[I had written this blog last week, when the anti-racism movement (and anti-discrimination movement as a whole) had just begun. I am proud to see how much of the country has strongly stood up against these institutionally-rooted issues, and I will continue to do my part in any way I can. I hope everyone stays safe and healthy!]
COVID-19 Global Impacts: Healthcare & Biomedical Research - UC San Diego School of Global Policy and Strategy
With all of the uncertainty and turmoil happening in the United States surrounding racial bias and police brutality, it almost seems as if COVID-19 has taken a backseat. Media coverage has essentially completely shifted from providing updates on the pandemic to reporting live from the peaceful protests, riots, and looting that have risen nationwide. In a sense, we are combating two fronts at once, but I wanted to take a step back and examine what experts are saying about our progress globally against the virus.
UC San Diego hosted a webinar on May 11 discussing the global impacts of healthcare and biomedical research, which consisted of three speakers that have extensively studied testing issues, treatment and vaccines, and delivery of these treatments to users. In recognition that knowledge of COVID-19 is continually expanding and dynamic, the webinar hosts hoped to at least shed some light on upcoming challenges that can be addressed against the pandemic.
Mr. Andrew Senyei compared the current, face-paced situation to ‘building a plane while flying it’. The virus is difficult to test for because it produces very common symptoms, and it is constantly mutating. The antibodies themselves are not always detectable immediately after infection – they may require a few days, or even longer, to replicate to a volume that can be tested in human secretions or blood (Figure 1).
Figure 1. Antibody detection may not be possible until up to a week after infection (dotted lines).
He noted that the COVID-19 tests that are now available to the public can be essentially split into two types: lab based, which are quantitative, and rapid point-of-care, which are qualitative. These tests were rapidly developed to meet accessibility demands, so accuracy has been a concern for researchers. Furthermore, the serology tests do not in fact test for immunity – the antibodies that are measured are not the ones that provide immunity protection, but rather those that merely serve as indicators of infection. Mr. Senyei thus discusses two up-and-coming testing methods for the virus, both of which promise higher accuracy but still are hindered by apparent flaws (outlined in Figure 2). His hope is that these tests can soon be optimized and replicated effectively so that we can better diagnose those at risk for the dangerous virus.
Figure 2. Current and New Testing Methods for SARS-CoV-2.
Mr. Joshua Graff Zivin then took over to talk about the three main types of treatments we can expect: repurposed therapies, novel drugs, and vaccines. The use of remdesivir to shorten recovery time during emergencies is one example of a repurposed medication, and more are likely on the way for the next six months. Novel drugs include antivirals, RNA-based therapies, and antibody therapies that focus specifically on the molecular symptoms of COVID-19. However, these typically require more extensive experimentation and can take up to three years to be approved. Finally, researchers are looking for vaccines that offer seasonal or multi-year immunity. Vaccines usually need a timeline of two to five years to develop, but many institutions across the world are already moving into clinical trials to expedite this wait time in the midst of a pandemic. Several options have been explored to discover a base for the vaccine, such as an inactivated virus, recombinant proteins, live hybrid viruses, and RNA-based viruses. More information about this research can be found in Figure 3.
Figure 3. Several treatments and vaccines for COVID-19 are being simultaneously investigated by biotechnology companies around the world.
Even before we begin to mass produce these treatments, Mr. Zivin insists we must invest in its distribution: streamlining the drug approval process, platforming technologies for manufacturing, and implementing policies to manage risk and fairness for all. The New Drug Application (NDA) timeline could be shortened from the typical 9-12 months, and efficient protocols must be created for the storage, transport, and administration of billions of doses. Not only do we need to find a way to effectively vaccinate the majority of the United States, but we must also develop a plan to reach developing nations and the rest of the world so that the pandemic can be stopped at a global scale.
Lastly, Mr. Gordon McCord discussed social policy and delivery of treatments to users. He emphasized how mortality rates per total population (i.e. number of deaths from the coronavirus in comparison to number of people in that country) were much lower in the Asian Pacific than in Europe or the United States. While lockdown policies have been effective, decreasing infection rates by 40-60 percent, the main reason why these Asian countries have done so well in containing spread is through the use of contact tracing. They have been able to efficiently locate sources of viral infection and track those who may be at risk, which results in more direct lockdown procedures. For example, during the height of its infectious spread, Wuhan employed one contact tracer per 1,200 residents, which would equate to 300,000 contact tracers for the United States. In stark contrast, the U.S. currently only employs 2,200 total contact tracers. This is nowhere near sufficient to adequately detect where, and how quickly, COVID-19 is moving in our country.
Mr. McCord thus calls for a targeted lockdown, as opposed to a general lockdown, as the most optimal method of pushing past this pandemic. A general lockdown is very inefficient in that all people (except for essential workers) are allowed to continue to work, which has destroyed the economy and left many families in financial crisis. A targeted lockdown would only require that the at-risk population (elderly, young kids) and those infected, or who have been in contact, stay home. However, this would necessitate massive testing and contract testing efforts, as well as emergency call-in and other supporting resources for the individuals who are isolated. Mr. McCord argues that setting aside just one percent of the economy for such purposes would go a long way, but only time will tell if the nation is able to mobilize quickly to control COVID-19, especially during times of social and political unrest.
UC San Diego School of Global Policy and Strategy. “Healthcare and Biomedical Research – COVID-19 Global Impacts Seminar.” University of California Television (UCTV), YouTube, 14 May 2020, https://www.youtube.com/watch?v=oar5Es61-Hg