It was mid-January when Dr. Prasun Mishra, founder of the American Association for Precision Medicine (AAPM), was on a call with his friend Jay Chen, who was visiting China to celebrate Chinese New Year. There was a word of a new virus sickening a small population in Wuhan, and some physicians thought it was highly infectious, with several deaths reported in local hospitals. Based on Mishra’s past experience working with RNA viruses and outbreaks, he felt things were not sounding good. He immediately started building a taskforce, by recruiting people through his network, later called ACT: AAPM Coronavirus Taskforce.
“We initially thought that the disease outbreak would be contained in China and wouldn’t impact the US,” Mishra said. “But soon we all realized the gravity of the situation when the whole city of Wuhan was quarantined, ahead of the Chinese New Year celebration, to prevent the spread of novel coronavirus virus, SARS-CoV2, associated disease, now called COVID-19.”
“Based on my previous experience studying RNA viruses and epidemics, my alarms went off. Could this be early warning of an eminent pandemic?” Mishra told indica, “I knew that there was something serious coming.”
Mishra formed the taskforce of people from all over the world – the US, Europe, China, India, and the Middle East – working together on finding prevention strategies, diagnostics and a cure for the deadly virus which, he says, much like a sci-fi movie, has infected masses with two confirmed strains of virus already reported.
Mishra said there was a lot of help from US-based communities and non-profits, who have been sending desperately needed medical supplies to China. “The situation was deeply concerning for China, which has advanced scientific and medical communities,” Mishra said.
However, back in the US, he said, “We all came together to form ACT: AAPM Coronavirus Taskforce. We knew this virus was highly infectious and was spreading very fast by using humans as a host. And no man- and nation-made borders are going to contain these deadly viruses.”
“Today we travel everywhere, so the world has become one big home,” Mishra said. “It’s going to be very difficult to contain this virus with porous communities and borders.”
According to the Center for Disease Control and Prevention’s latest report, 110 people in California, including at least 50 in the Bay Area, have been diagnosed with COVID-19; 423 cases across the U.S., including 19 deaths, with at least one of those deaths in California and at least 14 in Washington state. According to the World Health Organization (WHO) real-time dashboard, there are more than 110,000 confirmed cases worldwide and over 3,800 deaths and the spread has reached at least 108 countries and regions. The latest numbers of COVID-19 global cases is available at Johns Hopkins CSSE,.
The number of people infected is growing. Currently, there are no vaccines or drugs to prevent or cure COVID-19. The novel coronavirus is more infectious than the seasonal influenza, which has preventive vaccines and treatment available. However, as the COVID-19 has no drugs available, the medications given are basically to reduce the symptoms.
When asked about the ACT taskforce, Mishra explained the ongoing work, and said that ACT has seven different sub-teams – one is focused on prevention, the second is focused on developing novel diagnostics and faster vaccine development and other prevention techniques. There is also a therapeutics team, a supply chain team, working on how to get supplies to patients, and an AI machine learning team that basically uses AI/ML/DL to make sense of the available data, data visualization, and so forth. ACT is a global taskforce, with members in almost all time zones across the world, working 24/7 since Jan. 21.
The biggest challenge is to develop a safe COVID-19 vaccine, which is in development by governments and in the private sector and may take some time. Also, clinical testing of SARS-CoV2 has been a challenge. The US government and CDC have already ramped up the production and distribution of diagnostic kits and are supplying them to hospitals and healthcare providers. There is a positive correlation between widely available and fast lab tests with death-rate reduction. For example, effective lab tests have resulted in early detection and clinical intervention, which is critical to reducing the mortality rate. Recent mass testing done in South Korea of over 140,000 people has found that the death rate for COVID-19 is just 0.6%, which is far lower than in China or the US.
Another critical factor in the death-rate reduction is a stress test of the healthcare system. Cases outside China’s epicenter (outside Wuhan/Hubei) also reported a much lower mortality rate of around 0.7%, according to a WHO report. “As we scale the diagnostics efforts in US and test more people, the reported death rates might go lower in the US.” Mishra said.
Drug discovery and development are additional challenges. “This is a novel virus, and therefore there were no drugs that were developed as this was not a concern before. That’s why we are stuck with the drugs that we have in hand right now.” Mishra said. ACT-AAPM’s coronavirus taskforce is not only working on repurposing existing drugs but also finding new drugs for the novel coronavirus.
However, Remdesivir, a drug originally developed to treat Ebola by Gilead Sciences Inc., a Foster City, California-based drug discovery company, has shown some promise. Similar to SARS-CoV2, Ebola is also an RNA virus. Remdesivir was originally developed to inhibit viral RNA synthesis and virus replication and has a broad-spectrum activity on inhibiting the novel coronavirus replication, in vitro and in vivo, in animals, the doctor said.
Mishra said Remdesivir is being tested in clinic for COVID-19 and has been fast-tracked for regulatory clearance both in China and the US.
When asked how it all started, Mishra said there are many theories, but the origin of the novel coronavirus still needs scientific investigation. “Many believe the COVID-19 outbreak began after the virus jumped from animals to humans. Also, there is a media report suggesting the likely transmission from human-to-animal after a pet dog tested ‘weak positive’ for the virus after the owner had COVID-19. However, there are no published scientific studies to back these claims.
Viruses have the innate ability to undergo evolution and mutate their genetic sequence when they are transmitted to a new host. “Based on the differences in genomic sequence, there are two types of the SARS-CoV2 have been identified. A more prevalent L-type, which is thought to be derived from the older S-type. The older S type is thought to have emerged when the virus jumped from animal to humans.” However, WHO insists that although there is some genetic diversity of the virus, it doesn’t mean it is changing.
When asked when drugs might become available, Mishra said there are symptomatic treatment options already available to reduce the signs and symptoms of COVID-19. However, there are COVID-19 specific drugs and vaccines under development, which have very different timelines. For drug development, the new drugs will have to go through clinical trials for regulatory approvals, which is a time-consuming process. “The good news is that clinical trials for Remdesivir are ongoing and are on the fast track for the regulatory approval.”
He said that the world is at one table working on this, and it has been a great learning experience for ACT members on how the countries are dealing this outbreak.
Mishra said the ACT members, scientists and entrepreneurs are working around the clock on advocating prevention, creating new diagnostic tools, and drugs for SARS-CoV2. The team is also coming up with scientific content to address the public’s concerns and combat misinformation.