Dr. Pankaj Gupta, head of ACCESS Health’s digital health program based in the ACCESS Health India office, was recently featured in a webinar on how telemedicine could be a game changer in the Covid-19 crisis. In India, as in many other countries, there is a nationwide lockdown in place, with social distancing measures in place to help reduce the rate of new infections and safeguard the population’s health. The webinar was hosted by Elets Technomedia, a technology and media research organization in Asia and the Middle East. Their webinars and their previous in person events bring together industry leaders, policymakers, experts and thought leaders to discuss issues ranging from health and education to urban development and technology. View a recording of the webinar by clicking below:
Health Futures Webinar: Business responses to Covid-19
Health Futures Singapore and SGInnovate hosted a webinar on business responses to Covid-19. Many businesses are struggling to respond to Covid-19, weighing how to continue with current business strategies and best support employees' health and wellness while protecting the communities where they live and work. Watch a recording of the live webinar below. The full list of speakers is also included at the bottom of the page. List of Speakers: Dr. Hsien-Hsien Lei, CEO of American Chamber of Commerce and Adjunct Professor at the NUS Saw Swee Hock School of Public Health, discussing how AmCham members are adjusting and responding to COVID-19; Naveen Menon, President of Cisco Systems ASEAN, sharing how Cisco has responded to COVID-19 and how ICT technologies are being used for business continuity; Henry Ee, Managing Director of Business Continuity Planning Asia and Technical Expert to the Enterprise SG Standards Working Group, will discuss how businesses can interpret and contextualize Enterprise SG's guidelines; SzeKi Kim, Head of Community & Brand at SGInnovate, will share SGInnovate's approach to supporting deep tech startups, investors, and other stakeholders during this period; Alexander Krasavin, Partner, Radford Leader for Asia Pacific, Middle East and Africa and Chief Commercial Officer (Human Capital) Emerging Markets, will share common threads, concerns, and strategies he's encountered since COVID-19, including how these responses may differ by region.
Here’s How We Extricate Ourselves From This Lockdown
This article by Olivia Messer originally appeared in The Daily Beast. No politician or public-health expert can say when the novel coronavirus pandemic, and attendant lockdowns and social distancing, will end. But there is a roadmap-actually, a competing array of them-for extricating the United States from social isolation. In keeping with this convincingly dystopian moment, the hurdles are substantial ones. But if Americans are able to overcome them, the country will veer back toward a recognizable society-with some chilling new features. Public-health experts surveyed by The Daily Beast said there were three main things authorities need to be able to provide-effectively, affordably, and with quick results-to the American public before it's safe to send at least some people back to work and into public life. First are millions more diagnostic tests, which can tell if someone currently has COVID-19. Then come antibody tests, which can determine if people recently had it and may have developed enough of the right kind of immune response to offer some protection from illness. Finally, authorities need more robust "contact-tracing" to track who might have been exposed to the virus and prevent them from spreading it further. A much-discussed problematic and delayed rollout in the United States has kept diagnostic tests expensive, out of reach, and in some cases ineffective. Last week, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he doubted every American could be tested anytime soon. But one of President Trump's top advisers on coronavirus testing, Adm. Brett Giroir, told Bloomberg News in an interview on Saturday that the U.S. is working on rapidly improving diagnostic testing in order to reopen the economy, including both widespread surveillance to catch new flareups and testing of people who have specific symptoms. Giroir said that by May the U.S. will be in the "ballpark" of the diagnostic capacity it needs. According to William Haseltine, a former Harvard Medical School professor and the president of the global health think tank ACCESS Health International who recently chaired the U.S.