All relevant numbers in the corona crisis are still high. And the new, probably even more contagious Brazilian P1 corona variant is in the process of establishing itself here. But it was also the week of moderate optimism in which RIVM boss Jaap van Dissel said that the peak in the number of infections should now have been reached, the number of hospital and intensive care admissions stopped increasing, and the cabinet an opening plan presented.
The NOS spoke about that moderate optimism, the Brazilian corona variant and the ongoing vaccination activity with Jaap van Dissel, director of the Center for Infectious Disease Control (CIB) at the RIVM, and Jacco Wallinga, chief model of the RIVM.
In the latter OMT advice states that the Brazilian variant is estimated to be 49 percent more contagious than the classic variant. In the British variant, this was 33 percent. Yet the Brazilian variant seems to spread more slowly than the British one.
Jacco Wallinga: “The numbers you mention are the higher infectivity compared to the original variant. The British variant had to fight against this. That went quickly because of its much greater infectivity. The Brazilian P1 variant must be the now by far dominant British. the variant. The difference in infectivity with that British variant determines how fast that happens, and the difference is not that great. “
Will the Brazilian variant eventually replace the British variant?
Wallinga: “The Brazilian variant seems about 16 percent more contagious than the British one. But the numbers are still very small and in fact we are not so sure whether the Brazilian variant is that much more contagious. Actually, our biggest question is whether the Brazilian variant can and will displace the British. That could happen if the P1 variant is a bit more contagious, but that is still uncertain. “
Would vaccines work less well against this Brazilian P1 variant?
Wallinga: “Everyone is a bit afraid that the immunity from a previous natural infection or vaccination works less well against this Brazilian variant. If so, it could spread further. Our prognosis assumes that the Brazilian variant behaves in the same way as other variants. That is why the increase is going so slowly. We have yet to see whether the Brazilian variant can really infect so many more people who are already immune.
This variant has surfaced in Manaus, an area in Brazil where an extensive outbreak of other virus variants had already occurred. Has research already been published about it?
Jaap van Dissel: “Science just got there an article about published. This suggests that this variant is probably more contagious. In the Netherlands, this has yet to be proven, because we have seen very few here. That article also discusses whether a previous infection with the classic or the British variant provides cross protection against this Brazilian variant. Basically, the authors expect that protection will be there in about 55-80 percent of cases. The question then is: does it protect against illness, against hospital admissions or against IC admissions? If it provides sufficient protection against hospital admissions and the disease is limited to a kind of flu-like picture, then you shouldn’t have to deal with that tremendously.
The latest OMT advice ends with a remarkable passage on the importance of speed in vaccination. I read there that the evaluations by the EMA of possible side effects of the AstraZeneca and Janssen vaccines take far too long, and delay the vaccinations too much.
Van Dissel: “That is not quite as we intended. In general, you see that there are different reactions within Europe. We think that it would be best when communicating about how these kinds of problems are tackled. European greatest common denominator. So that you can avoid confusion in the communication about it. Europe has created the EMA and in particular the PRAC, the European Adverse Reaction Assessor, to use all the expertise available across Europe to identify possible side effects. We are actually making an appeal to improve that process. Everyone would benefit from that. “
You are actually saying: we have the EMA and the PRAC, that’s where the expertise is about side effects, so listen to their verdict.
Van Dissel: “Yes, but make it possible for a quick response. We suspect that countries are willing to listen to the EMA, but there must be a mechanism by which you can get advice very quickly. It is mainly the delay that occurs in that assessment process that causes countries to make their own decisions. This applies to the Netherlands, but also to Denmark, Germany or England. I can well imagine that it comes across as confusing. something different from the other. I think we would benefit a lot from making more use of the European fora. And faster. “
Has there not been an overreaction to the serious side effect of AstraZeneca and the possible side effect of the Janssen vaccine?
Van Dissel: “That really is a consideration of the Medicines Evaluation Board and the Health Council. They have a great deal of expertise and they respond quickly. Such an assessment depends on the balance between the efficacy and the risk of possible side effects in certain age groups, but also of circumstances such as the availability of alternatives. Things like that mean that countries’ approaches can differ. Again, and the OMT draws attention to that, if the EMA were to act faster, it would really help to harmonize an approach as much as possible at European level. “
This week, the cabinet announced a roadmap to slowly reopen the country, if the numbers allow it. Isn’t that a very optimistic plan in the current situation?
Van Dissel: “The main thing I learned from the press conference is that there will be frequent reviews of whether relaxation is possible without the risk of a significant increase in pressure on care and hospital admissions. And we will be working on that every week.”
Wallinga: “The latest prognosis still has many uncertainties, but it seems as if we have reached a peak. The highest number of reports of infections is on March 27, the highest number of hospital admissions on March 29 and the highest number of ICU admissions on April 2. . It looks like we have reached a plateau or a peak, but you can only be sure when a decline sets in. If it does, then that is a windfall for the hospitals. Then we do not go to code black and is it all just going to work out? Then the question is how it will go if we slowly relax. The positive thing is that hospital and IC admissions do not continue to rise. On the other hand, the situation is that there is little room for it. country to reopen at a rapid pace. “
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