Magiorkinis: The COVID-19 Committee, society, the economy and the magic ‘political filter’

In an exclusive interview with in.gr, tanea.gr, and tovima.gr, Professor Gkikas Magiorkinis details the major obstacles that arise in the effort to inform an often distrustful public about COVID-19.

Interview with George Gilson

Gkikas Magiorkinis became a household name in Greece when in late August, just before the start of the inordinately harsher second wave of the SARS-Co-V-2 pandemic that is currently raging in Greece, when he received the “honorific invitation” to become spokesman of the National Committee on COVID-19, a government advisory committee that has managed the epidemic from the start.

An Athens University assistant professor of hygiene and epidemiology, he succeeded Professor Sotiris Tsiodras in the hot seat of spokesman of the Committee – which advises Prime Minsister Kyriakos Mitsotakis on the course of the epidemic and recommends measures that are usually adhered to – just as the going was getting rough.

Yet Magiorkinis is hardly new to the task of making complex scientific concepts and data understandable to the general public, as for him it has been an area of interest for years. His frequent television appearance and print interviews during the first wave of the epidemic last spring amply demonstrate his effectiveness in meeting the challenge.

In an exclusive interview with in.gr, tanea.gr, and tovima.gr, Magiorkinis details the major obstacles that arise in the effort to inform an often distrustful public about the scientific and epidemiological dimensions of the virus in Greece and globally – and he explains the daunting task of persuading citizens to adhere faithfully to restrictive measures.

For the first time he bluntly addresses the problem of “political filters” in the interpretation of scientific views by the public, through which not only in Greece but internationally the judgment of virologists and epidemiologists passes.

These unconscious filters in the general public, he says, distort the expression of experts’ scientific thoughts and undermine their recommendations.

Magiorkinis underlines the Committee’s intense interest in the socio-economic dimensions of the epidemic in Greece and the complex effort to implement the right measures at the right time.

This, he says, necessitates striking the right balance in grappling with the terrible dilemma of whether to lean more toward physical health or economic survival – a balance that can ensure to the maximum degree possible the protection and support of both.

Naturally, he discusses the ongoing public health tragedy in Thessaloniki and northern Greece more broadly.

Hospitals in the region are desperately struggling, with the super-human efforts of doctors and healthcare workers, to stay on their feet.

The plainest demonstration that the crisis has spun out of control there is that patients are being airlifted to hospitals in other regions, as their ICUs are operating beyond capacity.

It is this region that accounts largely for the extremely sharp rise in deaths that of late have exceeded 100 daily and in intubations, which are now at about 600.

A world-class virologist with nearly 100 peer-reviewed papers published in top scientific journals, Magiorkinis offers his thoughts on the three vaccines – for which announcements of over 90 percent effectiveness have already been made – and on their arrival and distribution in Greece.

He refers to the deleterious impact of deniers as well as to achieving the objective of herd immunity, which he says will require vaccination of 70 percent of Greece’s population of 10.7 million.

Magiorkinis says that experts cannot yet tell whether the epidemic in Greece has reached its peak but he notes that until then there will be a rise in the number of deaths and intubations nationwide.

The full transcript of the interview follows:

You have been a clinical virologist for seven years and indeed one of the best. Did you ever expect to live through such a furious pandemic that was sufficient to turn the global economy and societies topsy-turvy?

The truth is that we did expect a pandemic that would create a global problem, but of course it is like big earthquakes. You don’t know when it will occur but you do know that it will occur let’s say in the next 50-years. You cannot pinpoint it precisely.

So we expected it and due to the fact that we could not predict when it would happen, many studied were conducted in order to prepare for things like rapid development of a vaccine, specialised tests, and so forth.

Sars-CoV-1 broke out in 2003, Was a vaccine that was never used developed at that time?

There was planning for a vaccine but because the epidemic ended quickly the clinical trials simply could not be completed.

Did that scientific work prove useful now?

It helped greatly in the study of SARS. Firstly, SARS moves through super-spreading. We knew its mode of transmission. We knew for example – it had been applied on a small scale – about plasma therapy.

On the way we had MERS, which is a closely related virus. Let us not forget that a vaccine for MERS had been developed but was never subjected to clinical trials because the number of cases was not large enough.

