Bengaluru: A vaccine for the Covid-19 could emerge in about a year, World Health Organisation (WHO) chief scientist Soumya Swaminathan has said, even as she sought to highlight the possibility of the novel coronavirus becoming a seasonal virus like the influenza, or an endemic infection.
In conversation with the ThePrint Editor-in-Chief Shekhar Gupta at the third digital Off The Cuff Saturday, Swaminathan said the fact that seven vaccines are in human clinical trials within three months of a pathogen’s discovery was ”unprecedented”.
She said it is important to start approaching Covid-19 in a more balanced manner. Eventually, she added, enough people may develop immunity, through antibodies or vaccination, and the disease may no longer be so catastrophic. “But for the next year or two, we should expect to see this virus continue to cause disease,” she said.
During the conversation, Swaminathan also offered a scientific explanation to dismiss rumours that the virus was made in a laboratory, and other myths related to Covid-19.
Vaccines and drugs
Speaking about the development of a vaccine for the virus that has now infected nearly 30 lakh people worldwide, the WHO chief scientist said it is quite unprecedented to have so many vaccine candidates within three months of a new pathogen being described.
Seven of these candidates are in human clinical trials, and WHO intends to help bring together manufacturers and scientists to facilitate prioritisation criteria for developing vaccine candidates and clinical trial protocols, she said.
“If we’re very, very lucky and everything goes well, we could have a vaccine in 9 to 12 months,” she said. “It would be an unprecedented scientific achievement if that was to happen.”
Beyond the vaccines currently in human trials, Soumya Swaminathan said she expects more candidates to start trials this summer.
Several drugs are also currently under trial to treat Covid-19. Swaminathan said drugs are developed by testing existing medicines that have been efficient in treating other diseases, citing examples like the lopinavir-rotnavir combination that worked against HIV. These drugs are being tried to treat Covid-19 too.
Mentioning hydroxychloroquine (HCQ), the drug that has been touted as a “game-changer” by US President Donald Trump and advised by the Indian Council of Medical Research (ICMR) as a preventive for healthcare workers, Swaminathan said the drug ” seems to have activity with the culture (in labs), but when you translate that into human beings, it has never been found to be protective against any other virus”.
The trials currently underway, including the large-scale Solidarity trials, still don’t have results.
“WHO decided to include it (HCQ) in Solidarity trials after some early studies from China demonstrating reduction in severity of the disease,” she said.
It’s better to test the efficacy of HCQ in a research setting as there is no evidence it works, she said – the official stand of the WHO. However, she clarified that it is a relatively safe drug that has been used to treat malaria and auto-immune diseases, so using it as a prophylaxis for Indian healthcare workers should be relatively safe.
She added that remdesivir was included in the Solidarity trial as it’s a broad-spectrum antiviral acting against the polymerase enzyme of the virus, which is crucial for the novel coronavirus to replicate.
Monoclonal antibodies, which are artificially injected to induce an immune response, are also showing promise but need to undergo trials, she said.
Future life with Covid-19
Discussing the future of the novel coronavirus, Soumya Swaminathan said it could become a seasonal virus like the influenza virus, coming in waves once or twice a year. However, it could also become an endemic infection in the human population, where people continue to get sick but at a much lower level.
The scientist said a large portion of the population is still under the risk of infection, so it is important to accept this virus as being “a part of our lives now” and start approaching Covid-19 in a more balanced manner.
Countries will now have to start to decide how to balance day-to-day lives without extreme lockdown measures and with enough caution to prevent the spread of the disease, she said. People will have to start going to work, children to schools, and all the other health problems that have been put on the back burner have to be taken up again.
Swaminathan said there was a need for change in behaviour to be able to sustain long-term measures like physical distancing and extreme personal hygiene.
“Mass gatherings, where thousands of people come together, won’t happen for the next few years until we can protect ourselves. Probably travel will pick up down the road, but we’ll need to travel only for very essential things in the near future,” she said.
