[COVID-19.P2]: The Dichotomy of Hope and complacency

(Source: NIH)

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Last month, I wrote about the COVID-19 pandemic for Vietcetera, during which I explained some scientific aspects of this novel virus—why it would not be particularly dangerous for most people—and made a comparison between COVID-19 and other pandemics in human history. The outbreak then potentiated a widespread panic in Vietnam as the number of infections in mainland China, in particular Wuhan, increased by the hour.

At present, my opinion remains largely unchanged: (1) Coronavirus would not be deadly to the majority of the world's population, and (2) Panic poses a negative impact on the sustainability and efficacy of containment. Today, I would like to share new information that may deliver us some hope.

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(1) Vaccine for COVID-19 trial starts recruiting volunteers

(ClinicalTrials.gov: NCT04283461)

This trial at Phase I aims to test the safety and address other pharmacological criteria of a vaccine candidate. This vaccine are made in the form of tiny lipid-bound nanoparticles carrying mRNA, the genetic material encoding the viral surface protein of SARS-CoV-2. For more information on the surface protein, called ACE2, please refer to my previous Vietcetera article. However, it might take between 12 and 18 months for any vaccine to exit testing phase and enter mass distribution.

(2) Repurposing anti-viral drug remdesivir to treat COVID-19

(ClinicalTrials.gov: NCT04280705; NCT04292899 (severe cases); NCT04292730 (mild cases))

Previously tested for treatment of Ebola, SARS and MERS, remdesivir is considered effective in controlling replication of some coronavirus strains, including 2019-nCoV and has now entered phase 3 in clinical trials. Phase 3 is the final step in drug development before the drug candidate is approved by the FDA for manufacture and distribution. But there is a potential caveat for remdesivir: according to research data, the timing of the treatment may be critical in preventing irreversible lung damage.

Our prospect for preventing and treating COVID-19 ends with that—a prospect. The most important thing we can do at the moment is to stay highly alert and proactive.

After following the news coverage on COVID-19 these past two months, I have realized that much of media still missed a crucial point. Some of us do not realize that this pandemic is not about most of us, who would likely recover fully after being infected. This has been, and will be, about the significant portion of population among us without a functional, robust immunological defense.

Up to date, the United States has recorded 752 cases of coronavirus infections with 26 deaths, 8th highest in the world. I would like to spend a few minutes discussing my concern about this outbreak, not by its numbers, but about the management of public health effort, or a lack thereof.

I have lived in the US for 10 years, and that is how I'm dedicating this post about the US, and about how for this outbreak, the outcome of prevention far exceeds treatment. I have worked in development of H1N1 detection kit and low-cost vaccine back in 2011. Most recently, I worked in an antibody engineering lab where my teammates were searching for a pan-influenza vaccine. Though my immunology training is still at a preschool level compared to my seniors and the vast numbers of experts in ID, I am confident enough to stress the importance of prevention in the management of infectious disease.

I am currently a trainee at MSKCC, the largest and oldest cancer hospital in the world. As some of you know, cancer patients might have to undergo chemotherapy, radiotherapy, or bone marrow transplantation, after which their immunity is significantly compromised. Concurrently, their treatment prolongs for months or even years. At the moment, MSK has implemented a "better safe than sorry" policy. Last Friday night, the hospital asked all its staff—including doctors, nurses, and professors—to cancel all business-related travels. Individual travel is also strongly discouraged. All conferences and seminars have been canceled until May, and MSK usually hosts 15-20 such sessions every week.

At the time MSK took executive decisions to protect the well-being of its patients and staff, the US administration still downplayed the spread of COVID-19 and encouraged everyone to resume their normal routine.

A few days ago, my mother texted me to assure that the U.S., as the world’s #1 superpower, will have this pandemic under control. Yet as early as March 5, President Trump still made an official statement that people with symptoms can go to work as normal and that the outbreak has been contained at the border.

While I expected that Trump is no companion of good science, I share the following heightened concerns with my colleagues in healthcare fields regarding COVID-19:

1. Faulty kit: The first US test kit failed, resulting in a delay in testing for people. A component of the kit, called a primer or probe, essentially failed to detect SARS-CoV-2 versus other coronavirus strains.

2. Testing Delay: In the beginning, all COVDID-19 tests had to be performed by CDC so the turnaround took several days, causing systemic problems for both states and healthcare providers to quickly respond with an action plan.

3. Strict Criteria: At the beginning, CDC imposed strict testing criteria for Americans, too strict to regard as effective for containment. Unless you show severe symptoms (i.e acute pneumonia, shortness of breath ...), and have recently traveled to outbreak centers, you would not be tested. If you present with only fever and cough, you would be instructed to go home and wait for symptoms to pass as you do not meet the criteria for testing.

4. Shortage of Tests: On March 3, Vice President Mike Pence, current head of the U.S. Federal Response Team, announced that 1 million test kits would be available for Americans by March 6. However, on that date, the promised number of distributed kits was never met. In fact, Integrated DNA Technology, the manufacturer of COVID-19 RT-PCR testing kit, said that they have delivered 700,000 tests. CDC has no effective measure on the number of tests already administered to Americans. The U.S. population is estimated at 328 million.

Starting on March 3rd, states’ labs and hospitals received approval to develop and administer their own test kits without sending the samples to CDC. At that time, the number of infected cases already stood at 90,000 worldwide. The lag in testing capacity allowed the U.S. infections to stay at 46 domestic cases as of March 2. However, one day after the release of the new policy, the U.S. reported 79 cases.

Similarly, by March 3, New York state had identified only 2 cases, including one person who has not left the country or interacted with any known COVID-19-positive person (this was the first evidence of “community spread” in New York). Within 7 days of available testing, New York case number jumped to 142.

Conclusion

Since the first case of COVID-19 was recorded in the U.S. on January 20, the country had two months to prepare and respond, but it has failed to take advantage of this golden window. Perhaps complacency has left the US behind in the race towards containment, to the point that it still struggles to offer enough tests for the population at risk.

I want to re-iterate that the reported number of positive cases is not a cause for alarm. What truly detrimental is our collective attitude towards this novel virus. This pandemic is likely not about us, the young and healthy, but it is about those who are not able to protect themselves with their own immune system.

Individual's alertness is a social responsibility. While we can be hopeful (and even optimistic) about options for prevention and treatment of COVID-19, the pending challenges of this public health crisis require our synergistic vigilance and responsibility, at the right time, and with the right method.

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Vietcetera article | Coronavirus: When Breath Becomes Terror (February 13, 2020).

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