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COVID-19: mass screening reveals significant transmission risk from asymptomatic carriers

Based on the results of the large-scale testing programme run in Luxembourg, researchers show that asymptomatic SARS-CoV-2 carriers represent an important vector for transmission.

Large-scale testing for SARS-CoV-2 has been a topic of intense political and societal debate, the rationale for screening asymptomatic individuals having been in particular questioned. Nevertheless, whether asymptomatic carriers play an important role in population-based transmission has remained an essential question.

Luxembourg had been one of the first countries to implement a large-scale testing programme in May 2020, offering all of its residents and cross-border workers the opportunity to regularly and voluntarily get tested for free. The first phase of testing ran from 27 May until 15 September 2020 covered 49% of the resident and 22% of the cross-border worker populations, enabling the detection of 26% of all positive cases of the first epidemic wave.  This provided decision makers with evidence-based data and allowed to break infection chains early whereby the total number of cases would have been 43% higher without the testing over this period as shown by computer simulations.

In addition, large-scale testing provides a unique test case for assessing the role of asymptomatic carriers. Based on the contact tracing data from phase 1 of the large-scale testing programme, Luxembourg researchers revealed that asymptomatic SARS-CoV-2 carriers are likely similarly infectious compared to symptomatic individuals.

“Indeed, our data show that they infect on average a similar number of people as symptomatic individuals. Asymptomatic carriers, including those that are presymptomatic at the time of the test, thereby represent an important factor in triggering and sustaining infection chains.”

Paul Wilmes, Luxembourg Centre for Systems Biomedicine, University of Luxembourg

The testing strategy was designed in a 3-layered approach by estimating exposure to the disease and physical proximity to categorise activity sectors into high and medium risk. Not surprisingly, the analysis shows that people who worked in the high-risk sectors had greater odds of being tested positive. Moreover, the data revealed that individuals with a disposable household income of less than 30k€/year also had the highest risks of being infected.

In addition to its direct effect on infection dynamics, the large-scale testing also enabled the collection of a wealth of pseudonymised data that can now be exploited to learn more about SRAS-CoV-2.”

Ulf Nehrbass, CEO of the Luxembourg Institute of Health

By clarifying the role of asymptomatic carriers in the transmission of SARS-CoV-2, this analysis provides essential insights for the development of future population-level containment and mitigation strategies.

About the large-scale testing

As part of its lockdown exit strategy, Luxembourg implemented an extensive and unique nation-wide testing campaign, inviting its residents and cross-border workers to voluntarily get tested for SARS-CoV-2. The aim of this large-scale testing (LST) initiative was to limit the spread of the SARS-CoV-2 virus by identifying positive cases early, including among asymptomatic individuals, thereby pre-emptively breaking infection chains. At the same time, LST contribute to the close monitoring of the spread of the virus among the Luxembourg population.

The first phase of the LST, coordinated by the Luxembourg Institute of Health (LIH) and supported by researchers at the University of Luxembourg, ran from 27 May until 15 September 2020 and relied on 16 ‘drive-through’ and 1 ‘walk-through’ test stations, with a maximum theoretical capacity of 20,000 tests per day. The population was divided into three main categories with different testing intervals. The first category was composed of people exposed to a high infectious risk by their professional activity (such as healthcare professionals) whereas the second category consisted of those having resumed their professional activity or were about to get back to work. The third category encompassed representative samples of the general population. The recurrent testing of the contingents and the rigorous contact tracing not only aimed at breaking nascent infection chains but also at providing decision makers with evidence-based data. Over the first phase of the LST, a total of 566,320 tests was performed based on a total of 1,436,000 invitations, which corresponds to 69,7% of all tests performed and an overall response rate of 39,4%.

Learn more on the large-scale testing

Read the article on The Lancet Regional Health – Europe website


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COVID-19: how could virus mutations affect current and future vaccination strategies?

The mRNA technology is often discussed in the context of vaccine development against SARS-CoV-2. Prof. Stephanie Kreis, Associate Professor at the Department of Life Sciences and Medicine at the University of Luxembourg, is a virologist by training who is now working in cancer research. She explained to us in her interview how virus mutations could affect current and future vaccination strategies.
Can you briefly explain what a virus is and what it does?

A virus is a small particle in which genetic material in the form of RNA or DNA is encapsulated by lipids and proteins. As they cannot live on their own, viruses are not considered living organisms as such. Instead, they need to infect a host cell where they hijack the molecular machinery and resources to replicate themselves to infect even more cells. There are thousands of different viruses out there many of which are still unknown. Typically, each virus has a specificity towards a certain host or cell type and thus only infects certain species, including humans.

An infection is started when surface proteins of the virus attach to specific receptors on the cell being infected. In the case of SARS-CoV-2, the new coronavirus, this is the so-called spike protein. It connects to ACE-2, a molecule that is present on many different cell types in our body. After docking to this receptor, the virus releases its own genetic material (RNA) into our cells and this RNA serves as a blueprint to generate and assemble new virus particles. Viruses have the ability to turn our own cells into virus-producing factories and the released particles then go on to infect other cells and eventually other individuals. Luckily, our immune system has several clever strategies to deal with such an infection and to contain and eventually eliminate the virus.

