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Associate Professor Angel Kunchev is the Chief State Health Inspector of the Bulgarian Ministry of Health. He graduated from the Plovdiv Higher Medical Institute with a specialization in medicine. He started working as an epidemiologist at the Haskovo Institute of Medical Care and in 2000 he moved to Sofia.
Since 2008 – Director of Surveillance of Communicable Diseases, Ministry of Health, and in his current important position since 2011. He is currently a key figure in the Headquarters of National Operations for the fight against the coronavirus and his experience plays an important role. to make decisions from NIGHT. Flagman.BG speaks to him to shed light on some of the important questions many Bulgarians are asking, especially after a slight relaxation of security measures was announced today.
– Associate Prof. Dr. Kunchev, there is a question that concerns an extremely large part of Bulgarian business, especially at sea. What happens to the summer season? Can we predict when and how it would start?
– This is the most difficult. First, we must consider whether and when it will peak, and call it a plateau. Second, we need to know what time this will continue. Both are related to many variables that make it almost impossible to make a forecast. The main point is that the virus is new and still has many unknowns.
It is largely clear that it has leaped from wildlife to humans, but so far we do not know what its natural reservoir is, whether it is bats, pangolins or any other fauna, this is not yet clear. Furthermore, there are many other uncertainties. At the moment, we know that its method of transmission is airborne, but it can be argued here, since it is rather dripping because it contaminates surfaces.
Like a new virus we’ve never encountered before, we don’t know how much its climate is affected. However, it is part of a large group of respiratory diseases that have “favorite” stations to spread and follow them fairly accurately. We all know that since December and especially January and February, the incidence of influenza and other respiratory infections is higher.
However, in seasonal viruses, when the temperature rises and when the air dries, these conditions are not conducive to their development and the viruses in question almost disappear during the summer season, replaced by other types of infections such as enteroviruses. The most normal thing is to expect this virus to behave in this way, but the problem is that we do not have any guarantee at the moment.
– However, SARS-CoV-2 is a type of coronavirus, should it somehow follow the rest of the family?
“That’s right, but generally the respiratory virus group says so.” There are 4 other types of coronaviruses that we know cause mild respiratory illness, even before the current pandemic at the National Center for Infectious and Parasitic Diseases, we were able to demonstrate their presence in secret samples and they were captured.
However, this one is different. It comes from the animal world and so far it is obvious that we do not know enough about the mechanism by which the immune system responds to it. Receive in time many strange messages from different parts of the world: United States, Hong Kong, China, etc. – that the disease does not develop exactly as virologists expected.
Very often, the immunity that is obtained after a fight is not strong enough, the antibodies are not at the required levels … For now, these are separate reports, but only when enough experience is gained will it be clear if this will affect the control of the epidemic. . From this point of view, any forecast for the summer season is extremely difficult and is nothing more than speculation.
– Let’s go back in time to Bulgaria: on March 8 the first positive samples of patients in Bulgaria were announced. Following the example of China and other countries in the world, has an analysis of infected people been carried out? Have they been interviewed with the first patients to determine how the virus got to them?
– Yes of course. In epidemiological studies, we always try to find the link between who obtained it and who transmitted it. This is especially easy when there are few cases. However, it is not always possible to trace the exact path of the virus. In Bulgaria there were 2-3 waves of different import of the virus, which are very typical.
Part of this was people skiing in Austria, Switzerland, and northern Italy, where there was apparently a place where the virus was actively spreading. One theory is that when the mucous membrane is exposed to cold, it becomes more sensitive and more susceptible. Contacts are also more intense there. I don’t know what the truth is, but the truth is that these places have become a very active infection breeder.
The other part of the first infected were people who massively visited northern Italy, mainly Lombardy. Many Bulgarians work there and upon their return here we see a significant import of virus agents from them.
– The first case in Bulgaria, as far as I remember, was an old, painful and hard-working woman. Has the path of infection been established at the end?
– No. The first cases in Gabrovo and Pleven were quite strange. They were related to people who are not typical and their profile does not match that of the expected infected. Those first cases after March 8 were really weird and it’s hard to say how the virus got there …
– That would not lead to two conclusions: First: to form a “nest” of the infection in the place where the first case was found. Secondly, does this not mean that the infection has not been completely transmitted from abroad since, in the first cases, there has been no contact with sick people who fit the profile?
– Certainly it is imported from abroad, because it has to come from somewhere. At first, we were even careful not to bring it from Wuhan, China, but somehow we managed to avoid it. But then, in one way or another, he entered our doors from normal doors: students, workers, returning and tourists who visited sporting events outside the country. In Spain and Italy, it was these sporting events that played an important role in the spread.
Regarding the transfer, it is normal to assume that if there is a case in one place, it will have more and can become a home. And in most cases, this is true, but we also have cases of SARS-CoV-2 infection that, although they have come into contact with humans, seem to have or have smaller amounts of the virus themselves and are still cases. unique.
The widespread rate of this new coronavirus is not very high. At first, the Germans calculated it as 1: 3 – 1 sick and 3 new infected. But later this index fell to 1-1.5. Compared to other diseases, say measles, one person infects 12 to 15 more.
– A study was published a few days ago by Stanford University, USA. The US, which estimates that the death rate of the virus is between 0.1 and 0.2%, in contrast to initial claims of 3-10%. Are staff familiar with the findings of their American counterparts?
