OCTOBER 2020 | COVID-19 MINI ISSUE
EXPLORING ANOTHER PIECE MEDUSTORY: OF THE PUZZLE DR. ANTHONY FAUCI
M E NE TA H ACRY H A L ILFEEN& G ECA S IRNE EC RH I L D R E N AC OSM C IOERNBTIIDS T’S XTLRAHOE AR LT DIN M D ICSOV O RI D E- 19 R RESPONSE AWSI TTHH EA UF TA ICSEMOSFPAEMCTE R IUCA’S
PHYSICIAN-ASSISTED DYING MEDPULSE - 19 E WB OA PL TPIEORNS PI NE CT CAINVAE DOI N A NC OV E N IDD O F L I F E CA R E A GN LO
SHINING LIGHT ON BIOMEDICINE: COVID-19 & DEPRESSION R.B NM DIN R EG CT O R O F TI NHTEESRV O CI EI AWL WD IETTHE RDM I NRAUNCTES WA O F IW O RA SN,E N O GMRA MUIRNI A Y NDEMIC DT H E PE REEDSUSCAT I V E I SOYNMPPRTO SD NN G ATO T H EMPA
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table of CONTENTS 01
INTRODUCTION
02
MEDPULSE
04
MEDBULLETINS
06
MEDUSTORY
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INTERVIEW SPOTLIGHT
M E D U CATO R
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COV I D-19 M I N I I S S U E
table of contents
OCTOBER 2020 I COVID-19 MINI ISSUE
COVER ARTIST WENDY ZHANG TOC ARTIST MANREET DHALIWAL
dear reader,
INTRODUCTION
We are excited to share with you a special issue of The Meducator dedicated exclusively to COVID-19. Since March, this pandemic has continued to alter many dimensions of our daily lives within a short amount of time and has challenged us both as individuals and as a community. As seen in the cover illustrated by Wendy Zhang, the reflection of the virus in front of us acts as a reminder of humanity’s progress thus far and the obstacles that await us. Our executive team felt that it was important to take this as an opportunity to reflect on and expand our knowledge of the progressing situation. Moreover, we wanted to provide an avenue for our readers to do the same. Due to the unpredictable and ever-evolving nature of COVID-19, we would like to remind you that the information presented in this issue is merely a representation of the current body of knowledge, and is subject to change. With the pandemic highlighting the influence that key figures have on global responses, we are excited to debut a brand new article type, MeduStory. MeduStory shines a spotlight on an important individual within the health sciences, highlighting their contributions to their field and their journey to prominence. In this issue, Aaron Wen and Sophie Zarb provide a brief history on the early life of Dr. Anthony Fauci, and illustrate his vital contributions to pandemic responses over the years.
This special edition was the result of collaboration between the executive team and many passionate individuals from the editorial board and graphics and design team. Thank you to everyone involved in this project, and to our readers for providing us with support to explore pertinent global issues. We also want to thank healthcare workers across the globe for their continued dedication during these tumultous times.
introduction
Accompanying MeduStory, Nick Teller and Meera Chopra showcase the impacts of COVID-19 across the globe, and how countries have chosen to respond to the crisis. Conversely, Adrian Wong, Nuri Song, and Zahra Abdallah employ a more bottom-up approach, examining how the pandemic affects individuals both physically and mentally. Finally, Dr. Karen Mossman, the Vice-President of Research at McMaster University and Professor in the Department of Pathology and Molecular Medicine, highlights her approach to understanding SARS-CoV-2.
May you continue to be curious and inquisitive, regardless of the circumstances. Sincerely, The Meducator Executive Team 2020-2021
Editors Adrian Wong Matthew Lynn Meera Chopra Nick Teller Nuri Song Rohan Aananth
M E D U CATO R
Graphic Designers Annisa Siu Manreet Dhaliwal
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WE WOULD LIKE TO THANK OUR SPONSORS FOR THEIR GENEROUS SUPPORT
Bachelor of Health Sciences (Honours) Program
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COV I D-19 I S S U E
CONTRIBUTORS Executive Team Daniel Rayner, Editor-in-Chief Karishma Mehta, Editor-in-Chief Aaron Wen, Managing Editor Sophie Zarb, Managing Editor Peri Ren, Creative Director Wendy Zhang, Creative Director Zahra Abdallah, Subcommittee Advisor Shadi Sadeghian, MeduCollab Director Michal Moshkovich, MeduCollab Director David Klitovchenko, Video Manager
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Guatemala | June 2020
MEDPULSE
Meerhopra & Nick Teller Artist: Peri Ren Authors: Meera ChoAuthors: Meera praMEERA & Nick Teller &&NICK TELLER Authors: Meera Chopra CHOPRA Chopra AUTHORS: &Nick NickTeller Artist: Peri Ren ARTIST: PERI REN
The Guatemalan government has been criticized for its handling of COVID-19 pandemic. Obscure regulations with unclear curfews ha rendered marginalized and susceptible populations unprotected. T government has been accused of tailoring policies towards the busin interests of the Guatemalan Chamber of Commerce. These policies ha created confusion amongst an uneducated population about pro approaches to medicine, reporting behaviour, and treatment of those t test positive for COVID-19. Reports indicate that the country has less th 400 intensive care beds and 50 respirators. By mid-May, when pandemic had not yet hit its peak, two reference hospitals had alrea collapsed. The president's response has been to refer to the virus a simple flu, assuming that infections would subdue with rising temperatur The country remains in a dire state and in need of aid.