How does a vaccination support the immune system in this?

By presenting a weakened virus or parts of a virus – such as the spike protein – during vaccination, we are priming our immune system, so that it can activate its lines of defence. As early as 1796, Edward Jenner performed the first well-documented vaccination of a young boy in England against smallpox virus. More than 200 years of research have yielded many different vaccines that have probably altogether saved more lives than any other clinical intervention.

How does vaccination work then?

The immune system recognises these vaccinated viral protein parts, also called antigens, and generates very specific responses and finally antibodies that detect these antigens. Upon a real infection with this particular virus, our immune system can now react much faster and more targeted to this virus so that the intruder has no time to replicate to numbers, which would make us feel sick. If the immune system is not primed either by vaccination or by previous natural infections, the viral replication cycles are usually faster than our immune response, so that we develop symptoms and get sick.

Furthermore, viruses constantly mutate and if the virus changes the composition of the key antigens, the previously acquired immunity might be impaired. Most likely, it will not disappear completely and all of a sudden, but it is possible that new viral variants are not efficiently recognised by our immune systems. This phenomenon is regularly seen with Influenza viruses.

Why and where do such mutations occur?

RNA-viruses such as SARS-CoV-2 are constantly mutating in a more or less random fashion. Most of these mutations do not change the composition or shape of the virus particle or become disadvantageous to the host. However, in the rare event that such stochastically generated mutants confer a survival advantage to the virus by allowing it to better adapt to an altered environmental condition or to escape an immune response or drug treatment, these variants will prevail. This is a normal evolutionary process not only seen in viruses but in all living organisms, including us. The only difference is that viruses, especially RNA viruses, mutate much more frequently and therefore it is important to routinely monitor the genetic sequences of pathogenic viruses. This knowledge is a pre-requisite to react quickly and adequately if we need to change the formulations of existing vaccines. These molecular epidemiological studies are performed for several important viruses around the world for many years already. We will now have to add Coronaviruses to this list of monitored viruses.

The UK-variant of SARS-CoV-2, which was among the first new variants to be reported in the media, has acquired small changes in the spike protein, which is also the target of our antibodies designed to neutralise the virus. The spike protein of SARS-CoV-2 consists of more than 1,200 amino acids, the building blocks of all proteins. Depending on which of these amino acids are deleted or exchanged, the impact on our immune response might be more or less critical. From all we know so far, the current vaccines are fully protective against the UK variant but might be slightly less effective against other variants.

How can the vaccination strategy be adapted fast enough to avoid the virus escaping the vaccinations?

Interestingly, the new mRNA-based vaccination technology might also offer ways to react quickly to emerging viral variants. The mRNA, which encodes the information needed to make a SARS-CoV-2 spike protein could be easily adapted to either encode other viral proteins or to code for the mutated variant of the spike protein. As the mRNA sequences are synthetically generated, they could be adapted to include the new sequences present in the UK, South African or other variants. It is even conceivable to combine several different mRNAs into one vaccine. This is an interesting and very promising development not only useful in the battle against coronaviruses.

Was mRNA technology used in the vaccination already established before?

Indeed, the COVID-19 vaccines developed by the German companies BioNTech, CureVac and the US-based company Moderna are the first mRNA vaccines approved worldwide. However, companies like BioNTech are working on mRNA-based therapies for far longer than a decade. Interestingly, this novel drug class was initially developed in the context of cancer treatment: Several clinical studies applying mRNA-based drugs have shown promising responses in late-stage cancer patients. Importantly, the safety profiles and assessments of these mRNA-based drugs have generally been very good even in severely ill, late-stage cancer patients; this was very important available knowledge when adapting the mRNA technology to anti-viral vaccines early last year. Given these promising data on mRNA-based cancer treatments and the current success with the SARS-CoV-2 vaccine, I am sure we will see more mRNA-based drugs in the future.

It is important to emphasise that the mRNA technology with all its components, including modes of delivery, synthesis, protection and modification of the mRNAs, etc. has been around for quite some time. The rapid adaptations to a successful vaccine were made possible by the pressure of a major pandemic and the concerted efforts and financial support of all stakeholders. The clinical trials starting in spring 2020 were performed according to common standard regulations. The vaccine trials involved several tens of thousands volunteers worldwide and have shown remarkable responses as the necessary components of our immune system are being successfully activated to provide protection against the virus. Moreover, observed and expectable side effects were overall very mild or absent.

What does this mean for the current vaccination strategy?

We have innovative, highly efficient and safe mRNA COVID-19 vaccines at hand and soon several other vaccines based on previously available technologies will follow. All vaccines getting approval in Europe have been thoroughly tested and can be considered very safe and efficient to prevent infections with SARS-CoV-2. The overall very mild side effects are by far outweighed by the benefits of vaccination not only for the individual but also for entire populations. Of course, we do not know yet if long-term side effects may appear but given the knowledge we have on vaccinations in general and mRNA biology in particular this is very unlikely. On the other hand, the potential long-term effects a natural COVID-19 disease might cause, are likely much more serious and frequent.

