Study links shifts to buildup of susceptible hosts, explores similar shifts in heart-related deaths
Creative layout featuring scientifically-based 3D renderings of respiratory syncytial virus (RSV). RSV is a common contagious virus that infects the human respiratory tract. Credit: NIAID
A German analysis explores what underlies shifts in the timing of seasonal surges of respiratory diseases, as well as shifts in surges of heart-related deaths, that occurred after the COVID-19 pandemic began. Michael Sieber and Arne Traulsen of the Max Planck Institute for Evolutionary Biology, Germany, present these findings in the open-access journal PLOS Global Public Health on July 15, 2026.
Rates of respiratory infections such as the flu and RSV typically peak during seasons when transmission rates rise. Rates of death from any cause – not just from infection – follow a similar seasonal pattern.
However, the drivers underlying the exact timing of these surges have been unclear. The COVID-19 pandemic provided a unique opportunity to explore these dynamics, since interventions like social distancing and masking disrupted typical transmission patterns of other respiratory diseases. Sieber and Traulsen analysed data on weekly respiratory infection rates and death rates in Germany, covering the last 14 years.
The analysis showed that, pre-pandemic, respiratory infections almost always surged for a few weeks February and March. After the pandemic began, intervention efforts tamped down infections, eliminating one seasonal surge. Once infections rose again, surges shifted to December or earlier. Now, these peak weeks are gradually resuming pre-pandemic timing.
Using well-established epidemiological modelling tools, the researchers found that population-level loss of immunity after the skipped seasonal surge led to buildup of susceptible hosts, resulting in higher transmission earlier in the season. That is, seasonal transmission variations present a window of opportunity for a surge, and the size of the pool of susceptible hosts at the start of that window determines when, exactly, the surge occurs.
Similarly, typical seasonal surges in rates of death from any cause – but particularly from cardiovascular disease – also shifted earlier post-pandemic. Thus, respiratory infections may be key drivers of the timing of seasonal surges in cardiovascular deaths. More research is needed to explore this connection, but it aligns with other evidence that respiratory infections are a significant risk factor for cardiovascular disease.
On the basis of their findings, the researchers emphasize the importance of monitoring people’s infection history and improving vaccination coverage.
The authors add: “News stories of an earlier than usual onset of the flu season during the COVID-19 pandemic motivated us to look into the available epidemiological data more closely. We were surprised by the magnitude of the shift in timing of seasonal respiratory infections in Germany, and interested in trying to predict if this would turn out to be a long-term effect of the pandemic or if we should expect a quick return to the normal seasonal timing. The most recent flu seasons confirmed that the seasonal timing indeed shifts back to normal within one or two seasons, most likely due to a return to the pre-pandemic population-levels of immunity to the most common respiratory pathogens. We were even more surprised to see that the seasonal dynamics of all-cause mortality, which is dominated by cardiovascular diseases, closely followed the shift in timing of respiratory infections. This adds to the growing evidence that respiratory infections are an important risk factor for cardiovascular problems.”
Over-the-counter antihistamines and a prescription anti-inflammatory drug both have a small benefit in reducing long Covid fatigue among people receiving care from specialist long Covid clinics, according to new findings from a large clinical trial led by UCL and UCLH.
The study, published in The Lancet Infectious Diseases, involved nearly 800 adults in England with long Covid who were randomised to either usual care or one of three types of drugs: a combination of antihistamines, colchicine, or rivaroxaban.
The research team found that all groups experienced a meaningful reduction in their self-reported fatigue over 12 weeks (improving an average of 4.3 points on a 40-point scale), supporting the idea that specialist long Covid care can lead to important improvements in symptoms.
Those taking antihistamines and colchicine, but not the blood thinner rivaroxaban, saw a small additional benefit in fatigue reduction at 12 weeks (an extra 1.5 point improvement on the scale). However, this benefit was not sustained at 24 weeks (12 weeks after the participants stopped taking the drugs).
The trial was conducted by a national team of researchers, clinicians and patients across 12 clinics in England and Scotland led by co-chief investigators Professor Amitava Banerjee at UCL and Dr Melissa Heightman at UCLH. More than 30 organisations were involved, with UCLH recruiting around half the patients on this trial and the University of Lancashire Clinical Trials Unit co-ordinating all of the recruiting sites.
