Intro: What follows is a series of daily posts that I am putting up on facebook, and have been asked to put up here for wider access. I’m not going to post each one separately (it would drive my followers mad), but I’ll probably start a new one every week or so to minimise endless scrolling. As you’ll twig from the title, I’m picking positives wherever possible. The COVID-19 situation isn’t positive, it’s absolutely dire. But as well as the frontline medical professionals there are a lot of very busy scientists working away on this in the background who I think we should pay tribute to. Best wishes to everyone at this difficult time.
Statement of interest: I am not, and never have been, medically qualified. I have an undergraduate degree and PhD in human physiology. This was more than 20 years ago, and since then I’ve worked in other disciplines. Consequently whilst I am comfortable reading the medical literature and distilling it into a few simple sentences, I am not going to comment in any detail on any of the science I’m referring to, and all of the posts will be short. Seeing as my blog posts are usually far too long and geeky, you’ll be glad of this… But I will always state my reference and provide a link. This last bit is important!
Moments of reprieve, day 1
Clinical research community are stepping up. There are new journal papers daily, pretty much every journal has waived its usual paywall. In today’s good news (in the Lancet), the virus sequence isn’t mutating significantly, and there doesn’t seem to be a difference in how infectious or severe it is according to the gene sequence. This means that those working on vaccines and treatments are not trying to hit a moving target.
Moments of reprieve, day 2
Drugs take ages to develop. But we know the sequence of COVID. And so it makes some sense to see how similar the sequence is to other retroviruses. It is most similar to SARS. The drugs that get used for SARS target particular parts of the sequence. What this paper published yesterday has done is to identify which bits of the COVID sequence are similar to the bits of the SARS sequence that we already have drugs to target. This means we can test drugs that are already licenced for use in humans (which reduces the risk of side effects). The paper is also suggesting combinations of drugs, because if we can use 2 drugs at the same time that target different bits of the sequence, this is often better.
Moments of reprieve, day 3
Not a specific chunk of science today, because I haven’t had time to sift through it. But, the scientific community is going flat out. 266 journal papers last week, 80 in the first 2 days of this week. All open access. The more these geeks understand and collaborate, the better we will all get through this. Collated here.
Moments of reprieve, day 4
Today, its spike proteins. The coronavirus has a spike protein on its surface that it uses to bind to the outside of a cell in the body (its like a docking station). Once it has docked, the virus inserts its RNA into the cell, and that’s when it all goes to shit. Scientists have worked out what this spike protein looks like. They are now testing a vaccine that teaches our bodies to make an antibody that stops this spike protein docking onto the cell surface. A bit more on this, and a fair bit of well explained other stuff about vaccines here.
Moments of reprieve, day 5
I’m not going to summarise this one, it doesn’t need it. If you want click bait, here is the second paragraph: “Having grown up in Northern Ireland during Troubles, worked through a war in Bosnia, lived with a baby under UN Sanctions in Serbia, worked as a clinician during the early days of HIV, and been involved in various outbreak investigations, I have been here before. What I have learned is this…” BMJ opinions, here.
Moments of reprieve, day 6
New word for you today, prehabilitation. In essence, getting even slightly fitter before illness strikes considerably improves your chances and rate of recovery as discussed in the BMJ, here. As does eating healthily. Note, this is a general theory, and it has not undergone trials specifically in relation to COVID (because that would be difficult to justify ethically). So please get your ass off the sofa, do 20 press ups, 20 star jumps and 20 sit ups and then resume scrolling mindless/scary/therapeutic stuff on facebook. Make sure you’re eating proper food. And if you can encourage people in high-risk groups to do appropriate exercise, please do; it’s more important now than ever. Which is why I convinced my 80 year old mum to go for a pootle around on her bike today.
Moments of reprieve, day 7
Today, serological testing and why it will be a game changer. The faster we can confirm/rule out COVID-19 in a person, the quicker we can decide what to do next. The current COVID-19 test relys on multiplying up RNA from the virus particle, using a swab from the nose and a technique called PCR. This takes a while (generally 24 hours) and involves faffing about with labelling samples, sending them to labs, and getting results back. As yet, it cannot be done at the bedside or at a testing station. Serological testing is where you test a blood sample for antibodies that are specific to the virus your interested in. Antibodies are produced by your immune system when it faces a specific threat (in this case COVID-19). They bind to virus particles and stop them binding to anything else. So if you have COVID-19, you will have recognisable antibodies in your bloodstream. Antibody tests that are virtually instantaneous are being trialled for their accuracy and specificity, and will allow testing of potential COVID-19 cases to be faster and at a much wider scale. New journal papers coming out on this almost every day. A review paper here, and an example of a COVID-19 antibody test being trialled here.
