Covid Updates as of March 20th & Final Thoughts

     It's a little over a year since the national shutdowns that send students home from school, adults home from work, and the country into a state of disarray (re: empty toilet paper shelves). Now, we are at 77,000,000 Americans with their first dose and over 10% fully vaccinated. More than 500,000 people have died in just a year.

    As of March 20th, cases have declined since the horrendous winter outbreak that had the US facing nearly 200,000 cases each day at some points. Still, the virus continues to spread with about 55,000 new cases a day, which still is relatively high considering the prior lockdown points over the past year. What's more concerning than this is the variants that continue to spread. The East Coast states have been struggling to reduce Covid cases amidst a public pushing for businesses to open such as bars, gyms, and casinos. Air travel was also at its highest rate since the pandemic hit, which could mean another surge in the weeks to come.    

    We as a country seem to be at a pivotal turning point in terms of curbing the transmission of the virus and increasing to see case numbers dwindle, and a so-called "fourth wave". Much of Europe right now is locking back down amid extremely high case counts in places aside from the United Kingdom. If I've learned anything from a year on this rollercoaster ride and through Humans and Viruses, it's that we need to pay attention to transmission and incidence and not just "trends". A little rain may seem inconsequential after a hurricane just hit, but it still is a weather event. We must not neglect our still high number of cases especially when variants could pose a risk to vaccination efforts. I don't know where we will be come March 2022, but I know the skills I've learned from class will equip me well to think critically about data and about habits as a population trying to curb a virus.

https://www.nytimes.com/live/2021/03/19/world/covid-vaccine-coronavirus-cases 

-Sammy

CRISPR Treatment for Flu AND Covid-19?

 At the Georgia Institute of Technology, researchers have developed a new treatment utilizing CRISPR to target RNA molecules. The treatment would theoretically be given to humans via a nebulizer, which would be a relatively easy way to distribute the treatment once in the hands of patients.

            The researchers had the mRNA technology code for a protein, Cas13a, that destroys parts of code that viruses use to replicate in the lungs. They were able to devise the treatment for flu and COVID-19 because the only change required was the guide strand—which is what tells the Cas13a protein where to attach to the RNA and destroy it. For the flu, the protein goes for the polymerase genes in replication. The treatment also is able to attack SARS-CoV-2 at conserved targets even given the variants circulating. As we know, influenza and SARS-CoV-2 have incredibly different genomes; this subtle change based upon each viruses’ genetic code is an amazing opportunity for multi-purpose treatment for respiratory viruses.

 

            The research trials showed that the protein can work for 99% of flu strains circulating, and also produced no side effects in animal models and helped them to fully recover. More work must be done on the safety of these treatments before human trials can begin; however, the mRNA does not get into your nucleus and affect the DNA and is relatively transient in the body as well. After successful vaccines so far, the data on successful treatments is very encouraging to see.  - Sammy

https://globalbiodefense.com/2021/03/19/mrna-treatment-shows-promise-for-stopping-flu-and-covid-19-viruses/ 

Controlling Avian Influenza

     There have been over 30 outbreaks of "High Pathogenicity Avian Influenza" (HPAI) in poultry and wild fowl in Japan since October 30, 2020 alone. Influenza A virus H5N8, a virus commonly known as one of the HPAIV has caused the outbreak. In order to keep this virus from spreading, uncovering the route for introduction of the virus is essential as is finding out how to halt its transmission route.

    At Hokkaido University, with Professor Yoshihiro at the helm, scientists found one possible route of introduction of HPAIV into Japan. The route they discovered was via migratory birds coming from Europe. They also concurrently found that human anti-influenza drugs could be used to treat the virus in poultry and foul, as opposed to killing the birds. HPAI in poultry leads to large economic and material losses, and the main way to control the spread is usually by killed all the infected birds. The virus can also infect wild birds in zoos and sanctuaries which would lead to the death of potential endangered species.

    Scientists collected duck samples from Lake Komuke in Hokkaido in October 2020. The H5N8 presence was molecularly confirmed, which was related to outbreaks in Europe in 2019 and 2020 as well as variants in Korea and Japan. They ascertained from this that it must have spread due to migratory birds going from Europe to Asia in a ten month span. A pressing concern is that there is yet another H5N8 variant wreaking havoc in Europe which could mean that the north is a reservoir for the disease.

    As a Humans and Viruses student, an equally and if not more pressing concern is the relationship between HPAI and influenza in humans, given that strains from poultry have made the cross into humans before. For example, in February 2021 in Russia a zoonotic strain emerged within the human population. Thus, halting the spread of HPAI not only has implications for the poultry market, but for entire human populations as well. Given we are currently in a pandemic, viral surveillance especially in animals should be of the utmost importance.

