[Part 1] A few thoughts on COVID-19

Bài viết đã được chuyển ngữ sang Tiếng Việt tại đây.

Last month, I wrote about the COVID-19 pandemic for Vietcetera (link below), where I explained some scientific aspects of this virus—why it would not be particularly dangerous for most people—and compared it to other pandemics in history. COVID-19 was then causing panic as the number of infections in China was climbing up every hour.

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At present, my opinions remain largely unchanged: (1) Coronavirus would not be deadly to the majority of the world's population and (2) Panic itself can pose a negative impact on efficacy of containment.

Today, I would like to share new information that may deliver us some hope:

🔺 (1) Vaccine for COVID-19 trial starts recruiting volunteers (Source: https://clinicaltrials.gov/ct2/show/NCT04283461…) This particular trial will aim to produce vaccine in the form of lipid nanoparticles, each such tiny particle carrying the RNA genetic material of the virus’ surface protein. For more information on the surface protein of SARS-CoV-2, please refer to my previous Vietcetera article. However, it might take between 12 and 18 months for any vaccine to go from discovery to mass distribution.

🔺 (2) Trial of repurposing anti-viral drug remdesivir to treat COVID-19 has proceeded to Phase 3 (Source: https://www.gilead.com/…/gilead-sciences-initiates-two-phas…) Previously tested for treatment of Ebola, SARS and MERS, Remdesivir is considered effective in controlling some coronavirus strains and has now entered phase 3 in clinical trials. Phase 3 is the final step in U.S. drug development before the drug 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.

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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 the public still misses a crucial point. Most individuals will likely recover fully after being infected—but this pandemic is not about them. It’s about the significant portion of minority among us whose already-weakened biological defense will crumble when exposed to the virus’ offense.

Up to date, the United States has recorded [•] cases of coronavirus infections with [•] deaths, [•]th highest in the world. I am personally worried about how this disease is being managed in the U.S., though it is not the numbers, but the public health effort or lack thereof, that is cause for concern.

I have lived in the US for 10 years, much of that time spent studying, researching and working in top-grade healthcare environments. From what I’ve seen, when it comes to COVID-19, prevention is more important than treatment. I am currently working at Memorial Sloan Kettering Cancer Hospital (MSK) in New York. This is the third cancer hospital I've worked with, and is the largest and oldest cancer hospital in the world.

When cancer patients undergo chemotherapy, radiotherapy, or bone marrow transplantation, their immunity is significantly compromised, and their treatment lasts 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—doctors, nurses, professors and so on—to cancel all domestic or foreign business travels. Individual travel is also strongly discouraged. All conferences and seminars have been canceled, and MSK usually hosts 3–4 such sessions every day. 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 to assure me 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 (MSNBC: https://www.youtube.com/watch?v = JQjqxO7N08I).

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. 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. 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. At the beginning, CDC imposed strict testing criteria for Americans, too strict to be effective for containment. Unless you show severe symptoms (i.e acute pneumonia, shortness of breath ...), and have recently traveled to outbreak centers, you will 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. 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 announcement, 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 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 it’s not the reported numbers themselves that are a cause for alarm. What causes harm is the collective attitude towards this novel virus. This pandemic is likely not about us, the young and healthy, but 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 treatment of COVID-19, the challenges of a public health crisis require vigilance and responsibility from the whole public, at the right time and with the right method.