EU Pandemic Adviser Peter Piot "We Will Have to Learn to Live with COVID-19"
DER SPIEGEL: Professor Piot, you aren't just a COVID-19 researcher, you are also a patient. How are you doing?
Piot: Thank you, a bit better every day. I start breathing quite heavily even when I’m just climbing a few stairs. It will probably take months for my lungs to completely recover. Nevertheless, my energy is returning. Today marks my first day back at work.
DER SPIEGEL: Your first symptoms appeared on March 19 …
Piot: Yes, exactly two months ago to the day. It lasts a hell of a long time, this illness.
DER SPIEGEL: You must have become infected somewhere. Do you have any idea where?
Piot: I've asked myself the same question, of course. It must have been in early March, a period when there were a lot of opportunities to get infected. I attended several events with hundreds of participants. I was in a lot of meetings. I gave talks, including about COVID-19. And I was in a restaurant almost every evening. I must have had close contact with about 100 people.
DER SPIEGEL: Were you never afraid of getting infected?
Piot: Well, I didn’t shake any hands, and I also took care to maintain distance, though not that strictly, I must say. We didn’t start working from home at the London School of Hygiene & Tropical Medicine until March 17.
DER SPIEGEL: By then, it was already too late for you.
Piot: Yes, though I didn’t know it yet.
DER SPIEGEL: Did you infect other people?
Piot: As far as I know, nobody except my wife Heidi. She later had an asymptomatic infection.
DER SPIEGEL: You are 71, which means you are part of the demographic most at risk for this disease …
Piot: I know. On the other hand, I’ve never been seriously ill in my life. I run 5 to 7 kilometers three times a week. I always thought I’m fitter than some 50-year-olds. And "risk group” also seemed like a very vague term to me.
DER SPIEGEL: So, even though you are a virologist and an expert in infectious diseases, you still underestimated this virus?
Piot: I’m afraid so, yes. Not intellectually. I held talks about COVID-19, and many people also accused me of exaggerating the danger. But I didn’t apply all that to myself. Maybe it’s because I’ve already been in so many situations that seemed much more dangerous to me. Or, rather, I’ve been saying for four or five years that we need to prepare for the next pandemic. Even in February in Berlin - in the Natural History Museum, amid the dinosaurs – I was warning people that this virus could spin completely out of control. And yet I still wasn’t careful enough myself.
DER SPIEGEL: But you’ve said that right after you felt the first symptoms, you sensed that the virus had gotten you.
Piot: I couldn’t know for sure, of course. But the symptoms were just so typical: horrible headache, high fever … it was a moment of recognition for me. "Ah, so this is what it’s like to have COVID-19.”
DER SPIEGEL: And then when the test results came back, you knew for sure.
Piot: Yes, and by the way, getting access to a test in London wasn't easy. Ultimately, a friend with a private clinic helped. It cost me 300 pounds. I can only say, we definitely need home-tests that everyone can buy in the pharmacy and then use themselves.
DER SPIEGEL: For one night in 1976, in what was then called Zaire but is now the Democratic Republic of Congo, you believed you had contracted Ebola. Was that situation comparable to this one?
Piot: Oh no, absolutely not. Back then, I was scared to death. I had a fever and diarrhea. I had had close contact with Ebola patients without the protections that are now common. I had sat in the back seat of an SUV for hours, shoulder to shoulder with people who had recently recovered from Ebola, being jostled back and forth. When I got sick back then, I thought: "This is it. I’m going to die.” Later, it turned out that it was just normal food poisoning. This time, I just thought: "How annoying that I caught this. But I don’t have diabetes, don’t smoke and I’m not obese. So it won’t be worse than the flu.” As such, the workaholic that I am, I simply continued working.
Isolating an Ebola patient in Zaire in 1976: "I thought: 'This is it. I’m going to die.'"Foto: CENTERS FOR DISEASE CONTROL / PICTURE ALLIANCE / DPA
DER SPIEGEL: But that didn’t go well for very long.
Piot: No, because for me, the dominant symptom was simply exhaustion. Total exhaustion. Normally I’m an energetic person. But suddenly, every part of me seemed to be tired. I could barely stand up, or walk one step.
DER SPIEGEL: When did you come to understand that this was serious, maybe even life-threatening?