-China Health Summit in Wuhan: "It should be a hand-held device for $5 a pop." "That could be done by the end of the summer," he told The Daily Beast. "We could do it if our economy depends on it." Of course, elsewhere around the globe, tests have been performed by the hundreds of thousands-in other words, far more per capita than the United States. And many experts still say it's necessary for the U.S. to reach that capacity, including those at the right-of-center American Enterprise Institute who put forward a plan this month that would require about 750,000 tests per week in the U.S. As for antibody testing, Fauci said last week the American public was "days" away from rapid antibody tests for COVID-19, which received emergency authorization from the FDA on April 4. But on Friday, New York Gov. Andrew Cuomo noted that re-opening the state would require the creation of "millions and millions" of antibody tests that don't exist. As Haseltine explained, however, there is precedent elsewhere for creating cheap and effective antibody testing on such a large scale. For example, he noted, the Egyptian Ministry of Health used so-called serology tests to screen more than 60 million citizens over the age of 12 for hepatitis C, diabetes, hypertension, and obesity. Those tests cost about 50 cents per person, are conducted using blood from a simple finger-prick, and the results were available in as little as five minutes, he said. But there are two main snags with the antibody tests currently approved by the FDA. The tests are coronavirus-specific, but not necessarily specific to the infection that causes COVID-19, according to Haseltine. That means that even if most people who've survived the virus are able to develop an effective immune response to it, some antibody tests being rolled out in the U.S. might not be able to tell if you've had COVID-19 or recently had an unrelated cold in the same family of viruses, he explained. People who are still holding out hope for returning to packed sporting events and boozy brunches are probably going to be disappointed. "One-third of colds are coronavirus," Haseltine added. "This test isn't going to be foolproof." What's more, experts are still uncertain that people who recover from COVID-19 can create enough of an immune response to keep them protected from reinfection. Even with adequate testing and a relatively strong trend toward immunity from the previously infected, a second wave of infections could grow out of control without robust and meticulous monitoring of infections as they appear. "We want to get back to work, but you've got to do extensive contact tracing and mandatory isolation for 14 days of everybody who has tested positive," said Haseltine. "These are real examples of what's happening in Wuhan today. They're getting back to work, but they're getting back to work really carefully." But Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University and an expert on U.S. readiness for pandemics, pointed out a significant problem: The U.S. has "decimated our public-health system over the last decade." In other words, there is reason to doubt there are enough health-care workers to provide the quantity or quality of contact-tracing the country needs. It might be possible, he said, to outsource that work to private companies. Timothy Brewer-a professor of epidemiology and medicine at UCLA who has served as an adviser for the World Health Organization, CDC, and National Institutes of Health-pointed to the Israeli health ministry's decision to hire the medical students who've had their classes canceled to do contact-tracing as a potentially worthy precedent. There are other hurdles, too. It's important to ensure hospitals around the country can handle a surge of cases without resorting to crisis standards of care, provide enough personal protective equipment for all health-care workers who could be exposed to cases, and-as the American Enterprise Institute plan notes-there should be a sustained drop in cases for more than 14 days before […]
Health Futures China Scholarship Applications Now Open
Are you interested in the healthcare industry and believe in the mission of improving healthcare quality and accessibility? Finding yourself filled with unique ideas and innovative thinking in problem solving? Wishing for a platform where you can grow with like-minded peers, and dive into real-world problem solving with leading industry experts? Then, you are the talent the Health Futures China team is looking for. As a global healthcare focused think tank, ACCESS Health China focuses on integrating industry resources, conducting in-depth topical research and analysis, and understanding the healthcare policy trends while discovering leading innovative business models and healthcare solutions. Over the past years in China, we have brought together industry opinion leaders, respected scholars, and rising entrepreneurs. Through promoting partnerships and cross- industry collaborations, we hope to collectively improve healthcare accessibility and accelerate the development of the entire industry. The Health Health Futures Scholarship program offers a platform for young talent to grow and gain firsthand knowledge of the healthcare industry. We want to enable our students by providing them opportunities to interact closely with leading experts, participate in relevant projects, with the goal to further nurture the young talents for the industry. For more information on how to apply, download THIS flyer.
