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ALWAYS PREPARED FOR NEW INFECTIOUS DISEASES EMMANUEL BOTTIEAU, HEAD OF THE UNIT OF TROPICAL MEDICINE
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COLOPHON Responsible Publisher Marc-Alain Widdowson Editor-in-Chief Ildikó Bokros Eline Dhaen Editorial Committee Ildikó Bokros Nico Van Aerde Eline Van Meervenne Louise O’Connor Layout Toech communicatiebureau Photography Astrid Bultijnck, Jessica Hilltout Translations Serv-U
*P³ - ITM’s essence captured in one letter We work to improve health worldwide by conducting and applying science. Our innovative and interdisciplinary work focuses on Pathogens (Department of Biomedical Sciences), Patients (Department of Clinical Sciences) and Populations (Department of Public Health). ITM researchers improve our understanding of tropical diseases, and develop better methods for their diagnosis, treatment and prevention. Others study the organisation and management of health care and disease control in regions where means are limited, but needs are huge. We also focus on the health of animals and the diseases they spread to humans.
Contact communicatie@itg.be +32 (0)3 247 07 29
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Dear Reader, What a change six months can bring! Our previous issue appeared in early March, and the world has turned upside down since, due to COVID-19. We stopped shaking hands, giving kisses to or hugging each other. We cover our faces with masks. We keep physical distance, even from our loved ones. We started working from home, en masse. We wash our hands for 40 seconds, about, what feels like, 50 times a day. We limit going out and try to adjust to the ‘new normal’, also in our minds. We wait and hope for a vaccine, and effective treatment. For most of us, this is all we can do. But for many at ITM, COVID-19 has become their new job. This issue of P³ focuses on SARS-CoV-2 and pandemics in general and on the people who have been involved: on medical doctors who look for ways of treatment, on virologists who carry out research for vaccine development, on laboratory technicians who diagnose COVID-19 in the labs, on dozens of fellow ITM-coworkers who became seamstresses overnight to provide ITM staff with face masks, on researchers who explore how COVID-19 affects potentially vulnerable groups in Antwerp our home base, and on how we can best take care of ourselves, in times of crisis. Stay safe and enjoy your reading. The Editorial Committee
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COVER STORY: “ALWAYS PREPARED FOR NEW INFECTIOUS DISEASES” - DOCTOR EMMANUEL BOTTIEAU SHARES HIS EXPERIENCES OF THE PANDEMIC
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THE NOVEL CORONAVIRUS AND OTHER RESPIRATORY VIRUSES: WHAT YOU NEED TO KNOW IN THE EYE OF A PANDEMIC: ALUMNI INSIGHTS FROM THREE CONTINENTS WHAT IS THE IMPACT OF COVID-19 ON POTENTIALLY VULNERABLE GROUPS IN ANTWERP? PHOTO STORY: POSITIVE OR NEGATIVE? DIAGNOSING COVID-19 REWIND: ONCE UPON A TIME IN THE TRAVEL CLINIC… PORTRAIT: ILSE MAES THE LIST: TIPS FROM ITM STAFF FOR GETTING THROUGH A LOCKDOWN
© The contents of this publication may not be reproduced in whole or in part without the express consent of the publisher. Images in this report were taken with full understanding, participation and permission of the people portrayed. The images truthfully represent the depicted situation and are used to improve public understanding of our work. Disclaimer: The bulk of the articles was written in June-July 2020. # TABLE OF CONTENTS
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The number of masks sewed by 25 enthusiastic staff members for all ITM employees. The project started in early May and in a month’s time the masks were ready for distribution. Their aim
was to make three masks per each employee – and they succeeded! Read more about this ambitious undertaking in “times of corona” on page 26.
