COVID-19: A Deep Dive into the Pandemic

It has been over nine months since the first reports of a novel respiratory illness were first released at the end of the first week in January. Quite a lot has happened in those nine months of living in a pandemic, much of which the media has attempted to cover in newspapers, magazines and live interviews. This column is an attempt to report to you, the Covenant community, on pandemic highlights, especially the technological development of treatments and vaccines, public health responses and related developments in the science of COVID-19. 

The format of the column will be a summary of the highlights called "the short of it" with more in-depth reporting to follow. I'll draw heavily from reputable sources such as the World Health Organization (WHO), The New York Times and various medical journals such as the New England Journal of Medicine. My hope is to serve you well as I write. 

Davy Codington

Class of 2021, Biology (Biomedical)

The short of it

On vaccines: Over 200 COVID-19 vaccines are in the pipeline. The U.S. expects to have vaccines available to the general population by spring 2021.

On treatments: The WHO says remdesivir and hydroxychloroquine should not be used to treat COVID-19, while corticosteroids should be used for severe cases.

On testing: Many locations, including Clínica Médicos and Lookout Valley Urgent Care, are using the rapid molecular viral test for COVID-19, with results back in 15-30 minutes. 

On vaccines

Since the late 1790s when Edward Jenner discovered that cowpox could be utilized to confer immunity against smallpox, vaccines—the name for which comes from the Latin for cowpox, vaccinia—have been utilized widely to stop the spread of disease and subsequent illness and death. Now, scientists and researchers around the world are working together to produce a vaccine against the disease COVID-19. In the interim, public health protocol—mask-wearing, physical distancing and regular sanitizing—comprise the strategy for slowing the spread of the disease.

Vaccines are produced and vetted in clinical stages called "phases." Before a vaccine reaches these clinical phases, it undergoes preclinical evaluation. This is essentially the process of creating a vaccine and identifying the biological mechanism through which that particular vaccine will accomplish immunization.

There are many mechanisms by which to create a vaccine. For example, an mRNA vaccine provides a blueprint for your body's cells to make a target that your immune system can recognize and attack. Preclinical evaluation is usually accomplished first in animal test subjects, but not always, as some vaccines do not necessarily require animal testing.

According to the WHO’s "Draft landscape of COVID-19 candidate vaccines," close to 200 vaccines are currently being evaluated, all of which are in various stages of the vaccine manufacturing process. Roughly 150 of these are in preclinical development and evaluation. Forty-eight are on clinical trials, as reported in the New York Times' Coronavirus Vaccine Tracker. The NYT Tracker has these 48 vaccines separated by phase of development, type of vaccine, responsible company and country of origin, along with a brief description. 

China and Russia have already collectively approved six vaccines for limited use, while US-endorsed candidate vaccines such as Moderna's mRNA-based vaccine and Johnson & Johnson's adenovirus-based vaccine are progressing steadily through Phase 3 trials. Phase 3 is the final phase of development before use in selected subpopulations of the general population.

Several of these candidate vaccines are being stockpiled by the U.S. government through Operation Warp Speed, a vaccine supply and distribution strategy developed by the U.S. Department of Health and Human Services (HHS) and the Department of Defense. The primary goal of the strategy is to provide 300 million vaccine doses to Americans by January 2021. If one of these U.S.-endorsed vaccine candidates is clinically-proven to be safe and effective by the end of 2020 or early 2021, as several are projected to be, it is possible that the COVID-19 vaccine will be available in Chattanooga by sometime during spring 2021.

On treatments

Much media attention has been given to various therapeutics thought to be effective at reducing sickness and death from COVID-19, including remdesivir, an antiviral drug, and hydroxychloroquine, an antimalarial drug. On October 15, the WHO released interim results for a multinational clinical trial testing the usefulness and effectiveness of several drugs for reducing 28-day mortality (the frequency of patient deaths within 28 days of disease onset) from COVID-19 or reducing length of hospital stay. According to these study parameters, remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon regimens—all drugs used previously or currently to treat COVID-19—are not effective in treating COVID-19.

The WHO's interim results come on the heels of other studies reporting contrasting results. One study from the New England Journal of Medicine demonstrated that remdesivir reduced median time of recovery for COVID-19 patients in hospitals by five days (p<0.001). It is possible that a drug like remdesivir is able to reduce hospital stay without reducing 28-day mortality.

Determining whether a drug has a meaningful effect on the 28-day mortality of a disease is often considered the endpoint of clinical trials for these kinds of drugs. That said, it's no surprise that WHO recommends against physicians and other health care providers using the drugs listed above to treat patients with COVID-19. 

Though the WHO recommends against using remdesivir, hydroxychloroquine and a few other drugs to treat COVID-19 at this time, it does say that corticosteroids, anti-inflammatory drugs, are effective for treating severe illness from COVID-19.

On testing

There are primarily two kinds of tests for COVID-19 currently used to assess the state of infection in an individual. The viral test determines whether an individual is currently infected. This is the kind of test referred to when you hear of someone going to "get tested" because they were exposed. 

The second test is the serology test, which determines whether an individual has had the disease in the past. The serology test looks for the presence of antibodies, which are the molecules your body produces to be immune to the virus that causes COVID-19. This is the kind of test used in the Mayo Clinic antibody study you may have taken part in by sending in a blood sample via Student Development. 

As the technology for testing for COVID-19 develops, viral tests are reporting results more quickly. How fast results are available depends on several things, including which lab processes the collected specimen and what technology is used. Most testing to date has been accomplished using the PCR test, which is a type of viral test that must be processed in a laboratory and can take up to several days to process.

Recently, many local clinics and testing sites are offering rapid molecular testing, another type of viral testing that reports results in 15-30 minutes. Two notable locations to get tested for COVID-19 with this rapid test are Clínica Médicos on E. 23rd Street and Lookout Valley Urgent Care on Cummings Highway. However, students should note that the likelihood of a false positive is higher with these rapid tests than PCR tests.