Technology for Pandemic Preparedness & Response
On March 6, ACCESS Health International and SingHealth Duke-NUS Global Health Institute hosted a Tech for Pandemic Preparedness webinar with experts in the fields of emerging infectious disease and technology for health. Please click below to view a recording of the live event. The full list of speakers is also included below. List of Speakers: Chang Liu, Regional Director for ACCESS Health International, speaking on how digital technology is being used in China for the coronavirus outbreak Danielle Anderson, Assistant Professor at Duke-NUS Medical School's Emerging Infectious Diseases Research Program, speaking on how technology has advanced the process for virus isolation, vaccine development, and contact tracing. Melisa Teoh, Director of Marketing at MyDoc, sharing how MyDoc is using its telehealth platform for triage and public education, supporting integrated health systems and reducing burden on hospitals. Alex Cook, Associate Professor at the NUS Saw Swee Hock School of Public Health, discussing how public policy has evolved since SARS, and re-sharing his study on discrete decision making and policy.
How Antibody Tests Can Be Used To Fight COVID-19
This article, written by ACCESS Health Chair and President William A. Haseltine, originally appeared in Forbes. There is a new antibody test that will change the landscape of Covid-19 testing as we know it. There are now two ways to test for Covid-19: one that measures the actual virus, and one that measures the body's reaction to the virus. The first is a genome test that detects the presence of viral genes in the body using a swabbed sample, usually taken from the nose and throat. The sample must then be sent to a lab where it can be replicated and analyzed in a PCR machine. Results could take anywhere from one day to a week and a half to deliver. Point-of-care genome tests have also been developed that can potentially shorten this waiting period to mere minutes. The second, which only recently has received FDA approval in the United States, is an antibody test, or serology test, that detects the presence of SARS-CoV-2 specific antibodies in the blood. Instead of a nasopharyngeal swab, results are obtained using a finger prick blood test. Like the point of care genome tests, antibody tests are a rapid diagnostic that will give users a verdict within minutes. One potential use of antibody tests is to measure the extent of the pandemic at the population level. Our understanding of the disease and its projected impact in the United States is weakened by our inability to monitor its spread amongst people with either mild symptoms or none at all. Another use is to measure the progress of individual infection. Antibody tests quantify the number of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies in the blood. The presence of more IgM antibodies, which are the first to appear and mobilize against an invading organism, indicates more recent exposure to the virus. It is through this result that an asymptomatic carrier of the virus could be identified-a feature of no small importance, since "silent carriers" have played a major role in transmission. More IgG antibodies, which are virus specific and produced in later stages of infection, would lead a person to test positive for immunity, implying recovery. This unfortunately doesn't guarantee full protection. The test won't reveal how neutralizing, or how potent, these IgG antibodies are; nor can it determine how long they will last. With certain families of coronaviruses, including the beta coronavirus family that includes SARS-CoV-2, reinfection has been found to occur, and for now it remains a possibility. Even with this taken into account, the advantages of antibody tests as a tool against infectious disease are still numerous-their low cost not least among them. Antibody tests can be administered for less than $10 each in the United States, and even less in other countries. The price is but a fraction of the PCR tests, which hover around $50 for Medicare patients. No special assembly or training is required; tests could be given in clinics and pharmacies, or at schools and popup stations. Successful deployment of antibody tests, as The Economist so succinctly put it, will depend on their "sensitivity and specificity." Sensitivity prevents false negatives, since a more sensitive test is more likely to actually detect it. Specificity, on the other hand, prevents false positives, since a less specific test may pick up on antibodies against a virus other than SARs-CoV-2. Either way, once an antibody test proves to be as sensitive and specific as constraints will allow, it must be distributed nationwide for maximum effect. If it is still difficult to imagine how one rapid diagnostic test could reach the majority of American citizens, consider the example of a country that has done it before: Egypt. Since October 2018, the Ministry of Health's 100 Million Healthy Lives program has used serology tests to screen more than 60 million Egyptians 12 years of age or older for hepatitis C, diabetes, hypertension, and obesity. The tests cost about 50 cents per person and come back in as little as five minutes. Results are logged and correlated with factors like age, sex, weight, blood pressure, and so on. It would take a concerted effort, but in the United States we have the infrastructure and manpower it takes to conduct rapid antibody tests quickly, cheaply, and at a massive scale. The small European country of Andorra has plans to give antibody tests to its entire population. Compared to other resource rich nations, we've failed to answer the WHO director general's call to "test, test, test." That can change-but only if we act now, and act fast.