ALWAYS PREPARED FOR NEW INFECTIOUS DISEASES Our colleague Emmanuel Bottieau has been a member of the Belgian COVID-19 Task Force since midMarch. Although giving media interviews is ‘part of the job’, Dr Bottieau remains humble despite the attention. He has been giving his all for ITM for the last 20 years and became Head of the Unit of Tropical Medicine in 2012. He now shared his pandemic experiences with P3. “We look very carefully at what is happening in the world to be able to deal with and treat tropical infections in returned travellers in the best possible way. Initially, COVID-19 was a tropical disease, which is why we have been monitoring it closely since 6 December. As soon as the number of cases started increasing in Italy, it became clear that the COVID-19 pandemic was no longer some remote spectacle,” explains Dr Bottieau. Every two years, a new infectious disease emerges somewhere in the world. Every hundred years on average, it turns into a pandemic. “A rare occurrence and hopefully I will not experience another pandemic during my lifetime. However, in the back of my mind I am always prepared for another outbreak of one or another
infectious disease. I hold my breath whenever a new infection emerges because you never know what its spread is going to be.” Together with four external colleagues, Dr Bottieau drafted the Belgian treatment guidelines for COVID-19 patients. “We monitored all new scientific publications and filtered the information to help Belgian doctors look after patients. We had never cooperated before, but it worked out well. You need to weigh words carefully when drafting guidelines to ensure clear and understandable instructions. This is not always straightforward. Sometimes you must also decide without hard evidence. Currently, more and more information is becoming available and we can treat patients with a more targeted therapy. For example, a recent UK study indicates that administering a light dose of cortisone may prove to benefit seriously ill COVID-19 patients.” Dr Bottieau also co-drafted treatment guidelines for Zika patients for the Belgian Superior Health Council in 2016. “What’s the difference between now and then? The speed at which everything has to be done now. Every day new publications appear. Over the course of three # COVER STORY
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Now, we are asked to address the public at large as all-round experts, however, every expert looks at the situation from his or her own perspective. I am looking at infectious diseases from the treatment angle.
months the guidelines were adapted 12 times. That’s a new version every week! I have never worked longer and harder on a guideline, ever.” But the result - a 20page document - is impressive. Although his eyes are still blazing with energy, Dr Bottieau admits he needs a holiday. The past months were tough. He not only had to draft guidelines but also put in quite some media appearances in Wallonia and Flanders. “All part of the job,” he says. He has also been called in as an expert on other emerging infectious diseases such as the Zika virus. “Before COVID-19, journalists seemed to take the specific medical background more into account. Now, we are asked to address the public at large as all-round experts, however, every expert looks at the situation from his or her own perspective. I am looking at infectious diseases from the treatment angle.” “For example, Marc Van Ranst or Steven Van Gucht are better placed to deal with questions about the virus itself or about public health in general. Journalists, however, seem to expect us to answer all their questions, even if they fall outside our field of expertise. There are times when you must dare to say: ‘I just don’t know’, but that increases people’s fears. As time goes by, however, I feel that the distinction between experts has become a bit clearer for the press.” Has Dr Bottieau learned anything in recent months? "Constantly. But what shocked me most as an infectious diseases specialist was that health care providers did not have protective masks. General practitioners, hospital and resi-
dential care staff, all categories of health staff experienced critical periods without masks. Apart from COVID-19, they have also been seeing patients with other infectious diseases such as tuberculosis or severe flu. I think we really need to do something about this mindset, and we should pay more attention to this in medical training programmes. But I remain convinced that things will improve. Additionally, it is not wise to be so dependent on other countries to produce masks. We were lucky that the epidemic had already subsided somewhat in China by that time. Otherwise we wouldn’t have had any masks at all.”
BIO » Professor and Head of the Unit of Tropical Diseases at ITM (since 2012) » PhD degree at the University of Antwerp with a thesis on fever after a stay in the tropics (2007) » Joined ITM’s Department of Clinical Sciences in 1999. Involved in clinical activities at the ITM clinic and at the Antwerp University Hospital » Specialisation in General Medicine (1993-1994, Université Catholique de Louvain) and in Internal Medicine (1994-1999, Université Libre de Bruxelles) » Working with Médecins Sans Frontières Belgium (1989-1993) – Ethiopia, Philippines, Mozambique, Nicaragua, Burundi » Graduated as MD from the Université Catholique de Louvain (1988) # COVER STORY
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THE NOVEL CORONAVIRUS AND OTHER RESPIRATORY VIRUSES: WHAT YOU NEED TO KNOW An in-depth interview with ITM’s Professor of Virology Kevin Ariën and Professor of Veterinary Helminthology Pierre Dorny about the COVID-19 pandemic and other epidemics: past, present and future. We have heard many times over the past months that virologists ‘have been warning us’ about a potential pandemic. Is this how you imagined it would be?
