If the Omicron variant that comes from South Africa and is causing a global alert will really be “diabolic”As it appears, with its 32 mutations in the proteina Spike, we will only understand “in 7-10 days when we have the clinical data of the people who have been hospitalized”. Know if people are infected with the mutation Sars The 2 named B.1.1.529 were vaccinated and what is the course of the disease will be crucial to understand if we are really facing a potential catastrophe, that is “the variant that is transmitted well and is insensitive to the vaccine“. Giovanni Di Perri, director of the school of specialization in infectious diseases of the University of Turin and head physician at the Amedeo di Savoia hospital in Turin, calls for caution while awaiting certain data. Even if “we say that compared to the various reports of variants and sub-variants of the past, with the information we have available today, this variant seems to have a minimum of specific weight more”.
For the Italian scientist it is probable, as hypothesized by the geneticist Francois Balloux (University College London), that the Omicron variant evolved during a chronic infection of an immunocompromised person, possibly in an untreated HIV / AIDS patient. Therefore the variant “should not have been selected in a vaccine“. The South Africa as of November 14 it had registered 245 positive cases and today there are about 1000. “What is striking is the short time in which it would be replacing the Delta. We have Delta here and we are obviously interested in all the data ”.
Professor Di Perri are we really facing a variant of horror?
Let’s say that compared to the various reports of variants and sub-variants of the past, with the information we have available today, this variant seems to have a minimum of additional specific weight. It is clear that all those data, especially of a clinical nature, are lacking to understand what properties it has. There is one of the epidemiological type: in a few weeks in the Johannesburg area it has ‘taken’ almost the whole panorama of variants. South Africa has just returned from a sharp decline in cases and is seeing a start of a rise in the curve. Cases that almost all seem to be attributable to the new variant. Obviously, as always, it is a question of understanding what happens with respect to the vaccine: infection, disease, transmission. The vaccine in South Africa has been administered to less than a quarter of the population and it seems unlikely that it was the vaccination that selected this variant which seems to respond to a characteristic, which for now has been the selecting factor of the others, namely the greater transmissibility. Now it is a question of understanding to what extent it is sensitive to the effect of vaccinations, the other property to know is whether it is a variant that causes more disease, that is, if it is more virulent.
But right now we don’t know.
Absolutely not, we don’t have a single figure to say it. But I saw the reaction of the Israeli government where a case imported from Botswana was described and where they have two suspected cases: they say they are on the verge of a state of emergency. Evidently they know more than we do and the Israelis have behaved in an orthodox way with respect to the attention given to this pandemic. The tones used by the press in general are tones that are more worrying than other reports that have been made in recent months.
Because of its HIV-positive percentage, South Africa has hosted many clinical tests for the vaccines we are now using.
Yes, it is. The hypothesis of Professor Balloux, according to which this important number of mutations could have been generated in a patient who has held the virus for a long time, and usually these are the immunosuppressed, is a hypothesis that must be tested, but must be listened to. A patient with HIV is a hypothesis that can be there.
As it had been hypothesized for the English variant later called Alpha, that is, that it came from an immunosuppressed Kent patient …
In that case it was a more accredited hypothesis because the patient had followed him. It is clear that the virus in replicating changes and the more time it replicates, the more it has the possibility of generating variants. Our great fear in recent months has been that the screen opposite to the virus from the vaccine could select a viral variant that would evade the effects of immunization. For now it has happened in a very limited way, Delta itself is still sensitive to the vaccine. Also in this case we ask ourselves if it will be able to reduce the impact of the vaccine and for this question to date we do not have even a pale answer.
And when will we have it?
In South Africa they already have a number of patients. They will tell us what happens in the next few days: how many were vaccinated, what was the course. It will take 7-10 days, They currently have 1000 cases, had a minimum value of 245 cases on November 14 and came from a July 8 peak nearly 20 thousand cases. The last cases seem almost all attributable to this variant. We hope they can give us news and clinical data as soon as possible. What is striking is the short time in which it would be replacing the Delta. We have Delta here and we are obviously interested in all the data ”.