‘Not made in a lab’
Speaking about the controversial origin of the novel coronavirus, with many rumours alleging that it was created in a Wuhan laboratory, the WHO chief scientist said a detailed study of the virus’ genome, of which there are over 5,000 sequences now, has provided evidence that it was not engineered in a lab.
A creation procedure will have a crucial genetic marker that this virus is missing, she explained, and the sequences also show an extreme level of similarity with naturally-occurring coronaviruses found in animals.
“This virus has a close similarity to bat coronaviruses. We don’t know how it moved from bats to humans, whether directly or through a wild or domesticated animal. We also don’t know where and when this happened, and whether it has been evolving over time among humans too. We only know that it transmits easily, and luckily has a much lower fatality rate than MERS or SARS,” she said.
There have been three clades of SARS-CoV-2 (novel coronavirus) described — S, G, and V — according to the normal mutations the virus has undergone, said Swaminathan. These clades are named after amino acid and protein mutations occurring in the virus.
Some clades are more prevalent in certain geographical regions than in others. But none of these seems to have any differences in clinical outcome, mortality, virulence, or transmissibility, she said.
There is no evidence to suggest that a clade in India is weaker than one elsewhere, she added.
Preparedness and mortality
Speaking about preparedness for a pandemic like Covid-19, the WHO chief scientist, who has had a three-decade long career in medical research, said the world was better prepared for an influenza pandemic than a coronavirus one.
Scientists had been anticipating that this pandemic would be induced by a zoonotic virus because a majority of viruses that have jumped from animals to humans in the past have had a predilection to become pandemics – such as HIV, Ebola, and Nipah.
Herd immunity, a solution looked at in many parts of the world, is associated with vaccination programmes and achieving it naturally would result in a very high death toll, she said.
Studies have shown that only 5 to 10 per cent of the population has antibodies, but aren’t conclusive if they are protective antibodies. But 80 per cent of the population needs to have protective antibodies to achieve herd immunity. The only way of achieving that safely is through a vaccine, she said.
Sensible and balanced public health measures, that are agile, adaptable, and driven by data, need to be in place until a vaccine, she added.
With a lot of discussion ongoing about the dangers of wet markets, like in Wuhan where Covid-19 allegedly emerged from, Swaminathan said such markets will not be shut down for food security reasons, but they will have to follow food safety standards and not allow trade of live wildlife.
Talking about the now-popular notion that heat kills novel coronavirus, Soumya Swaminathan said sunlight does indeed kill pathogens but, to act against this virus, at least two to three hours of exposure was needed.
“There is also no evidence to suggest that the kind of heat or humidity we have in India is high enough to destroy the virus. We have seen in other tropical-climate countries in Southeast Asia that the virus has been able to spread. Relying on the weather to control the epidemic is not a wise thing to do,” she said.
On whether the virus is airborne, Swaminathan said in close quarters, the virus is transmitted by only droplets of different sizes, which are expelled from our airways while breathing, coughing, or speaking. There is no risk of contracting it from the air, or from someone not in close contact with, she added.
On UV radiation, she said ultraviolet C used for disinfecting rooms is extremely dangerous to humans. Soap and 70 per cent alcohol are good enough to clean hands and surfaces.
On treating the critically ill
The small portion of people who succumb to Covid-19 do so very rapidly, said the WHO chief scientist. There can be a variety of complications ranging from renal failure to stroke. Such degradation is triggered by cytokine storm, which is the body’s own immunity overreacting to the virus.
But there is no clarity on the pathophysiology of the virus that causes this, she said.
“Doctors who have treated Covid patients in the ICU have said that it is unlike other causes of acute respiratory syndrome and they describe patterns such as where people respond better to oxygen than ventilators,” she said, adding that early preventive care is crucial.
Asked why more men seem to succumb to Covid-19 than women, Swaminathan said one of the reasons is that comorbidities, including obesity and lung damage by smoking, are more common in men.