    As for controlling virus spread in animals, the findings of two antivirals baloxavir carboxyl and peramivir being used to treat HPAI is very peculiar and could have implications for future outbreak situations.  BXM and permavir drugs were both successful in improving survival outcomes for infected poultry. As for now, however, the strongest method to stop transmission is to enact surveillance measures and continue to look at migratory birds. Finding suitable treatment is also a key step into not damaging the poultry industry or human populations with deadly diseases. - Sammy

https://www.sciencedaily.com/releases/2021/03/210311123449.htm

Chronic hepatitis C infection and opioid use

 Opioid abuse and overdose are one of the major public health threats of our time. A study by Butt et al. shows that a higher risk of prescription opioid use might be higher among chronic hepatitis C patients due to higher comorbidity burden and social vulnerability. All individuals with a confirmed chronic Hepatitis C infection from the Electronically Retrieved Cohort of HCV Infected Veterans data set were included in this study. Butt et al. measured acute and long-term prescription opioid use defined as having a drug supply of 90 days or more. Statistical analyses included chi-square and t-tests to determine the proportion of individuals with acute and chronic long term prescription opioid use by various social factors such as race, gender, homelessness, poverty (annual income <$45,200), rural/non-rural residence, alcohol use and diagnosis of psychiatric illness. Logistic regression analyses were also included to determine the risks of factors associated with the outcome of interest. The results show that among 160,856 chronic hepatitis C cases, 38.4% had acute prescription opioid use. This was significant with a p-value of 0.01. Additionally, those with chronic Hepatitis C were 60% more likely to develop chronic long term prescription opioid use (95%CI 1.63, 1.69). Black females who experienced homelessness were at the highest risk for developing chronic long term POU. Individuals with chronic hepatitis C had, in general, more social vulnerability factors compared to control groups. 

Although Butt et al. the long term effects of prescription use of opioids do require further study, this study adds to the pile of evidence that calls for addressing the public health threat that is opioid drug overdose and abuse. 

-Bethel 

https://www.nature.com/articles/s41598-021-85283-6

Hepatitis B chronicity: some light shed on cccDNA formation

 Approximately 257 million people are living with hepatitis B infection worldwide. Hepatitis B is caused by the hepatitis B virus of the hepadnaviridae family which is a DNA virus. The virus is transmitted through the parenteral route with exposure to infected bodily fluids and replicates in hepatocytes (liver cells). Hepatitis B is a disease of the liver with symptoms including jaundice, light or grey stools, hepatic tenderness and enlargement of the liver (hepatomegaly). While most adults recover, 90% of infants, 30-50% of children between the ages 1 and 5 years and 5% of adults with the disease progress to chronic HBV that causes serious diseases such as cirrhosis and hepatocellular carcinoma. The development of chronic HBV is established through persistence of the virus due to the formation of covalently closed circular DNA (cccDNA). Wei and Ploss showed in their study for the first time how cccDNA is formed from relaxed circular DNA (rcDNA). 

The genome of the virion is a double-stranded relaxed circular DNA with four lesions. These lesions are the covalently linked viral polymerase and DNA flap on the 5’-end of the negative strand and the 5’-capped RNA primer and ssDNA gap on the positive strand. After entry through the bile acid transporter (NTCP), the viral rcDNA is released into the nucleus and the four lesions on the rcDNA are repaired to form a stable cccDNA. In addition to establishing chronicity, cccDNA serves as a template for the HBV viral transcripts.  Both viral factors and host repair factors are involved in the repair process. Though Wei and Ploss identified the human factors involved in this process namely proliferating cell nuclear antigen (PCNA), the replication factor C (RFC) complex, DNA polymerase delta, flap endonuclease 1 (FEN-1), and DNA ligase 1 (LIG1), the exact mechanism by which these lead to the repair of the four lesions was not known. In their recently published work, they first showed that all five human factors are necessary for the repair of the lesions on the positive strand, whereas only FEN-1 and LIG1 are required to repair the lesions on the negative strand. Then they proceeded to understand the repair mechanism of each strand individually by monitoring the intermediates. The removal of the covalently attached viral polymerase was found to be required in the repair process with the product deproteinated rcDNA a critical repair intermediate. This research shows that the repair of the positive and negative strands are independent events with the positive strand repair resembling the maturation of Okazaki fragments. The negative-strand repair process involves a slow removal of 5’ protein adduct and removal of the DNA flap by FEN-1 leaving a nick that subsequently seals.

This remarkable work is going to be very essential in the development of therapeutics for chronic HBV infection. 

-Bethel 

https://www.nature.com/articles/s41467-021-21850-9 

https://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html

WHO is getting vaccinated on the African continent?

