Enos Bernasconi: Manager of infectious diseases at the EOC talks to ‘onthespot’

INTERVIEW

Starting today, and until the end of February, the new closures decided by the Federal Council come into force - But if cases of infection drop we ask the question: why close again? We reached out to Enos Bernasconi, Manager of infectious diseases at the EOC Manager

Enos Bernasconi: Manager of infectious diseases at the EOC talks to ‘onthespot’
Enos Bernasconi RSI.ch

Enos Bernasconi: Manager of infectious diseases at the EOC talks to ‘onthespot’

Enos Bernasconi RSI.ch

From today, and until the end of February, the new closures decided on Wednesday by the Federal Council come into force. The opening and closing has had many struggling to understand exactly what is going on. What’s more: the situation in hospitals has clearly improved since the beginning of January. At the Locarno Charity, for example, the COVID departments have been reoriented in recent days according to the decrease in the flow of patients. All right then? Yes. But then, why close again? We asked Enos Bernasconi, EOC infectious disease manager for an explanation.

Uneven situation

«It’s true, at this moment we notice a slowdown in the epidemic», notes the infectious disease specialist. «We have experienced a long peak, now the numbers of new infections are dropping, even hospitalized patients: which is a good sign». Yet, as Bernasconi himself points out, we must continue to keep our guard up: «The new variants of the virus are already present in Switzerland and Ticino. The hospitals are now taking a breather, but they remain alert. In the next few weeks or months, cases may rise again. In that case, the closed wards could be reactivated within 48 hours. However, we are in a phase where it is difficult to make predictions. As mentioned, some signs are favorable, but the situation is not uniform in the country: some cantons have a more alarming situation than others.

The look to tomorrow

Prudent optimism, yes. But also extreme attention to the English variant. Indeed, this is the meaning of the measures implemented by the Federal Council. Precisely preventive measures in view of what could happen. «We observed what happened in Great Britain, particularly in London» explains Bernasconi. «The situation was not evolving well, and with the arrival of the variant it worsened sharply. Switzerland is experiencing a downward curve of the pandemic, but it is not excluded that we also experience a surge in cases linked to the variant. In that case, as some define it, we could speak of a third wave». Therefore, the measures implemented are welcome. «I understand the discouragement of the population», continues Enos. «But we are faced with a serious danger, real. I remember that some countries around us, and with a far more positive epidemiological situation than ours, have adopted even more drastic strategies. Bern has taken the right step by considering all the variables currently at play. We must not think about today, but about the near future».

Refine recognition

«Presently it is not possible to establish with certainty how many cases with the new variant are present in our territory» «This is why virological surveillance must be increased» . «In recent weeks EOLAB (the analysis laboratory of the cantonal hospital, ed) is refining the variant identification technique. Today we are sending the samples over the Gotthard, to Basel and Geneva. But the waiting times are long. However, it will soon be possible also in Ticino to identify suspected cases with a screening test and subsequently confirm them by sequencing part of the virus. In this way we will be able to make a more precise assessment of the presence of the new strains».

An accredited hypothesis

Going into the specifics, we might wonder why these new variants are only starting to spread now. SARS-CoV-2 has mutated from the start, yet it has recently turned into a more contagious virus. «Yes, SARS-CoV-2 changes constantly». «But the main strains in circulation had a rather slow mutation rate, with on average one or two new mutations per month. This is typical of coronaviruses. However, particular conditions can push the virus to change very quickly until it becomes a more effective strain in being transmitted from man to man». So here’s how it could have gone with the English variant. «This variant was identified as early as September» continues the doctor. «A combination of several factors has therefore allowed the new strain to emerge becoming the most frequent isolated in the South London region in December. The surprise, however, is the discovery of 23 new mutations. An unusual number. An accredited hypothesis, then, is that many mutations evolved in a single patient with a weak immune system, prolonged infection and treated with antivirals and plasma from people recovering from COVID-19. However, these therapies lead to a selection of new mutations. They push the virus to change because otherwise it couldn’t survive. This could be the origin of the English variant in that many mutations have evolved in a single patient with a weak immune system, prolonged infection and treated with antivirals and plasma from people recovering from COVID-19.

The prospect of getting out of it

Variants, closures, dangers. But also hope. That relating to the vaccine, and to an increasingly concrete prospect of emerging from the crisis. «If we manage to vaccinate all people at risk and a large part of the general population by the summer, then by next autumn we may no longer have to fear a wave like the one we are experiencing. But it should be stressed that protective measures - distancing, hand hygiene and masks - will probably be maintained until next year. Even for a long-term speech: we are in fact finding that the normal flu is not circulating. And this is most likely thanks to the protective measures. I therefore think that in the future we will certainly be able to return free as in the past, but the measures mentioned could be useful in limiting the spread of many respiratory viruses. Viruses that during the winter often increase mortality in the most fragile groups».

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