Professor Banerjee (UCL Institute of Health Informatics), the corresponding author, said: “We tested potential medicines based on the most promising theories of how to improve long Covid when we started out in 2021. Our findings suggest these drugs alone are unlikely to be the answer to long Covid fatigue. Antihistamines and the anti-inflammatory drug, colchicine, did provide a small benefit, but this did not last once participants stopped taking them and so they are unlikely to improve symptoms over the long term on their own.
“Both antihistamines and colchicine affect the immune system and it may be that they address the immune dysregulation that long Covid has been linked to, but further research is needed to understand the possible mechanism.
“The blood thinner, rivaroxaban, had no benefit and so our results do not support the use of anti-coagulation medicine for long Covid.”
Dr Melissa Heightman, clinical lead for the post-Covid service at UCLH, said: “It is heartening that people had a significant reduction in fatigue across all arms of the trial. This is more than you would expect based on time alone, given that participants had severe fatigue at recruitment and been ill for more than a year on average.
“This level of improvement shows the importance of specialist long Covid care. These services in England offer integrated care from a range of specialties with community-based rehabilitation to develop a plan for a person based on their symptoms and all of the ways the condition affects them.”
Participants of the trial were adults with long Covid who had not been hospitalised. The 12 long Covid clinics ranged from Hull and the Highlands to Leicester and London. Fatigue was assessed with a questionnaire at the start of the trial and then after 12 and 24 weeks.
The trial was open-label, meaning participants knew which drug they were taking (there was no placebo in the non-drug group), and so the researchers were unable to rule out a placebo effect. However, they said the benefit seen in two of the drug groups was unlikely to be caused by placebo alone, given that no such benefit was found for the other drug group (rivaroxaban).
Professor Banerjee said: “We have shown it is possible to conduct a large clinical trial for long Covid and to test treatments as we would for any other condition.”
Professor Danny McAuley, Scientific Director for NIHR Programmes, said: “The NIHR is proud to have funded this vital trial, which highlights the value of specialist care in delivering meaningful relief for long Covid patients. Finding even modest benefits for these inexpensive drugs, which are safe and commonly used for other conditions, is incredibly important to improve the evidence-based treatment of this complex condition. By providing the high-quality data needed to refine clinical approaches, this research ensures that the NIHR is helping to build a clearer, safer path forward for patient care which can be provided in the community.”
Professor Emma Wall, Clinical Research Group Leader at the Crick, Professor of Infectious Diseases at Queen Mary University of London, and academic consultant in Infectious Diseases and Acute Medicine for UCLH,said: “Because long Covid is such a new and complex condition, when it came to designing the trial, we started by listening to what patients were telling us about their symptoms and experiences, then looking for biological signals that might explain them and treatments that might help.
“The value of these results is not only that they suggest a potential treatment approach, but that they help us understand the biology of long Covid itself. Every signal we see in the trial helps us refine our understanding of the immune and inflammatory mechanisms that may be driving the disease, to develop new, better targeted treatments for future trials.”
People with long COVID are at increased risk of developing cardiovascular disease, according to a new study from Karolinska Institutet published in eClinicalMedicine. The results show that the risk of conditions such as cardiac arrhythmias and coronary artery disease is higher even among those who were not hospitalised during the acute infection.
Long COVID has become an increasingly significant health problem worldwide, and a growing number of studies suggest that the condition can lead to secondary cardiovascular diseases. To date, research has mainly focused on people who were hospitalised, whilst the risks for those who stayed at home or were treated at a GP are less well known. In the current study, the researchers investigated how often major cardiovascular events occur in these individuals compared with those without the diagnosis.
Of the just over 1.2 million people aged between 18 and 65 included in the study, around 9,000 had been diagnosed with long COVID, corresponding to 0.7 per cent. Two-thirds of them were women. People who had previously had cardiovascular disease or been hospitalised for COVID-19 were excluded from this group.
During the follow-up period of around four years, people with long COVID were more likely to suffer from cardiovascular disease: 18.2 per cent of women and 20.6 per cent of men experienced some form of cardiovascular event, compared with 8.4 per cent of women and 11.1 per cent of men in the group without long COVID.
