The third year with the virus: scientists take stock of two years of the pandemic and make predictions

Yelena Ivanova, Natalia Seibil

We live with you in the textbook of molecular evolution and the emergence of new, more infectious forms of the virus - this is how the molecular biologist, professor of Skoltech and the American Rutgers University, Konstantin Severinov, described the current situation. It couldn't be better, although few of us would like to live in a time of rampant evolution. But, as you know, times are not chosen. In the past year, vaccines, virus mutations, drugs, health systems and social harmony have defined our lives. Moreover, this applies not only to Russia, but to the whole world.

Coronavirus vaccines

Scientists call 2021 the year of vaccines and, as a result, the year of scientific triumph. The world has produced 9 billion doses of vaccines in just one year. This is a gigantic figure. Thanks to vaccination, the number of deaths from the coronavirus, although it was high, would have become even greater if there were no new vaccines. On the other hand, this amount of vaccination preparations turned out to be insufficient, which is why new variants of the virus appeared.

Vaccines have never been developed as quickly in the history of medicine as they were during a pandemic. In 2020 they were ready, and in 2021 they were applied all over the world. According to its results, it is possible to make a rating of vaccines, says Ancha Baranova, doctor of biological sciences, professor at the School of Systems Biology at George Mason University (USA). But according to the scientist, the vaccine No. 1 in the world can be considered the drug Modern.

- It turned out that in the case of Modern, the effectiveness of the vaccine is longer, even in the case of Omicron. Modern is a little better than Pfizer, - says Ancha Baranova.

In the case of Sputnik, a situation has emerged when even very promising drugs are introduced for use in the world much later due to the fact that it was not produced by a pharmaceutical giant.

- If, of course, the Sputnik had been approved earlier, it would have been used more widely in other countries, and not only in Argentina and the states of the post-Soviet space. I think that 2022 will definitely bring us the registration of the WHO "Sputnik", it simply cannot be postponed any further.

2021 has brought a lot of clarity about certain vaccination technologies. Side effects from vaccinations are rare, scientists say, but they have managed to build dependency chains. When vaccinated with mRNA-based inoculations, myocarditis was observed, when using AstraZeneca, cases of thrombosis of the venous sinuses of the brain were revealed. Johnson and Johnson's drug, on the other hand, gave significantly fewer complications.

- No such checks were carried out on Sputnik, but it became clear how this effect can be eliminated by minimal reengineering of the virus capsid. For me, as a scientist, it was important to know that we can go through this chain even in the case of such rare complications, says Ancha Baranov.

Humanity met the second year of the pandemic already armed, says Professor Anatoly Altstein. However, new options require new solutions:

- Now the majority of cases in Europe and the United States are infected with the Omicron strain. In order to contain it, a fresh vaccination is needed, that is, a revaccination. And it began not so long ago. With the available vaccines, if people are revaccinated, the chance of infection will drop dramatically. Although omicron requires a much higher level of immunity than delta. If the available vaccines cannot cope with it, modified vaccines will be used, work on which has already begun.

The modification time will take significantly less time than the development of a vaccine. However, it will be necessary to conduct clinical research. Professor Altstein says it will take at least 3 months.

So far, there has been no such need, says Alexei Agranovsky, Doctor of Biological Sciences, Professor of Lomonosov Moscow State University, since vaccines work against all strains.

- Changing the vaccine is a complicated story. If we are talking about mRNA and adenovaccines, a week or two work in the laboratory is required, and then all stages of clinical trials are new, because a new gene for the spike protein inserted into the vector, the platform, formally creates a new vaccine. So this is not easy. This would have to be done if a new harmful strain appeared, which completely gets away from vaccines. And he has not appeared yet. By adhering to the fully recommended revaccination regimens, you will be protected from the full range of strains that are now.

Mutations and variants of the coronavirus

2021 was the year of the emergence of more and more infectious forms of the virus. Konstantin Severinov explains that the virus behaves like in a textbook. Its "behavior" could be predicted on the basis of general principles, and this is a clear case of the evolution of a predator and a prey, a parasite and a host, and in our case, a virus and a person.

- This is a situation when relatively resistant forms arise due to mass vaccination, that is, the combination of a significant number of vaccinated and unvaccinated people, immune and non-immune, leads to the emergence of new variants that go away from the action of vaccines, says Professor Severinov.

There are alarming results of the year, says Doctor of Biological Sciences, professor at Moscow State University. MV Lomonosov Alexey Agranovsky. The coronavirus has shown its unpredictable volatility. Evolution has led to the selection of new highly infectious virus variants such as Delta and Omicron.

- Although the tendency of RNA viruses to mutation and recombination has long been known, no one could have foreseen such a rate of change at once when the zero Wuhan strain appeared and began to spread. Further changes to SARS CoV-2 are possible. We must be prepared for such a scenario.

It is not yet clear what the consequences of the new Omicron strain are, and whether it causes long-term post-coronavirus syndrome, and how large the percentage of these cases is. We are talking about a situation when there is a live virus in the human body for a long time, and it does not go away. So far, this has been tested on the Wuhan version and on the Delta. Ancha Baranova says:

- It is clear that we cannot allow all of humanity to get sick with the coronavirus, and everyone has a slight cognitive decline - everyone became tired, with tachycardia. I would like to prevent this. I don't like the fact that omicron causes metabolic fatigue, because it indicates exhaustion, but it's good that there is no loss of smell, because it reduces the load on the brain.

