Prof. Marion Koopmans: ‘We will see more of this if we topple natural balances’

Interview on the COVID-19 pandemic with WHO expert Prof. Marion Koopmans, Virologist and Veterinary, Director of Virosciences, Erasmus MC, Rotterdam. She was appointed, together with six other leading European experts, as a member of the advisory panel on COVID-19 of the European Commission.

How is your assessment: did this virus come as a surprise?

ESMH Scientist Prof. Marion KoopmansThis specific SARS-CoV-2- virus, yes, it came as a surprise. But dangerous viruses from animals, no. Myself and other researchers in my field said this for quite a while. There is a WHO-list of 10 high-priority viruses for which preparedness research is considered crucial, and two of the viruses on this list are Corona viruses – these are the viruses SARS and MERS, both referring to serious threats for the respiratory systems. So, we knew that something will come up again.

Will we see more of this?

It is about the changes in the world. The more changes we will have, the more chances of a repetition we will see. Why? Look at the origin of the virus. It stems from the wild reservoir animal population. The space for wild animals is decreasing with ever more people punching in, expanding land use for farming, and biodiversity loss. As a consequence of these human expansions, we think that the contacts and the risk of so-called spill-over events will increase. And with the development of high-density urban regions (where viruses can spread very fast) and global connections through human travel and trade, the global spread of viruses will increase.

What has changed in terms of global relations since the SARS-outbreak in 2002?

We see quite a range of improvements, in terms of rapid action and exchange of information. China has acted professionally in characterizing the cause of the initial outbreak, and sharing information of the viral agent and its genetic sequence extremely fast. Through this, in Europe we could develop the first test already in the following week which then could be used worldwide to prepare for the testing of travelers. There are new coordination mechanisms doing their job. Finally, we see a good coordination by the WHO on what is the crucial research agenda.

And what does not work so well

The markets are shutting down; they are not keeping pace. This has knock-down effects: there is a shortened ability to test, there are shortages in masks and devices. And we also see considerable fragmentation in the coordination of critical studies. It’s so sad: China has managed to do a lot of clinical trials, but because there were too many, the initial studies may not be conclusive. We should learn from that and make sure we get answers to essential questions in collaboration.

Why are these conclusions so important?

It could be very helpful for the EU to predict the impact of different measures. At some point, the EU countries will have to loosen their current measures. Who then could tell us, when and how we will see another peak? We need to learn from the observations of colleagues in different regions of Europe, to get evidence for these next steps. I think there is also a need for a stronger collaboration in drug discovery and conducting trials. We have seen initiatives preparing for coordinated trials, but now that the pandemic hits, we see a lot of institutes that were not aware of this groundwork and that run the risk of re-inventing the wheel. We really would be able to move faster when working together.

You are part of the WHO pandemic expert panel, but also of the new EU scientific advisory group on pandemics. What is the most urgent measure that you recommend to the EU?

More coordination of the critical studies is a must. The EU mechanisms which are in place are okay for research. But it is not the case on the political level. There should be more political engagement and more buy-in to come to concerted actions.

What are the lessons we can learn from Italy?

I am not sure. They had in part really bad luck. In a critical phase they may have had many travelers from China, so the transmissions did not stop, but instead added up. And maybe there were some other unlucky events, like probably a super-spreading event, as we saw with the religious group in Korea or the cruise ship in Japan.

Most countries have had a lockdown strategy for a couple of weeks now. Could we wake up in a worst-case scenario with ruined economies and, at the same time, a virus that we can’t get rid of?

That is a question of extremes: you would need to compare the societal impact of a rampant, uncontrolled pandemic with this virus with the economic impact of what we do now. That is not a question for me as a health scientist. But it’s not likely that this virus will stop quickly and therefore will probably evolve to a regular winter virus in some years’ time. We will have to work hard to protect our populations until we have reached that stage.

Do you see the (in)famous ‘herd immunity’ as a manageable strategy then?

A group immunity going along with mass infections requires a vaccine when you opt for such as strategy. In addition, we should have treatments for the people with most serious disease. The fastest developments will come from the re-purposing drug trials, which means already tested drugs that can be used for other diseases than the original purpose. For instance, there are trials in clinics with drugs that have been used to treat HIV and malaria. These trial cohorts require the international collaboration that I mentioned above. The same applies for other types of treatment trials, like what are the best ways to provide ventilation support or immune modulating drugs for different patient groups.

How long will this pandemic endure?

Assuming the virus will not be stopped entirely, we will need to prepare for continued efforts in reducing the impact over the course of at least the coming year. Let’s be optimistic to find efficient and safe drugs in the near future. That’s an on-off scenario we have to prepare for. And it should go hand in hand with a vaccination.

About the future risks: Do you think we will see more outbreaks with climate change?

Indeed, we will. While sharing environments with a lot of creatures, we also share viruses and other microorganisms. As long as the environments are balanced, this will be fine. But when we change factors influencing the eco-systems, we may unknowingly topple the balances, increasing the risk for new outbreaks. The preventive core in such a situation will be that we now need a start of the One-Health-Concept.

Could you please explain to us what the One-Health-Concept means?

The concept is to regard human, animal, and eco-system health as one unity with critical interdependencies, and therefore working from the assertion that the health of humans, animals and ecosystems need to be studied jointly. Another important ongoing driver for disease emergence is climate change. Many still believe that this is not something for Europe. They think that mosquito borne infections are tropical diseases. But we see outbreaks of mosquito borne disease in birds in our backyard, which should be a warning sign. The One-Health approach also means that more disciplines need to work together in every part of the preparedness cascade.

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