When the researchers then adjusted the results for factors such as age, socio-economic status and other known risk factors, the differences remained. Women with long COVID had just over twice the risk of receiving a cardiovascular diagnosis compared with women without long COVID. Men had approximately a third higher risk.
“We found that cardiac arrhythmias and coronary artery disease were more common among both women and men with long COVID. In women, there was also an increased risk of heart failure and peripheral vascular disease. However, no clear association was found between long COVID and stroke,” says lead author Pia Lindberg, a nurse and PhD student at the Department of Medicine, Solna, Karolinska Institutet.
Need to be monitored more systematically
As many people with long COVID never required hospitalisation during their acute infection, there is a risk that secondary conditions may be missed, says Pia Lindberg, pointing out that the results suggest these patients may need to be monitored more systematically.
”Our results show that long COVID can be a risk factor for cardiovascular disease, even in younger people who were previously healthy. This underlines the need for structured follow-up that takes gender differences into account, particularly as cardiovascular disease in women often presents with more diffuse symptoms that can make diagnosis more difficult”, concludes Pia Lindberg.
Large study of patients in the US, Colombia, Nigeria and India finds symptom burden highest in high-income countries
Photo by Usman Yousaf on Unsplash
Patients with long COVID-19 in the US report far higher rates of brain fog, depression and cognitive symptoms than patients in countries such as India and Nigeria, according to a large international study led by Northwestern Medicine.
The authors note that higher reported symptom burden in the US may reflect lower stigma and greater access to neurological and mental health care, rather than more severe disease.
The study, the first cross-continental comparison of long COVID neurological manifestations, tracked more than 3100 adults with long COVID evaluated at academic medical centres in Chicago; Medellín, Colombia; Lagos, Nigeria; and Jaipur, India.
Among patients who were not hospitalised during their COVID infections (the majority in the study), 86% in the US reported brain fog, compared with only 63% in Nigeria, 62% in Colombia and 15% in India. Rates of psychological distress showed a similar pattern: Nearly 75% of non-hospitalised patients in the US reported symptoms of depression or anxiety, compared with only 40% in Colombia and fewer than 20% in Nigeria and India.
“It is culturally accepted in the US and Colombia to talk about mental health and cognitive issues, whereas that is not the case in Nigeria and India,” said Dr Igor Koralnik, senior study author and chief of neuro-infectious disease and global neurology at Northwestern University Feinberg School of Medicine.
“Cultural denial of mood disorder symptoms as well as a combination of stigma, misperceptions, religiosity and belief systems, and lack of health literacy may contribute to biased reporting. This may be compounded by a dearth of mental health providers and perceived treatment options in those countries.”
Brain fog, fatigue, myalgia (muscle pain), headache, dizziness and sensory disturbances (such as numbness or tingling) were the most common neurological symptoms across all countries
Insomnia was reported by nearly 60% of non-hospitalised US patients, compared with roughly one-third or fewer of patients in Colombia, Nigeria and India
Statistical clustering showed clear separation between high- and upper-middle-income (US, Colombia) and lower-middle-income (Nigeria, India) countries
Building on this work, Koralnik and his international collaborators are now studying cognitive rehabilitation treatments for long COVID brain fog in Colombia and Nigeria, using the same protocols developed for patients treated at the Shirley Ryan AbilityLab in Chicago.
Patients with cancer who received mRNA-based COVID vaccines within 100 days of starting immune checkpoint therapy were twice as likely to be alive three years after beginning treatment, according to a new study led by researchers at The University of Texas MD Anderson Cancer Center.
“This study demonstrates that commercially available mRNA COVID vaccines can train patients’ immune systems to eliminate cancer,” Grippin said. “When combined with immune checkpoint inhibitors, these vaccines produce powerful antitumour immune responses that are associated with massive improvements in survival for patients with cancer.”
How was this association discovered?
The discovery that mRNA vaccines were powerful immune activators came from research conducted by Grippin during his graduate work at the University of Florida in the lab of Elias Sayour, MD, PhD. While developing personalised mRNA-based cancer vaccines for brain tumours, Grippin and Sayour found that mRNA vaccines trained immune systems to eliminate cancer cells, even when the mRNA didn’t target tumours directly.
