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A New Year’s Celebration: Prayer, charity and good-will to all

By: Zafir Malik originally published in the review of religions - january 2020

Dawn broke today over the picturesque Mubarak Mosque in Surrey as nearly 1500 hundred men, women and children prepared to go home after performing the tahajjud– pre-dawn voluntary prayers and the fajr prayers . This was not an isolated event – indeed throughout the world thousands of Muslims woke up to start the New Year offering prayers in their local mosques or own homes. Muslims are not alone in beginning the New Year with prayers, as do many other religious groups . But while other religions may make a point of marking such occasions, for a Muslim, this is just another day. Indeed, some may choose to celebrate by spending New Year’s eve drinking and making merry. However, the Qur’an instructs that the life of a Muslim has two objectives: to fulfil the rights of God, and to fulfil the rights of mankind. So, at every occasion including New Year’s Day, Ahmadi Muslims will seek the opportunity to fulfil their duties in both. That is why, before 5am on New Year’s morning, worshippers, men women and children, descended on Islamabad, Tilford in the Surrey countryside to offer voluntary prayers. As for the second command, hundreds of Ahmadi youth across the UK and in other countries, will today head to their local town centres and carry out the famous “New Year’s Clean Up” by voluntarily helping clean up streets across the country. This way they will ensure that they begin the year by fulfilling these two vital tenets of their faith Where do these youths get their inspiration from? Humans are impressionable and often look to other people or other things for inspiration. For Ahmadi youths, there is one person who lives and breathes these two commandments every moment of his life. He is the Caliph – Hazrat Mirza Masroor Ahmad (May Allah be his Helper)– Spiritual Guide to Millions of Ahmadi Muslims across the world. His guidance on New Year celebrations, is that this is a time to self -reflect on what was one’s spiritual growth in the last year. The year must begin with a new resolve for spiritual growth and the best way to begin a year is to bow in prostration to our God. This instruction is beautifully illustrated by an incident reported by the fourth Caliph of the Ahmadiyya Community, Hazrat Mirza Tahir Ahmad, prior to becoming Caliph.

Hazrat Mirza Tahir Ahmad (rh) stated: ‘Once I was in the UK for New Years Eve. Countless people had gathered at Trafalgar square; on this night, people are usually engulfed in all sorts of indecent acts and as soon as the clock strikes midnight, they think they are free to do anything they please, losing all sense of morality and religious obligations. That night, by chance I happened to be at Euston Station. So I decided to offer nawaafil– voluntary prayers – which was nothing special on my part, as by the Grace of Allah the Almighty, the majority of Ahmadis begin the New Year in the same manner. I laid out a newspaper to offer my prayers. After a few minutes, I felt as if someone was standing beside me. I had not yet completed my prayers when I heard someone weeping. Upon completing my prayers, I saw an elderly English gentlemen crying profusely. I became deeply concerned and thought that perhaps he was sympathising with me, thinking that maybe I had gone mad. So I asked what was the matter with him? He replied: “There is nothing wrong with me, but my people have lost their senses. At this time, my people are engrossed in all sorts of immoral acts and there is only one person who is remembering their Lord. This thought had such a profound effect on my heart that I was unable to hold back my tears.” He then repeatedly said the words: “God bless you, God bless you.” Thus, even if the entire world mocks at us, an Ahmadi youth should not care one bit, for he has every right to exercise his freedom and is answerable to God Almighty alone.’

Coronavirus — Pursuit for a Cure By: Maleeha Qazi, PhD | MD Candidate, University of Toronto, Canada Originally published in the review of religions

In December 2019, the first cases of patients What is COVID-19? with pneumonia-like viral illness were identified in Wuhan, China. Subsequently, a novel COVID-19 is the official name assigned by the human-infecting coronavirus (termed SARS- World Health Organisation (WHO) to the disCoV-2) was identified as the causative agent ease caused by SARS-CoV-2 virus. SARS-CoV-2 for the illness. Since then 210 countries and belongs to a large family of viruses called territories have reported cases of COVID-19 coronaviruses that are believed to have been (COronaVIrus Disease-2019), with global cas- originated in bats. Through genetic mutations, es topping 4 million and close to 300,000 con- these viruses are thought to have spilled over firmed deaths (WHO COVID-19 Situation Re- from bats to other animals, and subsequentport – 112, 11th May 2020). With the COVID-19 ly mutated further to infect humans. Over pandemic raging across the globe, multiple the past 20 years, two such coronaviruses avenues of treatments are being developed have caused highly pathogenic outbreaks in and tested for efficacy against SARS-CoV-2 humans: 2002 severe acute respiratory synpathogen. As of yet, there are no universal drome (SARS) outbreak caused by SARS-CoV cures against COVID-19 and the search for an and 2012 Middle East respiratory syndrome effective vaccine still continues. (MERS) outbreak caused by MERS-CoV. ISMAEL MAGAZINE | 25