Why Researchers Are Exploring Antibodies From Recovered Patients For Possible Treatment And Prevention Of COVID-19
This article, written by ACCESS Health Chair and President William A. Haseltine, originally appeared in Forbes. Is there a Covid-19 treatment that can treat critically ill, hospitalized patients, on the one hand, and protect healthcare workers on the other? Passive immune therapy has the potential to do both-immediately, and with major improvements over time. Broadly speaking, it involves giving antibodies, in this case specific to Covid-19 virus SARS-CoV-2, to people who need them. The first stage is sera from convalescents. The second is purified antibody fractions that are safer and more potent, but also achievable-hopefully by summer. The third is monoclonal antibodies, which will take more time but is already on the fast track. Each approach mobilizes antibodies against SARS-CoV-2 in unique ways, with varying degrees of safety, speed, and efficacy-and all three must be explored. A primer on antibodies When the body is under attack, the immune system's B cells produce antibodies specific to the invading organism that fit its viral proteins with utmost precision. This hand-and-glove binding mechanism either marks the target for destruction via other white blood cells, inhibits basic biological activity, or targets the invading organism for clearance from the body. Some virus-specific antibodies linger on in the body long after infection has cleared. While immunoglobulin M (IgM) antibodies, the largest and first to be produced, disappear shortly after their role as the initial line of defense has been fulfilled, immunoglobulin G (IgG) antibodies remain in abundance in all bodily fluids, ready to leap into action should the virus ever return. If a patient makes a full recovery from Covid-19, the IgG antibodies their immune system weaponized to fight the virus will retain a memory of the disease at least for many months. Shortest term solution: convalescent sera In the event of an infectious disease outbreak for which neither a cure nor a vaccine yet exists, such as the current pandemic, medical practitioners can transfer the antibody-rich blood plasma of recently recovered patients to those critically ill. Collected at least a few weeks after the donor has been discharged, this convalescent plasma, also known as convalescent sera, still contains antibodies against the virus that can treat patients in critical condition. Treatment, not protection, is the purpose of convalescent sera, which buys enough time for some to stabilize and recover. Use of convalescent sera dates back to the 1900s but has more contemporary precedents that suggest its viability as a somewhat reliable stopgap measure against emerging infectious diseases. From H1N1 influenza to Ebola to Covid-19's foremost predecessor, SARS, medical practitioners have repeatedly turned to this basic form of passive immune therapy and, in several cases, reported back promising reductions in mortality and viral load. Combined with small studies recently conducted with Covid-19 patients, the evidence is favorable enough that convalescent sera transfers, as of March 24, are FDA approved for emergency cases in the United States. That said, there are many valid reasons why convalescent sera therapy is still considered experimental and reserved for emergencies only. Although modern blood banking technology does a fine job of filtering rogue substances out of plasma donations, the principle worry is infection from hepatitis and other viruses. Patients with certain immunodeficiencies or lung-related comorbidities, among the most vulnerable to Covid-19, may be ineligible. With so many lives on the line, and so few options in the way of treatment, these risks may be worth it-but there are safer alternatives worth pursuing. Shorter term solution: hyperimmune globulins In New York City, the new epicenter of the pandemic, the New York Blood Center has already started to collect blood plasma donations from convalescent Covid-19 patients for therapeutic use. The ultimate distribution of donors and donations will be determined by patterns in caseload and recovery, with convalescent sera moving between hospitals accordingly. As both the number of recovered patients and the number of infected patients continue to rise, a good portion of incoming donations received by the 380 licensed plasma collection centers across the country should be pooled for the creation of a cleaner, more concentrated, and more effective passive immune therapy: hyperimmune globulins. Unlike convalescent sera, which is processed and circulated through a network of hospitals and clearinghouses, the preparation of hyperimmune globulins-especially at a commercial scale-requires proper manufacturing infrastructure. First, in designated labs and manufacturing plants, samples of collected plasma are assessed