This finding led to the hypothesis that other types of mRNA vaccines might have the same effect, and the approval and use of mRNA-based COVID vaccines created an opportunity to test this hypothesis. Lin and Grippin initiated a major effort to retrospectively study if MD Anderson patients who received mRNA COVID vaccines lived longer than those who did not receive these vaccines.
How do mRNA COVID vaccines impact immunotherapy responses in cancer?
To better understand the mechanisms at work that can help explain the clinical data, the Lin and Sayour labs at both institutions studied preclinical models. They discovered that mRNA vaccines work like an alarm, putting the body’s immune system on high alert to recognise and attack cancer cells.
In response, the cancer cells start making the immune checkpoint protein PD-L1, which works as a defence mechanism against immune cells. Fortunately, several immune checkpoint inhibitors are designed to block PD-L1, creating a perfect environment for these treatments to unleash the immune system against cancer.
These preclinical observations held up in clinical studies as well. The investigators found similar mechanisms, including immune activation in healthy volunteers and increased PD-L1 expression on tumours in patients who received COVID mRNA vaccines.
While the mechanisms are not yet fully understood, this study suggests COVID mRNA vaccines are powerful tools to reprogram immune responses against cancer.
What are the major implications of this discovery?
“The really exciting part of our work is that it points to the possibility that widely available, low-cost vaccines have the potential to dramatically improve the effectiveness of certain immune therapies,” Grippin said. “We are hopeful that mRNA vaccines could not only improve outcomes for patients being treated with immunotherapies but also bring the benefits of these therapies to patients with treatment-resistant disease.”
A multi-centre, randomised Phase III trial currently is being designed to validate these findings and investigate whether COVID mRNA vaccines should be part of the standard of care for patients receiving immune checkpoint inhibition.
What are the key data from this study on mRNA COVID vaccines and immunotherapy outcomes?
This study included multiple cohorts of several cancer types, evaluating patients who had received an mRNA vaccine within 100 days of starting immunotherapy treatment.
In the first group, 180 patients with advanced non-small cell lung cancer who received a vaccine had a median survival of 37.33 months, compared to 20.6 months in 704 patients who did not receive a vaccine. In a cohort of patients with metastatic melanoma, median survival was 26.67 months in 167 patients who did not receive a vaccine, but it had not yet been reached in 43 patients receiving a vaccine – suggesting a significant improvement.
Importantly, these survival improvements were most pronounced in patients with immunologically “cold” tumors, which would not be expected to respond well to immunotherapy. These patients, who have very low PD-L1 expression on their tumours, experienced a nearly five-fold improvement in three-year overall survival with receipt of a COVID vaccine.
Findings were consistent even when considering independent factors, such as vaccine manufacturer, number of doses, and when patients received treatment at MD Anderson.
Scientists have uncovered a link between COVID-19 control measures and a surge in serious infections in children following the pandemic.
The findings, which come from a large European study led by researchers at Imperial, suggest that non-pharmaceutical interventions (NPIs) including lockdowns, school closures and social distancing may have inadvertently delayed the development of young children’s immunity to specific infectious diseases, leaving them more vulnerable to severe illness.
The researchers explain that while this impact was anticipated for viral infections (such as influenza and RSV), a surge in other infections, including the bacterial infection Strep A, had not been expected.
The authors advise the need to carefully weigh the impact of restrictions on children during future pandemics and stress the importance of development and delivery of vaccines to reduce the impact of severe infections across all age groups.
Associate Professor Tom Parks from Imperial’s Department of Infectious Disease, co-lead author on the study, said: “During the COVID-19 pandemic there was huge uncertainty about the spread and severity of a new disease and difficult decisions had to be made to protect vulnerable groups, as well as to maintain the health service. Restrictions like lockdowns and social distancing played a vital role in limiting the transmission of the SARS-CoV-2 virus, which undoubtedly, saved countless lives, reduced the impact on health systems including the NHS and bought countries time to roll out vaccine programmes.
“However, our study shows they also disrupted how children built immunity during these critical early years. Children aged 3-4 tested for Strep A immunity after the pandemic were approximately a year behind children tested before the pandemic. This difference in immunity appears to have contributed to the alarming rise in severe Strep A infections seen across Europe during 2022 and 2023.”
Strep A infections
Strep A (Group A Streptococcus) is a common type of bacteria that typically causes throat infections and scarlet fever. While most infections are mild, in rare cases Strep A can cause invasive infections which can be fatal. Each year, around half a million people, including many children and young people, die around the world because of serious Strep A infections.