With mass vaccination advances in developed countries, there is an ongoing worry some of the poor nations in the world are being left behind. By the end of February, per 100 people the UK has given out 31 doses, the U.S. 22, Asia just over 2 and Africa less than 0.3. As the World Health Organization has been emphasizing for months now, vaccinating individuals in all corners of the world is absolutely essential in curbing the spread of the SARS-CoV-2 virus. While some African nations have only started vaccination programs recently with the COVAX vaccines, deals with other countries and donations, some are still on the waiting line and a few countries have completely opted out of vaccinating citizens. 

The major source of vaccines for the continent is the COVAX initiative formed by WHO, CEPI and GAVI in efforts to address inequities in vaccine distribution and vaccinate 20% of Africa’s population. So far, a growing number of African countries including the first country to receive COVAX vaccines, Ghana, Kenya, Ethiopia, Ivory Coast, Nigeria, South Africa, Angola and Zimbabwe. A number of African nations have gotten vaccine donations from countries like China, Russia, India and the United Arab Emirates as well as from manufacturing companies such as Pfizer. A select number of African nations such as Senegal and Morrocco are buying their vaccines from donating countries as well. In addition, AU has allocated millions of doses to provide for member nations to help reach the goal of vaccinating the 20% African population. 

However, will vaccinating 20% of the population be enough? The head of Africa Centres for Disease Control stated that countries would need to vaccinate at least 60% of their populations to “get the pandemic out”. As a challenge to reaching this goal other than lack of resources and vaccines, there is the added burden of mistrust and resistance to getting vaccinated among the public within the continent. An online pan-African research network, Afrobarometer that collects and analyses data from more than 30 out of 54 African countries, showed that 60% of respondents of a survey said they are unlikely to try getting vaccinated. With the recent suspension of the AstraZeneca vaccines in European countries from fear of blood clot formations, this number might even be increasing. In addition, Tanzania, Burundi and Madagascar have indicated they will not be seeking vaccines at the moment until more scientific data is acquired on the vaccines. Many challenges lay ahead with shimmering hopes of death rates going down hopefully manifesting with vaccinations. 

- Bethel 

https://www.bbc.com/news/56100076 

https://www.afro.who.int/news/covax-expects-start-sending-millions-covid-19-vaccines-africa-february 

https://www.washingtonpost.com/politics/2021/03/12/africa-has-started-vaccinating-against-covid-do-citizens-trust-their-governments-vaccine-safety/ WHO is getting vaccinated on the African continent?

Controversies regarding AstraZeneca vaccine safety: the risk/benefit game

 European countries including Germany, France, Italy, Spain, Denmark, Norway and the Netherlands, among others, have paused the use of the AstraZeneca COVID-19 vaccine after reports of blood clots forming following the administration of the vaccine. In response, AstraZeneca released an update on the14th of March reassuring nations of the safety of the vaccine based on scientific evidence. 

The company reported that of the 17 million people vaccinated across EU member nations and the UK, 15 events of deep vein thrombosis and 22 cases of pulmonary embolism are reported as of March 8. The company also assured monthly safety reports to be made public with complete transparency next week. The Chief Medical Officer added, “The nature of the pandemic has led to increased attention in individual cases and we are going beyond the standard practices for safety monitoring of licensed medicines in reporting vaccine events, to ensure public safety.”

Since the clinical trial data and reports of adverse side effects following administration vaccines thus far have not shown alarming flags in terms of safety, the viability of vaccines during storage, shipments and distribution is another area to examine. This was also included in the safety update released by the company in which it reports ‘no confirmed issues’ in different batches of vaccines being distributed across the EU, UK and the rest of the world. 

The nations that suspended the use of the vaccine indicated that they are waiting for pending analysis from European authorities and regulators. WHO officials and the European Medicines Agency along with many health officials have been releasing statements that they are ‘firmly convinced’ the vaccine’s benefits far outweigh the risks. WHO officials are recommending the continued use of the vaccine and further highlighted the major challenge in the global fight against the pandemic is access to vaccines not concerns of blood clots. 

While European nations who halted the use of the AstraZeneca vaccine did so as precautionary efforts, the magnitude of the concern that resulted in this decision is questionable. Moreover, such powerful nations stopping vaccines in such a worry has an impact on the public’s perception of vaccines that is very concerning. This decision could feed into existing fears and mistrust of vaccines and even spark concerns among the public around the world. Did these countries act prematurely?

 

-Bethel

https://www.aljazeera.com/news/2021/3/15/which-countries-have-halted-use-of-astrazenecas-covid-vaccine 

https://www.washingtonpost.com/nation/2021/03/15/coronavirus-covid-live-updates-us/#link-4BVATIYKYFAL5J2ZC5IMBCEXT4 

https://www.astrazeneca.com/media-centre/press-releases/2021/update-on-the-safety-of-covid-19-vaccine-astrazeneca.html

No Tiers Left to Cry?

