She was among the first scientists in Europe to peer closely Sars The 2 and among the first researchers in Italy to receive the vaccine last December. Maria Rosaria Capobianchi, professor of Molecular Biology at the helm of the Virology Laboratory of theSpallanzani Institute of Rome, one step away from retirement after being held back by the emergency to be dealt with, wants us to know that now, even with declining infections, the summer, we must not give up the measures we have learned and continue to “vaccinate, vaccinate, vaccinate“. Committed for months on the front line against the virus is not afraid of Delta variant (formerly Indian), which became predominant in UK, because with two doses “the vaccine works very well”. And then “I don’t think there will be a fourth wave, because I am optimistic and I see that things are going well compared to last year. Today we have vaccines and soon we will have most of the population vaccinated ”. For the scientist in the end “we will win”This battle which has cost almost 4 million deaths in the world and almost 130 thousand in Italy.
She has also seen the Delta variant up close
On 2 April it is reported for the first time in Italy. Since then there has been an increase which, however, I would say very limited compared to what occurred in England where there has been an exponential growth that has led the new variant to completely supplant the previous one, the English one we now call Alpha. In Italy we still have a strong predominance of Alpha which is quite stable around 80-85%. We have seen groups of delta positives among people arriving from India before flights were blocked, but these cases were almost all circumscribed and there was no massive spread among the population.
In Britain at one point they decided to extend the time of the second dose to cover more people, but studies now show that only the double dose protects.
Decisions that are the result of contingent situations that have had their own logic and justification cannot be criticized. Lessons learned are useful. There is evidence that changes with time, incidence and frequency. It also happened in Italy, but not because the opinion has changed but because the situation has changed. The indications are changed according to the situation, analyzing the data and making the necessary forecasts.
The Delta variant seems more aggressive, will it force us to change directions again?
I believe that we should not think in terms of variants, but think about fighting the virus and its circulation because the variants emerge as a normal consequence of the circulation of the virus. If they are endowed with sufficient diffusibility, the variants that emerge occupy all the available spaces left free by the previous variants, supplanting them. We must oppose the circulation of the virus in all its forms.
And to counteract circulation, we know what to do.
Vaccine, vaccine, vaccine and the measures we have learned again and again to maintain: masks, social distancing and hand hygiene. As far as possible, bearing in mind that various social, economic and psychological factors must be balanced.
For months we have been talking about the importance of sequencing. At what point is the Italian consortium announced?
Sequencing has no diagnostic importance at an individual level and by itself does not hinder the spread of variants; instead it is important to understand what is circulating and how the epidemic evolves, so as to prepare adequate counter measures. So it’s a premise, an element of knowledge that is part of the public health response. The national initiative has not yet been born, it is struggling to take off because there are so many interests and conflicts in the field. Each, each institution claims authorship and leadership. Alongside this, there is the most serious problem, namely the economic one, because sequencing has a cost, this is the crucial issue. What is currently being done is based on the initiative of the Regions, on goodwill and thanks to research institutes, otherwise there would be no resources to respond to the requests in terms of molecular surveillance of the Istituto Superiore di Sanità.
Could this slowdown not only be present damage but also future damage as scientists speculate other pandemics for the future?
Exact. This initiative is late and comes at a waning stage of the pandemic emergency. Sorry we couldn’t do it sooner. The initiatives must be carried out in view of a more global design that looks to the future, is part of the preparedness (preparation, ed). We have experienced first-hand in Italy and throughout the world that the level of preparation was not adequate; at every epidemic we say the same thing. We must invest in being ready, but it is difficult to make this principle accepted if it is not touched by hand and does not fall into a chasm like the one we have experienced in this period. It is necessary to invest to keep the structures prepared, like a spring that must be held tight so that it clicks at the right moment without warning; however, all the energy needed to stretch the spring requires a commitment of resources. Although it must be said that sequencing is important to recognize the variants and evaluate their diffusion, but it is not enough to avoid their spreading; then we need adequate counter measures. A country that has invested a lot like England, setting up a powerful sequencing network, has been fully invested by the variants, first the Alfa and now the Delta, despite having recognized the signs early.
