About SARS-CoV-2 virus mutations, epidemics and chances for survival. Interview with Prof. Krystyna Bieńkowska Szewczyk, Head of the Department of Molecular Biology of Viruses of the Intercollegiate Faculty of Biotechnology UG and GUMed

It's summer, we all want to relax after a tough year under the threat of SARS-CoV-2, but another mutation of the virus has emerged - the Indian one. How much more dangerous is it than before and what do scientists already know about it?

It is a variant of the virus containing several mutations that make the virus capable of increased transmission. All it takes is a short contact, probably even a few seconds in the case of unvaccinated people, to become infected. The mutations of greatest concern are related to the region of the viral protein that binds to the receptor in the cell, the main "key" to the cell. It acts as an 'intermediary' between the host cell and the virus. It has a very important region that recognises a particular fragment in the receptor protein. The problem is that this is the same region that is the main target of neutralising antibodies, i.e. those that block the entry of the virus into the cell. So if the virus altered this region a lot, it would probably be unrecognisable by the antibodies as well, but it could not enter the cell either. The changes therefore occur selectively. There are such viral particles, in which small changes cause the protein to fit better into the cell receptor which acts as a "lock", but is still recognised by neutralising antibodies. In the case of the delta, Indian variant, very short contact with the receptor is sufficient for the virus to enter the cell. This means, that more viruses enter the cell, which then replicate and infect all the cells around, producing more and more new viral particles. Therefore, the dynamics of infection are also definitely increased. The delta virus is also said to be more pathogenic, but the course of the disease itself is unlikely to indicate this. It seems to be more the amount of virus that multiplies so quickly, that causes the acute course of the disease. It is clearly a virus, that has a remarkable capacity to mutate to better cope with entering the cell and spreading. This is related to the scale of the infection: millions of people are infected and, statistically speaking, the chance that there will be a selection of those particles that are the fittest, the best adapted to the 'host', is huge. So the race is on - if we do not minimise the scale of infection, the area in which the virus can change will continue to be gigantic.

Will currently available vaccines protect us from the Indian mutation of the virus?

Certainly, and we have the figures to prove it. Most come from the United Kingdom. The delta variant is now responsible for ninety-nine per cent of infections there, but people who have been vaccinated twice are very well protected. They can still become infected, but there is very little chance of them getting the disease. Worse for those vaccinated with a single dose. In the UK, an early attempt was made to vaccinate as many people as possible with at least one dose in order to halt the spread of the epidemic. This was a sensible policy at the time, but one dose gives a lower degree of protection. As a result, people vaccinated with just one dose also become infected, but this is still a very small number compared to the unvaccinated. However, there is no doubt, that vaccines do protect. The dynamics of an epidemic can be compared to a fire. If there are a lot of flammable elements in its path, it will spread much faster. Such outbreaks are sustained by unvaccinated people.

But Poles do not want to be vaccinated. How, and if at all, can we still convince them that COVID-19 vaccines are safe and worth vaccinating?

Since the vaccination rate in Poland started to decline, I keep saying all the time, that the authority of the Church, which is important for many people in Poland, especially the elderly, is important. I am glad, that the bishops have finally decided to support the vaccination campaign. But it could have been done earlier, because we are facing the fourth wave of the epidemic. The question is not whether it will come, but when. The least vaccinated people are in Podkarpacie, where the authority of the Church, individual priests, parish priests, can be very helpful. There are still some older people in Poland, who find it difficult to get to the place of vaccination, or the arguments about the effectiveness and safety of vaccines do not reach them. In this case, the announced individual invitations and persuasion through local structures may be effective. We also have to deal with the problem of reaching young people, who are not only reluctant to be vaccinated, but also ignore the disease. They do not wear masks in shops or on public transport. I sometimes see on their faces the challenge: 'I don't care, it doesn't affect me'. They may be encouraged by all sorts of certificates or covid passports, allowing them to travel, to go to concerts. But we have to remember that there is still a very large group of people in Poland, who are not convinced by any arguments and incentives, including material ones such as lotteries or competitions. I would opt for quite radical measures - for example, placing plaques in various public places with images of people who died of Covid - 19, people from the closest environment,who someone knew, liked or perhaps admired. If there was a plaque in front of every municipal office and in every parish with the inscription: "These people are gone, but some of them could have survived if they had been vaccinated", perhaps it would have changed the mindset. The fact is, that young people are mostly mildly or asymptomatically ill, but they infect their loved ones and others. They themselves also increasingly die or have to treat the dangerous consequences of an asymptomatic disease. People, who are not currently vaccinated, are disregarding the chance of saving their lives.

