In The Spotlight: Roberto Burioni, a prominent Italian virologist, reflects on the future of COVID-19

Roberto Burioni has been outspoken about medical issues in Italy and a prominent critic of the the anti-vaxxer movement for some time. A professor of microbiology and virology at Vita-Salute San Raffaele University in Milan, Burioni is active on social media. He maintains a popular blog, Medical Facts , where he and his team discuss common medical misconceptions and provide information about food habits, children’s health and most recently, issues surrounding the novel coronavirus.

Burioni was one of the first Italian physicians to warn about the coronavirus threat in Italy and worldwide. Italy was an early epicenter of the virus in Europe and now reports almost 200,000 confirmed cases of COVID-19, according to Johns Hopkins University. Spain now has the highest number of reported cases with 208,000.

As the virus continues to make its way into cities and towns across the United States and information gets lost in a constant traffic of breaking news, Burioni analyzed the current situation worldwide and gave an idea of what Americans should expect their lives to be like in the months to come.

Editor’s note: This interview has been slightly edited and condensed.

What was the public response when you began warning about the pandemic? Was there opposition?

At the beginning, I remember that I published it on my site where I try to correct medical misinformation, which is called Medical Facts, and on January 8, when the World Health Organization claimed there was a virus of human transmission I wrote: “There is something going wrong in China, warning.” And nothing happened, nobody cared. In the following weeks, something started to grow in China, and it got some attention from the Italian media.

The European Autonomies were claiming that the risk was minimal. And I said, “Well, I hope they’re right, but I don’t believe so. I think the risk is real. And what’s really, I think, surprising is that I was attacked by some people in the left wing saying “you’re a fascist, you’re racist because you want to quarantine people.” And, things just went on in Italy, we very rarely took measures of isolation for people coming back from China. Everything was basically voluntary.

I think the picture changed completely on February 20, when we discovered that we had the cases here in Italy. This was sort of a wake-up call for the volatility of the virus and community and government. At the beginning people panicked, and they just went to the grocery stores and emptied the shelves. This was during one weekend but then nothing happened. The government decided to lock down two places where the first outbreak was in the northern part of Italy, and schools were closed. This was around February 24th and what happened was, really, something incredible because all Italians took this closure as an unexpected vacation, you could take your children because they didn’t have school. So everybody was just skiing – everything was discounted in the ski resorts, museums were open and with discounted entry. Some politicians would say: “We don’t stop organizing Aperitivi,” which is a very Italian thing to do. So, people would say, “We don’t really understand the concerns.” To me, this was really stupid because you’re not facing a terrorist, but you don’t want to tell them a lie just to scare them.

So, unfortunately, we continued to have the soccer games. And this was bad because unfortunately, that circulation of the virus was stronger and more important than what we thought, and what we saw on the 20th – the first case, this was only one of the many cases that were not properly detected.

So, on March 8, we had to go on a complete lockdown. And then the lockdown was real for everybody in the area. And I think the great majority of Italians acted responsibly. What’s unfortunate in this situation, at least in Italy, is that we don’t have very reliable numbers. The number of tests for virus is not a reliable indicator because many, many people are obviously sick, but they are not diagnosed from the laboratory point of view. They just stay home isolated from other people and they go undetected.

I think things are getting better because we can see the hospital numbers are going down and, the most important thing in my opinion, is the decrease of the occupancy of beds in the intensive care units – that’s very important, it’s very reliable scientific backing, and it definitely has been getting better in the last 10 days.

What has been a huge problem is the health system was slow at the very beginning, but then reacted well and we were able to increase the number of beds, but at the beginning the spread in the hospital was important. One thing should be kept in mind, which made the death toll very high in Italy: First of all, the virus made its way into nursing homes and these people are old, they are weak, and they have other diseases. So, when the virus arrived in the assisted living facilities, the death toll was incredibly high, in some places, 30% of the people died.

The other thing is that here in Italy the population is aging, we have a lot of old people, and due to the fact that the health system is good because we have a universal system, many of these old people have a very active life. I mean, their social life is they dance, they play bocce, they play cards, they meet together. It’s not rare to find somebody who’s 80 years old, and he has a social life that is no more intense that yours is, really. This is a good thing because they are better, and they are happier, and they are actually part of the society. In this particular case, unfortunately, this kind of social activity of the older people allowed the virus to spread very easily, and this is the cause of the higher number of deaths that we have in Italy. Because of the structural features of the Italian society and the Italian family, many times the grandparents are living with the grandchildren, so the virus can travel very quickly from the youngest to the oldest.

Should countries follow the steps European nations are taking to slowly lift the lockdown?

I think that this is really a political decision because we can’t be sure from a scientific point of view – which will tell you, for example, if you jump from a fifth floor, you will die, we are sure of this. But in this case, there are so many things we don’t know. The reopening will mean to take a risk, and it’s politicians who decide that they know the risks and benefits and decide what’s better for the country. I think what science can say in a clear way is that if you reopen, we have to be first of all, ready with all the protection, masks and everything else.

