, but for completely different reasons.

We simply do not have a correct comparison for the coronavirus, it just so happened - well, we cannot match any other pandemic to the one that exists, and therefore only speculation will turn out.

- Now a video of a certain doctor Zelenko, who treated Trump, is actively spreading on the network. The doctor is opposed to vaccination. Considers it completely useless and even harmful. What would you answer to him?

- Firstly, Zelenko did not treat Trump! This is a famous bike, but it is not true. He is really a doctor who worked in New York in the Jewish community. That is, in our understanding - a district doctor, general practice therapist, to whom you can sign up under almost any insurance. There, on his site, he distributed a treatment regimen for covid to outpatients. Note, at that time, and even now in the United States, there was a general recommendation not to treat low-symptom cases of the disease at all, but only to lower the temperature with over-the-counter drugs. In the event of a deterioration in oxygenation indicators, patients should be sent to the hospital, where at that time they also did not receive much treatment. The expensive intravenous remsedivir has just started to appear. In accordance with the protocols of the time, the hospitals were treated with hydroxychloroquine. And Zelenko used the same hydroxychloroquine as the basis of therapy, only on an outpatient basis. Zelenko had such a proprietary protocol - hydroxychloroquine, and also various little helpers such as vitamin C, vitamin D, in which there is nothing wrong. He did it perfectly intelligently. True, he also gave them an antibiotic, azithromycin. But Russian doctors often do this, as if just in case. As a result, he got the impression that many of his patients were cured without being admitted to the hospital. This is, of course, unofficial statistics, since no clinical trials have been conducted. He just convinced himself that as a result of the therapy, patients with positive PCR were hospitalized much less. Against the backdrop of this observation, Zelenko gained fame in the local community, and recorded several videos that glorify hydroxychloroquine. These videos coincided with a very loud scandal in the "Lancet" about this drug. How long is it short, but the use of hydroxychloroquine for COVID has been banned. Note that there was logic in its use, because hydroxychloroquine is an immunosuppressant, and not just an antimalarial drug. It is used in people with lupus to control their autoantibodies, that is, to reduce the overreaction of the immune system. However, large studies have shown that the drug is rather ineffective than effective against covid, but it can cause arrhythmia, especially in the elderly. Plus there was a huge scandal in the Lancet. In general, hydroxychloroquine left the horizon long before Trump got sick.

In addition, this happened in the election year 2020. Everything was heavily politicized. The press laughed when Trump mentioned the word "hydroxychloroquine" in his speech. And the name of the drug was forever fixed precisely in connection with this mention. And since Zelenko spoke loudest about the benefits of hydroxychloroquine, of course he also got it from the press. He left his practice at the end of May 2020, and then left for Israel altogether.

- Why is he presented as the doctor who cured Trump?

- In March 2020, he wrote a letter to Trump with a story about hydroxychloroquine. They began to quote him in the press, and also, as I said, the president himself told the people about hydroxychloroquine.

But Trump was never treated with hydroxychloroquine. I have a complete protocol of how Trump was treated. I know him by heart. This happened in early October, and not at all in May, on the Columbus Day holiday. I was vacationing with friends at sea, where the Internet was bad. And then Trump fell ill, and all the time he had to catch the Internet to give endless comments. To this Zelenko has not been to the United States for a long time, he went to Israel for treatment. Trump had his own doctors. They did indeed use zinc, aspirin, vitamin D, vitamin C, melatonin, and in addition to that, in the hospital, he received an injection of remdesivir, a single dose of dexamethasone, and an antibody cocktail that was not yet approved at the time. It was in October. But Zelenko has nothing to do with it at all, it's just that doctors at an early stage of the disease had a certain common logic, and they used it. For example, on March 1, 2020, I posted a video about the coronavirus that received a million views, where I also gave the most general recommendations on the use of drugs that can be bought without a prescription. There I also have melatonin, aspirin, zinc, vitamin C and vitamin D. That is, simple, clear ideas. But I'm not saying that Trump was treated according to my recommendations, because this is ridiculous!

