Welcome to the perils of living in a global village. The outbreak of the novel Coronavirus (SARS-CoV-2 ) presents a significant challenge to the entire world. Coronaviruses are a large family of viruses which cause a range of diseases from the common cold to more severe ones like Severe Acute Respiratory Syndrome (SARS). In India, the National Centre for Disease Control (NCDC), state governments and WHO offices have established plans and procedures to detect and isolate the first cases of COVID-19 as they emerge. The country is working with customs and carriers to enhance health measures. The state governments have to identify, isolate and contain cases. Fifteen government laboratories have the approval to test for COVID-19 and another 19 are being prepared to test samples to ensure an adequate geographical spread across the country.
The WHO is continually updating its guidance and it is possible that an outbreak or pandemic of COVID-19 could occur in multiple waves. As of now, it is not known yet if the disease has a seasonal pattern, like flu. Depending upon the emerging evidence, it may be necessary to ensure readiness for future waves of outbreaks. Whenever the country faces public health emergencies, it is better to overreact and then scale back if necessary rather than under-react and then act too late. Here are the most important aspects of such planning required for the country.
First, a robust surveillance system is important as the backbone for planning any action. The Centres for Disease Control in the United States (US) operates on five times higher budget than that of NCDC in India which caters to four times larger population. It is time the government prioritised the strengthening of the surveillance systems.
Second, the quantum of research and its progress regarding SARS-CoV-2 is unprecedented in the history of science and public health. In the coming days, more than 100 research projects will provide significant insights into which tests and drugs to use and finding a safe and effective vaccine. As a result, a vaccine against Covid-19 might be realised soon with the first set candidate vaccines entering phase 1 trials by next few weeks. In a recent article published in Vaccine, Matthew McKay and others report that no mutations are present in the SARS-CoV-2 and hence, it is possible to design a vaccine by immune targeting. Scientists at Novavax have announced that their recombinant protein nanoparticle technology platform can be used to generate antigens derived from the coronavirus spike protein.
Third, the therapy currently consists of supportive care. No drug has yet been approved to treat coronavirus infections in humans. If everything goes well, new drugs can be developed and deployed by 2021. These drugs are targeted for other strains of virus that have not yet been identified in causing outbreaks. For example, there are drugs tested to act on a spike-shaped protein on the surface of these viruses. However, we need to be cautious as all the ongoing studies are in nascent stages and have to go through several phases before they are available for human use. However, several of the drugs already approved for other antiviral indications are being tested and are in advanced stages. Among these, chloroquine, darunavir, galidesivir, interferon beta, the lopinavir/ritonavir combination, the RNA polymerase inhibitor remdesivir, triazavirin. Umifenovir (Arbidol) and darunavir are probable hopefuls.
Fourth, intravenous hyperimmune globulin, by concentrating the pathogen-specific antibodies from plasma collected from recovered patients, can be helpful in reducing the severity of illness. Some research groups in China have found antibodies can act on the spike proteins, preventing coronaviruses from attacking human cells.
As we move forward, the drugs, diagnostics and vaccines can be evaluated in scientifically and ethically sound studies with the evolving phases of outbreak. While the funders such as Wellcome Trust and NIH have announced immediately available grants in early February, the governments need to step up investments and actions to conduct research in tackling COVID-19.
Giridhara R Babu
Professor and head, lifecourse epidemiology, Indian Institute of Public Health, Bengaluru