SPIEGEL: Ms. Ciesek, how would you describe the coronavirus to someone who has been missing for the past few months?
Ciesek: A new virus has triggered a pandemic since December 2019. This virus is very contagious and it can also be transmitted from people who have not had symptoms. While many people, especially children, fortunately do not get seriously ill in most cases, hundreds of thousands of people around the world have already died from the disease Covid-19. It affects the lungs, but also other organs. Consequential damage can also occur after an infection.
SPIEGEL: Is it unusual for Sars-CoV-2 to affect organs other than the lungs?
Ciesek: There are also other viruses that can damage various organs. For example, the hepatitis E virus, which mainly causes liver inflammation, can also cause paralysis of the shoulder (neuralgic shoulder amyotrophy) or the so-called Guillain-Barre syndrome, a nerve disease. What is new is that the corona virus affects so many people at the same time.
SPIEGEL: Patients with Covid-19 can damage the lungs, kidneys, heart, blood vessels and brain. That’s a wide range.
Ciesek: However, it is not yet definitively clear what damage the virus itself is causing and what the result of an excessive immune response is. Probably both play a role. It is not yet known exactly how often the different types of damage occur, how long they last, in which people they occur and how they could possibly be prevented.
SPIEGEL: Is it actually a specialty of the Coronavirusthat some people hardly notice the infection, while others become seriously ill or even die?
Ciesek: No, it is not uncommon for some people infected with a virus to have few or no symptoms while others get seriously ill. Other common pathogens that cause respiratory infections, such as the influenza virus or the RS virus, infections without symptoms and life-threatening courses, are found. Another example is yellow fever: In this viral disease, which is rightly feared, many infections are mild or asymptomatic, but can also be very serious and fatal.
SPIEGEL: Why is that?
Ciesek: Many different factors determine how serious an infection is. The immune system is of course important as it is subject to major changes over the course of life. Newborns, young children, adults, and the elderly respond differently to infections, which can affect the severity of an illness. Another factor is previous illnesses, for example existing lung damage or diseases of the immune system. Environmental influences such as fine dust also play a role and the general lifestyle, for example whether someone smokes. Last but not least, our genes influence the course of the disease in a complex interplay. It can happen that two outwardly very similar, completely healthy people have very different disease courses.
SPIEGEL: How do you reduce the risk of getting seriously ill with coronavirus infection?
Ciesek: Many seriously ill people are at risk from previous illnesses. What can you do yourself What is still recommended: eat healthy, do sports. The most important thing at the moment is to follow the hygiene rules. So keep your distance and wear a mask if the minimum distance cannot be maintained. And hand washing – this is certainly not the biggest factor, but it also helps against other pathogens.
SPIEGEL: And what is for example Vitamintabletten?
Ciesek: It makes sense to make up for a deficit. But if you are not deficient, you don’t need to take pills. With vitamin D, for example, it is important not to overdose in an uncontrolled manner. Otherwise, it can even be harmful.
SPIEGEL: Some studies conclude that around 40 percent of those infected had no symptoms. That’s great
Ciesek: It is not at all easy to decide whether the infection was symptom-free, ie asymptomatic, or whether the symptoms were mild. You can remember it Publication in the magazine “NEJM” to the first cases in Germany. Initially, the team wrote that the patient from China was asymptomatic. Only later did conversations with the woman show that she was some mild symptoms and took pain relievers to keep fit the next day.
Shortly afterwards, we interviewed returnees from WuhanTwo of them were positive but had no symptoms. After the excitement about the other release, we asked the two patients very carefully if they had any symptoms. And someone who said he had nothing at first reported an earache and a mild rash.
SPIEGEL: Can’t a very penetrating question also distort the picture? Because the respondents believe at one point that there has been an indication of a headache in the last few days, a bit of grumbling in the stomach – but that wasn’t even perceived as a complaint at the time?
Ciesek: Yes it is difficult. That’s why I prefer to talk about minor disturbances to well-being, not symptoms or ailments. Virus research does not usually focus on studying the asymptomatic course, so the percentage of people who are asymptomatically infected with other viral infections is often not known precisely. For the research of Sars-CoV-2, it is now interesting, for example, whether and how the immunity after an asymptomatic or very mild infection differs from that after a severe course.
SPIEGEL: There was a lot of talk about herd immunity, especially at the beginning of the pandemic – if 60 to 70 percent of people had gone through the infection, this would have been achieved. But would it even be possible to achieve herd immunity without a vaccine in the sense that you no longer have to worry about the coronavirus?
Ciesek: First, this path is not worth following at all as the virus does a lot of damage and many people would die. The idea of herd immunity is that a certain number of people have antibodies so that these chains of infection break – naturally and not through isolation as is happening now. If a sufficient number of people were immune and the virus couldn’t find a host, it could theoretically be eradicated. For this, the protective immune response would have to take a long time. As of now we don’t know how long this will take after coronavirus infection.
SPIEGEL: Do you think we’ll find a vaccine against Sars-CoV-2?
Ciesek: At the moment we have promising candidates and I expect one or more vaccines will be available in the next year. Of course, there are times when mutations that are important to a particular vaccine may happen by chance, or that a vaccine may not be suitable for all people – this should be monitored further. So it’s not a bad thing that several vaccines with different properties are being developed in parallel.
SPIEGEL: Does Sars-CoV-2 mutate fairly quickly or fairly slowly, or is it in the middle?
Ciesek: Anyone researching hepatitis C viruses laughs at the coronavirus mutation rate. The hepatitis C virus lacks so-called repair mechanisms, which is also one of the reasons why it has not yet been possible to develop a vaccine against hepatitis C. However, Sars-CoV-2 is not as stable as other pathogens. Sars-CoV-2 is an RNA virus and it is completely normal for errors to creep in again and again during reproduction. But it doesn’t have a fragmented genome like the flu virus. We have flu vaccines. That’s why I’m optimistic at the moment.
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