AstraZeneca’s vaccine for SARS-CoV-2 is based on such a vaccine. It had been tested on dromedary camels.

For about 10 months you and your colleagues who sit on the National COVID-19 Committee of experts and clinical doctors have undertaken a huge burden with the second, much harsher wave. That means that, along with the cooperation of citizens, the task of saving the country from this scourge by fighting it in a total war is is in your hands. How has that affected your frame of mind? Has it changed you at all as a person? Do you see life differently?

That’s a tough question, one you should pose after the pandemic is over. I think that right now under the weight of the current situation and conditions I have the self-awareness to realise that whatever I may think and feel is small compared to the duty with which we are faced. So I cannot say I have something to share that would be clear given the fact that we have a long road ahead crossing my mind.

Have you felt at any moment that you might not withstand this enormous burden?

I don’t have room for that.

Since August you have assumed the position of spokesman of the COVID-19 government advisory committee, replacing Professor Sotiris Tsiodras. How did you end up in the hot seat?

A proposal that particularly honoured me was made. Under normal circumstances, and because of my research duties, I would have declined. I accepted out of a sense of responsibility and duty.

What are the challenges in the battle as spokesman to communicate to the Greek people the scientific facts of the situation and the necessary behaviours that must be adopted? To what extent do you feel you have managed to persuade?

The most difficult challenge is the distrust of the public that is due to a variety of factors. One is that certain measures conflict with their possible economic interest, not in the sense that they make a lot of money but rather because it puts them I a difficult position financially.
It is certain that the pandemic creates an economic problem. It causes problems in jobs and hence it is natural and to be expected that a certain distrust would arise, without that meaning that there are solid reasons for such a situation to emerge.
The next big challenge in persuading the general public people is because there is an intense politicisation of the pandemic by many at different levels. This is true not only in Greece but globally.
Therefore the expression of scientific views internationally is interpreted through political filters – depending on whether the scientific view matches any particular political narrative – whether it confirms or negates it.
People in general do not look at the scientific view from an exclusively objective vantage point and that creates an additional difficulty in one’s expressing a scientific view as one objectively conceives of it.
I shall agree with the monologue of Valery Legasov [a top Soviet scientist who led the 1986 Chernobyl disaster investigation] in the film series “Chernobyl”: “We scientists are so absorbed in the search for truth that we forget how very few people truly wanted to find it.”

The pandemic gives rise to an excruciating dilemma. How can we balance two vital needs – the physical health and economic survival of human beings? What are your thoughts on whether and how we can handle this dilemma? Has this issue concerned the members of your committee as scientists and citizens?

It concerns all scientists. Logic dictates that any measures must have a proportionality, which means that they should be taken at the right time, which is to say the moment that they will create the least possible problems for people, both in terms of their economic welfare and their political freedoms.

Proportionality always poses a problem. You do not always know when the right time is to enforce a measure. You do not know 100 percent because this particular virus has demonstrated that it has an explosive spread and that it can create huge problems in a very small time span.

Whether or not we are at the peak of the epidemic in Greece there are fears that Greece might experience a nightmare such as we saw in Bergamo, Italy. Which parameters – such as differences between health systems, new therapies, possible mutations of the virus, and the coming vaccine – could avert such a prospect now and in the future?

In any event the only thing that has proven effective is the enforcement of public health measures, which means social distancing either through a lockdown or restrictions on certain activities, and these measures must be taken at the right moment.

Was the reason for the Italian nightmare that the right measures were not taken in a timely manner?

In the first wave I don’t think anyone expected such an intense epidemic based on the initial data coming out of China. Yet there were certain indications. In Wuhan they had built an enormous hospital. They implemented an extremely strict lockdown.

These things should have given anyone a sense of how serious the situation can become. However, the fact that the epidemic was quickly checked in the rest of China gave the impression of a situation that was easy to handle.

Is the difference between Greece and Italy that Athens moved more swiftly?

It was the fact that in Greece measures were taken in the early stage of the first wave. Bergamo preceded the Greek lockdown and there were data. Obviously, we would not have been able to take lockdown-type measures without clear indications that the situation could easily spin out of control.