Previous research has shown that while rates of Strep A infections fell dramatically during the pandemic, many countries recorded a surge in infection rates once restrictions were lifted.
In the latest study, the team examined immune responses in 452 children aged 0-4 year old across 10 European countries that participated in two EU-funded studies: PERFORM and DIAMONDS.
They found that children aged 3-4 who were exposed to NPIs during the pandemic had significantly lower levels of antibodies to Strep A compared to children of the same age who were sampled before the pandemic. The findings correspond exactly with the age group that experienced the greatest increase in life-threatening Strep A infections after NPIs were removed in England.
The researchers also found similar delays in immunity to respiratory syncytial virus (RSV), another common and potentially serious childhood infection, and a small reduction in immunity to some common cold viruses.
Professor Shiranee Sriskandan, co-director of Imperial’s Centre for Bacterial Resistance Biology and co-lead author said: “Strep A is one of the leading causes of unexpected death from sepsis in otherwise healthy children, and we know that sadly disease progression can be exceptionally rapid, making prevention – rather than intervention – our best option to reduce deaths. This study underlines the importance of immunity among young children in preventing outbreaks of serious strep A infections and highlights the value of developing a vaccine for Strep A.
Professor Mike Levin, from Imperial’s Department of Infectious Disease, who led the DIAMONDS and PERFORM studies, said: “Many of the children who had Strep A infections also had viral infections at the same time. Children appear to have been vulnerable to several infections all at once most likely because they had encountered fewer infections and so had little chance to build up immunity.”
A research team at Saarland University has demonstrated in a clinical study that a widely used anti-allergy nasal spray containing the active ingredient azelastine can significantly reduce the risk of infection with the SARS-CoV-2 virus. The results of the placebo-controlled trial involving 450 healthy participants have now been published in JAMA Internal Medicine.
The trial, led by Professor Robert Bals, Director of the Department of Internal Medicine V at Saarland University Medical Center and Professor of Internal Medicine at Saarland University, divided the 450 participants into two groups. The treatment group of 227 individuals used an azelastine nasal spray three times a day over a 56-day period. During that same period, the 223 participants in the control group used a placebo spray three times a day. Robert Bals summarised the key finding as follows: ‘During the observation period, 2.2% of the participants in the azelastine group became infected with SARS-CoV-2; in the placebo group, it was 6.7%—three times as many.’ All infections were confirmed by PCR testing.
In addition to showing a marked reduction in coronavirus infections, the azelastine group also displayed fewer symptomatic SARS-CoV-2 infections, a lower overall number of confirmed respiratory infections, and, unexpectedly, a reduced incidence of rhinovirus infections, another major cause of respiratory illness. In the treatment group, 1.8% developed a rhinovirus infection, compared to 6.3% in the placebo group—a proportion similar to that seen for SARS-CoV-2.
Azelastine nasal spray has been available for decades as an over-the-counter treatment for hay fever. Previous in vitro studies on azelastine had already suggested antiviral effects against SARS-CoV-2 and other respiratory viruses. ‘This clinical trial is the first to demonstrate a protective effect in a real-world setting,’ says Professor Bals.
For Robert Bals, the results suggest practical applications: ‘Azelastine nasal spray could provide an additional easily accessible prophylactic to complement existing protective measures, especially for vulnerable groups, during periods of high infection rates, or before travelling.’ But Professor Bals also stressed the importance of further research: ‘Our results highlight the need for larger, multicentre trials to continue exploring the use of azelastine nasal sprays as an on-demand preventive treatment, and to examine its potential effectiveness against other respiratory pathogens.’
Besides Professor Bals, the randomised, double-blind phase 2 study ‘CONTAIN’ also involved the Institute of Clinical Pharmacy (Professor Thorsten Lehr, Dr. Dominik Selzer), the Institute of Virology (Professor Sigrun Smola), and the Saarbrücken-based pharmaceutical company URSAPHARM Arzneimittel GmbH, which sponsored the study and manufactured the investigational product. The Helmholtz Institute for Pharmaceutical Research Saarland (HIPS) contributed through the research groups of Professor Smola and Professor Bals. The project serves as an excellent example of successful collaboration between academic research, industry partners and public health initiatives in the Saarland region.