Last but not least, the longer the virus circulates at such high case numbers in the world, the higher the chances for new and potentially more harmful variants to appear. High vaccination coverage is the most efficient way to stop this vicious circle and to allow us all to get back to a normal life.

This article was originally published by the University of Luxembourg

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COVID-19: how is the economy affected by the pandemic? And what can we expect from the vaccinations in that context?

The COVID-19 pandemic not only challenges our everyday routines, but also the overall economy. We spoke about this topic with Prof. Conchita d’Ambrosio from the Department of Behavioural and Cognitive Sciences and Prof. Christos Koulovatianos, working at the Department of Finance. How is the economy affected by the pandemic – and what can we expect from the COVID-19 vaccinations in that context?

This article was originally published by the University of Luxembourg

How can one assess the impact of the COVID-19 pandemic on the economy?

COVID-19 has changed our lives. To evaluate the complex interactions that take place in society, economists use mathematical equations that model what we observe. Economists reacted to the pandemic by combining epidemiological models, also called SIR – Susceptible, Infectious or Recovered models, which assess the dynamics of the disease, with existing economic models. This combination is necessary to answer key questions, such as: what is the economic impact if we do not impose lockdowns, with many sick workers absent from work, and with heightened healthcare costs? What is the cost of every lockdown? What happens if many people refuse to be vaccinated? Some more advanced economic models also incorporate expectations of investors and consumers about the future, asking questions such as: will the announcement or the anticipation of a future lockdown or of a slow future vaccination rate make investors pull out of stock markets and other investments, causing negative chain reactions such as bankruptcies and unemployment?

What can we learn from such models?

As SIR economic models vary, depending on the detail of available data from the production sector, there may be a wide range of economic predictions. Models from the European Central Bank make optimistic predictions of more than 3% growth in the Eurozone in 2021. Yet, models scrutinising more detailed national data tend to be more pessimistic. For example, the model from STATEC/LISER gives numbers ranging from 4% to -0.5% GDP growth for Luxembourg in 2021, compared to a growth rate of 3% expected in the pre-pandemic year of 2019. Yet, these numbers may become worse, considering the strength of the second COVID-19 wave and the possibility of a third wave, given the slow rollout of vaccinations. The lockdowns put a heavy burden on the economy and society, along with psychological challenges. The lockdowns oblige entire sectors, especially hospitality, to reduce, suspend or stop production, which could lead to bankruptcies, financial losses and debt. Yet, “no lockdowns” can deteriorate production as well: due to the high fraction of sick workers, damages to people’s health who recover from COVID-19 can be permanent adding to a long-term cost, and lives lost are highly undesirable. There is one common response to both problematics: the earlier and the more comprehensive the vaccination is, the better it is for the economy and society.

Which role does the vaccination play in the modelling? 

It plays truly an important part! With the vaccination rollout underway, we can now introduce that variable to predict a potential end of the pandemic which was not possible half a year ago. Finally, there is some light at the end of the tunnel.

The vaccination rate is however not the only variable in this model as the outcome also depends on our personal behaviourpolicies, and many other factors, such as political stability, the level and the risk of accumulated private and public debt, the exposure of the banking sector to such debts, etc. Still, the vaccination is the only realistic way to end the pandemic and the restrictions associated to it.

However, also the speed of intervention matters. We know this from studies on the optimal speed of monetary policy, for example: The “cold turkey” policy is less costly for the economy and the society than a gradual policy. From the models we can also see that the costs of economic recovery increase even more, the longer the pandemic lasts. In other words, the slower we vaccinate people, the higher are the costs for such a recovery.

What are the indicators that the availability of the vaccine has an effect on the economy?

The first to have made the predictions were the advanced SIR epidemiological/economic models that examine the expectations of investors and consumers. When the breakthroughs on the vaccine development were announced, the economy reacted to this news in a positive way: we could observe that the stock markets have stabilised again. This is a good sign as it creates a robust basis for investments and for rescuing companies and jobs. It is important for investors to have a stable and confident market rather than an unpredictable economic development. The vaccination also has a very positive impact on this.

Yet, there were negative updates to the good news too: As predicted, the oil price increased, as well as shipping costs for goods from China and general demand. Additionally, the slower rate of vaccine availability led to an update of expectations. Some models predict that the announced delays in vaccine availability in the EU, can lead to losses of 12 billion euros per week, about 3.5% of the weekly EU GDP.

In addition, the turbulent vaccine politics of “which country obtains vaccines first” is making financial markets nervous. This nervousness can impede economic recovery: nowadays, political and financial stability are intertwined more than in other normal times.

How do the lockdown measures impact the economy?

From an economic viewpoint, there is a short-term economic benefit to granting people the freedom to run their business, to go shopping and to invest money. However, during the pandemic, the benefits of this freedom are counterbalanced by the public and private costs imposed on our lives, the health system, the number of workers with sick leaves, the social turbulence. In the UK, during the first wave, the delay in imposing lockdowns brought with it a heavy toll on both human lives and on the economy. On the contrary, China is the other extreme, with drastic, very abrupt and extreme measures impacting the economy heavily, but for a shorter period, returning to economic and social normality earlier. Nevertheless, it would be difficult to implement such drastic measures in Western societies that have established laws respecting a high level of privacy and freedom of choice.

