COVID-19 expert says we need a 'tremendous effort from everyone'
In the second part of our interview with Prof. Paul Kellam from Imperial College London in the United Kingdom, he urges people to heed the advice of governments while he is busy helping the effort to develop a vaccine against the new coronavirus.
In Part 1 of our interview with infectious disease specialist and professor of virus genomics Paul Kellam, he told us what it is like to work during a pandemic and how serious he believes the situation to be.
Medical News Today also spoke to Prof. Kellam about his contribution to a vaccine and another treatment in development, as well as how long he thinks the pandemic will last.
‘A real joint effort’
MNT: What is your lab working on right now?
Prof. Paul Kellam: At the moment, we are doing two things.
My lab is in the same laboratory as the Imperial vaccine project. And so we are helping test that vaccine in different mice models.
We are also looking at identifying antibodies that are produced from those vaccines and determining whether they have the potential to be used as a short-term preventive for infection — that is, a prophylactic antibody that will prevent infection in certain risk groups.
MNT: What time frame are you looking at for the vaccine and the prophylactic antibodies?
Prof. Paul Kellam: The time frames are too long.
The time frames are really the first quarter to the first half of 2021. When we need them is most likely the last quarter of 2020.
We need to accelerate processes. We need to make these projects a national priority for countries with the capacity to make treatments and then to share them rapidly and equitably with countries that are less fortunate.
We need to work as hard as we can collectively. It’s unlikely that there will be one person, one laboratory, one agency, or one company that will provide the complete solution, so this has to be a real joint effort. We need some outstanding leadership, and we need to be aware that what we’re aiming to do is really, really hard on a ridiculously accelerated time scale.
But we do know that we have the knowledge of policies that are already in place, like social distancing and quarantining, to decrease the extent of the virus spread and transmission.
Those options are always there, and we can use them effectively to extend the window that we need to get the vaccine and therapeutics to work, but we cannot take forever to do this.
“The time frames are too long.”
That’s a concern because this is going to be very hard work for many months, especially for frontline healthcare workers, and although difficult, the science of developing treatments is straightforward compared with working in a hospital.
It is, however, going to be a very difficult time for everybody to live through. Every day lost is another that a healthcare professional needs to work.
MNT: How do you think clinical trials or clinical testing will change during this pandemic?
Prof. Paul Kellam: As we know, COVID-19 will be a self-limiting mild-to-moderate disease in about 80% of people.
Those individuals are really important, but they’re not the first priority. The first priority is the 20% of people who will go on to have a more severe disease and those who will go on to die.
We have a fairly good idea of who the risk groups are, based on age and comorbidity. That’s a good start. Over the next few months, there are projects running in the U.K. that are collecting the clinical, outcome, and treatment data for as many people who are entering the hospital system as possible as a huge study.
This will start to enable us to stratify in the future for any additional risk groups, comorbidities, or biomarkers that might indicate the likelihood of having a more severe course of infection.
Elevated risk group populations are the target groups for vaccination, for prophylactic antibodies that will prevent infection, or for making sure that you get the best clinical regimen of medicines in order to hopefully reduce the risk of going onto a ventilator or make you more likely to come off the ventilator alive.
Other things are happening, as well, such as using existing medicines and existing best practices and trying to conduct logical, ethical, and safe clinical trials in these populations of people who are severely ill.
From that, clinicians will learn quickly if there are new optimal therapies or optimal use of other medicines in order to improve survival or decrease the number of people who go on to become severely ill.
‘Stay home if you are showing symptoms’
MNT: Are you seeing a shift in the way that people are collaborating?
Prof. Paul Kellam: I think it’s interesting because with all infectious disease outbreaks, whether that’s H1N1 influenza in 2009, MERS, Ebola, or now with COVID-19, there are certain things that always seem to happen. There is the initial slowness, then speeding up, and then the real ability to get things done.
You only have to look at what happened with Ebola. From recognition, slowness to respond, followed by international responses through to building incredible Ebola treatment centers in West Africa.
There was real time genetic epidemiology with people using technology that was previously only in massive DNA sequencing centers to track chains of infection. This involved incredible collaboration — from medicine and science to infrastructure building.
