The European Center for Disease Control (ECDC) is the institution at the helm of Europe's defence in matters of control, surveillance, and recommendations on how to deal with the novel coronavirus. Its head, Andrea Ammon, is a renowned German epidemiologist, who had advised the German government during the earlier Sars and bird flu epidemics, and before that she led the epidemiology department at the Robert Koch Institute.

In an exclusive interview for N1 Television, dr. Ammon talks about what we know about the virus so far, measures imposed throughout Europe to fight the disease, and the possibility of a second wave of the pandemic.

You are in the centre of our universe these days, as you are coordinating these efforts in fighting the unknown, because we all as human beings, you know, are scared of the unknown, but you as scientists are dealing with it. Recently we saw that restrictions are easing all around Europe, concerning the somehow positive picture that we have now in terms of contagion. But you said that we have to be careful, and that the second wave is not basically the question of if, but how and how big, so can you just tell us the estimation at the moment?

Well I meant by this statement that the question is not whether another wave is coming – it's the question of when and how, how big it will be. And the reason is that, I mean, this virus is new to the population of the whole world – because it wasn't recognised before – and what we see now is that only a small part of the population so far has been exposed to it. That means that until we have an effective vaccine for everybody the rest of the population is at risk of getting infected – if we don't take measures.

And that is the assumption, that now when we are easing the measures – because the measures have really brought the figures down – but now when we are easing the measures, then of course the risk is that the case numbers rise again. And that is something that needs to be monitored, very, very carefully. This is why we said that before easing measures countries need to have a surveillance and monitoring system in place. They have to have testing capacity so that everybody with symptoms can also be tested.

And they need to have good contact tracing facilities and mechanisms, so that when there is a case, everybody who was in contact can be identified and put in quarantine. The other piece that is very important is that there is good communication to the population, that they understand why they still have to comply with measures, and that they also feel that they now have means, ways on how to minimise their risk.

You've mentioned several things we'll go through all of them. So what's now the percentage concerning the testing that has been going on in various European states. So, is there any estimation, what was the percentage of EU population that was basically exposed to the virus?

The figures that we that we have seen are really varying. Sometimes within a country, but definitely between the countries, it depends how heavily the area was affected, and the figures range between 2-3 percent to a maximum of 10-14 percent – which is not a big proportion.

So, basically, more than 95 percent of the population overall was not exposed to something that is new to us, and we still don't know how to how to handle it basically.

Yeah. I mean, we know how to handle it now, better than in the beginning, because now we know more about the virus.

You've mentioned tracking methods and surveillance systems. You've worked before and also at the Robert Koch Institute, your were an advisor for the German government, you did basically the whole mechanism of surveillance of disease and prevention in Germany. So how can we be effective concerning that, okay, we have recommendations on the level of the European Union, but basically countries are still being left to deal with health on their own.

Yes, that is the legal situation, that health and health care is the responsibility of the countries. So we can give advice, we can provide the evidence what is working, and provide options what can be done. But in the end, the choice is up to the countries who are responsible – and in the end, also, accountable, of course,

The summer is coming. Some countries which rely heavily on tourism – one of them is Croatia – are starting to open the borders to kind of facilitate the receiving of the tourists to save their economy. How hard will it be to monitor such kind of situation?

Well there are guidelines that have been published for tourism establishment, but also now we have, together with the European Aviation Safety Agency, issued some guidelines for airports and airplanes, both for passengers and for crew members. And with these measures the risk.. I mean, they aim at minimising the risk and maximising the safety.

The risk will not be zero, even with this measures, and I think this is important that people understand, and this is not to scare them, but to keep them alert that they they have to really follow these measures. And the monitoring – that is what I said is one of the prerequisites, in order to actually go this way. So, I mean we of course keep an eye on this, on the European level, but the countries need to do this also for their own area.

You've said that we basically now know much more about the virus than we did at the beginning. So who is this friend of ours, who will maybe visit us again, and who is still between us, in the population?

Well, it is a virus that, although it's a coronavirus, it's new, it has completely different characteristics than the corona viruses that we know about. And it is very easily transmissible. And we have also learned that people who are not symptomatic, or not yet symptomatic, can still transmit the virus. So these are kind of some things that we have learned, that also has implications on the measures to be taken.

But we cannot – or can we – now speculate or you have some scientific evidence about it, you know, is it going to be a seasonal thing, you know, all the speculations that been going around and stories, is it going to, in a way, disappear as the first Sars, or is it going to, I don't know, does it behave differently, as we see?

It behaves differently, and from that perspective, I personally don't think it's very likely that it will completely disappear. I mean, I don't know, but I don't think from what we see it's very likely, there might be that over the summer there is a seasonal reduction, but it will not go completely away, that I don't believe

You've mentioned travel restrictions and all these, basically, recommendations that we have. Can we talk about these ideas that are circulated around about immunity certificates or these tracing apps to be completely reliable, or do we have to trust, you know, the politicians and the government's, who are basically running the policies?

