The Solution Is in the DetailsWE ARE COVID19, ITS STRENGTH IS IN OUR BEHAVIOR, ITS ABILITY TO SPREAD DEPENDS ON THE MANY VARIABLES THAT CHARACTERIZE OUR CITIES. THIS IS WHY NOT ONLY ARE SIMPLISTIC FORECASTS DIFFICULT TO MAKE, BUT A MULTIDISCIPLINARY APPROACH MUST ALSO BE ADOPTED, SAYS THE DIRECTOR OF THE ONE HEALTH CENTER IN FLORIDA AND MEMBER OF IAC BOCCONI, ILARIA CAPUA
Virologists and scientists aside, the way we have dealt with Covid-19 in recent months is an example of a fundamental error that as humans we tend to repeat: simplifying complex problems. We tend to consider situations with a thousand nuances within a binary system, zero or one. Like wanting to paint a sunset with only two colors. “Covid-19 is a complex system and should be treated as such. There is an utterly palpable need for multidisciplinarity," explains scientist Ilaria Capua, Director of the University of Florida's One Health Center of Excellence, member of Bocconi's International Advisory Council (working with CERGAS Bocconi on a study that aims to analyze the real mortality rates of the virus) and author of Circular Health: A necessary revolution, published by Egea.
Let's start with Circular Health. Picking up the hypotheses on the origin of the virus that produced Covid-19, in this book you write that we have created the perfect environment for certain pandemic pathogens like this to originate and be supported within certain host populations.
We are an integral part of nature, we are inside an aquarium together with plants and animals. What Covid-19 has shown is that the organizational system of humans is not flexible enough to host such a virus. So Covid is a huge wake-up call because it has told us that we cannot handle an unexpected event of this type. It is the proof that this emergency must be faced with different points of view, because cities are affected differently. The virus makes the virus, it's our surroundings that make the difference.
Should we also look at our place in the ecosystem with different lenses?
Absolutely. We have to stop acting like invaders and start acting like guardians. In the plural, because everyone has to do his or her part to face the post-pandemic period.
During the emergency, a certain creativity emerged in dealing with it, like the engineers who transformed a snorkeling mask into a respirator. How important is it to think outside the box?
I am of the opinion that every institution should have a sort of 'Outside-the-box office,' an office in which there are people who do not belong to that area, but who are continually on the edges of that environment. To respond to Covid, each of us must find new ways, we can’t waste this crisis, we have to use it to improve.
What is Covid's most important lesson?
Our fragility and the fragility of our health. We take for granted that they aren't fragile but the virus has brought us back to our earthly weakness. It hit us hard and made us understand that we have no escape clauses. Just like for the environment people say, 'There is no Planet B,' we must understand that 'There is no Plan B' regarding the virus.
Which countries did the best job of handling the emergency?
Nobody was prepared. Some very small or very organized countries, such as certain Northern European countries and New Zealand, fared better. Covid is a multifactorial system: the mobility of people, their age, the country's health policy and pollution all matter. Each country is a different setting, so ranking who has done better is sheer folly. We all made mistakes, it's not like someone did a great job. We just have to learn from our experience, for better or for worse.
And what about the US, where you live and work?
In the United States there is a polarization of opinions and information that is truly unreal. There is a negationist front, the Republican and Fox News front, and a catastrophic one, which is the Democrat and CNN front. The tragicomic thing is that both are right: there was a catastrophe in some cities, mainly Democratic-majority ones, while not many deaths occurred in rural America. The effect of this polarization is that people are confused and lost.
And here we return to the issue of complexity in dealing with Covid-19. What do you feel is your job as a scientist?
I think my role is to explain to people who are not in the industry that there is a need, first of all, to take responsibility on a personal level, and then how much an emergency like this requires a multidisciplinary approach. There are no simple solutions.
Should we expect a second wave in the fall?
The second wave is us, because without people the virus cannot go anywhere. We have flattened the curve, but we have not reset it. There will be second waves that can do more or less damage based on the conditions in which they break loose. But a prediction is not possible, because it depends on individual behavior.
In recent months there has often been talk of an 'infodemic,' that is, an excess of information about the virus that may not have been properly verified. What do you think about how information about Covid has been communicated?
In general, nobody was prepared, so information was handled badly. We should reflect on this because it is clear with social media that incorrect information influences epidemiology. Information is one of the main drivers of how the infection evolves and therefore should be used well.
What can we say about Covid's real mortality rate?
That the data, in recent months, have been generated and collected unevenly. There is a need to clean up, reorganize and re-categorize the data to understand how many lives Covid has taken in Lombardy, Italy and Europe.
Was there collaboration in the research or did everyone want to work by themselves?
There was a certain level of collaboration, sequences were shared, but a network should have been organized in advance. If we had already had an organized network, a vaccine would have been ready in six months.
Finally, big data. 2020 is not 1990: how can the ability to analyze large numbers contribute today?
They are the future, they will be islands of light that will allow us to see and understand things we didn’t see. Like it was during this emergency, when, thanks to big data and not to individual cases, we understood the greater risk of a severe form developing in men. Thanks to big data, today we can understand all the facets of this gigantic puzzle.
Ilaria Capua is a veterinarian by training and for over 30 years she has led research groups in Italian and international laboratories in the field of diseases transmissible from animals to humans and their epidemic potential. In 2008, the magazine Seed included her among their "Revolutionary Minds" for being a catalyst for more collaborative approaches in influenza virus research by promoting data sharing on open access platforms. In 2013, she was elected to the Italian Chamber of Deputies where she held the position of Vice President of the Science, Culture and Education Committee. During her tenure, she was swept up in a judicial investigation that turned out to be unfounded. After being acquitted, she resigned as a Member of Parliament and moved to the United States, where she directs the University of Florida's One Health Center of Excellence. She is a member of Bocconi's International Advisory Council.
by Andrea Celauro
Translated by Jenna Walker