Corona bigwig Marc Bonten: ‘Before this crisis, I’d never done anything to do with viruses’

Photo: UMC Utrecht

When Bonten answers the phone, he says he needs a minute to wrap up an online meeting. In the background, I hear him tell his colleagues: “The journalist is now listening in. You know what we’ve decided.” Followed by another voice: “Ten years of lockdown!” Bonten laughs: “No more toilet paper, ever!”

It probably won’t get to that, but Bonten and his colleagues are the ones at the frontlines of the pandemic. Bonten is head of the department of Medical Microbiology and head of the programme Epidemiology of infectious diseases. He still physically works in the UMC hospital instead of from home: “It’s easier to keep an eye on things when I’m here. We perform all the coronavirus tests, so it’s quite busy. And everyone is highly motivated. The rate of absence due to sickness leave has never been this low.”

Newspaper De Volkskrant recently called you an epidemiologist – a scientists who studies the spread of diseases within and between populations. But the UMC website states that you’re a doctor and microbiologist. What are you, exactly?

“Doctor-microbiologist. I do a lot of epidemiological work, though. My work has always focused on clinical research on resistance to antibiotics and infections in hospitals. Before this crisis, I’d never worked on viruses.”

How is that switchover going?
“It’s very refreshing. I haven’t heard a thing about antibiotics for two months now. I mostly work on the epidemiology and clinical trials, and then it doesn’t really matter whether you’re talking about bacteria or a virus, actually.”

But how did you end up in this research on corona?
“From within the field of resistance to antibiotics, I’ve been working for a few years now on establishing a large clinical trial network in Europe. A network of hospitals where clinical research with new antibiotics can be conducted very efficiently. And that network is now being asked to also conduct research on Covid-19. Aside from research on resistance to antibiotics, we also already wanted to focus on emerging infectious diseases, ones with a high risk of spreading, and Covid-19 is one of them.”

Marc Bonten (55)
has been head of the department of Medical Microbiology and the programme Epidemiology of infectious diseases at UMC Utrecht for a few years
is professor of Molecular Epidemiology of infectious diseases
has been working at UMC Utrecht for twenty years now
became a doctor in 1991, graduating from Maastricht University
obtained his PhD in 1994 at the same university with his thesis “The role of colonisation of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia”
was named Honorary Fellow of the Royal College of Physicians in Ireland in 2017
was awarded the Escmid Award for Excellence in Clinical Microbiology and Infectious Diseases in 2015
likes football

What does the Covid research involve?
“On the one hand, we do observational research to improve our understanding of the virus, but more importantly, we evaluate treatments – both preventive treatments and treatments of people who have already been infected.”

What can this study achieve?
“For the IC population, this will hopefully show which antivirals work best for those patients. And hopefully, it will show whether anti-inflammatory agents, such as corticosteroids, are useful or not. We’re also studying whether the new immune-modulating medications have anything to offer for these patients. These are medicines that regulate the immune system, because an extreme reaction from the immune system sometimes causes more harm than good. We don’t have a lot of experience with that yet, but it might increase the patients’ chances of survival.”

“With the coronavirus, part of the damage to the lungs is caused by a too extreme response from the immune system to the virus. That’s why we’re now looking into whether medicine that regulates the immune system might help. For example, a preventive medicine that works through the immune system is the old BCG vaccine against tuberculosis. With the research group led by professor. Mihai Netea of the Radboud UMC in Nijmegen, we’ve now set up a study to see whether this vaccine can help now.”

“When you administer the BCG vaccine, it alarms your immune system. The hypothesis is that in the first couple of years after receiving the vaccine, you’re better protected against viral infections and additional complications. So we administer either the vaccine or a placebo, to see whether these people actually do get sick less often.”

Which people are that, then?
“So far, nearly 1,500 employees in eight hospitals have been included in the study with the tuberculosis vaccine. And the research with elderly people is in the starting phase right now. Hopefully, we’ll know within the next couple of months whether the vaccine offers any protection.”

“Immune-modulating medicines that aren’t for prevention but for treatment, include anakinra, icatibant, and tocilizumab. We’re now testing tocilizumab in a large-scale international stud, and we’ll soon test them all in the platform trial REMAP-CAP.”

In the research application of this research set-up, we focused on an imaginary pandemic with a pathogen that causes pneumonia. Well, that turned out to be a very accurate guess.

You say you’ve been working for a few years now to set up a large clinical trial network in Europe, but when you started, there was no coronavirus to speak of, of course. How does that work?
“In the research application of this research set-up, we focused on an imaginary pandemic with a pathogen that causes pneumonia. Well, that turned out to be a very accurate guess. That was the most likely cause for a pandemic. This all truly started after the swine flu in 2009. That’s when politicians and policy makers started saying that we really needed to be better prepared when the next pandemic hit.”

“Five years ago, we received a European grant and were able to start preparations. The study focuses on intensive care units and is set up in such a way that in times of a pandemic, it can be adjusted quickly to the questions you have at that time. The trial was already ongoing in New Zealand, Australia, about ten European countries, and Canada. And it’s now being adjusted for this virus. Hospitals and intensive care units from across Europe and America want to join the study now as well, so we’re also very busy with expanding the network.”

Would you say that means we were well-prepared now?
“When you look at the research, we were definitely better prepared than ten years ago during the swine flu. We hadn’t expected this either, but setting up the research for the trial network itself cost about three, four years. All the preparations to make things run smoothly across three continents, setting up a team, establishing protocols, etcetera. It’s only been the past six months or so that we were satisfied with the infrastructure. So in that regard, it’s good that Covid-19 didn’t show up a year ago.”

How long will it take before we fully understand Covid-19?
“Some things will never be fully understood. The most important things, such as the rate of infection, we already know, thankfully. That’s what we base our policies on. As for treatment, I hope that in a few months’ time, we’ll know a lot more than we do now.”

The government has also reserved millions of euros for corona research. Are you entitled to some of those funds?
“Some funding is being channelled from ZonMw, and some of our studies will be paid with that money. As for the study in which employees receive the tuberculosis vaccine, we funded that with our money. But the most important funding comes from European grants. The issue with those research grants is that you have to compete, and you’re never sure whether you’ll actually get it. So if you wat until the money is actually there, and only start your research then, you’d lose too much time. In any case, we’ll try to apply for those millions of euros from the government through whichever way we can.”

Lastly: do you think the measures the government has introduced so far are sufficient?
“They are definitely sufficient; we’re seeing the results. Thankfully, we’re seeing the numbers go down. And now, we’ll have to see what we can – slowly – start to normalise.”