REUTERS/Ann Saphir
Neel Kashkari, president of the Minneapolis Federal Reserve Bank
Speaking of potential therapies. KSTP reports: HealthPartners Institute says its begun testing a drug for severe COVID-19 pneumonia that could help prevent lung inflammation in patients. HealthPartners said the FDA gave fast-track investigational approval for testing of the drug, formally known as CM4620-IE, which can block the bodys production and release of molecules that cause inflammation, potentially reducing lung damage and the need for a ventilator.
Social distancing while homeless. The Star Tribunes Chris Serres reports: Jennifer Hernandez hunched her shoulders against the biting wind and contemplated how she would find water to wash herself and her children. A month ago, the 40-year-old mother of two and her partner were among the first to pitch a tent along the light-rail line near Hiawatha Avenue and E. 28th Street. They wanted to be alone, to insulate themselves from the pandemic. But others have followed, turning a once-vacant stretch of grass and mud into a makeshift encampment with more than two dozen people. Most say they feel safer sleeping in the open air than being in shelters where physical distancing is impossible.
The doctor is on Fox News. City Pages Hannah Jones reports: Minnesota Sen. Scott Jensen (R-Chaska) takes issue with the Centers for Disease Control and Preventions guidelines on how to classify COVID-19 deaths. Jensens opinions on the subject tend to carry more weight than most lawmakers. He happens to be a family physician in Watertown. That experience is why Jensens clashed with some of his fellow Republican colleagues over, say, outlawing conversion therapy, or providing emergency insulin. His beef with the death guidelines, in simple terms, is he feels theyre too squishy about designating COVID-19 as a cause of death.
The U is keeping things remote this summer. The Minnesota Dailys Niamh Coomey reports: University of Minnesota students and faculty are preparing for the summer semester to continue online. Due to ongoing COVID-19 concerns, University President Joan Gabel announced last week that the University would offer summer courses online only. Faculty are currently reworking courses to better fit the digital format. Some are concerned about student access to the internet and whether there will be financial resources to support the online-only instruction.
Good news: Twin Cities jazz great Nachito Herrera off ventilator, in stable condition [Pioneer Press]
Sad news: Tarvaris Jackson, former Vikings quarterback, dies in car crash [Star Tribune]
Op-ed from Sen. Amy Klobuchar and colleagues: Amid coronavirus uncertainties, dont put voter health at risk in fall election: Senators [USA Today]
Food help: Coronavirus In Minnesota: YMCA, Loaves & Fishes, UnitedHealth Group Partner To Provide Fresh Food To Communities [WCCO]
Five covers: Trampled by Turtles selling new EP exclusively through two Twin Cities record shops [Star Tribune]
That warm feeling inside isnt just the beer talking: Surly taps into our essential humanity to host food drive at liquor stores [City Pages]
CALGARY (660 NEWS) The impact of the COVID-19 pandemic is forecasted to last many months with health officials being cautious about when to start easing health restrictions.
If we release our hold on restrictions too soon that could undo all the work and all of the sacrifices we have collectively made to get to this point, Albertas Chief Medical Officer of Health Dr. Deena Hinshaw said Monday.
Back on April 3, the City of Calgarys Emergency Management Agency announced it was cancelling all public events until June 30, which included the Mothers Day Run, the Sled Island Music Festival, and the Calgary International Beer Festival
Some organizations are taking extra steps and cancelling their events scheduled months ahead, such as the Edmonton Fringe Festival.
We will fringe again, and we look forward to celebrating the 40th Edmonton International Fringe Theatre Festival August 12 22, 2021, a statement reads on the festivals website.
Hinshaw said these types of events are risky, calling them super spreader events where one person could end up transmitting the virus to 20 or 30 people.
Until we have a vaccine, or some other means of ensuring widespread immunity, some of these gatherings are going to be the riskiest kinds of activates to engage in, especially gatherings that bring together people from all over the country or all over the world, Hinshaw said.