Kevin Ariën: Respiratory viruses probably have one of the highest chances of becoming pandemic: coronaviruses, influenza viruses and paramyxoviruses all have members that can spread pandemically. Societal changes in the past 100 years made conditions easier for epidemics to spread. During the time of the 1918 Spanish flu epidemic the world’s population was 1.7 billion; now it’s almost 8 billion. Most people then were living in the countryside, travelled by foot or horse-
drawn carriages. Now there are commercial airlines, immense changes in travel and trade and of course large-scale urbanisation. In China there are 15 cities which have more than 10 million inhabitants. Cities, and the world in general, have become denser and more connected. This also accounts for the shrinking of habitats for wildlife – so that wild animals that have never been in contact with people are not that secluded anymore. Coronaviruses have jumped from animals to humans several times before… so this pandemic is not a surprise for virologists. What about the flu viruses? Those are close contenders when it comes to possible pandemics. There have been serious flu epidemics since 1918 as well, such as the Mexican flu epidemic of 2009, the Russian flu in 1977 and the Hong Kong flu in 1968. The H5N1 variant of avian or bird flu is for the moment a dead-end infection in humans, as it does not yet transmit well from person to person, but viruses continuously evolve. Alarmingly, the mortality rate of some bird flu viruses in humans is around 30%. It’s no coincidence that the World Health Organization (WHO) is keeping close track of flu viruses in animals and humans. These are mostly transmitted by aquatic birds, but there have been many instances of infected poultry, in China and also in Europe. In order to prevent further spreading to and within poultry livestock, mass culling has taken place to stop the spread of flu viruses such as H5N1. By the way, the same needed to happen in mink farms in the Nether-
lands, because many of them tested positive for COVID-19. Interestingly, flu viruses use different receptors in the airways to enter into birds and humans. In birds, flu viruses mainly cause gastrointestinal infections, but in people they present themselves as respiratory illnesses. So, most avian flu viruses are not well adapted to infect and propagate in our human airways. Pigs have both types of receptors that are used by avian and human flu viruses respectively. As a consequence, pigs are ‘mixing vessels’ where avian, pig and human flu strains can exchange genetic material to create new variants. These viruses might also become potentially dangerous for humans in the future.
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Coronaviruses have jumped from animals to humans several times before… so this pandemic is not a surprise for virologists.
You also mentioned paramyxoviruses. What are they? Well known human diseases caused by paramyxoviruses are mumps and measles for example. Other paramyxoviruses have emerged more recently in humans and livestock in Australia and Southeast Asia, such as the Hendra virus (HeV) and the Nipah virus (NiV). Both are contagious, highly virulent and cause a potentially fatal disease in humans. 9
Nipah comes from bats, then infects pigs and then goes on to humans. Hendra also originates in bats, but then it infects horses, and lastly, humans. Let’s talk a bit about vaccines and possible treatments, because this is what the world is so eagerly awaiting. It takes years to develop a vaccine, why? We can look at the example of the vaccine for the seasonal flu, in terms of the production process. There are about 100 sentinel sites of WHO globally, where they track year-round what is circulating in the population in terms of flu strains and their genetic composition. Based on that information, WHO then determines the composition of the vaccine. In order to make sufficient vaccines by the time the flu season is here, companies need six to eight months. It is very likely that in the meantime the virus keeps mutating, so by the time the flu season hits, the virus might have drifted away from the vaccine strains and offer suboptimal protection. Many companies still rely on old technologies for flu vaccine development that originated in the 1950s, where vaccines are made on embryonated chicken eggs. Eggs are inoculated by the flu virus, which then replicates and from there the vaccine strain is harvested. You need about one egg for one dose of vaccine, so you can imagine the logistics of this. There are also other, more efficient recombinant technologies but the big vaccine producers have heavily invested in the egg-based process, that now allows the production of vaccines at an afford-
able price and profit margins. Hence there is little incentive to change the production process. But if we are to produce vaccines for the entire global population, our development strategies and production processes require a paradigm shift. Making vaccines for a newly emerging pathogen such as SARS-CoV-2 is still in a different league. First, you need to study the basics of this new pathogen and understand which proteins/antigens elicit strong and protective immune responses. Next, you need to express these antigens, formulate them as a vaccine, develop the right animal models for preclinical evaluation, perform phase 1 and 2 clinical studies to assess vaccine safety and finally large-scale phase 3 clinical studies need to be undertaken to assess efficacy. At the same time, the production capacity has to be scaled up to fit the demand. This process takes time, a lot of time. For COVID-19, a vaccine is promised within 12-18 months, but we need to understand that this would be an unprecedented success. And we have not even mentioned the political and societal challenges to make this vaccine accessible to everyone in need, including for the poorest populations on this planet. What about antivirals? For HIV they took many years to develop. Vaccines will probably arrive before effective treatment is discovered. We know that some people were administered hydroxychloroquine (HC) in Belgian hospitals and that it appeared to benefit them. However, there is a lot of debate internationally on the use of HC and that large-scale studies have not found any benefit of HC
for the treatment of COVID-19. HC is not a coronavirus-specific treatment: originally it is a malaria medicine. Remdesivir, a broad-spectrum antiviral that was also tested for Ebola virus treatment, seemed to have helped reduce recovery time in some severe cases of COVID-19. HIV medication, which indeed took many years to develop, is a very specific combination drug, which stops the virus from replicating itself - it fits as perfectly as a key in a lock. Such coronavirus-specific medications are currently unavailable and will take several years to develop.
