Interview with Prof. Tobias Welte – ERS Past President, on the COVID-19 outbreak

This insightful Q and A was held online for the staff working for both the European Respiratory Society and the European Lung Foundation on 25 March, 2020. Prof. Tobias Welte answered some of our questions about COVID-19. We wanted to share this with you, so we have written-up some of the questions and answers.

We have also produced a short video of his Q&A about COVID-19.

Why is the number of people dying from COVID-19 so different in different countries?

There are a lot of reasons that the number of people that the coronavirus is killing is different in different European countries. These include:

1. How quickly patients were identified as having COVID-19. For example, in Italy, there were patients in the intensive care units that were very sick, but that were not diagnosed with COVID-19. As it was so early into the pandemic, they were unaware of the disease. It was different in other European countries where the cases appeared later, as they were more aware of the start of COVID-19 in their countries and had time to prepare.
2. Society structure is different in different countries. For example, six times more people live alone in Germany as compared to Italy. And in general, if people live closer to each other they are more likely to spread the virus between each other.
3. The healthcare systems work in different ways in different countries. Different countries have different numbers of intensive care beds and ventilators. This means that some patients have less access to treatment. Some of the countries that are coping more effectively have double or triple the number of intensive care beds.
4. The number of tests being done. Some countries are testing lots of their population and some are only testing those who are seriously ill or in hospital. If a country is only testing and confirming cases in people that are seriously ill, it will look like they have a higher death rate then the countries that are testing more of their population including those with mild symptoms who are more likely to survive.

How does COVID-19 spread? Does everyone have symptoms?

You can spread the corona virus 4-5 days after catching it. However, it is 1 week from catching the virus to when you notice symptoms. It can be up to 1 month from first showing symptoms to experiencing the most severe symptoms. This means that people can spread the virus before they even know they have it.  This also explains why the death rate we see reported seemed to go up very suddenly.

Most people will have some symptoms, but most will be quite mild. This could be a slight fever, cough or tiredness.  A small number of patients will experience diarrhea.

Some people have also reported a loss of smell when they have COVID-19, this usually returns within 1-2 weeks.

Most people will be no longer be able to pass on the virus after 2 weeks. Although people who have been in intensive care seem to have the virus for longer.

The main spread of coronavirus is by aerosol (liquid droplets that remain in the air, for example from a cough or sneeze). Some cases have been transmitted by surface contact. Therefore, the main protection is to keep distance (1.5m-2m) and wash your hands often.

How long will we have a restriction on our daily lives for? When are things likely to go back to normal?

COVID-19 is likely to come in waves; where we will see a lot of cases and then it will slow down before coming back in higher numbers again. The top of the first wave of COVID-19 cases and deaths is expected to be in the next few months (April-June). Numbers may reduce in the summer until the autumn (November-December) when they may increase again.

Most European countries are trying to limit the spread of the disease by using a containment policy. This means by enforcing social distancing, lock downs and other actions. The impact of these actions on the economy is huge.  It is likely that restrictions will be lifted to limit the effect on the economy in different countries. This means that it is likely that the infection rate will rise again.

Are there any treatments for COVID-19 at the moment?

So far there are no effective treatments for COVID-19. But there are trials underway, some being run by The World Health Organization (WHO). We will not have any clear evidence until later in the year.

Are there any vaccines for COVID-19?

Studies for a vaccine are being fast tracked. However, you need to make sure that vaccines are safe.  9 in 10 people who get COVID-19 have mild symptoms. This means that a vaccine that causes big side-effects could cause more harm than the disease. We need to make sure that the vaccine doesn’t cause any big side-effects, so we will not have a vaccine until next year at the earliest.

Why aren’t children getting seriously ill with COVID-19?

The younger you are the less likely you are to be ill or severely ill with COVID-19. This could be due to children being exposed to other coronaviruses more often (i.e. more colds etc. in schools and nurseries). Antibodies produced from these other coronaviruses may in part protect from COVID-19 and give them better immunity.

Another reason could be that you need a special lymphocyte (white blood cells – the bodies defense mechanism) activation to cause a severe response to COVID-19. Children have less advanced immune systems than adults and so cannot make this response.

Does smoking increase the chance of getting COVID-19?

There are no studies about this. However, smokers are probably more at risk, as smoking damages the linings of the airways and provides an entry point for the virus.

Is there a link between high air pollution and COVID-19?

We will need to wait for some more evidence to be sure about this – but at the moment cities with high levels of pollution have seen more COVID-19 cases. But this could also be because these are the areas with the highest population levels.

What is the impact of COVID-19 on people living with lung conditions?

The current data from China and Italy do not show a very increased risk of COVID-19 infection or risk of death if you have long-term lung disease. Most deaths from COVID-19 so far are in people with underlying conditions such as chronic heart disease, hypertension and diabetes. It is not clear why this is the case.

Are there any mutations of the virus so far?

There are currently two strains of the coronavirus. S in the original strain and L is the mutant. The two different versions do not appear to be more or less dangerous than the other.

Does coronavirus impact people with immune deficiency?

There doesn’t appear to be any higher risk for individuals who have impaired immune systems.

What is the long-term damage to the lungs if you have had COVID-19?

At the moment, there does not appear to be any long-term lung damage for people who have mild symptoms or even for people who have been on a ventilator.

Does COVID-19 affect men and women differently?

Men have a higher death rate from COVID-19, however this is the same for all infectious diseases.

Are you immune to the coronavirus once you have had it?

There are  no clear data in humans yet. However, some studies have found that when animals are infected for a second time with coronavirus they have some levels of immunity. We do not know how long this protection will last. It will depend on whether the virus changes.

Do you think there will be any positives coming out of this pandemic?

The impact will be very large, many people have lost their lives and many people’s lives will forever be changed because of that. The economic impact will be massive, and this will be a big issue for many countries. But there  may be some positives for respiratory infections:

• We will see the positive impacts of a reduction in air pollution
• This pandemic will highlight the importance of vaccinations and why it is so important for everyone that we have them each year