There’s so much to talk about with Effrossyni Gkrania-Klotsas, not least of which is her career path from the child of citrus farmers in the northern Peloponnesian town of Argos to head of infectious diseases at the University Hospital of Cambridge in the UK. But our conversation inevitably began with the big issue: the coronavirus pandemic.
“We are in a very critical phase,” she says. “People may not realize this about the transmission of the virus, but it can flare up because of a small group of people at a bar. Until a vaccination come out, there are no certainties.”
Are you optimistic that we will soon have an effective vaccination against the coronavirus in our hands?
We already know that the Oxford vaccination triggers an antibody response, but the big question is whether it also protects against infection and onward transmission. Can people who have had the vaccination be infected, even if they do not become ill?
If they are infected – in spite of the vaccination – and can therefore transmit the virus, this means that the lockdowns and restrictions will not stop until everyone belonging to vulnerable groups has been vaccinated. If they are protected from becoming infected, then we’re saved.
Personally, I have some reservations about whether the vaccination will be able to stop onward transmission. There are also a lot of obstacles to the production of a vaccination, though. For example, it is really hard for European research teams to ascertain whether their formula works as long as the number of new cases remains relatively low, so they have moved their clinical trials to the United States and Brazil, where there are serious outbreaks.
How does the situation in Greece look to you?
Personally, I am worried by the upward trend in new cases because our country is not like any other epidemiologically. I believe that there is still a very real danger of the situation spiraling out of control. We need to continue intensifying efforts to stem the spread of the virus. Social distancing measures may also help contain the seasonal flu, so they really should continue. Vaccination against the flu must also take place as quickly as possible.
What is happening in the UK right now?
We have a rising number of cases among younger age groups and are implementing local mini-lockdowns, though there is some concern that a second wave will follow soon. The discussion is mostly focused on schools in England. Scotland already opened some of its schools, with mandatory mask use. I am very afraid that we will have a lot of problems going forward.
There is also the fact that we still don’t know the effect of the pandemic on people who put off preventive tests and surgeries, even cancer treatments. These people can no longer wait. In the past months we have seen only patients who had no other choice coming into the emergency room. I am convinced that many people preferred to die rather than to go to a hospital and risk being exposed to the virus.
This is backed by the fact that weekly figures compared to the past five years show a significantly higher number of deaths that are not attributed to the coronavirus. So, in combination with the flu and the coronavirus, we are looking at an explosive mix. Hospitals will come under a tremendous amount of pressure.
I am not expecting this to be a good winter – at least not until a vaccination becomes available.
Coronavirus deniers keep increasing along with case numbers. As a doctor on the frontline of the fight, how does it make you feel hearing all the different conspiracy theories?
Powerless, bitter and a failure. It is our fault and failure – the scientists that is – that we have not managed to educate a part of society properly. As professionals in the service of public health, it is our responsibility – even now – to try to reverse this wave of doubt that is also associated with several other issues. The roots of the problem run deep: from denying the value of vaccinations and the debate on what is healthy and what it not, to extreme veganism, which is dangerous given that human beings are not designed by evolution for this kind of a diet. The taxi driver who brought me here to our meeting told me with absolute sincerity that the Americans run Greece and want to manipulate us with the coronavirus.
By fighting meritocracy, we have made it so that citizens do not trust the system and the experts. And I use the first-person plural, because we are all to blame for this.
What did your parents do?
My mother was an operator at OTE telecom and my father studied to become an army medic and earned a scholarship for Naples. When he came back to Greece, though, he decided that medicine did not suit him and went into farming, returning the scholarship money to the Greek state. I believe he regretted the decision, even though he never admitted to it. The proof is that he wanted both me and my brother [a professor of periodontology in London] to become doctors. Now that I’m older, it’s easier to understand his decision. He loved the arts, he painted and he was a workaholic. One of the last things he told me before he died, at the age of 89, was that “no one ever came to any harm from too much work.”
So you grew up in a farming family…
My father and my uncles were citrus farmers. I remember all the difficulties of farming, the ups and downs of the market, the problems with cooperatives and how the farmers of Argolida struggled when imports from Spain and Israel pushed prices to the floor.
Why did you choose to specialize in infectious diseases?
Because I believed that if you have to deal with a dying person, only three areas of specialization give you a chance to do something to save their life right there: surgery, endocrinology and infectious diseases. Becoming a surgeon was not possible because I have a serious orthostatic hypotension and would faint during surgery. But I also chose infectious disease because I was fascinated, mentally, by the search for a diagnosis.
You have studied and worked in Greece, the United States and Britain. What are the biggest problems you see in Greece in terms of how universities and the public health system function?
A lack of funding and the burden of bureaucracy. Hospitals should have a certain amount of independence and be able to act on their own and ask for what they need – their needs cannot be the same as other medical organizations. Another thing that is obviously needed is absolute, crystal-clear transparency.
What is life in Cambridge like?
It is a small city of 120,000 residents, with a very cosmopolitan atmosphere. It is a joy to walk around the streets and hear so many different languages being spoken.
The Greek community of Cambridge is large and flourishing. The Greek school had no more than 40 pupils when we moved there and this year admissions surpassed 160. The economic crisis in Greece really bolstered us by prompting many young scientists to immigrate. We also have our own church now.
Let me share a fun anecdote: A few years ago, on Good Friday, the priest at the old Orthodox church, in the middle of town, decided to hold the customary procession of the funerary bier even though he did not have permission. The procession blocked traffic and dozens of people came out to see what was going on. “What can you do? That’s the Greeks for you,” they said, but it was not said in anger.