When I tell friends and colleagues that I’ve been sick of COVID19, I feel that they are scared. Some people congratulate me for confessing, but no one likes to see me, even if he’s sick himself. There is a social automation that we have left since the time of tuberculosis, that is not consistent with the rationalization of society in the information age,” says professor of oncology and genetics at Harvard Medical School – Director of clinic at Massachusetts General Hospital, Oton Iliopoulos.
In one of his rare interviews, at the AMNA, the Greek man who also painted the Nobel Prize in Medicine 2019 in Greek, states that there is a terrible exaggeration about the risk of the virus, which is based, as he claims, on the wrong images of mortality, from this infection. “Now that we are beginning to estimate how many people have been exposed to the virus, the impression is established that most people will be asymptomatic, or have much milder symptoms, than the clinical picture I experienced.”
The internationally renowned scientist, in addition to the stigma he believes accompanies the next day, says that a return to normality should be done gradually and with large-scale antibody tests. “Those who are with antibodies, be able to return to their jobs so that we can get out of the cast immediately, restart the economy, but also return the world to its normal life.”
On the subject of immunity, Mr. Iliopoulos stresses that “we have not a single proof that he does not protect. Those who well-intentionedly claim otherwise forget that at first we did not appreciate that the disease is two-phase and therefore the second part can be considered re-infection if you have no experience.” I don’t believe there’s a single confirmed case of reinfection in the hundreds, thousands of sick, professor stresses. As for the symptoms of the disease, he says the most shocking observation is how many people have been exposed to the virus and have antibodies, but have been completely asymptomatic, or have had very mild symptomatology.
In a recent online discussion with other colleagues, you jokingly said that you are no longer an oncologist, and you have become a pulmonologist, at Massachusetts General Hospital (Massachusetts General Hospital) who works and is a reference hospital for COVID.
General Hospital is the most historic and largest of the three Harvard University Hospitals, which covers a large and heterogeneous population in the Boston metropolitan area. It is hospitalized from very common cases, to unlikely rare diseases, for which it has specialized centers. When we saw the epidemic coming, we remodeled selected departments in COVID departments, increased ICU beds from 110 to 300, while at the same time mobilizing doctors from different disciplines to address the new needs presented. We currently have 345 internal patients plus 135 in the ICU in a 900-bed hospital. We learn a lot about the biology of the disease that is valuable, not only to cure the sick, but also to propose health policy. You can’t deal with an epidemic if you don’t have experience of evolution and aspects of the disease.
What observations do you make? Are there aspects of the clinical picture that are not more widely known?
There are. The most shocking is how many people have been exposed and have antibodies, but they have been completely asymptomatic, or have had very mild symptoms. They think they are still virgin organisms, but in fact they have passed COVID and are immune. In recent sampling, we found neighborhoods where 32 of the residents have antibodies. And I really don’t understand why these neighborhoods are still in general confinement. We also learned that about a quarter of COVID patients can only experience nausea, vomiting, diarrhea and other gastrointestinal symptoms without affecting the lungs. Patients of this type may be cured quickly and some may experience respiratory problems (mixed clinical picture). What we have also appreciated from the experience so far is how useful the general markers of inflammation are to the prognosis of the disease. Similarly useful are forgotten simple clinical manipulations, such as turning a patient face down. This can improve his oxygenation so much that he doesn’t have to get into the ICU. I would also like to stress something that is now known and not from the beginning of the pandemic. That the disease usually has two phases. They last 4-5 days each and in between for two or three days the sick feels so good that sometimes it is as if he was healed. The second phase is usually clinically heavier.
Immunity is considered important for the next day’s planning. However, many views have been expressed as to how long it can last. Cases of re-epinetherapy have also been reported, e.g. 51 patients from South Korea, who had been cured by Covid-19, were tested positive again.
I don’t believe there’s a single confirmed case of reinfection in the hundreds, thousands of sick. I think this is paraphilia that stems from how much we have terrorized the world, in my opinion unjustifiably. From all our experience with infections (viral and non-viral) we know that immunity (i.e. antibodies in the blood) protects from too much to completely infection. That’s where all the childhood vaccines are based, which have come to completely eliminate some diseases.
