Drosten: "I regret that in hindsight"
*Few experts have been in the public spotlight during the Corona-Pandemic like Christian Drosten. Millions of people listened to his podcast in uncertain times, and politics relied on his assessments. Now, the Charité Virologist is back - this time with a book he wrote with journalist Georg Mascolo. In an interview with ntv.de, they discuss how this reconstruction could look, what mistakes were made, and if a new pandemic is already looming.
ntv.de: Mr. Drosten, the World Health Organization declared the international health emergency due to Corona - and thus the pandemic - officially over more than a year ago. But people are still getting sick - and it's not just a little cough. Is the pandemic really over?
Christian Drosten: Yes, it's over as a pandemic. We expect a summer wave across all of Europe and other parts of the world right now. Some variants are particularly good at escaping immunity. Therefore, summer waves are still possible. Later, it will probably only work for the virus in winter. However, the disease is currently limited in its peak by the broad immunity in the population. We don't quite know yet how often an adult has to get infected to not notice it anymore. It seems that's not enough yet. Many people have had two, three, or even four infections behind them. And yet, they are still getting sick when they get this variant. Many are still feeling a little feverish and generally unwell.
But the Coronavirus is harmless to us now, as it was at the beginning of the pandemic in 2020?
Drosten: We're at a point where many would have liked to have the Coronavirus at the beginning of the pandemic: at a level of a normal flu.
So we won't have to worry about the Coronavirus in the future?
Drosten: I don't think we'll have to fear contact measures, or lockdowns, as much anymore. These things won't be necessary.
So it's all over? That's also the title of your book that you wrote with Georg Mascolo. It's interesting that there's a question mark. Are you expecting a new pandemic?
Drosten: I read this question mark more as a question a doctor asks a patient during a follow-up visit: "Has everything passed?" "Surgery went well?" "And how are you feeling now?" I don't necessarily want to warn about the next pandemic right away. However, I believe we need to look ahead. From an epidemiological and medical perspective, we can never give absolute reassurance. We need to stay alert.*
Avian flu H5N1, which is currently spreading among dairy cattle in the US, seems to be at least a concerning candidate for the next pandemic...*
Drosten: H5N1 is an issue. We have known the virus for a long time, essentially since the end of the last millennium. And the virus keeps changing. The variant we have now is not as concerning as one that circulated in animals a few years ago. The unique aspect that is currently emerging is the transmissibility in chickens. We have not seen that before. And it does not spread like usual through the respiratory tract, but through the liver tissue in the uterus. This currently leads to a mixture of curiosity and perplexity as to how it all works, how it came about, how the virus can be contained, and what risks result from it. However, there is currently no reason for alarm for the general public. It is rather a reminder of politics that such an event should not be left unattended, but monitored and controlled.
Georg Mascolo: No one can say at this point how H5N1 will develop in the USA. But it is significant that we are dealing with this topic again at the publication of the book. We have seen that pandemics have not only health, but also social consequences. They truly change the world. And that's why it's necessary to document a series of experiences for the next time. To learn. It's certain that this won't be the last pandemic the world experiences.
How big is the risk that the avian flu virus makes the leap into humans? Is H5N1 the next virus whose pandemic potential we underestimated?
Drosten: It's difficult to assess the risk on a typical scale of 0 to 10. However, one can say that if you give Influenza viruses (to which H5N1 viruses also belong - Anm. d. Red.) a lot of time or a lot of infection opportunities, they will adapt in some way. Currently, H5N1 has such opportunities because it is now present in a food source, namely in milk. This is new and it should be closely monitored. In addition, Influenza viruses can reassort, that is, combine with other Influenza viruses. What will happen next winter, when the influenza season starts in humans again? People who contract the avian flu virus may have a human virus in the background. A reassortment is not always given. Some Influenza viruses can mix well with others, some not. For H5N1, we don't know that yet.
If a pandemic were to occur through avian flu or another agent, would we be better prepared? Have we learned from the Corona crisis?
