Dr. Joan Soriano, epidemiologist: “Neither endemic nor end of covid until 2023”

Also a CIBERES researcher at the Carlos III Health Institute, Dr. Soriano highlights, without being alarmist, that “current vaccines are essential because they save lives, preventing the severity of coronavirus disease with fewer hospital admissions, especially in UCRI and ICU, but they do not nip the transmission of mutations in the bud, as has happened with omicron or its companion delta».

Associate Professor of Medicine at the Autonomous University (UAM), as well as associate editor of European Respiratory Journal and of The Lancet Respiratory Medicine and senior researcher at the Institute of Hospital de La Princesa (IISP), Dr. Soriano has led in 2021 the working group of international experts that has defined “persistent covid” for the WHO for the first time.

In an interview granted to EFEsalud online, Dr. Soriano not only analyzes the situation of the pandemic today worldwide, a crisis generated in China at the end of 2019, but also argues the epidemiological reasons that explain the unreason of the “flu” or the arrival of new waves, small or large, once the downward trajectory of sixth-wave infections in countries like Spain has flattened.

Gregorio del Rosario, journalist for Agencia EFE, interviews Dr. Joan B Soriano Ortiz, epidemiologist

Doctor Joan Soriano, what is the epidemiological situation of the COVID-19 pandemic?

“We are not doing well with this patient. If we talk about Planetary Medicine, the World patient is worse than ever before in these two years of the pandemic. The WHO reports that there are more than 340 million confirmed cases of COVID-19 (up from 352 million according to Johns Hopkins University data), and more than 5.5 million deaths.

Each wave has behaved as if it were a different epidemic on each continent (graph 1) and each variant affected different age groups according to the levels of vaccination and natural immunity of the population.

Graph with WHO data on covid-19 cases worldwide.

Unfortunately, the current sixth wave comes with a record number of weekly cases, with 20 million new cases during the week of January 10, mostly due to the omicron variant, which is outrageous.

The good news is that as of January 19, 2022, a total of 9,571,502,663 doses of vaccines have been administered (9,811,716,017 according to JHU), although, as we know, with an uneven distribution. Above all, there are still very few vaccines and complete guidelines in African and Latin American countries.”

Dr. Soriano, in countries like Spain, mass vaccination of the population has ensured that the omicron variant has not collapsed the hospital system with thousands and thousands of patients… Are we on the verge of an endemic disease?

“There are at least three different concepts in this question, all very complex and interrelated with each other. First, vaccination, which is undoubtedly fundamental, saves lives; but until we are all vaccinated, and well vaccinated, we will not be safe.

The real paradigm shift will come with the development of new vaccines that prevent transmission of the virus. The current ones do not, they only reduce the severity of the infection.

Medical epidemiologist Joan Soriano

Second, the new variants (figure 2). The original virus, identified in the Wuhan (China) market in December 2019, no longer exists, it does not circulate naturally because after alpha (UK), beta (South Africa), gamma (Brazil) and others, we currently have a combination of delta (India) and, above all, of ómicron (South Africa, again).

SARS-CoV-2 variants most prevalent during the COVID-19 pandemic
Figure 2

These mutations are saturating Primary Care in Spain and Europe, although not so much the hospital centers or their ucris and ucis. The key is found in the high level of vaccination and natural immunity.

And thirdly, speculating on the transition from epidemic to endemic and the so-called “flu” of COVID-19… What is this?… Is it an authorized voice who says it?… I don’t have a crystal ball and I continue having many uncertainties on my table».

Doctor Soriano, do we have the goal in sight to put an end to the coronavirus pandemic?

“This is not a social gathering or football or politics. Epidemiology, vaccination and immunity are science, not opinion or taste. For example, there can be no à la carte vaccination. And not everything goes, nor all opinions are worth the same.

My colleagues who do modeling say that there is no end to the epidemic in 2022, no abrupt decline in the sixth wave, and no flu. You don’t have to be optimistic or pessimistic, but you don’t have to create false expectations either. People are tired, even exhausted and fed up. And he wants to return to relative normalcy.

Medical epidemiologist Joan Soriano

But we have to be realistic: any improvement, from 2023. Relaxing universal hygiene measures now (masks, hand hygiene, social distance, interior ventilation, etc.) is irresponsible.

Our politicians have to be up to the task and not play with Public Health. In my opinion, the management of the pandemic must be with and by the experts, under unified criteria in all the Spanish Autonomous Communities, and as determined by the WHO and the European Union.

Medical epidemiologist Joan Soriano

So, doctor, will there be a seventh coronavirus wave in Spain?

“Undoubtedly. Here and beyond there will be more waves. It’s what viruses do, replicate, multiply and spread. And this particular coronavirus is very infectious and generates many variants, since it replicates very poorly.

By natural selection (Darwin), variants are self-selected that overcome artificial immunity (vaccination), natural immunity and cause reinfections. What we cannot predict yet is if the seventh or the eighth will be small waves or big waves.

By the way, our Pneumology team at La Princesa, together with Italian colleagues from the University of Milan, and based on the first omicron data from South Africa, has succeeded with a study on infections: on Monday, January 24, the Maximum of cases in Spain for this variant… and next Saturday, January 29, the maximum number of new hospitalizations will be reached.

The study was published in Archives of Bronchopulmonology of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). These mathematical models (figure 3), validated by external reviewers, must guide current and future Public Health decisions».

Graph of the trend of COVID-19 infection and new hospital admissions in Spain due to the omicron variant.
Figure 3

Lastly, Dr. Soriano. You have led a World Health Organization working group to define persistent covid, which has also been recently published in the journal The Lancet.

What should we know about the consequences of the virus in our body?

“Indeed, last year I had the privilege of being a senior consultant at WHO. Initially, I went to Geneva to do a modeling of COVID-19 in relation to influenza (Flurona), but this co-infection has not occurred at the expected levels.

So, I dedicated myself to updating the treatment guidelines for COVID-19 and putting order in the investigation of the sequelae after overcoming acute covid, now called Persistent COVID (Long COVID).

In December 2021 we publish in Lancet Infectious Diseases a first definition of Persistent COVID obtained by a Delphi consensus method with a broad panel of patients, their caregivers, and basic and clinical research experts from five continents.

The Delphi method is a structured communication technique, developed as a systematic and interactive consensus method, combining the opinions of patients, their clinicians, basic scientists, managers and other experts.

Having the same terminology and definition is a first step for dialogue between specialists and specialties, and progress in the management of Persistent COVID, as previously occurred in new diseases such as AIDS, fibromyalgia or postuci syndrome.

After overcoming acute COVID, one in six patients will have sequelae between three and twelve months after hospital discharge. There are already more than 200 symptoms and signs described, with enormous inter-individual variability. And seven potential mechanisms are studied.

Medical epidemiologist Joan Soriano

Dr. Joan B. Soriano Ortiz, epidemiologist at CIBERES-efe
Doctor Joan B Soriano, expert epidemiologist in COVID-19

We describe in our study three main phenotypes of Persistent COVID: respiratory, based on shortness of breath, chest pain, and cough; fatigue with a constitutional picture, related to tiredness, muscle aches and permanent and intermittent fever; and cognitive, especially with a kind of brain fog.

Furthermore, these sequelae are interrelated and even vary from week to week in the same patient. In Spain alone, we estimate that there are between 400,000 and 800,000 people with Persistent COVID. We have much to investigate regarding the measurement and management of persistent COVID«, concludes the Dr. Joan B. Soriano Ortiz.

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