And now the Delta variant is rampant in Britain and has imposed the postponement of the elimination of the latest restrictive measures
There has been a huge drop in circulation however. The overtaking of the variant occurred in the unvaccinated or single dose population.
So as recent studies say, the vaccine is not “punctured” by the Delta variant
This variant is more widespread, but the vaccine almost completely protects against severe forms and hospitalizations. The protection against mild and asymptomatic infections is a little less consistent. It is stopped less by a single dose.
Can we be a little more confident then?
Yes, I am, even by nature. The effort that has been made with the vaccination campaign has already borne important fruits. The more the coverage continues and expands, the more the circulation of the virus is hindered; but if the barrier is not strong enough, the variants with higher diffusivity will not be stopped. We expect this, the current vaccines have been designed against the original, unchanged virus. Therefore it is normal that where there is an intense and widespread coverage the circulation of the virus is stopped; if the coverage is not total, the less sensitive variants will continue to circulate and evolve, and will take over. This phenomenon should not surprise us, it is part of the virologist’s knowledge and experience. Where therapy is not blocking, the variants are affirmed and risk of selection, but if vaccination coverage is kept high and behavior-based measures are not violated, overall a large reduction in the circulation of the virus will be achieved, and in the end I think we will win it. We must not slow down, we must not be discouraged, we must not think that the vaccine is not needed because there are variants. Indeed the vaccine is needed more. The higher the wall the more difficult it becomesescape. In Israel they have published a beautiful work: the protection in vaccinated adults has also led to indirect protection in unvaccinated young people because if the circulation is reduced, the possibility of the virus to infect even those who are not protected is reduced.
So you don’t see a fourth wave in perspective?
I don’t think there will be a fourth wave, also because I am optimistic and I see that things are going well. Compared to last year, today we find ourselves with the vaccinated population. Last year we didn’t have this situation, after the summer the whole population was susceptible and it was easy for the virus to take over. Now in this reduction there is not only the vaccine, but also the summer, being more outdoors, the higher temperature and other factors as well. Last year we had an almost arrest of the epidemic which resumed because there was no protected population; now we are exceeding half of the protected adult population and therefore after the summer I do not think we will find ourselves facing a new rampant circulation with direct and indirect effect.
The antibodies will protect us
There is still no direct evidence that the level of antibodies is proportional to the level of effectiveness of the protection; for now it is a reasonable indirect parameter. The immunity of T cells (with the task of recognizing cells infected by the virus, ed) is not measured with conventional methods, so in fact it is an inaccessible parameter. It has been shown that even if the level of antibodies is lowered because there are no more plasma-producing plasma cells in circulation, memory cells remain in the marrow and these are able to function at the right time. So detecting circulating antibodies is a crude measure of what the level of protection can be.
It is an important mechanism
It is simplistic but it is reasonable, we have seen that the booster increases the level of antibodies therefore substantially also the level of the specific immune cells for the virus. So it is natural to think that the recall is necessary. I agree with those who believe that booster with different vaccines can even be an advantage because this exposes the immune system to a different challenge and trains it to a broader response spectrum: combined mechanisms mature, which with a single vaccine would have been more restricted. This is why we are starting to think that a third recall will be useful. Over time the level of antibodies decrease and this is evident, however it is not evident that over time the level of protection ends. We have memory cells, cells are educated to make antibodies. At some point they return to a state of quiescence otherwise they waste energy, regress and become memory cells. They remain dormant, because our immune memory is an archive. These cells restart when they encounter the virus, even years later. This is true for both B cells and T cells. Thus, although generally the encounter with the virus in a vaccinated person does not prevent it from entering the body and infecting the cells present at the site of entry, the prompt activation of the memory cells (B and T) prevents the engraftment and propagation of the infection, so not only does the subject not get sick, but he does not spread the infection to his contacts.