Kevin AriĂŤn
It is important to keep in mind that medicine is far more advanced now than say, 100 years ago. At the time of the Spanish flu, antibiotics, which could have saved many people from the fatal secondary infection of bacterial pneumonia, were not discovered yet. The world population in 2020 will probably not be decimated by this coronavirus, but we need to be vigilant about other known viruses and other viruses yet to arise, which are a constant threat to global public health. The scientific world, epidemiologists and virologists learn a lot from these outbreaks, so we learn more about the novel coronavirus every day.
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Tell us more about the role of intermediate hosts in zoonoses. In the case of COVID-19, bats were blamed first but then we started hearing about pangolins. Pierre Dorny: That’s one of the possibilities. It may be that the SARS-CoV-2 virus did not jump from bats to humans directly, but that the transmission chain included a so-called intermediate host. This is not uncommon: in case of MERS these were camels and for SARS they were civet cats. Pangolins are small mammals, wholly covered in scales to fend off predators. In some parts of the world, for example in China or in Ghana, their meat is considered a delicacy. Their scales are also used in traditional Chinese medicine. They are similar to what game is for Europeans: think of wild boar or deer which are on many restaurants’ menus in autumn. Similarly, civet cats are eaten in some communities as bushmeat and camels live in close contact with humans in the Middle East as livestock: there are camel farms, camel races, etc. Intermediate hosts may act as vectors for viruses to reach their definitive host and viruses may undergo certain developments in intermediate hosts. They keep adapting.
are popular, so it is likely that their trade would continue underground. In many parts of Africa, people simply have no choice but to keep hunting wild animals for protein. Bushmeat also finds its way to Europe and is sold in black markets. As humans keep cutting the territories of wildlife down, the opportunity for contact increases. Intensive farming, where there is close proximity with animals, accelerates the transmission of airborne diseases. We need to take care of our environment and realise that we are part of a larger ecosystem: our future depends on it.
Is the definitive closing of the socalled ‘wet markets’ – the place where the corona virus is purported to have originated from – a solution? Closing them while the pandemic is ongoing helps of course. But in many countries of the world, buying a live animal or having one slaughtered at the market is the only guarantee of fresh meat. Pangolins are an endangered species – but they Pierre Dorny
IN THE EYE OF A PANDEMIC: ALUMNI INSIGHTS FROM THREE CONTINENTS ITM students come from near and far. This diversity allows ITM to weave this multitude of viewpoints, insights and local and global knowledge into the scientific and cultural fabric of the Institute. Despite the lockdown, the peak of the global pandemic in the spring left this global exchange unhampered. Our alumni stepped up and shared their experiences and approaches with the larger ITM community via a series of alumni webinars. P3 had the chance of catching up with three of the speakers to get their local views on living through the pandemic and their hoped-for visions for the future from Africa, Asia and Latin America.
When talking with her in June, the pressure of the pandemic, even over the phone, was palpable. She spoke of her 12-hour, seven days a week working schedule that was only just starting to ease. This is because, as project manager of a COVID-19 Response Project, she was still in the COVID-19 storm, one that had been brewing since January 2020, when
DR SOLOME OKWARE, UGANDA, AFRICA Solome Okware is a medical doctor with a Master of Science in Public Health - International Health from ITM. Since January 2019, she has been working in Kampala at the Ministry of Health of the Republic of Uganda as Senior Health Technical Advisor from the Infectious Diseases Institute of Makerere University.
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they saw the numbers of COVID-19 cases mounting in China.
DR PRASHANTH N SRINIVAS, BENGALURU, INDIA
During these stressful months, her role has encompassed, along with general project management, the development of guidelines for case management, infection prevention and control and occupational health and safety of healthcare workers. While actively participating in the Incident Management Team of the government’s COVID-19 Task Force, she has also been advising on strategies needed for community-based surveillance and continuity of essential health services.
Full of energy, Prashanth N Srinivas tells me about the re-appropriation of the name Bengaluru, the local word for ‘Bangalore’ given during colonial times. This comes as no surprise given his leadership role at the Institute of Public Health in Bengaluru of the health equity cluster team. Like all three of our interviewees, he too is a medical doctor and like Solome also did a Master’s in Public Health at ITM but added to it a sandwich ITM PhD in public health at the Catholic University of Louvain.
Beyond her current storm of national infectious disease response, we ask her to look to her hopes for the future, for the end of the year and into 2021. “Like many places across the world, the pandemic has shown a lot of cracks in our healthcare system and the inequalities that exist across society in relation to access to care. I hope this will stimulate a bigger focus on helping underserved groups.”
He manages a public health research field station in southern India and through a DBT/Wellcome Trust India Alliance fellowship is examining health inequities in indigenous communities in both southern and northeast India. A group that were inadvertently affected by the coronavirus, due to the large numbers of mainly young men from these communities whose livelihoods were cut literally overnight due to the lockdown.