What will happen to the economy in the future? Can we come back to a pre-pandemic situation?

Strictly speaking, the economy was still recovering after the financial crisis of 2009 as banks have been undercapitalised in the past. The additional burden due to the COVID-19 measures has caused a setback on this track. However, this holds true for almost every country. It is important that we get back on track as fast as possible to minimise the damage for the economy and the society.

In the best-case scenario, the economy will return to its past economic performance once herd immunity is achieved. Yet, governments and the public will have to coordinate contracts to repay the accumulated debts during the pandemic.

If the immunity to SARS-CoV-2 is acquired too slowly, more and more companies will go bankrupt, for example. This might as well impair investments and lead to a prolonged recession causing socio-political problems for several years.

At the same time, some of the changes we now experience in everyday life might also bring new opportunities: An accelerated digitalisation as well as an alternative business-meeting culture with less travelling might very well transform the economy by also saving expenses. History has shown that after big crises of mankind such as wars, or pandemics, often major changes were implemented which improved the overall condition of society, such as Universal Suffrage, introduced in many countries after WW1 and the Welfare State after WW2. Along those lines, we hope that COVID-19 is also an opportunity to perform better. Thus, everybody should get vaccinated as soon as possible in order to end this pandemic and to move on to new opportunities.

As Luxembourg’s Minister for the Environment, Climate and Sustainable Development Carole Dieschbourg said at the October Days for Sustainable Development 2020, we need a shift from the old standard economic approach to a well-being socio-economic system with the Sustainable Development Goals as a framework.

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COVID-19: What can we expect from the vaccines?

What can we expect from the COVID-19 vaccines? And how do they perform compared to previously developed vaccines against other diseases? We spoke with Prof. Gilbert Massard, Director of Medical Education at the Department of Life Sciences and Medicine, who explained the benefits and the development process of vaccines.

This article was originally published by the University of Luxembourg

What is the general benefit of vaccines?

Over the last century, there have been many success stories of vaccines as a response to epidemic situations. One famous example is the life-threatening smallpox virus which was considered eradicated after a large-scale global vaccination in the 1970s.

Likewise, poliomyelitis was successfully fought by oral vaccinations in the past and has disappeared from Europe. Overall, there are many examples where vaccinations have prevented disasters in the past and present: protection against flu and pneumonia, prevention of various children’s’ diseases such as measles, rubeola, pertussis, diphtheria and others and finally against hepatitis B, prevention of tetanus, and of cervical cancer thanks to the vaccination against papilloma virus.

We cannot tell yet how long the newly developed COVID-19 vaccines protect against the disease. However, if we refer to other vaccinations against similar pathogens, it is reasonable to assume that the COVID-19 vaccines enable an efficient protection for at least several months up to a year. Regular follow-ups of the participants in the clinical trials will soon give us a more precise figure on the long-term protection which depends on the strength of immunity.

How was the efficacy of the COVID-19 vaccines of approximately 95% determined? And how does it compare to other vaccines or drugs?

Just like any other drug, the COVID-19 vaccines were tested in different stages of clinical trials first of all to ensure that they are not harmful for people. At the same time, the efficacy was tested by vaccinating half of the probands with the real vaccine whereas the other half received the standard of care. As in the present case no alternative COVID-19 vaccine was available yet, a placebo vaccination not containing the active agent was used.

Both groups were closely observed to determine the efficacy of the vaccine, while the individual probands typically did not know to which group they belong. It was shown that the number of severe cases of COVID-19 was drastically reduced in the group of people receiving the real vaccine, which ultimately determines the efficacy.

Compared to other drugs and vaccines, an efficacy of around 95% is quite excellent. There are other vaccinations, for instance against typhus or cholera, which only show an efficacy between 50 and 70% – still the benefits of these vaccination are clearly visible. Moreover, a 100% level of protection can in practical terms never be achieved, so even after a vaccination against SARS-CoV-2, some people might get infected with the virus and fall sick – but will most likely not develop a severe course anymore.

On how many people have the vaccines been tested?

The vaccines have been tested with several tens of thousands of people during the clinical trials: For the Pfizer/BioNTech vaccine, around 35,000 people and for the Moderna vaccine over 40,000 people participated in the phase 3 testing alone.

Compared to other drugs or vaccines, this is a remarkably high number as usually only several hundred up to few thousand people take part in these trials. As a matter of fact, the COVID-19 vaccines have been tested more thoroughly than many other drugs and vaccines on the market.

Yet, this was also necessary to ensure the safety of the vaccine as the probability to discover potential side effects increases with the number of participants. Still, no unexpected or severe side effects were observed since the testing started in summer 2020, except for some individuals with a proven history of anaphylaxis.

What are the effects and side effects of the COVID-19 vaccines?

When people think of vaccines, they often also think about side effects. Indeed, what is relatively frequent is some minor pain or swelling at the injection site. Around 5% of vaccinated people may also develop headache, mild fever or fatigue which usually lasts not longer than one or two days.