People who have had COVID are at increased risk of developing certain inflammatory diseases of the airways, such as asthma, hay fever and chronic sinusitis. However, vaccination against the SARS-CoV-2 virus appears to reduce the risk, according to a comprehensive epidemiological study led by researchers at Karolinska Institutet.
The international research team used an electronic health database in the United States, TriNetX, to investigate the link between COVID and so-called type-2 inflammatory diseases, a group of chronic conditions in which the immune system overreacts to allergens or infections.
The researchers compared 973 794 people who had had COVID with 691 270 people who had been vaccinated against the SARS-CoV-2 virus and 4 388 409 healthy controls with no documented infection or vaccination.
Inflammation in the airways
The results are presented in The Journal of Allergy and Clinical Immunology. People who had had COVID had a 66% higher risk of developing asthma, a 74% higher risk of chronic sinusitis and a 27% higher risk of hay fever compared with healthy controls. However, no increased risk was seen for the skin disease atopic eczema or for eosinophilic oesophagitis, an inflammation of the oesophagus.
“Our results suggest that COVID-19 can trigger type-2 inflammation in the airways, but not in other organs,” says Philip Curman, a physician and researcher at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, Sweden, who led the research.
Vaccination against the virus had the opposite effect. The risk of asthma was 32% lower among vaccinated individuals compared with healthy unvaccinated individuals. The risk of sinusitis and hay fever was also slightly lower.
More than twice the risk
When people who had had COVID were compared with vaccinated individuals, an even clearer effect was seen. Infected individuals had more than twice the risk of developing asthma or chronic sinusitis and a 40% higher risk of developing hay fever compared with those who had been vaccinated.
“It is interesting to see that vaccination not only protects against the infection itself, but also appears to provide good protection against certain respiratory complications,” says Philip Curman.
The study is retrospective, i.e. based on data that has already been collected. This means that the researchers cannot draw any firm conclusions about causal links. Another limitation is that some infections may have gone undiagnosed, especially if they were detected through self-testing.
The research was conducted in close collaboration with the University of Lübeck and the Lübeck Institute of Experimental Dermatology in Germany, the Technical University of Madrid in Spain and Bar-Ilan University in Israel. It was mainly funded by the German Research Foundation (Deutsche Forschungsgemeinschaft), Region Stockholm and Karolinska Institutet. Two researchers received travel grants from TriNetX, which provides the database used in the study, and one of the authors is employed by the company.
Thanks to vaccinations against SARS-CoV-2 in the period 2020-2024, 2.533 million deaths were prevented at the global level, one death was avoided for every 5400 doses of vaccine administered. The 82% of the lives saved by vaccines involved people vaccinated before encountering the virus, 57% during the Omicron period, and 90% involved people aged 60 years and older. In all, vaccines have saved 14.8 million years of life (one year of life saved for 900 doses of vaccine administered).
These are some of the data released in an unprecedented study published in the journal Jama Health Forum and coordinated by Prof Stefania Boccia, Professor of General and Applied Hygiene at Università Cattolica, with contributions from Dr Angelo Maria Pezzullo, Researcher in General and Applied Hygiene, and D. Antonio Cristiano, a medical resident in Hygiene and Preventive Medicine. The two researchers spent a period at Stanford University, collaborating directly with the group of Professor John P.A. Ioannidis, director of the Meta-Research Innovation Center (METRICS), in the context of the project “European network staff eXchange for integrAting precision health in the health Care sysTems- ExACT” funded by the European Research Excellence Programme RISE project-Marie Slodowska Curie and coordinated by Professor Stefania Boccia.
Professor Boccia and Dr Pezzullo explain: “Before ours, several studies tried to estimate lives saved by vaccines with different models and in different periods or parts of the world, but this one is the most comprehensive because it is based on worldwide data, it also covers the Omicron period, it also calculates the number of years of life that was saved, and it is based on fewer assumptions about the pandemic trend.”
The experts studied worldwide population data, applying a series of statistical methods to figure out who among the people who became ill with COVID did either before or after getting vaccinated, before or after Omicron period, and how many of them died (and at what age). ‘We compared this data with the estimated data modeled in the absence of COVID vaccination and were then able to calculate the numbers of people who were saved by COVID vaccines and the years of life gained as a result of them,’ Dr Pezzullo explains.