– I would not say yet that the mortality rate is 0.1-0.2%. To be sure of the data, there must be consistency in the criteria for determining who is positive and who is likely to be diagnosed with COVID-19 deaths.
There you can play around with the numbers. Anyway, if we have extensive enough evidence, we can “paint” a clear image. Global mortality rates ranged from 1 to 2-3% in China and much higher in Italy, Spain and Belgium. But it depends a lot and what contingent is covered. If the infection develops in a nursing home where everyone is elderly with accompanying illnesses, it is only natural that mortality will jump a lot.
– Are you really dependent on age? Who is more at risk in this case?
“There is definitely an addiction, and it is almost completely confirmed. It is no secret that when we investigate, we find positive results in younger people, but the word “contagion” does not mean “disease”.
It is understood that a person is a carrier of the virus. Therefore, there are almost no children in clinics, much less almost no mortality, with very few exceptions in some European countries. People over the age of 60-65 remain at risk, including those with chronic conditions. The average age of the deceased in Bulgaria at the moment is 56 people is 66 years.
– In this morning’s briefing, Major General Prof. Dr. Ventsislav Mutafczyski spoke of a “second peak”. How did Bulgaria end up in the “second peak” of the infection without even knowing that we had officially passed the first one?
“I don’t take that as a second race. The general showed a slight increase in early April, which depends on many indicators. If a person is in a place where there is a higher concentration of those infected, if more research has been done and, from there, the number increases: the variables are many.
I would even say that morbidity should not be given much attention during the day, as many factors work and can be misleading. It is more correct to work weekly.
And there the data shows that, although slow, we are making progress and I don’t think we have reached a maximum level yet. The idea is not to get there, because we can’t prevent it from spreading entirely anyway. However, our goal is not to have very high values in the short term and that the number of newly infected people is acceptable, compared to other countries.
– In the last week there has been an increase in cases. But is this at least in part due to the greater number of tests performed per day?
– Of course, that’s one of the factors too. The more we investigate, the more people take positive samples. So I say that the number of infected is not the most accurate indicator. The number of deaths carries much more information because they cannot be hidden and no one wants to hide them, and there is no way to miss them.
Either way, people in Bulgaria rarely die in their homes; most of them are in medical institutions where they investigate. When a patient is shown to be a carrier of a coronavirus, we do not care that he has other comorbid chronic conditions; The main one is that SARS-CoV-2 has led to its exacerbation.
– The parks in Bulgaria have been partially opened today. In your opinion, is there any reason to believe in the Swedish model, especially after official statistics show that the curve is smoother than Italy, Spain and other countries, where despite drastic measures, exponential growth continued much then?
– It depends on what we take as a starting point. Sweden, compared to Italy and Spain, is definitely much better. But since the disease depends on many social factors, it is better to compare people by culture and mentality.
That is why when we talk about Bulgaria about anything, including the coronavirus, I don’t like to compare it to Germany, France or Great Britain, but to our neighboring Balkan countries: only our temperament and understanding of our lives are almost the same. Similarly, when we talk about Sweden and compare it to its closest countries (Denmark, Norway, Finland), the morbidity and mortality rates are much higher there.
– In recent days, there has been talk of a correlation between the number of cases and the corresponding death rate with respect to whether a country has implemented mandatory vaccination against tuberculosis: BCG. Is there a reason for such claims?
– God forbid! Because if so, from this point of view we will have a great advantage. This vaccine has been used here for a long time and is very strict, including reimmunizations.
Now, although we have slightly reduced the compulsory vaccination initiative, we are still the first in Europe in this regard. In fact, Europe is de facto divided into two: eastern, where this immunization was mandatory in the soc, and western, where it was never carried out.
The problem with asking if there is a reason for such claims is timing. To reach a valid conclusion that there is a cause and effect relationship between morbidity and BCG, it is necessary to investigate many other factors and a much larger number of people. We find differences … If you look at Spain and Portugal, for example, you will see that Portugal is much safer and with much lower morbidity and mortality.
– However, BCG vaccine was introduced for a certain period of time at the end of the last century …
-I don’t have secure data. However, even there, the information is not related to what is happening in Eastern Europe. Yes, but at the moment we cannot say for sure.
– Today, as we said, the relaxation of the measures in the parks began. Are you considering phasing out certain measures but still maintaining them for people at increased risk of coronavirus? However, the economy has to restart at one point or another.
-This is logical and if the epidemic lasts too long, this is the most anticipated movement. But these types of measures are very difficult to implement and very difficult to control.
The social stratification hypothesis is highly significant, but ask yourself the following question: How will a family living in a 3-bedroom study adhere to these measures? But there is definitely a logic. In general, our idea is to protect the elderly, because it is clear that they are at greater risk anyway. We are trying to do this so as not to ruin entire sectors of the economy, because then the situation will become much more complicated. Decisions at headquarters are extremely difficult.
– Let’s dispel a conspiracy. Many people think that the cause of the virus lies in the 5G network. What would you say on the subject?
“I don’t see any way to link the two things, neither in origin nor in distribution. There is also no correlation between where this new technology spreads and where the serious epicenters of infection are worldwide. In my opinion, there is no way that a virus can be affected by an electromagnetic field.
The values at which the network currently operates are so low that they cannot affect health. But I’m also not a fan of the endless optimists who claim that there is no danger that everything is “fine.” It may not be so, but we must investigate and not conclude beforehand that this new technology cannot have a detrimental effect on people’s health.
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