I imagine that all those terrifying pictures of coffins and such persuaded the Greek people to faithfully comply with the lockdown. Would you agree?

It is what they call the principle of proportionality. You cannot enforce a lockdown without it being absolutely necessary. If it were not for the situations in Wuhan and Northern Italy, with what evidence could scientists request as serious a restriction of individual freedoms as a lockdown?

We have heard of the possibility of a mutation of the virus in Europe. What are the chances of a spread of such a mutation and what would the repercussions be for Greece?

This is one of those viruses that mutate very slowly. There are mutations not only in Europe but also globally. The mutations it has acquired are not sufficient to create a problem and the speed with which it mutates is not great enough to engender concerns. One cannot rule out the emergence of a strain that can circumvent an immune response but that is not an immediate danger based on the profile we see currently.

Greece never lacked a surplus of very good doctors. Why do you think that in the current crisis there is lack of critical care specialists to staff ICUs?

I don’t know. What I do know is that in the years of Greece’s financial crisis a large percentage of doctors went abroad. Many specialists decided to do so because they could not find work in Greece. An intensive care doctor cannot work as an independent private doctor. Once there were no available jobs then or in the immediate future it is natural and to be expected that you will not have a surplus of doctors with a specialisation that is directly linked to hospital care. Given the fact that there was no substantial growth during the economic crisis you obviously will not have such doctors immediately available as they have gone abroad.

How is it that Greece, which in the first wave last spring was considered an international paradigm in terms of the excellent results of its management of the crisis, has turned into a country where in many cities the National Health System has reached its limits?

This specific virus has demonstrated that it is capable of creating exponential epidemics. The fact that the second wave has developed with greater ferocity created a situation that changed the picture in the country, but not nationwide. We must not forget that it is not the entire country that has a problem. In one part of the country there is great pressure but that occurred in a brief time span.

What dysfunctions of the National Health System has the pandemic exposed?

Ι don’t have a clear picture to give you. There is no health system without dysfunctions. I do not think that there is a health system that has handled the pandemic effectively.

What went wrong in Thessaloniki?

Thessaloniki has become ground zero in Greece’s epidemic and its hospitals are in a desperate situation. Why is that?

Whereas for months the epidemic was under control namely because of intensive epidemiological monitoring and the implementation of tailored local measures, suddenly in mid-October, the situation changed dramatically in Northern Greece in a minimal time span.
For us to understand why that happened we must first comprehend what changed dramatically in this region precisely in that period.

A major change in Greece in that period is that entertainment moved from outdoors to closed spaces and that shift occurs somewhat earlier in the northern part of the country than in the southern part due to a slight but noticeable temperature difference in the evening hours.

That fact combined with epidemiological data which show that the impact on the epidemic of the 19-39-year-old age bracket “skyrocketed” – with a hike of about 60 percent over expected infections – point to the fact that Thessaloniki, being the largest urban centre in the north, passed into a super spreading situation that was initially caused by the movement of crowded entertainment venues indoors.

Can we know if the second wave of the epidemic in Greece has reached its peak and what data must one have in order to know?

The second wave of the epidemic reached its peak almost 2 weeks ago for the majority of the Greek territory. There is a constant decline in the number of cases mainly in the large cities such as Athens and Salonica.

Many have argued that light COVID-19 cases would best be handled on the level of primary health care. Do you agree?

I am not aware of whether mild cases actually go to hospitals, but it is certainly best that people that fall into the category of mild cases not go to hospitals. Primary healthcare facilities exist and they are functioning.

European countries like Britain, Italy, France, Spain and Belgium are among those globally that have been hit hardest. Is that because they made more mistakes or simply because they delayed?

It is well known that Britain greatly delayed. In Spain there were definitely mistakes regarding the protection of old-age homes. They did not manage to adequately either those facilities or hospitals during the first wave. The main characteristic is that their programme was unable to protect the vulnerable groups in the population.

How do you judge the EU’s performance as a Union in managing the crisis?

I think that the European Union could have managed things more effectively on two levels. The first level is that of movements of populations. It could have created a common framework in order to facilitate the implementation of measures at member-states’ points of entry.

The second level is that I think the EU could have offered stronger assistance in the distribution of economic aid in the framework of the lockdown so as to facilitate its enforcement.