“I also very much hope that our citizens have heard the Ministry’s messages and now understand their own personal responsibility in protecting themselves from the virus. It is something that we have to live with for the foreseeable future and I hope each individual sees that government intervention has its limits in stopping the spread of the virus and that they have a key role in staying safe and keeping others safe.”
He explained his position and his hopes for the future involving a focus on a holistic approach: “The pandemic highlighted that health is intricately linked with other social systems. Migrant workers in India are the backbone of the economy, yet they have been made invisible in our policy and planning. The pandemic forced us to acknowledge their problems. Their incomes were feeding families in remote areas. A swathe of issues related to withdrawal from chronic alcoholism came as people had no income to feed their alcohol habit.
Chronically ill people were unable to get treatment. These already difficult issues became acute problems under the COVID-19 response. So, I hope it has highlighted the need for publicly funded primary healthcare.” “Also if we look at it through a ‘One Health’ lens – we know the virus was transferred from animals to humans – a fact
that can be linked to land-use methods and the loss of habitats and other drivers of climate change, you see how it’s about addressing the whole system. I think if we don’t take a system-wide approach, we’re going to encounter the same problems again and again. So, I really hope we take systemic lessons away from the whole experience and drive real change.” 15
DR AQUILES R HENRÍQUEZTRUJILLO, ECUADOR, LATIN AMERICA Aquiles R Henríquez-Trujillo is a family doctor and professor and researcher for the One Health Research Group, Universidad de las Américas. He is also a graduate from our Short Course in Clinical Research & Evidence Based Medicine (SCREM). Ecuador was called the Latin American epicentre of the COVID-19 epidemic in the spring. Again, it was a moment that showed the inequities and the fragmented nature of the Ecuadorian healthcare system and the lack of public access to health. As such, Aquiles had also been working nights and weekends with the team at the university and this particularly around
the production of COVID-19 tests for underserved populations such as prison detainees and tribal populations in the Amazon basin. His hope for the future? “The crisis proved there is no global solidarity when it comes to ensuring the supply of the needed equipment during the pandemic – countries have been hoarding these things. This included the ingredients for testing – reagents and primers for example, also for personal protective equipment and for ventilators. I hope we can develop the capacity to produce these things locally and lose our dependency on imported technology. This is what we are currently doing in our team at the university – focusing on testing. So, this is my direct future as I don’t see it easing up over the next six months or more.”
WHAT IS THE IMPACT OF COVID-19 ON POTENTIALLY VULNERABLE GROUPS IN ANTWERP? Researching ethnic minorities during a pandemic requires a distinct approach. Since March, ITM researcher Christiana Nöstlinger has been coordinating a research project on the impact of COVID-19 on three ethnic minority groups in Antwerp. Before the lockdown started in Belgium, Christiana was working on the HIV-SAM project, which implements interventions of HIV prevention and sexual health promotion for communities with sub-Saharan African background in Flanders. “Due to the COVID-19 situation, the outreach prevention work was no longer possible. At the same time, we got questions on COVID-19 from this particular group,” Christiana explains. Also, the Governor of Antwerp and Chair of ITM’s Board of Governors Cathy Berx and ITM Director Marc-Alain Widdowson proposed researching the information reach of COVID-19 measures among cultural-ethnic minorities. The Orthodox Jewish community, the Turkish/Moroccan community and the
sub-Saharan African community living in Antwerp were the three groups of interest. “At the beginning of the lockdown the Orthodox Jewish community was singled out in the media. To us, it was very important to avoid the stigma-
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What we did notice is the collateral damage of the lockdown measures.
tisation of any group and to look from an objective point of view. Are these groups getting the information they need? That was our main question.” Because of COVID-19 measures, real-life face-to-face interviews were off the table. “We then opted for another procedure and did video calls with the interviewees. This approach presented its own challenges: there were instances of poor internet connection, distracted interviewees as the calls took place in their homes, and limited body language. But we managed.” 17
This rapid assessment had to run quicker than usual. “That’s why our preliminary findings are based on summaries of the interviews. The full transcripts of the interviews were typed out in a later phase, to be able to produce more detailed publications.” Similar to other research assessments, key community members were contacted. For instance, integration services such as Atlas and Samenlevingsopbouw vzw (community development organisation), helped to create a snowballing system for finding key people in the Turkish/Moroccan community. Also, people taking up a leading role or a coordinating position in the Orthodox Jewish community were
invited to take part in the project. More than 20 key informant interviews, indepth interviews and online group discussions have taken place so far. Research is a process. Along the way, from ‘Are these groups getting the information they need?’, the research question evolved into ‘What is the impact of COVID-19 on the community?’, Christiana explains. “During the process it became clear that a lot of information on COVID-19 reached these groups, and in particular the Jewish community of Antwerp. They are very well organised internally, with their own structural network that informs other Jewish inhabitants of Antwerp.”
