“We need to realise that we are only at the beginning of this pandemic and there is no way that this spiral will just one fine day disappear. As long as we don’t have a vaccine and there are susceptible people in the world, the virus will look for them and find them. We will have to start thinking about not only how we deal with it today, but also for the years to come. We need to start thinking about societies living with COVID-19 just as they are living with other contagious illnesses such as TB and do everything possible to minimize the risk of infection.”
This is the stark reality the world is facing according to one of the world’s foremost virologists, Prof Peter Piot. Currently the Director of the London School of Hygiene & Tropical Medicine, and Professor of Global Health, Prof Piot has dedicated his live to researching and fighting viruses throughout the world. He discovered the Ebola virus in 1976 and is one of the chief researchers and advocates in the fight against HIV/AIDS. But in March this year, a virus finally got to him, pushing him towards death door and leaving him with lingering and probably lasting scars to his health. https://www.sciencemag.org/news/2020/05/finally-virus-got-me-scientist-who-fought-ebola-and-hiv-reflects-facing-death-covid-19
Last week, he was the guest at a webinar hosted by Discovery in partnership with the Desmond Tutu HIV Foundation, the SA Medical Association, the SA Private Practitioners Forum and the Unity Forum for Family Practitioners. In an interview with fellow infectious disease specialist, Prof Linda-Gail Bekker, he relived his encounter with COVID-19 and gave his perspective on a pandemic that has stumped scientists and forced the world to a virtual standstill.
Here are some of his insights:
On the virus:
“Being a survivor of COVID-19, has given me a whole new perspective on the pandemic. There is a perception that this is a respiratory virus and that it only involves the lungs. No, it is a multi-organ disease. There is renal, cardiac and brain involvement. In my case, I developed atrial fibrillation and clots in my lungs. It tells me that there is some chronic morbidity associated with the virus. But there is a perception that either you get it very mildly or you die. This is not true. If you manage to survive, it remains with you but currently health systems are too overwhelmed to follow up on the possible debilitating effects the virus has on long-term health.”
Outlook for the future:
“Without effective therapies and a vaccine, this virus will remain with us possibly for years. We will have to start thinking more about risk management as we cannot protect everybody. Although we are dealing with an emergency, we need long-term planning and a long-term view that will enable us to deal with it in the same way than HIV and other contagious diseases eventually.
“A lot of work is being done to find a vaccine and promises have been made that we could have one before the end of the year. I think it is highly unlikely. Vaccines take many years to develop and as we have seen with HIV, the rate of success in finding one is very low. When you look at respiratory viruses and vaccines, we have the various flu vaccines and RSV, but they are not 100% protective. The debate is now whether we should focus on a vaccine that will protect us against infection acquisition or on therapeutics that can impact on disease progression and mortality. The biggest challenge with finding a vaccine is that it should be safe. It will have to be given to billions of people, which has never been done before. Even if a vaccine’s risk for adverse events is less than one percent, it could harm thousands of people if administered to such a huge population. Secondly, organizing trials to demonstrate a vaccine’s effectiveness is extremely challenging as you need to do them in populations where there are active transmissions. Thirdly, nowhere in the world do we have the capability and the capacity to produce billions of vaccine doses. Lastly, we need to make sure that there will be equitable access once a vaccine has been found but we are already seeing, what I call “vaccine nationalism” with the US saying that vaccines manufactured in the US will only be for Americans.
“At the moment, therapeutics is the most likely option, but we are still on a fishing expedition. The key would be to have rigorous large-scale trials and test all likely candidates where there is a reasonable hypothesis that they may work. The obvious start is the repurposing of antivirals and antimicrobials, but we also need to look at anticoagulants and immuno-suppressive therapies. I am fairly optimistic that we will soon find something but then there needs to be collaboration and a bit of creativity and imagination. At the moment, everyone is working in his little corner doing small trials on a small number of people. The world does not need dozens of trials on the same thing…we need to collaborate and find a balance between rapidly moving new products through and ensuring that data are peer reviewed and critically scrutinized. We cannot afford to take shortcuts and land up in another hydrochloroquine scenario.
“Access to testing remains a challenge all over the world even now that more tests are becoming available. We need to get to a point were tests are available in local pharmacies. The technology for point-of-care rapid tests are available but currently their quality is not good and there is no real validation for these tests, which complicates matters. Also, I believe that current recommendations that only symptomatic people should be tested is bad policy. There are many uncertainties, but it has been shown that people who are asymptomatic can transmit the virus. So, we need to reconsider our testing policies as we go forward.”
“The term herd immunity is used in the wrong way. It can only really be achieved through vaccination and you need 90 percent of the population to be vaccinated before we can talk about immunity from an infection and bring a stop to the pandemic. We are now seeing it with Sweden where the strategy was to protect the most vulnerable and allow for young people to get it as they are less prone to develop complications. However, Sweden is now paying the price for allowing life to go on fairly normal as it now has the worst COVID-19 per capita mortality in Europe. We are no longer in the middle ages where it was survival of the fittest when pandemics struck because they didn’t have anything else. We should not let the natural cause of an infection go because we now have the science and the technology to fight it. We also need to believe that there is protective immunity because otherwise what is the point of investing in vaccines…and if there is no protective immunity, we are in deep, deep trouble but it is far too early to tell.”
Lessons learned from the Covid-19 pandemic:
- “When we had the SARS and MERS epidemics, it gave us a hint that something like this was coming but still we were not ready. What we know now is:
- You need to act early…
- You need an infrastructure that can adapt to act early and speedily through testing and contact tracing…
- Support from the highest level is key but more crucial is investment in public health and infrastructure…
- The poorest countries, particularly in Africa, will need some international support…
- We need to ensure that all the protocols are in place to start with clinical trials immediately.
“In terms if these criteria, the world has failed badly. It has shown that you cannot create a fire brigade when the house is already burning. You must ensure that the fire brigade is there all the time and hope that it will never need to do its job.”