However, these effects are desired and entirely expected as they also indicate the activity of the immune system. Thus, they must not be confused with real complications due to the vaccination. As mentioned above, in some rare cases, severe allergic reactions have been reported which concern only 1 to 2 out of 100,000 people and can be treated. In the vaccination centres, the physicians will interrogate everybody about allergies prior to the vaccination to minimise the risk of any negative reaction.

Is it possible that long-term effects might still occur in the future?

First of all, we need to keep in mind that the time frame in which the development of the vaccination was performed is very short. Thus, we don’t have data yet on long term complications covering several years. However, it should be noted, that generally complications due to vaccination occur with few days or weeks after the vaccination. Having vaccinated several million people over the last months and starting about half a year ago, no long-term consequences have been documented. But of course, everybody who gets vaccinated in Luxembourg will be registered for follow up.

On the other hand, we know of many severe long-term effects of the COVID-19 disease itself, and they do not only affect people of the high-risk group. People who have been on intensive care often need several weeks to months until they fully recover after the infection. In addition, around 10% of all COVID-19 patients suffer from severe long-term consequences such as decreased lung function, myocarditis, renal disfunction, fibrosis, diffuse thrombosis, or simply long-lasting fatigue. It is not yet clear if these consequences of COVID-19 are reversible and who is at risk. What is clear on the other hand is that the current vaccines are able to protect from the disease and its consequences with around 95% efficacy.

Couldn’t we wait for a few months more before we start the vaccination to gather more data?

The probability of discovering negative effects of the vaccine which have been unknown so far is extremely low. Apart from the fact that delaying the vaccination would also prolong the protective and distancing measures in place, the speed of action is crucial at this stage.

We know that RNA viruses such as SARS-CoV-2 are constantly mutating which will occasionally change their properties. Although SARS-CoV-2 mutates less frequently compared to the flu, for instance, its sheer abundance all over the world also increases the absolute number of mutations.

We already saw several new variants of the virus in the UK or South Africa, with are assumed to be more infectious. In general, mutations also always bear the risk that new variants might escape the immune response build up by vaccination.

If we wait too long to vaccinate people, we might run into the danger that another mutation will appear in which the virus is no longer recognised by the antibodies that are triggered by the available vaccines.

On the positive side, the new mRNA vaccine technology allows to also react to such mutations quite fast and the vaccine can be adapted comparably easily. Still, in the worst case there might be a gap of several weeks or months during which the infection will spread again if we do not manage to get the virus under control now.

We should keep in mind that vaccination is not only a selfish behaviour to protect oneself. It is the only effective way we have to get the pandemic under control and achieve the required global immunity level of at least 70% in the population. In addition, we must consider that anyone who is hospitalised with COVID 19 pneumonia in a standard ward or in an intensive care unit will impede access to appropriate care to people suffering from other, non-COVID diseases – these hospital beds remain accessible if all of us accept vaccination.

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COVID-19: How do different vaccines work?

How do different vaccines work? And why are people reacting differently to them? These are questions we asked Prof. Paul Wilmes, microbiologist at the Luxembourg Centre for Systems Biomedicine. As a spokesperson of the Research Luxembourg COVID-19 Task Force, he follows the development of the pandemic very closely. In this interview, he provides insights on the current status of the COVID-19 vaccines.

This article was originally published by the University of Luxembourg

Can you give us an overview which COVID-19 vaccines are currently available?

In Luxembourg, there are currently two vaccines against COVID-19 available, one from Pfizer/BioNTech and one developed by Moderna. Another vaccine from AstraZeneca has been approved by the European Medicines Agency (EMA). However, there are others being tested in clinical trials at the moment, so we can expect additional COVID-19 vaccines to become available during the year.

There is also ‘Sputnik-V’, the vaccine developed in Russia, but this has so far not been approved by the EMA. Likewise, China developed a vaccine, but recent data show that this vaccine has a quite low efficiency of only around 50%, in contrast to more than 94% for the vaccines by Pfizer/BioNTech and Moderna.

What is the difference between these vaccines?

Apart from the differences in efficacy, there are different underlying mechanisms in how the vaccines work. The Chinese vaccine uses inactivated viral particles to evoke an immune response which is a classical approach still used in vaccinations against rabies and polio, but also often results in more side-effects.

Another way is to use another virus as a carrier, for example an adenovirus, to deliver parts of the genetic material of SARS-CoV-2 into the cells. This has become a standard approach for many vaccines in the past. The COVID-19 vaccines from Russia and from AstraZeneca use this approach.

A new approach which has been in development over the past decade involves bypassing the carrier-virus and injecting directly parts of the SARS-CoV-2 genetic information in the form of mRNA. A great advantage of this technology are the comparably low production costs and easy adaptability of the vaccine in the case that the virus mutates and escapes the vaccine.

The type of vaccine also determines how many doses one needs to receive in total. The currently approved vaccines require a second dose after a few weeks to achieve an optimal effect. Some vaccines which are now in the final stages of clinical development need to be administered only once to acquire immunity, which will hopefully simplify the logistics of vaccination procedures in the future.

What happens in the cells when you get vaccinated? 

