… that we do not possess. However, our knowledge and experience do allow us to make a projection.
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We are facing a problem, that was described by Arno Karlen in his book worth reading „Man and Microbes“ (1995):
“Our most troubling vulnerability is our spotty record of serving our own best interests. Ignorance, greed, and shortsightedness often keep us from using the tools we have.”
The pandemic is returning yet again to an exponential growth, not just in Germany, but globally. We are in the middle of the third wave, with new SARS-CoV-2 mutants. Last week, in Germany there were more than 90,000 new infections, an increase of more than 30 % compared to the previous week. How is the current week going to be?
Today, we are dealing with the mutants, what is driving their emergence, how they are driving the pandemic, turning an ever bigger wheel running over too many people.
We realize that the pandemic waves are reaching a new and bigger dimension by way of the mutants.
Several factors are playing into the emergence of new viral variants:
The virus needs some space (through numerous infections) to accumulate changes. With each round of infection, the virus gets a chance to mutate, this is a simple biological process. The viral generation time is spanning mere hours hence its evolution is running in fast motion.
This way, numerous mutations arise, being more aggressive and infectious, able to escape immune responses and spread at a faster pace (especially with weak or no quarantine measures in place). Older variants are pushed aside and disappear.
Since the virus had ample time to accommodate itself in the global population, it is here to stay. It will not disappear or hide in the animal kingdom (to come back from sometime later). This was an original hope, should the pushing back of the virus have worked, using nonpharmaceutical interventions such as face masks, distancing, and quarantine, with a population sticking to some rules. This chance we had botched in summer 2020, unfortunately.
What would be the alternative to a forceful fight against the virus with the goal to eliminate it? The alternative is an endless succession of infection waves.
Numerous ethical and not-so-ethical opinions by politicians, medics, self-proclaimed experts, and advisers are giving a hint as to how to deal with such pandemic waves. The spectrum is reaching from a laissez-faire policy to let the virus soar through the population (as in Brazil and Sweden) to a dictatorially imposed total lockdown as done in China.
The strategy to try and let the virus infect as many people as to finally reach herd immunity is bound to fail, since new virus variants will emerge with time, and a long-lasting immunity is not at hand. Herd immunity is possible only if individuals obtain a long-lasting (even lifelong) resistance. This was attained with several viral diseases, either through vaccination or a survived disease.
An example is given by the Brazilian city of Manaus, home to more than 2 million people. The Brazilian government had ignored the pandemic with all its consequences. Manaus was hit hard in the first wave of spring 2020. Hospitals did not have the capacity to treat most of the patients, thousands died at home, cemeteries were overwhelmed, and thousands of corpses were buried in makeshift graves. What dreadful scenario. The seroprevalence was estimated to be between 50 and 70 %, leading to the misconception of herd immunity. All protective measures were lifted, and in consequence infection numbers started to soar again in November.
The situation in Manaus is offering an important lesson: After a mere eight months, herd immunity is no longer given. There is NO long-term immunity. New variants are infecting those who already had survived a bout of COVID-19. This bears important implications for the vaccines: They not only need to be administered repeatedly they also need to be adjusted to any new variant.
What else is driving the emergence of mutations?
In biology we know the impact of selection pressure. Upon a certain pressure on a pathogen, it tries to evade. The pressure (by imposed measures) needs to be strong enough to eliminate the pathogen. Otherwise, the pathogen will adjust or escape. This is known for bacteria, viruses, and parasites alike.
Treatment of bacterial diseases with antibiotics very quickly showed that their use in industrial livestock farming resulted in the opposite of the desired outcome. In hospitals as well, today we observe numerous multidrug resistant bacteria that emerged through the incorrect administration of antibiotics and a lack of understanding of microbiology and hygiene.