Costa Rica | May 2020
Costa Rica's healthcare system has been praised for its success in improving health outcomes such as longevity, as well as decreasing stillbirths and infant mortality. Since February 2020, the Costa Rican Ministry of Health and the Costa Rican Social Security Fund have been making suggestions and guidelines through mass-media public educational campaigns in an effort to reduce the transmission of respiratory viruses before the country's first case of COVID-19. Recommendations began with churches reducing hand and mouth contact during ceremonies, and were followed by suggestions about improved hygiene, including hand washing, sneezing into the elbow, and avoiding contact with the mouth and nose when hands have not been washed. Enforcement of physical distancing has been steadily increasing since March 11, 2020. Since then, schools and public spaces have been closed, international travel has been limited, and long-distance transit and free transit have been forbidden.
Panama | June 2020
Panama has the second highest level of wealth inequality in Central America, one of the highest testing rates in the region, and one of the highest numbers of detected cases of COVID-19. By May 11, 2020, over 8,616 people in Panama City had been infected, and 249 of those people died. The Ministry of Health in Panama has established an effective containment strategy and has covered all ports of entry into the country since January 2020. To combat the spread of COVID-19, one idea that has been brought up is the introduction of a phone application that allows those affected to report their symptoms, so that people know if they have been exposed. Currently, schools are closed nationwide, and stringent social distancing regulations have been implemented, such as absolute quarantine during weekends and curfews based on gender and personal identification numbers.
References can be found on our website: meducator.org References can be foun
Citations can be found on our website: meducator.org
Rwanda | July 2020
After the outbreak of COVID-19 in Rwanda, several techniques were used to contain the spread of the virus. On social media, two campaigns were organized to encourage compliance with public health measures, including #GumaMuRugo (encouraging staying at home) and #NtabeAriNjye ("Let it not be me") to fight complacent feelings about the virus. Furthermore, testing in Rwanda is widely available and returns results quickly. Rwanda uses a system called "pool testing," where groups of nasal swabs are tested together for COVID-19 —if they return a positive result, then the swabs are tested individually. Technology is also used to limit the spread of the virus; robots check temperatures, find medical records, and monitor patients to minimize infections among healthcare workers. Furthermore, Rwanda has enforced mandatory face coverings and physical distancing guidelines.
the ave The ness ave oper that han the ady as a res.
Japan | September 2020
A study in Japan is aiming to determine the feasibility and accuracy of saliva samples for COVID-19 testing. The current method of testing is nasal swabs, which may result in higher levels of exposure to the virus for the healthcare professionals taking the sample. Researchers obtained both nasal swabs and saliva samples from symptomatic patients and staff at a hospital in Tokyo, and used reverse transcription-polymerase chain reaction to detect the presence of the virus. The study found that saliva samples displayed the same result as nasal swabs in 96.4% of tests. Researchers concluded that saliva samples can be used instead of nasal swabs to test for COVID-19, especially if the saliva sample is taken within ten days of the onset of symptoms. Furthermore, saliva samples are viable for testing even after long-term storage at room temperature, although more research needs to be done on a larger sample size to verify this result.
Indonesia | July 2020
A study in Jakarta, Indonesia aimed to determine the correlation between weather and the spread of COVID-19. Researchers recorded the minimum, maximum, and average temperature, as well as the humidity and amount of rainfall, and determined their correlation to the number of new cases. The study determined that the average temperature was significantly correlated with the number of COVID-19 cases. Researchers further explained that the spread of the virus in Jakarta is also mediated by high mobility and high population density. Further research needs to be done to assess the impact of other factors on virus transmission that may correlate with temperature, such as population mobility and endurance, as well as hand hygiene habits.
