COVID-19: What’s the prognosis?

Live 2020

By Mark Witten

Canada had a rocky start to the COVID-19 pandemic, especially in Quebec and Ontario. But public health officials, governments, researchers, and individual citizens worked together and mobilized their efforts, knowledge, and expertise to get through the first wave of the pandemic in better shape than many other countries.

What is the prognosis for Canada and the world in winning the battle against COVID-19 in the short and long term?

The prognosis for 38 million Canadians and 7.8 billion people globally will depend very much on the progress and advances made in testing; understanding immunity and the spread of the virus; finding viable treatments; and developing and equitably distributing safe, effective vaccines against COVID-19.

Researchers from the recently renamed McGill Faculty of Medicine and Health Sciences and across McGill University are making key contributions in each of these four areas that already have had and will have a positive impact in helping to prevent, control and limit the spread of the novel coronavirus, and reducing its health and economic consequences in Quebec, Canada and globally.

Three leaders in directing these COVID-19 public health and research efforts share their views on where we stand and what lies ahead:

Dr. Timothy Evans, inaugural Director and Associate Dean of McGill’s new School of Population and Global Health, is the Executive Director of Canada’s COVID-19 Immunity Task Force. Dr. Don Sheppard, PGME’99, Professor and Chair of the Department of Microbiology and Immunology, is Director and founder of the McGill Interdisciplinary Initiative in Infection and Immunity (MI4), which brings together over 250 researchers from McGill, the McGill University Health Centre (MUHC) and the Jewish General Hospital and beyond, and leads the MI4 Emergency COVID-19 Research Funding Program. Dr. Catherine Hankins, Professor of Public and Population Health, School of Population and Global Health, is Co-Chair of Canada’s COVID-19 Immunity Task Force.

Faster, wider and more targeted testing

When Canada needed to develop the domestic capability to produce a huge number of SARS-CoV-2 tests to help get control of the pandemic, Dr. Martin Schmeing, BSc’98, Director of the Centre de recherche en biologie structural (CRBS) and Associate Professor, Biochemistry, at McGill, and Dr. Don van Meyel, Director of the Centre for Translational Biology (CTB) at the Research Institute of the MUHC (RI-MUHC), got initial support in March from the MI4 emergency fund for a project to develop 15,000 made-in-Canada testing kits for COVID-19. The McGill team then worked with National Research Council (NRC) scientists in Montreal to ramp up production of millions of tests to help make Canada self-reliant for the duration of the epidemic.

“Canada had relied on importing many key chemicals and enzymes needed for COVID-19 testing. A key factor that limited our ability to ramp up testing capability at first was a shortage of reagents. Our McGill team rolled out large amounts of high-grade enzymes and other critical components for testing kits that will help health authorities carry out testing on a national scale,” says Sheppard.

Effective testing strategies and better testing tools will play a critical role in preventing or limiting the impact of a potential resurgence of cases in Canada in the fall and winter. An MI4-funded project, co-led by McGill civil engineering professor Dr. Dominic Frigon, BSc(Agr)’95, MSc’99, is testing Montreal wastewater samples to track the spread of the novel coronavirus in the population as a complement to individual testing. “This could serve as an early warning system to identify hot spots of high prevalence in the community and get ahead of outbreaks,” says Sheppard, also noting that an MI4 project by Dick Menzies, MDCM’78, MSc’89, a senior scientist at the RI-MUHC, a professor of medicine, epidemiology and biostatistics and a Canada Research Chair in Tuberculosis, has identified and promoted effective testing strategies for extinguishing outbreaks.

Getting ahead of the curve also requires new and better tools for rapid, wide-scale testing.

“We need to move to rapid tests that are less invasive and less expensive, which could give reliable results in 30 minutes or less. I’m optimistic we’ll soon have saliva-based tests for rapid screening and diagnostic testing. These could be used for regular, large-scale testing in schools, workplaces and other settings where transmission rates may be high to stem and contain outbreaks,” says Evans. “We also hope to use saliva-based antibody testing for easier, wide-scale immunity testing.”

Immunity findings will help guide pandemic control strategies

The serological testing for antibodies being led by Canada’s COVID-19 Immunity Task Force is measuring the scope and scale of immunity across Canada over a two-year period. What is learned about the extent of immunity and its protective effects against COVID-19 will be vital in helping to guide public health policies and strategies for reducing transmission and targeting vaccination distribution across the country and within specific geographic regions and subpopulations.

