First we have to fight the virus. It will take may be half a year. May be a year or more. [...] I can not see any tour this year, and there will be no economy private or enterprise wise willing to pay for a tour next year. Sorry folks, it is time to pull the heads out of the ground and face the reality.
German´s top virologist, Professor Christian Drosten, about everything
you need to know [in English]:
]ZEIT ONLINE: Life as we know it is changing at the moment. Mr. Drosten, are you worried?
Christian Drosten: Like many other people, I, too, am in denial about the current situation to a certain extent. I hope for my family and for myself that it won't affect us. But it very well could. And then there are others who are ignoring our new reality completely.ZEIT ONLINE: People in this country, though, are listening to you and what you say carries great weight. What effect is this role having on you?
Drosten: I just sort of slipped into it. It's also becoming a bit overwhelming, all the media inquiries, advising politicians. I'm not a politician, I'm a scientist. I'm happy to explain what I know. Scientific findings must be communicated to everyone transparently, so that we all can get an idea of the situation. But I'm also honest about what I don't know. I always have been.ZEIT ONLINE: The country is grinding to a halt. Daycare centers and schools have been closed nationwide as of this week. Is the government reacting appropriately at the moment?
Drosten: Few of the decisions made in recent days were purely evidence-based. Many were political, and certainly correct. Some were surely influenced by the strict measures in neighboring countries. But either way: I have the impression that a switch has now been flipped in all states across Germany. Now a decision has been made to ban public events and close daycares and schools.ZEIT ONLINE: It is said that you played a central consultative role in the decision to close schools. Was it the correct decision to do so now?
Drosten: I don't know. It probably won't be clear until later whether it was the right time to do this. I've always maintained that scientists from other disciplines must also be heard, and that kind of decision is outside the realm of competence of an epidemiologically trained virologist like myself. I don't see my job as condensing the truth, but as explaining aspects of the truth and allowing for uncertainties and saying, 'We don't know' – which makes a political decision necessary. And as long as it's communicated as a political decision, I think that's fine.ZEIT ONLINE: Will the measures work?
Drosten: Hopefully, they will decisively change the dynamics of the disease's transmission. It's possible that we'll be able to judge this by Easter. Maybe we'll see that fewer people have been infected than we would have expected amid the current exponential growth. That the curve has grown flatter. Initially, however, this will have less of an impact on the death rate, because some of those who will die before Easter are already infected now or will be in the coming days. What's more, the recent decisions won't have an immediate effect. It will take a few days. Some things have become normalized. Many people have figured out childcare solutions, for example. And more and more people are understanding that they shouldn't meet up in groups anymore. It will take some time for people to get used to this.ZEIT ONLINE: Stricter measures, such as forbidding people from leaving their homes for non-essential reasons, are under consideration – largely because apparently not everyone has understood that they should stay home and reduce their contact with others in order to protect the community at large.
Drosten: I think that in the next few days, the penny will finally drop. These measures are still quite new, but most people will have grasped it. There will always be some people who are incorrigible. Of course, people like that don't exist in China – there, they are censured. But I'm glad that we don't live in that kind of society. And I'm not sure whether it's even necessary, in terms of the overall epidemic, to find every last person who's not following the rules.ZEIT ONLINE: So, given the corona parties that have been taking place, you wouldn't say: "From now on, no one is allowed to go outside?"
Drosten: Who am I to say such a thing? I can say that as a virologist, in my field, up to a certain point, this is the way things are. Other things just don't fall into my area of competence. Then I'm no longer a scientist, but a private citizen. I don't have a mandate from voters. But I do believe that by shutting down bars and restaurants, cancelling major events and closing daycares and schools, a great deal has already been achieved. The goal is to prevent as many people as possible from coming into contact with one another.ZEIT ONLINE: What's your assessment of how Germany managed the earliest stages of this outbreak?
Drosten: I believe that Germany recognized its own outbreak very early on. We're two or three weeks ahead of some of our neighbors. We've been able to do this because we've been doing so many diagnostics, so much testing. Of course, we missed some cases in this early stage, that always happens. But I don't think we overlooked a major outbreak. This assertion is also supported by the fact that we are seeing cases in Germany increase as expected. But we're also seeing that we have fewer deaths than other countries. One could deduce, therefore, that we're not that far off from the total number of cases we have. We certainly aren't identifying all of the cases, but relatively, we are seeing more than other countries that are testing less.ZEIT ONLINE: Like Italy, for instance?
