They are heroes by chance, by necessity, by choice, by vocation. The doctors, biologists and nurses who are fighting against Covid 19 are the troops in the trenches defending our health, the ones who at least guarantee us hope for a future. Maria Carla Re, virologist, university professor, with a curriculum full of national and international qualifications and experiences, today works full-time on the new Coronavirus, as head of CRREM, the Regional Reference Center for Microbiological Emergencies of the Sant'Orsola hospital in Bologna, the laboratory that does the most number of swabs for the whole region. An expert on HIV and Ebola, she is one of the most respected professionals in her field and is putting all her energy into identifying new cases of the global pandemic that has also infected Emilia-Romagna. FIRSTonline interviewed her to take stock of the situation and to understand what we can expect.
Professor, how is your work going?
“We are in an emergency, we work very long shifts, we work seven days a week, day and night. It's hard. CRREM has 3 managers and 6 technicians, who undergo stressful shifts, without respite. Many people have made themselves available to help us and are helping us in a concrete and silent way, but it is good that only people with previous experience in emergencies work in the laboratory, like the ones we have today. The problem is that the demand for exams is growing all the time. We receive over 400 swabs a day and they are all urgent. How do we give an immediate response to everyone? We manage to find a maximum of 200 and the others go to the queue. The average response time for 100-150 swabs out of 400 is within the day, then it takes 24-48-72 hours. We give priority to patients with interstitial pneumonia, then to new attacks of pneumonia, then to simple pneumonia, then to health workers from the seventh day of any contact. However, we are unable to have rules that last a week, things change every day".
Are the measures implemented by the government to contain the epidemic at this stage right?
“Very right: Government, region, hospital management, everyone is doing very well. Prevention is basic. Limiting the spread is essential, so that the health system does not collapse and to lower the chances that the virus mutates ".
In recent days, German Chancellor Angela Merkel spoke of a risk of contagion for Germany of 60%-70% of the population. Is that so?
"I do not know. I believe that by testing the entire Italian population we would discover much higher numbers than the current ones, but in this situation we are forced to give priority to the symptomatic. Once this phase has passed, we will be able to look up from the swabs and also focus on other things, for example on the immune response of some asymptomatic people or with mild symptoms, on the characteristics of the virus, on its replicative capacity in cell cultures, on the pathogenic mechanisms. There would be so much to do, because basic study is essential for understanding”.
Does this epidemic swarm help us immunize ourselves to any extent?
“We can only speculate. We are dealing with an RNA virus, therefore a virus that is capable of constantly mutating during its replication cycle. We learned this from the flu virus, from Ebola, from HIV. These mutations, which occur in large numbers during the replicative phases of the virus, can lead to further mutations that will allow the virus itself to find new receptors on other cells, to modify its pathogenic power (both positively and negatively), to make a further leap of species. Simply said, if the virus were stable, the immunity produced would allow us to have protection against subsequent contacts with the same pathogen. But RNA viruses are unfaithful viruses, they replicate, mutate and broaden their spectrum of infection. We must respect the new rules, not go to crowded places, not go out unless it is essential both to limit the spread and because the more people get infected, the more likely the virus will change. After all, colds are also coronaviruses, but no one has ever found a vaccine, because the virus is constantly changing. Whoever finds the vaccine for the common cold would probably win the Nobel Prize”.
Is the new Coronavirus transmitted only by air or by ingestion as well? To be more explicit: if there is the virus on my sandwich, will I get sick after eating it?
“Theoretically not, but nobody knows for sure, because, I repeat, it can change. At the moment we can say that the new Coronavirus, Covid 19, is a respiratory virus that spreads mainly through close contact with a sick person. The primary route is the breath droplets of infected people that reach us through saliva, coughing and sneezing. We can also infect ourselves if we touch our mouth, nose or eyes with our unwashed hands that have encountered the virus. Some literature data report that, in some rare cases, the contagion could occur through faecal contamination, but for this we have to wait for precise and punctual studies. For now it is a respiratory virus, so his sandwich is safe ”.
How should we behave with the food we buy? Can they be "infected"? Better to cook everything? What about packaged products? And the clothes we wear?
“At this level I would be calm, even if, we must always remember, that we are facing a new virus, of which we know little. A lot is being studied, but we need some time to be able to understand the real capabilities of this new pathogen".
Why was the fire so rapid and disruptive in Italy?
“Because we are talking about a virus that can be transmitted by air, therefore easily spread and we are talking about a new virus, against which no one had an immune heritage. It may be that the first person infected from Codogno had a very high viral load ”.
Is it true that other countries have fewer cases because they did fewer swabs in the beginning?
"Maybe! Surely we immediately started a very close monitoring. Our laboratory was already in a state of pre-alarm in January and the real start of the tests is February 2".
Why did you start so early?
“The alert was pressing. In China the cases became too numerous to believe that the infection did not reach Europe too, or Italy. The first week of February we began to examine the cases that our clinicians sent us, as the symptoms could be significant. However, the real boom came after 20”.
What does the Chinese experience teach us?
"The Chinese experience teaches us that the containment of the infection takes quite a long time, but at the same time we are cautiously optimistic about the results they are achieving".
When could the peak of the epidemic be?
“It depends, whether we are talking about China, Europe or something else. In China we have 81.000 cases, we have more than 15.000 and then Iran, Korea, Spain up to the United States. The last countries have to learn from the first countries involved. We from China, the others from us”.
Is there hope for a vaccine and when?
“There are many hopes, the whole world is working on a vaccine. However, this involves several experimental phases before being available on a large scale and no one can say when it will be ready. We will then see if it will be a preventive or therapeutic vaccine and if we will have to use it immediately, because we will not have the time to test it on animals first. There is only one positive aspect in Covid-19 and it is the silence of the No Vax. Fear finally silenced them. Do you know how much time we could save at this stage if all people were vaccinated against the flu? Very very much. Instead we swab those who, perhaps, only have the flu, stealing time from those trying to survive. Furthermore, the two pathologies can add up, increasing the risk of complications. Every year the flu has very high social and economic costs. I hope that this hard lesson, which I never wanted to experience, will serve us for the future".
How long do you think this acute phase will go on?
“I still see badly for at least a month. Maybe I'm too optimistic."
Do you think the heat will lessen the epidemic?
“I don't know, I hope so. If it belongs to the so-called cold diseases, we are more likely to decrease as the season progresses”.
Did this virus amaze you?
“I am always amazed by our invisible enemies, viruses, by their ability to replicate themselves, to silence themselves on some occasions, to trigger different pathologies (and right now I am thinking of oncogenic viruses). My experience studying HIV has taught me a lot about the transfer of viruses from animals to humans. At the time it was monkeys and in the 80s mortality from AIDS was very high. Then it was understood that the virus could be stemmed with protected sexual intercourse, therapies were found and HIV became a chronic condition for those who are positive. There have been other passages of species: avian flu, mad cow disease, sars. Well, we could have expected it. Now we have to fight with all our strength and use this terrible experience to improve. The earth is a single cycle and we must take this into account: if it gets sick, the foods we eat and the animals get sick and therefore us. Let's remember this when we are out of the emergency”.
