I spent last week at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Copenhagen. ECCMID is the main international conference on infection. American meetings that were once pre-eminent have fragmented, becoming parochial; Asian rivals have failed to gain traction. Copenhagen was ECCMID’s comeback: 2020 was cancelled; 2021 was online and 2022 was a ghost. This time was ahead of 2019: 15,000 attendees; lecture halls overflowing and the biggest trade show I’ve seen in 40 years of international meetings.
I went with curiosity. Denmark ended all Covid restrictions a year ago, but the conference blurb promised anti-Covid measures. Delegates – mostly laboratory scientists and infection specialists – would be “offered” N95 masks. As luck would have it, I went with an incipient RTI (respiratory tract infection, i.e., a cold). This progressed inexorably into a hacking cough and a blocked nose.
Much was encouraging. Only 1 or 2% of my fellow infection specialists wore masks, and I saw only one in a contraption combining goggles, shield and mask. No one appeared perturbed by my symptoms, nor suggested I leave, wear a mask or do a test. A noted physician amiably diagnosed, “It’ll be Covid”, but sat beside me nonetheless. It was quite like the old days. Of course, it’s possible that only the blasé attended in person whilst the fearful attended online. It’s also possible that some folks avoided me so effectively that I was unaware of being shunned. But, even if both caveats are true, it’s beyond dispute that most professionals are now relaxed about Covid.
All that’s positive, for any reasonable person has to accept that the virus isn’t going anywhere. Virology textbooks must be rewritten to say that we have five ‘common cold’ coronaviruses not four, with SARS-CoV-2 the commonest.
Other developments left me less sanguine.
I’ve mentioned that huge trade show, at least double the area of the last pre-pandemic ECCMID in 2019. Many unfamiliar companies had PCR machines to sell. Friends from established companies told me that molecular diagnostics had ‘come of age’. Manufacturers have grown rich, I think.
Whether all this testing does any good is quite another matter. A sponsored-session speaker proudly described how she’d run a mobile virus testing service for New York Schools. I asked what it had achieved, given that New York had endured 18 months of school closures. Sweden, sans testing, had kept schools open throughout, without catastrophe, I pointed out. “What’s more, it now has the lowest excess mortality in Europe,” I added.
“I’m not the Governor of New York,” she responded defensively. “He’s the one who shut the schools.” This was followed by the point that her service could also detect influenza, identifying children who ‘should’ be given Tamiflu. Given the questionable risk-benefit profile of Tamiflu in healthy children, I found this underwhelming.
Back to the trade show. It was surprising to see AstraZeneca still promoting its adenovirus vector vaccine, which has been abandoned everywhere in Europe. Merck’s ‘Antiviral Corner’ was another curiosity, not mentioning molnupiravir (which has slumping sales) – let alone ivermectin (no surprise) – and stressing monoclonals. These have fared poorly against mutants, mostly being withdrawn or restricted.
Pfizer and Moderna’s trade stands were large and, as expected, promoted their vaccines (Moderna has nothing else to promote). Both also had sponsored sessions that were too packed to enter. I did squeeze into another session where Moderna’s folks presented developmental non-Covid vaccines, also based on mRNA technology, and asked what was being done to monitor for myocarditis. I added, conversationally, to explain my question, that is it was unclear to me whether the hazard with the Covid mRNA vaccines related to the spike protein (as I actually suspect) or to the lipid carrier nanoparticles.
This pulled one of Moderna’s senior staff to the podium, telling me that “We have a cardiology panel to review all adverse events”. Interestingly, there was no effort to assert that myocarditis wasn’t a concern. No one followed up on my question, nor on others I asked in the same vein. No one challenged – nor concurred – when, asking about an adenovirus vector anti-Ebola product, I suggested that the corresponding Covid products were “mediocre and briefly effective, at best.” (I should add that the anti-Ebola prototype gave a robust immunoglobulin response and is directed against a high-lethality bloodborne virus; it might have merit.)
Aside from my own questions I didn’t hear myocarditis mentioned at all. Rather, a lady from the WHO asserted that Covid vaccines had saved 1,004,927 lives in Europe. Lordy, such precision! As question time was truncated, I just shouted “Confidence intervals?” “They’ll be in the paper,” she responded. Which sounded like “Very wide”.
And now let me spell out what did deeply trouble me. That, after three years dominated by the pandemic, ECCMID – the world’s premier infection meeting worldwide – lacked sessions for professionals to debate four central questions:
- First: where did the virus come from? And what are the implication for laboratory work that seeks, or may lead to, ‘gain of function’.
- Second: did NPIs work? I believe that the answer is, “Not very much; they just selected for more transmissible variants”, but others, including friends from Singapore, have a different view. There was no session on masks, and precious few posters or free papers, despite Cochrane and despite their centrality to the response.
- Third: vaccination. Even if you believe vaccines did some good in the old and vulnerable – as I and most professionals do – their coercive deployment in low-risk populations, especially children, looks ever more dubious. They fail to prevent viral circulation and occasionally harm or kill people too young to be at any real risk from Covid. And, believing vaccines did initial good doesn’t mean that they should be given time and again. Repeated boosting is supported by scant data and is challenged by Cleveland Clinic findings indicating that infection becomes more likely in those who’d had multiple boosters. I asked a UKHSA speaker (and erstwhile colleague) on this last point after she’d presented on the SIREN study, also following Covid infections in healthcare workers over time. She claimed ignorance of the Cleveland data and hasn’t acknowledged a copy that I forwarded.
- Fourth: what is the responsibility of infectious disease professionals when advising governments, if their advice has massive consequences for civil society? Should these professionals simultaneously advise government and run media campaigns advocating particular courses of action?
Everyone I spoke with has a view on these topics. Many, like me, think that much evil was done, though they’re less willing to say it openly. Others support the pandemic response.
ECCMID has hosted many debates in the past – I’ve argued that we should choose antibiotic treatments by identifying the pathogen’s mechanisms of resistance whilst my opponent argued we should just measure what antibiotic concentration stops it from growing. And ECCMID isn’t averse to ethical controversies. There was an excellent session on the ethics of futile antibiotic use – meaning when the patient is dying of an underlying disease. At best one delays the Grim Reaper by a few low-quality weeks, condemning the patient to a slower and more painful death. At worst one does that and drives antibiotic resistance, hazarding future patients.
If we professionals can debate these topic, surely we can and must also dissect anti-viral responses – many likely also futile – that turned the world upside down and whose collateral harm will be with us for years to come. The WHO’s threatened Pandemic Treaty – which hazards the supra-national embedment of bad responses – makes this debate even more vital.
Oh, and that cough? The test I finally ran in Norwich came up negative. So, if you caught Covid in Copenhagen last week, it wasn’t me.
Dr. David Livermore is a retired Professor of Medical Microbiology at the University of East Anglia.