New Zealand | August 2020
The first case of COVID-19 in New Zealand was discovered on February 26, 2020. After a few weeks, officials found that the country did not have adequate contact tracing and testing abilities to contain the virus. The government decided to enforce a national lockdown on March 26 by limiting travel, eliminating public gatherings, and closing all non-essential businesses. After seven weeks of implementing these guidelines, the last known COVID-19 case was identified in early May. The country continues to enforce certain public health measures, such as preventing public gatherings with larger than a 100-person attendance and mandating that face coverings are worn in most public areas.
Argentina | May 2020
Argentina was hit with the COVID-19 pandemic at a time of weakness; a new national government had taken office in December 2019 and the Argentine peso had lost 68% of its value since April 2018. In response to the pandemic, Argentina instituted policies that provide free alcohol gel and sodium hypochlorite deliveries to homes. Several municipalities have produced educational materials that have been distributed on social-media networks, while others have promoted production of clothing for healthcare workers. Recently, some local governments have begun creating tunnels for vehicle disinfection, and municipal governments have been preparing isolation beds in hotels and schools for the infected. Twelve modular hospitals have been built in the most densely populated regions of the country, adding 350 intensive care beds and 650 intermediate therapy beds to the system.
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COVID-19 INFECTS BRAIN ORGANOIDS AD R I A N W O NG
NUR I SO N G
W hi le COV ID-19 is most k now n for causing respirator y i l lness, neurologica l sy mptoms have a lso a risen a mong infected pat ients. In Apri l, Mao et a l. repor ted t hat out of 214 pat ients in Wu ha n, China, 36.4% a lso suf fered f rom neurologica l ma nifestat ions. 1 These sy mptoms ca n ra nge f rom t he common headaches, dizziness, a nd loss of smel l or taste, to more severe condit ions such as acute ischemic stroke, encepha lit is, a nd Gui l la in-Ba rré sy ndrome. 2 Yet, to date, t he connect ion bet ween COV ID-19 infect ion a nd pat hologies of t he ner vous system rema ins incomplete.
Ev idence shows t hat a nosmia, or loss of smel l, is a prominent sy mptom of SA R S -CoV-2 . 1 Ident if ied as one of t he ea rliest signs of v ira l infect ion, a nosmia is present in 33.9% to 68% of sy mptomat ic ind iv idua ls, as fou nd by a nu mber of cross-sect iona l stud ies. 2 , 3 W hi le t he loss of smel l is a n accepted consequence of SA R S -CoV-2 , its pat hogenic mecha nism has been u nclea r u nt i l recent ly.
New resea rch f rom t he Universit y of Hong Kong has revea led t hat t he SA R S-CoV-2 v ir us ca n direct ly infect neurona l progenitor cel ls (NPCs) a nd bra in orga noids. W hi le NPCs may dif ferent iate into va rious neurona l cel l t y pes, bra in orga noids mimic t he str ucture a nd development of t he hu ma n bra in a nd have been used to understa nd how v ir uses ca n cause encepha lopat hy. 3,4 Zha ng et a l. f irst infected NPCs w it h SA R S-CoV-2 , using SA R S-CoV v ir us as a control. It was found t hat on ly SA R S-CoV-2 was capable of replicat ion in NPCs, a nd t hat t he qua nt it y of NPCs was reduced to 4.7% of its origina l va lue fol low ing SA R S-CoV-2 infect ion. 3 The resea rchers t hen infected a bra in orga noid w it h SA R S-CoV-2 a nd discovered signif ica nt a mounts of v ira l a nt igen 72 hours a f ter infect ion, indicat ing direct infect ion by t he v ir us.
Hy pot hesizing t hat t he loss of smel l in pat ients was due to t he binding of a ng iotensin-conver t ing enz y me 2 (ACE2) receptors by t he v ir us, resea rchers at Johns Hopk ins conducted a notable prelimina r y study mapping ACE2 receptors in nasa l t issue. 4 The study resu lts demonst rated a hig h concent rat ion of ACE2 receptors in t he olfactor y neuroepit heliu m. To obta in study f ind ings, Chen et a l. collected olfactor y epit heliu m a nd respirator y epit helia l sa mples f rom chronic rhinosinusit is pat ients a nd cont rol subjects. They conducted a n immu nohistolog ica l a na lysis, revea ling a hig h concent rat ion of ACE2 receptors on sustentacu la r cel ls, which a re a t y pe of st r uctura l nasa l cel l in t he olfactor y neuroepit heliu m. 5 It is li kely t hat SA R S -CoV-2 ta rgets t hese cel ls as a key point of ent r y into t he body, ex pla ining t he onset of a nosmia in t he ea rliest stages of infect ion. As a resu lt, Chen et a l. have suggested t hat when pat ients a re asy mptomat ic, t he olfactor y cel ls of t he nasa l t issue might be t he sing u la r site of infect ion.
