Corona bigwig Patricia Bruijning: ‘We’ll need to learn how to live with the virus before the new peak comes’

Everything in her life currently revolves around corona. As an epidemiologist, Patricia Bruijning (45) is a scientist who researches the spread of infectious diseases, as well as a paediatrician at the UMC Utrecht hospital. She’s also a teacher. She’s a member of the Covid-19 team that advises doctors, and does a lot of research on how infections happen.

Patricia Bruijning, how are you?
She laughs. “I’m doing well. Of course, these are hectic times. Society is a little divided between people who are working extremely hard, and people who are unable to do much. I’m in the first category.”

You work in both research and in an advisory capacity.  What are you working on now?
“I’m mostly working on research, and teaching online classes, of course. I’m also in the Covid team for the Dutch Association of Paediatrics, in which we issue advice to paediatricians regarding the coronavirus. And these days, I have a third job of talking to the media. That takes a lot of time, but it’s important to clarify and explain things, as everyone has so many questions.

“Before the corona crisis, I already worked as epidemiologist of infectious diseases. I did a lot of research on emerging infections such as dengue fever and diseases such as the rotavirus. When Covid emerged, we quickly realised in our department that we had to do something with this, it seemed to become so big. By now, the entire department of epidemiology of infectious diseases is working on Covid. There’s so much to do that everyone’s contributing, even outside of our department. I think that there’s never been a moment in history when so many scientists worldwide have been working on a single disease at the same time, the way they’re doing now with the coronavirus.”

That sounds very positive.
“Definitely. We have to achieve the scientific breakthroughs within half a year now, when normally that would take place in succession over the course of a decade. It’s going fast, and it has to. It’s almost impossible to keep up with literature, as fast as it’s produced. Scientifically speaking, it’s become a whole new world in three months’ time.

“A nice side effect of the epidemic is the move towards open science. I’m surprised about the collaboration and that everything’s accessible to everyone. Articles are immediately published on preprint servers, and paywalls are removed. The information becomes available much faster, and I sincerely hope that stays that way in the future.”

Speaking of new literature: recently, news service NOS published an article about a German top virologist who states that children are just as contagious as elderly people. He’s warning others against reopening the schools. You’re a proponent of relaxing the measures and would like to see the children returning to school as quickly as possible. How do you view that article, then?

“Funny you should mention that. This study is causing quite a stir… I read the article with a critical eye. There are some points to critique about the statistics they use for their conclusions. Furthermore, the study is only about 18 children on a population of 3.8 million Berlin residents who, at the moment of testing, had enough virus in their noses to be contagious. Whether they’ve actually infected others hasn’t been studies. That’s an important nuance that isn’t mentioned by this man.

“And moreover, what they’re saying isn’t actually new. Their conclusion is that a small percentage of children who have symptoms, and have been tested, have a high viral load, and therefore can be contagious. But we already knew that; I think no one in academia doubted that. Of course, it’s possible that a child can infect an adult. The question you should ask is: are children an important factor in the spread of the virus? By reopening schools and putting children together again, would you be giving the epidemic a push? This study doesn’t prove that at all.”

Patricia Bruijning:
Is paediatrician-epidemiologist at UMC Utrecht
Conducts research on children’s vaccinations and the effect on society
Is associate professor Infectious Diseases and Epidemiology
Graduated from her studies in Medicine at Erasmus University in Rotterdam in 2001
Studied epidemiology at McGill University in Montreal
Obtained her PhD at Utrecht University in 2013, on research on the rotavirus in children

So, on May 11, the primary schools will reopen. Shouldn’t we be relaxing the measures on more points?
“I think there’s no way around it. Society will not be able to keep this up for another one or two years, regardless of the damage to the economy. I’m a proponent of looking at each separate measure to see what’s needed. How much does a measure actually contribute to limiting the spread of the virus? And could you replace it with something that has the same effect, but isn’t quite as far-reaching? I think we’ll need technology and apps to do so, as well as face masks. If only so we can relax some of the other measures.

“Mathematical models are very important in this, but so is basic research on how the virus particles behave, and studies on the dissemination process. Because if some routes only contribute a little, then you shouldn’t impose a measure on that, and just relax it. That will make life a lot easier already.

“We can also take these measures too far. I recently received a protocol sent by my children’s sports association. Fifteen pages with made-up rules about how the sport would work, down to the centimetre. That makes me think: is this really going to slow down the epidemic in the Netherlands? It still has to be liveable for people. Yes, we should do whatever’s necessary. But we should also *not* do what doesn’t help much. There’s just no point. And we can’t stay stuck the way we are now. That realisation seems to have penetrated the minds of people in this country, now.”

What do you think about reopening secondary schools?
“The same goes for those schools: education is essential. I assume the schools will reopen in early June, with the 1.5-metre rule. That’ll be a test, too. If things go well, perhaps we’ll be able to relax that 1.5-metre rule for education. But you won’t know for sure until afterwards. People find it hard to accept that, that you have to create policies based on probabilities.”

Knowing what you know now, what would you have done differently?
“If the Netherlands had introduced social distancing a week and a half earlier, the peak in the epidemic would’ve been a lot lower. But I think that we acted with what made sense at the time. Now that the epidemic has reached a lower point, the trick is to figure out the measures as well as we can before a new peak in autumn.”

A new peak in autumn, you say, how certain is that? And will things never go back to ‘normal’?
“We’re nowhere near immune, all of us. Not in the slightest. The moment the virus gets the chance, we’ll see an increase in infections again. That’s mostly when we spend more time inside and have more direct contact with each other – in other words, when the weather gets colder. Climatologically and behaviourally speaking, it’s very likely that we’ll see an increase in the number of infections in autumn. So it’s important that we know what settings are important for infection before that time.

“One thing I think is a shame, is the government’s decision to only reopen the primary schools for 50%. We could’ve used the coming two months until the summer holidays – now that the epidemic has been significantly reduced – to learn how fully reopening schools would affect the epidemic. That’s an opportunity we’re missing now, and come September, we’ll still have the uncertainty about what we can and cannot do in terms of schools.

“Group immunity will take so long to achieve, but there are other options. I expect that this autumn, we’ll take steps to get a better grip on the disease. And we’ll achieve proper treatments, preventing people from getting very sick. But the nightmare scenario remains of course that we’ll have to keep stumbling on for a few years until we’ve reached 60 percent immunity. And even then, we don’t know whether that’ll be permanent: maybe you can still get sick a second time, if perhaps less severely.

“I’m placing my hopes on a vaccine. That doesn’t have to be 100 percent effective; we can be happy even if it protects 60 percent of people. That way, the virus wouldn’t spread as fast, and we could live relatively normal lives. All of us are working extremely hard to achieve that.”