     California has gone through many "tiers" throughout the Covid-19 pandemic. When cases were lowest in spring, Governor Newson opted to close everything down as we still were hopeful that we could get the pandemic under control, at least on the West Coast. The summer spike in July prompted a most restrictive lockdown with beaches closing and malls, gyms, and movie theaters shutting down once more. Perhaps California's most devastating period came during winter, when places such as Los Angeles had to extend crematorium environmental limits because they had so many bodies to burn.

    California's system places certain counties in different tiers- with purple being most restrictive to yellow  allowing many businesses to open, though with a few restrictions mainly involving masks. Up until now, there hasn't been a designation on the tier system for "full steam ahead" and moving life back to "normal" pre-pandemic. Newsom has recently announced that the state is working on a "green tier" amidst all the progress the state has made to vaccinate individuals. Green tier doesn't indicate that everything will be completely open to pre-pandemic operations-- there will very likely still have some restrictions such as mask wearing in public areas. The green tier would allow concerts to occur and for most indoor businesses to operate. Swartzberg, an infectious disease specialist, said the state could enter green tier possibly this summer.    

    Our very own Dr. Siegel commented as well, saying that the tier system creators should be cautious to rush to a "green tier" metric, as most people would associate green with all operations "a go". In humans and viruses, we discussed the implications of reopening too early simply with the vaccinations on the horizon. If we look at the prevalence of Covid-19, it bears similarity to summer levels-- which at the time were the highest we'd ever seen them and thus caused an influx of strict rules. Looking at trends alone clearly has limitations when the relative Covid cases are still very high. California as a state should not be looking to run any red lights to the light at the end of the tunnel before enough people are protected from the virus. 

https://www.sfchronicle.com/local/article/California-may-soon-get-a-green-reopening-tier-16025359.php

-Sammy   

Mosquito Proteins and Therapeutic Avenues

    Despite the extremely remarkable pace of Covid-19 vaccine development and deployment, it is treatment options for Covid as well as many viruses that seem to lag behind in success. Recently, a study showed that convalescent plasma showed no real benefit in terms of treatment for the coronavirus, and other attempts at treatment have similarly seen little success. False information had also led to the touting of hydroxychloroquine as a viable coronavirus treatment option, though data shows that the medication shows no significant reduction in the usual effects of the virus. In the non-coronavirus realm, significant treatments have resulted for viruses such as HIV, but antiviral treatment lacks for many other viruses.

    Recent studies from the NIH have shown that the mosquito protein AEG12 can strongly inhibit the flaviviridae family viruses such as dengue, West Nile, and Zika virus. The study also showed the protein to weakly inhibit coronaviruses. How this protein accomplishes this task is by breaking down the viral envelope and the protective coverings which could lead to potential therapeutics for millions of people across the world who have contracted enveloped viruses but less so against naked viruses. 

   Dr.  Geoffrey Mueller, the head of the NIEHS Nuclear Magnetic Resonance Group, said the group figured out the AEG12 structure by utilizing X-ray crystallography and that at the molecular level AEG12 wreaks havoc on the membrane by stealing the lipids which hold the virus together. Thus, through great disruption, the AEG12 protein can kill some viruses with great efficacy. The downside to these results showing success in flaviviruses and minor success in coronaviruses is that therapies would take years to make the compound successful within humans. The issue comes from the fact that AEG12 splits open red blood cells so it would have to be genetically engineered to avoid that drastic outcome. 

    This new finding, although not going to revolutionize treatments at least in the near future, is an exciting foray into how discovering proteins from insects and animals can contribute to human therapeutics. The "One Health" approach into looking at animals and insects and how viruses interact with them should be heavily on the radar of scientists looking for treatments for human ailments. To understand the structure of a protein can be pivotal in its ability to help treat diseases. 

-Sammy

https://www.news-medical.net/news/20210310/Mosquito-protein-study-could-lead-to-therapeutics-against-deadly-viruses.aspx

The Mystery of Asia and Africa’s Low COVID Death Tolls

  One of the strangest things most of us have forgotten to take note of in the frantic scramble that has been the last year with COVID19 are the remarkably low death rates in many Asian and African countries. David Leonhardt pointed out in his Good morning article for The New York Times that this is not how pandemics usually work. We expect pandemics to take their greatest toll on the developing world due to poor sanitation, lack of access to medical care, and inaccessibility of resources needed to combat a pandemic. With COVID19, however, death per million residents in the U.S. and the U.K. due to the virus is over 1,500 while in places like Ethiopia, Pakistan, Tanzania, Thailand, and Bangladesh it is no more than 100. What might explain this unexpected phenomenon?

