Former Obama administration advisor Dr Bengoa on coronavirus pandemic and Omicron variant
Dr Rafael Bengoa talks to AS about the coronavirus pandemic, its future and policies to mitigate it, along with misconceptions about vaccination.
Covid-19 has been spreading around the world for just over two years and governments and health experts have been doing their best to tackle the virus that is continually evolving. Likewise, their efforts have been adapting to a situation that is constantly developing, juggling policies, solutions and restrictions.
Recently, Dr Rafael Bengoa spoke with Mario Espinosa from AS to answer questions about the future of the covid-19 pandemic, policies governments are implementing and the spread of Omicron variant. Here are excerpts from that interview.
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Dr Rafael Bengoa, Caracas 1952, is a expert in management and public health. He is a former Minister of Health for the Basque Country in Spain, a former Health Systems Director for the World Health Organization (WHO), and a former adviser to President Obama on implementing the Affordable Care Act.
You don’t stop a virus with a bombardment, it slows down gradually
Will the coronavirus become endemic?
There are many people that think all of the sudden, on one concrete date, we’ll be in the endemic phase. Viruses don’t do that. We’re still in the pandemic. You don’t stop a virus with a bombardment, it slows down gradually, with outbreaks that we will have to continue to control. The outbreaks will be more controllable because there will be a lot of immunity in [Spain], but we shouldn’t think that endemicity means the disappearance or eradication of the virus, but that it is staying with us.
Its evolution and adaptation to us hasn’t finished
Is it possible that a new, more aggressive variant will appear that will displace Omicron?
It must be said that not every virus that is more transmissible is less virulent. In this case we were lucky because the virus was more interested in the transmission aspect, but that isn’t automatic. We were lucky with this scenario and that is positive, but the virus still isn’t done defining itself. Its evolution and adaptation to us hasn’t finished. Since the start of the pandemic we’ve had four or five variants that have hit us hard and others that appeared they would but in the end didn’t. We have to wait and see if the virus will continue trying to evolve to be more and more infectious.
It’s unforeseeable, not even the virus knows if it will manage to create another more successful variant. We have to do what we haven’t done in this sixth wave, and that is create the capability to manage the unexpected. If I were to use an analogy to soccer, coaches have [players] on the bench to bring about the unexpected. If the first half goes badly, they switch things up. And that’s what counts. We didn’t have that against Omicron. Consequently, since we don’t know if there will be another variant, what we need to do is prepare ourselves for that eventuality.
Primary healthcare is our team’s bench. We need to sign up more players
How does a country prepare for the unexpected?
First, make sure we have a plan B. We didn’t have that for Omicron and we are constantly improvising schools, hospitals, primary healthcare, etc. The most evident measure is to ensure that the primary healthcare system, which is our team’s bench, is strengthened in a very, very solid way. Hence, we need to sign up players.
it’s logical to create the infrastructure that is needed… where children aren’t infecting other children
Are we improvising constantly with schools, especially now that in-school learning has returned?
With schools we see an example of certain improvisation. It’s not necessary to talk in terms of restrictions. That is to say, once you’ve decided to resume in-school learning, which is correct, knowing that a lot of students are going to get infected, it’s logical to create the infrastructure that is needed, such as ventilation, CO2 controlers, making masks available and lots of tests.
In the United States, they will make eight tests per month free. In England there have been free tests for months so that people can go back to work. There are countries that require a test to leave quarantine. It makes sense to provide them free. In the majority of schools across Europe testing is free. So, it’s not necessary to debate strategic restrictions in schools, but to create the conditions where children aren’t infecting other children and people can be tested for free.
not even the virus knows if it will manage to create another more successful variant.
With such high rates of contagion, can we say that vaccination efforts have been a success?
Vaccination has been a spectacular success. For the majority of Spaniards that have been infected, [vaccination] has kept them from being hospitalized, being in an ICU and dying. That’s to say, the neutralizing aspect of the vaccine. There is one thing that wasn’t well understood in Spain, the vaccine is not a shield in the sense that you won’t get infected with Omicron, because the variant can get partially past that barrier. But once infected, vaccination neutralizes the effects of the virus.
When we have it, we hope this year, the [coid-19] sterilizing vaccine, we will be able to say we have a shield against infection and, as well a neutralization. That is very important because a lot of people in Spain and other parts of the world haven’t understood this separation and believe being vaccinated means not getting infected. No, Omicron manages to get past some barriers but it is less severe [when it does].