Article Writer-   Sudipta Biswas, Int. MSc., School of Biological Sciences, NISER, Odisha(India)

T

 he SARS-CoV-2 virus started its impact by infecting a considerable population in China. With over 11 million people being diagnosed worldwide by the deadly virus, it has become a severe issue in the area of medical sciences [1]. By now, over 700 thousand people are affected in India, with the number still rising [2]. It has been forecasted that some countries are about to reach the peak number of cases by the end of this year. However, India’s situation remains bleak, the rate of increase of the number of cases has still not reached the peak in India [3].

This has created a lot of complexities in the country’s economy, governance, and healthcare facilities. With the number of cases rising, the hospitals’ beds are not going to be sufficient, and many are not able to receive the proper treatments [4]. In these times, rather than glancing at the losses that have transpired due to COVID-19, let’s try to get acquainted with all the research that is going on to solve the problem. The general public should always be up-to-date with the information being issued every moment so that they can be more conscious of the gravity of the problem and act accordingly to reduce the quantity of spread. Therefore, we have pieced together some vital information regarding the research and policies that have been going around to fight COVID-19. We will first discuss the physiological ways in which the medical and STEM researchers try to battle the virus; these methods involve vaccines, drugs, and then the non-physiological techniques like social-distancing, lockdowns, and others.

Studies related to SARS-CoV-2

In the meantime, when people are diligently trying to find a solution, many new research works have been published on the characteristics of the virus, and they state why creating vaccines against a virus is more laborious than earlier perceived. First of all, the origins of the virus are still unknown. The fact that it came from bats may or may not be accurate. Recent works show that the virus shares about 96% of its genetic material with a similar group of viruses found in a community of bats living in a cave near the city of Wuhan. However, the spike-like protein receptors found on the coronavirus (which are needed for the attachment of the virus to our cells) were not the same as those which were present in that group. Nevertheless, the coronavirus colonies present in the pangolin population had a similar kind of spike properties [5]. Hence, it can be debated that the origins of the virus are still unknown, and we need more information to back up the data. Furthermore, new studies have shown that SARS-CoV-2 has a good grasp over the cells present at the upper respiratory tract than the MERS-CoV and SARS-CoV, making it more contagious even before it reaches the lungs. It has been affirmed that SARS-CoV has the transmission capability of common cold viruses and the lethality like the MERS-CoV, which makes it more challenging to manage. Also, it is discovered that SARS-CoV-2 is less inclined to mutation. It has a peculiar repair mechanism for its genetic material, which poses a big problem for drugs to overcome to combat the virus [6].

Physiological techniques

As the new information proves how tough it would be to work with the virus, more and more ways are being discovered to tackle it. Physiological methods include the vaccines and drugs that can change the normal functions of the human body, helping it fight off the virus.

Vaccines:

Vaccines are the preparations that can induce humoral immunity against a specific disease by designing antibodies particular to it. They all mimic the functionalities that a typical SARS-CoV-2 virus would do in a person’s body and try to give the body’s immune system a generous amount of time for constructing specific antibodies against the virus [7]. Currently, there are more than 80 vaccines in the trial for SARS-CoV-2. They are primarily of 4 types: Virus based vaccines, Nucleic acid vaccines, Viral vector vaccines, and Protein-based vaccines [8].

 

  • By March, many vaccine trials started worldwide, with companies like Moderna and Oxford University taking the lead [9].

  • Some Australian scientists have begun testing two potential vaccines on a population of lab ferrets [10]. It is the first documented pre-clinical trial involving animals before the human trials.

  • At the time of April-May, the first human trials also started with about 1000 people signing up to take part in it in Oxford [11].

  • Till now, only one human trial in India has begun in Hyderabad’s NIMS institute.

  • However, other 12 medical institutions are in line, where the trials are about to commence shortly.

  • ICMR has partnered with Bharat Biotech International Limited (BBIL) to fasten the process of this trial of the indigenous COVID-19 vaccine –Covaxin(BBV152) made in India and the viral strain used in it was isolated by the National Institute of Virology, Pune [12].

Developing a vaccine usually takes years. However, researchers are racing against time to build one in just a few months to curb the spread of infection.