The f indings of Zha ng et a l. have implicat ions for understa nding t he lin k bet ween COV ID-19 infect ion a nd its neurologica l ma nifestat ions, especia l ly by suggest ing t he possibi lit y of neurona l infect ion by SA R S-CoV-2. Addit iona l ly, t he infect ion a nd subsequent reduct ion of NPCs cou ld negat ively a f fect possibi lit ies of recover y. 3 Given t he increasing impor ta nce of t he neurologica l sy mptoms of COV ID-19 —especia l ly t he loss of smel l a nd taste —t hese f indings inv ite f ur t her resea rch into t he long-term impact of SA R S-CoV-2 infect ion on t he centra l ner vous system as wel l as neurologica l lyfocused treat ments. 3
The g iven f ind ings have va rious implicat ions for t herapeut ic approaches for COV ID-19. By helping to ex pla in t he ra nge of nasa la nd taste-related sy mptoms of COV ID-19, t he study has adva nced t he sea rch for t he best topica l or loca l a nt iv ira l dr ugs for COV ID-19, as wel l as ot her t herapeut ic approaches. W het her sa line irrigat ion, a common t reat ment for sinonasa l cond it ions, has potent ia l to mit igate spread of infect ion is st i l l u nclea r; however, a nt iv ira l dr ug add it ives such as detergent or pov idone iod ine d irected at nasa l v ira l reser voirs shou ld be f ur t her ex plored. 6
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COVID-19 AND ANOSMIA
Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683–90. Available from: doi:10.1001/ jamaneurol.2020.1127. Zhou Z, Kang H, Li S, Zhao X. Understanding the neurotropic characteristics of SARS-CoV-2: From neurological manifestations of COVID-19 to potential neurotropic mechanisms. J Neurol. 2020;1–6. Available from: doi:10.1007/s00415-020-09929-7. Zhang B-Z, Chu H, Han S, Shuai H, Deng J, Hu Y, et al. SARS-CoV-2 infects human neural progenitor cells and brain organoids. Cell Res. 2020;1–4. Available from: doi:10.1038/s41422-020-0390-x. Trujillo CA, Muotri AR. Brain organoids and the study of neurodevelopment. Trends Mol Med. 2018;24(12):982–90. Available from: doi:10.1016/j.molmed.2018.09.005. Garcez PP, Loiola EC, Costa RM da, Higa LM, Trindade P, Delvecchio R, et al. Zika virus impairs growth in human neurospheres and brain organoids. Science. 2016;352(6287):816–8. Available from: doi:10.1126/ science.aaf6116.
Image: Vaccarino Lab, Yale University. Research published in: (Amiri et al., Transcriptome and epigenome landscape of human cortical development modeled in organoids. Science 362,2018)
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Meng Z, Deng Y, Dai Z, Meng Z. COVID-19 and anosmia: A review based on up-to-date knowledge. Am J Otolaryngol. 2020;41(5):102581. Available from: doi:10.1016/j.amjoto.2020.102581. Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: A cross-sectional study. Clin Infect Dis. 2020;71(15):889–90. Available from: doi:10.1093/cid/ciaa330. Menni C, Valdes A, Freydin MB, Ganesh S, El-Sayed Moustafa J, Visconti A. Loss of smell and taste in combination with other symptoms is a strong predictor of COVID-19 infection. medRxiv. 2020. Available from: do i:10.1101/2020.04.05.20048421. Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, et al. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. 2020;24:422. Available from: doi:10.1186/s13054-020-03120-0. Chen M, Shen W, Rowan NR, Kulaga H, Hillel A, Ramanathan M, et al. Elevated ACE2 expression in the olfactory neuroepithelium: Implications for anosmia and upper respiratory SARS-CoV-2 entry and replication. Eur Respir J. 2020;56:2001948. Available from: doi:10.1183/13993003.01948-2020. Higgins TS, Wu AW, Illing EA, Sokoloski KJ, Weaver BA, Anthony BP, Hughes N, PharmD, Ting JY. Intranasal antiviral drug delivery and coronavirus disease 2019 (COVID-19): A state of the art review. Otolaryngol Head Neck Surg. 2020;163(4):682–94. Available from: doi:10.1177/0194599820933170.
