“The lockdown? Are more effective discipline and hygiene”
I share an interview with Professor Ariberto Fassati, MD, PhD of the Division of Infection & Immunity, School of Medical Sciences, University College London.
Professor, she is a virologist and researcher, makes it clear to us what is the difference between the sequencing and the isolation of a virus? And when the Sars-Cov-2 was isolated?
“In recent years, the procedure of isolation of a virus has changed. Before you insulated only physically, today the identification is mainly based on the sequencing. This technique has become very sophisticated: the genome is recovered in the fragments. Each fragment is sequenced several times, sometimes even 50 or 60, in other situations, a lower number, this way you will reach an adequate depth of sequencing. Then he does a sort of ‘cut and paste’, and, on the basis of particular algorithms, and align the fragments between them, as if they were tiles or puzzle pieces, you recognize what comes before and what comes after, the fragments are of different length, each of which can contain tens of nucleotides.
Two chinese appeared in Nature in February (A new coronavirus associated with human respiratory disease in China and A pneumonia outbreak associated with a new coronavirus of probable bat origin) have shown the completeness of all the nucleotides, more or less 30 thousand, these sequences were confirmed by several laboratories in the world, even italians. In all today there are 70 thousand sequences deposited coming from different laboratories of the globe. Is the periodic analysis of the sequences, that allows to establish if the virus has mutated in the months”.
Therefore, the Sars-Cov-2 has not been isolated physically?
“Yes, it was (and is reported in “Nature”). Because, for as it is refined, a sequence that is not enough, you need to prove that a virus exists, therefore even today it is important to not settle, to examine the fragments, but to isolate it physically (using a standard procedure), the chinese group has extracted the virus from the bronchial washing of a patient, then grown in the laboratory on cultures of healthy cells and has found that the virus is grown. Not only that, it has been seen that even the genome assembled with the various sequences of the laboratory, the infected cells as the virus natural. In other words, the virus artificial behaves – in the lab – such as natural men”.
In Italy the disease Covid 19 is changed over the months, it means that the virus has changed?
“Professor Alberto Zangrillo, anesthesiologist and resuscitator of the San Raffaele hospital in milan, he suggested, on the basis of its data and of its experience, that the disease is less aggressive than at the beginning (a phenomenon that also appears from the data in the intensive care units of other hospitals).
However, the sequenziamenti recent have not seen change, such as to infer that the Sars-Cov-2 is mutated in such a way that change the nature patogenica in a stable manner. In the laboratory appears to be the same virus, but the disease manifests itself in a different way. However, with the Sars-Cov-2 , still prevail, the unknowns, and therefore we cannot exclude the possibility that this is changed.
It is true that viruses do jump species are more virulent when they come the first time and then become less and less aggressive?
“It depends from virus to virus: in some cases, the steps on the man, they become less virulent, in others not. There was a coronavirus that at the end of the 1800’s has caused an epidemic of pneumonia rather serious and then became less aggressive. Then there are other coronaviruses that cause only colds. However, the HIV that has made the jump of species from primates, and is considered to be quite ‘young’, has always the same characteristics, aggressive as before.”
There is a study, or more studies, about the people who have contracted the virus and have not shown the disease, or have had it in a light for understanding what is different about those who are not sick? You know today the protective factors?
“Of course, the big challenge is figuring out how to ever in most people this virus causes only mild symptoms and only a 10-20% are seriously ill. Why happen to have not yet understood very well. We have seen that diabetes, hypertension, heart disease and advanced age contribute to the aggravation of the disease and, at the same time, found that it is an infection that affects many organs, not just the lungs. There has been a important contribution on the part of Italian scholars: thanks to the autopsies, it was understood that the virus causes a coagulation uncontrolled blood”.
As ever we have to worry about if it increases the number of positive people? My question is: increase the positive, because you get more pads here and there or the pads are following a policy of observation is representative (on a certain type of population and repeated in the time)?