It also turned out that most of the saved years of life (76%) involved people over 60 years of age, but residents in long-term care facilities contributed only with 2% of the total number. Children and adolescents (0.01% of lives saved and 0.1% of life years saved) and young adults aged 20-29 (0.07% of lives saved and 0.3% of life years saved) contributed very little to the total benefit.
Professor Boccia concludes: ‘These estimates are substantially more conservative than previous calculations that focused mainly on the first year of vaccination, but clearly demonstrate an important overall benefit from COVID-19 vaccination over the period 2020-2024. Most of the benefits, in terms of lives and life-years saved, have been secured for a portion of the global population who is typically more fragile, the elderly’.
During South Africa’s COVID-19 hard lockdown, Dr Sandile Cele became the first to successfully grow the beta variant of SARS-CoV-2 in the lab. PHOTO: Rosetta Msimango/Spotlight
In a Durban laboratory in 2020, there was dancing and scientists jumping with joy when Dr Sandile Cele realised they had finally successfully “grown” the SARS-CoV-2 Beta variant. It was the holiday season and Cele and a few colleagues had sacrificed their Christmas to continue research at an otherwise deserted laboratory.
The Beta variant (501Y.V2) was first detected in the Eastern Cape in October 2020 and was announced to the public on 18 December that year.
“It was December 2020 and Tulio [Professor Tulio de Oliveira] had just flagged the beta variant and we had been struggling trying to grow it, really struggling for about two weeks,” says Cele. “But then as a scientist, you have to think outside the box and eventually it [the virus] did catch on. I was with Professor Alex Sigal that day in the laboratory. We were so excited. There was a lot of dancing in the lab, jumping up and down…”
The 35-year-old’s work on the Beta and Omicron variants helped propel South Africa to the forefront of COVID-19 research. Cele is the scientist credited with growing both Beta and Omicron in record time as the world reeled under lockdown pressure. Last year, he was awarded a special ministerial Batho Pele excellence award for his contribution to COVID-19 research in South Africa.
The moment of greatest fulfilment
Speaking to Spotlight, Cele says growing the beta variant was the moment of greatest fulfilment in his career so far.
“It was just a crazy, crazy moment. Like, you know when you are with your superior, usually you meet on a basis of respect. I mean, you talk seriously. They ask a question, you answer, and so on. But [at] that moment, all that got thrown out the window. We were celebrating. So yes, it was really special.”
At the time, they were leaping with joy inside PPE (personal protective equipment), including specialised masks, double gloves, plastic sleeves, and boots. Cele points out that due to all the safety measures in place, infection risk was smaller in their lab than at an average mall.
He was working inside a state-of-the-art biosafety level 3 (BSL-3) laboratory at the Africa Health Research Institute (AHRI). The laboratory is on the third floor of the University of KwaZulu-Natal’s medicine building. In the same eight-storey glass and face brick building, on the first floor, de Oliveira had been studying virus samples for genetic clues at KRISP, the KwaZulu-Natal Research and Innovation Sequencing Platform, from where the discovery of Beta and Omicron was first announced.
How he did it – growing the beta variant
Cele explains that viruses are isolated or “outgrown” by infecting cells in the laboratory, using swab samples from infected individuals.
“Growing a virus simply means isolating it from an infected host (humans) and making more of it in the lab for research purposes,” Cele explains. “You cannot study a virus within an infected person, especially a new virus. You need to have it in the lab for identification and clarification. Usually, you get small quantities from an infected person, thus you have to expand or grow – or make more of it – for research.”
Photo by Shvets Production on Pexels
However, the beta variant had not responded like previous SARS-CoV-2 variants. At the time, Cele found a creative solution using both human and monkey cell lines. First, he infected human cell lines with the beta variant, incubating the assay for four days. Then he used the infected human cell lines to infect monkey cell lines, which successfully lead to production of the virus.
Their moment of triumph arrived when they noticed the monkey cell lines starting to die, meaning that the virus was growing. The isolated virus could then be used in the laboratory to run experiments, like testing vaccine efficacy.
“Looking at the cells under the microscope, you can see them starting to die,” he says. “That they’re not happy. That they have been infected, which then obviously needed to be confirmed.”