I think we’re now at or just past the inflection point, where we are seeing, particularly in Europe and in the U.S., a massive acceleration in cases. The directions from the government can bring this under control, I am sure, but only if people follow the instructions — everyone has their part to play. The SARS-CoV-2 virus is highly infectious.
On average, one person will infect two and a half other people every few days. So over just four rounds of infection in a 2 week period, 100 infected people become about 4,000 infections. The only way to drive this number down is by strict social distancing and quarantining of those with symptoms of infection. This is the biggest collaborative project ever — we are all involved.
I do think the measures that we have implemented in the U.K. are exactly right for bringing the first wave of this pandemic under control, but it will need a tremendous effort from everyone.
MNT: Do you think that the current guidelines in the U.K., across Europe, and in the U.S. are effective?
Prof. Paul Kellam: The measures are pretty much all the same and aimed at complete suppression of infection transmission.
This means social distancing, only going out of your home for very limited purposes, schools, pubs, and most shops closed, and so on. The advice is also to stay at home if you are showing symptoms either for 7 days if you live alone or to quarantine the household for 14 days if there are two or more people in the home.
However, it will take 2–3 weeks to start seeing the results of such policies. I think we’re just seeing the first signs of plateauing of new cases now in Italy, and then, hopefully, it will head in the same direction as China and South Korea.
But it is really, really hard work to get people to do this, and it takes a long time. I do think the measures that we have implemented in the U.K. are exactly right for bringing the first wave of this pandemic under control, but it will need a tremendous effort from everyone.
However, different countries will have different abilities to do this, coming down to many different factors.
We cannot forget that when we’re looking at what’s happening in our own countries, how places like Sub-Saharan Africa and other places in Asia with less developed healthcare systems are going to cope. We have to be very mindful of that, and we really have to help.
‘We will be with this virus forever’
MNT: Once there is a vaccine, do you think SARS-CoV-2 will behave like the seasonal flu, changing rapidly each season, or more like measles, which is highly infectious, but a vaccine can keep it in check?
Prof. Paul Kellam: Well, we don’t know, but we do know what is possible with vaccines. We can take an incredibly infectious disease like measles, develop a vaccine, and if people are vaccinated, we can get to the point of almost complete control and eradication of the infection.
We also know that for a virus such as influenza, which varies genetically on a regular basis to escape from immune responses, we have to update vaccines regularly, but we can manage that, as well.
So, we can deal with a virus that is incredibly infections and vaccinate to the point where we could eradicate it completely, if we have the will, or we can deal with a virus that’s genetically variable and prevent its impact on people with timely updates of influenza vaccines.
In that sense, I’m very optimistic that we will be able to live with this virus eventually. Whatever the appropriate means of preventing the infection will be, they will be developed, and we will return to a world where SARS-CoV-2 is a new but tolerable addition to human infectious viruses.
We will know much more about the virus, appropriate vaccines, and the best public health measures by the end of this year and into the first half of next year. In the context of people’s lifetimes, that might seem like a long time to be getting back to normality.
I’m absolutely convinced that we will be able to return to more normal times even though SARS-CoV-2 will still be around. However, we will have found a way of dealing with it, protecting those who are susceptible and vulnerable, and living with it as, hopefully, a mild but nonetheless seasonal infection.
MNT: How long, overall, do you think this pandemic will last?
Prof. Paul Kellam: Well, that’s really hard to say.
Certainly, for the next 2 to 3 months, all of the countries that have a growing epidemic locally will be working hard to get it under control. And then we have to work out how we get people back to the life that they were used to, and how to get the economies running properly.
At the moment, that is something that we’ve got to think about and work quickly toward, but it looks like we’re going to be in this for the long haul.
Of course, there are already four human coronaviruses that are endemic in the human population. These cause seasonal colds and respiratory illnesses, some of which can be quite serious in people with underlying health conditions. How they first came into the human population, and how fast they became an endemic infection is not known.
I think what we’re looking at now with SARS-CoV-2 is that process of becoming a new seasonal human pathogen. And so, in that sense, humans will be with this virus forever.
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