The same may be seen in plants. If a parasite is being controlled with chemical pesticides, the parasite with time will adjust to the chemicals, very much to the farmers’ (or gardeners’ or the park owners’) chagrin. The garden’s beauty is more important than the plants’ health or the ecological balance. Where this kind of thinking is leading to may be seen with the oak processionary moth, whose caterpillars currently are devastating oak trees in German forests and gardens. Natural control is done by parasitic wasps and predators such as birds. A garden that is being treated with chemical pesticides does not host any wasps or birds to keep the moth’s caterpillars at bay.
With HIV/AIDS it was seen early that a monotherapy, that is a treatment with one single drug, is resulting in the emergence of mutants which spread very quickly. These variants upon transmission were already resistant to the treatment. Our colleagues in the US, with whom we had collaborated for years, were able to device a triple therapy regimen, using three different drugs, that are administered immediately after diagnosis, before the virus could spread through the patient’s body. This was, and is, the only treatment option to-date. Otherwise, protection is given through the interruption of transmission pathways by prophylaxis (i.e., using condoms).
The current situation: There is a weak selection pressure upon SARS-CoV-2 by way of limited vaccinations. Even a 70 % vaccination rate will not be enough, as seen with Manaus. At the same time, people are not willing to change their behavior. Things that are not forbidden, are undertaken, the immediate satisfaction of desires is more important than a sense of purpose.
This is one more influence on the pandemic: Starting last week already, thousands of tourists now are descending upon the Balearic Islands from all over Europe. Each country is contributing its individual mix of mutants to the islands, to happily spread all over. What a melting pot. This, in consequence will lead to more infections, which again are giving the virus space to change its characteristics.
Should the according politics not change immediately, giving people a meaningful, clear-cut, long-term guideline, not only will there be more waves of infection, but there will be an enduring loss of credibility for the politicians.
Unfortunately, the federal and state governments are acting too late, inconsequentially, inconsistently, lacking transparency, and driven by lobbyism, instead of imposing meaningful, comprehensible measures. The see-saw changes of lockdowns and liftings of measures need to stop. The situation will not be different two weeks from now. The virus is calculable, while the German politics is not.
Should the individuals’ behavior not change, this virus with all its properties will wear us down on several levels in numerous epidemic waves with more and more mutants. The most significant level is health. Without physical and mental health, no system is working, no country, no economy, and no social system. In the end there will be a pile of shards. This may be prevented only through a consequential and forceful campaign. Besides mandatory masks and distancing there are more means at hand now. These need to be used comprehensively, consequently, and correctly. The consistent application of all the means (vaccination, tests, contact tracing, quarantine) are a MUST if we want to prevent further damage. This also includes the option to close schools and childcare centers, mandatory testing at the workplace, as well as nation-wide education campaigns since there are too many people who still do not comprehend the situation. Millions of Euros are being spent in political election campaigns, why not for a meaningful purpose?
In future, it will be necessary next to vaccines to develop an arsenal of drugs. Vaccines are protecting preventively, while drugs are saving lives in acute situations. This is the only way to fight a pandemic without keeping people insecure for months in a row.
To wrap things up, there is an addendum to the German vacation travel madness: The British government this week will enact a law penalizing those people who are travelling abroad without good reason. Upon return these travelers will have to pay a £ 5000 (€ 5800) fine per person. The British government wants to avoid an import of new infections, while realizing that an appeal to individual responsibility is not enough. Why did we have to find this news in British and American media, while the German media remain mute?
The measures agreed upon yesterday in Berlin are too little too late, they are inconsistent, they will not be enough to “break the wave” as Helge Braun boasted in an interview.
Remember: The race against this virus is in full swing. We are in the midst of it!
We are again pointing to our two previous blog posts dealing with the strategy for 2021 to being able to defeat the virus.
Yours, Sabine and Jörg
SAJO is consulting all around infectious diseases. We are applying our know-how, that we have acquired in more than 20 years. We do what we can to fight this pandemic.
SAJO – for a healthy world and better future!
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A heartfelt thanks to Oliver Hoogvliet for the awesome cartoon, ollihoo (https://hoogvliet.de).
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