“Prisoners of the virus”, as the headline Republic, or prisoners of the fear of Covid? The question arises somewhat spontaneously in the light of the fact that, on the one hand, the Omicron variant increases infections, sends tracing into fibrillation, pushes 2 million Italians into quarantine, increasing the number of subjects who decide for the fiduciary self-isolation, but – fortunately – on the other hand it does not create as quickly, in step with its fast transmissibility, an excessive number of hospitalizations or deaths, even if hospitals and intensive care units are close, and in some cases beyond, the thresholds considered critical. And while Israel is taking a pause to reflect on the fourth dose and in France they anticipate the booster dose to three months later, in Italy there is talk of a revision of the quarantine protocols, because the country is at risk of blocking. To take stock of the epidemic, we spoke with Donato Greco, epidemiologist, specialized in communicable diseases, hygiene and public health and medical biostatistics, as well as a member of the CTS.
Boom in infections, but not in hospitalizations or intensive care. Because?
Two thirds of the cases are positive swabs performed on asymptomatic people, so much so that at Christmas, having done much fewer swabs, the number of infected fell from 50 thousand to 25 thousand. Let’s remember that we are in the middle of the winter season, the one that Covid adores like all its coronavirus brothers. However, as you rightly pointed out, we have 6-7 times fewer hospitalizations, intensive care hospitalizations and deaths, because we have been vaccinated: 90% of Italians have received at least one dose. And the vaccinated who get infected get a trivial infection.
Are we heading towards a peak of infections? When could it arrive?
It is not very predictable, even if we are trying to buy time. If vaccinations continue to proceed at the rate of 500 thousand a day and if the 2.5 million adults over 50 who have not yet been vaccinated are recovered, and who are largely those who then end up in hospital and intensive care, it is clear that we will be able to break the peak more and more. Now, however, the trend is not decreasing, nor will it be before the end of the year and certainly in the first two weeks of January.
How to convince the undecided to vaccinate?
They are not undecided, it is wrong to call them that.
Because?
Six and a half million adults are not yet vaccinated, including over 290 thousand over 80. Don’t tell me these over-eighty-year-olds are no vax who go to the streets to protest …
But they haven’t been vaccinated yet …
They are simply people not yet reached due to a system defect.
In what sense?
Our large primary medicine system – we have 48,000 family doctors and about 6,000 pediatricians – was not fully involved in the vaccination campaign, which was conducted a little outside the doctors’ offices, also for logistical reasons. It is clear that these doctors, who are in direct contact with these people who have heard the invitation to get vaccinated thousands of times since January, must convince them to get vaccinated. In the local health authorities where individual doctors have been provided with the list of patients not vaccinated against Covid, as well as those who are not vaccinated against the flu, things have gone much better. It is a fundamental counseling function, because ideologically convinced or politically motivated no vaxes do not exceed 4-5% of the population. The rest are precisely these subjects not yet reached: you have to go door to door, you cannot proceed to vaccinate only with the hubs.
And the third doses?
The third doses are not a priority with respect to the recovery of those who have not yet received even the first, because the colors of the Regions unfortunately depend on the number of unvaccinated adults. The average age of hospitalizations and deaths is still around 80 today.
However, there are also around infected with the third dose: do we have to demand new vaccines because the current ones are now less effective?
Absolutely not, because the goal of vaccination is not to eliminate the infection, which is a non-existent concept in the epidemiology of infectious diseases. Only in one case, with smallpox, were we able to eliminate the infection; in the other cases, including poliomyelitis, where we are also close to its elimination, we did it.
Therefore?
It is no harm for people to become infected if they have no symptoms. Indeed, it can be good, because it means having a natural booster. These vaccines were commissioned to prevent deaths and injuries, not to avoid infections.
It should be noted, however, that public communication, in this case, sent a different message. Many today think that, after vaccination, they no longer risk anything and can do whatever they want …
This is clearly a wrong concept. Here we are at the abc of infectious diseases. We can’t stop the virus, which goes about its business, is venting this season, and is showing it to us in a blatant way. Being a new virus, it found the world population with no previous memory.
In Israel they talk about a fourth dose, even if they are holding back a bit at the moment. A path to follow?
The fourth doses are still fantasy. We took Israel as a model, but it is totally different from ours: not only is it a completely different climatic zone, but above all it is a para-military country. They initiated this fourth dose discourse without having consistent data on the third dose follow up. If the booster doses started in September, after three months it is difficult to decide to do the fourth. Also because in vaccinology, the third dose usually gives long-lasting immunity.
According to the ISS, the serums still lose their effectiveness: after 5 months the protection drops from 70% to 30%. Is that so?
Warning: applies to infection, not serious illness. In this case, in fact, the drop is 10 percentage points, down from 92% to 82%, which is still an excellent result.
Vaccine effect expired for 15% of the population. Is there a risk of the emergence of new variants?
The word “expired” is completely inappropriate, it means that we are dealing with a degenerate drug. We are not talking about curdling milk. That said, we have never seen a virus without variants, because variants are part of the normal life of any virus.
How scary must Omicron be?
We made a lot of fuss with this variant and in the end we found that it is almost better to have the Omicron than the Delta. Omicron is much less pathogenic: it spreads very quickly, but in fact it’s like a flu. He’s not taking anyone to the hospital. And now we have very solid data, not just from Israel or South Africa.
Will we have other variations?
Of course, but only because we do not have a very high coverage, that is, more than 90% of the entire Italian population, not just the adult one. Variants will always come out.
Chaos swabs and quarantines: is it time to review the protocols because the country risks blocking?
It is an evaluation that we do regularly, but remembering an important point.
Which?
The quarantine is not meant to stop the disease, but to reduce infections. The time of quarantine is derived from the infectivity estimate of a person compared to a susceptible person. Since the incubation time of Covid varies from 2 to 14 days, with a median of around 5 days, the choice of quarantine can be more political, based on caution, or more social, reducing the time a bit.
His idea?
Doing 900 thousand swabs in a day means still having a population that has not understood that – instead of spending money on the test, creating many asymptomatic positives that then quarantine themselves together with their family members, thus stopping half the country – the best thing would be to go and get vaccinated.
(Marco Biscella)
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