After almost two years of the pandemic, there are scientific voices that continue to be as essential as the first day. One of them is that of Adolfo Garcia-Sastre. This professor of Medicine and Microbiology, director of the Institute for Global Health and Emerging Pathogens at Mount Sinai Hospital in New York, has been studying the flu virus for more than a quarter of a century, although others like this SARS- CoV-2 that has led the world to face the greatest health crisis in decades. In an interview granted to RTVE.es, the renowned virologist analyzes the evolution of the disease and the appearance of new variants. García-Sastre is convinced that the omicron tsunami represents the true turning point of the pandemic, since he believes that it will be the last wave of great magnitude.
QUESTION: Is Ómicron here to stay?
ANSWER: Other variants will come, but what is not clear is whether they will be as different from the previous ones as ómicron has been. It is much easier for future variants to be based to some extent on omicron, such as BA.2, which is currently co-circulating with it. That is what we would normally expect. It is possible that there could be another variant that changes a lot, but it is more unlikely.
Q: Can any of these omicron sub-variants give us any serious scares?
A: How much disease remains after omicron passes and new waves come, especially next winter, remains to be seen. Talking about flu is right now a word that has a meaning that can be misunderstood, because the fact that SARS-CoV-2 becomes a virus very similar to the flu seems to mean that it is not dangerous , when the flu virus is dangerous, and also causes quite a lot of illness. The only thing is that every year there is not a flu pandemic, but there are flu epidemics and there are years that are hard.
“SARS-CoV-2 will remain as the flu virus. There will be years in which it will give more problems, and there will be others in which less.“
I think this is how this virus will stay. There will be years in which it will give more problems, and there will be others in which it will give rise to fewer problems, depending on factors such as how much it changes in all those years, how the immunity is also in people, or how much vaccines are being used or not… In short, much more similar to what happens with the flu virus, but without causing as many problems as it is causing now.
Q: So, are we going to have some peace of mind, at least until the fall-winter?
A: It is difficult to return to previous situations, taking into account the number of people who are being vaccinated and the number of people who are becoming infected with omicron even if they are vaccinated, which gives rise to booster immunity. I think it will be difficult for there to be waves of the magnitude of the omicron, but that does not mean that there will not be more, but rather that they will be smaller. Although we can’t completely rule out the possibility of another variant coming that has a lot more changes from omicron, but it’s more unlikely.
“The most normal thing is that after this wave we have already passed the waves of great magnitude.“
The most normal thing is that there are still waves, but that they are not as big as this one, and that after this wave we have already passed the waves of great magnitude. This does not mean that you have to stop getting vaccinated. We will see if a specific vaccination for omicron is developed, which is now being tested in clinical trials… I imagine that there will continue to be vaccination, but possibly restricted to risk groups, or to people who are not yet vaccinated.
Q: Would a wave like the one in ómicron without vaccines have been a massacre?
A: It would have been quite difficult. Possibly, in order to stop it, we would have needed a confinement just like it was done at the beginning of the pandemic. And then, the confinement would not have stopped it completely, the only thing it would have done is delay it or make the cases go more slowly.
Q: And yet, there are still millions of people around the world who are wary of these vaccines. One of his most repeated arguments is the side effects, both immediate and long term. What could you tell them in this regard?
A: What is clear that it has side effects, because enough has already been seen, is infection by the virus, which in many cases leads to sequelae. In other words, the infection not only gives rise to a disease that can be severe, but also to sequelae. However, the data on the problems caused by vaccines in the same time interval is practically nil. There have been very few vaccine-related adverse events, and there are no vaccine-related sequelae, even though all that time has passed.
So the only way a person can think that vaccinations are worse than getting sick is if they don’t trust the data, and if they don’t, it’s because they think it’s false. It is very difficult to convince a person who thinks the data is false due to various conspiracies. Unfortunately, these people exist. But of course, how are you going to convince someone who thinks they are being cheated on?
Q: What about longer-term side effects?
A: Although the technology for these vaccines is new, it is based on existing biological molecules. It is not that they have an indefinite composition, and that they are foreign molecules for the human body. These are biological molecules that are among those to which we are exposed, and therefore there is no reason to think that they can cause sequelae. It is very difficult. There is no biology for us to think that these vaccines can lead to long-term side effects.