        There are some hypotheses, but no single hypothesis or combination of hypotheses has yet to account for the extreme discrepancy in death rates between the world's wealthiest and poorer countries. One of the hypotheses being explored is that countries in Asia and Africa have fewer old people -- most people die before reaching old age. Take the Philippines for example. The percentage of people in the Philippines who are over 65 years of age is only 5.5% compared to 16.9% in the U.S. Another interesting hypothesis is that these regions of the world may have endemic coronaviruses that the Western world doesn’t have. The theory is that exposure to other coronaviruses may confer greater immunity to people in Asia and Africa against SARS-CoV-2. Given the large number of viruses that probably circulate among humans undetected, this theory could hold its own under investigation. Indeed, many different coronaviruses are thought to be causes of the common cold syndrome. 

        Finally, it’s thought that policy matters and response to the initial warning bells of COVID’s arrival have played an important role in the spread of disease. Preparation for the pandemic in the U.S. was poor, and response was disjointed and disorganized. In contrast, several African and Asian countries took heed of the WHO’s recommendations and instituted mask mandates and closed their borders early on. Clear messaging from governments about the dangers of the virus could have made a difference in the behavioral response of the people living within their borders. When we have no vaccine and no drugs, behavioral changes are paramount in combating a pandemic. 

        While all of these factors probably played some role in the surprisingly low death tolls seen in Asia and Africa, they are not enough to account for the vast difference. Studies to determine other factors at play will provide heavily searched for answers to this pandemic mystery. 

- Renata

References

The Morning - The New York Times, March 8th

Share of population older than 65 in the Philippines from 2015 - Statista, accessed 3/12/2021

Share of old age population (65 years and older) in the total U.S. population from 1950, accessed 3/12/2021

Viral Surveillance & Predicting Pandemics

     Many people have agonized over what could have prevented such a large scale disaster in terms of catching SARS-COV-2 before it spread across the United States and beyond. Dr. Michael Mina, an epidemiologist at Harvard, has a plan to create a "Global Immunological Observatory" for the future, so that blood samples of different individuals can be looked at and tested for all different types of antibodies. 

    This type of observatory would probably cost $100 million dollars to get off the ground but could have enormous implications for preventing the next pandemic. How the observatory would work would be that scientists could collect samples from people and look at how different viruses have generated antibodies. This would be different than wide scale testing in that antibodies take around one to two weeks to be generated after an infection. However, with new viruses this would allow for scientists to track the spread throughout the population perhaps before it gets out of control amongst the population. Mina thinks, for example, that if this "weather system" were put in place in 2019, New York City could have been shut down long before it was and many lives could have been saved. Likewise, doctors looked at the Zika virus' effects when babies were born with microcephaly months after moms were infected. A widespread immunologic survey could have allowed people to scope out this virus long before the birth of the babies with birth defects.

    Because the immune system provides historical evidence and a track record of the pathogens that which the body has seen before, this would be a great way to be on the look out for all sorts of viruses with pandemic potential. Mina has half a million plasma samples from the summer and are beginning to do large serological testing. Investigating these samples will provide information on the spread of Covid-19 on a week-by-week basis and explore how immunity to Covid-19 has developed over time. Mina hopes this movement will inspire others to start to look at plasma on a much bigger scale as a harbinger for future pandemics.

-Sammy

https://www.nytimes.com/2021/02/15/health/scientists-viruses.html?auth=login-email&login=email&searchResultPosition=1

    

Viral Party: College Students Driving Viral Spread

    Amidst the many restrictions easing up nationally, the country is still having issues with noncompliant individuals with regards to masks, flat out COVID-19 deniers, travelers, and of course, young adults attending colleges who choose to throw parties. 

    Many universities have struggled within the past year whether to bring students back to campus to get a more well-rounded education at the risk of spreading COVID-19, which among other viruses is easily transmitted in these shared spaces and dormitories. Those who have brought students back have historically faced issues, such as University of Washington with a huge surge at the beginning of the pandemic to recent parties in Boulder where large masses of students showed up to gatherings near the school. Most recently, in Durham Duke University has seen immense Coronavirus spikes which threatens progress the institution has made to mitigate the virus among the student body.

    A high count of 32 students tested positive on Tuesday, which was the highest one-day total that Duke has seen during the entire pandemic. Also, over the weekend over 102 students tested positive. Interestingly, the majority of positive cases came from Greek affiliated students or first year males who may be participating in off campus rush events. A big issue is that many of these gatherings have occurred outside of campus in dwellings not operated by the school. Duke has previously limited student gatherings to only 10 people whether inside or outside.

    Duke's recent uptick in cases could be a harbinger for even bigger rises in cases. In particular, Stanford University plans on bringing back the junior and senior population for housing this spring, amidst a backdrop of athletes and freshmen and sophomores with special circumstances. Given that Stanford does not have off-campus housing, all of the students would be living in dormitories across campus. Even though vaccination ehttps://www.wral.com/coronavirus/duke-blames-fraternities-for-virus-spike-on-campus-threatens-sanctions/19569108/fforts are certainly improving, as President Biden has also promised that most adults can be vaccinated by May, the rush in returning life "back to normal" is problematic. This is especially worrisome when you look at the track record of college students. If the university brings back students to have a more "social" experience, then they shouldn't act surprised when the students end up having social interaction that causes coronavirus to increase. 