Drugs:

Along with vaccine development, many resources are also being used for the production and testing of some already available drugs. The most talked-about being the WHO sponsored SOLIDARITY Trial, it’s an international clinical trial that analyses the ability of 4 drug treatments to perceive their effectiveness against the virus [13].

They include:

  • RNA polymerase inhibitor drugs: Remdesivir and Chloroquine/Hydroxychloroquine.

  • HIV protease inhibitor combination: Lopinavir-Ritonavir plus interferon beta and Lopinavir-Ritonavir.

The results of Hydroxychloroquine and Lopinavir-Ritonavir are not so encouraging. Their use has resulted in no or little decline in the mortality rate of the hospitalized COVID patient. Along with that, no reduction in the viral titer was found as compared to the standard care facilities used in the hospitals. Hence the leg of the trial containing these drugs was discontinued [14].

However, two drugs Remdesivir and a corticosteroid Dexamethasone are showing confident results. Dexamethasone has shown a decrease in the mortality rates of the hospitalized COVID patients needing oxygen support by about 35% [15]. Remdesivir showed the shortening of the time of hospitalization [16]. As usual, these drugs need supplementary studies to back up the claims. However, some world governments like that of the UK is expected to use the Dexamethasone and Remdesivir combination for the treatment of their patients [15]. India and other countries like Japan, Bangladesh, and UAE have already given the nod to the international companies like Cipla and Glenmark to sell their antiviral drugs against SARS-CoV-2 in the market, with medical supervision [17].

Along with these, plasma therapy is also being employed for the treatment. It usually consists of injecting the plasma taken from a person who has recovered from COVID into the blood of the hospitalized patient. The plasma from the recovered patients is considered to contain the antibodies needed to combat the virus. Studies are still going on for it, with NewYork City being the first one to implement this testing phase [18].

Non-physiological Techniques:

As there are many clouds of uncertainties still predominating over the use and safety of vaccines and drugs, it will usually take time for them to be released in the market, and there’s no guarantee till now whether they will be fully effective. Hence, governments worldwide are trying to take immediate steps to decrease the spread of the virus so that their health care systems can remain stable. These non-physiological methods include social distancing, contact tracing, making models for COVID infection rates, and others. These methods can be implemented faster than the physiological ones and also are somewhere effective in controlling the cases if appropriately followed. They can be used to manage the number of patients for a more extended period of time, at least until the vaccines or drugs are out [19].

Primary Interventions:

Primary interventions like rapid testing, social distancing, contact tracing, and lockdown are useful measures in the category of non-physiological methods. By contact tracing, the people who were in close contact with someone infected will also get tested for the same virus. It is useful in breaking the chain of transmission. Middle-income countries like India have done an extensive amount of contact tracing comparing to higher income group countries, where a shortage of people to investigate confirmed cases are being reported [19].

South Korea emerged as a global leader when it came to rapid testing. They have tested more than 270 thousand people by mid-April and were able to curb the spread by following the ideology of test, trace, and contain [20]. Now their daily rise of cases is in single digits. Countries like New Zealand, Austria, and Germany adopted aggressive and early lockdown measures, making their COVID counts stable [21]. With different intervention mechanisms being present in the bag, it’s difficult for countries that are still struggling with the disease to decide which one to implement and which one to reject. Different strategies are working best for different countries. Therefore, scientists are trying to get COVID infection data from many countries to generate patterns of transmissions of the virus. The data will be used to compare the different countries’ infection rates based upon when they began introducing the preventive interventions and which ones were used. Machine learning processes will then be used to learn from these data sets and form the infection patterns and make predictions about transmissions. By this, scientists can know how useful a given intervention will be by looking at how infection-based prediction patterns shift when they remove information about the intervention from the population. Hence, helping the governments to choose the best policies/interventions for their countries [21].

