By Joel Achenbach, Ariana Eunjung Cha, Ben Guarino and Chelsea Janes,
Washington Post – June 1, 2020 at 8:36 p.m. EDT

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Has the novel coronavirus in Italy changed in some significant way? That was the suggestion of a top doctor in northern Italy who reports that patients to his hospital have been showing up with lower levels of the virus in their upper respiratory tracts compared with those two months ago.

Alberto Zangrillo, head of San Raffaele Hospital in Milan, roiled the global public health community on Sunday when he told RAI, the national TV station, that “the virus clinically no longer exists in Italy,” with patients showing minute amounts of virus in nasal swabs. Zangrillo theorized in a follow-up interview with The Washington Post that something different may be occurring “in the interaction between the virus and the human airway receptors.”

He added, “We cannot demonstrate that the virus has mutated, but we cannot ignore that our clinical findings have dramatically improved.”AD

The comments, which received widespread attention following a Reuters report, prompted vigorous pushback from Michael Ryan, a top official with the World Health Organization, who said Monday during an online news conference that “we need to be exceptionally careful not to create a sense that all of a sudden the virus by its own volition has now decided to be less pathogenic. That is not the case at all.”

The consensus among other experts interviewed Monday is that the clinical findings in Italy likely do not reflect any change in the virus itself.

Zangrillo’s clinical observations are more likely a reflection of the fact that with the peak of the outbreak long past, there is less virus in circulation, and people may be less likely to be exposed to high doses of it. In addition, only severely sick people were likely to be tested early on, compared with the situation now when even those with mild symptoms are more likely to get swabbed, experts said.AD

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The pandemic is evolving rapidly, with the rate of new cases declining in some hard-hit areas of the world, including northern Italy and New York City, while rising dramatically in Brazil, Peru and India. The virus, however, is mutating at a slow rate, experts say.

Some strains of the virus have become more dominant, but there is no firm evidence yet that any of them are more contagious or deadly, according to scientists who have reviewed recent genetic studies.

Vaughn Cooper, an infectious-disease expert at the University of Pittsburgh School of Medicine, said the new coronavirus mutates slowly compared with influenza and other microbes, and its genetic changes appear to be “mostly inconsequential.”

“I believe it’s safe to say that the differences that doctors are reporting in Italy are entirely due to changes to medical treatment and in human behavior, which limit transmission and numbers of new infections initiated by large inocula — a larger dose of virus appears to be worse — rather than changes in the virus itself,” he said.

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