-Sammy

https://www.wral.com/coronavirus/duke-blames-fraternities-for-virus-spike-on-campus-threatens-sanctions/19569108/

Global Solidarity Amidst Crisis

  In the face of crisis, we protect our own. But is protecting this own above all else the best way for the world’s leading nations to deal with the pandemic? When vaccines against COVID19 first arrived, the U.S. was at the peak of the pandemic. There was a rush to vaccinate health care workers, then those most at risk, and efforts have now turned to vaccinating teachers. Amazingly, nearly a third of the American population has already been vaccinated (NPR) and similar rates are being reached in other wealthy countries. But according to a joint statement made by WHO and UNICEF directors in mid-February, almost 130 countries around the world had yet to administer a single dose -- not even to healthcare workers. What’s more, the statement says that “of the 128 million vaccine doses administered so far, more than three quarters of those vaccinated are in just 10 countries that account for 60% of global GDP.” From this, it seems clear that people in wealthy nations are getting vaccinated while people in poorer countries, even those countries’ health care workers, are not. 

        This is a tough issue to wrangle, let’s look at America as a case study. On the one hand, Americans are still dying from the virus and the number of new daily cases in the U.S. hovers around 64,000 (Google, accessed 3/9), a number that is not at all insignificant; on the other hand, keeping much of the world’s vaccine supply to themselves is unethical and could eventually backfire, putting Americans at great risk once again. This risk that’s run by hoarding vaccines in wealthy nations is that poor countries are left vulnerable to the virus, enabling the virus to replicate and mutate within those populations. Much like how influenza replicates and mutates in the Southern hemisphere to re-infect the northern hemisphere come winter and vice versa, COVID could mutate to the point where it is no longer susceptible to the vaccine that wealthy nations are currently reluctant to share. 

       Then there’s the ethical challenge -- Some of my peers who are teaching assistants for classes are getting vaccinated because they fall into the category of “educators”. And while I respect them for their work (teaching to a bunch of faceless names in boxes over Zoom is no small task) the reality is that they will be fulfilling all their responsibilities virtually from their homes or dorm rooms without much risk of becoming ill. In contrast, health care workers in poorer countries must continue to attend their jobs in person, putting themselves at great risk of becoming ill to help those who already are ill. Vaccines are much more likely to mean the difference between life and death for these health care workers than for my peers tucked away in their bedrooms. 

        It is notable that Biden and other world leaders have committed financial resources to improving COVID vaccine access in the global south. But this funding can’t bring vaccines to poor countries if the entire vaccine supply has been effectively committed to these same wealthy nations. It would be much more effective for the U.S. and the U.K. (some of the nations poised to receive enough vaccines to immunize their country’s populations several times over) donated doses instead of dollars. In the present, the choice of these nations to reserve vaccines for their own people makes sense while the high incidence of COVID cases remains high. But once incidence decreases, even if it means younger groups will have to wait longer for the day they get their shot, wealthy nations ought to show solidarity with the rest of the world by donating excess vaccines to other countries. This is both the compassionate and smart thing to do.

- Renata 

References 

Wired Magazine: The Pandemic Can’t End While Wealthy Nations Hoard Shots (3/9)

BBC News: Covid vaccines: G7 increase support for Covax scheme (2/19)

WHO: In the COVID-19 vaccine race, we either win together or lose together (2/10)

Social Distancing is Getting a Little Bit Less Distant

         America is moving full steam ahead with vaccine rollout with an average of 2.17 million doses of vaccine being administered every day. While people are reporting some less than pleasant side effects of vaccination and a few people have had serious allergic reactions to the vaccines, these issues have remained manageable and are on par with side effects from other commonly administered vaccines. The vaccines have proven themselves to be both effective (estimated to be 100% effective at preventing death in the elderly) and safe. 

        In response to the huge strides that have been made, the CDC issued new guidelines today saying that fully vaccinated people can safely have small, indoor gatherings. The CDC also said that fully vaccinated people can safely gather with healthy, unvaccinated people. These announcements indicate a turning point in our run with this virus and are a huge first step in curing the nation of its pandemic fatigue. Elderly people who have been especially isolated during this pandemic will be able to see their grandkids and other family at last. 

        These new guidelines are also important in motivating people to get vaccinated. There has been some vaccine hesitancy that has held people back from getting vaccinated. But the lure of being able to safely socialize in some circumstances might be enough to convince people to take the first opportunity to get vaccinated that they have. Too many lives have already been lost in the wait for these vaccines, now that they are available, there is no reason lives should continue to be needlessly lost. 