Residents in Calgary are waiting to hear whether the Calgary Stampede will be cancelled as officials with the organization continue to consider all their options.
Health officials are currently focusing on how to reduce restrictions for smaller activates and workplaces.
Those are the kinds of things we are looking at. How can we ease off on some of those things at the appropriate time so that we can have a little more of a normal return to our day-to-day, while some of the other pieces will probably be with us for a lot longer, Hinshaw said.
At least 70 potential coronavirus vaccines are currently in development, with 3 already in clinical trials, according to the World Health Organization.
WHO published an updated list of vaccine efforts on April 11, showing a vast array of companies pursuing shots that could halt the coronavirus. Bloomberg News reported on the document earlier.
As the virus continues to spread, infecting more than 1.9 million people and killing more than 110,000 worldwide, researchers have been racing to develop vaccines. Those research efforts involve a range of organizations, from pharmaceutical giants and tiny biotech companies to academic centers and nonprofit groups.
Read more: Here are the top vaccine efforts to watch, including 8 set to be tested in people this year.
Developing a new vaccine is typically an expensive, complicated and lengthy process, requiring hundreds of millions of dollars and years of testing to determine whether a vaccine is safe and effective. While this current pandemic is the third coronavirus outbreak of the 21st century the first two being SARS and MERS there still aren't any approved vaccines for coronaviruses.
Drugmakers and health officials have been hoping to significantly cut down those timelines in response to the severity of the current situation. Chinese biotech company CanSino is already working on phase two of human trials for its experimental vaccine, while US-based biotech startups Inovio Pharmaceuticals and Moderna have both begun human testing. Large corporations like Johnson & Johnson and Sanofi are also sprinting to develop vaccines.
Dr. Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said the US is still at least 12 to 18 months away from seeing a coronavirus vaccine, and some experts have warned that even trying to hit that deadline is a risky plan that could backfire.
"When Dr. Fauci said 12 to 18 months, I thought that was ridiculously optimistic," Paul Offit, the co-inventor of the rotavirus vaccine in the late 1990s,told CNN. "And I'm sure he did, too."
New vaccines are generally required to be tested first in a lab, then in animals, and then among a small group of people for safety before they're finally tested in larger groups to see if they can prevent a disease. But experts are concerned that bypassing any of those steps in order to get a vaccine approved risks leading to "immune enhancement," where a vaccine actually weakens a person's response to the virus.
Never miss out on healthcare news.Subscribe to Dispensed, Business Insider's weekly newsletter on pharma, biotech, and healthcare.
"The way you reduce that risk is first you show it does not occur in laboratory animals," Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine,told Reuters. But in the rush to find a vaccine for the coronavirus, some drugmakers are skipping animal trials,Stat News reported.
"I understand the importance of accelerating timelines for vaccines in general, but from everything I know, this is not the vaccine to be doing it with," Hotez said.
Andrew Dunn and Bill Bostock contributed reporting to this story.
Microsoft (MSFT) founder and billionaire Bill Gates wants life to get back like it was before the global coronavirus outbreak.
The only way to truly do that is with a vaccine and that will take time.
"People like myself and [Dr. Anthony] Fauci are saying eighteen months, Gates told BBC Breakfast. If everything went perfectly, we could do slightly better than that. But there will be a trade-off: Well have less safety testing than we typically would have... we just don't have the time to do what we normally do.
The urgency to develop a COVID-19 vaccine is necessary, Gates stressed.
If you want to wait and see if a side effect shows up two years later, that takes two years, he said. So when youre acting quickly... this is a public good, so those trade-offs will be necessary.
Bill Gates, Co-Chair, Bill & Melinda Gates Foundation speaks onstage at 2019 New York Times Dealbook on November 06, 2019 in New York City. (Photo: Mike Cohen/Getty Images for The New York Times)
The Gates Foundation, through the Coalition for Epidemic Preparedness Innovations (CEPI) a global public-privatepartnershiplaunched in 2017 that the Gates Foundation funds has thus farmade investmentsin eight vaccine programs.