Drosten: In Italy, tests are apparently primarily performed on people who get admitted to the hospital. That's because people there know that there aren't enough tests to go around anyway, so they initially stay home, even if they have symptoms. They only go to the hospital if their condition worsens. There, they arrive with shortness of breath and are immediately admitted to the intensive care unit, where they are then tested for the first time. This is why the average age of recorded cases is much higher in Italy than here in Germany. I assume that many young Italians are or were infected without ever being detected. This also explains the virus' supposedly higher mortality rate there.ZEIT ONLINE: How much longer will we be able to keep up with testing in Germany?
Drosten: At some point, this won't be possible anymore. We're simply not able to increase our testing capacity as quickly as the number of cases rises. Then two things will coincide: First, some of the people who are now sick with COVID-19 will die. And second, because we won't be able to test everyone, our statistics will be incomplete. Our fatality rate will then also rise. It will appear that the virus has become more dangerous, but this will be a statistical artifact, a distortion. It will simply reflect what's already starting to happen: We're missing more and more infections.ZEIT ONLINE: What can we do about it?
Drosten: We have to take shortcuts. If one person in a household tests positive, we could, for instance, consider the entire household to be positive, even without a test. Because we know that is what is going to happen: If one family member gets infected, they infect everyone else. If you say right away that the entire family is positive, you save yourself a lot of testing. Imagine that you're infected, and the next day your wife has to go and stand in line. And then imagine the test doesn't detect her infection yet, and she has to come back. That doesn't make any sense. So, it's better if the entire family isolates at home from the get-go. They're already doing this in the Netherlands and I'm going to suggest that Germany follow suit in discussions with health authorities.ZEIT ONLINE: What other options are there?
Drosten: At some point, suspected cases will be reported only on the basis of symptoms and then the statistics will begin to reflect this. At the same time, available tests will have to be reserved for those people most at risk. If an otherwise healthy student is at home on her couch watching Netflix, as a general practitioner, I don't need to know whether she's positive or not. She should just stay there and get better. But when a 70-year-old patient of mine gets sick and is isolated at home, then I'd like to test him in order to then be able to call every two days and ask how his breathing is. That way, he can be admitted to a hospital early enough and doesn't show up to an out-patient clinic with a clotted lung and have to immediately be transferred to an intensive care unit.ZEIT ONLINE: Will we soon have tests that are faster than the current ones?
Drosten: Some are already commercially available, mostly those that detect antibodies. Their quality probably varies. And they only work after 10 days, since that's when patients have developed antibodies. In the first 10 days, these tests are blind, so to speak. We have to wait until antigen tests are developed, which can actually detect viral proteins. These tests will work like a pregnancy test – and they'll also provide results just as quickly. If the tests work well, they'll be able to completely replace the current ones. Then people won't have to wait in lines anymore. I hope this will happen by May.ZEIT ONLINE: By then, millions of people could be infected. How well are German clinics prepared for that eventuality?
Drosten: No matter how you count or who you speak to: We have to bring down the number of cases now. Otherwise we won't be able to handle it. Otherwise we'll have exactly the same problems as Italy within a few weeks. We do have more beds, and maybe we're a little better trained. But even though intensive care in Germany is good, there's still not enough of it. Based on the current figures, we would need – even by conservative estimates – to double our current intensive-care capacity in order to even come close to ventilating everyone who needs it.ZEIT ONLINE: Germany's federal and state governments have now adopted an emergency plan. Additional capacities for minor cases are to be created and the number of intensive care beds doubled.
Drosten: That's a good plan. And in order to do this, we need the time that we hope to buy with the current measures. Now is the phase in which ventilators are still being ordered and hospital wards cleared. All this (points to a nearby building) belongs to the hospital. Normally it's used for offices. Now it's being cleared out and beds are being set up inside – including ones with ventilators. Processes like these take a few weeks. That's what the weeks we're trying to buy ourselves now are for, and not primarily for developing a vaccine.ZEIT ONLINE: Let's look at the virus itself. You have been researching coronaviruses for many years. What has surprised you most about SARS-CoV-2 so far?
Drosten: Clearly the fact that it replicates in the throat. With the SARS virus, which caused the outbreak in 2002-2003, we were never able to isolate it in the throat. SARS patients had far fewer viruses in their bodies and the pathogens were far less infectious. In addition, the new coronavirus contains an astonishing biological innovation: a protease cleavage site in the surface protein of the virus. In the case of bird flu, for example, whether this site is there or not makes the difference whether the pathogen makes poultry very sick or not.ZEIT ONLINE: What's so special about this cleavage site?
Drosten: The surface protein must be cut so that the virus can mature and enter the next cell. And this cleavage site may enable the virus to be cut even when it's only just been released from the last infected cell. It's like a sheet of paper that's easier to tear off the notepad because it's perforated. And SARS-CoV-2 has this perforation.ZEIT ONLINE: What does this mean for the disease?