Do you believe that the epidemic in Greece has reached its peak? Can we know yet and what are the definitive signals that it has peaked and will decline from thereon in?

The second wave of the epidemic reached its peak almost 2 weeks ago for the majority of the Greek territory. There is a constant decline in the number of cases mainly in the large cities such as Athens and Salonica.

We now have three leading vaccines that will soon hit the market – Pfizer-BioNTech, which was just approved by the UK, Moderna, and Oxford-AstraZeneca, How do they differ and how will each country and each patient know which to choose? Should people have a choice?

Pfizer’s and Moderna’s are mRNA vaccines with slightly different ways of delivering the mRNA payload. Oxford’s vaccine is an adenoviral vector vaccine. We do not have comparative studies with respect their effectiveness, that means we cannot say which is more effective. This would need another Phase III trial where vaccines would be compared with respect to their effectiveness.

Based on what criteria does a country choose which vaccines to order? Does one order some of each and then judge? The health ministry has said that individuals will not have a choice. Hence, some will receive one and others another. How will authorities choose who gets what and should a citizen not be able to choose based on ongoing data collection on effectiveness and side effects that may emerge? Do you have an opinion based on current data?

As I said, right now we don’t have comparative data on the three vaccines so as to say whether A,B, or C is better. Right now Pfizer and Moderna appear to be on a par because they have reported similar rates of effectiveness. People will know which vaccine they get at the point of vaccination. This information is important as they will have to come back for the second dose. All vaccines are safe based on data collected from tens of thousands of volunteers.

Both the Pfizer and Moderna jabs use technology known as mRNA. In brief, what are the comparative advantages and disadvantages of each method/structure? If Oxford’s works as other vaccines that have been tried and tested is that not a prior a comparative advantage in terms of engendering public trust in the vaccine?

All three vaccines are similar with respect to the mechanism of action, i.e. they carry a part of the virus mRNA which when delivered in the target cells, generates SARS-CoV-2 proteins which then induce humoral and cell immunity. The difference between these vaccines is in the “packaging” of the payload. Oxford’s vaccine uses an adenoviral vector while Pfizer’s and Moderna’s vaccines use lipid nano-particles.

In theory the adenoviral vector might induce immune responses against adenoviral surface proteins, thus reducing the effectiveness of potentially needed boosting doses, while the nanoparticles are more likely neutral in terms of immune responses. As a results Oxford’s vaccine is more stable and may be stored in standard fridges in the long-term, while the other 2 vaccines need low temperatures.

When should we expect the first vaccinations in Greece? Over the recent period the health ministry has contradicted itself on that one.

I would like to see it happen, though it is exceptionally difficult make such a prediction, at the beginning of next year.

How long will it take to vaccinate doctors and healthcare workers and members of vulnerable groups?

If all doses of the vaccine were available in January, I believe that within four months most people will be vaccinated. That depends on how quickly will be received by Greece rather than the time required to vaccinate them.

You have said that 70 percent of the population of Greece must be vaccinated in order to achieve herd immunity. If a large percentage of the population refuses to be vaccinated, what impact would that have?

If, let us say, 50 percent of the population is vaccinated, that would definitely slow down the epidemic. If that 50 percent includes people who are in vulnerable groups, then we shall see a decline in disease and fatalities. That however, does not preclude an epidemic among those who refuse to be vaccinated.

Gkikas Magiorkinis: Milestones in a distinguished course

Far before the current pandemic Professor Gkikas Magiorkinis was known to the international scientific community through dozens of peer reviewed papers – 99 publications and 2,396 citations, and 13,259 reads [at least intro and summary]- according to data provided by google scholar and researchgate.net – in a variety of areas of virology published by top scientific journals.

His research areas are Epidemiology, Genetic Epidemiology and Virology.

His groundbreaking work on the origin and global transmission and spread of Hepatitis C (HCV) established him in the ranks of notable virologists internationally. Human endogenous retroviruses is the main focus of his ongoing research.

He has published extensively on a large variety of issues pertaining to HIV and AIDS and as of last February he is the Scientific Coordinator the National Retrovirus Reference Laboratory at the University of Athens.

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