We're doing everything we can, Gates said. We'll write checks for those factories faster than governments can and they'll come along. It definitely shouldn't be money limited. It should should be all the best constructs, full-speed ahead, science limited.
The prominent philanthropist has advocated for widespread testing and previously a nation-wide shutdown to slow the spread of coronavirus in the short term.
Confirmed coronavirus cases are still on the rise.(David Foster/Yahoo Finance)
The ultimate solution, the only thing that really lets us go back completely to normal and feel good about sitting in a stadium with lots of other people, is to create a vaccine, Gates said last week.And not just take care of country, but take that vaccine out to the global population so that we have vast immunity and this thing, no matter what, isnt going to spread in large numbers.
The timing and eventual emergence of a coronavirus vaccine is being closely watched and considered as an early indicator of the end of the outbreak.
Were looking around the world. As they relax the economic controls, the virus flares back up again, Federal Reserve Bank of Minneapolis President Neel Kashkari said on CBSs Face the Nation. We could have these waves of flareups, controls, flareups and controls until we actually get a therapy or a vaccine. I think we should all be focusing on an 18-month strategy for our health care system and our economy.
Confirmed coronavirus cases are still on the rise.(David Foster/Yahoo Finance)
Story continues
Melinda Gates shed some light on the processes involved in that 18-month vaccine timeline.
From everything we know from working with our partners for many, many years on vaccines, you have to test the compounds ... go into preclinical trials, then full-scale trials, Melinda Gates explained in a separate interview with Business Insider. And even though I'm sure the FDA will fast-track some of these vaccine trials like they did with Ebola, still by the time you get it through the trials safety- and efficacy-wise, then you have to manufacture the vaccine and manufacture at scale.
U.S. President Donald Trump has called the coronavirus a horrible, invisible enemy and declared that the country is at war and were fighting an invisible enemy.
But Gates noted that the severe lack of preparation for such a war despite the vast implications was a serious mistake by governments around the world.
Unlike the defense budget that prepares us for wars where we simulate the problem when we make sure we're good at it, this risk which I viewed as even greater than the risk of war there was very, very little preparation, very few of these germ games, said Gates, who famously warned about a pandemic in 2015.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, listens as U.S. President Donald Trump addresses the daily coronavirus response briefing at the White House in Washington, U.S., April 1, 2020. REUTERS/Tom Brenner
In a germ game, researchers would say: Okay how do you build up the ICU capacity? Can you make ventilators? How do you prioritize the diagnostics? Gates explained. That we're just figuring out.
In any case, once a vaccine becomes available and various public health responses are carried out, the world will better prepare for the next pandemic.
People just didnt organize their governments to have that function, Gates said. I do think now, because this has been so dramatic, ... we will be ready for the next pandemic. And using the new tools of science, that's very, very doable.
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Hello!
It's been a dark few weeks, but there's been some light in the past few days, as the number of patients in New York ICUs dropped for the first time since the coronavirus pandemic began, and there was some promising data on a potential treatment.
As Andrew Dunn reports, more than two-thirds of hospitalized COVID-19 patients improved in condition after receiving remdesivir, an experimental antiviral treatment from Gilead Sciences. More tests are needed, as the study had no control group, but the lead author called the observations "hopeful." You can read Andrew's story on remdesivir and 14 other leading treatments that are now being tested against COVID-19 here.
The pandemic is upending medical research across the board, as big pharma mobilizes to find a treatment. GSK for example is betting $250 million on buzzy biotech Vir as the two team up to hunt for coronavirus treatments and vaccines. In related news, Blake Dodge reported this week that Alphabet's life-sciences firm Verily may use its giant patient registry to help sign people up to test coronavirus treatments.
And Blake separately reported that tests that can tell if you're immune to the coronavirus are on the way. She breaks down the companies racing to bring them to the US healthcare system here.
