7 minute read
Time to Vaccinate
Writer: Alicia Yang • Editor: Haley Pak
The United States leads the world in medical research and healthcare spending. In 2005, President George W. Bush announced a detailed and comprehensive plan written by the Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) to prevent and respond to infectious diseases at the state and federal levels. Congress allocated $8 billion to map outbreaks, accumulate resources, and create preparatory policies.
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Despite nearly two decades of anticipation, the COVID-19 pandemic has provoked tremendous loss of life, exhausted the medical system, and started an economic downturn in the United States [1, 2, 3]. In hopes that the long-awaited vaccine will restore normalcy, Congress has directed almost $10 billion to Operation Warp Speed, an initiative by the U.S. Department of Health and Human Services and the Department of Defense to “produce and deliver 300 million doses of safe and effective vaccines with the initial doses available by January 2021.” The arrival seems a long ways away, but is a sprint in the research world.
The science of immunization makes progress slow. Coronaviruses such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and SARS-CoV-2–the disease agent of COVID–have a surface protein S that gives the viruses their characteristic crown-like appearance and their ability to attack host cells. Previous research on SARS and MERS indicate that a weakened or killed coronavirus with modified S proteins could stimulate antibody production and confer immunity; however, these vaccines were never developed [4]. COVID vaccine candidates have been researched at unprecedented speed, but not at the expense of safety and effectiveness. Dr. Rachel Presti, a Principal Investigator of the NIH-AIDS Clinical Trials Unit at WUSM and Medical Director of the Infectious Disease Clinical Research Unit, underscored the importance of thorough and representative vaccine testing in the final Phase 3 human trials of COVID vaccines in a Zoom seminar from the Harvey A. Friedman Center for Aging at WashU. Isolating an agent that effectively targets human cells without causing the painful and dangerous symptoms of SARS-CoV-2 is the first challenge. Hasty vaccine administration could harm not only recipients, but also public perception of vaccinations—a historically contentious topic in the United States. After analyzing two telephone surveys from the National Immunization SurveyFlu and the Behavioral Risk Factor Surveillance System (BRFSS), the CDC estimated that flu vaccination coverage was only 62.6 percent among children and 45.3 percent among adults over 18 years old. Distrust in vaccines could be especially detrimental this winter. Dr. Presti underscored the importance of the influenza vaccine during the ongoing COVID pandemic. While the familiar flu vaccine does not protect against coronavirus, it would prevent an even worse scenario of co-infection. Vaccines can only give immunity if a critical mass of individuals receive it.
Since the highest priority is the health of clinical trial participants, studies often draw from a pool of relatively healthy volunteers. Lack of diverse participation may contribute to non-representative findings on the vaccine. COVID-19, however, disproportionately affects people older than age 65 and minority groups. Adults over 65 constituted 80 percent of COVID-related hospitalizations and have a 23-fold greater risk of death. To achieve maximum protection, “we need dedicated programs to expand vaccine coverage,” specifies Dr. Presti. This starts with clinical trial recruitment. Researchers must create a vaccine that works well for older adults with slower and weaker immune systems. Clinical trials must also recruit minorities and essential workers that have been most affected by the disease. The COVID-19 Prevention Network formed by the National Institute of Allergy and Infectious Diseases, with an arm at WashU, is working to respond to this global pandemic, conduct Phase 3 efficacy trials for vaccines and antibody treatments, and ensure fair representation. For more information about vaccine testing at WUSTL, email idcru@ wustl.edu or call 314-454-0058.
Even if every individual was able to receive a dose, no vaccine works 100 percent of the time. Not all vaccinated individuals develop immunity. A vaccine would, however, be a major step toward recovery. Moderna, an American biotechnology company, is using messenger RNA—the transition molecule between DNA to proteins—to engineer a vaccine that is currently in Phase 3 testing. Their study is close to full enrollment of 30,000 participants. Other Phase 3 studies are being conducted globally. While researchers work hard to deliver a vaccine, it is imperative that we act with vulnerable populations in mind. Physical distancing, face masks and good hygiene are here to stay.
