Is there a path to a vaccine? Are there novel therapeutic treatments? Will we ever overcome this silent viral enemy?

In an international webinar facilitated by Hadassah Australia on Thursday 21 May, Medical Journalist Dr. Norman Swan was joined by Prof. Eyal Mishani, Head of R&D at the Hadassah Medical Organization, Israel; Prof. Sharon Lewin AO, Director of the Doherty Institute; and Dr. Russell Basser, Senior Vice President of R&D at Seqirus, a leading global biotech company.

Hadassah was fortunate to have Dr. Norman Swan serve as the moderator for this important meeting. Dr. Swan has become the trusted medical voice of the COVID-19 pandemic for the people of Australia, explaining and answering questions for the public as they arise.

Prof. Sharon Lewin, who heads the Doherty Institute in Melbourne, is an expert on infectious diseases and immunity, and has been advising the Australian Government during this pandemic.  She started the scientific discussion by putting Covid-19 into context for the audience of about 500 people from 19 countries. She explained that Covid-19 is the name of the disease, and that about 80% of infections are mild, while 20% lead to a far more serious disease. SARS-CoV-2 is the name of the actual virus. The virus is so new, little is known about how it affects humans. We do know that it can be spread unknowingly while someone is relatively well. Currently, every country is at a different stage of the infection.

She added that both Australia and Israel are outliers in the pandemic, in that they have dealt relatively successfully with Covid-19 with a relatively low mortality rate.

Prof. Eyal Mishani, who is heading the COVID-19 research activities at the Hadassah Hospitals in Jerusalem, concurred with this assessment. With approximately 60,000 infections and 260 deaths in a population of 8 million residents, Israel is now over the first wave of infections and has started to open up the country. There are still 160 people hospitalized with Covid-19 in Israel today, most of whom are in a mild to moderate condition. 54 are still critical, and of these 44 are still on ventilators.

The key to success in both countries was not allowing international travel. Israel also quarantined all Israelis who returned home in March.

Dr. Russell Basser spoke about developing a vaccine for Covid-19. The initial response in looking for a vaccine was based on the influenza virus. However, the viruses belong to different families. Flu requires a new vaccine to be developed every year, so we are set up to produce large amounts of vaccine every year. We do not know if the system used for flu will work for Covid-19. We do not know what to expect.

Prof. Lewin added that the mechanisms of death in the two diseases are very different. The reactions in children are very different too. Everyone has some immunity to flu as they are exposed frequently. Children are more affected by flu as they have not built up immunity over time.

Covid-19 is new, and about 2 % of children get infected with a mild disease. We do not know why. Until recently we thought that children are not affected as seriously as adults, but recently there have been cases of a severe Covid-19 related reaction in children. Research is indicating that there may be different expressions of the mechanism allowing the entry of the virus into the cells in children and adults.

She discussed the statistics on mortality due to Covid-19 as they are being reported around the world, and that the statistics depend on the accuracy and amount of testing that is done in a particular population. On average, there is a 1-2% death rate globally. The rate is very age dependent, with older people dying at a greater rate. The mortality rate is dependent on the average age of the population and the quality of medical care available. If the medical system is overwhelmed, the quality of care is compromised, and there are more deaths.

Prof. Mishani was asked about current research on COVID-19 at Hadassah. He responded that Hadassah has been working on different levels:

  1. Mechanisms to increase testing for both the infection (PCR testing) and antibody testing.
  2. Mechanisms to purify and supply high flow air to patients with respiratory problems.
  3. A mechanism for concentrating antibodies.
  4. Repurposing existing drugs and testing them (sometimes using combination antiviral cocktails with different abilities) for use in Covid -19 patients at various stages of the disease.
  5. Finding biological markers of the disease.

Because everything has been done in a compressed time frame, there has not been time to complete some of the clinical trials at Hadassah in enough patients. However, the current Covid-19 wave is over in Israel, and Hadassah now needs to collaborate with hospitals in other countries who are now going through the epidemic to complete a successful clinical trial with enough patients.

For example, three moderately ill patients at Hadassah participated in a clinical trial with Camostat Mesylate, a medicine that had been used in Japan to treat pancreatitis. The results were very good. However, a larger sample is needed to come to any definitive conclusion about the use of this drug to treat Covid-19 successfully.

Prof. Lewis agreed that worldwide collaboration is essential, and we need to learn from one another.  Everything is new with Covid-19. We need to learn when to use the different drugs or treatment methods as there are 3 distinctive phases to the disease. Some drugs or treatments will be more effective in the first week when the viral count is high and symptoms are relatively mild. Others will work better in the second phase when the viral count is lower and antibodies are forming, but the patients are moderately ill. Still other drugs and treatment are needed later on in the progression of the disease if the patient experiences a cytokine storm and organs other than the lungs are affected. We need to be prepared for the future.

Dr. Basser stated that time is the crucial factor for making an effective vaccine for Covid-19. Vaccines will probably not be available for a while as they take a lot of time to develop and produce. He stated that there are several different approaches being taken to developing a vaccine around the world. We are not yet sure which approach will work. Because time is of the essence, we will have to live with uncertainty as to how effective each vaccine will be, and society will have to decide how much risk is acceptable. Vaccine trails are also a problem, as there is an ethical question as to whether we can ask someone to participate in a trial when there is no known cure for the disease.

Prof. Mishani stated that Hadassah is not involved in vaccine research. Instead Hadassah been focusing on collecting blood from recovered patients and concentrating it to create a hyper-gammaglobulin that can be used for serum therapy, particularly in acutely ill patients. Hadassah treated 12 patients with this therapy, and most survived and recovered.

Prof. Lewis presented her conclusions about what works and what does not work with the coronavirus.

  • Those countries who went hard and early with isolation, testing and quarantine, have fared better than those who delayed.
  • We need to understand what parts of lock-down work and are effective.
  • The virus is spread more easily indoors and some people are more infectious than others.
  • It is not yet clear whether temperature makes a difference or how important surfaces are in spreading the disease.
  • Face masks seem to help. They do not protect you, but they do prevent you from infecting others, particularly if you are asymptomatic. In countries in Asia where masks are commonly worn, the masks appear to have controlled the outbreaks. If you cannot practice social distancing, wearing a mask will help you.
  • Testing is important. There are two tests.
    • Throat swabs detect the virus and are accurate. They take longer to analyze and are harder to access.
    • Blood tests are used to test for antibodies and show whether you have been exposed to the virus. They do not show active disease. We do not yet know if a positive result indicates that you are immune.

Professor Mishani added that Hadassah has been engaged in research to improve testing for Covid-19. Hadassah has developing a way to purify genetic material on magnetic beads, which shortens the time needed for testing. Hadassah has also developed a method for pooling samples from different swabs into one test tube. This makes testing cheaper as one test can show whether up to 8 people are negative. If the pooled sample comes out positive, then the individual samples can then be tested to find the person who is positive.

To defeat the coronavirus, international collaboration and peer review of research will be needed. We need to enrich one another with new ideas.

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