The flip side here, as Andrew and Blake report, is that dozens of biotechs are putting clinical trials on hold as the search for a coronavirus vaccine makes it harder to find cures for cancer, heart disease, and neurological disorders.
(For more on how Andrew is covering the high-stakes race for a coronavirus vaccine, he talked to deputy executive editor Olivia Oran about his reporting.)
Meanwhile, Apple and Google on Friday announced they are building a system to track COVID-19 cases. But as Rob Price reported, the plan islet down by America's testing failures.
Samantha Lee/Business Insider
From Melia Russell and Paayal Zaveri:
The coronavirus outbreak has changed not only where people work from, but how they work and what tools they use.
Already, apps likeZoomandSlackhave seen huge increases in usage in the past few weeks, as users grab onto ways to stay connected in their work and personal lives while social distancing.
The urgent need for better work tools could catapult some enterprise startups into the pantheon of unicorn startups, as their users multiply and venture capital investors jump to fund them.
They asked VCs to tell them about one startup in their portfolio, and one where they have no financial interest, and came up with a list of 30 startups to watch. You can read more here.
Elsewhere in startup news:
Eduardo Munoz/Reuters
The week started with the news that WeWork board members are suing SoftBank for backing out of its plan to buy $3 billion of shares. Meghan Morris reported that former CEO Adam Neumann is still weighing legal options.
Meghan and Dan Geiger then revealed that WeWork rival Knotel is scrambling to pay millions in bills that started stacking up before the coronavirus hit, and hasn't paid April rent at some locations. They also got leaked Knotel financials, which show it struggled to hit sales targets.
Elsewhere:
Below are headlines on some of the stories you might have missed from the past week. Stay safe, everyone.
-- Matt
The coronavirus mutation that threatens the race to develop vaccine South China Morning Post
(Reuters) - With much of the world living in lockdown, the spread of the new coronavirus, SARS-CoV-2, that was first detected in China late last year is beginning to slow in some places. As of April 12, 1.8 million had been infected and 115,000 killed by COVID-19, the disease caused by the virus.
FILE PHOTO: Scientist Linqi Zhang shows a tube with a solution containing COVID-19 antibodies in his lab where he works on research into novel coronavirus disease (COVID-19) antibodies for possible use in a drug at Tsinghua University's Research Center for Public Health in Beijing, China, March 30, 2020. REUTERS/Thomas Peter
While a safe, effective vaccine is still more than a year away, researchers are rushing to repurpose existing drugs and non-drug therapies as well as testing promising experimental drugs that were already in clinical trials.
Even moderately effective therapies or combinations could dramatically reduce the crushing demand on hospitals and intensive care units, changing the nature of the risk the new pathogen represents to populations and healthcare systems. New drugs, together with new diagnostics, antibody tests, patient- and contact-tracing technologies, disease surveillance and other early-warning tools, mean the anticipated next wave of the global pandemic does not have to be nearly as bad the first.
More than 70 vaccine candidates are also in development around the world, with at least five in preliminary testing in people. Here are some of the drugs, vaccines and other therapies in development:
REMDESIVIR - GILEAD SCIENCES
Antiviral drug, originally developed to combat RNA viruses including respiratory syncytial virus. At least 13 trials underway in China, Europe and the U.S. with preliminary results from two Chinese trials expected as soon as April 2020. A February assessment by the WHO flagged this candidate as the most promising for battling COVID-19.
CAVEATS: Initial data are expected to come from studies of patients with relatively severe COVID-19. Because antivirals work best when patients are healthier, those results may show limited effectiveness.
STATUS: Repurposed Experimental
EARLY RESULTS: 0-3 months
Gilead starts two late-stage studies to test drug for coronavirus
Link: here
Investors await data on coronavirus drugs as market rally builds
Link: here
Gilead asks FDA to revoke orphan drug status for potential coronavirus drug
Link: here
Clinical Trials
Link: here
New England Journal of Medicine, April 2020
Link: here
Malaria drug also believed to have antiviral activity. Blocked SARS-CoV-2 entry into cells in an in-vitro experiment. In one small French study, some COVID-19 patients showed improvements but there was no way to know if the drug was the reason. Results published in April from another study in France and one in China found no benefit in patients treated with the drug. Dozens more clinical studies are underway around the world.