Moments of reprieve, day 8
I write this with an overwhelming sense of relief as we are now effectively in lockdown. This is the most effective way of preventing COVID-19 from spreading, and I feel much less concern for my loved ones because of it. There been a few studies that have used travel data to estimate the likely true outbreak size. At its simplest, you take the number of infections associated with travel from a particular country (e.g. from Italy), combine it with the number of travellers leaving that country, and use it to estimate how many people in that country are infected, compared to the official estimates. In the case of Italy, a study of this type suggested that around 72% of cases were un-reported. The percentage of unreported cases will vary a lot between countries depending on their testing capacity (if you don’t test, you can’t report). But it also chimes with the data coming out of Iceland (who have a very high testing capacity for a relatively small population). Stay at home everyone, let’s try and be nice to each other. Wishing you all the best.
Moments of reprieve, day 9
I’m cheating today; Nature have done a great article on what I posted about on day 7; how the tests work at the moment (PCR) and the promise of serological testing. Meanwhile, over 400 papers published on COVID-19 last week; scientists are working their butts off on this and the collective understanding of how we deal with this shitstorm is improving by the day. Stay at home and read about science my friends. xxx
Moments of reprieve, day 10
Today, convalescent plasma. Antibodies are proteins in your bloodstream that bind to specific pathogens, in this case COVID-19. If your body succesfully fights off COVID-19, it means you have loads of these antibodies that will specifically neutralise this virus. What if we take some blood from a patient who has recovered, separate out the plasma (which has the antibodies in) and give it to someone who is still ill with the disease, to give them the benefit of all those antibodies? It was a moderately successful treatment for Ebola, was used in HIV for a while, and has now been trialled against COVID-19. Needs some tweaking of doses, understanding of safety procedures, and a more detailed trial to come up with recommendations, but it may well be an option in the not too distant future.
Moments of reprieve, day 11
The aim of social distancing is to reduce the rate of infection. This has two effects, it stops people getting covid, and it also improves the prognosis for those that do; the so called flattening the curve’ effect that is an attempt to avoid the health system being overwhelmed. We are in for a long period of social distancing, probably several months. But a key difficulty is what happens afterwards; potentially when we start mixing with people again it causes a second wave of infections. Scientists are therefore looking at what measures we would need to have in place in order to safely ease social distancing restrictions and the impact of timing of these measures. So for example, a high level of testing, sufficient capacity to do contact tracing, and localised quarantining are all measures that are being looked at in models based on the gradual easing of restrictions in Wuhan. The hope is that the capacity to implement these measures will soon exist and can be incorporated into models applicable to the UK. In the mean time, stay at home…
Moments of reprieve, day 12
Today, COVID-19 and pregnancy. Previous coronaviruses (SARS and MERS) were both significantly more dangerous to pregnant women. So far, evidence suggests COVID-19 is not. Neither has transfer of the virus from mother to foetus occurred, as judged by testing of newborn babies.
Moments of reprieve, day 13
Movement tracking and understanding interactions. Getting data on how much people are moving around is useful to understand the amount of contact people have with each other (and therefore the number of interactions that might lead to the virus spreading). This study from Italy uses an app downloaded to people’s phones to study how much movement declined as Italy went through various stages of lockdown. We don’t know anything about the type of people who have downloaded the app, and we certainly can’t expect them to be ‘typical’. But monitoring people’s movements could well provide useful data on when and by how much it is appropriate to ease restrictions in the future. NB The study itself has not been peer reviewed and there isn’t enough detail to know how good it is, but the approach itself is potentially really useful.
Moments of reprieve, day 14
Today, GISAID. This is a German initiative launched in 2008 that promotes the completely open sharing of gene sequences for viruses so that we can understand their ‘family trees’. This information gets used to track transmission (and so for example it is key data when deciding what strains of flu to vaccinate for each winter). In the case of COVID it’s being used to track transmission routes, and also to analyse how much it’s mutating. Key information in vaccine design and a major cooperative effort.