So there are two elements that you mentioned. Tracing apps – I think they can be a supporting tool in this whole contact tracing. The most important part is that they will not replace the contact tracing that you need people for. And the other important aspect is that these apps need to trace the contacts across borders, so that is very important.

Regarding this immunity passport – we still are developing our knowledge about the immunity of persons who have been through this infection. And that is something also that is evolving. So far, we have some some encouraging signs that actually there is an immunity, but we don't know for sure yet. And until we know for sure, these immunity passports, is something I would put a question mark on that. It might be something that will change, and we will keep an eye on this, but at this moment I will put a question mark.

You've mentioned the second wave. So, we know that we kind of get out of this, dependent on the country, more or less now, by locking ourselves down. Your centre is located in Sweden, Sweden had its model. So, do you think that we'll be acting in this second way when and, you know, depending how big it is, in the way that Sweden has, or the other way around?

I think that is something that we have to see, we have to really now monitor what's happening when these measures are eased. Because what we don't know yet is about the impact every single of these measures had – because there were school closures, closures of restaurants, and so forth. We don't know what the impact of the single measures is. We know that the package works, that we know. But what the single measures’ impact is, we don't know yet.

So we have to learn, and also what I see is that countries are not completely abandoning the measure, but they're modifying it. And maybe that is the way to go, that it's not a complete lockdown, but a modification of these measures that will be enough to hold the increase of cases at bay. Because the main point is also to have the increase of the number of cases not above the capacity of the healthcare system being able to deal with them.

You've mentioned immunity. So we've read, in your reports and in the reports of other epidemiologists around the world, talking about different manifestations let's say, you know, about what can develop out of this virus, or what can virus do to people's organisms, depending of their state. So maybe you can just collect this knowledge and tell us, in that sense, what we know? So, some people can walk and transmit it without knowing it, some can evolve what kinds of symptoms… Because we saw different variations, you know, of people dying with, or by, this new coronavirus, but can you just sum it up, because people don't have, you know, the real information, I think.

I mean what we see from the data that has been reported to us is that the main symptoms is really fever and cough. There are a number of other symptoms that people can have – diarrhoea, you know, muscle pain, congested nose… But the main symptoms are really fever and cough. And what we also see is that around 30-40 percent of the cases are hospitalised. That doesn't mean that they all need intensive care or critical care, but they are severe enough that they are hospitalised, and then it's around 15-20 percent that really need critical care.

Talking about what we read, we heard that the hospital Mount Sinai announced several weeks ago that they saw blood clots being developed very fast, for example, and you've issued also one analysis about these symptoms that develop in a certain percentage of children. Can you tell us a little bit about it?

Yeah, that is a symptom, signs of inflammation. That has indeed now been observed in a very very small proportion of children, because what you need to be aware of is that it's only a very small proportion of all cases are actually children, and of them, only a very small proportion gets severe disease, and a small proportion of these with severe disease, actually get this syndrome. So we're still talking about a very very rare condition. But, I mean, of course, if it's there, then it has a high impact. So, paediatricians in particular, but also general practitioners, need to be aware that this is possible.

How difficult was for you personally, because you're a woman of science, all your life was to fight in one way the political discourse in this crisis, and on the other side, the disinformation and fake news that overwhelmed us unfortunately?

Yeah, I think the issue of disinformation and fake news is very very difficult. The only way that I see is that there are, you know, trusted sources for the population where you can say “Well, if you go there, they you can find the right information.” Because running after all these false messages will take, I mean, it takes really a lot of time that you can better invest in something else. Nonetheless, of course, some of the real bad and obviously wrong information that is circulating – we also have to put right

And talking about this, there is lots of dissemination of disinformation concerning a possible cure. We know that basically the only prevention to a virus, still, as a population, is a vaccine, at the end. And we saw the other day that WHO announced that they stopped this testing of hydroxychloroquine that American President Trump announced that he is going to take, or that he was taking. So, how this kind of putting out this kind of information, basically, is not helpful at this moment?

So, the status right now is there is no vaccine, and there is no licenced drug. There are clinical trials going on, where hydroxychloroquine is also one of the arms, and that is something that has been stopped now, until it's reviewed by experts. But there's currently no licenced drug, and the importance is also that at the beginning, these positive messages about certain drugs came out of very small groups of people that have been observed. And that might not give the right picture. This is why, also, our sister agency, the European Medicines Agency, has said Well these trials have to be big enough, so that you can actually make conclusions.