STATUS: Repurposed
EARLY RESULTS: 0-3 months
Special Report: Doctors embrace drug touted by Trump for COVID-19, without hard evidence it works
Link: here
Coronavirus drug hopefuls are cheap to make but may be in short supply
Link: here
Clinical Trials
Link: here
Journal of Zhejiang Univ (Med Sci), March 2020
Link: here
Mdecine et Maladies Infectieuses, March 2020
Link: here
Nature, February 2020
Link: here
ACTEMRA (TOCILIZUMAB) - ROCHE
Monoclonal antibody approved for rheumatoid arthritis and also for treating the cytokine storm immune overresponse in cancer patients. Fifteen registered trials in China, Europe and the U.S. are testing it on COVID-19 patients, alone or in comparison to other therapies. One French trial is looking at 28-day effects on COVID-19 in patients with advanced or metastatic cancer.
STATUS: Repurposed
EARLY RESULTS: 0-3 months
Coronavirus drug hopefuls are cheap to make but may be in short supply
Link: here
Clinical Trials
Link: here
KEVZARA (SARILUMAB) - SANOFI, REGENERON PHARMACEUTICALS
Monoclonal antibody approved for inflammatory arthritis, and in trials targeting the cytokine storm immune response in severely ill COVID-19 patients. Regenerons chief scientific officer has said initial data on effectiveness could come by late April.
STATUS: Repurposed
EARLY RESULTS: 0-3 months
Data on arthritis drug to treat coronavirus could come within weeks, according to Regeneron executive
Link: here
Exclusive: Sanofi can produce millions of doses of potential coronavirus drug - CEO
Link: here
Sanofi, Regeneron expand testing of potential coronavirus treatment
Link: here
Clinical Trials
Link: here
JAKAVI (RUXOLITINIB) - NOVARTIS, INCYTE
Developed to treat inflammatory and autoimmune diseases, and in late-stage development as a cream for atopic dermatitis. One trial each in Canada and Mexico will test the drug in COVID-19 patients with severe respiratory symptoms associated with the cytokine storm immune response, with preliminary results expected by June 2020. In the United States, Novartis established a managed access program for use in severe/very severe COVID-19 illness on April 7.
STATUS: Repurposed
EARLY RESULTS: 0-3 months
Novartis, Incyte join repurposing wave to give Jakavi a trial run in COVID-19
Link: here
Clinical Trials
Link: here
KALETRA (LOPINAVIR/RITONAVIR) - ABBVIE
Antiviral combination used to treat and prevent HIV infections. More than twenty trials around the world are testing the drug as a COVID-19 treatment or post-exposure prophylaxis for people with high-risk close contact with a confirmed case. Initial results expected as soon as May 2020.
CAVEATS: One randomized controlled trial in China published results in March showing no differences in viral load or 28-day mortality among 199 patients. Median time to clinical improvement was one day shorter in patients taking the drug. However the same investigators, doctors at Jinyintan Hospital in Wuhan, said in April that they believe Kaletra, as well as a second drug, bismuth potassium citrate, helped some of the COVID-19 patients they treated.
STATUS: Repurposed
EARLY RESULTS: 0-3 months
Key China coronavirus hospital says HIV drug beneficial to patients
Link: here
Mylan waives exclusive U.S. distribution rights for potential COVID-19 therapy
Link: here
Clinical Trials
Link: here
New England Journal of Medicine, March 2020
Link: here
RHACE2 APN01 - APEIRON BIOLOGICS
A recombinant human angiotensin converting enzyme 2 (rhACE2) under Phase-2 clinical development in ALI (Acute Lung Injury) and PAH (Pulmonal arterial hypertension). This synthetic version of the human protein that the novel coronavirus uses to enter cells is being tested in Austria to see if it can block viral entry and decrease viral replication in COVID-19 patients, reducing deaths or need for mechanical ventilation. Preliminary results from the trial that was announced on April 2 are expected in September 2020.
