“Covid, the risk of hospitalization is still there for the frail. The fourth dose is needed “

The interview

Rizzi («Pope John»): «In hospitals, patients are elderly with Omicron 2 and comorbidities. Up-to-date vaccines will be decisive for the autumn ».

«It is necessary to reiterate that in the most delicate people the risk of ending up in hospital is still there. In frail people, however, the fourth dose reduces the risk ». Marco Rizzi, director of the infectious diseases department of the «Pope John» of Bergamo, has been watching the evolution of the pandemic closely for over two years. And also the trajectory of the vaccination campaign: at a new turning point, that of the fourth dose (or “second booster”), we start again from the evidence of the scientific literature and from the indications of the regulatory authorities, which certify its protective efficacy for more fragile subjects. «For the most delicate people the recommendation is to receive the fourth dose. And it is a valid recommendation », Rizzi reiterates. Looking ahead, after the summer when the campaign could be extended, it will be important to have “vaccines updated to current variants”.

Doctor Rizzi, let’s start from the hospital situation: who are the hospitalized for Covid today?

«Of the approximately 40 patients admitted to our hospital, there is a significant part of people who are positive for swabs but are being treated for other diseases. In infectious diseases we have about 20 people with more or less relevant Covid symptoms, with numbers that have been declining for a few weeks. In addition to the unvaccinated, there are also vaccinated but particularly fragile people: patients with haematological diseases or in chemotherapy, who in any case thanks to vaccination have calmer pictures. The average age is mainly high, with comorbidities, and Omicron 2 prevails ».

Do the new antiviral drugs work?

“If these frail people are intercepted early, they can benefit from these drugs and not end up in hospital. The difficulty, however, is in the speed with which positivity is found and therapy is started: it is necessary to start treatment within five days of the onset of symptoms. This is an issue on which we can still improve to protect the frail, working in conjunction with the treating doctor ».

To protect the frail, there is now also the fourth dose. What does the literature tell us?

“The protection after previous vaccinations tends to decrease over time, and the second booster leads to increasing protection again. Also because we now have people who have been vaccinated with the third dose for four, five or six months. Some countries have been oriented in a different way, essentially the choice made by Italy seems reasonable to me: now approach the most fragile people with the fourth dose, thinking that later, after the summer, the recall can be extended through targeted vaccines , updated to current variants of the virus ».

Are the safety profiles also confirmed for the fourth dose?

“Even the most recent data from AIFA (the Italian Medicines Agency, ed) show an excellent tolerability profile: the incidence of adverse effects is always very low, this is also confirmed by the data from countries that have already started longer time the call ».

What can be done to increase adhesions at the fourth dose?

«It should be reiterated that in the most delicate people the risk of ending up in hospital is still there, and also of ending up in intensive care. The Italian choice, among other things, is quite conservative, the audience could have been extended: for people for whom the fourth dose is indicated, the probability of hospitalization decreases. The recommendations then are two: that of vaccination, in fact, and that of using early therapies if positive is found. But you have to really work on earliness ».

The virus remains unpredictable. But what can we expect, at least in the short term?

«In the short term, we won’t see any disasters. We are witnessing a relaxation of the measures, a relaxation that is in the individual behavior even before in the legislation: if you look around, you already see more casual people. But loosening the rules is inevitable ».

“There is some risk, inevitably. But this virus is so highly contagious that I don’t think it will change much. Hospitalizations remain at low numbers, a significant number of people are struggling with mild infection at home, and there is a share of people who test positive with self-administered tampons thus escaping the system’s tracking. There will probably still be some swings in the curve, but I am moderately optimistic for the summer. From autumn onwards, we’ll see. Up-to-date vaccines will be important ».

Is it still possible to leave the mask?

«Beyond the regulatory requirements, it is still a good idea to take it with you to crowded environments. Especially if you are fragile ».

What do the latest Omicron mutations tell us?

“As for contagiousness, perhaps the virus is being transmitted even more effectively: it is in the nature of the virus, the most contagious variant always imposes itself. As for clinical severity, however, there are no relevant variations “.


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