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Interview
8 May 2022 2.00 h

Magda Campins

Expert in infectious diseases.

“With Covid, better prudence than haste”

Dr Magda Campins chairs the Covid-19 Scientific Advisory Committee, which the Catalan government has commissioned with defining a plan for the new normal. Far from euphoria, Campins shows cautious optimism

What the vaccines do above all is reduce severe forms of the disease ANY FUTURE MEASURES WILL DEPEND ON THE VARIANT OF THE VIRUS AND ITS EFFECTS
At the moment we can only consider removing all health restrictions in schools WITH MOST OF THE POPULATION PROTECTED BY VACCINES, WE NEED TO LIVE WITH THE VIRUS THINGS ARE GETTING BETTER BUT WE NEED TO BE CLEAR THAT THE PANDEMIC IS NOT YET OVER IN THE HEALTH SYSTEM THERE SHOULD BE A PUBLIC HEALTH AGENCY WITH POWERFUL TOOLS
The coro­n­avirus health re­stric­tions are now grad­u­ally being re­laxed. What is the likely sce­nario for the com­ing months?
There’s still a high in­ci­dence of in­fec­tions and so we still can’t think about nor­mal­is­ing every­thing. How­ever, it is true that we’ve seen a few weeks of ac­cu­mu­lated de­cline in the epi­demic curve. This pro­vides a rel­a­tively good out­look for the next few months, un­less there is a scare with the ap­pear­ance of some new vari­ant or with the Omi­cron sub­vari­ant (BA.2) that is cir­cu­lat­ing mostly in Den­mark. But if the in­di­ca­tors con­tinue to im­prove, we can begin to relax the re­stric­tions.
When will that time come?
When the rate of in­ci­dence comes down to the level of 50 cases per 100,000 in­hab­i­tants, which is our point of ref­er­ence for low virus cir­cu­la­tion. This would be the mo­ment to re­turn to nor­mal life, al­beit with epi­demi­o­log­i­cal sur­veil­lance in place in order to allow us to pre­dict ahead of time the threat of any new wave. The fore­cast is that if the same vari­ant or sim­i­lar less se­vere vari­ants con­tinue to cir­cu­late, we could be talk­ing about an en­demic sit­u­a­tion de­vel­op­ing: i.e. the virus is there but it cir­cu­lates in a con­trolled way and Covid-19 cases can be treated with­out af­fect­ing the treat­ment of other patholo­gies.
You talk about the thresh­old of 50 cases per 100,000. Right now the rate is still much higher than that, so we’re still some way off.
That’s why I don’t favour re­mov­ing all the health re­stric­tions. When we reach the thresh­old of 50 cases per 100,000 is when we can con­sider stop­ping di­ag­nos­tic tests on every­one who has symp­toms, as well as stop mon­i­tor­ing close con­tacts, and we can elim­i­nate all quar­an­tines. At the mo­ment we can only con­sider re­mov­ing all re­stric­tions in schools, be­cause we know that chil­dren are the peo­ple who are least vul­ner­a­ble to the dis­ease; it af­fects them very slightly and there are al­most no hos­pi­tal­i­sa­tions among chil­dren due to com­pli­ca­tions with Covid, and so se­ri­ous cases among chil­dren are very ex­cep­tional.
Could you see a sce­nario like in the UK, where the of­fi­cial ap­proach has been to ac­cept that we have to live with Covid just like any other virus?
We still have to wait. I don’t rule out that pos­si­bil­ity com­ing up in a few weeks, as long as all the in­di­ca­tors con­tinue to fall at the cur­rent rate.
You chair the sci­en­tific ad­vi­sory com­mit­tee. What has the Cata­lan gov­ern­ment asked of you?
The gov­ern­ment asked us a few weeks ago to pre­sent a paper on this tran­si­tion phase, on how we can live with the virus when the in­di­ca­tors im­prove and im­mu­nity is high enough – we are now above 80% among the gen­eral pop­u­la­tion. We are work­ing on a plan and will pre­sent it soon.
You pre­fer to be cau­tious?
We think that by far the best idea is to be pru­dent, to begin to make the mea­sures more flex­i­ble in schools, under close su­per­vi­sion, and if all goes well, to then apply it to the gen­eral pop­u­la­tion.
The mes­sage used to be that we had to stop trans­mis­sion of the virus at all costs in order to pre­vent the emer­gence of new vari­ants. Now this doesn’t seem so im­por­tant and we’ve seen record num­bers of in­fec­tions with Omi­cron. It’s hard to un­der­stand.