COVID-19 RECOVERY IN ADULTS AND CHILDREN
COVID-19 AND DEPRESSION AD R IAN WO N G , NUR I SO N G & ZAHR A ABDALLAH Depression is a cl i nica l cond it ion ma rked by reduced day-to-day pleasu re, a lack of energ y, a nd low sel f-esteem a nd has become a n issue of i ncreasi ng i mpor ta nce i n recent yea rs. 1 In 2017, over 260 mi l l ion people worldw ide were repor ted to be su f fer i ng f rom depressive d isorders. 2 E x ist i ng resea rch has establ ished t hat depression tends to i ncrease t hroug hout a nd a f ter t rau mat ic events. 3 In t he wa ke of its devastat i ng i mpac t on t he menta l hea lt h of i nd iv idua ls g loba l ly, t he COV ID-19 pa ndemic has been rega rded as a t rau mat ic event, prompt i ng resea rchers f rom Boston Universit y to hy pot hesi ze t hat depression levels wou ld i ncrease i n response to t he pa ndemic. 4
Prel i m i na r y resu lt s f rom A mer ic a n, C a nad ia n, Ch i nese, a nd Ir ish st ud ies have show n t hat c a ses of COV I D -19 may be less severe i n ch i ld ren t ha n i n adu lt s. One ped iat r ic c a se ser ies f rom t he Un ited States repor ted 56% of pa r t icipa nt s had a fever a nd 5 4% had a coug h; i n cont ra st , t hese rat ios i n adu lt pat ient s were 71% a nd 8 0% , respec t ively. 4 T h is d ata is relat ively consistent w it h mu lt iple st ud ies across t he g lobe. 1 Interest i ng ly, t he la rgest ped iat r ic c a se ser ies to d ate concluded t hat over 9 0% of ch i ld ren d iag nosed w it h COV I D -19 had a sy mptomat ic , m i ld , or moderate for ms of t he d isea se. 4 , 5
A lt houg h t hese f i nd i ngs sug gest t hat COV I D -19 i n ch i ld ren is m i ld i n sever it y when compa red to adu lt s, it is i mpor ta nt to mon itor t rend s i n it s ma n i festat ion a s new d ata emerges. 1 Add it iona l ly, f u r t her d ata i nd ic at i ng t he r isk of t ra nsm ission of COV I D -19 i n a school env i ron ment w i l l be essent ia l i n deter m i n i ng t he appropr iate mea su res to ta ke a s ch i ld ren ret u r n to cla sses. 2 , 3
T hese f i nd i ngs cor roborate ex ist i ng st ud ies on menta l hea lt h a mid t he COV ID-19 pa ndemic i n Asia, which demonst rated t he ex tent of t he pa ndemic as a psycholog ica l bu rden. 6 W hi le f u r t her monitor i ng depression preva lence t hroug hout t he pa ndemic is necessa r y, t hese f i nd i ngs st rong ly suggest t hat t he negat ive menta l hea lt h consequences of COV ID-19 w i l l be w idespread a nd long-last i ng. 7 Wit h t hese f i nd i ngs i n mi nd, govern ments may become more i nfor med to i mplement hea lt h pol icies to a l lev iate such consequences, especia l ly a mong i nd iv idua ls i n low-resou rce set t i ngs. 1. 2.
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Ho CLT, Oligbu P, Ojubolamo O, Pervaiz M, Oligbu G. Clinical characteristics of children with COVID-19. AIMS Public Health. 2020;7(2):258–73. Available from: doi:10.3934/publichealth.2020022. Kakkar F, Hepburn CM, Drouin O, Morris SK. Canadian Paediatric Surveillance Program commentary on hospitalizations from COVID-19 among children in Canada [Internet]. Canadian Paediatric Surveillance Program, COVID-19 Study Team. 2020 [cited 2020 Oct 9]. Available from: https://www.cpsp.cps.ca/ uploads/publications/CPSP_COVID-19_Commentary_September_2020.pdf. Viner RM, Bonell C, Drake L, Jourdan D, Davies N, Baltag V, et al. Reopening schools during the COVID-19 pandemic: governments must balance the uncertainty and risks of reopening schools against the clear harms associated with prolonged closure. Arch Dis Child. 2020:archdischild-2020-319963. Available from: doi:10.1136/archdischild-2020-319963. Tezer H, Bedir Demirdağ T. Novel coronavirus disease (COVID-19) in children. Turk J Med Sci. 2020;50(3):592–603. Available from: doi:10.3906/sag-2004-174. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than
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American Psychiatric Association, (ed.) Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, D.C: American Psychiatric Association; 2013. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858. Available from: doi:10.1016/S0140-6736(18)32279-7. Goldmann E, Galea S. Mental health consequences of disasters. Annu Rev Public Health. 2014;35(1):169– 83. Available from: doi:10.1146/annurev-publhealth-032013-182435 Kleber RJ. Trauma and public mental health: a focused review. Front Psychiatry. 2019;10:451. Available from: doi:10.3389/fpsyt.2019.00451. Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open. 2020;3(9):e2019686. Available from: doi:10.1001/jamanetworkopen.2020.19686. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976. Available from: doi:10.1001/jamanetworkopen.2020.3976. Galea S, Merchant RM, Lurie N. The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention. JAMA Intern Med. 2020;180(6):817. Available from: doi:10.1001/jamainternmed.2020.1562.