“In general, if one increases the number of positive and after a few weeks you can have even more serious illnesses. Recently in the Usa is experiencing this. Certainly in Italy, the Higher Institute of Health has conducted studies to sample in order to understand what percentage of italians are positive” (we asked to the ISS and we have been told that they have not been made studies of this type).
It was useful to the lockdown? It can be considered the lockdown a useful means to contain outbreaks among the sick? We observed that in Sweden, where it has been made a lockdown reduced, open the schools and the local, in proportion (have a sixth of the population compared to the us) have had almost the same deaths in Italy (568 per million against 581). And in all the crowded Japan (no lockdown) only a thousand dead.
“In fact, there are going to explain how ever many dead in Italy. A factor might be the density of population because of a high population density facilitates contact between people and the transmission of the virus. It is true that in Sweden, part of Stockholm, the population density is very different from the Italian, 25 inhabitants per km2 against the 206 km2 in Italy and 420 km2 in Lombardy region, in nearby Norway is 15 per km2, and there were only 255 of the dead (47 per million) by the lockdown.
In fact, the japanese situation is inexplicable: they have a high population density (347km2) of a little less than Lombardia, and a population very elderly. Japan together with South Korea and Hong Kong had relatively few casualties. I don’t have a definitive explanation but I can propose some hypotheses, including this one: are people conscious of the hygiene and keep the discipline in scrupulous way, they wear gloves, masks, and respectful of the material, the social...”.
To be effective, it may have been the discipline most of the lockdown?
“It is likely. We have seen, then, that the lockdown was a devastating experience, destroying the economy and raises the number of the dead because people no longer go to the hospital. We must try to do everything to avoid it in the future and make for example the populations that contained the outbreaks with the discipline. Today are are impressed favorably by the numbers in Italy and I would like for my Country to go forward as well, re-opening schools and activities. I encourage all of you to be careful, wash your hands often, respect the distances, ventilate the premises, avoid crowded places, wear a surgical mask in public places and monitor the situation”.
The vaccine “burn the stages” (in fact, she is already burning): to be able to have in a short time you have skipped some of the steps that relate to safety and effectiveness, what do you think?
“More than ‘burn up’ the stages, these are ‘condensed’. In normal situations, the phases are 4: pre-clinical, phase I, phase II and phase III (effectiveness on the field), and each starts after the previous is completed, and if the criteria of safety and effectiveness have been achieved. In this emergency situation, do not wait for the completion of each phase, but it begins a new phase as soon as certain criteria of efficacy and safety have been verified in the previous. This means, however, that some of the information from phase I will be known as phase II and phase III are in progress. So it goes for the phase II and so on. In the end, the information will arrive almost together, and public agencies should carefully evaluate all of these data to determine if the vaccine is safe and effective. It is a new approach, that requires accepting a certain risk for those who produce the vaccine (all of the investments for phase I, II and III are made in a short time, and the answer is known only at the end), and it has some limit because at the beginning we will not know if there will be some unwanted effect to the longer term, and if the protection offered by the vaccine will last a long time. It should be borne in mind that the vaccine, when approved, will be’ first of all offered to groups of people at highest risk of death for COVID-19”
Some vaccines in preparation include a new technology, they will not have the same characteristics of those used so far. For example there is a vaccine, a Rna, a tattoo or a nanochip, what do you think?
“There are more than 100 vaccines tested in clinical trials, a more or less advanced, of whom 26 are in clinical trials on volunteers.Among the vaccines tested in clinical trials, there are ‘classics’ such as the inactivated virus, and of the ‘new’ such as those based on RNA and DNA. The results published to date indicate that all three of these approaches are promising, in the sense that they induce a strong immune response to the coronavirus. However, each of them is a little different: some seem to stimulate more antibodies, other stimulate a bit less antibodies but also enable the T cells or lymphocytes. So it is possible that, in the field, several vaccines have an efficacy that is different, offering a degree of protection different and probably a different term of protection. You cannot know now which of these vaccines will be the best, but I think that more than a vaccine could be approved and it could happen that different countries will use different vaccinations depending on availability and cost. We could then make comparisons based on the data available. That said, if the vaccines “new” demonstrating effectiveness in the field (phase III) and are approved, we would have to find a new production platform, much faster and more flexible of the “classic” that will allow us in future to respond to possible new pandemics in a more’ effective’.
