It seems like we are part of a Hollywood horror movie with government from the local to the federal level making announcements every minute. Scientists and healthcare workers have been working across the globe since January, around the clock, to find new solutions to combat the COVID-19 pandemic.
At breakneck speed, the virus has spread around the world, infecting humans on every continent. Soon after the World Health Organization declared COVID-19 a pandemic, U.S. President Donald Trump called for national emergency tactics to try to contain the virus. But some U.S. cities have announced their own stringent measures – and acting with great speed. Six counties in the San Francisco Bay Area on March 16 announced shelter-in-place restrictions. On March 18 California Governor Gavin Newsom projected that “56% of state’s population will be infected” in the next eight weeks. He then issued a statewide stay-at-home lockdown order for all California counties as a new measure to contain the spread of SARS-CoV-2.
At the national level the State Department has issued a Level Four travel advisory applying to all countries. The federal government is instructing Americans not to travel internationally. They are also urging U.S. citizens abroad to return home amid the coronavirus pandemic, fearing the U.S. homeland doesn’t reach the crisis level that Italy has. And the Indian government has banned the landing of international flights on its soil.
Silicon Valley-based Dr. Prasun Mishra, founder and CEO of the American Association for Precision Medicine (AAPM), a non-profit organization established with a mission to accelerate the field of precision medicine through research, education, communication, and collaboration to foster new medical breakthroughs;in response to the COVID-19 pandemic, AAPM rapidly launched the AAPM Coronavirus Taskforce (ACT) in January 2020.
ACT brings together a worldwide network of experts spanning clinical, scientific, technical, and advocacy backgrounds that are focused on discovering and disseminating strategies for COVID-19 specific prevention, diagnostics, therapeutics, Artificial Intelligence-driven solutions, funding opportunities, and other patient-centric prevention techniques.
The team members gather several times a week remotely to discuss the progress. In a recent meeting, Dr, Mishra sounded worried but forced himself to smile, while sharing the latest developments in medical research to overcome the COVID-19 outbreak.
Indica talked to Dr. Mishra, chair ACT to learn the gravity of the situation and how to quickly create awareness among the community in real-time. Excerpts:
Please answer what’s going on. How bad is the situation in the U.S.? Worldwide 244,517 cases of COVID-19 have been identified with over 10,000 documented deaths.
Things are pretty serious. In just one week there is a step rise in COVID-19 cases in the U.S. According to the Johns Hopkins University online COVID-19 map, U.S. confirmed cases reached 14,250. California Governor Gavin Newsom predicted that about “56% of state’s population will be infected” in the next 8 weeks. We already have a statewide stay-at-home lockdown order issued by state of California for all the counties. That means 40 million California residents are now confined to their homes with exceptions for essential work, food, or other needs.
Our main pandemic response now is focused on flattening the curve as described in a figure below (from Vox.com). The strategy is focused on reducing the infection rate and the total number of sick people at a given time during the pandemic. As we have learned from China and Italy that the death rate is directly proportional to how overwhelmed the hospitals and healthcare systems are. If the infection rate is very high, the health care system gets overwhelmed quickly, and physicians have to engage in triage (who will live and who will die).
New Jersey, New York, and Connecticut issued a joint regional action to limit crowds; bars and restaurants will be only open for delivery or takeout. The cities are closing gyms, cinemas, and casinos. The cases are increasing, and if the right precautionary measures and social isolation is not practiced, we may be on our way toward repeating what is happening in Italy.
Why is the novel coronavirus more infectious and deadly?
Novel coronavirus has evolved to be more infectious. Unlike SARS and other coronaviruses, SRS-CoV-2 spike proteins have furin binding sites. Furin plays a role in the activation of viruses. Furin is abundant on human cells and is found in lots of human tissues, including the lungs, liver, and small intestines. As a result, this virus can potentially attach to multiple organs. Also, SRS-CoV-2 binds with ACE2 receptor on mammalian cells 10 to 20 times tighter as compared to SARS. These adaptations make the virus sticky and highly infectious and deadly. Moreover, the death rate for influenza is 0.1% (1 in 1000 will die). Whereas the lowest reported death rate for this novel coronavirus is 0.6% to 0.7%, which is still 6-7 times higher than flu, making the virus more infectious and deadly.
Please brief our readers on why President Trump declared a national emergency?
In case of a pandemic, it is better to prepare for the worst-case scenario. President Trump has declared a national emergency to contain COVID-19 spread. The national emergency will also allow the government to act efficiently, expeditiously and also have access to emergency funds to deal with this crisis. The viral pandemics usually weaken in summer due to higher temperatures, so one might anticipate that. However, this is the new virus, and there are several unknowns to make that assumption. So, let’s be prepared for the worst-case scenario and hope for the best. As per the president’s coronavirus briefing, he said that the COVID-19 virus is “very bad”; the pandemic is very serious and could last until July or August. The president also urged Americans to practice social distancing in America to slow the spread for the next 15 days. The guidelines include the following:
1) All the gatherings must be limited to 10 people or fewer.
