Are you getting enough sleep?

“Not particularly.”

The Erasmus MC is one of the leading European centres of expertise called on by the WHO to think along during one of these outbreaks. How did you actually hear the news within your department?

“We first became aware of it due to an article published in a Chinese finance journal that was making the rounds on Twitter. After reading this, we decided to get in touch with the WHO. We asked them: is this on your radar? Well, it was, but not that much was known about the nature of the virus at that point. That was 30 December.”

When did you know for sure: there’s something going on here?

“In Rotterdam, we devote a lot of research to viruses that are transmitted between animals and humans. When this happens, you see that a lot of people can fall ill at the same time. This happens regularly, of course, but in most cases we’re familiar with the virus that’s causing it. Initially, we thought we were dealing with a new strain of avian flu, since this is fairly common in this part of China and a lot of wild animals are traded at the market in question in Wuhan. When it became clear that we were looking at a novel coronavirus, people became a lot more vigilant. At that point, you’re wondering: could this become the next MERS or SARS?”

Marion Koopmans is Professor of Virology and head of the Department of Viroscience at the Erasmus MC. She is considered one of the leading international researchers in the field of the spread and containment of viral infections. She has contributed to the fight against outbreaks of ebola, zika fever and coronaviruses like SARS and serves as an adviser to the WHO, specialising in viruses that transmit between animals and humans. In 2018, NWO awarded Koopmans a Stevin Prize to the amount of 2.5 million euros in recognition of the social impact of her research.

How do you determine this?

“You can use patients’ material to map out the virus’s genetic sequence. You can then compare this information to other viruses in a kind of international virus database that we have put together over the past few years.”

Based on this genetic sequence, could you automatically predict how the virus in question will behave?

“No, that’s the tricky part. Although you do have an idea. With some coronaviruses, the symptoms can be compared to a regular cold. But of all the viruses we’re familiar with, this one resembles SARS more than anything else. That virus can cause a serious case of pneumonia. What we’re seeing now – and this figure is adjusted day by day – is that around 25 percent of the people who are diagnosed with the virus gets pneumonia and 3 percent die from it. To give you an idea: when this virus becomes global, that’s almost double the mortality rate of the Spanish Flu of 1918, which is considered the worst flu epidemic in recorded history. SARS took 10 percent of the patients, and during MERS, the rate stood at 1 out of 3. If we manage to stop this virus at the gate, it will go down in history as a mild variant in the list of SARS and MERS. But if it starts spreading across the nation, or even the world, we’ll be talking about a serious pandemic.”

Kwestie EN – coronavirus race tegen de klok – bas van der schot
Image credit: Bas van der Schot

The key question is: will this happen?

“We’re slowly starting to find out how easily the virus can spread. For the moment it doesn’t seem too bad. It doesn’t appear to be airborne. Instead, it’s transmitted via respiratory droplets – when you cough, for example. As long as you keep 2 metres distance between you and the people around you, the risks are minimal. There’s no need to panic – although you do see this here and there on social media. Nevertheless, it’s a major and serious outbreak. We need to pull out all the stops to control it.”

Imagine this fails and it becomes a pandemic. What do we do then?

“Right now, the focus is on containment. But you’re right: what if? Then pulmonologists and physicians in IC have a number of resources they can turn to, including antibiotics that can be used to tackle the associated bacterial infections. In China, they’re currently working on a treatment that may fight the virus itself. The third scenario would be inoculating people as a protective measure. In that case, we would need to convert existing vaccines. The good news is we’re a lot better at this than ten years ago. During the SARS outbreak, we were still working with a ten-year plan. Now we should be able to produce a working vaccine within four to five months.”

By now, it’s almost twenty years ago since the SARS outbreak. Have we learnt any more since then?

“For months, there were a lot of rumours during the SARS outbreak of 2002, but China tried to keep everything under wraps. It was only after a Chinese doctor had travelled to Hong Kong – which led to an outbreak abroad – that it became clear what was going on. At the time, everyone thought: this needs to change. The international community made, and updated, countless agreements, from WHO collaborating centres that specialise in specific diseases and an international virus database to formal and diplomatic circuits that can be launched in response to an outbreak. We believe the first patients with pneumonia were infected around December. This was flagged fairly early – thanks to a system that was set up in response to SARS. As it is, China has far more expertise than it used to. The country can handle all sorts of studies by itself nowadays. Quite different to 20 years ago.”

In a sense, isn’t it reassuring that this is going on in China, where the political system is such that a metropolis like Wuhan can be cordoned off without a problem? In the Netherlands, a decision like this would have to be signed off by a variety of parliamentary commissions.

“It may seem a bit too much in our eyes, but in terms of infection containment, this is a very solid approach. In Wuhan, you hardly see anyone out on the street anymore; people are all covered up when they go out to get food. The only question is: how long can you keep this up? And what do you do when it turns out to be necessary in other cities too?”

What’s it like for you to work with scientists who have less freedom to operate than their colleagues in the West?

“There’s an obvious spirit of competition. This doesn’t necessarily benefit our efforts to control the disease. We’ve amassed a wealth of invaluable knowledge at our WHO centres in London, Berlin and Rotterdam, so it’s incredibly important – particularly in these early stages – to share anything and everything that can be shared. This process doesn’t always run smoothly. Incidentally, you can expect the same situation here in the Netherlands. If we had an outbreak here and the WHO started phoning people, many of them would say: ‘Here are our first findings, we’re working on it and we’ll inform you as soon as we know more.’”

What are the risks for the Netherlands at present?

“The outbreak management team under RIVM’s supervision have got together, and the various protocols are in place. We may not have the virus here right now, but sooner or later someone who’s infected will travel to the Netherlands. And the chances of this happening will only increase as the virus slips out from under China’s control.”

Kwestie – coronavirus – bas van der schot
Image credit: Bas van der Schot

Three people have been tested so far, right?

“More than that. In some countries, each request for a test is front-page news, but that isn’t our style.”

Are these tests performed as soon as people land at Schiphol?

“No, we handle that, and RIVM. If people have travelled to the Wuhan region and don’t feel too well, they can report to their GP or the Municipal Health Service. At that point, we rule out whether the person in question is infected with the virus – because in most cases, it’s something else. Because let’s not forget: it’s the middle of the winter too – with all the accompanying colds and regular cases of flu. But at the same time, we’ve set up an infrastructure that ensures that whenever we have a serious indication that someone may have contracted the virus, we can put him or her in quarantine. We did the same thing during MERS, although the general public didn’t hear too much about it at the time.”

Should we be careful ordering packages from Aliexpress?

“As long as you aren’t buying live snakes or bats, I wouldn’t consider packages a risk.”

The world population is growing, people and animals are living in closer proximity than ever, and they’re travelling further and more frequently. Does this mean that outbreaks like SARS, MERS and the present coronavirus are becoming inevitable?

“We can expect more of this kind of thing. And that is precisely why we need to quickly establish what kind of virus it is. The great thing is that we can see that the system that we set up for this purpose over the past few years actually works, as do the international networks – albeit with some hitches. But no matter how quickly you track down a virus, develop a treatment or vaccine, you’re still fighting a running battle. That’s why we’re also examining whether we can’t ultimately predict outbreaks before they occur. We’re studying how to use data from tweets and information about locations where humans and animals live close to each other to set up a far more efficient disease detection system. At some point, we’ll be needing it.”