Dr. Effrosyni Gkrania-Klotsas: “We Have to Learn to Live with COVID-19 for a Long Time”

Εθνικός Κήρυξ

At work in Cambridge University Hospitals in 2020.

Effrossyni Gkrania-Klotsas is a Consultant in Infectious Diseases at Cambridge University Hospitals in Cambridge, UK. She is a board-certified practitioner of infectious diseases and internal medicine by the American Board of Internal Medicine (ABIM), a Fellow of the Royal College of Physicians (FRCP), a Fellow of St. Edmund's College, and an associate lecturer of the University of Cambridge. She is a member of the European Taskforce against Emerging infectious diseases and is an investigator for the RECOVERY COVID-19 trial and the ISARIC4C consortium and is also leading COVID-19 epidemiological research. She is also a member of the CoronaNerve group that studies COVID-19 neurological manifestations and conducts a study of viral evolution in patients with weak immune systems.

THE NATIONAL HERALD: Greeks in the United States have been worried about flying back to Greece this summer. What would you advise them?

DR. EFFROSYNI GKRANIA-KLOTSAS: Sadly, the summer is already behind us. Greece managed the epidemic in an exemplary way, and I hope that we will be in a position to continue to do so. Hopefully, next summer Greece will continue to be the global pandemic-handling leadership example. If we take one lesson from how Greece dealt with the pandemic, it is that it is imperative that there is only one guiding public health voice heard at all times and not multiple voices.

The National Herald

With my children Paraskevi and Panagiotis and my husband, Angelos Klotsas, in Greece in 2019.

TNH: Greeks in the United States have been worried about the risk of transmission during travel. What would you suggest?

EG: There is always a risk during traveling, as with any type of social activity. People must comply with public health advice, including using facial masks correctly, social distancing, etc. The risk of transmission in the aircraft itself is minimal, provided the infected person does not sit within two rows ahead or behind us. This is because of the way air is circulated in airplanes.

TNH: Coronavirus and COVID-19 are not the same things, but sometimes the terms can be used interchangeably. This `novel coronavirus' is novel because it just emerged in humans in late 2019. How deadly is it?

EG: It is difficult to estimate the mortality as we can mainly calculate it for people who get admitted to the hospital. Even among those admitted to the hospital, mortality risk also seems different, depending on several factors, including age, sex, and comorbidities. We recently analyzed the outcomes of approximately 16,000 patients in the UK hospitalized with COVID-19 and calculated that in-hospital mortality from COVID-19 has been at least 33%. This is not the only answer as not everyone with COVID-19 is symptomatic, not everyone symptomatic is admitted to the hospital, and people may also die at home or in a nursing home. We certainly know that COVID-19 is more deadly compared to the annual infuenza.

The National Herald

During residency training in the US in 2001.

TNH: There have been six other coronaviruses known to infect humans, such as SARS (circa 2003) and MERS (circa 2012). What makes this virus so different?

EG: Like SARS and MERS, COVID-19 appears not to have been previously encountered by humans, so some people tend to have a more severe illness when first becoming infected. However, COVID-19 seems to be less deadly compared to both SARS and MERS. In a way, this is what makes COVID-19 so challenging to combat. If everyone who has COVID-19 were seriously unwell, it would be easier to isolate ill people and stop transmission. Because some people have no symptoms, it is more challenging to prevent transmission.

The scientific name for this novel coronavirus is SARS-CoV-2, which stands for "severe acute respiratory syndrome coronavirus 2." It is not just a respiratory disease, though. COVID-19 affects various organ systems, including the blood vessels, the heart, and the brain. We also see several patients developing chronic sequelae, even when they recover from the illness, including debilitating chronic fatigue. It is not possible to predict, yet, who will be getting ill and who will not, so everyone needs to be vigilant.

The National Herald

With the rest of the founding members of the Cambridge Hellenic Learned Society in Cambridge, UK, in June 2015.

TNH: Right now, there are so many emotions to process. What is your method and advice on handling the mental aspect of the pandemic?

EG: It is true that several aspects of this pandemic are novel and present many challenges. Some of these challenges include the lack of experience that will allow doctors to advise patients who are most at risk from COVID-19 about their daily activities and the potential risk. Additionally, medical education has been restricted because of the COVID-19 risk: we have to adapt medical education to the pandemic environment to continue to train students safely. Everyone's mental health is suffering to a certain extent.

I suggest to my patients and students that we all collectively reflect on the knowledge that this is only one of many pandemics, past, and future, that humanity had to deal with. And although it looks like this is an unprecedented situation, in reality, it is not. It is just the first one most of us have had in their lifetimes. This, too, shall pass. We are also lucky to have access to novel technology that allows us to share information efficiently globally and a system that will enable us to develop COVID-19 vaccines more rapidly.

TNH: People all over the States are not keeping social distancing. How infectious is this disease?

EG: We have learned that social distancing slows the pandemic dramatically, and lack of social distancing rapidly results in more cases. We have also known that social distancing works to prevent other infections, including influenza. There is some emerging information that the virus might be evolving to be more infectious as well, although no discernible difference can be seen in how dangerous it is. We are all best advised as societies to employ every strategy we have to slow this pandemic down so that health systems can cope. Economies do not wholly collapse, and human lives are spared. Using masks and following public health advice is paramount.

The National Herald

Presenting Grand Rounds in Albert Einstein in Philadelphia, PA, in February 2020.

TNH: Is the United States like the phoenix? Will it be reborn? It is said that the economic fallout could last for a decade.

EG: It is certainly interesting to comment on this during the week that the President of the USA has been diagnosed with COVID-19 and he has needed oxygen therapy.

COVID-19 will in my opinion cause dramatic changes in world economies. It is difficult to predict how long the economic fallout will last, but it will undoubtedly last for many years. From the epidemiological standpoint, we have not yet seen the worst of the pandemic, unfortunately, neither in the United States nor in Europe. Sadly, this point does not appear to be made a lot in media.

One of the critical things we need to find out is if the vaccines against COVID-19 will work and how well will they work. There is also an apparent reason to worry about the effects of policies on many non- healthcare industries that could then be translated to poor global health. A simple example would be that global warming is being neglected as attention is shifted towards managing the COVID-19 pandemic.

It is paramount, in my opinion, that societies make informed choices when financial decisions are made: what each decision is going to mean for the future of the population.

TNH: What lessons are we learning now that can help us lessen the impact of future pandemics?

EG: There are already many lessons emerging, from the importance of international collaboration, of funding research, of strengthening public health systems, of maintaining societal equality, of educating people about the benefits of vaccines, of not discrediting the experts. It is also abundantly clear that anyone can become infected with COVID-19.

Because of the sometimes pervasive use of social media, our society is now potentially fragile in containing the spread of misinformation.

And what use will an effective vaccine be if a large part of the population might not accept it?

This is the goal that the United States and the rest of the Western world should currently focus on to guarantee its future survival.