"This virus will continue with us forever"

Ian Lipkin, an epidemiologist at Columbia University, during an interview on CNN.

In 1999, a pathologist at the Bronx Zoo found several dead crows at the park entrance.

Shortly after, flamingos and other birds began to die inside the zoo, all with strange brain hemorrhages.

Around the same time, New York City detected an unusual number of emergencies for brain inflammation among humans.

Seven people died.

No one was clear about what had killed them.

The doctor and epidemiologist Ian Lipkin was one of the first to identify the culprit thanks to genetic analysis.

It was the West Nile virus, a pathogen that originated in Africa and imported into America, probably through illegal animal trafficking.

Lipkin has since become one of the biggest virus hunters on the planet - he has discovered more than 1,500 - including another mysterious pathogen that killed four people in a chain of infections related to organ transplants in South Africa.

Lipkin directs the Center for Infection and Immunity at Columbia University, where animal and human samples continue to arrive from around the world for analysis.

In 2002 he was chosen by the Chinese Government as an advisor to contain a worrisome coronavirus that killed almost 800 people, SARS, for which he developed the first screening test.

In 2012, he was required by Saudi Arabia and helped identify the animal from which the second coronavirus, concerning its lethality, had emerged: the 2012 MERS that jumped from camels to humans.

Since January, it has collaborated again with the Chinese authorities in the investigation of SARS-CoV-2 to develop better tests to detect the virus.

Question.

What are you currently working on?

Reply.

For many years I have researched new ways to detect infections and understand how infectious agents cause disease.

Now I work with an engineer at Columbia who creates circuits on which molecules are imprinted: proteins or DNA, for example.

If SARS-CoV-2 or another virus is present in the detector, these molecules will bind to it and send a positive signal.

The most interesting thing is that this also allows us to identify other viruses that can produce the same symptoms as SARS-CoV-2.

It is a multiple test.

It's the future.

Q.

What molecules do you use to detect viruses?

R.

Flame antibodies.

Camelids not only produce conventional antibodies like those of other mammals, but also much smaller, single-chain antibodies.

These are very effective at binding to viruses.

In theory, the test could work with samples of saliva, blood and even aerosols, something key now that we are thinking about reopening theaters, concert halls and other public spaces.

We hope to have the first prototypes in January.

Q.

When do you think this pandemic will end?

A.

We are going to live the rest of our lives with this virus;

will not go away.

Newborns will have to be vaccinated forever and we will probably have to give additional booster doses to those already vaccinated.

It is going to be a recurring problem.

I don't think life will ever be completely normal again.

"The data on the Messenger RNA-based vaccines from Moderna and Pfizer are staggering"

Q.

Not even if we eliminate all possible animal reservoirs?

A.

Compare it to smallpox, the only infectious disease eradicated.

It does not have an animal reservoir and all those infected suffer from disease.

On this occasion, neither of these two things is true.

There is asymptomatic or presymptomatic transmission and there are also many animals around the world that are going to become reservoirs for this virus.

Bats, mustelids, maybe others.

Once we start mass vaccinations, infection levels will drop drastically.

These vaccines plus the immunity associated with the actual infection will mean that from 2022 we will see a dramatic reduction in deaths.

But SARS-CoV-2 will not go away and we will have to continue monitoring.

Q.

What do you think of the latest vaccine efficacy results?

A.

The data for Moderna and Pfizer messenger RNA vaccines are staggering.

I am sure these vaccines will also reduce the amount of virus that an infected person generates and will also reduce the time that a person emits contagious viruses.

And we will be able to distribute these vaccines in most of Europe and the US But getting them to developing countries will be a daunting challenge.

In these areas we need vaccines that do not need cold.

Q.

Will these vaccines allow us to return to normal?

A.

The only way to get back to normal is to achieve global group immunity.

For this, between 60% and 80% of the world's population must be immune.

Covid requires global solutions and it is encouraging to see the G20 commit to a global vaccination program, rather than pursuing national solutions.