Piot: It took a while. When I got the test result, it was mostly just interesting to me at first. "Wow,” I thought. "I always held talks about this, and now I have it myself.” But when the fever kept going up, up to 39 or 40 degrees Celsius (102-104 degrees Fahrenheit), I slowly started getting worried. My wife said, "You need to go easy on yourself!” But I didn’t want to take it seriously. Then came the chills, apparently because of a bacterial pneumonia. That’s when I went to the hospital.
DER SPIEGEL: How long was this after the start of the infection?
Piot: Oh, wait (looks at his calendar), after 11 days. Normally you think, if I make it through the first eight, nine days, then it should get better. But the fever stayed. Still, I could still make it up to the fourth floor without any problem. When I got to the emergency room, my oxygen saturation was at 84.
DER SPIEGEL: Just 84 percent? That’s low!
Piot: Yes, at first the emergency room doctors didn't want to believe it. Now, it's known that this is totally typical for COVID-19 patients: extremely low oxygen saturation with the patients hardly even noticing.
DER SPIEGEL: In the hospital, you had to put yourself, an expert, in the hands of other experts. Did you trust the doctors, or did you want to control your own treatment?
Piot: It was very strange. Shortly after arriving in the hospital, I was no longer a virologist or researcher, but only a patient. I cooperated with everything that the doctors did with me. On one hand, I was extremely weak, and just stared at the ceiling and could barely have a cogent thought. Also, I'm not the type of person who tells the taxi driver exactly which route they should take.
DER SPIEGEL: But were you conscious the whole time? You weren’t put on a ventilator?
Piot: I immediately got oxygen. But luckily, invasive ventilation was not necessary.
DER SPIEGEL: How afraid were you of such invasive therapy?
Piot: I prefer not to think about what could have been … it would only drive me crazy. But just around the time I got sick, the first publications came out showing that the death rate for invasive ventilation was frightfully high, and that it might not always be the best path. But I survived.
DER SPIEGEL: You were released from the hospital after a week.
Piot: Yes, but I was still far from having overcome the sickness. I’ve lost 7 kilograms (15 pounds) – a kind of sickness bonus. My BMI is normal again. And then, after about one week, I suddenly had problems breathing. My family doctor referred me to University College (Hospital), and they found that my entire lung had been infiltrated – I was suffering from a massive immune reaction.
DER SPIEGEL: An immune overreaction, weeks after the acute infection – does this kind of thing happen often?
Piot: In the hospital, they told me I was the first patient where they had seen such a thing, but now it seems like doctors are encountering it more often. Just yesterday, I spoke with a COVID-19 researcher from Paris, who has also observed this kind of delayed immune response. I’m sure there will soon be scientific publications about it. COVID-19 is an illness about which we are constantly learning new things.
Imag of a SARS-CoV-2 virus: "Suddenly, every part of me seemed to be tired."Foto: visual science
DER SPIEGEL: In 2014, you told DER SPIEGEL that the best thing that can happen to someone is surviving a close encounter with death. Do you still believe that, after your experience with COVID-19?
Piot: Yes, absolutely. An experience like that forces you to think about what is really important in life. Of course, I don’t wish such a painful experience on anybody, but nevertheless, it does lead to deep insights.
DER SPIEGEL: How has the illness changed your life?
Piot: Oh, it’s too early to say that. But one thing is clear: It has boosted my motivation to better understand COVID-19. In Belgium, there is a term, "experience expert.” Previously, I was only a scientific expert, but now I’m also an experience expert. That makes me more sensitive when it comes to the virus, but also to people’s problems -- to the loneliness of isolation, to the increase in domestic violence, but also to the people with the chronic long-term effects.
DER SPIEGEL: Your first task after recovery is to resume your role as adviser to European Commission President Ursula von der Leyen. Is the fight against the pandemic primarily a European task?
Piot: Europe will certainly play a key role. Even before falling ill, I was a member of a group of seven experts, including Christian Drosten from Berlin’s Charité Hospital and Lothar Wieler from the Robert Koch Institute (Germany’s disease control agency). We hold video conferences to advise Ms. von der Leyen. Of course, every country is responsible for the safety of its own citizens, but when it comes to research, we can achieve more when we bundle our efforts. In terms of developing vaccines, for instance, each individual country is too small on its own.
DER SPIEGEL: The U.S. government has launched Operation Warp Speed, which is named for the so-called "warp drive" in "Star Trek," which can propel a spaceship faster than the speed of light. The project aims to create a vaccine by November, if possible. Is that the right path forward?