The same is true of COVID. In the statement “we do not yet have proof that immunity is not protected”, I reply, after experience of the scientific community to over a million patients, “we do not have a single proof that it does not protect.” Those who well-intentionedly claim otherwise forget that at first we did not appreciate that the disease is two-phase and therefore the second part can be considered re-infection if you have no experience. Also the virus detection test can easily be false negative, since it has a sensitivity of only 65%.
With this data, what do you think is the best way to get back to normality?
I think we need to map the population directly with large-scale antibody tests. Those with antibodies, be able to return to their jobs so that we can get out of the cast immediately and restart the economy, but also to get the world back to normal. If we wait for the vaccine, or medication, we may be locked up for months or a year, and that’s impossible now. Those who don’t have antibodies may be out in a second year.
People living with people belonging to vulnerable groups, how do you think they should go back to work and their normal lives?
People with immunity are not carriers of the disease. So I would recommend them to wash their hands very well before returning home where they live with the vulnerable people, and apply relative isolation within the house. As far as people without immunity who are left with susceptible people are concerned, they should also sit at home in the first phase. Until the immunity of the population reaches a level of 30-35%, in which case the contagiousness will then decrease.
What about the float of the curve now that we’re going out?
If we base de-escalation on immunity, the curve will not flare up. If we continue to have people locked up in their homes and one day we allow them out, without having cultivated the conditions for generalized population immunity, then we will simply have carried the outbreak a few months later. Until there’s a vaccine, the question isn’t whether someone’s going to get stuck, it’s when he’s going to stick.
So you say that the question is not whether we will get sick. But when. The severity of the disease has to do with how many antibodies one has? Or can genetic background play a role?
I’m saying the question is whether we’re going to get stuck, not whether we’re going to get sick. Ail means I have symptoms, i get stuck means I’ve come into contact with the virus. I might get sick, maybe I don’t. Just create antibodies and be immune. Of other viral infections, such as influenza, we know that above a level of antibodies (usually achieved by vaccine or simple exposure to the virus) the body is immune. The genetic background may be playing a role, but I think that role has been over-emphasized. I would not rely on genetic differences, either on prevention, on treatment or on health policy making.
Where can the solution of the puzzle lie in the treatments under investigation – vaccine?
In a pandemic, you try everything. I would invest in drugs and the vaccine and not in the genetic background.
The issue of stigma is an issue right now. Do you experience it that you have been relatively painlessly passed by COVID19?
I spent eleven days with 39.5 fever, complete weakness, pains and only water. It was probably a relatively intense clinical picture, not the worst of course. There is a terrible exaggeration about the risk of the virus, based on the wrong images of mortality from this infection. Now that we’re starting to estimate how many people have been exposed to the virus, the impression is that most people will be asymptomatic or have much milder symptoms than the clinical picture I experienced.
Does the virus change face during its stay in the human body? What’s wrong with mutations? Do antibody tests pick up all his variants?
The virus is interested in spreading. Like common microbes it doesn’t have to change much to make it, as long as it doesn’t find resistance, i.e. it’s not exposed to drugs or a vaccine. So we don’t expect it to undergo changes that make it unrecognizable to the antibodies we’re now getting. On a much larger time scale, i.e. one to two years, it can change as the flu virus changes every year, but this is not a factor of complexity at this stage. Antibodies usually recognize many virus proteins, the antibody test detects those that recognize stable characteristics, so yes antibodies catch all variants.
What’s your feeling? Is the virus going to disappear all of a sudden, as some people say? Or did it come to stay?
The family of suckers has many members who aspire to be at the forefront of our lives, such as SARS, MERS and now COVID-19. It’ll go into obscurity at some point, but it’ll probably be succeeded by a new cousin. That is why we need to prepare the health systems we have, and civil protection for the next pandemic. The question again is not whether it will be presented. But when.
*Oton Iliopoulos contributed decisively, with his pioneering multi-year research work on cancer and his gene mutations, to be honored with the 2019 Nobel Prize in Medicine, the team of Professor William Kelin of Harvard. The scientific arguments of the Committee of the Swedish Academy of Sciences pointed out that two of the three publications for which the Nobel Prize was awarded at Harvard were the ultimate conception and the practical work of Mr. Iliopoulos.