I share with you the testimony of her friend and colleague Martha, who lived the illness of his mother and her boyfriend, which has experienced fear, anxiety, and loneliness, and suffered the consequence of the dehumanizing of separation from their loved ones. Fortunately, the illnesses of the family members of Marta have settled without straschichi. The thought flies to other friends and colleagues are not so lucky, their parents, admitted to hospital in the RSA, to all who have returned their last breath in solitude, without a caress.
A japanese saying says:
“The man must die in beauty like the leaves of the cherry tree in the autumn”.
My experience, by Marta Calcagno Baldini.
“I have written a table, “History Crown”. Summarizes all of the events that took place, my family and me, from the 29th of February to the 24th of June, i.e. from the date of possible infection for the negative result of my buffer. In the middle there are two shelters, Flavia, my mother and James, my boyfriend, and my days in quarantine at home with the anxiety of not being able to breathe. Passed to call vacuum toll coronavirus in Lombardia (“has had contact with a positive?” “yes,” “and the chinese”, “no”, “feel the typical symptoms of the virus?” “shortness of breath, in certain moments, it seems, I miss the air,” “a fever?” “no” “then sorry we can not do something”). Waiting for the Ats I summon for the serological examination or swab. Between demanding unnecessary tests, of the blood common to check the values of IgG and IgM antibodies (I later discovered that there is a specific examination for these values, the serological. Not just a blood test! Still I curse the doctor, friend of friends, who sent me to do this test 2 times, exposing me and others to further risk).
Everything begins on the evening of 29 February in Franciacorta, in the province of Brescia, in the area that then turned out to be a red zone as Bergamo or almost. It was a dinner with a dozen people, all at the table for a few hours, all close together, we also talked about the virus. It seemed a matter of distant even if it is serious, that would have been resolved quickly in spite of the poor victims that had already started to harvest. And then, two days later, on 2 march, my mother Flavia does not feel so well. Seems like a seasonal flu. The news we get from others also invited to the dinner: also in bed with the fever. James and I feel healthy. Always on the 2nd of march we go to Milan. On the 5th of march we went out to dinner with another couple of friends. It takes two days from this evening, and all four are fine. In particular, James, who is sick, has 37 of the fever. Between phone calls to the red cross to the empty and not a, passes another week: one of the guests at the dinner in Franciacorta is admitted to hospital with coronavirus, my mother is taken to the Hospital San Matteo of Pavia, and my boyfriend at the Fatebenefratelli of Grass, where I accompany myself in the car (wearing both the mask). We are to march 14: in this providential institution had just purchased two machines for breathing C-pap (and finds out about my cousin, the online just known the conditions of James). Flavia, less severe, on the 19th of march comes home and, out of danger, three in the quarantine (but the call to do the swab only on the 24th of June!). He, however, is not intubated, but is applied to the “Continuous Positive Air Pressure”, the helmet is transparent, that infuses continually air helping the exchange of oxygen in the lungs. Initially, throughout the first week, James was under the helmet Cpap almost 24 hours on 24, except just at meal times. From the second day only, and in the third he wore only the mask Venturi, which covers the nose and mouth. It was in a room with another patient: after the first few difficult days, in which both were lying belly-down to encourage oxygenation to the lungs, and wearing a helmet, when they could at least sit on the bed and began slowly making friends. Which has relieved significantly the sense of isolation from the world, by the sick Covid, however, have experienced. Doctors and nurses come into the room fully lined: suit, double gloves, mask, face shield and hood. Unrecognizable, if not for the name written in marker, directly on the uniform almost as an astronaut. Direct contact with friends and relatives is strictly prohibited.