I do not believe that we will return to the normality before the pandemic in the same way that we did not return to the normality before after 9/11.

Covid has shown us our vulnerability to emerging viruses, but it has also demonstrated our ability to respond with science, compassion, and a common goal.

"Remdesivir is not a good drug and probably not worth its price"

Q.

How do you think this virus became a pandemic?

A.

The only thing we can say for sure is that no one, no human, has deliberately created this virus.

Beyond that, no one knows how it happened.

China is going to invest a lot of money in analyzing wild animals.

In 2012, when we went to find the origin of MERS, we started looking in bats because the virus closest to this that was known was found in these animals.

But the MERS patient zero had four camels and so we started looking at these animals.

We found they had antibodies.

We began to study camels in practically the entire Arabian peninsula and we found that 75% of all camels had antibodies.

We went to camel blood banks and saw that this virus had been circulating for at least 10 years.

There were probably cases of MERS in humans that no one knew how to see.

Q.

Can our surveillance systems for new viruses be improved?

A.

My team has estimated that there are at least 320,000 unknown viruses that can infect mammals.

Other estimates speak of a million.

In the United States, an international cooperation project was considered that was going to dedicate some 6,000 million dollars to characterize all these viruses.

The problem with this approach is that finding one of these viruses does not tell you whether it will infect humans or not.

Due to limited resources, is this the best way to spend the money?

I believe there are other ways.

For example, there are zoos all over the world.

Every new pathogen that arrives can infiltrate zoos.

Some animals may die and studying them would give us many clues.

The same can be done with dead and domestic wild animals.

They can be the thermometer that a new virus is circulating.

Characterizing these outbreaks is easier than looking for the virus itself.

Q.

Are there more ways to get there earlier?

A.

Before an epidemic breaks out, the virus circulates silently for a period of time.

This is what happened with HIV in the 1940s. The same will happen with SARS-CoV-2.

When we have the appropriate antibody-based technology, we may see that people were infected long before it was detected in Wuhan in December.

It could be even years before.

One way to detect this is by using blood banks;

do serological tests.

Another way is to do more autopsies.

They are made very few because it is expensive and they are usually not very useful.

But if we can find a way to do a quick autopsy based on serology, we could know a lot more than we do about this and other viruses.

"There are advantages and disadvantages of dictatorships, but in public health clearly the policy is much more consistent"

P. It

also studies the use of plasma from cured people as a treatment. Are there results?

A.

We have a study with about 200 randomized patients receiving either immune plasma or normal plasma.

They are serious patients.

Then we have another trial with people with very mild symptoms.

We believe that it is in these cases where this intervention will work best: you prevent the infection from spreading and rule out the possibility that the immune system itself overreacts and causes severe covid.

Q.

What do you think of remdesivir, the first drug approved against covid at a price of 2,000 euros?

A.

It has a very modest effect.

It shortens hospitalization, but does not reduce mortality.

It is not a good drug.

Probably not worth its price.

But people are going to take it because it has been approved.

It is possible that like monoclonal antibodies and plasma, it only works in the early stages of the disease.

Once the virus has spread throughout the body, it is too late.

In this it will be more important to control the immune response with steroids and to use anticoagulants.

Q. You have

collaborated with China for years and you were there in February.

Do you think they really contained the virus?

A.

Yes. In China, if the government decides to do something, it is done.

It is not like in Spain or the US where there can be debate on lockdowns and closures.

Everybody obeys.

There are advantages and disadvantages of dictatorships, but in public health clearly the policy is much more consistent.

By comparison, the EU and the US should have more consistent policies.

Q.

In 2011 you were a scientific advisor for

, a film that narrated how a pandemic virus took over the world.

Does the resemblance to reality surprise you?

A.

I am not surprised by the accuracy of what the film recounted because we are based on our experience during the outbreaks of the western virus, SARS, Ebola, the state of the biological surveillance programs for new emerging viruses and on how social networks were evolving.

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