Piot: Politicians can direct money into the right channels, and they can clear bureaucratic hurdles. For this reason, I welcome this initiative. But this is a program with a purely American perspective. For this reason, it is also important that Europe also become active. The Americans have an advantage by virtue of being s single country. That makes it easier to tackle something like this. In Europe, with its many nation states, it's much more difficult. Nevertheless, von der Leyen organized a truly historic COVID-19 donors’ conference on May 4, which raised 7 billion euros ($7.6 billion) for the development of vaccines, therapies and diagnostics – an important example of European decision-making.
DER SPIEGEL: Isn’t the November timeline being followed by U.S. President Trump completely unrealistic?
Piot: The political pressure is extremely high because of the presidential election in the U.S. I very much hope that no dangerous shortcuts are taken on the path to approval. We cannot forget that we are talking about a vaccine that is to be given to billions of people. If even a tiny percentage of people develop serious side effects, the consequences would be horrifying.
DER SPIEGEL: It will need to be proven that the vaccine is not only safe, but also effective.
Piot: And that will require thousands and thousands and thousands of test subjects. These kinds of tests can only start in July or August, more likely at the end of this year or the start of next year. And then where will we be with the pandemic? We don’t know. At first, the disease only spread in China, then in Europe, and now especially in North and Latin America. Will it spread in Africa? Will there be a second wave? At the moment, predictions are nothing more than qualified guesswork.
DER SPIEGEL: Will the vaccine that everyone is pinning their hopes on really be the solution to the COVID-19 crisis?
Piot: I said previously that the vaccine is our only true way out. At the moment, I have a more nuanced view. Of course, a vaccine will be part of our exit strategy. But there are plenty of indications that we, as a society, will have to learn to live with COVID-19.
The article you are reading originally appeared in German in issue 22/2020 (May 23, 2020) of DER SPIEGEL.
DER SPIEGEL: Why are you suddenly so pessimistic? Won’t a vaccine eradicate this virus?
Piot: That is very unlikely. We don’t even know yet how well a vaccine will work. When it comes to respiratory viruses, our experiences haven’t been great thus far. Even with flu vaccines, the protective efficacy is generally only between 60 and 70 percent. I’m actually an optimistic person. But I don’t believe that a vaccine will provide 100 percent protection. We should consider what we actually want to achieve. To completely eradicate the illness? To reduce mortality? Or something in between? We will have to address such questions as well.
DER SPIEGEL: In the case of AIDS, we still don't have a vaccine. Instead, we've had to learn to live with the disease, largely thanks to help from antiviral medication. Could something similar happen with this coronavirus?
Piot: I do think it is possible that we will have a treatment for COVID-19 before we have a vaccine. On that point, I also return to my experience as a patient, in a slightly different way. Thus far, the goal has exclusively been that of combatting the virus. But maybe we also need to think about controlling the immune response. In addition, the correct timing of intervention measures is also important. I have the impression that not enough attention is being paid to that issue in the clinical studies. We should also test whether antiviral agents might be suitable as preventive agents as well. If so, we could find all of the people that a newly infected person had contact with and treat them prophylactically – which would be comparable to a vaccine, but much more targeted.
DER SPIEGEL: And ultimately, we would arrive at a broadly orchestrated response to COVID-19?
Piot: Yes, why not? A bit of this, a bit of that, a few days earlier or later, with a lot of fine tuning, similar to cancer or AIDS treatment. I’m just brainstorming here, consistent with my belief that we should be much more open to unconventional ideas.
DER SPIEGEL: What are the psychological effects of the pandemic?
Piot: What’s clear is that COVID-19 is connected to numerous psychological and emotional problems – reactions to the sickness itself and to the measures against it. We are already noticing this. One indicator could be an increase in suicides. I personally broke down psychologically when I came home from the hospital. I cried for a long time. I know that about myself: When faced with danger, I can manage the situation. The fear and the emotions: that comes afterwards.
DER SPIEGEL: Have you now overcome the sickness?
Piot: No, I’m far from being over it. I still can’t make it up the stairs without stopping. I tried jogging because I miss it, but I very quickly gave that up. I still take blood thinners because I have atrial fibrillation, and that might continue for the rest of my life. One of the reasons I’m giving this interview is because I want to direct people’s attention to precisely this. Many people think that for people who get COVID-19, it is a kind of flu for 99 percent, and that 1 percent die. I want it to get it into people's heads that there is also something in between – large numbers of people who survive, but who are seriously ill for a very long time.
DER SPIEGEL: Professor Piot, we thank you for this interview.