M E D U CATO R | A P R I L 2015 M E D U CATO R | COV I D-19 M I N I I S S U E
Despite t hese scopi ng rev iews of COV I D -19 i n ped iat r ic pat ient s, t he u nderly i ng c ause for t he m i lder sy mptoms i n ch i ld ren is st i l l u nclea r. 4 Severa l hy pot heses have been proposed , of ten cit i ng super ior hea lt h outcomes i n ch i ld ren’s respi rator y t rac t s a s a consequence of m i n i ma l ex posu re to ciga ret te smoke a nd a i r pol lut ion when compa red to adu lt s. 4 Moreover, ch i ld ren tend to have fewer r isk fac tors for compl ic at ions, wh ich cou ld reduce t he preva lence of severe c a ses. Fi na l ly, it ha s been proposed t hat SA R S - C oV-2 bi nd s to a ng iotensi n-conver t i ng en z y me 2 (ACE2), a nd t hat ch i ld ren may have l i m ited ACE2 f u nc t iona l it y compa red to adu lt s, t hus prov id i ng protec t ion aga i nst t he v i r us. 1, 5
Et t ma n et a l.’s st udy is t he f i rst to exa mi ne depression sy mptoms i n US adu lts before a nd du r i ng t he COV ID-19 pa ndemic. It col lec ted data f rom t wo su r veys — one for pre-pa ndemic depression levels a nd t he ot her for levels du r i ng t he pa ndemic. T he resea rchers fou nd t hat t he preva lence of such sy mptoms fol low i ng t he onset of t he pa ndemic (at 27.8%) was t r ipled compa red to t he preva lence before t he pa ndemic. T his i ncrease i n preva lence was hig her t ha n recorded levels a f ter prev ious mass t rau mat ic events. Moreover, t hese sy mptoms i ncreased i n a l l demog raphic g roups st ud ied, w it h women bei ng more l i kely to su f fer f rom depression t ha n men. Impor ta nt ly, people w it h lower socioeconomic stat us a nd hig her ex posu res to st ressors, such as loss of employ ment, were more l i kely to su f fer f rom depressive sy mptoms. 5
introduction medbulletin
Z A HR A A B DA L LAH In December 2019, a new i n fec t ious d isea se emerged i n Wu ha n, sit uated i n t he Hubei prov i nce of Ch i na . Si nce t hen, SA R S - C oV-2 (COV I D -19) ha s rapid ly spread across t he g lobe, wa r ra nt i ng cou nt r ies to i mpose t ravel rest r ic t ions, school closu res, a nd physic a l d ista nci ng. 1 As nat iona l gover n ment s d iscuss how to approach school reopen i ngs, t he need for ped iat r ic-speci f ic d ata on t he i mpac t of COV I D -19 ha s become a topic of focus. 2 , 3
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MEDUSTORY
Anthony Fauci Fauci’s work on the treatment of “ Dr. polyarteritis nodosa and granulomatosis with polyangiitis [is] among the most important advances in patient management in rheumatology over the previous 20 years. ”
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- Stanford University Arthritis Centre
Quick Facts Early Life • Family ran a neighbourhood pharmacy High School • Captained the high school basketball team, but his career ended early because of his short stature • Took four years of high school Latin, three of Greek, and two of French Hobbies • He enjoys fishing, playing tennis, and cooking • Relieves stress in his office by “shooting hoops” in a toy-sized net • One day as he was fishing on the Potomac River, he got so excited about a fish on the line that he flipped over the canoe
AUTHORS: AARON WEN & SOPHIE ZARB ARTISTS: PERI REN & WENDY ZHANG
HIV/AIDS The year is 1981 —Anthony Fauci is hard at work investigating abnormal cases of severe immunosuppression in individuals presenting with pneumonia and Kaposi’s sarcoma, when he realizes that this novel disease has the potential to “explode into a worldwide catastrophe.” From this point forward, his lab rapidly shifted away from their work on Wegener’s granulomatosis to elucidate the pathophysiology of AIDS, a term that Fauci helped coin. Fauci’s publication established the defect of CD4+ T-cells in HIV infections, and became the most cited paper in medicine in 1989.