The change of mes­sage is due to the fact that until re­cently vac­cine cov­er­age was not high enough and we had very lit­tle in­for­ma­tion about the virus. Each new wave led to a very high num­ber of hos­pi­tal­i­sa­tions and deaths, so re­stric­tive mea­sures had to be taken to pre­vent the virus from cir­cu­lat­ing eas­ily and to pro­tect the pop­u­la­tion with non-phar­ma­co­log­i­cal mea­sures, be­cause at first we had no vac­cines or an­tivi­ral med­i­cines. Now there are more tools to deal with the virus and it means that after two years of pan­demic we do not have to main­tain the same level of re­stric­tions, which come with a cost that is not only eco­nomic. Every time there’s a new wave, we have to halt trans­plants, heart surg­eries, the care of many other dis­eases and the early di­ag­no­sis of can­cer, and we will surely pay a price for this in the com­ing years. Now, with a large part of our pop­u­la­tion pro­tected by vac­cines and new an­tivi­ral treat­ments ar­riv­ing, we need to try to live with the virus with­out ap­ply­ing such re­stric­tive mea­sures. Of course, while also avoid­ing deaths and fo­cus­ing ef­forts on vul­ner­a­ble peo­ple.
The Omi­cron vari­ant has by­passed im­mu­nity and peo­ple who were vac­ci­nated or who have had Covid have got the dis­ease again. Some peo­ple won­der why they should be vac­ci­nated.
We knew from the start that the Covid vac­cines would re­duce the chance of in­fec­tion but not pre­vent it com­pletely. What they do above all is re­duce se­vere forms of the dis­ease. Omi­cron has changed every­thing, and the ef­fec­tive­ness of the vac­cines against in­fec­tion has been low. In ad­di­tion, it has been found that more than six months after the sec­ond dose, the pro­tec­tion de­creases to around 70% com­pared with the ini­tial 90%. That’s why we have in­sisted on the need to ad­min­is­ter the third booster shot. Vac­cines won’t pre­vent us from be­com­ing in­fected but they can help us avoid se­ri­ous com­pli­ca­tions, which is where their im­por­tance lies. It’s im­por­tant for peo­ple to get a third dose, and that those who are im­muno­com­pro­mised should be given a fourth dose about five months after the third.
Is Omi­cron less se­vere due to the vari­ant it­self or the ef­fect of the vac­cines?
We now have a lot of in­for­ma­tion, es­pe­cially from the UK’s health de­part­ment, which has analysed the data based on the level of vac­ci­na­tion and con­cluded that it is due to both fac­tors to­gether.
The death toll is pro­por­tional to the num­ber of in­fec­tions. Shouldn’t we de­bate what thresh­old of in­fec­tions we are will­ing to ac­cept?
It’s a de­bate we need to have. In the case of in­fluenza, for ex­am­ple, the thresh­old we con­sider to be an epi­demic is 90-100 cases per 100,000 in­hab­i­tants. Some­thing sim­i­lar will have to be done in the case of Covid-19, set­ting thresh­olds that will sound the alarm and trig­ger health mea­sures. And the mea­sures will de­pend on the vari­ant of the virus and its ef­fects; if there’s no sig­nif­i­cant in­crease in hos­pi­tal­i­sa­tions, less re­stric­tive mea­sures will suf­fice. How­ever, if a vari­ant causes more se­ri­ous ill­ness and more hos­pi­tal­i­sa­tions, the mea­sures will have to be more dras­tic. We may have to re­turn to lim­it­ing the ca­pac­ity of cer­tain places or shut­ting down some ser­vices if the health­care sys­tem be­gins to suf­fer and the death toll goes up. At the mo­ment, how­ever, this sce­nario is not ex­pected with Omi­cron.
It sounds like an un­cer­tain sce­nario: what may serve us today may not serve us to­mor­row.
We need to be clear that the pan­demic is not over. Things are get­ting bet­ter and the fore­casts sug­gest that they will con­tinue to get bet­ter in the com­ing months. But every­thing can change at any time. This virus has al­ready brought sur­prises with it, and there could be more.
We’ve al­ready heard that the pan­demic is on the point of end­ing sev­eral times now.
Com­mu­ni­ca­tion has not been the best. Pan­demic fa­tigue and the need to hear good news has prob­a­bly led us to jump the gun at times. When the vac­cines first ar­rived, it seemed that we were al­ready near­ing the end. We must be care­ful not to cre­ate false ex­pec­ta­tions, but it’s clear that the cur­rent sit­u­a­tion is noth­ing like what it was a year ago.
Peo­ple are still dying de­spite all the in­di­ca­tors im­prov­ing.
Things are bet­ter, but the high num­ber of in­fec­tions in the lat­est wave means there have also been more deaths. There’s been a lot of talk lately about Covid be­com­ing like the flu, a com­par­i­son I don’t like, and one we heard at the start of the pan­demic when it was often said that we were deal­ing with a kind of flu. But no, Covid is not like the flu; it is a more se­ri­ous dis­ease. There are be­tween 500 and 1,000 deaths every flu sea­son in Cat­alo­nia; in the most re­cent sixth wave of Covid, we reached 500 deaths in just the first two weeks.