for their potency. The goal is to locate and quantify highly neutralizing antibodies, those most adept at fighting the virus, and concentrate them into a clinical grade solution. Once identified, the highly neutralizing antibodies are pooled, purified, and incubated in large batches over the course of several weeks. If all goes well, the resulting hyperimmune globulin preparations should be safer and less variable than a dose of convalescent sera. They can be administered to critically ill patients as treatment and healthcare workers as protection. Hyperimmune globulins have already been produced for diseases like cytomegalovirus, H1N1, and hepatitis. They were even prepared for SARS, though these, like so many other potential coronavirus therapies, never left the lab. The process of industrial purification may be more labor intensive and time consuming, but with enough resources and facilities mobilized, it can also be accelerated. At this point, the coronavirus pandemic is so widespread that recruiting enough plasma donors for rapid manufacturing-usually one of the most significant challenges in yielding high volumes of hyperimmune globulins-will only grow in feasibility. Another technique that has demonstrated success in the past is the collection and refinement of equine plasma. Groups of horses would be immunized with a killed version of SARS-CoV-2, the Covid-19 virus, and develop antibodies in response. Because horses are larger animals, they produce more plasma than humans that can, in turn, be purified just as we purify that of convalescents. Either way, hyperimmune globulins would take longer to prepare than convalescent sera, but not nearly as much time as vaccines or antiviral drugs-meaning they're well worth the effort. Long term solution: Monoclonal antibodies The final, most advanced, and most specific of the passive […]
Houston Public Radio Interviews William A. Haseltine
ACCESS Health Chair and President William A. Haseltine recently appeared on Houston Matters: Special Edition with Ernie Manouse. The full interview is available to listen to HERE. A transcript of the conversation is also available, below. William Haseltine (WH): It is a pleasure to be here. Ernie Manouse (EM): It is sad that it is under these circumstances, but I am thrilled you accepted our invitation and can join us to talk about this. You have had a lot of experience in what goes on in these global pandemics and understand the way to treat it, the way to look at vaccines and medications. At this point, do you have hope? WH: We always have hope, and in this case, I have got a lot of hope. This is not a hard problem to solve from a drug point of view. This is a virus. It is not cancer. It is different from your body. It is a foreign invader. Not only that, there are many, many points of vulnerability. We have very powerful tools to find new drugs that target these specifically. We have a lot of drugs that we know work against viruses, not this one, but we are confident that because we have been able to find drug cocktails for HIV, we are able to cure hepatitis B, there are great drugs for herpes virus infections. This is a problem that can be solved. It will not be solved immediately, but I guarantee you we will solve this problem. As for vaccines. We are hopeful. Vaccines are more complicated. These viruses have developed ways to evade our immune systems in one way or another. That is why they are successful. We certainly will have vaccines. Vaccines will raise immunity, whether it is a perfect shield or not, we do not know yet. And for how long if you are vaccinated, whether protection be long lasting or not, we do not know yet. I am reasonably confident we will also have effective vaccines and that if they do not stop the disease will certainly weaken its impact on the human population. EM: The problem with vaccines, though, it is going to be a wait before we get them. No matter what we want to do, no matter what we hope for, there is a little lag time there. WH: There is going to be a lag time for truly effective drugs and there is going to be a lag time for the vaccines. EM: I was going to say, early on, the President was talking about different drugs we could use and it felt as though they were talking about it like no matter what your illness, just go into a drug store and just pick something up. There has to be more thought when people say what kind of drug can actually show potential to help with this particular virus. This is a little bit in the weeds of a question, I know, but how do you go about deciding where you should even look in the world of drugs that currently exist or even in vaccines that were started to know that they might show hope in this battle? WH: Let me answer that question in a couple of ways. First of all, I want to make sure whoever is listening knows there are no drugs that we are currently certain will