So far, not much is known about Omicron, so its distribution can go in two ways.

The first scenario is positive. Omicron, as a more infectious, but milder form, will crowd out Delta. There is a hope that it will become the dominant option, although there is no need to be mistaken - this is not about the fact that a person, having fallen ill, will cough twice and heal, says Ancha Baranova. For the spring of 2022, the researcher's forecast is as follows: after a large, but short wave, there will be a respite.

The second scenario is scary.

- The two strains will walk at the same time with little cross-immunity to each other, and will live in two different ecological niches. Delta will infect the lungs more, and omicron more in the nasopharynx. Accordingly, a person can get sick with one, and then another. And here you cannot do without two vaccines, otherwise you will have to get sick.

Medicines and treatments for coronavirus

Over the past two years, doctors have learned a lot about the immune processes occurring in the body, and the mechanisms of action of the virus have become clear to them, says Larisa Popovich, director of the Institute for Health Economics at the Higher School of Economics:

- It is not so much respiratory as immunopathogenic, and refers primarily to the circulatory system, causing a disease such as vasculitis, which naturally leads to multiple organ pathologies in case of impaired blood circulation. Therefore, it is clear that treatment regimens are very individual, depending on what kind of lesions people have. And it is clear that severe forms of the disease requiring hospitalization are very difficult to supervise, because at the stage of development of pathology, immunosuppression is necessary - suppression of the immune system.

The main task that doctors set themselves is to prevent a severe course of the disease. For this, tests and new drugs are being developed. Larisa Popovich says that Russian scientists keep up with foreign ones. Today Russia is the fifth largest vaccine producer in the world. A lot of publications have appeared, new treatment protocols are being developed.

- There are drugs that are treated at the initial stages. And those three drugs of hope that everyone is talking about now are Pfizer's Paxlovid, Merkov's Molnupiravir and our MIR-19, which turns off the genes of the virus and prevents them from multiplying. This is an incredibly cool technology, and the fact that Russia was able to do this is a very good signal regarding the development of our science.

Ancha Baranova also notes the Paxlovid drug, which was created by Pfizer. It reduces the likelihood of hospitalization tenfold. But there is a problem with its production.

- In the USA there are 180 thousand courses that are needed at an early stage, but if 250 thousand people get sick a day, then you understand that the numbers are completely incomparable. The production of the drug takes 9 months. So I think that by the end of 2022 the drug will be available in Russia. In the meantime, it will be necessary to somehow trample with all the same medicines and "little helpers", and masks, and recirculators...

Coronavirus mortality and social harmony

For the researchers, there was no mystery that there is a correlation between the number of unvaccinated and mortality. This statement has become a commonplace, but with every death from covid it finds new confirmation. As Professor Altstein put it a little pompously, the fate of this pandemic is in the hands of humanity. It is hoped that further weakening of the virus will occur and the pandemic will end there.

- People must be vaccinated, then only we can get the effect and the ability to end the pandemic in 2022. But this is possible only if people use vaccines and do not neglect other anti-epidemic measures - social distance, masks.

However, the excess mortality in Russia in 2021 cannot be explained by covid alone, Ancha Baranova believes:

- Excess mortality in Russia in 2021, from my point of view, is caused by the "optimization of health care", and many people began to die from other diseases for which they could not receive normal help during the coronavirus. I think this is the big mystery of excess mortality.

The pandemic will end anyway, says Aleksey Agranovsky, but if we don't get vaccinated, more people will die.

- I think that the coronavirus will become a less serious problem in one and a half to two years. You can acquire massive immunity in two ways: either everyone (or almost everyone - the majority of the population) gets vaccinated, or everyone gets sick, but the lethal losses from the disease will be large, and even more people will suffer postcoid syndrome, the consequences of which cannot yet be accurately predicted. Plus, while huge populations get sick, new strains are more likely to emerge. The law of large numbers - the more sick people, the higher the chance of the appearance of new dangerous variants of the virus. Let us hope for the best.

However, vaccination around the world is not proceeding at the pace that scientists had hoped for, although there is enough vaccine now, confirms Maria Lagarkova, Professor, Head of the Department of Immunology, Lomonosov Moscow State University, Corresponding Member of the Russian Academy of Sciences:

- Everything was done to make vaccines available to everyone. And this is the responsibility of citizens, which turned out to be low. This is not only a Russian problem, but in our country it manifested itself to a greater extent.

One of the reasons why Russian citizens are so wary of vaccinations lies in the polarization of society. As it became clear in hindsight, it is impossible to conduct a successful campaign where there is no agreement. Russia is not alone in this. Scientists strongly recommend identifying strategies that will lead to a complete vaccination and analyzing the mistakes made.

"I think that Russia could have achieved better vaccination results if first they brought mRNA vaccines, which would be available not for free, but for money. Since they are quite expensive, the budget was not affected, but the main wave of popular anger would be directed at why it is expensive. Against such a background, all the talk about the fact that vaccination destroys natural immunity would simply wither", - suggests Ancha Baranova .

Despite all the difficulties, the growing numbers around the world and in Russia, all experts interviewed by Novaya Izvestia express moderate optimism that this hassle may soon end. Someone says - a year, someone - one and a half to two years. It is difficult to guess, but there was a light at the end of a long tunnel.