COVID Transmission Models:

The above strategy involves getting the infection data from the populations and then learning about them to find the best interventions. Hence, it would be better if we have a tool that can predict infection data or patterns precisely. The mathematical models are trying to do that job right now, which helps the health care facilities get extra time to be prepared for adversity. Countries like the US and UK rely heavily on these data to stock up several drugs, make PPEs, equip the hospitals, and make crucial decisions. These models try to build a virtual copy of a region or country and use differential equations to predict the movement and interaction of the people in that area in space and time. They calculate so by knowing all the number of individuals who are either infected, suspected and have recovered [22]. Hence, it can be argued that these models require a lot of data to predict nearly accurate projections. However, the scientists who are building these models have stated that the information given to them is insufficient or inaccurate. They blame the surveillance and healthcare systems of the governments for this, who are not working correctly to gather the data. Models are like a simplified representation of reality. Many teams like the Imperial team in London have predicted that if all countries adopt strategies/interventions of social distancing, testing and isolation of infected cases before their deaths reach 2 per 1 million people per week then the global death total would be less than 1.9 million from COVID by the end of this year [22]. Therefore, the proper acquisition of data regarding the patients is needed to be collected carefully by the respective systems so that these data could be given to such teams who can predict the models, which gives the government and the common public a sense of awareness about the graveness of the situation.

Even in the presence of such methods, there are some bits of information going around, which made big headlines. Like, some scientists believe that the virus will get weaken over time so that it will be able to persist in humans without killing them. It will help the virus to propagate its genes forever. This may happen by the effect of mutations in the virus; if even it occurs, then the virus will have more ways to spread. However, this theory has been debunked when a researcher named Rambaut argued that as long as the virus can infect new cells and its genes are being carried forward, it will not matter if the humans are harmed or not [6]. Also, it has been proposed that the antibodies produced in a recovered patient might be able to give that person a superior immunity to the disease than others. Again, this theory also got some opposition when people started arguing that this gained immunity will be imperfect and may not be able to save the person from the infection again [6]. Hence, rather than listening to this news, we should remain prepared and follow all the guidelines issued by the government. With a lot of information and hoax being around on the internet, it is the public’s job to gather the proper data from the concerned authorities. The time when the vaccine or drugs will come out is still not known; therefore, it’s beneficial for us if we stay indoors, practice good respiratory hygiene, wash our hands. These exercises/practices will not only save our lives but also, it will ease the load on the hospitals and help the government to manage the pandemic more precisely.

 

References: 

 1.https://www.worldometers.info/coronavirus/?utm_campaign=homeAdvegas1?
2.https://www.mygov.in/covid-19
3.https://www.hindustantimes.com/india-news/many-countries-including-india-don-t-know-when-covid-19-peak-will-come-top-chinese-expert/story-wPJlAD9TfnypRNsV6Po5tI.html
4.https://economictimes.indiatimes.com/markets/coronavirus-impact-on-economy
5.https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-020-00665-8
6.https://www.nature.com/articles/d41586-020-01315-7
7.https://www.who.int/health-topics/vaccines-and-immunization
8.https://www.nature.com/articles/d41586-020-01221-y
9.https://www.nature.com/articles/d41591-020-00026-w
10.https://www.bbc.com/news/health-51665497
11.https://www.news-medical.net/news/20200705/Oxford-COVID-19-vaccine-trials-move-to-stage-3-human-trials.aspx
12.https://www.livemint.com/news/india/coronavirus-vaccine-covaxin-update-human-trial-process-has-started-at-hyderabad-s-nims-11594129924566.html
13.https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
14.https://www.who.int/news-room/detail/04-07-2020-who-discontinues-hydroxychloroquine-and-lopinavir-ritonavir-treatment-arms-for-covid-19
15.https://www.who.int/news-room/detail/16-06-2020-who-welcomes-preliminary-results-about-dexamethasone-use-in-treating-critically-ill-covid-19-patients
16.https://www.medscape.com/answers/2500114-197451/what-is-the-role-of-the-antiviral-drug-remdesivir-in-the-treatment-of-coronavirus-disease-2019-covid-19
17.https://www.business-standard.com/article/current-affairs/two-vital-drugs-get-regulator-nod-for-treatment-of-covid-19-cases-120061901776_1.html
18.https://www.ny1.com/nyc/all-boroughs/news/2020/05/27/data-shows-plasma-therapy-potentially-effective-to-treat-hospitalized-covid-19-patients-
19.https://www.nature.com/articles/d41586-020-00798-8
20.https://www.theguardian.com/world/2020/apr/23/test-trace-contain-how-south-korea-flattened-its-coronavirus-curve
21.https://www.nature.com/articles/d41586-020-01248-1
22.https://www.nature.com/articles/d41586-020-01003-6