While Cele’s Durban mentors – de Oliveira and Sigal – kept the public abreast of research developments, the young scientist kept his head down, pouring over his microscopes. “The world was going crazy, everything was crazy, but I had work to do,” he says.
‘a rising star’
During the interview, Cele readily shares anecdotes and laughs often.
From Ndwedwe, a rural area forty kilometres north of Durban, Cele joined Sigal’s laboratory team at the AHRI in 2014, where he studied HIV drug resistance and later COVID-19. His PhD obtained from UKZN in 2021, focused specifically on understanding the beta variant and its escape from antibodies.
“Actually, Professor Alex Sigal really took a chance on me,” he says. “Because on that post for a laboratory technologist, they stipulated that they wanted someone with three years experience. And I had only been doing my internship [at the Technology Innovation Agency] for eight months.”
But Sigal’s faith paid off, and he subsequently praised Cele in national press interviews on COVID-19. “Sandile is a rising star who spent all his holidays in a laboratory,” Sigal told journalists in January 2021.
Last year, the Bill and Melinda Gates Foundation invited Cele to present his findings at the Grand Challenges Annual Meeting in Brussels. This was his first time abroad. “It was my first time traveling outside South Africa and my first time talking in front of so many people. I presented my go-to talk – based on a paper I did on COVID-infection and HIV – and it went well,” he says.
Earlier this year, Cele was named one of Mail & Guardian’s 200 trailblazing young South Africans in the technology and innovation category. At the time, he could not attend the gala event as he was at the University of Nairobi in Kenya for training relating to a project involving HIV research for the Aurum Institute. Cele started a new job at the Aurum Institute in Johannesburg in March.
Over Zoom, Cele is speaking from his new home in Johannesburg. He is wearing a fluffy blue robe over his clothes, laughing as he says how cold Johannesburg is coming from Durban.
A sudden death
In Ndwedwe, Cele was one of ten boys born to his father, who was away from home often for work. Describing his mother as “a busy lady”, Cele says she was the one who shaped his young everyday life. Growing up in a mud hut without electricity and running water, he recalls how his mother would get up early every morning to prepare vetkoek, which she sold at a local school, and to boil water so her children could have a bath before leaving for school.
In the afternoons, he would look after his father’s goats and play soccer. He says that as a child he preferred herding goats to cows, as goats grazed for only about five hours, whereas cows took all day to eat their fill. From Grade 9 on, he attended school in Durban, at Overport Secondary School.
A childhood memory that inspired him? “Before my mother died, she sat us down and said one day I will be gone and I want you to know there are no shortcuts in life. Work hard and look after one another and you will be okay.”
His mother’s death was sudden, following complications from minor surgery.
“Like, I came back from school on a Friday only to find my father wasn’t around and had left a note… On the Saturday morning, I found out my mother had passed. And I think she went for, I don’t know, an operation or something. But as a kid, I guess they didn’t tell us because they thought it was something minor; that she would get operated [on], then go back home. I’m not really sure what happened. So, yes, it was a sudden death.”
The year after his mother died, Cele’s matric marks suffered. He says his final grade 12 marks had been 48% for maths, 53% for physics, and 66% for biology.
“I wasn’t really studying, I couldn’t really concentrate,” he says. “There was a lot going on when I was doing my matric. My mother passing away… and also the move from a rural school to the city where we were taught in English, everything in English.”
Cele came to study biology quite at random. He applied to study at UKZN only in October of his matric year – with admissions to most of the university’s courses having closed the previous month. He picked one of the last remaining options, which had been biology.
Soon, the young student started excelling. Cele obtained his BSc Biomedical Sciences degree with a Dean’s commendation and his Honours in Medical Microbiology, summa cum laude. He completed his Masters in Biochemistry with an upper-class pass.
To the Mail and Guardian, he shared advice he would give to his younger self: “Do not be afraid, you are a force to be reckoned with.”
Cele’s driving passion is to advance public healthcare, which he will continue to do at the Aurum Institute – an organisation that amongst others does research into Africa’s tuberculosis and HIV response. Cele has a ten-year-old son who lives in Durban.
Note:The Bill and Melinda Gates Foundation is mentioned in this article. Spotlight receives funding from the foundation, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