work to treat this disease. No drugs. You may have heard about of a whole series of drugs. We do not know that any of them work for sure because they have not been done and tested under the proper conditions. The first place to look for drugs that we might already have approved that could be useful are drugs that are useful for cancer, as well as those that are useful for other viruses. So far those have not proved to work. That does not mean that they will not. It just means it has not been proven yet. The next place you look for drugs is all of those chemical compounds, drug candidates that were produced to fight SARS and MERS. There were many, as many as twenty possibly thirty, that were shown to be potent in their ability to stop the virus growing in the laboratory. That is different from showing that it is safe in humans and that it will stop it in humans, but at least it is a good start. Why you might ask, don’t we have those available today? Because we stopped all research when we thought SARS or MERS would go away, despite the fact that I, and many, many people who understood how dangerous these viruses were, urged that we bring those to completion. We did not. The third place to look: We know what this virus needs to grow. There are at least four or five absolutely critical parts the virus cannot do without. I have great confidence that we can find new compounds not yet discovered that will work to stop each one of those. So, we are very confident in the long run. The short run, I would say is still very much open. EM: When we talk about coronaviruses, we tend to use the term coronavirus to mean what we are talking about today, but as we know it is a whole family of viruses. Are there other drugs out there that are effective against other coronaviruses. Is that somewhere we might look? WH: There are a lot of coronaviruses. There are eighty eight different families of coronaviruses and within each family there are many, many variants. There are no known drugs that are shown to stop coronaviruses. There is a short term potential treatment and a way you might even prevent these infections and that is being tested right now, passive immune therapy. Passive immune therapy initially uses convalescent sera. That sera can be used to treat those that are most critically ill. That is being done today. The next step […]
Why Don’t We Have A Coronavirus Drug Yet—And How We Can Develop One As Soon As Possible
This article was written by ACCESS Health Chair and President William A. Haseltine for Forbes. How will the new coronavirus pandemic end? It could prove to be seasonal, meaning it peters out with the weather with a chance of returning at this time next year. A significant plurality of all people on Earth could contract the disease-prolonging its duration, slowing it over time through a gradual buildup of herd immunity, and inevitability leading to the death of millions. Or one of the many pharmaceutical companies hard at work on inventing a vaccine could succeed and administer their product widely and cheaply, though at least a year will go by before this comes to pass. Our best option-the option that will save the most lives in the least amount of time-is to accelerate the development of therapeutic antiviral drugs that treat infection and prophylactic antiviral drugs that prevent infection. Two approaches can realistically achieve this. The first is to repurpose existing antivirals. The second is to develop de novo, from scratch. Pharmaceutical companies and national health agencies have begun to pursue both strategies aggressively as the Covid-19 outbreak intensifies. Lucky for them, a massive corpus of laboratory studies conducted around past coronavirus outbreaks already exists-remnants of drug discovery efforts marshaled around SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) that never came to fruition. Much of the preclinical and phase I clinical trials showed promise and, had they advanced to the stages required for FDA approval, we might have had therapeutic or even prophylactic antivirals in our possession on the eve of Covid-19. What happened to halt the pipeline then, and how can we accelerate it now? SARS & MERS: Why a drug was never developed The origins of the SARS outbreak can be traced back to November 2002, when cases of an "atypical pneumonia" first appeared in the Guangdong Province of southern China. Come February 2003, similar reports were surfacing in regions as near as Hong Kong and countries distant as Canada. These outbreaks, previously thought to be isolated, began to occur with more frequency in March, mainly in hospital settings and therefore mainly infecting healthcare workers. By early April, a slew of research groups had determined a novel coronavirus to be the epidemic's likeliest causative agent. Initially, the international research response was robust. Once the virus was