STATUS: Experimental
EARLY RESULTS: 3-6 months
Clinical Trial
Link: here
CAMOSTAT MESYLATE - UNIVERSITY OF AARHUS, DENMARK
Protease inhibitor licensed in Japan and South Korea to treat chronic pancreatitis. In vitro experiments found it blocks a mechanism SARS-Cov-2 uses to enter human cells. As of early April, an estimated 180 COVID-19 patients aged 18-110 were being recruited at nine locations in Denmark for a phase 2a trial that will examine 30-day changes in disease severity and mortality, with results expected by December 2020. The University of Tokyo also announced plans for a trial of camostat mesylate and a related drug, nafamostat mesylate, starting as early as April 2020.
STATUS: Repurposed
EARLY RESULTS: 6-12 months
IFX-1 - INFLARX
Monoclonal antibody targeting complement activation product C5a. Designed to block a mechanism of inflammation, the drug is also in clinical trials for Hidradenitis Suppurativa, ANCA-associated vasculitis and Pyoderma Gangraenosum. In early April, a trial in the Netherlands launched to test IFX-1 in patients with severe COVID-19 pneumonia, with preliminary results expected in late October 2020.
STATUS: Experimental
EARLY RESULTS: 6-12 months
ASPIRIN, CLOPIDOGREL, RIVAROXABAN, ATORVASTATIN, OMEPRAZOLE - IMPERIAL COLLEGE LONDON
Trial of cardioprotective drugs to prevent direct damage to the heart muscle that appears to drive the severity of COVID-19 in certain patients as well as their likelihood of needing invasive critical care. The trial will include more than 3,000 patients in the UK, with a completion date of March 30, 2021.
EARLY RESULTS: 9-12 months
MRNA 1273 - MODERNA/NIAID
RNA vaccine made with messenger-RNA (mRNA) encoding the spike protein of SARS-CoV-2 encapsulated in a lipid nanoparticle. The phase 1 trial with 45 subjects aged 18-55 at three locations in the U.S. will evaluate the vaccines safety and provide early data on the immune response it induces. Trial completion is anticipated to be June 1, 2020.
STATUS: Experimental
EARLY RESULTS: 0-3 months
J&J, Moderna sign deals with U.S. to produce huge quantity of possible coronavirus vaccines
Link: here
Clinical Trial
A pharmacist gives Jennifer Haller, left, the first shot in the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. (AP Photo/Ted S. Warren)
In the fight against the coronavirus outbreak, numerous drugs are being explored and a vaccine is still ages away. Prominent among the drugs being explored is hydroxychloroquine. Whats the status of the research for its use in treating this virus?
Hydroxychloroquine was invented for the treatment of malaria, and malaria is a parasite. So in order to treat parasites, you need an antiparasitic drug, which is what hydroxychloroquine has. If you want to treat a bacterial infection, you use an antibiotic and the other drug in this COVID cocktail is azithromycin, which is a common antibiotic, said local MD Dr. Gordon Cohen.
But COVID-19 is a virus, and when we want to treat viral infections, we need antivirals. There have been some antiviral drugs that have been tried the first two drugs that were tried were drugs that were used for the treatment of HIV and the results were poor.
Overlake doctor: Do not delay medical care for fear of COVID-19
But Cohen points to Favipiravir, a drug being tested by the Fuji Film corporation in Japan and in the U.S. that looks promising.
This drug has the correct mechanism of action. When you look at how it works at fighting viruses, its actually designed to treat viruses like COVID-19, so it looks very promising, he said.
Is there any chance of getting a vaccine before the 18 months that were told its going to take?
