By Dr. Hammonds
From the 2002 – 2003 Severe Acute Respiratory Syndrome (SARS) Corona Virus outbreak, virologist around the world recognized that a new dangerous strain of the virus family was about to cause major problems. SARS-CoV-1 was only moderately contagious, generally caused mild to severe illness (mostly respiratory and GI symptoms), but was deadly in 9% of those infected (60% in those over 60 years old). Virologists knew this virus would probably cross-mutate into a strain that was not only deadly, but highly contagious and produce severe illness in most people.
The World Health Organization (WHO) in Switzerland, the Centers for Disease Control and Prevention (CDC) in the U.S., the National Microbiology Laboratory (NML) in Canada, the Erasmus University (EU) in the Netherlands, the University of Hong Kong (UHK) in China worked together to quickly map the genome successfully, searching for a vaccine against this virus and others in the family of corona viruses – unsuccessfully.
The Middle East Respiratory Syndrome (MERS) Corona Virus outbreak in 2012 emphasized that the corona virus family – including several highly contagious common cold viruses (CCC) – would produce a more contagious, more deadly mutation, given time. While minimally contagious, the MERS Virus symptoms were mild to severe and 35% of those infected died, mostly by an overreaction of the immune system (cytotoxic storm), especially in those with weak immune systems or with pre-existing medical conditions. No vaccine was forthcoming.
In December, 2019, SARS-CoV-2 or COVID-19 was diagnosed in Wuhan, China. This virus proved to be highly contagious (like CCC viruses), producing mild to severe symptoms in those infected (respiratory and GI symptoms – like SARS-Co-1). 81% of those infected had mild symptoms, 14 % had moderate to severe illness, and 5% were critically ill. While the overall death rate was 0.5% (5 per 1000 infected), the death rate increased dramatically in older populations, 20% in those over 70 (1 in 5 infected) and those with weak immune systems (like MERS). Additionally, COVID-19 caused the deadly cytotoxic storm in some, both young and old (like MERS).
The major problem was 45% of those infected demonstrated no symptoms at all and half of these, especially children, carried 2-3 times the viral load of sick people while showing no indication that carried the virus. A significant number of people carrying a high number of virus particles were mixing with susceptible people with no way to tell who these carriers were. The nasal swab test (RT-PCR) accurately identified who was carrying virus particles in their airway. But the results of the test required 1-7 days before getting the results, not useful for public health tracking. A quick turnaround test was able to identify those who were actively infected (making antibodies against the virus) but required the person to have a high antibody level, missing 30-40% of those with only mild infections.
Because of the rapid spread of the virus (highly contagious), quickly discovering an effective, safe vaccine was the answer to stopping the ensuing pandemic.
From the mapping of the COVID-19 genome in January, 2020, WHO began facilitating a collation of international research in search of a vaccine, sharing research findings (through the Solidarity trial database) among more than 50 countries, laboratories, and pharmaceutical companies, using ten different technologies. The Coalition for Epidemic Preparedness Innovations (CEPI) created an $8 billion fund supported by 165 countries. Thirty-five heads of state from G7 and G30 countries created the Global Alliance for Vaccine Immunizations (GAVI) $8.8 billion fund to vaccinate 300 million children in under-developed countries. France, Canada, U.S., China, Russia, UK, Netherlands, Germany are funding cooperative efforts of specific university laboratories and companies in their own countries. The Gates Foundation has donated almost $2 billion to these various efforts.
Because of unique computer programs shared among all the researchers which can quickly identify potential vaccine candidates and techniques, as of September, 2020, three hundred twenty-one different vaccine candidates are in development and five different vaccines have advanced to Phase III trials in 7 months (what usually takes 5-10 years). While all five of these vaccines show good neutralizing antibody production after two injections, only one demonstrated robust T memory cell production for long term protection and three have moderate to significant adverse side effects following injection. Despite the public pronouncements by various countries around the world, none of these vaccines are realistically expected to be available before the summer of 2021.
The good news? We still have the power to protect ourselves and others by wearing masks when in a building or in prolonged contact with people closer than 6 feet. We can still wash our hands and use hand sanitizer when touching others or items touched by others. We still have the power to respond with mindful caution until the vaccine is approved and available. And we can pray that the international cooperation that has gotten us this close to an effective, safe vaccine so rapidly – will quickly find, test, and distribute equitably the vaccine that will help us all get back to a more normal life.
Max Hammonds, MD (retired) MPH.