“What we did notice is the collateral damage of the lockdown measures. Practicing their religion is very important for the Jewish community: not being able to pray together, to go to the synagogue and do other religious rituals caused a lot of harm. In a really early stage people within the community worked out a plan on how to safely practice their religion while respecting COVID-19 prevention measures. For them, the governmental permission for reopening the synagogues took a very long time.” “Religious practices and social gathering seem really important in the other two communities as well. We found out that among sub-Saharan communities, people tend to rely more on their own social networks and certain types of social media when gathering their information. Due to the amount of ‘fake news’ that people are confronted with, we observed a great need for correct and clear information about the new disease and effective prevention measures to reduce COVID-19 related anxiety and uncertainty. In general, people in this group tend to be more afraid and anxious when they don’t get reliable and clear information.”
Christiana Nöstlinger coordinates the project as principal investigator (PI) together with Koen Peeters as Co-PI. The project involves several ITM research groups. These are: the Unit of Sexual & Reproductive Health, the Unit of Medical Anthropology and the Outbreak Research Team (ORT). ITM investigators who worked on this assessment are: Jef Vanhamel (responsible for the Orthodox Jewish community), Anke Rotsaert, Maya Ronse, Yoriko Masunaga, Ella Van Landeghem (responsible for the Turkish/ Moroccan community), Thijs Reyniers, Charlotte Gryseels, Lazare Manirankunda and Charles Ddungu (responsible for the African community), Deogratias Katsuva, Stef Dielen, Marie Meudec (ORT), and Greet Segers, Monique Ceulemans (for administrative support).
With the resurgence of COVID-19 infections during the summer, this type of action research can play an important role in informing policy and prevention, such as channelling tailor-made information to community members through the established networks. The project has been consulted by the City and Province of Antwerp to support target group-specific policies.
Christiana Nöstlinger
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PHOTO STORY
POSITIVE OR NEGATIVE? DIAGNOSING COVID-19 The spring of 2020 was an extraordinarily busy period for our colleagues of the Department of Clinical Sciences, namely those in our Clinical Reference Laboratory. This included: evenings and weekends for the team, the reorientation of several lab technicians, who work on other diseases, towards diagnosing COVID-19, and brought the enlistment of extra hands and minds from the Unit of Virology of the Department of Biomedical Sciences. This is because the pandemic saw our diagnostics being under high demand for SARS-CoV-2 — the strain of the virus that causes COVID-19 —, with the lab servicing hospitals from the Antwerp region and Médecins Sans Frontières (Doctors Without Borders) in its project with homeless people in Brussels. So, what happens to a sample and how is COVID-19 diagnosed in a laboratory?
1. For safety, samples marked CORONA arrive directly at the lab. During the April peak, the lab received up to 60 samples a day. Numbers by June were down to around ten.
2. Lab technician Lara Balcaen wears two pairs of gloves and protective sleeves to work in a biosafety cabinet. Here she inactivates the suspected COVID-19 samples, so that no live virus remains. The cabinet is an enclosed, ventilated workspace protecting her from any (potentially) hazardous microorganisms.
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3. To deactivate the samples, Lara adds buffers and enzymes. Lab technician Amina Taibi passes reagents and samples to her, which allows Lara to keep her poten-
tially contaminated gloved hands inside the biosafety cabinet during the entire procedure.
4. Once inactive, samples go into an automated instrument for RNA extraction. RNA stands for ribonucleic acid and it is where the genetic information of the virus is encoded. Following extraction, lab technician Fatima Zajmović-Huseinović adds the RNA to a mix prepared in the
‘clean room’, a space where test reagents cannot be contaminated by other DNA/ RNA of previous tests. RNA/DNA contamination is the ‘horror story’ of genetic diagnostics as it can lead to false positive results and misdiagnosis.
5. Fatima puts the mix with the extracted RNA in ‘the PCR machine’. PCR stands for ‘polymerase chain reaction’. The PCR machine amplifies the genetic sequence of SARS-CoV-2, so that there is enough genetic material for an accurate detection of the virus and diagnosis of COVID-19.
6. After 4-5 hours, the results are ready for final validation by the clinical biologist (here Dr Marjan Van Esbroeck). Once validated, results are sent to the requestors.