The first human trial for a vaccine was announced just last month by scientists here in Seattle, and theyre actually taking sort of the unusual step of skipping any animal research to test the vaccine for its safety or effectiveness, he said. Theres also some Australian scientists who have been injecting ferrets with two potential vaccines, and its really the first comprehensive pre-clinical trial to move to the animal testing stage. So thats sort of where were at with the vaccine landscape.
Parenting and working from home during coronavirus
We need to keep in mind vaccines may seem like theyre the answer, but are they really the answer? So, first of all, we havent been that effective at developing vaccines against coronaviruses. Coronaviruses are responsible for the common cold. Well, how often do you see people getting a vaccine for the common cold? We dont see that.
Dr. Cohen believes were more likely to find a drug treatment than a vaccine in the near future.
If I had to bet, I think were more likely to get to a drug as a treatment solution earlier than we do as a vaccine. And the benefit to that is we can get a drug to everybody. If you get sick, you get the treatment. Whereas with the vaccine, its going to be hard to suddenly inoculate 350 million Americans overnight and inoculate the rest of the world.
Listen to Seattles Morning News weekday mornings from 5 9 a.m. on KIRO Radio, 97.3 FM. Subscribe to thepodcast here.
Coronaviruses have been causing problems for humanity for a long time. Several versions are known to trigger common colds and more recently two types have set off outbreaks of deadly illnesses: severe acute respiratory syndrome (Sars) and Middle East respiratory syndrome (Mers).
But their impact has been mild compared with the global havoc unleashed by the coronavirus that is causing the Covid-19 pandemic. In only a few months it has triggered lockdowns in dozens of nations and claimed more than 100,000 lives. And the disease continues to spread.
That is an extraordinary achievement for a spiky ball of genetic material coated in fatty chemicals called lipids, and which measures 80 billionths of a metre in diameter. Humanity has been brought low by a very humble assailant.
On the other hand, our knowledge about the Sars-CoV-2, the virus that causes Covid-19, is also remarkable. This was an organism unknown to science five months ago. Today it is the subject of study on an unprecedented scale. Vaccines projects proliferate, antiviral drug trials have been launched and new diagnostic tests are appearing.
The questions are therefore straightforward: what have we learned over the past five months and how might that knowledge put an end to this pandemic?
The Sars-CoV-2 virus almost certainly originated in bats, which have evolved fierce immune responses to viruses, researchers have discovered. These defences drive viruses to replicate faster so that they can get past bats immune defences. In turn, that transforms the bat into a reservoir of rapidly reproducing and highly transmissible viruses. Then when these bat viruses move into other mammals, creatures that lack a fast-response immune system, the viruses quickly spread into their new hosts. Most evidence suggests that Sars-CoV-2 started infecting humans via an intermediary species, such as pangolins.
This virus probably jumped from a bat into another animal, and that other animal was probably near a human, maybe in a market, says virologist Professor Edward Holmes of Sydney University. And so if that wildlife animal has a virus its picked up from a bat and were interacting with it, theres a good chance that the virus will then spread to the person handling the animal. Then that person will go home and spread it to someone else and we have an outbreak.
As to the transmission of Sars-CoV-2, that occurs when droplets of water containing the virus are expelled by an infected person in a cough or sneeze.
Virus-ridden particles are inhaled by others and come into contact with cells lining the throat and larynx. These cells have large numbers of receptors known as Ace-2 receptors on their surfaces. (Cell receptors play a key role in passing chemicals into cells and in triggering signals between cells.) This virus has a surface protein that is primed to lock on that receptor and slip its RNA into the cell, says virologist Professor Jonathan Ball of Nottingham University.
Once inside, that RNA inserts itself into the cells own replication machinery and makes multiple copies of the virus. These burst out of the cell, and the infection spreads. Antibodies generated by the bodys immune system eventually target the virus and in most cases halt its progress.
A Covid-19 infection is generally mild, and that really is the secret of the viruss success, adds Ball. Many people dont even notice they have got an infection and so go around their work, homes and supermarkets infecting others.
