Week in Review
It’s not the apocalypse, but yes, you should care
*Update: Since this story was published, officials have confirmed the first verified case of coronavirus in New Zealand*
When will there be a vaccine? What can we do and how do we stay up to date? Helen Petousis-Harris gives an update on the COVID-19 global health emergency.
Less than two months after China told the World Health Organisation there was a problem, a lot has happened. Sadly, deaths, confirmed cases and countries affected are increasing every day.
However, on a scientific and medical level, what is going on to contain, cure and prevent this new disease is truly inspirational. Let’s look at the build-up to this global health emergency and what is being done by medical teams all over the world to combat its effects.
What we know
COVID-19 is likely to have jumped from an animal to a human towards the end of last year (as with MERS and SARS, most likely bats). We can estimate this timing by looking at mutations accumulated by the virus over time, like a clock. The genetic sequence of COVID is very close (96 percent similar) to some coronaviruses in China’s bat populations, and 99 percent the same as coronaviruses infecting wild pangolins. This indicates a very recent jump and some scientists put this at about October/November 2019. (Somewhat prophetically an article published in March 2019 warned coronaviruses from bats were a pandemic threat and needed urgent attention.) The point is that this happened while many people were doing their Christmas shopping and the streets had their festive decorations up.
The first COVID-19 case appeared on December 1, the second on December 8. Imagine a busy hospital receiving mainly older people with pneumonia-like illness in the middle of winter. Nothing unusual. However, by December 12 more cases had presented to hospital and the state broadcaster reported a new viral outbreak and by December 21 the Chinese Center for Disease Control and Prevention identified a cluster of pneumonia of unknown cause.
On December 31, China informed the WHO of the cluster in Wuhan City and just one week later uploaded the entire genetic sequence into the public domain to allow the world’s scientists to start working towards solutions. In no other outbreak have we seen such speed. But what happened next is truly incredible.
The global scientific community, across many disciplines, immediately got to work on therapies, vaccines, and understanding the virus and how it behaves. New knowledge exploded almost instantaneously, and an example is the progress on vaccines. Amazing fact - as of writing there were 37 companies working on a COVID-19 vaccine. Most of these companies are biotech, a few are institutions like universities and just one is big pharma. This is due to unprecedented cooperation from all concerned, from China to the WHO, from independent scientists to industry everywhere.
Are therapies realistic?
Therapies are likely to be a reality. More than 80 clinical trials have already launched, which is mind-boggling. One approach is to develop a new drug, another is to re-purpose existing ones. For example, there is optimism about the potential of HIV medications, and results from a clinical trial will be available in just three weeks. Another drug is a newly developed broad-acting antiviral medication called remdesivir. Animal tests have shown it reduced the severity of MERS infections as well as the virus’s ability to replicate, which is promising.
About COVID-2019 vaccines
Getting an emerging infectious disease vaccine to market is not for the faint hearted or those short on cash – it needs on average $2.8 billion USD. The traditional model poses high financial risk and does not work well for emerging diseases or those affecting low income countries who cannot afford to pay. As a new disease emerges we don’t know how much of a problem it will be and whether a vaccine is warranted. But on the other hand, if it is really problematic, delays will cost lives. Fortunately, there is now a new model for progressing pandemic vaccines, and COVID-19 is the first test. The CEPI (Coalition for Epidemic Preparedness Innovations – a global alliance that finances and coordinates the development of vaccines) can leverage huge resources and has already kick-started four initiatives including one based in Australia.
When will there be a vaccine?
Pulling out all the stops, the WHO and CEPI hope safe and effective vaccines will be available within the next 12 to 18 months. The goal of CEPI is to get a vaccine into human testing within just 16 weeks of the identification of the new pathogen’s gene sequence (which was in early January) and one vaccine that CEPI are backing goes forward to clinical trials in just a few weeks. Approaches to developing a COVID-19 vaccine will range from the sort of technology used in familiar vaccines like hepatitis and HPV, to the more cutting-edge using DNA platforms and things called viral vector templates. Solving the COVID-19 vaccine challenge is a massive test and if successful should change the vaccine development landscape for the better in the future. I think we are entering an exciting new era of vaccinology where the previously impossible becomes possible.
Where are we at now?
At the moment almost all cases of COVID-19 are still in China. This is purely due to the massive effort made in that country to shut this disease down. The population of China is about 1.4 billion – nothing approaching this level of cooperation in outbreak control has ever been tried. Will it work? Maybe. There is still hope that it could. The rate of spread has slowed thanks to this monumental undertaking. However, spread is now evident in other countries, particularly Italy, Iran, and South Korea. If containment is not successful and the disease spreads globally then China have at least bought the world time, at great cost to their citizens and economy.
You can follow the number and location of cases here in real-time.
What is truly incredible
The swift response from so many quarters is enabling us to rise to this pandemic challenge as never before. The resolute determination and unprecedented transparency of so many authorities both in China and internationally have made possible the almost overnight development of ways to diagnose people (using test kits), define cases, and potentially, develop a vaccine. More than 100 researchers, journals, funders and the CEPI have signed a commitment to ensure research findings and information relevant to the outbreak is shared fast and openly. This will translate into lives saved because progress will happen at cheetah pace instead of snail pace.
What we need to remember
Infectious diseases such as COVID-19 do not respect borders. We are all in this together and what happens from now will affect us all. Perhaps not through getting infected but certainly economically. As demonstrated by the scientific community, solidarity is called for as this is what will solve the COVID-19 problem, and the next Disease-X that emerges. We fear what we do not know or understand, and new diseases are scarier than the ones we live with all the time. Remember that this year influenza will probably carry off many more people than COVID-19. Not necessarily because COVID-19 is less serious but because we are not going to let it. We worry because if COVID-19 gets away in places such as some of the fragile African countries with weak health systems then the results could be truly devastating.
Something we can all do
One of the things that contributes to the spread of a pandemic is human behaviour and this is influenced by what we know. The spread of misinformation and the lack of information can influence the way we behave and also contribute to a pandemic of panic. At the moment there is not enough being done to make sure health professionals and communities have the information and tools they need. In my opinion we urgently need strong active social media campaigns that disseminate accurate and useful information, which brings me to the next bit.
Finally, how to keep up to date and get good intel about COVID-19
There is a tremendous volume of information flying around about this pandemic and the virus. While some is the best of science, there is also bad science and fake science. There are misunderstandings and there is deliberate spread of misinformation.
To help cut through the overwhelming and the crazy, a team of Kiwi doctors have developed exactly what the doctor ordered – a chatbot to answer your questions in a just a second: Āmio.
Āmio is a piece of software that you can have a conversation with; he responds to your questions in Facebook Messenger with friendly answers that are based on scientific sources in language that is easy to understand. He speaks English and Mandarin and learns fast. Āmio was launched on February 6 by doctors Canaan Aumua, Sanjeev Krishna and Cole Rudolph who created a similar chatbot called Mītara during last year’s measles epidemic. Their team works around the clock to make sure Āmio, and users, are always up to date. You can find Āmio on both Facebook and Instagram, so be sure to check him out.
Credible information is crucial in a crisis.
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