Interview with Stefania Salmaso, epidemiologist at the IEA (Italian Association of Epidemiology). In recent days the curve of contagions ‘seems’ to have reached a plateau, but it is difficult to make predictions about the future because the virus ‘finds its ‘fuel’ in people who are still susceptible’

To protect against severe forms of the infection, then, it is important for everyone to complete the vaccination cycle and for the frail and the over-60s to take the booster dose, not to wait for an updated variant vaccine that ‘may not arrive before the end of the year’.

In the meantime, it is a ‘contradiction’ to allow asymptomatic positives to leave home and those who know they are contagious ‘should take all the necessary precautions’, even if by now with ‘do-it-yourself’ tests ‘much is left to individual responsibility’.

In any case, especially in view of the summer holidays, it is ‘complicated’ to stop every cold, which is why if someone is careless ‘everyone else should be cautious’ and preferably wear FFP2 masks ‘even on planes’, for example, where ‘surprisingly’ they are no longer recommended.

Stefania Salmaso, epidemiologist at the IEA (Italian Association of Epidemiology), spoke about this during an interview.

– Has the infection curve reached a plateau?

“As far as the pandemic trend is concerned, the number of new infections has tended to stabilise in recent days, and this suggests that an ‘equilibrium’ has been reached.

But it is not necessarily the case that the plateau indicates a decline in cases, we need to see whether the number of new infections on which we are stabilising, in a sort of coexistence with the virus, will remain high or not. The number of infections, in fact, is directly correlated with the number of severe cases and deaths; so if the viral circulation is very high, it is inevitable that infections will also reach those people who are more likely to experience absolutely undesirable events such as hospitalisation or intensive care.

In short, it is plausible that we are reaching a point where new infections tend to stabilise and hopefully decrease, but there is still a proportion of people (albeit quite small, around 5%) who have previously contracted Covid but reinfect themselves.

In this context, it is then very difficult to make predictions, because we know that the viral circulation finds its ‘fuel’ in people who are still susceptible, such as the unvaccinated or those who have previously contracted the virus.

On the other hand, however, it is now comforting to see that the number of identified infections is not growing at the previous rate’.

– While waiting for an updated vaccine, many express misgivings about the appropriateness of doing the booster dose now…

“The surge in infections has led to an increase in even severe cases, hence the recommendation to do a new booster (or booster) dose even for those over 60. Similar strategies have been adopted in several countries around the world, even in Australia they have recommended the fourth dose for people over 30.

It has to be said that the benefit of a fourth administration is not prevention of infection but of complications, so even with a booster one should not abandon individual precautions.

Certainly this dose is strongly recommended for people who have health problems, those who have already had the first three doses, or who may not have had the infection recently.

We know that the first three doses give us fairly good protection against complications, just look at the latest report of the Istituto Superiore di Sanità: deaths among people who have not been vaccinated or who have not completed the vaccination cycle are 7 times higher than among those who have been vaccinated, as are hospitalisations, which are 3 times higher among the unvaccinated.

The call for everyone, therefore, is to complete the three doses and to do the fourth for the fragile and vulnerable.

I don’t think we will have a new vaccine between September and October, also because for now we are evaluating the effects of the bivalent vaccines that have been developed, which also contain the Omicron variant, but not the latest one.

By the time we have a new vaccine, the virus will certainly have changed again, but after all, a fourth dose done now does not affect future vaccination’.

– But when will those who vaccinate now be able to do it again?

‘I think an updated vaccine with a new antigen will be available by the end of the year.

And between now and five months from now I don’t think there is any problem to repeat the vaccine.

Of course we are making pure assumptions, because we don’t have anything in hand.

It must also be said that it has been shown that these new variants are so contagious that new vaccinations should induce a very high antibody response to prevent infections.

Let’s remember that so far our whole strategy has been to prevent severe events, i.e. hospitalisations and deaths, so in my opinion we need to make access to treatment easier, knowing from the outset that it will still be very difficult to stem infections.

The only way to do this is to take precautionary measures at an individual level, i.e. to wear a mask and to be more cautious in our exposures, i.e. to go outdoors rather than indoors’.

– Going back to the dose booster, do you think it can decide the fate of autumn?

“Certainly not towards the infection: the viral circulation is not inhibited by the fourth dose, because we know that this dose has limited power towards the prevention of infection, whereas it can help to reduce severe cases as we have seen in other countries”.

– Some experts, meanwhile, are critical of the timing chosen by the Ema for the administration of the fourth dose, which should possibly have been extended in the spring to younger people as well. What do you think?

‘A mistake was not made, in my opinion it is right to take countermeasures every time with respect to what the epidemiological picture is.

Putting vaccination in place for the entire population is also very complex, and the action must be justified by the benefit derived from it.

Unfortunately, vaccination does not stop viral circulation, but it does greatly reduce the risk of severe cases; we now have effective treatments, but we need to investigate whether the people who had complications or died had a delay in diagnosis or prescription, or were not recognised as vulnerable. In short, we need to understand if there is room for improvement in order to intervene more promptly’.

– Can asymptomatic positives come out or not?

‘If there is someone who can infect others and if we don’t have any tools to prevent infections, sending infectious people out seems a contradiction to me.

Now with the ‘do-it-yourself’ tests it is clear that a lot is left to personal responsibility, because some of these are not even reported by official sources.

But it is clear that if you know you are contagious you should take every precaution not to infect others, especially in the workplace.

Personally, I am perplexed enough that, internationally, we have had to adjust to the fact that a face mask is not compulsory on aeroplanes, but the fact that it is not compulsory does not mean that it is not useful to wear it.

Not least because it is likely that many people on holiday who realise they are ill decide to jump on the first plane back home.

And this is absolutely wrong: it is true that planes have special filters and that air circulation is ensured, but if you sit next to someone who is contagious and there is no barrier in between, it seems to me at least common sense to put on a mask.

– And let’s hope that the common sense is also there now with the summer departures. Because the risk could be that someone will say, ‘I have a sore throat, but the holiday is booked so I’m leaving…’. Don’t you think so?

‘The Italians up to now have been very good and have done everything they have been told to do. It is clear that regulations dropped from above forcing us to behave in certain ways can last for the time span of a declared and perceived emergency, whereas now everyone has to take responsibility.

It is obvious that if we stop for every cold it becomes complicated, the important thing then is to take all the necessary precautions.

If someone is reckless, everyone else has to be cautious, so it is important to wear a barrier like the FFP2 that blocks any type of infection very well, including the normal cold that our seat neighbour has’.

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Agenzia Dire