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REWIND
ONCE UPON A TIME IN THE TRAVEL CLINIC…
Many years ago, our travel clinic was visited almost exclusively by missionaries, sailors, globetrotters, and expats. A lot has changed since then, and the role of the clinic has greatly expanded. We talked with now retired Dr Fons Van Gompel, the clinic’s ‘living memory’ and a walking encyclopaedia. Dr Van Gompel started working at the Institute in 1986 and became head of medical services in 2000. Until his retirement in 2015, he remained the point of contact for staff and press on travel health, and today he regularly helps out as a volunteer in the clinic.
“ITM is still dear to me and I feel happy every time I walk in,” muses Dr Van Gompel. Looking back in time, how did the travel clinic operate 35 years ago? “Travel clinics did not really exist then. In 1987 we set up a separate ‘pretravel policlinic‘, where departing travellers could get a vaccine against yellow fever and some other diseases, possibly supplemented by malaria pills. We mainly did clinical work with patients who had health problems after a stay in the tropics. We got to see plenty of interesting pathologies and almost always found a remedy.”
During the renovation of the clinic in the early 90s, containers were placed in the garden.
The reception of the clinic in 1991. Today’s reception is located at the same place, but it was renovated in the early 90s.
KEY SOURCE OF TRAVEL INFORMATION The number of travel vaccines has increased over the years and we have gained a better understanding of the prevention and treatment of many diseases, such as malaria. At the same time, the number of travellers – and the number of potential travel diseases – have also increased year after year. The role of the travel clinic as an information provider was and is extremely important. “We relentlessly worked on brochures and manuals to provide general practitioners and travellers with the correct information. If there was an outbreak or an epidemic anywhere in the world, the Institute could be counted on to give the press a thorough insight into what was happening” says Dr Van Gompel. A MYRIAD OF TRAVEL ADVICE In 1992, ITM modernised the services and set up an automatic travel advice helpline. “I recorded hundreds of travel advice messages,” he recalls. Since 1999, the Institute has put this information
on its website and in 2019 we developed Wanda, a smartphone app that supports healthy travels. Over the years, the clinic also became involved in ITM’s education programme and helped train nurses and doctors who intended to work in the tropics by giving them a thorough immersion in tropical medicine. PUTTING ITM ON THE MAP “The travel clinic’s scientific undertakings have expanded nationally and internationally since I started in 1986. In the early years we described mainly instructive cases. We were active members of the International Society of Travel Medicine and numerous other international research groups,” adds Dr Van Gompel. “Colleagues like Jef Van den Ende, Manu Bottieau, Mieke Croughs and Patrick Soentjens really gave a boost to structured research on pretravel issues in the past decades. During and after their doctoral studies they carried out international ground-breaking research that put our Institute on the map,” he concludes, not without a measure of pride.
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PORTRAIT
THE MAKING OF THE MASKS In times of crisis, like the one presented to the world in spring of this year, people react differently. Sticking your head in the sand is one possible option, another is to panic and to start hoarding toilet paper, and then there are those who become resourceful and who get very, very busy. ITM’s Ilse Maes, laboratory technician in the Unit of Molecular Parasitology, Department of Biomedical Sciences, is a shining example of the latter. It all started in a discussion on the rarity of protective mouth masks during the beginning of the COVID-19 pandemic with her head of unit, and member of ITM’s COVID-19 Committee, Jean-Claude Dujardin. From this discussion at the end of April, Ilse, an accomplished seamstress, found a good pattern, made a three-foldfabric-with-space-for-a-filter prototype, bought 55 metres of African Wax fabric, three km of black cord and 10, 200m bobbins of black thread, enlisted the help of 24 ITM volunteer seamstresses, made a ‘how to’ training video for YouTube and got cracking to make sure everyone had all they needed to produce 1500 masks to help keep ITM staff safe during the pandemic.
“A local charity – ’Creatives tegen Corona’, in English creative artists against corona – had provided the material for 300 white masks, so the plan was to buy the material for another 1200 so that we could make 1500 in total. This meant we could offer three masks to each 500 of our colleagues,” explains Ilse. “Sewing started on 3 May, and by 20 May, we’d put together 300 packages. By 2 June all masks were done and ready for distribution to everyone,” says Ilse, almost unbelievingly. Ilse’s work in the laboratory, assisting masters and PhD students in their research projects, had to stop during the Belgian confinement period. She was given knowledge management tasks to start, and once her mask production and distribution ‘cottage industry’ began, Ilse, as so many others involved in pandemic activities, was working nights and weekends, along with caring for and home schooling her two small children. “It was a very busy period. Luckily the mask making was something my whole family got involved in. My husband took on the task of cutting the three kilometres of black cord into 50cm lengths needed for the 4,800 mask ties. To begin, he started cutting one at a time. Then my daughter invented a machine with a building-block toy that could measure
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Sewing started on 3 May, and by 20 May, we’d put together 300 packages [of 3 masks].