You’ve worked on dif­fer­ent pro­grammes aimed at pre­vent­ing and con­trol­ling emerg­ing viruses. From your ex­pe­ri­ence work­ing on the likes of Zika and Ebola, how do you think the pan­demic will evolve?
There are three dif­fer­ent sce­nar­ios. The most im­me­di­ate, pre­dicts that in the next few months pos­si­bly very trans­mis­si­ble but much milder vari­ants of the virus will con­tinue to cir­cu­late, caus­ing small waves of in­fec­tions but with­out it be­com­ing a sea­sonal virus, al­though that could eas­ily change. This is the sce­nario that the World Health Or­gan­i­sa­tion sees as most likely. Sec­ondly, there is the worst case sce­nario: that a new vari­ant ap­pears that can by­pass the pro­tec­tion of the vac­cines in a more dras­tic way than Omi­cron has. This could send us back to the be­gin­ning. It’s a sce­nario that is con­sid­ered un­likely, but we can­not rule it out. And the third sce­nario – the most op­ti­mistic of all – is that with so much of the pop­u­la­tion vac­ci­nated, the virus dis­ap­pears, as hap­pened with SARS-CoV- 1 or MERS. How­ever, after two years of pan­demic this seems to me highly un­likely. The far more likely sce­nario is that over the next few years we will see the virus con­tin­u­ing to cir­cu­late – prob­a­bly in a sea­sonal man­ner – and it will con­tinue to cause reg­u­lar epi­demic out­breaks and waves of in­fec­tions that we will have to counter with vac­cines and an­tivi­ral treat­ments. The most vul­ner­a­ble peo­ple will need the most pro­tec­tion and will have to be re­vac­ci­nated. Spe­cial at­ten­tion should be given to these peo­ple; they should be di­ag­nosed quickly through PCR test­ing and then they should be treated early with an­tivi­ral med­i­cines to avoid com­pli­ca­tions.
Will a fourth booster be needed for the gen­eral pop­u­la­tion?
It’s only been a short time since we ad­min­is­tered the third booster shot and so we need to see how the im­mu­nity evolves. Yet if we con­tinue to deal with the Omi­cron vari­ant or sim­i­lar, non-vul­ner­a­ble peo­ple should not be given a fourth dose. In the case of the vul­ner­a­ble, yes, and in fact that is al­ready being rec­om­mended.
Apart from the im­muno­com­pro­mised, who else should be con­sid­ered as vul­ner­a­ble?
The list needs to be fi­nalised, but in gen­eral we’re talk­ing about im­muno­com­pro­mised pa­tients, peo­ple with Down syn­drome, el­derly peo­ple in nurs­ing homes, and he­modial­y­sis pa­tients. An­other group that might be in­cluded are mor­bidly obese peo­ple, be­cause many Covid pa­tients who ended up in the ICU who had no pathol­ogy other than obe­sity. And we will prob­a­bly have to es­tab­lish an age cri­te­rion – from 60 or 65 years old – as we do with the flu. With Covid we know that age is a risk fac­tor in it­self.
To mon­i­tor the virus, epi­demi­o­log­i­cal and ge­nomic sur­veil­lance will be im­por­tant. Will new health­care struc­tures also have to be es­tab­lished?
The pub­lic health sys­tem needs strength­en­ing and within the sys­tem there should be a pub­lic health agency with pow­er­ful tools, not just epi­demi­o­log­i­cal sur­veil­lance, but in­te­grated sys­tems of case mon­i­tor­ing, such as mi­cro­bi­o­log­i­cal sur­veil­lance, an­i­mal sur­veil­lance or waste­water mon­i­tor­ing, as they an­tic­i­pate the cir­cu­la­tion of viruses very well. Ge­nomic se­quenc­ing should also be in­creased, as that way new vari­ants can be de­tected ear­lier. And there’s still the whole issue of digi­tis­ing the case log to give us a real-time pic­ture of what the sit­u­a­tion is at any mo­ment so that we can move for­ward and tackle the prob­lems. All these ser­vices need to be re­struc­tured, and that’s what we’re work­ing on.
Look­ing back over the past two years of pan­demic, what mis­takes need to be cor­rected?
Tak­ing ac­tion late. At times we’ve seen what’s hap­pen­ing in other coun­tries and yet we’ve been very slow to put mea­sures in place. I’m think­ing, for ex­am­ple, of when the Delta vari­ant en­tered the UK and the sit­u­a­tion started to get com­pli­cated, or when Omi­cron ap­peared in , in both cases it took us far too long to im­ple­ment health mea­sures. Mea­sures need to be taken ear­lier.