        Concern about the virus variants from places like the U.K. and Brazil have also arisen. According to Moderna CSO, Melissa Moore, the mRNA vaccines made by Moderna and Pfizer appear to maintain good efficacy against most of the variants, with only a somewhat reduced effect against the South African variant. During a talk she gave to the Stanford community today, she said that Moderna already has a new mRNA vaccine in the drug development pipeline targeting the South African variant. In the meantime, the public should rest assured that the vaccines they are getting will protect them from becoming seriously ill from the virus. 

- Renata

References

New York Times: Covid-19 Live Updates: Vaccinated People May Meet Indoors in Small Groups but Should Still Mask in Public, C.D.C. Says, accessed 3/8/2021

New York Times: As Virus Grows Stealthier, Vaccine Makers Reconsider Battle Plans, Jan 25, 2021, accessed 3/8/2021

Lessons from Ebola in the Time of Corona

    The Ebola presence in Guinea as of February 14, 2021 had placed the country into "an epidemic situation" after seven cases and 3 deaths had emerged. The virus popped up in Gouecke, a place where many people travel to the capital from and thus poses a risk for the spread of Ebola. Even though the patient zero has been identified, he previously traveled over 620 miles which motivates closure of borders. Health authorities are particularly cautious in present day as just five years ago, West Africa faced the frightening Ebola epidemic which left 11,000 dead.

    On a positive note, the deadly epidemic in 2016 led to the establishment of the National Health Security Agency (ANSS) to manage epidemics and health crises. 38 epidemic treatment centers for diseases with epidemic potential have been established in Guinea and 17 health centers were built to manage epidemic cases in local communities. Likewise, Guinea has established 5 laboratories in Conakry to detect diseases and transportation has been established to help mobilize intervention teams. Epidemic surveillance has improved as well-- with response teams set up on the regional scale as well as vaccination teams.

    The quick pace in responsiveness with regards to epidemic interventions as well as mitigating community reluctance is something that West Africa has learned with its devastating Ebola history. Interestingly in the wake of the COVID pandemic, it is seemingly something that globally needs work as well. In the United States, mask resistance and pandemic denial are factors which propagated the spread of COVID throughout the country. In West Africa, hiding the sick and refusing to part with community burial practices resulted in the spread of the disease. Ultimately, to address future epidemics and pandemics as well, a certain trust that outsiders (and even Presidents) often fail to establish must be established. Local cooperation in vaccine and surveillance distribution must be permitted and even encouraged. It is often said that public health succeeds when nothing is occurring. In order to get to that point, resources and money must be poured into public health initiatives and programs so that we don't have to continuously learn lessons from devastating viral outbreaks.  -Sammy

https://promedmail.org 

Building Vaccine Corps of Medical and Nursing Students

  Vaccine rollout in the U.S. has not gone as smoothly as most public health officials would have liked. In the face of the hundreds of thousands of deaths in the U.S. due to COVID19, the vaccination process was frustratingly slow to begin. Although it’s picked up steam, distribution still faces many challenges. Two of the most significant challenges that have arisen are the public’s hesitation to get vaccinated and poor organization around notifying and vaccinating people once they become eligible. Chancellor Michael Collins of the University of Massachusetts Medical School thinks he has a solution. Beginning in late January of this year, Collins organized a vaccine corps of medical and nursing students to improve vaccine roll out in the school’s area. In February, the corps launched a large scale vaccination site in Worcester where they began administering vaccines to up to 2,000 people per day. The extra hands offered by the vaccine corps is essential, but the corps offers another critical tool -- the students are able to address vaccine fear by connecting with people of similar backgrounds to themselves and convince them to come in for vaccination. “Students often represent their region’s races, ethnicities, and backgrounds,” says Collins, “which can make it easier for them to connect with communities that are hard to reach and might not trust vaccination.” Students are also involved in phone banking and making appointments for people who have poor access to the internet or who struggle with the online system. Collins argues that the vaccine corps he has spearheaded is a model that can work across the country. He believes that the vaccine corps enables America’s medical community to deliver on the promise of equitably distributed vaccines allowing all Americans to benefit from major health advances.

- Renata

References

The Conversation: We’re building a vaccine corps of medical and nursing students - they could transform how we reach underserved areas, Feb 10, 2021

Tag Team: Merck and Johnson & Johnson Join Forces for Vaccine Production

             Shortly after the FDA authorized Johnson & Johnson's vaccine for emergency use on Saturday, an unusual deal was brokered by the White House that is allowing the pharmaceutical company Merck & Co to manufacture the vaccine. This is going to significantly increase the supply of Johnson & Johnson vaccine and help speed up the pace of vaccination in the wake of new variants being identified in the United States.  Merck has attempted to make their own failed Coronavirus vaccine, but the company has experience in manufacturing vaccines in the past. The partnership is historic due to the fact that these are two competing companies. The agreement is allotting two of Merck's facilities to produce the vaccine- one of which that will make the "drug substance" and the other that will make the "fill-finish" which is the final phase of putting the vaccine into vials for shipping.