Talking about this, there was a huge debate about the transparency of China. We saw the critics of the World Health Organisation. And German EU presidency announced, before the pandemics, that one of the key points of this presidency is going to be the EU-China summit concerning the trade, but now we have also this issue being raised within the European Union. So basically the trustworthiness towards China. What do you think in terms of public health and sharing information of this kind, should be put out towards Beijing at this summit, or before it?

For me, this is a question that I have been asked many times. And in particular, at the beginning when the origin was in China, and when Asia as a continent was mainly affected, we had a collaboration with the Chinese CDC and the colleagues there, we were in contact with them from the very beginning, and they were providing us with all the information they had. Whether this was all the information that was available, I have no way of assessing. So, that's for us, not not possible to say.

People say that in this crisis, the collaboration of the international scientific community was never seen like this before. Everyone is searching for a vaccine, everyone says that it will be available to all when it comes out, and it's tested rightly. How do you assess basically this… Let's talk about Europe, European… How can I define it, this European cooperation and collaboration concerning public health issues, you know, public policies, big pharma, public health, commercialised things?

Well I think we have to be aware that it's the commercial companies that in the end, will produce the drugs and the the vaccines. But of course, there has been also from the side of the European Commission, huge amounts of money that have been made available for the development of such a vaccine.

Now, whenever there is a positive candidate coming out of the currently ongoing trials, they will have to go through a licencing process. And at the end of the process, the production will start. So, we have to be also very clear about that at the beginning, there will not be enough vaccine to vaccinate everybody. So what we are discussing right now is who would be priority groups.

And, any answers to that?

No, we are still discussing that, that is not clarified yet.

But the stance of ECED is that it should be, you know, for everyone, not some groups that are being prioritised in the not the positive discrimination side.

I mean, In the end, of course, we would recommend, at least for adults. For children, we will have to see how the picture will evolve, they don't seem to be so affected, but definitely for adults, everybody should be able to be vaccinated. But I mean in terms of the priority groups, we really have to discuss with countries, and with our experts in the countries

From UN expert level down to Europe and all around the world, there has been warnings over the years that, you know, the pandemics can be looming, that there are zoonotic viruses that are present, that we have to build up our preparedness, and safety, security measures towards this kind of pandemics. When it finally hits, from the experience that you now have, what do you see as the main obstacles, or positive sides maybe, of EU and global cooperation in disease prevention, in surveillance, for our future, because we are not going to be left alone?

I think what this pandemic shows is that in the end it is a global issue. So, there is no way that one country alone can solve the situation. And there has to be a collaboration. I think that becomes quite obvious. The other point, what I also think that we can see here, is that health is actually really linked with every aspect of the society, especially also the economy. I mean, for me having worked in public health that was always clear, but I believe that now it's evident for almost everybody. And I think this is a good thing, because it may help in the future to see health not only as a cost, but really as an investment. And that I think should be a good outcome.

And as an epidemiologist who worked with these kinds of diseases all your life, we know how we live. We are a globalised world, we are urbanised world, we are mobile world, interconnected world. We penetrate into nature, we, you know, keep our animals for farming, we go into wildlife. So what can we do as human beings in that regard, maybe to kind of stop this mixing that we see through years, through various viruses that we experience?

I'm not sure we can stop it, but maybe we can learn to better deal with it. The impact of this pandemic has been so fundamental that I believe there will be very thorough evaluations, and lessons learned, not only for the health area but as I said for the whole society. And I think that we can really learn how to better deal with our planet that we have here.

Our mouths are full of these words – virus, vaccine, immunity. But what is virus? I know it's a chicken and egg story, but we read a lot of the origins of the virus, and I don't think that anyone fundamentally explains to people who is, what is, the virus, as such.

Viruses are actually a very interesting entities. They're not really living because they need another living organism to actually propagate themselves. So they always need another living cell to multiply, and that depends on specificities of a virus, which cell it is – if it's a human cell, or an animal cell, or whether it's a cell in the nose, or somewhere else in the body. And that determines what kind of disease a virus will cause.

Public health for Europe now.. You said that we will have a lot of lessons for us in the future. How important it is for Europe to invest in public health, and to have this kind of security for a wide range of the population?

I believe this is one of the points that will be discussed once we have done, sort of a lesson learned review of how we dealt, what happened, what went well, what needs to be improved.

And for the end, just once again, we are heading to the summer, people in the streets I look at from my balcony, they are very relaxed, they're not wearing masks, they're, you know, hanging around in larger groups now. So just to repeat once more, what will be your recommendation, until we find out, you know, how can we tackle this virus finally?

My message is – the numbers have gone down the virus is not gone. So, whatever kind of vacation we have in the summer, it will not be comparable with what we are used to in the past years. So we have to keep our distance, we have to adhere to the hand hygiene, and to the covering etiquette, and wearing masks, if the distancing is not possible.

Is Ms Von der Leyen listening to you?

She is.

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