“There is no biology for us to think that COVID vaccines can lead to long-term side effects.“
However, the disease does cause sequelae in a fairly high proportion of people who suffer from it. So, you have two options: either you get vaccinated to have fewer effects due to the infection, or you get infected, because you’re going to get vaccinated or don’t get vaccinated, and what is clear is that if you get infected you risk having a disease and more severe sequelae.
Q: Apart from its explosive contagiousness, ómicron has left behind the general idea that it is a very mild variant that there are even those who see it from a positive perspective… Is it really that mild?
A: What we know from animal models is that it’s milder, but animal models can never be sure whether or not they actually reflect what happens in humans. They have that limitation. In humans, the problem is that it is very difficult to compare the severe cases that exist now with those that existed before, and the main reason is that there are many people vaccinated, especially in risk groups, because the vaccine protects against severe disease with omicron, and also omicron highly infects the vaccinated.
The way to know if it causes more severe disease or not is in similar groups without vaccination; of those that were at the beginning and those that are now, what amount of disease does it induce in those groups. We will know a little more when we see the cases in children, because many of them are not vaccinated, especially those under five years of age; and we can compare the cases of severe disease in them, which are very few but do occur, with those that existed before. That will give us a little more idea of how severe omicron is.
Q: What scenario do you think we would be in now if this variant had not appeared?
A: We would be better. There would still be infections, but there wouldn’t be many, and furthermore, infections little by little help to strengthen the existing immunity, and also to immunize those who are not vaccinated. The only thing is that it would have taken longer to acquire the immunity that is obtained by omicron. Omicron is a very high peak that is going down right now, and if this variant had not arisen, instead of a peak there would have been a plateau and in the end there would have been the same number of infections, but perhaps the plateau would have lasted a year .
Q: Since the vaccination campaigns began around the world, the danger of low vaccination coverage in countries with fewer resources has been warned. To what extent does this fact represent a danger to the relative stability that can be achieved when the waves of omicron end in highly vaccinated regions, such as Europe?
A: I believe that we are already arriving too late, and time is running out. It is very likely that the number of infections in places where there is no vaccine is skyrocketing even more than it is in places where there is a vaccine, and therefore immunity is reached there through natural infection, not through vaccination. So, it is a problem that still exists, but unfortunately it will eventually disappear because people acquire immunity not due to vaccination, but due to exposure to the virus.
“I believe that we are already arriving too late in vaccinating countries with fewer resources.“
I believe that the number of infections that are taking place throughout the world must be similar in Africa, even more so, and therefore people are going to become immunized with exposure to the virus. Yes, it is true that these are populations in which, in general, there are not so many older people, because there is a high mortality from other causes. By the time a vaccine becomes available to them, it may already be too late for it to have an impact on the pandemic. So, immunity will be achieved in those sites by infection, and that will also reduce the number of cases that exist, which will slow down the appearance of new variants.
Q: What seems increasingly clear is that we will have to get used to living with the SARS-CoV-2 virus…
A: Yes, but that’s not so much of a problem. It will coexist with us, although it will be a very different situation from now. For example, when the 2009 flu pandemic occurred, it could have been the same or worse than SARS-CoV-2, and now we are living with the 2009 pandemic virus. If that virus, what is known in Spain as Influenza A, would have caused as much disease as the one caused by SARS-CoV-2, we would also have been in the same situation for two or three years as we have now. However, we are living with it, and we don’t even consider it.
Q: And why didn’t it cause so much disease?
A: Part of the explanation is that there was some pre-existing immunity, especially in the highest risk groups, who had antibodies similar to that of the virus, because it was antigenically similar to the viruses that circulated in the 1940s and 1950s, so that the risk groups had some protection, and it mainly affected groups that were not at risk.
Q: After two years studying it, what has surprised you the most about SARS-CoV-2?
A: Ómicron has surprised me a lot, of course, because I did not expect such a different variant. And the host range of this virus is also very amazing, which is much greater than expected, since in addition to humans it is capable of infecting other animal species such as rodents or white-tailed deer, and that gives rise to certain fears, because if the virus stays not only among us, but also in some other animal, both domestic and wild, and it also remains endemic there, well, that gives the long-term possibility that it can jump out of the animal reservoir to humans again, and the evolution of the virus in animal reservoirs is different from the evolution in humans. This is what happened, for example, with influenza A of 2009, which was a swine virus descended from that of 1918.
George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.