Winning the COVID Marathon

The COVID-19 pandemic, caused by the novel SARS-CoV-2 virus, has stressed many of our institutions and revealed weaknesses and disparities in our society. But it also has showcased a great deal of strength. The question is – which forces will predominate in the end? I think the overarching lesson the pandemic has reinforced is that science is the most powerful tool humanity has developed to deal with nature, but it needs support from society and other institutions.

Let’s start by quickly reviewing the state of the science of COVID-19. In December 2019 four pneumonia cases were identified in Wuhan, China that were all tied to an animal market. This triggered a rapid response team which used epidemiological disease tracing to identify more patients and determine that there was person-to-person spread. By January 12 the novel coronavirus was isolated and identified as the cause of a new respiratory illness. On January 24 a full genome sequence of the new virus was published. This sequence was rapidly shared with the world. Scientists around the world then began sequencing different strains of the virus, which played an important role in our ability to track the spread of the virus.

It’s easy to take this technology for granted, but we should not forget how powerful and recent this tool is. In about a month we went from discovering an entirely new disease to identifying and sequencing the genome of the responsible virus, then using it to track its spread. This information has also armed scientists with tools they could use to understand the virus, probe for its strengths and weaknesses, and begin the search for treatments.

That search also started very early on in the pandemic. Hydroxychloroquine has received a disproportionate amount of attention, but for political, not scientific reasons. In any case this spawned dozens of scientific studies, with increasing rigor, and again within a couple of months we were able to determine that the drug probably does not work for COVID-19, and in fact may make outcomes worse due to cardiac side effects. Still, even more rigorous studies are under way to increase our confidence in this conclusion.

But hydroxychloroquine is not the only game in town. Doctors have tried over 100 different drugs for off-label use against the virus, based upon scientific plausibility. This is perhaps not ideal, but because of the nature of the pandemic speed is being prioritized. As long as some scientific method is used to determine as objectively as possible if there is any benefit, some useful treatment may come out of this.

Perhaps most promising so far is remdesivir. Clinical trials have now shown that recovery is quicker for patients receiving this anti-viral drug, although the percentage of patients recovering was not statistically different – although there was a trend toward greater survival. More studies are needed to confirm these results, and more powerful studies may reach statistical significance on survival. But we will wait to see what these trials show, and will listen to the data whatever it says.

In fact, one challenge for doctors and scientists is dealing with the flood of scientific evidence:

By one estimate, the COVID-19 literature published since January has reached more than 23,000 papers and is doubling every 20 days—among the biggest explosions of scientific literature ever.

What this means is that we have a deep reserve of scientists in the world, who can mobilize their efforts to address an acute threat, like COVID-19. This is an incredibly rapid explosion of knowledge.

Scientific research has also informed us about the accuracy of our various testing methods. We can test for the virus to see if someone is currently infected. We can test for antibodies to see if someone has been previously exposed. Better and more rapid tests are being developed, with greater sensitivity and specificity.

Scientists are studying the effectiveness of wearing masks, in what situations, and by whom.

There is also research promising to introduce new treatments for COVID-19. A recent study was the first clinical trial published of convalescent plasma for the treatment of COVID-19. This uses the plasma from blood of patients who have recovered from the disease, which likely contains antibodies to the virus. These antibodies can provide temporary treatment against the virus in those who are currently sick but whose immune systems have not had enough time to gear up against the virus. This is a preliminary study, showing safety and that the outcomes appear promising. But it sets the stage for more rigorous studies that will determine effectiveness.

And of course scientists are working on rapidly developing a vaccine for SARS-CoV-2 that could potentially change the nature of this pandemic. It remains to be seen how long this will take, and how effective such a vaccine will be. But a vaccine is perhaps the best hope of reducing the spread of the virus so it is no longer at pandemic levels.

Because of the strain of the lockdown, and climbing numbers of cases and deaths, and the disruption to society, it may seem like this pandemic has been going on for a long time. But in reality it has only been a total of five months since the first cases. Still, the burden it taking a heavy toll and in the US and elsewhere we are moving into a tricky phase of this pandemic. This is where patience and a respect for the power of the science that has been unleashed against this virus is important.

This is the great irony of humanity. We have incredibly powerful tools, and the ability to use them quickly to understand and deal with this threat. We are doing it, more quickly than ever before. There is still a lot we don’t know about this virus, but the amount of information we do know increases daily. Doctors are getting better at treating the disease. We are collectively getting better at knowing how to flatten the spread. Treatments are coming online, with many promising treatments in the pipeline.

We also can use science to quickly spot pseudoscience, snake oil, and the hucksters that would use the pandemic to cynically make money off their fellow citizens. A lot of this snake oil is still thriving, but for people who want to listen to the science, they can protect themselves.

But in the face of all this powerful science, we are also seeing the weaknesses in our other institutions. Clearly China failed to quickly warn the world about this disease, and the delay has contributed to the pandemic. The slow response of the US has also demonstrably led to increased deaths. Politicians and pundits have also not always listened to scientists.

This is a time when understanding and dealing with reality in incredibly important, with immediate and obvious results. The penchant of politicians and those in power to determine their own reality simply does not work. The virus does not listen to political propaganda.

Epidemiologists are now showing the path forward, for how we can safely open up while minimizing the chance and size of a second wave. This includes using objective metrics, testing, contact tracing, and targeted isolation. We don’t know what will happen, but we have a good idea how to give ourselves the best chance of minimizing the damage this pandemic is causing. Right now we are trying to buy time so that we can identify effective drugs to treat the disease, develop a vaccine, and bring other treatments online such as plasma treatments. The key is – not to get restless. We need the endurance to see this through.

I find it helpful to think of past pandemics. Imaging living through the 1918 flu pandemic that conservatively killed 50,000,000 people around the world. That virus was no worse than SARS-CoV-2, and may not even have been as deadly by itself. The difference was largely in the state of the science at the time. Imagine how helpless people felt at the time. Think about how much more powerful our response is to COVID-19. The difference is the power of our science.