In addition, the basis of the Zelenko protocol is not "little helpers", but hydroxychloroquine, which Trump has not been treated with! Moreover, we were still discussing why Trump did not drink the hydroxychloroquine, which he advertised so much. Indeed, at that moment, contraindications to the use of hydroxychloroquine were already known. One of them is previously recorded episodes of arrhythmia. We don't know if Trump had arrhythmia, but judging by the fact that he was not given the hydroxychloroquine he loves so much, he may have had such episodes in the past. In general, to say that Zelenko treated Trump ... it's like Vasya Pupkin and Fedya Vaskin are sitting in the kitchen and discussing what kind of cocktail they would give the president. This does not mean that they are treating him, treated him or will treat him ...

- Why do people who have been ill need to be vaccinated?

- Firstly, because we have a huge number of recurrent diseases. Secondly, because the repeated infection enters the already undermined organism and, as a rule, proceeds more severely. If once a person came to his senses easily enough, then the second, third and fourth time he will simply erase.

In addition, it has been shown that natural immunity plus vaccine protects much better than simple immunity after an illness. It has been proven that people who had been ill before the advent of vaccines, and then were vaccinated, are now in golden armor. Of a hundred people who have had covid, after six months only three have such an antibody level that they no longer need vaccination. But the other 97 need it.

- Are there any specific drugs for the treatment of coronavirus?

- We are with covid trying to find a magic bullet, a chemical compound that is easy to produce in large quantities, and it will directly shoot down the virus on approach. To do this, first we decided the structure of the proteins that produce the coronavirus, then we drive ligands into them, and now we are looking for substances that bind to these proteins. We are looking for these substances, adjusting the structure to the structure. This stage is done in computers, then tested in vitro, then tested on animals and humans. Sooner or later, we will have the best anti-coronavirus medicine, and a safe one.

The first stage of screening for chemical molecules is computer-based. Whoever does not do it! Because it is inexpensive, the computer works, reagents and permits are not needed. My students do this part just as an exercise, as a thesis. Any student who sits down at a computer is sure to find something good and find it. Then all these findings are published. Nowadays, a lot of such articles have been published. That is, there are already thousands of theoretical models of chemical compounds that can suppress coronavirus.

There is another approach, when they take not just a set of structures of chemical molecules, but some natural substances. After all, we know their formulas. Here we already start not with some abstract molecules without functions, but with drugs that already exist and are approved, or with plant components, natural molecules. These molecules, already existing in nature or lying on the shelves, are much more studied. Molecules from some kind of edible plant or, say, pharmacopoeial plants are a good start for a business, because there is a shorter path to the market. Sooner or later, someone will pick up something suitable. But most of these molecular races end in nothing. Because computer models need to be tested on living organisms, and this requires a lot of money.

Computer models in pharmacology can be compared with the TRP program in the USSR. What is the likelihood that you will be able to identify among the millions of adolescents participating in passing these standards, not just a future master of sports, but a champion who is already fully prepared to win the Olympic Games? The probability is not very high. But to identify those who run faster than other students, you may well select.

With penicillin, only thirty years after the start of production, chemistry caught up with biotechnology.

Thirty years in a pandemic is a very distant horizon. Can you imagine how many people will die? Nevertheless, a lesson can be learned from the past. Most likely, with covid, some half-measures, imperfect ones, will be quickly achieved. And they have already been achieved. And then, as a result of long-term work, we will see the final version.

For example, the vaccines that we now have. First, thanks to those we have - Moderna, Pfaizer, AstraZeneca, Sputnik - vaccines that have shown their effectiveness. A good vaccine NovaVax, it has not yet gone into production. It is a recombinant vaccine with very decent efficacy, including against the Beta variant (from South Africa). Vector vaccines can have a reaction to the vector and low antibody titers when boosted. Well, there is such a limitation, you can't get away from it. And recombinant and mRNA vaccines do not have it. But mRNA vaccines are expensive and recombinant vaccines are cheap. The Novavax vaccine is twenty times cheaper than Pfizer.