Generally speaking, vaccination is an artificial way of exposing your immune system to key molecules from a pathogen against which you want to build up immunity. The immune system recognises specific protein parts of the virus which are called antigens. Such antigens can either be introduced directly during the vaccination process or by using their genetic information such as mRNA to produce the antigen within cells. However, it is important to note that only a very small part of the virus’ genetic information is brought into one’s own cells upon vaccination. It is not possible to create a virus out of these fragments and thus vaccination cannot induce the corresponding disease.

In either case, the antigen produced by the human body is then literally presented on the surface of the muscle cells around the injection site. This then triggers the immune system as the antigen is recognised as being foreign to the body.

Why do people react differently to vaccinations and why is it not 100% efficient?

Although the principal mechanism of action of a vaccine is defined, the responses in different individuals might be different. In some people, the immune system might not recognize the presented antigen as a foreign particle, and thus not raise an immune response towards it. Also, the production rate of the antigen in the cells might be lower in some people and thus not enough of it might be available to trigger the immune system.

The individual’s prior exposure to other viruses also can play a role: the immune system could potentially identify this as a viral antigen easier if the person was infected with another closely related coronavirus in the past as for instance those causing the common cold. We now know that there is some cross reactivity between different coronaviruses in terms of our immune response, so people having developed antibodies against other coronaviruses may have a different response towards SARS-CoV-2.

Yet, it is important to keep in mind that in principle everybody is susceptible to be infected by the SARS-CoV-2 virus as humankind has not been exposed to it throughout evolution. As a consequence, there is no specific and efficient immune response by default.

Is there enough vaccine available for everybody? How long will it presumably take for everyone in Luxembourg to receive the vaccination?

At the moment, there are two major bottlenecks: one is the production of the vaccine in itself and the other concerns the logistics of administration.

The manufacturers are constantly upscaling their production and also new vaccines are expected to be approved in the near future, yet at the moment the number of doses promised have not been met.

Nevertheless, to ensure an efficient vaccination procedure for everybody in Luxembourg, national vaccination centres have been opened. One of the mRNA vaccines requires storage and transport at extremely cold temperatures of -80 °C which makes the logistical efforts quite challenging and thus requires centralisation.

The European Union has negotiated the number of doses to be received from the manufacturers to distribute them equally among their member states according to population size. Thus, the absolute number of doses available in Luxembourg is lower compared to countries such as France or Germany. According to the Joint Purchasing Agreement, Luxembourg will receive 0.14% of the doses ordered by the EU, which is also the proportion of Luxemburg citizens in the EU. While this sounds low, there is a good chance to offer the vaccination to everybody in Luxembourg until the end of 2021, as far as we can tell now. However, what remains absolutely crucial is that as many people as possible will get vaccinated as fast as possible to get out of the pandemic.

What are the priority groups for vaccination and who decides when people are invited to get vaccinated?

The Luxembourg Government has decided to give the highest priority to individuals with the highest risk to be exposed to the virus and infect others or to develop a severe course of COVID-19 upon infection. This includes for example healthcare professionals in key positions as well as older age individuals or those with specific pre-existing conditions which increases the likelihood of severe medical complications linked to COVID-19. The reason behind this strategy is to minimise the number of deaths while at the same time ensuring a functioning healthcare system.

In the end, the authorities will decide when the next group of people is invited to the vaccination centre. The Government’s vaccination strategy is informed by the recommendations of the national ethics board. Recently the Government announced phase 2 of the vaccination strategy in which people over 75 years of age and those particularly vulnerable to the disease because of existing pre-conditions will be vaccinated.

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COVID-19: Why is it safe and important to get vaccinated?

At the time of this interview, two COVID-19 vaccines have been approved by the European authorities, with both of them found to be more than 94% effective. Yet, some part of the Luxembourg population is somewhat hesitant as to whether they should get vaccinated or not. Rudi Balling, Director of the Luxembourg Centre for Systems Biomedicine (LCSB) explains the question many people have been asking: “How is it possible that the vaccines were developed so fast?” 

This article was originally published by the University of Luxembourg

When the SARS-CoV-2 virus started spreading around the world in January 2020, it was clear to the scientific community that the world is faced with a new dangerous type of virus. This led to a tremendous commitment, focus of efforts and resources made available by the entire scientific community worldwide like I have never seen before and this helped a lot in developing effective vaccines.  

Also, one should not forget that vaccine development is not something new but has a history of several decades. In the case of the COVID-19, scientists could benefit from what they knew about the SARS and MERS infections in 2002 and 2012, respectively. Those are two other types of coronaviruses against which a vaccine has started to be developed for back then. The researchers therefore did not start from scratch in this but rather focused and funnelled all their resources to develop a vaccine targeting the new virus. 

How could the vaccine be properly tested in such a short time frame? 

Generally speaking, clinical testing of any vaccine is divided into subsequent phases. Usually, the manufacturer starts the final production of a vaccine only after all phases have been completed and the vaccine is approved by the authorities, to avoid a financial risk.  