    The Johnson and Johnson vaccine is considered slightly less effective in terms of vaccinated individuals contracting the virus; however, the success rate against hospitalization and death is nearly the same. Even better, Johnson & Johnson only requires one dose of the vaccine and still provides efficacy of curbing the spread of the virus. The vaccine doesn't use mRNA as Pfizer and Moderna, and it instead uses a virus vector to deliver genes into the cells and can be kept at normal refrigeration temperatures. It is also significantly cheaper than other vaccines.

-Sammy 

https://www.nytimes.com/live/2021/03/02/world/covid-19-coronavirus

    

Covid-19 On the Brain: Research Suggests COVID-19 Enters the Brain

        It has been known since last year that Covid-19 could cause problematic "long haul" symptoms such as brain fog and other cognitive difficulties. Recent research has shed a light on why these could be occurring-- SARS-CoV-2 is entering the brain, which is quite frightening.

    A recent study published in Nature Neuroscience looked at the spike protein called S1 in SARS-CoV-2 can cross the blood brain barrier in mice. The spike protein in itself can detach by itself and lead to a cytokine storm in the brain. The virus entering into the brain could be even more detrimental since the spike protein can cause these concerning effects on its own. The spike protein attaching to blood brain barrier receptors can cause the brain to release inflammatory products such as cytokines. The overreactive immune system is a common occurrence with COVID-19; this type of overreaction in the brain could cause inflammation and issues in such an important organ in our body.

    An interesting finding for William A Banks, a professor of medicine at the University of Washington School of Medicine, is how similar the S1 protein in SARS-CoV2 is to the gp120 protein in HIV. Both proteins are termed glycoproteins for their high presence of sugars, and both also have similar functions in terms of getting into the brain. 

    COVID-19 has already demonstrated a plethora of concerning long-term symptoms and syndromes. If people weren't concerned before, this finding of the virus' ability to penetrate into the brain could indicate complications which outlast the 10 day course of the disease common for many people. 

-Sammy

https://www.sciencedaily.com/releases/2020/12/201217154046.htm

 

P.1

        The city of Manaus in Brazil lies alongside the Amazon River. Like many of the cities and villages connected by this life source, the COVID pandemic hit the people swiftly and with might. At the peak of the pandemic, people were dying at unprecedented rates and the city was forced to cut down swaths of forest to create more gravesites. While the toll has been large, health experts were hopeful when a drop in incidence corresponding with a greater than two thirds seropositivity rate among people in Manaus appeared. They thought Manaus had reached a point where enough people had been infected that the spread was slowing. 

But soon, cases began to rise again and researchers didn’t know why. Meanwhile, across the world reports of new SARS-CoV-2 variants began popping up. Suspecting the worst, one Brazillian doctor began doing genetic sequencing of the virus that was being isolated from sick patients in Manaus and found that there were mutations of the receptor binding domain of the spike protein in this strain of SARS-CoV-2. 

Mutations in the receptor binding domain of the spike protein are the most dangerous. Antibodies that protect us during the course of an infection do so in part by preventing the virus from being able to bind to and enter its target cells. Antibodies that bind to and directly block the receptor binding domain of the virus are the best at offering protection from infection. Mutations in this region by the virus may allow them to escape recognition by both vaccine-induced and naturally produced antibodies. 

When the researchers back traced the rise of this variant in Manaus, they found that while it had initially only caused about 20% of the COVID cases, it gradually rose to become the dominant form of the virus active right now. What’s worse, researchers suspect that 60-70% of those who currently have COVID in Manaus have actually been re-infected by the new variant. Their studies found that convalescent serum of previously naturally infected people was six-fold less potent at neutralizing the new variant, named P.1. 

As P.1 has begun to spread to other places in the world, people are rightly becoming concerned. As public health officials are saying, it is important that we continue to use all the means we have to fight back against the virus’ spread including social distancing and mask wearing. Settling into a new normal of life with the pandemic still requires a degree of vigilance.

- Renata

References

NYT: Virus Variant in Brazil Infected Many Who Had Already Recovered from COVID-19, March 2021, accessed March 1, 2021

NYT: The Amazon, Giver of Life, Unleashes the Pandemic, July 25 2020, accessed March 1, 2021

Souza et al., Levels of SARS-CoV-2 lineage P.1 neutralization by antibodies elicited after natural infection and vaccination, The Lancet (Preprint), March 2021