Very Close to the End of the Tunnel

Every Sunday, Metropole brings you a COVID-19 update from Prof. Dr. Florian Krammer, an Austrian virologist who works and teaches at the Icahn School of Medicine at Mount Sinai, New York City.

Since the beginning of the pandemic, Prof. Dr. Florian Krammer has been writing weekly updates in German for family and friends. Metropole was kindly granted the permission to translate and publish these updates.

January 17, 2020

Here is again my weekly update. Worldwide we have had 95 million officially infected cases so far and now already over 2 million dead. There was one day this week with 16,500 deaths, which is unfortunately a new record. But the infection numbers per day seem to have reached a plateau. About 40 million people have been vaccinated worldwide so far, most of them with RNA vaccines.

Mixed Situation in Europe, Hope in Austria

In Europe, the situation remains mixed. Cases in some countries are going up sharply (Spain, Portugal, etc.), others are just coming down from the third peak (Great Britain, the Netherlands, the Czech Republic, etc.), and still others remain constant, but unfortunately at a high level (France, Italy, Germany, Poland, Romania, Sweden, Switzerland, Hungary, Slovenia, etc.).

No on seems to have found yet a good recipe for how to get back to very low numbers which can be kept under control with contact tracing. But there are a few countries where numbers either never went up much in absolute numbers (Norway, Finland) or came down far enough to maybe control them with additional measures (Belgium, maybe Croatia, Denmark and yes, maybe Austria).

We will see how the additional measures may be. The FFP2 mask obligation (which is now also in force in Bavaria) and larger distance I find good, especially because that probably works better against the British variant. But you have to stick to the measures, and that is often the problem.

Keeping open the ski areas honestly annoy me, just as as much as Corona demonstrations where no one adheres to mask obligation and the mandated social distance. In my opinion, the situation can be controlled by contact tracing if the number of infected people allows efficient contact tracing. And I hope that the tightened measures will bring us there.

I also hope that the Austrian government will do everything possible to help people who are in financial difficulties. What makes sense from an epidemiological point of view can mean a personal disaster – and I think a rich state like Austria has to cushion that, especially when the matter has been dragging on for so long.

Precarious Situation in the US

The number of cases in the US is flattening out (which does not mean it is going down). Deaths are unfortunately still going up, this week we once had a day with almost 4,500 dead. Cases in New York City, by the way, have also gone up, but as mentioned many times, nowhere near as much as other parts of the country.

The number of cases looks as if it were the same as in the spring, but of course, in the spring we detected only a fraction, whereas now we probably find the bulk of them. Basically, there are two factors coming together that allow for better control: The seroprevalence (i.e., the proportion of the population that has antibodies/was already infected) was already above 20% after the spring wave, and if 20% of the population is protected, that has an impact on the incidence of infections. The more important point is that we actually have mandatory masks everywhere since March and that the rules were actually quite strict throughout and are also largely adhered to.

Difficult Times in Latin America, Hope from Israel

Canada also seems to be over the peak. In Latin America, unfortunately, the trend is showing upwards everywhere. In Asia, cases in Indonesia and Malaysia are going up quite a bit, unfortunately. South Korea has coped with its small wave, of course, and Japan also seems to be over the peak. In Thailand, there is an accumulation of cases at the moment, but due to the small absolute number, one cannot speak of a wave. In China, there are also cases time and again. China always reacts very energetically and immediately brings it under control. In Africa and the Middle East, the situation is quite constant, South Africa and Egypt have apparently reached the peak, Israel apparently also.

Israel, by the way, should now be kept a very close eye on. They now have a vaccination coverage rate of about 25%. They should soon have data on protection and perhaps – since the vaccination coverage in the high-risk group is much higher – also see a reduction in the case fatality rate (i.e. the ratio of deaths to infections should change for the better). The situation is similar in Denmark, where the focus is really on vaccinating the elderly and where all people in nursing homes are already vaccinated.

Mutations & Vaccine

So, a few more words about the variants and the vaccination.

The British variant, as has been mentioned many times, is probably somewhat more infectious (but does not cause more severe disease). While it spreads more easily, there is no need to panic. With appropriate measures, you can contain it just the same. Masks and distance help as against other variants. And, of course, you can see this in the UK, where cases are now going down due to tighter measures, despite the new variant. The same applies to South Africa. And as I’ve said many times before, there’s currently no reason to believe that the vaccination won’t work against these variants. Of course, we need more data, but we and many others are working on it.

I now get the question again and again whether one should be vaccinated if one has already had COVID-19. People who have already had COVID-19, there is good data on this, have a very low risk of getting sick again. But, after infection, we see relatively variable antibody titers. Some people make a lot of antibodies, some people make less. Vaccination leads to high and uniform antibody titers, about in the top third of what we see after infections.

So it makes sense to get vaccinated despite having been through an infection.

Maybe not first, because others need the protection more urgently, but still. It could also be that for people who have already had an infection, one vaccination (instead of two) is sufficient. There is not enough data yet, but my colleague Viviana Simon and I are working on it and looking at it.

In the end, something that is important to me.

I know it doesn’t look rosy at the moment, we’re all tired and annoyed, the lockdown is about to be tightened and extended, and vaccines are not yet widely available. This thing has been going on for almost a year now, and for some of us, a little over a year. We started looking at the virus quite intensively in the lab on January 10, 2020.

I have to admit, a year ago I was panicking, I thought it would not end well. I then wrote the first of these newsletters on January 25, 2020. But I must honestly say, despite the current situation, we are almost through. Maybe I’m wrong, but in my opinion we are very close to the end of the tunnel and the situation will normalize by late spring. Hang in there!

Stay healthy and get vaccinated if you have the chance!

Prof. Dr. Florian Krammer
Prof. Krammer is the Principal Investigator of the Sinai-Emory Multi-Institutional Collaborative Influenza Vaccine Innovation Center (SEM-CIVIC). Currently Prof. Krammer holds a position as a Professor of Vaccinology at the Department of Microbiology at the Icahn School of Medicine at Mount Sinai. He has published more than 100 papers, is member of the editorial boards of the Journal of Virology, Plos One and Heliyon and is a peer reviewer for more than 30 journals.

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Furthermore, the ministry will constantly update its German-language website with information on the number of people tested and cases of COVID-19 in Austria.

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