And compulsory vaccination, is that not too radical way?

They should certainly be compulsory for healthcare workers, not only for doctors, nurses and paramedics, but also for technical staff.  It must not be the case, that coming to a clinic or hospital puts one at risk of contracting Covid-19; vaccinations there must be universal and compulsory, and the same should apply to employees of care homes, carers of children and staff of nurseries and kindergartens. In my opinion, any company employing workers, who have to produce a health certificate before being employed, should have the right to demand that a vaccination certificate be part of this certificate. If coronavirus outbreaks recur, such vaccination could be included in the routine general vaccination programme.

What can we say about the survival mechanism of the virus so that we are aware of the threat we face?

It is important to realise, that there are mutations of viruses which do not just affect the process of entering the cell, but also the process of manipulating the immune system. Typical for viruses is that they try to "escape" to a large extent from the immune response, also from the whole organism, that is from T lymphocytes. But the virus has its own mechanisms to weaken such protective measures on the part of the body. There are plenty of proteins, that serve the virus to take control of the cell. Coronavirus produces about thirty proteins and only a few of them build the viral particle. The others are used to replicate the virus, but also to control the cell, which slowly becomes an "incapacitated virus factory". This is a process that we have to fear, because we have to reckon with the fact that the virus will get better and better at dealing with the immune response. Not only will it become less and less sensitive to antibodies, but it will find other ways by which it can survive more easily in the body. The real danger is, that the virus may find another route of entry into the cell, not through the receptors known and studied by scientists. This would mean, that the virus could infect other cells. We are already observing this. SARS-CoV-2, in addition to the cells of the respiratory system, enters the cells of the intestines, kidneys and, to some extent, the nervous system without problems. In my experience as a virologist, virtually any viral infection can take an unexpected course, especially if there is a very large-scale multiplication of the virus in the body. This is called viremia: a multitude of viral particles appear in the blood of an infected person, which can reach various organs. Depending on the condition of the body, the presence of other diseases, the infection starts to develop in an unusual way and can be life-threatening. The problem continues to be that the SARS-CoV-2 virus is so abundant, which generates the possibility of mutations, new routes of infection, atypical courses of infection and many other dangers. The example of SARS-CoV-2 shows, that epidemics on a massive scale are now possible and will continue to happen. They are favoured by the global situation - the progressive erosion of the environment and its consequences, such as climate catastrophe. In recent years, we have also experienced very violent weather patterns here in Pomerania on a small scale. But I can still see how, in Bory Tucholskie, deforestation continues on a massive scale. Even the natives of these places rub their eyes in amazement and say they have never seen anything like this before... Cutting down forests will intensify the drought. And drought is one of the climatic factors, that encourage biological imbalance and the emergence of new organisms. Viruses are fantastic opportunists. They take advantage of every opportunity. It seems, that the path from tree felling to virus formation is incomprehensible or indirect, but it exists. With the drought, for example, there are many more ticks and with them more diseases, including diseases as dangerous as tick-borne encephalitis. If the virus does not find other hosts, it mutates very quickly to adapt to new ones. Disrupting the biological balance will have these consequences.

All over the world, especially in the European Union and the United States, there is a heated discussion on releasing patents on vaccines against COVID 19, which would increase the chances of vaccinating as many people as possible, especially in India or Africa, thereby reducing the emergence of new mutations of the virus and halting the development of a pandemic. Is this a solution to the problem, or will it generate further risks?