Secondly, if you reopen, you have to be able to identify immediately new cases, track all the contacts and isolate those cases and contacts. This is really something that’s crucial, and unless we provide these services to the citizens, there is a really big risk of starting too soon. So, reopening is a political decision and what science is saying is if you reopen, be ready and be prepared.

Is it possible there will be another coronavirus outbreak in the months to come as social distancing rules begin to relax?

Well, the virus is there, the virus won’t disappear. In fact, from a theoretical standpoint, we have to try to decrease the transmission and social distancing – face masks are something we will get used to, I think, but we are now fighting this virus with bare hands. Basically, what we use is nothing compared to what we have from science, what we could have from science in some time. We are fighting coronavirus in a medieval way: quarantining, masks, staying away. This is something that could have been done basically in the 13^th Century, so I really do hope that in the next months, something will come out from science.

We have to remember that the virus appeared on the face of the Earth out of nowhere, I mean, a few weeks ago basically. And we were already able to diagnose it and able to create antibodies. For some other diseases, it took years from the appearance of the virus to the diagnosis, think about AIDS. So, I really am confident that something will come out: a new drug, or a new treatment, not to say a vaccine, but a new treatment could really be a game changer.

We have to keep being careful while doing everything we can to help science because from it will come the liberation from this really nasty virus, which is changing and worsening our lifestyle, which used to be so nice before.

Is it plausible that there will be a confirmed treatment soon? And how soon?

It’s impossible to make a prediction at this time, but I really do think that there are some very promising tracks on the way. I’m confident in science and I’m sure that the time we are gaining with this lockdown will be very useful to know more and think about a better approach. We need to be patient.

At the moment, we don’t have a treatment that has proven efficacy against coronavirus. But there are many drugs that are looking very useful, some are old drugs, and some are new developed drugs. So, I think the proper way to face this pharmacologic treatment of this new disease is to wait for the for the clinical trials to be over when we will have some more information. Some of these trials are showing temporary results for some compounds but we just have to wait. This lockdown will give time to science to draw some conclusions and allow a better treatment of the patients, and continuing in this state could really change, in a really short time, the outcome of the infection.

In your recently released book, “Virus, The Great Challenge,” which talks about epidemic behavior, you say “the later the reaction, the more likely that defeat.” Is this how most countries reacted given the gravity of the situation? Did they react too late?

I asked a publisher to speed up the publishing process because I thought, and I now think I was right, because the book tries to explain what the virus is, how it spreads and what are the potential impacts of an epidemic. And I imagined that this kind of tools would help understand the virus, they needed to read it now and not in the fall. This is the time we need to understand what’s going on.

You can’t compare Italy to China, or the United States to China – they are very different. But Italy, Germany, France, the U.K. and the U.S., these countries are different but they are the same type of democracy: we have free press, we can say anything we want without being arrested, and we can share our experience with colleagues. So it’s understandable that what was going on in China seemed a bit far away from us, but what surprised me is that we in Italy weren’t the first ones to start with the virus. It was really surprising that the majority of the other countries, they were just looking at Italy and doing nothing.

And you just can’t think that if there’s something happening in Milan, it won’t happen in New York, or Boston or Philadelphia. These are all big cities with people getting around, the shape of the building and the name of the roads are just different, but they live the same life we live: We go to bars, we go to restaurants, we go to theaters and we go to movies. What surprised me was seeing other countries standing still while the tragedy was developing in Italy.

Is it possible the virus arrived to Europe and the United States before January?

That’s really unlikely because it seems that the virus appeared at the beginning of the year. We can really trace very precisely when the virus arrives in a certain place and when the vitals appears with the molecular analysis techniques. We can imagine the virus was in China, let’s say, early December 2019. So, I would say it’s very unlikely that the virus circulated in Italy in 2019. What’s likely is that the virus arrived in Italy well before February 20 and it circulated there for a couple of weeks before the first confirmed case.

Should a total lockdown be implemented until the virus disappears or a treatment is found?

I don’t think a total lockdown until the virus is eradicated would be compatible with the survival of any country. It could take many, many months [until that happens.] I think any country will go bankrupt because we can’t afford it, nobody can afford a total lockdown. We have to find a way, once we face the emergency like we are doing now, to minimize the risk and try to resume work to start again the production of companies and getting employees back to work.

What should people expect life to be like for the rest of this year? Should we start getting comfortable to have these masks on whenever we leave our homes?

This is something new so it’s impossible to know, because, this virus is something that appeared on the face of the earth a few weeks ago, and there are so many things we didn’t know, we had no idea what was going on.

And you don’t have a glass bowl [to see the future,] you know? I would say my educated guess would be that it’s very likely that for the next month, we will need to use masks. And then we will see what the virus does during the summer because respiratory viruses are usually transmitted less during the summer months. But I would say that we should get used to masks, that would be a good idea.

I’m a soccer fan, I’m a music fan, I like to go to La Scala here in Milan, and, well, in the next month, I imagine I won’t be able to go back to a soccer game or to go back to La Scala because these are the things that would make it better for everybody. We’ll have to leave them out for a few months.

I stay home and I go to work, that’s what I do. The only place I go is if I’m the guest in a talk show in television, but that’s it.