Born:
Christmas Eve, 1940
Fauci starting writing prescriptions “by the time he was riding his bike”
Started medical school at Cornell 1962
Joined the National Institutes of Health 1968
1981
Zika & Ebola Fauci firmly believed that “one gets unique insights into disease when [one] actually physically [interacts] with patients.” He explained that he would never tell healthcare workers to do something he would not do himself. During this outbreak, he went so far as to set aside a few hours on most days to help treat Ebola-infected healthcare workers.
COVID-19
| A P R I L 2015
Following the emergence of SARS-CoV-2 in early 2020, U.S. President Trump announced the creation of the President’s Coronavirus Task Force, which included the ranks of Dr. Anthony Fauci. Since then, Fauci has been working to educate and inform the public about COVID-19, with hundreds of appearances online and in the news. Although he has not received support from all individuals, Fauci has stood as the key representative for the U.S. government on COVID-19 research. When commenting on his persistence, Dr. Fauci said in an interview: “When you are dealing with the White House, sometimes you have to say things one, two, three, and four times, and then it happens. So, I am going to keep pushing.”
M E D U CATO R
Beginning in 2015, Dr. Fauci showed exceptional leadership in handling the Zika virus epidemic as the head of NIAID. Fauci spearheaded small cohort studies performed by the National Institute of Child Health and Human Development (NICHD) to help confirm that Zika was the cause of the affected individuals’ birth defects.
2014-2015
introduction
Appointed Director of National Institute of Allergy & Infectious Diseases (NIAID) 1984
2019 - Present
3 References can be found on our website: meducator.org
IN T E R V IE W S P O T L I G H T
table of contents
A N INTERVIEW WITH THE VI CE-PRESIDENT OF RESEARCH AT M CMASTER UNIVERSITY
DR. KAREN MOSSMAN VIRUSES AT PLAY MATTHEW LYNN1 & ROHAN AANANTH2
1
Bachelor of Health Sciences (Honours), Class of 2022, McMaster University Bachelor of Health Sciences (Honours), Class of 2021, McMaster University
2
Dr. Karen Mossman is a Professor in the Department of Pathology and Molecular Medicine, and a member of the McMaster Immunology Research Centre. She currently serves as the Vice-President of Research at McMaster University and previously served as the Chair of Biochemistry and Biomedical Sciences. Her research explores virus-host interactions with a particular focus on interferon responses, oncolytic viruses, and coronaviruses. Her lab was a part of the first effort to isolate the SARS-CoV-2 virus earlier this year. Photograph by Daily News; Communications & Public Affairs - McMaster University
HAVING STUDIED BOTH MOLECULAR BIOLOGY AND BIOCHEMISTRY THROUGHOUT YOUR ACADEMIC CAREER, WHEN DID YOU FIRST BECOME INTERESTED IN VIRUSES AND WHY? Growing up, I only had a Plan A and that was to be a vet. I only applied to one university and was fortunate enough to get [in] and volunteer [at] the [...] animal clinic. I hated it. Plan A was in jeopardy. [However], in [my] program I was able to do thesis projects for the last two years of my undergrad degree, [where] I was working with Dave Evans and [...] with viruses. I really loved it! THE COVID-19 PANDEMIC HAS LED TO MANY DRASTIC CHANGES IN DAILY LIFE AROUND THE WORLD. WHAT DIFFERENTIATES IT FROM THE SARS EPIDEMIC OF 2003? When it first surfaced, we recognized what the virus was very quickly because we [had] gone through the original SARS in 2003. [SARS-CoV-2] can transmit really efficiently and we’re seeing it doesn’t cause the same disease as the original SARS. We see the mortality is much lower, but that also means there’s a lot of asymptomatic infections. A combination of asymptomatic infections,
the ability to transmit efficiently, and the lack of a vaccine [allows] this virus to spread around the world and keep us on our toes. THE MOSSMAN LAB ENGAGES IN MANY PROJECTS, INCLUDING STUDYING VIRUS-HOST INTERACTIONS IN BAT COLONIES THAT COULD ACT AS RESERVOIRS FOR ZOONOTIC VIRUSES. HOW HAS THIS WORK HELPED TO INFORM YOUR APPROACH TO STUDYING COVID-19? If you’re a virologist, bats are fascinating because they can harbour many types of viruses including [many] that cause pandemics in humans. Even duriing experimental infection with viruses such as coronaviruses, [bats] show no signs of disease [even though] their immune system[s] [...] are very similar [but not identical]. We’re interested not only in how a host responds to a [viral] infection, but how the virus counter-responds. [Once we] know what happens in bats [and humans], we can also start to understand [how] viruses evolved [and] use tricks that we’re learning in the lab [...].