The release of a patent is insufficient. A patent is a 'recipe' for a vaccine. It is, of course, an elementary matter, but very important is the entire production technology, which involves specialists, appropriate equipment and reagents to ensure that the quality of the vaccine, and therefore its safety and effectiveness, is at the required level. This is a complex biological production, requiring large-scale cell culture, sterility and precision in its individual stages. I know how things are done in the laboratory, but it is a mystery to me how they are done in large-scale production, for example, in large fermenters. Of course, the companies producing vaccines earn billions of zloty and they are not doing so for altruistic reasons. But I also think, that an important aspect for these companies, and the vaccine makers themselves, is to maintain the right standards, which requires a highly advanced biotechnological culture. To do otherwise would undermine confidence in vaccines. After all, false preparations have already appeared. We tested one of them in our laboratory. Dr Łukasz Rąbalski sequenced such a preparation from the black market and it turned out, that there was nothing in it that resembled vaccine mRNA. I am also convinced, that there should be more and more places in the world where vaccines are produced. This process is in fact developing - none of the vaccines available today are produced in just one place, but in a dozen or so different centres, specialising in specific stages of production. Vaccines should be produced on as large a scale as possible to shorten their distribution route, but in a responsible manner.

In February 2020, the Director-General of the World Health Organisation announced, that the fight against the COVID-19 virus is not only about epidemics, but also about infodemics and stated that "Fake news spreads faster and easier than this virus and is just as dangerous". Does the professor agree with this statement?

There is some exaggeration in it. No one has yet died from reading fake news, and contracting a virus is a very real possibility, but it is important to remember that one thing leads to another. Fake news and conspiracy theories are the reason why people do not want to be vaccinated, why they become ill and why they die. We have a problem reaching the public with reliable information. A lot of bad things are happening, because of politicians and the lack of political culture in Poland. Even the President, to put it mildly, has not urged people to have vaccinations. Public debate is at a very low level, there is a lack of trust in state and non-state institutions and in authorities. All those who have any influence on public opinion should use a consistent message based on knowledge and science: vaccines are safe and vaccinations are necessary. However, we cannot control what is happening on the Internet. What we are left with is a consistent stream of reliable information from the various sources available and more active efforts to reach young people on the Internet, for whom this source is their first and often only choice. I am convinced, that our current holiday recklessness and lack of vaccination will be paid for in the autumn. Only one third of the population in Poland is vaccinated with two doses. In September we will go back to work and the children to school, the viruses will be favoured by lower temperatures. The scale of the fourth wave does not appear to be as large as the third. But our health service is devastated, and if even 'only' a few hundred, and not tens of thousands of people were to die because of a lack of vaccinations, as has happened recently, then anyone who makes the conscious decision not to vaccinate takes on this responsibility.

The role of the scientific community in debunking false information has become very important. You are distinguished by your activity in disseminating scientific knowledge in the media, which is not a common attitude. How do you find time to conduct research, win grants and popularise science?

Like everyone else, I live in a constant hurry and "not enough time". But I just really enjoy my work. In the beginning it was molecular biology, since many years virology. It was the most important professional choice of my life. Viruses are enormously abundant and working with them is fascinating. There have been huge technological advances and today we can see them with our own eyes, for example with a fluorescence microscope. However, I admit that if my husband and I had not worked together, we would not have been able to do it... To work with viruses, you have to learn cell biology, microbiology, biochemistry, and then you have to get money for research, which is very expensive, requires special equipment, expensive media, sterile materials.  We started in the late 1980s, working in very difficult conditions. Gradually, we won grants, formed scientific teams, encouraged young people to deal with virology. When it came to disseminating science in the media, I was very reluctant at the beginning, but when I got a positive response, it gave me courage, encouraged me to continue working with journalists. I don't like to make short appointments, because misunderstandings arise from such journalistic shortcuts. It's not so bad if it's funny, but it's worse if it's sometimes misleading. A good form are the so-called “knowledge pills”. Short recordings containing concrete, scientific information given in an accessible way. The recording we made at the very beginning of the pandemic at the University of Gdańsk was very well received. However, we have to remember that not everyone wants to listen to them or read more extensive interviews, which give the opportunity to explain various complicated scientific processes. I assume, however, that any reliable information which reaches at least several people and convinces them to vaccinate will do the job. Therefore, I will not say anything revealing, just 'let's do our job'.

Interviewed by Dr. Beata Czechowska-Derkacz, Institute of Media, Journalism and Social Communication, University of Gdańsk, PR specialist for the promotion of scientific research