Given the urgency of the COVID-19 crisis worldwide, the different processes of final testing, approval and start of production have not been caried out sequentially, but in parallel while constantly exchanging information between all parties involved. This does not mean that the quality standards have been lowered by any means. Instead, the companies were financially backed up by the authorities so they could take the risk to move ahead faster than usual. Out of many vaccines developed in parallel, the ones that have now been approved fulfil all common regulatory requirements just like all other vaccines outside a health crisis. 

In other words, are the COVID-19 vaccines which are currently on the market safe? 

Based on the tens of thousands of people that have been vaccinated so far, there is no evidence that the COVID-19 vaccines are raising any concern about safety. As for any medication, side effects may occur for some people. However, I do not see any reason why getting the COVID-19 vaccines should be any riskier than other vaccines used for many years as the same strict criteria have been imposed for approval. 

So how can the vaccination help to protect myself? 

Up to now, we know that the infection fatality rate of SARS-CoV-2 very much depends on the age of a person. Whereas elderly and other people at high risk may have a chance of 1:100 to die from the virus, this risk is somewhat lower for younger people. Yet, the chance to die from the vaccine is still several orders of magnitude lower, in the order of millions. Just from looking at these numbers, it becomes evident that a vaccination protecting you against the virus tremendously reduces infection fatality among all age groups. 

Why is it important for everyone to get vaccinated? Isn’t it sufficient to only vaccinate the elderly population? 

A vaccination against COVID-19 can be expected to reduce the level of virus transmission to some extent. In that sense, not getting vaccinated would mean to put others at a severe and potentially deadly risk. Even if one has no symptoms one might still transmit it on to his family, at school or any outings and visits. This might ultimately impose distress on the health system which then indirectly may affect people’s health. Additionally, while the consequences of getting a SARS-CoV-2 infection are not the same for everybody, it does not take away a single bit of the responsibility everybody has for our society.

In that context, the term herd immunity is often used. What does this relate to? 

The concept of herd immunity has been discussed for several decades now. Basically, it describes an indirect protection of the population due to the people who are immune and thus cannot transmit the virus any longer. 

To picture this, imagine 1,000 mouse traps closely to each other in a room. If you throw a table tennis ball randomly into the room, you will get an exponential chain reaction without being able to stop it. Now, if you start disengaging the mouse traps one after another, the probability to trigger a chain reaction will drop as the traps become too isolated. Vaccinating people follows the same principle, reducing the amount of people infectable by the virus which may lead to herd immunity. 

Although we do not know yet when such herd immunity will be achieved as this also depends on our personal behaviour and many other factors; it will be reached faster the more people will get vaccinated and become immune. 

What are in your eyes the immediate challenges we are facing in 2021? 

Well, it’s hard to predict the future, but I would assume that towards the end of the year everybody in Luxembourg will be given the possibility to get vaccinated. Still, until then it’s a race: recently, new viral strains from the UK and South Africa have been reported. Likewise, other variants might occur with time if the virus is not stopped as soon as possible.  

In the end the virus might eventually become endemic, and we will have to live with it. Hopefully by then enough people will be protected either via vaccination or overcome infection that it will not distress the health system as it does now. 

Do you have any final recommendations? 

I can only recommend everyone to get vaccinated. Personally, I would be the first to take it. By this, you are not only protecting yourself, but are taking responsibility for the people around you. All vaccines approved in the European Union have been thoroughly tested and there is no reason to assume that they are not safe in any way.

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Survey about “social distancing”: What is our average daily contact with others?

You would like to help combat the current COVID-19 crisis? Take part in this survey and help researchers to find out how our social interactions and contact patterns change during the pandemic.

Why this study? Scientists want to find out how the current pandemic affects our social behavior. Specifically, the aim is to quantify the average number of contacts in the population at different times and compare them with previous studies and results. This data is important to include in forecasts, to generate better statistics and to better understand the spread of the virus as well as the effects of different measures.

Here the link to the survey (Surveymonkey).

The survey is anonymous and takes less than 2 minutes to complete. You are asked to indicate your gender, age and nationality, but no other personal data is requested. The results of the survey can be transmitted to research institutions, statistical offices and ministries in Luxembourg for analysis.

We do this survey regularly, in order to track the change in behaviour during the different phases of the COVID-19 crisis.

Many thanks for your participation!

Author of the survey: Joël Mossong, Ardashel Latsuzbaia
Editor: FNR

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Scientists call for synchronised curbing of COVID infections in Europe

Hundreds of scientists have called on European decision-makers to take steps for a quick, synchronised and efficient reduction in the number of COVID-19 cases across Europe.

Hundreds of scientists have called on European decision-makers to take steps for a quick, synchronised and efficient reduction in the number of COVID-19 cases across Europe.