identified, diagnostic assays and profiles of its clinical, virological, and epidemiological characteristics soon followed. Potential antiviral candidates were investigated, animal models were developed-mice, macaque monkeys, and Golden Syrian hamsters among them-and vaccine strategies were charted and advanced, sometimes as far as phase I clinical trials. In the meantime, most patients infected with the disease were treated using experimental combinations of ribavirin, interferons, steroids, and antibiotics, though it was never proven at the time whether these therapeutic interventions corresponded with actual rates of recovery. In July 2003, around 8,000 cases and 800 fatalities later, SARS was deemed to be officially contained. Efforts to research the SARS coronavirus, of which much remained unknown, continued, motivated by the certainty that it wouldn't be the first to wreak havoc on human life. The lack of knowledge around the molecular biology of SARS-CoV, i.e. ideal targets for entry and replication inhibitors, that impeded drug development during the outbreak was largely resolved in its wake. All the pieces needed to bring new antivirals to the finish line were falling into place. All except for one: the money. The funding streams funneled by pharmaceutical companies, governments, and nongovernmental organizations into labs around the world had all but dried up by 2006. No cases of SARS had been reported since 2004, and previously invested parties were losing interest. Thousands of scientific papers had been published on SARS, and yet nearly a decade later, when MERS first appeared in Saudi Arabia in late 2012, not a single antiviral drug was available for public consumption. Since some of the more promising inhibitors identified in the SARS literature had yet to undergo large scale testing for toxicity, healthcare workers treating MERS stricken patients up and down the Arabian Peninsula reverted back to the experimental therapies administered to SARS patients-even though they were ultimately found to yield "little to no clinical benefit." The MERS epidemic went on to infect fewer people than its predecessor-around 2,500, to be exact-but racked up a mortality rate triple that of SARS. At first, it seemed like the momentum for finding antivirals had mounted anew. Calls came more urgently not just for a MERS vaccine, but a broad spectrum antiviral that could successfully neutralize future coronavirus threats. Yet by 2016, the year MERS cases definitively began to dwindle, the antiviral drug to make it furthest down the pipeline was only just entering phase I dose escalation trials. Three years later, that number had increased to three. The estimated date of completion? Ten years from now. Covid-19: Paying for our past mistakes and avoiding new ones As of March 23, Covid-19 has infected nearly 350,000 and killed more than 15,000. The tally has increased so exponentially that it has become difficult to keep track. From the beginning, it has already been too late; we had almost two decades to prepare ourselves and instead met our enemy unarmed. Back when SARS research was still ongoing, the Singapore based biomedical research hub Biopolis commissioned a sculpture for their central plaza. SARS Inhibited (2006), the winning design conceived and actualized by artist Mara G. Haseltine, was erected as an homage to the notable contributions that Biopolis scientists made to the coronavirus drug discovery and development front. While their findings were unduly shelved, they are now seeing the light of day. The Covid-19 coronavirus is called SARS-CoV-2 for a reason. While their genomes aren't exactly identical, the two coronaviruses have between 80 to 90 percent of the same genetic material. Like SARS-CoV, SARS-CoV-2 penetrates a human lung cell by binding to ACE2, a receptor protein located on its surface. In an effort to expedite the search for efficient therapies, scientists […]
Test, Trace, and Quarantine: The Only Way to Overcome SARS-CoV-2
This piece originally appeared in Project Syndicate. Kentucky Senator Rand Paul's behavior over the past two weeks is exactly what's wrong with America's response to COVID-19. Paul has a compromised lung, so he decided that he should be tested for the disease out of an abundance of caution. From the time of his test until he was confirmed positive six days later, Paul did nothing to protect those around him. On the contrary, he met with other senators, cast votes on the Senate floor, played a round of golf at a private club, and even squeezed in a few laps at the Senate pool. In the countries that have contained the coronavirus outbreak, such irresponsible behavior has not been tolerated, and even could have landed Paul in jail. As a physician (ophthalmologist), he, more than anyone, should know that if he was concerned enough about COVID-19 to be tested for it, he should have been equally