Drosten: We don't know for sure yet. It could allow the virus to already be mature when it leaves the cell – ready to enter the next one. This could also be the reason why SARS-CoV-2 replicates so well in the throat and why it can be transmitted so easily. We now have to figure all that out.ZEIT ONLINE: Just like the question as to the precise case fatality rate.
Drosten: Right now, there's actually another variable that's more important: the so-called infection fatality rate. This indicates the percentage of infected people who die – including those who have no or only a few symptoms and are therefore not recorded as cases. As such, it also serves as an estimate of how high the number of unreported cases is. How many people who contract the disease don't show any symptoms at all, or only have sore throats? Among the first infected people in Germany, whom we closely examined for a study, there were quite a few. At the moment, I often hear that 80 percent of cases have only mild symptoms. But my impression is: Maybe it's even a lot more. That would be important to know.ZEIT ONLINE: Elderly and sick people are particularly at risk of contracting COVID-19. Yet over and over again, there are also reports of people in their early or mid-30s who have to be admitted to intensive care or who even die. Why is that?
Drosten: This is also the case with other respiratory diseases, that younger people sometimes fall seriously ill. But we often don't know a lot about people. In the media, you'll here: "A 35-year-old is in intensive care." But a 35-year-old can have massive underlying diseases. We know, for example, that a high body mass index is a major risk factor for COVID-19, as is coronary heart disease, i.e. a narrowing of the coronary vessels due to vascular calcification. Pneumonia puts a massive strain on the cardiovascular system. If that system is already damaged, the extra strain can sometimes overwhelm it. And there are many people between the ages of 35 and 50 who live with such risk factors. Another hypothesis is that someone may inhale a huge dose of the virus directly into their lungs. Then the virus immediately replicates deep within the respiratory tract without having previously triggered any immune response in the throat. Then people might get really sick right away and the body has no remedy for it yet. Like I said, it's a hypothesis.ZEIT ONLINE: According to what we know so far, men are more likely to fall ill than women. Are there clues as to why that might be?
Drosten: We don't know for sure yet. It's possible that risk factors like the ones we just discussed are more common in men. Some studies also suggest that the binding site the virus uses to enter cells is especially common on the cells of Asians, and especially males. But honestly, I think this explanation fits into the picture well and that's why it was interpreted this way. Besides, the virus is also spreading outside China, so I don't think this argument is very likely. There just isn't any good data on this yet.ZEIT ONLINE: You've often said that neither drugs nor vaccines will be available in time for this outbreak. Is there no hope at all?
Drosten: It is conceivable that the situation will become so bad that regulations will be suspended. One could imagine certain aspects of vaccine approval being ignored during this crisis and vaccines that haven't been tested well being used on people. These are far-fetched scenarios, and they're speculative. But if things get very bad – and I don't want to rule that out at the moment – something like this could be conceivable. A number of biotech companies have had vaccine candidates in the pipeline for quite some time.ZEIT ONLINE: In the U.S. this week, a volunteer test subject received a possible vaccine manufactured by a private biotech company. It is based on mRNA, so small pieces of genetic material. Is this the right approach?
Drosten: I can't really say yet. I think it's a quick approach. I don't know if it's also the mass approach we need right now. At the moment, this would perhaps more likely be a surface protein of the virus that can be produced en masse and against which the immune system produces antibodies in large quantities. Some companies are pursuing this approach. That kind of vaccine would then be earmarked for risk groups. If things were to get really bad, one could imagine something like this happening.ZEIT ONLINE: At what point would you say things are bad enough for such steps to be taken?
Drosten: I can't and don't want to imagine that at the moment.ZEIT ONLINE: Do you consider any medications promising?
Drosten: I see the antiviral drug remdesivir as the best option. It was originally developed to treat Ebola. Studies are currently underway, but at the moment, the manufacturer only permits it to be used on people who are already seriously ill, and only then under a special protocol and only within a small timeframe. Ideally, it would be possible to give it to patients sooner, and for that, much greater quantities would have to be available. We now have to wait and see what the first results are.ZEIT ONLINE: And other drugs?
Drosten: I don't see any real alternatives. Neither the malaria drug chloroquine nor the HIV drugs ritonavir/lopinavir. Both have been the subject of clinical studies, but the results haven't been convincing.ZEIT ONLINE: Italy is apparently considering experimenting with treating patients with the plasma of people who have already recovered from the infection.