Now there are many complaints about the full-sized S-protein, perhaps because of it, thrombus formation increases. It would be necessary to make vaccines with a truncated version of the S-protein, but to find the best option that is effective as an antigen and safe for the blood coagulation system, it will take years of experimentation.

Many people complain that anti-coronavirus vaccines cause side effects. They say that vaccines are underdeveloped, under-tested. Let the scientists do their best, they say. However, it is impossible to set scientists the task of making a vaccine that would not cause any side effects. After all, the effect of the vaccine is to stimulate the immune system. And no two immune systems are alike. Someone will receive too much antigen with the vaccine, but not enough for others. If, on average, there are many side effects in the population, and protection against it is weak, then this is a bad vaccine, unsafe. But if the disease is serious, and the protection against it is adequate, then the side effects are acceptable.

A vaccination is the purchase of protection against infection. Such a business transaction. We buy ourselves protection, and we pay for it with something. You have to understand that you are at the bazaar. Any human action is associated with risk. You go out to the bakery in the morning, there is a small risk that you will be crushed by KAMAZ. Covid is a KAMAZ, it is definitely more dangerous than a small bicycle vaccine. But if a person gets hit by a bicycle, there is nothing pleasant either. The health risk is much less. The probability of surviving a meeting with a bicycle is much higher than the probability of surviving a meeting with a KAMAZ. There are, of course, people who have suffered from vaccinations. This cannot be denied. But it is the cases that are exactly those people who, if infected with a covid rocket, would fly on a ventilator. Those people who easily tolerate vaccination will also tolerate covid more easily.

- What happens to the herd immunity that everyone hoped for?

- Nothing. No herd immunity is visible. The last one from whom I heard about herd immunity is Sergey Netyosov, whom I respect very much. (virologist, corresponding member of the Russian Academy of Sciences). He says we are heading for this. I do not think so. I am a superwaxer, all hands and feet for the vaccine. The only thing that now protects us from the severe course of covid and death from infection is vaccination.

But we now already know from the results of an epidemiological study in Masachusetts that in case of re-infection, vaccinated people can shed the virus, yes, not for as long and not in such quantities as naturally sick people, but they can. And they can also transmit this virus to another.

But if a vaccinated person is able to carry the virus in an asymptomatic form, then he can bring this virus home. In this, the most important sense, our collective immunity ceases to function. But in some other sense, it still works. The more vaccinated people we have, the more we reduce the viral load in the population, and thereby reduce the transmission of the virus in the population. With the greater prevalence of vaccination, the incidence of infection per capita is still less. One patient with natural coronavirus, not vaccinated, transmits the virus on average to 6 - 8 people. And the average vaccinated person who asymptomatically transmits the disease is transmitted to 2 people. At the same time, the society functions more normally. You need to get vaccinated!

However, if it turns out that vaccination does not guarantee against long covid, it will be a disaster.

- What are the prospects for solving the long covid problem?

- The main question for humanity today is the long covid question. Those who have recovered and who have not completely recovered are leaving the labor market. These are experienced, most active people who know how to do everything. If these people are gone, young people will have to take their place - not because they know more, but because they have a better immune system. This is a huge problem. It is already there.

I believe that we are missing the most important thing. These are long-term or delayed effects of covid in those who have been vaccinated - whether they have them or not. If vaccination allows you to reduce the severity of symptoms, but at the same time eliminates the long-term post-covid state, this is a victory! But we do not know this yet. There is no data. Post-covid is still very poorly and little studied, and there is no data on covid after receiving the vaccine.

Breakthrough post-vaccination cases are very recent. In the USA, Israel, Great Britain, the border of the postcoid state, when you can get a diagnosis of "postcoid", lies at 12 weeks. You have to get sick, and then you have some symptoms. A weakened state after a viral illness is normal. This is convalescence, that is, the period when a person comes to his senses after a serious illness. When it takes a month, this is normal, not a long covid. Therefore, the doctors drew the line at 12 weeks after PCR negativity, three months later. Only after this period, if the symptoms have not stopped, you can be diagnosed with long covid. So much time has not yet passed for us to have such a cohort.