SARS CoV-2,like its predecessors, infects human cells found in the respiratory systems, leading to common symptoms like fever, cough, and shortness of breath. However, in severe cases, the disease progresses to pneumonia and multi-organ failure, ultimately leading to death. The rapid spread of the SARS CoV-2 is what has set it apart from other coronaviruses, leaving nations across the world scrambling for ways to reduce its transmission. Furthermore, there are no known treatments to either prevent or treat the disease, with disease management limited to supportive care. As we all watch the pandemic affecting people close to us, we are left to wonder when a treatment will become available to cure us of this disease?

Disease and its cure – the Islamic perspective

The Holy Qur’an explains that Allah the Almighty is the source of health for those who are sick as Prophet Abraham (as) told his people, ‘And when I am ill, it is He Who restores me to health‘ (Holy Quran, 26:81). This injunction is further corroborated by a Hadith of the Holy Prophet Muhammad (sa) as is narrated by Abu Hurairah (ra), ‘There is no disease that Allah has created, except that He also has created its treatment.’ (Sahih al-Bukhari, 5678, Book 76, Hadith 1). While human effort result in the discovery of new treatments for diseases, it is Allah the Almighty in His infinite compassion and grace Who has given mankind the intellect to support these endeavours and He guides those who seek them to fulfilment. Allah’s compassion for His creation provides hope that while the situation maybe dire, He will provide the necessary cures. Though, human effort is indeed needed which is channeled towards research efforts that attempt to better understand human diseases and use that knowledge in the development of treatments. The Fifth Caliph and worldwide Head of the Ahmadiyya Muslim Community, Hazrat Mirza Masroor Ahmad (aba) clarified the purpose of these efforts in his message to students conducting research during his 2016 tour of Germany, ‘Every person is going to die one day, however it is very important that we use our brains to try and find cures for the illness and ailments that cause so much suffering and to try and improve the quality of people’s lives. This is the essence and true spirit with which research should be conducted.’ (From ‘A Personal Account’ by Abid Khan — Huzoor’saa tour of Germany 27th Aug – 10th Sept 2016 — Part 1, under ‘Student classes with Huzoor (aba) page 20-21). With this hope that a cure, God willing, will be found, we relate some of the efforts that are being performed around the world for curing COVID-19. Furthermore, millions around the world are praying for the success of these scientists — it is this combination of effort and prayer that attracts the mercy of Allah.

Repurposing Drugs

Although a vaccine against SARS-CoV-2 will serve as the most effective strategy for longterm infection control, repurposing of drugs designed to treat other conditions may offer quicker solutions to control the pandemic. While the treatment landscape for SARSCoV-2 is rapidly evolving, a number of candidate therapies are already being evaluated in human patients by both government-funded organizations (for example NIH in USA, NIHR in UK, and CIHR in Canada) and pharmaceutical companies. Here we describe some of the current therapies being tested for the treatment of SARS-CoV-2 and detail the absolute need for a vaccine against SARS-CoV-2 to control the COVID-19 pandemic.

Chloroquine

One of the promising agents touted widely in the media is the use of chloroquine and hydroxychloroquine for the treatment of COVID-19. These two drugs are most commonly used for treating malaria and autoimmune conditions, including lupus and rheumatoid arthritis. While malaria (caused by a single celled Plasmodium ) is biologically very different to coronavirus, the drugs have different effects on human cells which can disrupt the ability of pathogens to infect cells and also limit their ability to replicate. Hydroxychloroquine was first tested as a possible treatment against coronavirus infection back in 2002, after the emergence of SARS outbreak. At that time, the drug was only tested in laboratory cell cultures and no randomized control studies were conducted in actual patients.

Similar to its effects against SARS-CoV, chloroquine/hydroxychloroquine has now also shown promise against SARS-CoV-2 in laboratory settings. Early clinical studies seemed to suggest it could be quite effective in patients infected with SARS-CoV-2, which created much enthusiasm that it could be used as a treatment for COVID-19 patients. These were preliminary observational studies and were not the high-quality randomized trials that are typically used to assess effectiveness. Despite the limited clinical data, the US Federal Drug Administration approved the emergency use of hydroxychloroquine in COVID-19 patients. Soon after, conflicting evidence for the efficacy and safety of these drugs emerged, pressing the need for randomized controlled trials. In fact, the first randomized controlled trial of hydroxychloroquine for the treatment of SARVCoV-2 infection that enrolled 150 patients did not show any effectiveness of the drug11. Currently, National Institute of Health (NIH) has started a blinded, placebo-controlled randomized clinical trial (NCT04332991), which aims to enroll more than 500 adults to further elucidate whether treatment with hydroxychloroquine can in fact help COVID-19 patients beyond standard hospital care. Similar clinical trials have also been undertaken in Canada, Australia and in multiple European countries. However, until conclusive evidence in support of chloroquine/hydroxychloroquine becomes available, the use of these compounds is being recommended only in an emergency situation for patients with severe COVID-19 symptoms while carefully considering the risks associated with this drug related to heart issues.