concerned about the risk he was posing to others. Containing the transmission of any infectious pathogen - especially one as contagious as COVID-19 - requires aggressive action. Defensive moves like closing businesses or social distancing are effective only when combined with rigorous, systematic efforts to get ahead of the spread of the disease. In Singapore, South Korea, and other countries that have stanched the spread of the coronavirus, public-health authorities have followed a simple process. First, widespread testing has identified those who are infected even before they show symptoms (which many never do). Then, aggressive contact tracing has identified everyone with whom the infected person has interacted. Finally, everyone identified has been subjected to a mandatory 14-day quarantine. This process not only contained the outbreak; it also avoided some of the extreme lockdown measures used elsewhere. Success lies in an uncompromising approach involving mass testing, contact tracing, and selective quarantining - all of which the US has failed to do. In Singapore, the moment a person tests positive for COVID-19, a team of contact tracers is deployed. Someone sits with the patient for hours asking where he has been and with whom he has been in contact in the previous days. Others track down names, phone numbers, addresses, and anything else the patient can tell them that might help identify more positive cases. The team then delivers its findings to the Ministry of Health, which corroborates the information through phone calls, CCTV footage, and traditional detective work like reviewing retail receipts or checking rideshare apps to find drivers and passengers who might have interacted with the patient. Once the list of potential contacts is known, everyone on it receives a call, and those most at risk of having been infected are required - not asked - to quarantine themselves for 14 days. Depending on the closeness of the contact, some are moved to a secure quarantine facility, whereas others may be permitted to remain in their homes. Earlier this month, a close friend of mine returned from Europe to Shanghai and lived through the quarantine experience. Three days after arriving in China, he received calls from the police, the Shanghai Municipal Center for Disease Control and Prevention (CDC), and the district CDC telling him that a passenger on his flight had tested positive. My friend and his wife were then put into controlled quarantine, in a hotel that had been converted for the purpose. They resided in separate rooms, received three meals a day (along with other amenities), and were prevented from leaving until 14 days had passed since the point of initial contact on their flight. In China, quarantines are monitored through an app. Everyone receives a unique QR code showing their status - green if you're clear of infection, yellow if you've been instructed to stay indoors, red if you are under quarantine. If you're roaming the streets and your QR code flashes red, you will immediately be moved back to quarantine, or else you may face fines or jail time. Singapore has taken this technology even further, launching a new TraceTogether app that people can download to help protect themselves and those around them. If a user passes within two meters of someone who is found to be infected, the app immediately notifies the user of the risk. Since late January, when Singapore reported its first case of COVID-19, more than 6,000 people have been identified through contract tracing and put into proactive isolation and quarantine. Owing to these efforts, infections have been contained, hospitals have not experienced a major surge in new patients, and only three people have died of the disease. By contrast, although the US has many of these methods at its disposal, it has failed to deploy them effectively. The Centers for Disease Control and Prevention has trained more than 3,600 disease detectives who are skilled in identifying those infected, tracing their history of contacts, and mitigating the wider risk to the community. But they have been unable to do their jobs, owing largely to early testing failures, which still have yet to be resolved. Contact tracing is costly and time-consuming even in the best of times, when an outbreak is still small. With large outbreaks that have gone undetected because of a lack of tests, it becomes nearly impossible logistically. But failure must not be allowed to follow failure. Tests are finally becoming available to more Americans. Widespread testing, together with exhaustive contact tracing and selective quarantines, can still help us wrestle the outbreak back under control. As Paul himself said when defending his reckless behavior, "America is strong. We are a resilient people, but we're stronger when we stand together." True, but we are stronger when we stand together and act responsibly.