“Long Covid keeps the elephant in the room”

“Long Covid keeps the elephant in the room”

Andreas Bergthaler, an immunologist at OeAW, explains the signs of an imminent end to the coronavirus pandemic and why high-risk patients still cannot breathe deeply.

The pandemic as we have known it for nearly three years could soon end. Andreas Bergthaler of the Medical University of Vienna and the CeMM – Research Center for Molecular Medicine of the Austrian Academy of Sciences (ÖAW) assumes this. However, the immunologist does not want to rule out the possibility of a new type of virus emerging.
In the interview, he explains how much the omicron variant has led to a paradigm shift, why Long Covid will keep us busy for so long and what we can learn from this pandemic for future pandemics.


Mr. Bergthaler, in an interview with the German weekly Die Zeit, Berlin virologist Christian Drosten said that the virus situation is precarious and that it is at an evolutionary dead end. do you agree?

Andreas Berthaler: The virus has surprised us more than once, so I’m wary of making predictions for the future. However, if we review the mutation process, the omicron variant, which spread from December 2021, brought about a paradigm shift: after new variants such as alpha, beta or delta, we are left with the omicron – with all its sub-variants.

The virus has surprised us more than once.

Did Omicron’s many fallout trip the virus?

BergthalerAll sub-variants had in common that they accumulated additional mutations, including in the spike protein receptor-binding site. When the same mutation occurs several times independently, it is called convergent evolution. This, in turn, is strong evidence that the virus is exposed to a relatively high immune pressure. The virus is now trying to escape this immune pressure by making mutations at the sites where antibodies stick.
We may continue to move in this universe of sub-omicron variants. Or a completely new variable will appear again, which I don’t want to rule out.

Omicron is not much lighter than Delta. But: About 97 percent of the population had an immune connection to the virus antigen.

Omicron is seen by the public as a more moderate alternative. right?

Bergthaler: Omicron is not inherently lighter. Data from England showed that Omicron is only slightly lighter than the Delta variant, resulting in significantly more intense cycles than the original Wuhan variant. But: According to calculations, 97 percent of the population now has an immune connection to antivirals, either because people have been vaccinated, infected, or both. This resulted in broad immunity through antibodies and T cells. Unfortunately, this immunity does not prevent us from getting infections, but it does contribute to the fact that severe cases rarely occur in otherwise healthy people.

High-risk vulnerable individuals

So the danger remains for the weak?

Bergthaler: It seems to me a central aspect that the epidemic is not over by itself, especially for vulnerable people. From an ethical point of view, we must pay attention to how to better support people at risk so that they can participate in society. This includes the availability of current vaccines and medicines, wearing masks in solidarity at indoor events or improving the indoor climate with cleaner air. In general, it is not at all easy to accurately define the category of vulnerable people.

We must pay attention to how we can better support people at risk.

Even with Long Covid, there is still a lot undefined.

Bergthaler: Yes, Long Covid remains the elephant in the room. The level of knowledge about this is still insufficient and it is difficult to determine the molecular causes and the extent of chronic consequences. Some accounts assume that up to ten percent of those infected have long-term symptoms and that those symptoms may get worse if they become infected again.

Seasonal effects, fewer tests

How do you assess the current epidemiological situation?

BergthalerSeasonal effects mean that the number of infections will increase again. In addition, we now have a less precise set of tools for collecting individual infection numbers — there are far fewer tests. Increasingly, attempts are being made to manage the viral load in wastewater. In general, I expect that sub-variants of new viruses will always escape our antibody response a little better and thus lead to new waves of infections.

Settlement does not automatically mean that all is well.

Are you still seeing the first signs of transition from pandemic to endemic?

Bergthaler: This is a question of definition. Pandemics are usually understood to mean supra-regional events involving infectious agents affecting all regions of the world. Settlement, on the other hand, means that only a particular area is affected. An example of this is malaria, an infectious disease that kills more than half a million people each year. So localization does not automatically mean that all is well.

Crucially, we are no longer systematically subject to short-term waves of critical proportions, as we have been in the past two and a half years. If this positive trend continues, I assume the pandemic as we have known it is over. Then it remains more formal when the World Health Organization downgrades an epidemic to a pandemic or pandemic.

No country has been so well prepared for a pandemic

What can we learn from this epidemic for future epidemics?

BergthalerAcross the world, we’ve seen that no country is really well prepared for this, even if pandemic plans are lying in drawers everywhere. What has worked very well internationally is the rapid development of vaccines. Vaccination built broad immunity in a community that had never before encountered this new pathogen, saving serious cases and countless lives.

What has worked very well internationally is the rapid development of vaccines.

And in Austria?

BergthalerUnfortunately, some things went wrong in the disagreements and polarizations that followed. If anything could be avoided in Austria, it would be the indescribable debate about compulsory vaccination. This was very politicized from start to finish and unfortunately smashed more dishes than I brought.

Retrospective critical analyzes will be necessary. This requires appropriate data, which is then combined and analyzed scientifically. There is still a lot of room for improvement, although some progress has been made in the past year. We hope to learn as many lessons as possible so that we are better prepared for future crises of similar magnitude.


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