This article focuses on:

- The development of treatments and vaccinations

- Recommended public health measures where treatments and vaccinations are lacking.

Treatments and vaccinations

Currently, there are no antiviral treatments or vaccine specifically for COVID-19. Nearly a dozen pharmaceutical companies, such as Sanofi Pasteur and Regeneron, are using work done on vaccines for SARS to try to expedite the development of a vaccine to work effectively against COVID-19. Even with a potential head-start, a vaccine could take 12-18 months to be ready for deployment, according to the World Health Organisation (WHO). It took Regeneron 6 months to develop the vaccine for the Ebola virus to the point of testing. By the time any vaccine for COVID-19 is developed, millions of people worldwide could be infected.

Within China, Wuxi Biologics claims that it may be able to develop antibody treatments and have those ready for mass production within 4 to 5 months, which would be unprecedented. In Wuhan itself, two Randomised Controlled Trials have already started. One is testing Gilead Sciences’ remdesivir, which was developed and tested in patients with the Ebola virus without success, but it is hoped it may work in COVID-19 patients.

The second trial is testing two drugs taken together, lopinavir and ritonavir, that are otherwise used to treat and prevent HIV. In early February in a Thai hospital, doctors have used this combination to successfully treat older patients with the virus. If these treatments work, then roll-out and availability of these drugs will be relatively straightforward: the capacity to manufacture these drugs on a large scale is already in place and the drugs themselves are easily available.

From a public health perspective, finding a vaccine is more valuable than developing treatments, as immunisation is a better way to prevent the spread of COVID-19 and to protect the populations of entire countries.  The challenge is not only the time it will take for a vaccine to be deployed, but also potential limitations in the manufacture of antibodies and, so, making enough of the vaccine will not be easy.

Falling back on public health measures

Given that a vaccine may be months away from development, all countries must, therefore, fall back on the public health preparations and measures they are already supposed to have in place. Some measures, such as locking down entire regions, may not be successful in other countries. For example, the quarantine of London or New York City could be unthinkable.

Just today, Italy announced extraordinary measures to enforce the lockdown of nine towns in the Lombardy and Veneto regions. This follows the number of confirmed cases in Italy rising to 133 and the second death of an Italian citizen due to the virus. The towns in lockdown are relatively small. How Italian authorities will respond if/when the virus finds its way to a city like Milan or Venice, will remain to be seen.

Is it possible to quarantine completely a whole region? With border closures, as neighbouring countries did with China in the early weeks of the outbreak and Pakistan, Armenia and Turkey have this week enforced with Iran, is it not a question of closing the stable door after the horse has bolted? A different geographical and cultural region West Africa may be compared to Central or East Asia, but closing of borders in Sierra Leone, Liberia and Guinea during the 2014 Ebola outbreak did little to stop the spread of the virus.

Also potentially ineffective is airport screening, as was first introduced in UK and USA airports for returning passengers from China in late January 2020. During the SARS outbreak of 2003, Canadian screening detected no instances of SARS amongst people arriving from China, yet the virus went on to kill 44 people that year on Canadian soil. Border closures and airport screening may only be effective as tools for political posturing: demonstrating that a country is taking action and to reassure their populations.

According to public health experts, the most appropriate ways to deal with detecting and treating new cases outside of China would be to:

• Isolate and treat cases as soon as they happen

• Tracing and quarantining people they have been in close contact with.

• Isolating measures, such as cancelling of events, such as closing schools and businesses, Serie A football matches, church gatherings, not having 40 000 people attend a food event when an outbreak is raging. How far do we go: cancelling the Tokyo Olympic Games?

However, tracing and quarantining people only works when the number of cases are small. What happens when a large number of cases emerge from an event, such as a concert, a rally, the Hajj? Even with smaller numbers of cases, how do public health workers trace infected people who reported having been on the London Underground, New York Subway or Paris Metro at rush hour?

The next article focuses on what we do not yet know about COVID-19 and possible outcomes of the current outbreak.

By Mark Gibson, Health communication specialist, UK, 23rd February 2020.

References:

• Best we be prepared, New Scientist, 1st February 2020

• Bruno L, Winfield N, Italy towns close down amid virus case clusters, 2 deaths, AP News, 22nd February 2020, https://apnews.com/cc5d1db9353b21297d987ef594f0facc

• China coronavirus: Misinformation spreads online about origin and scale, BBC, 30th January 2020 https://www.bbc.co.uk/news/blogs-trending-51271037

• Campbell C, Gunta A, A deadly new virus goes global, TIME, February 3rd 2020

• Coronavirus. How bad will it get? The Economist, February 1st 2020

• Klein A, Drug trials under way, New Scientist, 25th February 2020

• MacKenzie D, Wuhan-like virus discovered seven years ago, New Scientist, 15th February 2020

• Le Page, The race for treatment, New Scientist, 8th February 2020

• Park A, Campbell C, Containing a crisis, TIME, February 10th 2020

• Prepare for the worst, hope for the best, The Economist, February 1st 2020

• Ridley M, Off the bat, Spectator, 22nd  February 2020

• Sealed off, The Economist, February 1st 2020.

• The Wuhan crisis, The Economist, January 25th 2020.

• Time and again, The Economist, January 25th 2020.

• Viral Slowdown, The Economist, February 13th 2020,

• Wu JT, Leung K, Leung GM, Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study, The Lancet, January 31st 2020 https://doi.org/10.1016/S0140-6736(20)30260-9 

• Yu C, Disease control, Chinese-style, Spectator, 1st February 2020

© 2020, Mark Gibson, protected under British Copyright Law 1988.