- The Minister of Health of the Russian Federation Murashko made a statement that elderly people who have recovered from covid may die within the next six months. What is the reason for this? Is this a long covid?

- This is not a long covid. This is another dire aspect of the coronavirus pandemic. Even if the patient does not have symptoms of long covid, he has latent coagulation disorders for some time. They are invisible, a person does not feel them. Often people put themselves in a situation where these violations can play a bad role. And not only among the elderly, but also among young people. For example, a person has been ill with covid. He was cured. He has no covid tail. But there is a hidden problem with coagulation. The blood is liquid, but it can also clot, locally. She can curl up a little, turn around a little. She is in dynamic equilibrium. We have it different depending on the time of day, on what we ate. This balance depends on external circumstances. Suppose a person has a slightly impaired coagulation, hemostasis is shifted towards the formation of a thrombus. The person knows nothing about it. Or he even knows - he passed a coagulogram, there are slight deviations, but the doctor did not consider it necessary to prescribe therapy. Everything can be fine in a couple of months. Let's say this person is forced to sit for a long time - behind the wheel, or on an airplane. In the case of flights, a state of dehydration is possible when there is not enough fluid in the body. The man flew to rest in Miami or Vladivostok from Moscow, and two days later he had a stroke. Against the background of post-covid, such events are more common than without it.

In the United States, at the very beginning of the pandemic, there was a surge in strokes and heart attacks in young people. Especially with strokes. Large vessel stroke. This surge continues now, they just stopped writing about it. Young people, they didn't have any risk factors. These are people who have undergone covid asymptomatic or low-symptom. In March, the coronavirus was thought to be a disease of the elderly. At the beginning of the pandemic, young people were practically not tested. Many people still do not know that they have been ill.

There are figures on how many young people were taken to hospitals with a stroke in March 2018, 2019 and 2020. If you compare them, the conclusion is obvious. Strokes in young people for no reason are a mega important problem.

And in general, we are now solving the issue of reducing the average life expectancy of mankind. What we fought for, was amicably reported at UN meetings, all the gains in life expectancy are now down the drain. In the US, life expectancy has already dropped by more than a year as a result of covid.

- Have you already identified groups of symptoms that indicate that a person has a post-covid?

- Described a lot. A group of symptoms from neurology, from thrombosis. There are consequences for all organs and systems. But who gets what effect depends on the initial state of each of our organs. Today there was news about the condition of the kidneys in the postcovid. We wrote about it last year, but then they forgot. It was about the fact that many who were discharged from the hospital have severely deteriorating kidney function. Then patients who were on mechanical ventilation were meant. And now it turned out that those who avoided mechanical ventilation, the kidneys also work worse.

In humans, the kidneys are designed for a certain number of years. At 120 if nothing bad happened. Normally, kidney life decreases with age. We do not expect an 84-year-old to have kidney function like a 20-year-old. There is an analysis called the glomerular filtration rate. He has an age norm. If a young person at 20 years old has a glomerular filtration rate of 75 units, then this is cause for concern. And if the same figure is for an 84-year-old person, then this is normal. It will be enough for 120 years. And now there is such a small figure - 60 units. If a person has a glomerular filtration rate less than 60, then he is diagnosed with renal failure, even if he does not feel any symptoms. Such a person should be registered with a nephrologist and regularly measure this indicator. There are definitely more cases of renal failure after covid. Before covid, the filtration rate was 72, and six months after covid - 53. This is not a disaster, this is a movement towards disaster. And there are people who have already been registered with a nephrologist, and their situation has worsened. Renal failure from the first stage passed into the second. And after a drop to 30 units, problems already arise, dialysis may be required, followed by a queue for a kidney transplant.

- It turns out that the vaccine is not a panacea. How to protect yourself? What is needed for prevention?

- For prevention, you need to maintain your health. If you have adequate levels of zinc, adequate levels of vitamin D and other metabolites, then you will carry the coronavirus with minimal losses. And, of course, you need to be vaccinated.