Remdesivir

Remdesivir is a broad spectrum antiviral treatment (meaning it works against a range of diseases), that has shown positive signs in animal models for treating viruses like SARSCoV , MERS-CoV, and MERS. Remdesivir works by blocking the ability of viruses to replicate. For this reason, researchers are interested in testing Remdesivir as a possible treatment for COVID-19. Early in the spread of COVID-19 this drug was used to treat patients with severe symptoms on compassionate grounds. A small study with a limited number of patients had promising results as 36 of 53 patients (68%) with severe symptoms showed clinical improvements. A study with close to 300 patients with COVID-19 tested remdesivir in a randomized controlled trial and while the researchers noted a reduction in time to clinical improvement, no significant clinical benefit was associated with remdesivir treatment. However, larger randomized controlled trial of this treatment are currently underway to comprehensively evaluate remdesivir efficacy in treatment of COVID-19. Gilead, the pharmaceutical company that developed Remdesivir, has started a Phase 3 clinical trial as of March 2020. Approximately 1,000 randomized patients have been enrolled from countries with high prevalence of COVID-19 to test the safety and efficacy of Remdesivir in patients with moderate symptoms of COVID-19 compared to standard-of-care. Among the leading drug candidates, Remdesivir is considered to be the most promising. The above two drugs are some of the most popular ones that have gained attention in the recent weeks, but as highlighted above, both are not proven treatments. Without conclusive evidence, it is not clear whether these drugs will improve recovery for all patients or if they are even safe. This is why in late March, the World Health Organization (WHO), launched an extraordinary international initiative to test over a dozen different treatment combinations in the ‘SOLIDARITY’ trial1. The trial will test several drugs, such as chloroquine/hydroxychloroquine, Remdesivir, and others as trials go underway in different countries. All of the drugs are approved treatment for other diseases and are being essentially re-purposed for treating COVID-19. The aim is by bringing together clinical data from more than 100 countries, the SOLIDARITY trial can quickly recruit thousands of patients, coordinate efforts to analyze the results, and ultimately generate evidence that can rapidly inform health authorities across the world.

Plasma Therapy – sharing the immunity

Drugs may be one option, but perhaps the treatment of COVID-19 may lie in something less pharmacological. One idea is to look towards the people who have beaten the virus i.e. the patients who have recovered from the disease. The answer may lie, quite literally,

within their veins. As with any infection, the human body responds by generating an immune reaction, that produces antibodies that can bind and neutralize the pathogen. In the case of COVID-19, such antibodies are generated against components of the SARS-CoV-2 virus that block the virus from binding to the human cells, prevent them from causing an infection. Once COVID-19 patients develop enough antibodies, they can fight off the virus and see improvements in their health. Importantly, this built-up immunity remains within recovered patients’ blood in case the virus reappears, and the antibodies need to be redeployed to attack the virus. One therapeutic hypothesis is that as more patients recover from COVID-19, it may be possible to transfuse the plasma (component of the blood that contains antibodies) from recovered patients into those who are suffering from severe COVID-19 infection. The recovered patients essentially share their immunity against SARS-CoV-2 infection helping others recover. While the idea may seem peculiar, it won’t be the first time a similar approach has been used. Plasma therapy was previously used during the 2002 SARS epidemic, various influenza pandemics (H1N1, H5N1) and against Ebola, demonstrating safety and effectiveness is certain cases. A small series of patients (5 adult patients in the first study and 10 adult patients in the second study) have already been treated with plasma therapy for COVID-19, showing clinical improvement after plasma transfusion containing anti-SARS-CoV-2 antibodies from recovered patients’ donor blood. While the results are encouraging, as with previous testing, the plasma therapy intervention has not tested on a wider scale in a randomized controlled trial. In addition, the characteristics of the donor, the dosing and timing of the therapy, and other aspects of care cannot be assessed with the current research. Lastly, as with any immune response to a pathogen, the strength of immunity can diminish with time and make the patient vulnerable to possible reinfection. Hence, even with a generation of a primary immune response against SARSCoV-2, it is unknown whether recovered patients or those who receive plasma therapy remain completely immune and protected against future reinfections. Researchers are now undertaking large-scale clinical trials to fully assess the utility of plasma therapy in improving clinical outcomes for COVID-19 positive patients without resulting in any adverse side-effects.