The Delta, according to some Japanese scientists, appears to be destined for self-destruction. In the past you have stated that probably Sars Cov 2, having not yet done so, could not be able to generate the variant that would have escaped the vaccine.
It was a cautious interpretation, but above all a hope. We have been working in the field of virology all our lives. If you take a patient with HIV and give him nevirapyrine (an antiretroviral, ed) the next day, the virus is totally resistant to this drug. I have opposed an obstacle to the virus which is immediately capable with a spontaneous mutation to select a new viral clone that is resistant to this drug. When the virus has in its genetics the ability to jump over obstacles in this way it usually does so right away, it doesn’t wait. The first South African and Brazilian variant entered Italy first of the Alpha which then swept everything away. The first two responded less to vaccines but did not have the high transmissibility property of Alpha that it has and has had. It has conquered its targets that is us very quickly. We hope that this variant is not characterized by the diabolical variant that we have not had until now, that is, the variant that is transmitted well and is insensitive to the vaccine. For now there is no need to be alarmed because there is not a single clinical datum.
Also because, as we have learned, the virus also wants to live and without targets, as you say, it dies.
If I were the virus I would try to be less harmful as possible, because the less harmful the less humans react and the more easily I exist. From the Darwinian point of view it is an evolutionary rule. Today we can say that Delta is more virulent than the previous ones: we hoped not to say it and we hoped from the probabilistic point of view that it would follow the Darwinian course of evolution giving us a less pathogenic variant. Unfortunately this is not the case with the Delta which has a gross 30% higher estimated virulence, well described in two studies: one Scottish and one English. And it is also a perception of ward doctors. We see it in 40-50 year olds who get sick: compared to Alpha with Delta it is easier to end up in hospital.
How is the situation in your hospital?
In the last two weeks the cases have tripled, in Piedmont we have 31 patients in intensive care. Every month I take stock of who is admitted to my infectious disease ward. I have 30 hospitalized patients including 19 vaccinated and 11 unvaccinated. They are two different populations: because the average age of the vaccinated is over 83 years, that of the unvaccinated is 61 years old. This data also tells us a lot about the virulence of the Delta. In resuscitation the relationship is reversed: despite being younger, the 60-year-olds represent 2/3 of the patients. Gray scales in the effects of vaccines need to be studied. We all wanted the vaccine with 100% coverage. But seeing that vaccinated 80-year-olds who are less likely to end up in resuscitation than 60-year-olds is a data in favor of the vaccine.
What a Christmas awaits us. Will it be peaceful?
In my opinion yes, we must not give up on the third dose which is extremely important. We have seen with one of the latest studies from Israel how much protection increases with the third dose and we also hope that the duration of protection is longer. Maybe it will ferry us out of this phase of emergency even if the vaccine is currently entering our lives, even for children. To plan for the future we have to build it. With this vaccine or others improved.
But some people don’t even want to hear about the vaccine.
What we see is a horrendous media theater. There are so many dead, there is suffering and fear. This disease then leaves frightening emotional traces in those who have had a helmet or been intubated. Seeing all this minimized is like having no memory. If on November 26 a year ago they had brought us a blank bill for this situation that we have today, we would have signed. Our poor country is doing better than others: Austria closes, Germany, Holland and Belgium are in trouble. We go to the stadium, to the restaurant. We have vaccinated more and we have the Green pass. A great result and must be the key to commit to vaccinating again and trying to reduce contagion. The tragedy of this pandemic is that it was about to wipe out our society. There is little memory of this, I remember the autumn of last year when we scientists were told that we didn’t give a damn about the economy. Today the health and economic centers are no longer opposed, the third pole that has been formed, that of the no vax, is something for me has a much lower specific weight. Theirs is not an opinion, but an affiliation.