The declaration which was published in The Lancet today was signed among others by :

  • Prof. Rudi Balling, Luxembourg Centre for Systems Biomedicine (LCSB) at the University of Luxembourg
  • Dr Jean Beissel, Centre Hospitalier de Luxembourg
  • Dr Guy Berchem, Luxembourg Institute of Health
  • Dr Stefan Beyenburg, Centre Hospitalier de Luxembourg
  • Prof. Conchita D’Ambrosio, University of Luxembourg
  • Dr Isabel de la Fuente, Centre Hospitalier de Luxembourg
  • Prof. Dr Nico Diederich, Centre Hospitalier de Luxembourg
  • Prof. Enrico Glaab, LCSB at the University of Luxembourg
  • Prof. Jorge Goncalves, LCSB at the University of Luxembourg
  • Dr Pierre Kolber, Centre Hospitalier de Luxembourg
  • Dr Barbara Klink, Laboratoire National de Santé
  • Dr Monique Reiff, Centre Hospitalier de Luxembourg
  • Till Seuring, Luxembourg Institute of Socio-Economic Research
  • Prof. Reinhard Schneider, LCSB at the University of Luxembourg
  • Prof. Alexander Skupin, LCSB at the University of Luxembourg 
  • Prof. Paul Wilmes, LCSB at the University of Luxembourg 
  • Prof. Skerdilajda Zanaj, University of Luxembourg

The signatories call for firm action to reduce case numbers quickly to low levels, to keep numbers low and to devise strategies for elimination, screening, vaccination, protection of those at high risk, as well as support for those most affected by the pandemic. The declaration argues that prompt and efficient action to curb SARS-CoV-2 infections will benefit public health, society and economy.

More than 300 representatives from research centres, hospitals, public health care institutes, universities and companies from across Europe signed the declaration.

Read the full declaration (available in multiple languages) on

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Give your voice to help COVID-19 research

Luxembourg Institute of Science and Technology (LIST) is currently conducting a research project on the detection of COVID-19 via cough and voice analysis.

Luxembourg Institute of Science and Technology (LIST) currently has many areas of research regarding the COVID-19 pandemic.One intriguing direction of research is the detection of COVID-19 via cough and voice analysis to help emergency services identify critical cases needing rapid intervention.This is done with the use of artificial intelligence to detect a COVID-19 signature that can be present in voice and in coughs.

The research project currently being carried out at LIST is called CDCVA or COVID-19 Detection by Cough and Voice Analysis. While most Coronavirus diagnoses require a physical consultations, which increases the risk of infection for staff and patients, and consume significant amounts of health system resources, the CDCVA system can be done remotely.

This exciting research could eventually lead to rapid detection of COVID-19 just through a simple telephone call.

“Respiratory conditions, such as dry cough, sore throat, excessively breathy voice and dyspnoea, caused by Covid-19, can make patients’ voices distinctive, creating identifiable voice signatures, that may be discovered using our system”, explained the project leader Muhannad Ismael.

However, the project is still in the early testing phase and LIST recently launched an appeal to the public to take a five-minute survey that includes taking vocal samples via computer or smartphone microphone.

Reaching Luxembourg and beyond

Since then over 400 samples have been taken via the online survey, but more data and completed surveys the system receives, the more it can learn and improve in the battle against COVID-19.

Therefore, the move now is to not only appeal for more vocal samples in Luxembourg, but beyond the borders too, and with that in mind three more languages; Arabic Serbian and Portuguese, have been added to the list of languages the survey can be carried out in.

“We decided to add them to reach more people from around the world. The platform is now available in eight languages and we are open to adding more soon!” said Muhannad, before adding “now, our plan is to reach out the media outside Luxembourg. At the same time, we are looking at working with the health ministry to help us by informing COVID-19 patients of the survey.”

CDCVA is also supported by the Luxembourg Institute of Health and the University of Luxembourg.

Take the survey !

Would you like to take part? It’s easy and takes about five minutes to do. The survey asks you for some general information, before asking you to record saying “aaaahhh”, cough, and read a short text. Of course everything is totally anonymous. Full details are explained on the CDCVA website.

Choose link in your language

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How bad will the Covid-19 second wave be for Luxembourg’s economy?

A newly published policy brief examines Luxembourg’s macroeconomic and epidemiological prospects for 2020-2021

The Covid-19 second wave is hitting much of Europe. While this wave mostly affected young healthy people at its start, it is now spreading to older and more vulnerable segments of the population. It is thus with a weary sense of déjà vu that European citizens have been impacted by new packages of restrictions implemented to contain the virus and to prevent healthcare systems from being overwhelmed.

In theory, such restrictions induce ambiguous effects on the economy as they directly curtail market transactions but also avoid panic-driven responses. Yet, lockdown measures implemented in March and April generated mechanical and sizeable cuts in output and plunged most economies into a temporary recession. History might be repeating itself in the coming weeks and the specter of a re-confinement hangs over Luxembourg’s economy.

In a new published policy brief “How bad will the Covid-19 second wave be for Luxembourg’s economy?” co-authored by Michal Burzynski (LISER), Frédéric Docquier (LISER) Joël Machado (LISER), Ferdy Adam (STATEC) and Tom Haas (STATEC), the authors combine recent tools developed at STATEC and LISER to assess the macroeconomic impact of the second wave, to shed light on the interactions between macroeconomic and epidemiological outcomes, and to compare the implications of moderately and highly coercive sanitary measures.

The publication stems from the FNR supported ‘MODVid’ project. The project develops analytical tools to nowcast and forecast the macroeconomic, distributional and epidemiological effects of the crisis and related public health vs. economic policy responses in Luxembourg. To learn more about MODVid and discover its research outputs, follow this link.