For this whole process, we [had] phenomenal collaborators both at McMaster and other institutions like the University of Toronto. A great collaborator of ours, Dr. Samira Mubareka, a clinician-scientist, [was] starting to see some of the first [COVID-19] patients in Toronto. A postdoctoral fellow in my lab, Arinjay Banerjee, had been talking to Dr. Mubareka and said, ‘wouldn’t it be interesting if we could isolate the virus from the patient so that we can start working on the virus?’ All viruses have their own little tricks [so] we need to understand what the tricks are. It was great that Dr. Mubareka had access to patients [and] patient samples, and Arinjay had the expertise in how you actually work with, grow, and isolate pathogenic coronaviruses [...]. WHAT WERE SOME DIFFICULTIES ENCOUNTERED DURING THIS PROCESS?
YOU
DO YOU HAVE ANY ADVICE FOR STUDENTS LOOKING TO ENTER THE FIELD OF VIROLOGY IN THE FUTURE? So, I don’t think anyone that gets into virology will ever be out of a job because viruses aren’t going away. [Viruses infect] different species, the plant industry, [and] even [the] aquatic industry. Whether [someone] is interested in the negative aspects of infections, [including] pandemics and how to control that; or [the positive aspects, such as], or biotech, viruses for therapeutics or gene therapies, there are many avenues. I always tell students it doesn’t matter what field you get into, you just have to be passionate. There [are] eureka moment days and frustrating days, but it’s easier to get those good days and get beyond all the bad days if you’re passionate.
M E D U CATO R | A P R I L 2015 M E D U C ATO R | C O V I D - 1 9 M I N I I S S U E
I mean, nothing working with these viruses [is] easy, you have to go to a certified [level three containment] facility. Everything takes three times longer in containment level three [...]. [Although] Arinjay worked at a level three facility in Saskatchewan, [he] still had to go through training and get certified in [the] Toronto facility, and [again] at McMaster. I wouldn’t say it’s a challenge, [but] it was an added level of complexity. Arinjay worked with a number of colleagues and within two weeks they had the virus isolated [but] of course, we had to sequence it to make sure it was SARS-CoV-2.
This has been a global effort I [have] never seen with any other pandemic, [where] every lab that has expertise in virology [or] vaccines is somehow involved in this. This is a pandemic that has affected everybody, [no] matter where you are in the world. Coronaviruses are challenging. There has not been a vaccine against any coronavirus, [including] SARS, MERS, and [the] four human coronaviruses that cause 10-30% of yearly respiratory infections. Patients infected with the original SARS had immunity [to reinfection] estimated at only a couple of years, but we’ve [already] seen evidence of SARS-CoV-2 reinfection. This [has] implications for a vaccine. With [multiple] labs using every possible strategy, we’ll probably have multiple vaccines. I don’t think anyone is expecting that any vaccine is going to be phenomenal because it is a challenging virus to make [a] robust immune response against, and it’s likely that any vaccine [will require] boosters to [maintain] the response. I’ve heard reports that [in] phase three clinical trials, if a vaccine shows at least 50% efficacy, that will be deemed sufficient, [whereas] normally you’re looking for 90-95%. Hopefully, there’ll be multiple different vaccines [that are] shown to be safe —that’s the good part of having different labs around the world working on different approaches.
introduction interview spotlight
YOUR LAB WAS PART OF A COLLABORATIVE INITIATIVE WITH SUNNYBROOK HOSPITAL AND THE UNIVERSITY OF TORONTO THAT FIRST ISOLATED SARSCOV-2 IN MARCH 2020. WHAT WAS THE PROCESS FOR ISOLATING THE VIRUS?
WHAT ARE YOUR THOUGHTS ON THE GLOBAL EFFORT TO FIND VACCINES AND WHAT WILL LIFE LOOK LIKE AFTER?
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