By contrast, Sars which is also caused by a coronavirus makes patients much sicker and kills about one in 10 of those infected. In most cases, these patients are hospitalised and that stops them infecting others by cutting the transmission chain. Milder Covid-19 avoids that issue.
Occasionally, however, the virus can cause severe problems. This happens when it moves down the respiratory tract and infects the lungs, which are even richer in cells with Ace-2 receptors. Many of these cells are destroyed, and lungs become congested with bits of broken cell. In these cases, patients will require treatment in intensive care.
Even worse, in some cases, a persons immune system goes into overdrive, attracting cells to the lungs in order to attack the virus, resulting in inflammation. This process can run out of control, more immune cells pour in, and the inflammation gets worse. This is known as a cytokine storm. (In Greek, cyto means cell and kino means movement.) In some cases, this can kill the patient.
Just why cytokine storms occur in some patients but not in the vast majority is unclear. One possibility is that some people have versions of Ace-2 receptors that are slightly more vulnerable to attacks from the coronavirus than are those of most people.
Doctors examining patients recovering from a Covid-19 infection are finding fairly high levels of neutralising antibodies in their blood. These antibodies are made by the immune system, and they coat an invading virus at specific points, blocking its ability to break into cells.
It is clear that immune responses are being mounted against Covid-19 in infected people, says virologist Mike Skinner of Imperial College London. And the antibodies created by that response will provide protection against future infections but we should note that it is unlikely this protection will be for life.
Instead, most virologists believe that immunity against Covid-19 will last only a year or two. That is in line with other coronaviruses that infect humans, says Skinner. That means that even if most people do eventually become exposed to the virus, it is still likely to become endemic which means we would see seasonal peaks of infection of this disease. We will have reached a steady state with regard to Covid-19.
The virus will be with us for some time, in short. But could it change its virulence? Some researchers have suggested that it could become less deadly. Others have argued that it could mutate to become more lethal. Skinner is doubtful. We have got to consider this pandemic from the viruss position, he says. It is spreading round the world very nicely. It is doing OK. Change brings it no benefit.
In the end, it will be the development and roll-out of an effective vaccine that will free us from the threat of Covid-19, Skinner says.
On Friday, the journal Nature reported that 78 vaccine projects had been launched round the globe with a further 37 in development. Among the projects that are under way is a vaccine programme that is now in phase-one trials at Oxford University, two others at US biotechnology corporations and three more at Chinese scientific groups. Many other vaccine developers say they plan to start human testing this year.
This remarkable response raises hopes that a Covid-19 vaccine could be developed in a fairly short time. However, vaccines require large-scale safety and efficacy studies. Thousands of people would receive either the vaccine itself or a placebo to determine if the former were effective at preventing infection from the virus which they would have encountered naturally. That, inevitably, is a lengthy process.
As a result, some scientists have proposed a way to speed up the process by deliberately exposing volunteers to the virus to determine a vaccines efficacy. This approach is not without risks but has the potential to expedite candidate vaccine testing by many months, says Nir Eyal, a professor of bioethics at Rutgers University.
Volunteers would have to be young and healthy, he stresses: Their health would also be closely monitored, and they would have access to intensive care and any available medicines. The result could be a vaccine that would save millions of lives by being ready for use in a much shorter time than one that went through standard phase three trials.
But deliberately infecting people in particular volunteers who would be given a placebo vaccine as part of the trial is controversial. This will have to be thought through very carefully, says Professor Adam Finn of Bristol University. Young people might jump at the opportunity to join such a trial but this is a virus that does kill the odd young person. We dont know why yet. However, phase-three trials are still some way off, so we have time to consider the idea carefully.
This article was amended on 12 April 2020. The original version incorrectly described the Covid-19 virus as measuring an 80-billionth of a metre, when it should have said 80 billionths of a metre. A quote from Mike Skinner, responding to whether Covid-19s virulence could change, was also corrected.