After having accompanied James into the hospital, I’m 3 weeks in quarantine as I have warned to make the doctors of Grass. The right recommendation is not reached immediately, but in the evening when I have reviewed in the waiting room, where I was back to bring to James, the newspapers and the charger for the mobile which I had purchased in a nearby shopping centre. I had already in fact booked a hotel in that vicinity to be present the first few days and see how you would have developed the situation. A doctor to me has, however, recognised in the waiting room (no one can access the rooms: leave the objects for the sick, nurses them deliver it): “If she was in contact with a covid positive should go straight home and put in quarantine”. And so, in anxiety, I call my sister Roberta that evening (they were 21) from Milano to pick me up to the Grass and scortarmi home again (I was came driving the car of James).
Proximity is a dangerous word, when it speaks of Coronavirus. Yet the affection of the family and their support actions at certain times are the only thing that really helps you have the strength to come out of a moment of solitude, a necessary and complete. This trip with two cars was crucial, and then, in the weeks home, whatsapp has become my faithful companion: I communicate with James when he is able to write because they remove the helmet in the hours of meals (for several days his voice is feeble, does not have the energy to talk on the phone), with my mother, with relatives and friends to inform everyone of the status of the two . I also speak by phone with the doctors of the Grass, that once a week they call me, and then again for friends and family to James what I was told. My cell phone becomes a switchboard.
About me, I often hear my uncle, a surgeon, and my cousin virologist, who hear me with great patience and availability, giving me advice and directions. Breathing heavily, will be to anxiety or the virus? Contact repeatedly the toll-free number Covid and my national health doctor: not having severe symptoms every time I repeat that I can only wait. What? Of aggravarmi? Are not to make the buffer because they have too many serious cases to follow and I can not get out of the house in no doubt that it is positive. Thanks to my two sisters, I can have the expense, and a great psychological help and happiness: every morning, the Marina comes to me with the little Umberto, his first son, in the stroller, and we talk from the window to the courtyard. I leave the newspapers under the door and leave. The solitude in poverty Covid is necessary, but a cause of great anxiety and sadness. For anyone who is at home in isolation, like me, and for those who are in the hospital even more. Here is Roberta with great generosity, and the door several times with food, letters and readings of James I and the friends in turn preparing for it.
March 30, ends up in my quarantine, not knowing if I made the virus and if they are healed. However, I can get out of the house, even if it is almost useless in those days: Milan seems to be under siege, very few activities are open and even fewer people on the street. I need just to avoid my sisters of having to provide food and favors various.
James was discharged on April 11, almost a month later, and have to stay three weeks in quarantine. Luckily I can continue to go out, even if, in respect of all, I must avoid all possible contact with him. At this point begins the long wait of its buffer, which extends until may 11, almost two weeks after the end of compulsory quarantine at home (which would be ended on the 2nd of may). On may 15, after the second buffer, via mail arrives the document which declares that James is immune to the coronavirus. At home, in those weeks, the time spent to disinfect, the disinfect enclosure, given that, when James is back, we should sleep in separate rooms and he had to stay in isolation even if the bathroom was a (in his room, before his arrival, I had brought alcohol, and various sponges, as well as masks, gloves and changes of clothing. Every time he was in the bathroom, opened the window and after disinfettava, with the mask, all the surfaces that used. I for safety I repeated the operation before use I the bathroom and after). We had to leave the food in front of the door of his room, prepared on paper plates to throw away after use in the undifferentiated collection. Masks worn for 24 hours, and in the house, change daily and even multiple times per day.
As for me, in mid-may, still I was not able to know if I had or I had or I had had the virus, perhaps with mild symptoms, given that I had never been examined despite repeated phone calls. I decide to do the serological test to be private, at least to know if I have the antibodies: may 18, arrives home, the doctor, and there were positive to IgG antibodies, i.e. those which remain after you have had the virus. Thinking back to all the phone calls that I made to the toll-free number and how many times they have been put aside, in recalling the expectation of the call of the Ats for having a buffer, the mind goes to all of the positive light as me, who knows, maybe not having two positive with strong symptoms in the hospital, have not had the compulsory quarantine and were in the midst of others, increasing the infections. The slowness and superficiality were fatal. Finally, on the 24th of June, June, the Ats is calling me for the pad, which I do two times: negative.