Drosten: It is a tempting idea. There still isn't any published data on the treatment, but there are a lot of young, healthy patients who would be perfect plasma donors. When they become infected, they produce the best antibodies around. If they are administered to patients at the right moment, then it is certainly a possibility. I can imagine that in maybe two months, the first small analyses of case studies – potentially also from Germany – will be available. But extremely rapid results, at least on a large scale, cannot be expected from all of these measures.ZEIT ONLINE: What about from rising springtime temperatures?
Drosten: This effect isn't likely to be particularly pronounced. It won't be able to stop the outbreak, but it may help a bit. And combined with the isolation measures, I strongly expect that we will see an impact in a month.ZEIT ONLINE: And then? What happens after that?
Drosten: We perhaps have to assume that from a societal perspective, we'll have to go through a year in a state of emergency. But we probably won't continue pursuing all measures precisely as we have now introduced them. We will be able to, we will have to, adjust them. Some things will be phased out. But during the initial phase between now and the week after Easter, we really have to take rigorous action and keep a close eye on the development of the number of cases.ZEIT ONLINE: A year of a state of emergency? What will our lives look like during this period?
Drosten: Nobody knows. I can't imagine it yet either. More than anything, a solution for our schools must be found. That is the most important thing. At the universities, I think it's OK to lose a semester or two. But losing an entire schoolyear is simply too difficult because there is so much depending on it, not least for our economy. We'll have to find a solution. And, of course, also for those who are particularly at risk.ZEIT ONLINE: What kinds of things do you have in mind?
Drosten: Certain arrangements could be made specifically for such risk groups, for example by rigorously testing the elderly and those at risk early on and giving them priority when it comes to hospital admissions. And those at higher risk will have to continue to work from home, for an extended period. It could be possible to find ways to isolate elderly people at home. There could be shuttle services for them, and groceries would have to be delivered to them. Volunteers could help, perhaps even the German military. And in day-to-day life, children would have to be kept away from those at risk as strictly as possible.ZEIT ONLINE: And then the schools could be opened again?
Drosten: Perhaps measures could be imposed, like half the school can use only these hallways and the other half the other hallways. There would no longer be a long recess, and perhaps no short ones either. Common rooms would no longer be used and would be locked. With such measures, you can reduce effective group sizes in the schools. That would require some planning, but we have time between now and the week after Easter. The most important thing is that we need scientific data regarding the situation at schools.ZEIT ONLINE: And what if grandparents want to see their grandchildren again?
Drosten: Perhaps it will be the case that grandchildren will first have to undergo a test when they want to visit grandma and grandpa to be sure that they don't infect them. Such details now need to be clarified. With the political decisions that have been made, social life has been put on hold. But hopefully adjustments can be made with the help of scientific findings and modelling that apply specifically to Germany.ZEIT ONLINE: When will people be able to go back to work?
Drosten: In the medical world, consideration is already being given to the idea of testing people so they can go to work. Once antigen tests are available, that could be expanded to include other occupational groups. Plus, if we assume that during the current wave of infections, perhaps 10 to 15 million people will become infected in Germany by autumn, we will soon have a large number of people with antibodies. People who are immune. Then, there will be doctors and nurses who can work without masks, and in other occupational groups, there will also be people who say: "I've made it through." And their number will continually increase.ZEIT ONLINE: For how long will those people be immune?
Drosten: Those who have become infected will likely be immune for the rest of the pandemic, I would think – for a couple of years. And even if you were to become infected again, then it would be experienced as a harmless cold. The second infection wouldn't be as bad. That, at least, would be my best guess at present.ZEIT ONLINE: How can we find out who has already been infected?
Drosten: By performing large, cross-sectional studies in the population, once in summer and again in October. Ideally it could be done with the help of blood banks, where blood is already being taken and stored. The goal must be that of establishing a decent estimate for each age group as to how many people have made it through the infection and now have antibodies. By doing so, it will be possible to find out whether we have reached the 60 to 70 percent level, which is the share of the population that will likely ultimately be infected.ZEIT ONLINE: And then the virus will be gone after a year and a half?
Drosten: No, it will likely follow the path of the other coronaviruses that merely give you a cold. We will have to live with them, but they aren't as dangerous to us anymore once with have withstood the current outbreak.ZEIT ONLINE: That all sounds like an immense challenge. Are we up to it as a society?
Drosten: It will be a difficult time and there will be huge economic losses. But yes, of course we'll get through it. We have to.Translators: Chris Cottrell and Charles HawleyIn another interview he said about footballmatches in stadiums (that includes packed stadiums for concerts as well):
“I don't believe at all that we'll be filling football stadiums again in the foreseeable future. That is superfluous. That will not happen until this time next year," explains virologist Christian Drosten in an interview with “stern”.