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five cords at a time – she ended up saving her dad a lot of time!” And this is not to mention logistics: “Along with my fellow seamstresses, a big thank you goes to the packaging team of six people who made up separate bags of three masks each for every colleague. A special thank you goes to Simon Geerts from the Unit of Safety, Health, and Environment at ITM. He did a wonderful job sourcing and ordering the packaging materials and managing logistics with me. He even came up with a sticker for each of the bags. Alongside his heart illustration, he wrote ‘Houd moed, ook dit komt vast weer goed’ – which is a Dutch rhyme for, ‘stay courageous, all will soon be OK’.” Despite all the uncertainties this global pandemic entails, one thing is sure: ITM staff are safer (and very individual) with their masks on. And what’s next for Ilse? “We’ve had another order of 50 masks, this time with elastic ear attachments, rather than cord ties, which will be used as gifts to people visiting the Institute. And talking of visitors, we’re proud to say the King and Queen of the Belgians visited ITM in June, and they each received one of our masks – what better way to end a difficult period!” she added with a smile.
Seamstresses and seamsters » » » » » » » » » » » » » » » » » » » » » » » » »
Gertrudis De Greef Isa Bogaert Davy Hendriks Lieselotte Cnops Anita Vermeulen Lieve Vermeiren Marleen van Dijk Raquel Inocencio Da Luz Caroline Theunissen Fiona Robertson Anne Marie Trooskens Christel Desmaretz Lieve Vanherck Linda Paredis Louize Brants Evi Pockele Simon Geerts Françoise Dehondt Britta Campe Sandra Coppens Margo Wouters Jolein Laumen Katrien De Pauw Ann Ceulemans Ilse Maes
Packaging team » » » » » »
Karin De Ridder Stéphanie Raeymaekers Valerie Bastiaensen Margo Wouters Lieve Vermeiren Simon Geerts
THE LIST
TIPS FROM ITM STAFF FOR GETTING THROUGH A LOCKDOWN 18 March 2020. Belgium went in lockdown to halt the spread of the coronavirus. We stayed home, banned all but essential travel and generally put our
life on hold. How did ITM staff and students experience this challenging period? And how did they look after themselves?
KEEPING IN TOUCH! As a PhD student at ITM, Kéfilath Bello comes to Belgium only occasionally. She works as a researcher at the Centre for Research in Human Reproduction and Demography (CERRHUD) in Benin, her home country. When Belgium went in lockdown, she was suddenly stranded here for far longer than anticipated. “When the borders closed, I felt rather upset because nobody could tell me when I would be able to return home. I ended up staying in Antwerp for four months instead of the two that I had planned. The only way I could deal with this situation was by keeping in touch with people at home.” I was glad that I could go to the office regularly. Some of my colleagues became good friends. However, once my workday finished, I longed for my family. We talked on WhatsApp, but long calls were too expensive. Luckily, my husband and three children were doing fine.”
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I was glad that I could go to the office regularly. Some of my colleagues became good friends.” # THE LIST 29
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And once I danced until the early hours of the morning during an online dance party!
RUNNING IN THE WOODS Philippe Selhorst is a member of ITM’s Outbreak Research Team. As a virologist, he travels the world to crack the genetic code of viruses. For example, he helped decode the chikungunya virus in Congo, and the Zika virus in Cuba. “Before COVID-19, I had a similar work schedule. We work through evenings and weekends, even during small virus outbreaks. The lockdown actually took away my stress, because my social life came to a halt and I could fully focus on my lab work. I normally go rock climbing in my spare time, but during the lockdown I went running instead in the beautiful St. Annabos. Occasionally I met up with some good friends, while respecting the social distancing rules. And once I danced until the early hours of the morning during an online dance party!”
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I am lucky to have my own ‘office’ space [at home].
ONLINE WORKOUT FOR A SMOOTH TRANSITION Shortly after the lockdown, Nandini Sarkar finished her PhD thesis on health care in rural Uganda. Her next ITM project was turned upside down. “Even before the lockdown I occasionally worked from home and I am lucky to have my own ‘office’ space there. However, things got really busy because my planned field work was cancelled.
To keep my body and mind active, I started to exercise more. After a while, I liked it so much that I added an online cardio workout to my daily yoga session. During all these months at home the workout helped me structure my time and made for a smooth transition between my work and me-time.”
# THE LIST
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CALENDAR 31 Aug
Start of the Academic Year
27-29 Oct
61st ITM Colloquium (online)
8-11 Nov
6th Global Symposium on Health Systems Research (virtual)
22 Nov
Flemish Science Day (digital edition)
Nov
Documentary series about ITM goes on air on Canvas
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