SARS-CoV-2 antibodies – creating the immunity

Although the presence of neutralizing antibodies against SARS-CoV-2 can lead to clinical improvements in patients with COVID-19, plasma therapy can be limited by the availability of patients who have recovered, the ability of different medical centres to collect plasma and perform transfusions, and adverse events related to sharing of plasma from one person to another. A similar but alternative option for treating patients with neutralizing anti-SARSCoV-2 antibodies is to produce these antibodies in another organism – the quintessential research mouse or even a llama. Two recent studies have showed the production of antiSARS-CoV2 antibodies in animal models that can be easily deployed for use in humans. Using a special mouse model that can generate human antibodies rather than mouse antibodies, a group of Dutch researchers exposed mice to a specific part of the SARS-CoV-2 virus (termed an antigen) such that the mice generate an immune response in a manner similar to seen in humans. Upon studying all the various human antibodies produced by the mice in response to SARS-COV-2 antigen, the researchers identified a potent antibody that could neutralize both SARS-CoV and SARSCoV-2. Similarly, an international group of researchers from Germany, Belgium and the US were initially using llamas to develop small neutralizing antibodies against SARS-CoV and MERS-CoV viruses that can be administered via inhalers, much like those used for the treatment of asthma. The researchers found that one of these neutralizing antibodies produced in llamas was also able to neutralize SARS-CoV-2 and can be mass produced in cell culture systems. It is worth noting that llamas belong to the camel family. While antibodies from both sources have only been tested in cell culture studies, they open a wide avenue for further development and production of these antibodies as therapeutics against COVID-19.

All treatments, be they pharmacological or antibody-based, rely on people becoming sick before they receive any intervention. In medicine, a common idiom is that ‘prevention is better than a cure,’ and accordingly a vaccine provides the opportunity to stop the virus in its early infectious tracks. Since the genetic sequence for SARS-CoV-2 was first made available in early January, significant and rapid efforts have been undertaken to develop a vaccine against SARS-CoV-2. Vaccines have been effective at preventing lethal infectious diseases such as polio, tetanus, measles and mumps to name a few and has even led to the eradication of smallpox. A vaccine against viral infections is generally composed of a weakened virus (live or dead) or a component of the virus (termed antigen) such that injection with the vaccine elicits an immune response without causing a complete infection. As the immune system gets activated, it starts producing neutralizing antibodies in the same manner as it would if the host was infected by the real virus. This induced immune response gives our cells the opportunity to retain this immune memory and consequently protect us from future infections for a period of time by quickly deploying to attack the virus. The development of a vaccine is an arduous process that requires months of preclinical investigations, laboratory work to find good antigens that can generate an appropriate yet strong immune response, and showing that it can work in proof-of-principle animal studies. Under current circumstances, many steps involved in vaccine development have been accelerated but challenges around proper antigen identification and design, mitigating potential adverse effects (such as an allergic reaction to the vaccine) and determining how long vaccine-induced immune memory lasts remain. Currently, six candidate vaccines are in clinical trial stages, which test for safety and dosing of the vaccine, while over 70 vaccine candidates are in pre-clinical stages of testing. The majority of vaccines currently under development aim to induce neutralizing antibody production against parts of SARS-CoV2 virus that bind to the surface of human lung cells. If the virus can’t bind or latch on to our cells, it will not be able to infect and replicate to cause any substantial harm.

The Pursuit of Excellence

COVID-19 pandemic has shown that we need the highest-level of evidence to decide which treatments are the most effective. While urgent situations may require that established drugs be given based upon limited evidence and on compassionate grounds (e.g., hydroxychloroquine in COVID-19), this, however, is not ideal. Research studies which are observational in nature are prone to bias and thus are not very reliable for determining effectiveness of a treatment. While it can seem exciting when some early results show promise, until they can be tested rigorously, it is possible the therapies are no better than supportive care. Sacrificing the rigour, standard, and quality of scientific research may expose patients to undue harm and pose strong ethical challenges for healthcare professionals. Randomized controlled trials have been considered the gold standard for judging the benefit of treatment for more than 70 years in evidence-based medicine, and in COVID-19, it will also be the method of choice to find which treatment is the best. High quality randomized trials remove bias by randomly allocating patients in to two groups and thus any other factor that might affect them are equally distributed. In addition, a control arm allows for direct comparison of the effectiveness of any treatment against another or placebo. Therefore, with many more treatments being tested on a daily basis for the treatment and prevention of COVID-19, the answers to how researchers and clinicians will finally treat the patients and control COVID-19 spread will lie in high-quality randomized controlled clinical trials.

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