Mascolo: One would hope so, but we have not yet seen a systematic political, scientific, social process of reflection. I find it particularly sad that the loudest call for reflection in this country comes from the AfD and from this political corner. They bask in the claim that all others, the media, the science, the established parties, have something to hide, are afraid, and want to make decisions in the pandemic once again. Only the AfD wants to clarify what really happened. And I believe that we should not let them have this narrative. This form of reflection and transparency owes itself to the state itself.
And how does it look in science, Mr. Drosten?
Drosten: In science, there is no formal process, but it would also be useful for us. It's not about who is right or wrong. It's about saying which information was correct and which was incorrect. What could we have correctly assessed? What did we make of it? What do we need as a basis next time? Which investigations do we need to carry out earlier? Which ones didn't help at all? Such things would be good for scientific processing.
Let's go back to the beginning of the pandemic. In February 2020, we still knew relatively little about the new coronavirus. After the first infections and deaths, there followed lockdowns, school closures, hygiene rules. Mr. Drosten, can we now say which of these measures were effective and which were not?
Drosten: Yes, we can say that quite clearly. We have now completed the evaluation process for the year 2021, that is, the time of lockdowns and non-pharmaceutical interventions. For example, general contact measures such as lockdowns, group size restrictions, and similar measures had a strong and clear effect on disease burden, infection numbers, and death numbers. And then there are variations. For instance, school closures also had a clear effect on the same parameters. The same applies to measures at workplaces, such as home office regulations, testing at workplaces, or the limitation of attendance in offices. For hygiene concepts, the evidence is weaker, such as frequent handwashing or specific rules, like how long you can stay in a room. The effect is difficult to prove. Part of the problem is that the studies were not designed correctly.
Frequent handwashing, in contrast to school closures, has no consequences, except perhaps rough hands. However, the after-effects of closed schools are still affecting children and adolescents. In the public, there was an impression that you played a leading role in political decision-making. Is that true?
Drosten: No, that's not true. That's a media attribution. In the first phase of the pandemic, when schools were closed, I thought it was still a bit early for that. In Germany, we had the advantage that we had already installed PCR diagnostics nationwide when the first cases came. Therefore, we could precisely identify where our outbreaks were and limit them locally. That's also stated in the resolution of the Ministers' Conference: It is only recommended to close schools locally and temporarily.
Why were schools closed nationwide despite that?
Drosten: Politicians at the state level made that decision. These school closures had no direct connection to the scientific advisory process. However, they are understandable in a certain way. At that time, we knew nothing about this virus. We didn't know if there were specific damages for children. Imagine a federal state closes its schools, and another one does. And then there are minister-presidents who say: In my federal state, all children in my federal state can get this virus, in my federal state, there is no protection for the children. That's not feasible. It was like a chain reaction that one federal state after another closed its schools.
It shouldn't have been the last time schools were closed.
Drosten: During the second school closures in the Winter Wave 2020, the situation was different. With new data, it became clear that the virus was evenly distributed among all age groups. Therefore, we told politics that it didn't matter where measures were set, it only mattered to reduce the total number of contacts. Where that was done was a political decision. In Germany, it was decided to make fewer people go to workplaces and make more in schools.
Was this decision a mistake in hindsight?
Mascolo: In this regard, Christian Drosten and I agree: It shouldn't happen again. Above all, during the pandemic, the question was: Who really bears the burdens? This is something that people are still preoccupied with. We should have said much earlier: We will defend the opening of schools and kindergartens until the end. And we try to use every other means available to us to limit contacts before we land back with the children. For example, through restrictions in the economy. However, for a long time during the pandemic, the mechanism was rather the reverse. This is an experience that is worth holding on to.
Meanwhile, many politicians have said that the school closures may have been a mistake. One might recall the statement of the then Health Minister Jens Spahn: "We will have to forgive each other a lot." Mr. Drosten, did you make mistakes?
Drosten: I certainly made scientific assessment errors. For example, when the Alpha variant came, the first variant that suddenly spread again. I found it hard to believe because I didn't see the signs from the lab. I had to trust the calculations of epidemiology, and that was a bit shaky for me. I made false assessments here and there in this degree. Also, when the studies on vaccines came. They provided very convincing data that these vaccines initially also contained the transmission.
But it turned out differently...