For more information about vaccine testing at WUSTL, email idcru@wustl.edu or call 314-454-0058.
A Double Whammy: Flu & Coronavirus
Writer: Kevin Oloomi • Editor: Eileen Yang
Many countries across the globe are beginning to experience a second wave of SARS-CoV-2, the virus responsible for Covid-19. The horrific prospect of two epidemics, the flu and coronavirus, occurring at the same time is now an all too real possibility. Canadian Chief Public Health Officer Theresa Tam stated that “unless protective measures are strengthened the nation is on track for a major resurgence in cases” [9]. European cities are doing exactly that, with many of them re-imposing restrictions on indoor/outdoor gatherings in an attempt to prevent another nationwide lockdown[4]. However, the question remains: what will happen if and when Covid-19’s second wave arises, and how will it interact with the flu.
This raises an interesting question to researchers who are trying to understand the biochemical and cellular factors that give rise to Covid-19’s varying effects on the human body. Scientists at Washington University School of Medicine recently conducted a study[7] analyzing the immunopathology and causes of severe respiratory distress, like influenza and Covid-19. For the most part, these two viruses seem symptomatically similar except for some key molecular differences. For one, individuals with Covid-19 experience a cytokine storm, an aggressive
Illustrator: Elena Bosak
inflammatory reaction to a virus. In humans, this storm typically leads to the deterioration of endothelial cells in the lungs and increases the risk of contracting pneumonia[11]. However, these scientists were intrigued that patients with Covid-19 experienced “profound type I and type II IFN immunosuppression in comparison to influenza patients” [7]. It is believed that this immunosuppression is what leads to significantly high viral counts found in Covid-19 patients, as “IFN receptors are critical to modulating the antiviral
immune response” [5]. These two viruses have vastly different underlying pathologies, regardless of the similarity of their visible phenotypes, so doctors need to adopt new protocols to treat each respective patient.
Beyond the molecular scale, these two viruses pose a unique problem for the healthcare industry. There are significant similarities between the typical symptomatic representation of influenza and Covid-19, so distinguishing between the two based solely off of visible symptoms is almost impossible. It is only through the various PCR and saliva tests that scientists are able to definitively differentiate the two from one another.
Now, as the seasonal flu commences, individuals who would otherwise have just treated themselves at home will now go and get tested for COVID-19. An estimated 25 to 50 million Americans are infected annually, and if a significant portion go to get tested, they will put an increased strain on the United States’ already overburdened testing apparatus[6]. At the present moment, United States labs conduct about “800,000 diagnostic tests daily, but various estimates assert that there needs to be 6-10 million tests per day” [6] In areas where access to these laboratories is limited, this can have significant consequences, preventing individuals from obtaining the necessary testing and contact tracing they need. This, combined with the “mask and isolation fatigue”—exhaustion with lockdowns and significant healthcare precautions—sets the stage for an incredible burden on an already overdrawn healthcare industry.
However, it is not all doom and gloom. An observational study conducted by Professor Benjamin Crowling determined that “influenza transmission [in Hong Kong] declined substantially after the implementation of social distancing measures and changes in population behaviours in late January [2020], with a 44 percent reduction in transmissibility in the community” [3]. The mandated masks, social distancing and handwashing proved to be effective in curtailing viral transmissions as a whole. Moreover, a separate study determined that “transient immune-mediated interference can cause a relatively ubiquitous common cold-like virus to diminish during peak activity of a seasonal virus” [10]. In essence, this means that because of the high infection rate of SARS-CoV-2, the human population’s burst of temporary immunity can
protect against more common seasonal viruses like the flu and the common cold when they are most active[10].
It is important to understand that the only thing people are certain of during this time is uncertainty itself. These aforementioned studies are used to forecast what could happen in the coming months, and all of them can only be right to some degree of certainty. It is important that we, as citizens, remain vigilant to combating this virus, following public health guidelines and amending our personal behaviors for the benefit of the community. •
