“Another two months of sacrifices, without reopening and changing colors” – Corriere.it

If we keep the virus at bay for the next two or three months, we may be out of reach of its threat. Respiratory infections peak in winter and subside in spring-summer. We must, trust! Boost vaccines and give up for a few more weeks to tone down the colors and temptations to reopen. The teacher is optimistic and prudent Giorgio Pal, virologist, president of the Italian pharmaceutical agency Aifa.

And the dreaded third wave?
It can be avoided. We are in a downward phase of the epidemic curve, albeit a slow one. This is not the time for distractions. As long as the drop in RT is not significant, we are all called to respect individual protection measures and avoid meetings.

Variations worry you?
The three variants that circulate around the world, English, South African and Brazilian, make Sars-CoV-2 more contagious and therefore increase the risk of hospitalization and death. The concern cannot be denied. We repeat, to keep the variants under control, starting with the English one, which is more widespread in Italy, the same precautions and measures used for the original stock in Wuhan, the Chinese city where the pandemic originated, are needed.

opposed to reopening?
S. Sorry to say, even ski resorts could pose a risk.

And the schools?
We know from 4-5 studies that the infection, regardless of mutations, has a certain prevalence between 12-19 years and then between 19 and 50 years. So I would be cautious when resuming high schools and colleges. It would be ideal to be able to advance the school calendar when the image is better.

There is a lot of fear of variations.
As a virologist, I would like to reassure you. The virus has every interest in doing us less and less harm. Its purpose is to become endemic, to remain with man forever, since the human species has become its natural reservoir. We are your favorite guests. It is a parasite of our cells, it does not have an autonomous life, it does not want to eliminate us because in this way it would become extinct. It will be important to study all of its genes to understand how well it will adapt and how long it will take to stop scaring us.

The English variant in Italy could become predominant in 6 weeks. Are we sure it is susceptible to vaccines?
The English variant, discovered in September 2020 in Kent, has a series of mutations in the Spike protein, which the virus uses to attack cells. It is 20-40% more contagious than the Chinese strain, but not more lethal. The vaccines target Spike, but all immunized people in Britain have not been reinfected, so the answer is yes, they work. As for those of Pfizer and Moderna, their effectiveness against the English variant has been proven by studies already known to the scientific community.

What about the South African and Brazilian strains?
They are very similar, they have other mutations in the Spike protein. Against them, vaccines lose some effectiveness, especially AstraZeneca. In addition, the preparation of the Anglo-Swedish company protects against the most serious forms of the disease and fatal events. So much so that the South African government, which had blocked the prophylaxis campaign with this vaccine, is backtracking.

So is vaccination still the priority?
The loss of efficacy of vaccines does not generate distrust also because they always maintain the ability to block infection by producing neutralizing antibodies directed against the entire Spike protein.

In Italy, Aifa suggested immunizing people under 55 and in good health with AstraZeneca, while Germany and France expanded to under 65. A mistake?
In fact, the vaccine is indicated for all ages, but perhaps, given the lack of doses, it would not be wrong to suggest its use until 65 years of age. All the more so as the studies that follow those collected in the trial show that after the first dose the efficacy of AstraZeneca increases from 60 to 80% at week 12.

Monoclonal antibodies, newly introduced in Italy, whose function blocks the Spike protein, works against variants?
Yes, they work, although with little activity against variants. The activity depends on the mutations present in protein S and the possibility of using suitable combinations based on virological indications. Remember that monoclonal therapy works if it is given within 72 hours of the onset of symptoms.