in­ter­view HEALTH

in­ter­view HEALTH

Two long years under the virus Schools to be the testing ground

Since the beginning of the pandemic, Magda Campins (Barcelona, 1956), head of the Preventive Medicine and Epidemiology Service at Vall d’Hebron University Hospital, has been a key voice in helping us to better understand the virus that brought the world to a stop two years ago. An expert on infectious diseases, Campins chairs the scientific committee that advises the government on handling the pandemic. She never tires of repeating that right now vaccines are the best tool we have to deal with Covid. In a recent article in El País newspaper, she gave two figures to explain the evolution of the pandemic: in 2020 there were around 20,000 deaths from Covid-19 recorded in Catalonia; after vaccination in 2021, there were 5,000. “The data is clear,” says Campins, “It should not only convince people who are against the vaccines, but also those people who, especially during this sixth wave, lost confidence in the vaccines.”

The government plans to start the process of adapting to life with Covid by using schools as a testing ground. Depending on what happens in classrooms, the plan could be extended to the rest of society. Using schools in a trial, says Dr Campins, is backed by a recent study that found that the rate of cases correlated with age rather than mask use. “The study, which was carried out in Catalan schools, concluded that there are fewer cases among the smallest children – who no longer wear masks – than among children from 6 to 7, who still wear them in class. The rate increases as the children get older. “This suggests that the use of masks could be made more flexible according to age groups,” argues Campins. The idea is to start with children aged 6 and 7, to let a couple of weeks pass, note the rate of infection, and if no increase is detected, to move onto another age group. “Once we see what happens in schools, for the summer we can consider making the use of masks indoors among adults more flexible.”

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