What’s happening? About this, the observer “MK” talked with the director of the Institute of Medical Parasitology, Tropical and Vector-borne Diseases named after E.I. Martsinov Sechenovskogo University, corresponding member of RAMS Alexander Lukashev.
– Alexander Nikolaevich, according to the latest data, the number of registered cases of COVID-19 in Italy reached 12,462 and 827 people died. But in Germany for 1966 infected – 3 deaths. Now there are many versions explaining the high mortality from coronavirus in Italy: from the fact that the reason is the high life expectancy of the population, the risk of mortality among which is higher, to the mutation of the virus. What is the reason, in your opinion?
– I think, first of all, the point is the effectiveness of diagnostics. There is no reason to suppose any changes in the virus today. We are talking about low efficiency in detecting mild cases and their absence in statistics. I assume that the true scale of the spread of the virus in Italy is an order of magnitude higher than the statistics show.
– It turns out that in Germany statistics are better and the matter is not at all about the higher level of medicine in this country?
– Maybe the level of medicine there is higher, but certainly not ten times than in Italy. And statistics, of course, in Germany is better. It turns out that mild cases of the disease are also detected there – therefore, “on average” mortality is low. Most likely, the situation in Germany and Korea, where statistics and quality of patient identification are also high and mortality rates are low, demonstrates the true state of things.
– That is, for example, the version that the Germans invented a secret medicine – from the realm of fantasy?
– If they had invented, they would have already informed. Of course, the quality of treatment also affects the mortality rate, but there is no fundamental difference between Italy and Germany in this regard. And even how many Russians brought the virus from Italy today, speaks in favor of the fact that the prevalence of infection in this country is higher than in statistics. Italy has 60 million people. When our tourists arrived there, officially there were about 3 thousand infected. And the assumption that more than 20 of our fellow citizens managed to get in touch with a sick Italian, that is, with one in twenty thousand, and even get infected from him, raises serious doubts. And it may mean that the scale of the epidemic in Italy is greater.
– Versions about a new mutation of the virus and the emergence of a new ferocious subtype in Italy have the right to life?
– The virus, of course, mutates – this is a natural process. But talking about the emergence of new subtypes is inappropriate so far. On average, a circulating virus scored 10 mutations, but this is too little to compare their properties and pathogenicity. Subtypes may appear in a few years. It is not at all a fact that mutations somehow affect the properties of the virus, most of the mutations are “silent”, this is a normal process.
– By the way, it is also mentioned that in Italy they started testing for coronavirus all the dead, including those who did not seek help, but died, for example, from a heart attack or stroke. And many are diagnosed posthumously with COVID-19. Therefore, including so high the mortality rate …
– This, in principle, fits into everything that we discussed: if we examine only seriously ill or dead people, we will distort statistics. That is, this is another example of how statistics can be distorted.
– Can one assume today what is the real mortality rate for coronavirus?
– Calculating it today is pointless: in most countries, all mild cases are not detected. According to my feelings, not only in Italy but also in Iran, the incidence is an order of magnitude higher than reported.
– A WHO report on the situation in China showed that two-thirds of close contacts infected by patients (and only 1–5% were infected) turned out to be asymptomatic carriers …
– I am not surprised. Of course, mortality is not microscopic, it is noticeable. But really it is much smaller than expected according to the first data. Moreover, if you look at the Chinese data, it fell very quickly every week of the outbreak and was much lower in other cities than in Wuhan. Again, this may be due to a more thorough registration of mild cases.
– There are versions that in the Far East there are no less patients than in China …
– I do not think so. Today, all pneumonia is being screened in Moscow, I don’t think that thousands of patients could have missed it – these are fakes that are unjustified. But in fact, most countries of the world could not completely prevent the spread of the virus in their territories.
– There is an opinion that this virus is a natural focal and the main focus is extinguished, nothing will go further …
– A natural focal virus is one that circulates in the outbreak and periodically infects people. A type of MERS coronavirus that constantly circulates among camels and sometimes infects humans. But COVID-19 made a one-time transition from an animal to a new owner – and now it is purely human.
– What is your forecast for the spread of the virus in Russia?
– Today, our sanitary services, apparently, were able to avoid the uncontrolled spread of the virus, and even if it begins, we will have a time handicap and an example of European countries where it started earlier, so that we can avoid many problems from their experience, including organizational and medical. And this is a very big achievement. On the other hand, until collective immunity is developed, it is difficult to prevent the full spread of the virus.
– What preventative measures are effective?
– The contact path of transmission takes place, so you can advise to try first to follow your own hands in transport, public places, how often you touch surfaces and mucous membranes (nose and eyes), whether you eat with unwashed hands. This is the transmission path that can be interrupted by just controlling yourself.
– Italians are recommended to keep a meter distance.
– It is right. The virus is not as contagious to transmit 6 meters as the measles virus, so 1 meter is a reasonable compromise between reducing the spread of the virus and communication. Well, it’s better not to say hello to hands. Elderly people can go to the cottage to reduce the risk of infection.
– Many doctors are skeptical about the appearance of the vaccine. And you?
– I also think that this year there will be no vaccine licensed for use in people. Vaccines from human coronaviruses for widespread use in the world have not yet been. There is no industry for the production of such drugs, there is no fundamental knowledge about their safety and effectiveness. In general, developing such a vaccine will not be quick.
– Many predict that the situation will stabilize with warming. Does the circulation of this virus depend on weather conditions – given that it feels great in hot countries?
– All known human coronaviruses spread in temperate countries mainly from December to April. Of course, there is no guarantee that this will happen this time, but there is hope. Of course, the virus will not disappear anywhere, but its spread is likely to slow down.
– In China, we are already seeing a sharp decline. There are recorded only a few cases per day. Could there be a second wave?
– The second wave cannot be ruled out. For example, it is not clear to me how China will quarantine, and indeed any other country. Now the outbreak is under control there, but no one can live in quarantine for a long time.
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