Interview on COVID-19 with Ilaria Capua, DVM, PhD, Director of the One Health Center of Excellence for Research and Training, University of Florida, USA.
There are tests for COVID-19 which detects the virus, other which detects antibodies. Could you briefly describe the differences of these two tests?
The rapid spread of the outbreak required rapid tests to diagnose the infection. At the beginning, only the viral-detection test – pharyngeal swab, with Real Time PCR technique – was available. Only at a later stage serological tests are being applied for the detection of antibodies directed against COVID-19. The virological test is used to diagnose the presence of the virus in the body and therefore an ongoing infection. This test answers the question: have you been infected over the last few days? If it is positive it means that, yes you have encountered the virus over the last week or so and that you are to be considered as infectious. Serological tests are used to understand if a subject has already come into contact with the virus over the last few months and up to approximately two weeks prior to testing. The serological test therefore tells us if that individual has been exposed to the virus in the recent past. It is important to underline that serological tests do not replace the virological test, they are complementary and they yield different information.
Is the body’s immune response to the virus really protective?
The virus was discovered 4 months ago and there are currently little data available on the development of immunity. At the moment it is not possible to know how long this protective immunity lasts and the degree of protection which it confers.
Can we get infected several times?
An infected subject is declared cured after 2 consecutive negative viral assays. There is some evidence that this may occur but it is to be confirmed and its significance understood. In addition, there is a variability among patients and the virus may be shed with different dynamics. A definitive answer to this question is hard to provide at this stage.
It seems that women are less infected, developing less severe clinical symptoms.
There is some evidence on gender susceptibility which is emerging from different countries. Unfortunately data are difficult to collate, compare and understand and at the time of writing we are unable to confirm any defined trend. Ideally – if there was a significantly lower risk for women of developing the severe form, it would make sense to repopulate the post-lockdown with a workforce that reflects this difference.
COVID-19 is a product of “natural evolution” and not a “laboratory construct”: many false conspiracy reports continue to infest the internet.
The evidence we have is that the virus is the result of a natural phenomenon that is well known to occur in nature. The truth is that this natural event has been facilitated and amplified by human behaviour. Invasion of naturally segregated areas results in dramatic unbalances in natural ecosystems and in some instances facilitates the jump of viruses from animal to human. If this occurs in small villages the virus probably self-extinguishes due to not finding any susceptible hosts. In contrast, if we allow the virus to reach large cities, where often widespread poverty and lack of health care are endemic, the consequences can be dramatic. In addition, the multiple mechanisms of globalization have favoured the spread through local, national and international movements of people and goods.
You work in the United States. What differences do you see between the American and the EU response to the epidemic?
The comparison is not easy for many factors. What I can say is that the first two states affected, Washington and California, have implemented physical distancing – I do not like the definition of social distancing at all – where there is a progressive reduction of infected people. In other contexts, I think of New York or New Orleans, where there is a more general operational management difficulty, the situation is more critical. This is also in relation to the fact that the American health system does not have a universalistic approach that Europe – despite significant differences between Member States – may offer.
What did Europe miss in the management of the epidemic? A weak centralized data system, a lack of logistics organisation (drugs, ventilators, etc.), the limited mandate of the ECDC (European Centre for Disease Control) …. What else?
The absence of a preparedness plan against an unknown virus. We were prepared – or at least we had a preparatory plan for pandemic influenza. Europe does not have a similar plan for a pandemic produced by new viruses. With great respect and gratitude as a scientist that has operated in the European research environment, I have to say that I am saddened by the lack of leadership in a tragic situation like the present one. In the future, a European pre-pandemic plan is absolutely essential. The different approach from country to country, and sometimes within each country even from region to region, is no longer sustainable.
We have to be aware that what is going in these months is going to be the “new normal” in the future. Faced with this “new normal” imposed by new viruses, we must have a “new normal” in the response to epidemics, acting immediately, having guidelines ready, having potential candidate vaccines to be developed, having adequate therapies to be used, and so on. We must build a European central hub for the exchange of data, equipment, for the activation of clinical trials, etc. Everything must be put into action from day 1 of the epidemic, not from day 30 or 40.
Research in Europe is not yet sufficiently valued. There are many bureaucratic difficulties to do anything, including animal testing.
A heavy bureaucracy in research is absolutely counter-productive, and European research must be able to improve on this. Animal research is still a necessary evil, a bitter obligatory passage. For example, in a context like the current COVID pandemic, animal experimentation – which must be well regulated – is an essential component of research. Nowadays however, with artificial intelligence and data driven science, parts of animal testing procedures can be replaced, offering at times more solid data.
STOA – the scientific panel of the European Parliament – works to facilitate the dialogue between science and policy. The dialogue between science and politics remains intricate…
As a former member of the Italian Parliament – where I acted as Vice president of the Cultural, Science & Education Commission – I ironically described myself as a PMO – a “politically modified organism.” As a scientist who has been enriched by exposure to the political arena, I have a broader grasp of the complexity of the science/policy interface. This pandemic shows us – once again – that one of the big fragilities we have is the communication of science to the general public but also to the decision makers. For example, the uncertainty with which scientists are often confronted with their work is a dimension that politicians struggle to understand. I believe the time has come for governments to equip themselves with chief-scientific officers and permanent scientific committees in straight contact with policy makers.
The wind of anti-science ideology is now strong on both sides of the Atlantic and Pacific Oceans. We are in an era in which competence and truth are devalued. What is your opinion?
Let me mention that I recently organized the #BeautifulScience initiative to champion the importance of scientific research and the role of scientists in determining the future of society. It is hard to be a scientist these days. As a scientific community we need to stand up for each other, we need to stand up for our scientific institutions, and we need to develop a better network, because fake news and manipulation of information is perhaps as dangerous as the coronavirus itself! I am concerned that this climate may weaken institutions and impair future battles that scientists are called to fight, such as antimicrobial resistance or developing novel vaccines.