2) Visits to bars, restaurants, nursing homes, shopping malls, and all non-essential travel should be avoided.
3) Importantly, if a family member is sick, all the members of a household should stay home.
4) Most mobile members of society, adults aged 25 to 40, should constrain their mobility; seniors should self-quarantine
5) Gyms, bars, restaurants, and any public places where people congregate should be closed.
6) Governors to work with the U.S. government stockpile in obtaining necessary medical equipment for the local hospitals.”
Mishra quoted NIAID director Dr. Anthony Fauci, who said “It will always seem that the best way to address it would be to be doing something that looks like it might be an overreaction. It isn’t an overreaction. It’s a reaction we feel is commensurate with what is actually going on in reality.”
Is there any diagnostics, medicine or vaccine yet?
The FDA has already opened the emergency use authorization (EUA) process creating a new regulatory pathway for regulated assay development. FDA approved the first commercial coronavirus tests in the U.S. by Roche and Thermo Fisher, who collectively have nearly 2 million COVID-19 diagnostic tests.
Vaccine: First Phase 1 trial of Moderna, a COVID-19 vaccine (was prepared in just 65 days) began in Seattle on 45 healthy individuals ages 18-55. Follow-up will last at least 1 year.
As in the meeting, I felt everyone was giving their best shot to reach the goal, and any tiny information seems valuable today. Are we close to this great discovery? If yes, how many more days? What progress you have made from your side since its outbreak in December 2019.
Our teams at ACT are working together on finding both short-term and long-term solutions. ACT is a global taskforce and has seven different sub-teams focused on 1) prevention, 2) developing novel diagnostics, 3) Therapeutics, 4) Supply chain team, working on how to get supplies to patients, 5) AI machine learning team that basically uses AI/ML/DL to make sense of the available data, data visualization, 6) Writing (PR, grants, reports) team and 7) Impact investments team.
Every task force member has been serving as a knowledge base for the community, providing scientifically backed information. We are using social media to spread the message.
We are also launching a series of online events for COVID-19 and cancer patients. As cancer patients are currently at a five-fold increased risk of mortality from COVID-19. To date, there are no official recommendations in terms of ongoing oncology treatments with COVID-19.
To solve this, AAPM has partnered with GRYT Health to launch the series of free, live, virtual programming, bring timely ongoing updates, expertise, resources, and connection to those dealing with a cancer diagnosis.
All programs will be recorded and also available on demand. Users can register for these free programs by visiting grythealth.com/coronavirus, where they can also connect with our cancer community at any time and receive support. Additionally, users can sign up to receive ongoing updates regarding the latest COVID-19 news impacting their journeys.
One of the members of the taskforce, Andre Watson and his team, has created a viral exploration group on social media that currently has over 2,000 members. The platform has become a great source to ask questions and share scientific information privately in a forum.
Right now, we are working side by side with some of the brightest minds in medical research on several breakthrough research projects. In fact, we are thrilled to share that ACT-affiliated companies have filed several patents that address diagnostics, rapid vaccine, and antibody-based tests and treatments. We are working on the next steps to eventually bring these to patients.
What lessons do you think we’ll be able to learn from this?
It has been a great learning experience for ACT members on how the countries are working together in dealing with this outbreak. I classify these learnings in four categories:
- Act earlier rather than later. 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.
- An overwhelmed healthcare system can’t treat all patients. 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 as compared to a WHO report. “As we scale the diagnostics efforts in the U.S. and test more people, the reported death rates might go lower in the U.S.” We have to make sure we do not overwhelm our healthcare system, which directly correlates with increased death rates.
- Communication is key. Experts need to come to an instructive discussion with the public quickly as well as take decisive action on the best initiatives to help stop viral spread and the deaths. There has to be a pandemic scientific communication system that needs to be built beyond traditional journal publishing to take quick actions. All journals have to make all the articles on COVID 19 immediately released free to the public. People’s offices, companies, and schools need to know how infectious the virus is, where it has spread, and what actions they should take to prevent the spread of the disease.
- Investment is necessary to support all aspects of the war against this virus, its physical and economic damage to humans, including lowering the death rate. AAPM has methods in place to help secure additional funding to support the best practices, new technology development, and timely communications.
AAPM ACT requests all to follow social distancing and to stay home, even if one has no symptoms, to avoid the spread of the virus. Please avoid all crowds, including bars, restaurants, social gatherings, parties, or places of worship. Please note that comprehensive social distancing can stop the spread of this virus in the U.S.
[Photo courtesy:Johns Hopkins University]