Marcos López Hoyos, immunologist: "We should wear masks indoors and eat on terraces"

A new wave of covid (the seventh or eighth, depending on how you count it) has again infected a good part of Spain or, at least, surrounded by people who are suffering from the disease.

The culprit has the same name as always: SARS-CoV-2, as the coronavirus is technically called, but he has changed his last name again.

Now it is the BA.4 and (especially) BA.5 sublineages of the omicron that cause it to circulate like wildfire, although the disease is already very different from the one we experienced two years ago.

Marcos López Hoyos, a Cantabrian from Torrelavega about to turn 54, analyzes this new reality as president of the Spanish Society of Immunology and director of the Valdecilla Health Research Institute.

Ask.

Has the virus surprised us again?

Response.

The [subvariant] BA.5 has surprised us all.

Its architecture

antigenic [molecular composition] clearly changes with respect to the first omicron and the previous variants.

It escapes antibody immunity, although it is difficult to know at the level of T cells [the deepest protection that prevents severe disease] because there is no data.

Probably, what he is doing is inducing hospitalization in people with chronic pathology or very old, with more than 80 years.

P.

But, whether due to vaccines, mutations or both, gravity has nothing to do with the first waves.

R.

It has nothing to do even with the delta.

It is less serious, but with the data we have from the United Kingdom and Portugal, it seems that it is inducing more hospitalization than BA.1 [the first omicron that arrived at the end of 2021].

However, it is not accompanied by ICU.

The patients are admitted to the ward, but they don't have such serious respiratory symptoms, at least initially.

A very important issue that is happening with SARS-CoV-2 is that it is mutating at a significant rate, generating variants and subvariants every two or three months.

There is no time to develop an effective monoclonal [antibody], there is no time for antiviral indications to be validated with clinical data in real life, with the current variants.

Everything goes so fast that there is no time.

The same goes for vaccines.

Pfizer and Moderna seem to have the bivariate [formulated] with alpha and omicron, but with BA.1.

Logically, it will always be better than the original [from the first Wuhan virus], but it is not enough.

The virus always goes faster than we can react.

Q.

Are you in favor of a fourth dose of the vaccine for those who already have the complete schedule and the first booster?

R.

On the one hand, we have the bivariate option: although there are escapes, I think it is useful, more than the one in Wuhan alone.

And, on the other hand, there are going to be new vaccines on the way.

For example, in Spain there is Hipra, which may have its possibilities, because it can generate a type of response that can provide certain benefits.

Q.

Would it be like adding more complete protection?

R.

Yes. But we have to look for other models of vaccines.

The idea is one that is pancoronavirus, [that they work] regardless of whether variants come out.

Ideally, it can be applied at the nasal or respiratory level so that it is more effective at the entrance door.

Q.

But right now neither these nor the bivariates nor the Hipra are available.

Would you give a fourth dose already with the original vaccine?

R.

Now what I see best is to try to avoid infection.

Many people are vaccinated with three doses and have passed the omicron;

It has been seen that this induces a more powerful immunity than if you pass the omicron without being vaccinated.

We have adequate protection against gravity and in that sense we can be calm and we can start giving a fourth dose in the fall, starting with the most vulnerable.

And we will have to see if we do it with the bivariate or with others that the EMA is reviewing.

Q.

Are we seeing more and faster reinfections than ever before?

A.

Sure.

Neutralizing antibodies can prevent infection, but they always react against the complete structure [of the virus], not the degraded structure that T cells do recognize. So if there is a mutation, [the antibodies] no longer recognize the virus;

is going to escape and that is what is happening.

Eye, in terms of infection, not serious illness.

That's why there are people who had the BA.1 at Christmas and now the BA.5.

Q.

Are these mutations causing less reliability in the antigen tests that we buy in pharmacies?

R.

In principle, the antigenic tests are not failing, they detect parts of the virus that are not mutating.

In the cases that I know of, they are testing positive from the very beginning of the symptoms.

Q.

It seems that the new sub-lines have shortened their incubation period.

A.

Yes, but I have no evidence or know of any [published] work to prove it.

Q.

Are you in favor of the mask indoors?

A.

I use it.

As soon as I enter an interior place I put on a mask.

It is the means we have to protect ourselves today, along with the positives self-isolating as much as possible so as not to infect anyone.

What I don't see well is going to a shopping center and everyone without a mask, as if this had already happened.

And it has happened in the sense that it is no longer the covid of when we did not have vaccines that induced a large number of hospitalizations and deaths.

Now it's a flu-like cold that does decompensate patients and kills people, beware, we don't take it down.

Because above all it decompensates the oldest, the most vulnerable.

We all want to forget about covid, but we can't forget completely.

Is there.

P.

In March and April almost all measures were eliminated: isolation of positive cases, masks, indication of tests in those under 60 years of age... Would you take a step back?

A.

For example, I do not understand why we have stopped having incidence data in the general population.

Knowing the situation is good for all of us.

We know that we are at more than 1,000 cases per 100,000 [inhabitants] in more than 60 years [the Spanish average is 1,135], we assume that in the general population it will be 3,000 or more.

But we assume it, we don't know.

There is a pandemic fatigue, it is clear, we are all up to our noses and obviously the economy cannot stop.

But there are situations that we have abandoned... and wearing the mask indoors I don't see it as a big problem;

Meals on terraces and outdoors are always better.

They are a series of things that we should do without being limited.

P.

Would you return to the mandatory mask?

R.

I use it [answers after a silence of a few seconds].

Q.

How do you expect the virus to evolve?

R.

It will continue to mutate and we do not know if it will surprise us or not.

It mutates constantly, every two or three months we have a variant or sub-variant.

And every six months, one that surprises us.

At Christmas 2020 we had the beta;

the delta in July, the omicron in Christmas 2021 and now we have the BA.5.

What we are seeing is that the variants have a greater capacity to reinfect, but it does not seem that they are going to be more [severe].

And I say it seems because I am not clear about it with BA.5.

I believe that this disease will remain a viral cold such as the flu.

But, as with the flu, there are people who decompensate and die.

P.

Do you think something similar to what happened in Portugal with BA.5, which caused a high rate of infections, but not a huge hospital condition, could happen here?

R.

That is what we have to see.

Between the holidays and sick leave of health personnel, resources are very limited.

We have to see how far this peak goes, if it stays in this week, we will hold.

If it continues to rise, we will probably have stress and difficulties in hospitals, because there are limited resources and if the incidence continues to increase, there will be more need for hospitalization of people and it will continue to put stress on the system.

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