Drosten: After a while, more precise information came that the vaccine protection only lasts for a certain time, approximately 1.5 years. Then the virus came and mutated, which we hadn't really reckoned with. During the Delta wave, it really took off, and the transmission protection was only minimal. We needed a third vaccine dose for a stronger disease protection. And with Omicron, there was almost no transmission protection left. With the dissipating virus waves, it is difficult to catch up with the data on transmission protection. Until we get it, months have passed. And it was really also difficult, from a scientific perspective, to catch up with the complexity and also to communicate it to the public.
With some of your colleagues, you go hard after the court when you write: "Unfortunately, there was a whole series of people within science or from their environment who spread significant minority opinions or even demonstrably false assessments on a broad stage." It is no secret that you mean Hendrik Streeck or also Jonas Schmidt-Chanasit. Why didn't you publicly contradict their positions? For example, when it came to the lockdown in the Winter Wave 2020?
Drosten: I mean, at the time I had the feeling that I was contradicting myself, yet I didn't name or attack anyone. The reason being, it sets a false focus. The public would then just focus on a sort of chicken fight, rather than what the supposed fight was actually about. Looking back now: It happened as it happened. There was an ineffective lockdown and many deaths in this wave. And in the end, we had to impose more measures after the new year. Politics then decided on the additional school closures. All of this happened at a time with less than optimal knowledge and data. And I regret not speaking up again in the public sphere and saying: This can't go on.
What held you back?
Drosten: One must admit, it was a different media climate back then and I felt that I couldn't and didn't want to continue with the public exposure, which I already had. That became dangerous at some point.
Mascolo: But this is about something big, it's about the question of how we actually organize scientific consultation in the future, no matter what the case may be. How do we establish understanding for the integrity of scientific processes? How do we deal with dissenting opinions? Given the conflicts that have arisen, it's difficult for us to find this out for ourselves and for science in Germany. Christian Drosten suggested in our conversation that we should look for a group of wise scientists and scientists from abroad who have not played a role in the pandemic in Germany. You take a look from the outside, without a Hendrik Streeck or a Christian Drosten. I find that an interesting consideration. Why not choose experts who are completely neutral in these matters and let them take a cool and detached look at the question of scientific action in the pandemic?
Wouldn't you be involved in the internal political processing, Mr. Drosten?
Drosten: I find it unthinkable that those directly involved could be selected as experts in the future, for example for an Enquiry Commission. I don't consider that valid. Such a thing would also be against all rules in science. We don't evaluate our own scientific end results and products. We always let neutral persons look at them, in most cases from abroad, because they are neutral due to the distance. I would also refuse to appear as an expert if the proceedings are to be judged. In retrospect, I can say that I have always made all my statements transparent. The podcast protocol is the protocol of my statements. I have never said anything in political consultation other than what is recorded there.
With all the experiences you have gained in the last four years, would you still take on the same role in the case of a new pandemic?
Drosten: I am also always in favor of only talking about things we truly understand. H5N1 is now a tightrope walk for me, I don't work on Influenza, that's not my expertise. Of course, it's a respiratory virus that is similar to Coronaviruses in the way it is transmitted. And I currently have a certain reach, but I don't feel the need to step into the public spotlight right now to issue major warnings, as I don't yet find that this situation exists. My role might be, if such a situation ever arises, to help the people who truly know about this virus, perhaps to give them a voice. But as a subject matter expert, I'd rather stay in my field. And that's just the Coronaviruses.
Interview with Christian Drosten and Georg Mascolo by Hedviga Nyarsik. The conversation was shortened and smoothed out for better understanding. You can listen to the entire conversation in the podcast "Wieder was gelernt".
Drosten mentioned that H5N1, a strain of avian flu currently spreading among dairy cattle in the US, could potentially be a concerning candidate for the next pandemic.
Drosten emphasized that while H5N1 is currently not a threat to the general public, it's important to monitor its development in the US closely due to its potential for reassortment with other influenza viruses.
Mascolo mentioned that pandemics have not only health but also social consequences and that it's necessary to document their experiences for future reference, emphasizing that there will likely be more pandemics in the future.