“We’ve learned from immunity testing of antibodies that we’re at a very low level of exposure in Canada to SARS-CoV-2 infection, the novel coronavirus that causes COVID-19 disease. The reason that it’s so low is we’ve been really effective at controlling the pandemic since the early stages. The findings also mean we’re very far from herd immunity and vaccines will play a really important role in achieving widespread immunity against COVID-19 in the population,” says Hankins.

In the coming months, the Task Force aims to answer key questions about whether people who have been infected and show antibodies have immune protection against the virus, how strong that protection is, and how long it lasts. “While there have been a few recent reports of reinfection to the virus in recent weeks, we still don’t know how many people are susceptible to reinfection and whether reinfection is associated with worse or milder disease,” says Evans. The COVID-19 Immunity Task Force studies are following large numbers of infected persons across Canada to gain insights into these questions. “The answers will be important to inform vaccine strategies as well as understanding how to manage the front lines of hospitals, schools and other work environments.”

The Task Force is also doing targeted serological studies in COVID-19 hot spots, places disproportionately affected by COVID-19.

“We want to understand better why 25% of long-term care facilities had outbreaks but 75% did not; and evaluate which mitigation strategies are working and which are not,” explains Evans. “We want to look more closely at the hot spot neighbourhoods in Toronto and Montreal, where infection rates among racialized minorities are unacceptably high: what is driving the risk and what can be done to prevent transmission and disease?”

More treatment options

Considerable progress has been made in finding treatments that show promise and are helpful in managing and treating COVID-19 symptoms. “There were no treatments at the beginning of wave 1 and now we understand more about treating the disease. We have a toolkit of therapeutics in hand going into wave 2, so we can successfully save more people and expect to see lower death rates,” says Sheppard, a member of the Canadian COVID-19 Therapeutics Task Force with three other McGill/MUHC investigators.

Treatments such as blood thinners, the corticosteroid Dexamethasone, convalescent plasma therapy, and the antiviral Remdesevir are being used with varying degrees of success in treating hospitalized patients and improving the odds of survival. MI4-funded researchers such as Matthew Cheng, MDCM’11, PGME’17, clinician-scientist at the MUHC, are performing clinical trials to test the efficacy of existing drugs against COVID-19 and working to identify biomarkers that can help predict disease outcomes and response to treatment in individual patients. Assistant Professor of Surgery Jonathan Spicer, BSc’01, MCDM’05, PGME’12, PhD’14, is evaluating neutrophil extracellular traps (NETS) as a potential therapeutic target for therapies directed against the lung inflammation that is seen in severely ill COVID patients.

Evans, Hankins and Sheppard are optimistic about the potential of monoclonal antibody therapies being developed and tested as a treatment for COVID-19. “AbCellera Biologics, a Canadian company, in collaboration with Eli Lilly, has a neutralizing monoclonal antibody in phase 3 trials. Monoclonal antibodies may prevent the virus from entering into human cells and without access to cells, the virus can’t replicate. For other diseases like HIV and respiratory syncytial virus, we’ve seen the significant benefits of these therapies, and I’m hopeful the same approach will limit COVID-19 severity and reduce transmission of the virus,” says Evans.

Equitable vaccine distribution to prevent disease and stop transmission

The impressive progress made in accelerating vaccine development and moving multiple COVID-19 vaccine candidates into human clinical trials in such a short period is reason for cautious optimism that vaccines will help to contain and possibly end the pandemic. “Getting eight vaccine candidates into late-stage trials in eight months is phenomenal. So, there is reason to be optimistic. But as someone who has dealt with vaccines for close to three decades, it’s a humbling business. It’s rare that vaccines are 100% effective,” says Evans.

Hankins cautions that the primary goal of the early clinical trial vaccine candidates focuses on the kind of vaccine that prevents the disease but may not do enough to stop transmission. “I’m hopeful that the first vaccines will prevent severe disease, which is the primary objective of some major vaccine developers. A secondary goal is to reduce infection and transmission. Ideally, you want vaccines that can both prevent disease and stop transmission to help end the pandemic,” she says.

It’s also essential, says Hankins, that people at higher risk of COVID-19 disease—who are over 65, obese, or living with HIV, diabetes, heart disease or other chronic conditions—be included in clinical trials: “I’d like to see the vaccine developers do supplemental bridging studies early on in people at high risk of serious disease, so they have an opportunity to be among those vaccinated first.”

A big challenge will be to distribute the limited supply of vaccines rapidly and equitably in Canada and internationally. “In developing the criteria for access to vaccines, Canada should be a beacon of reason and fairness in ensuring equitable access everywhere,” says Evans.

Hankins expects that the elderly, those with chronic conditions, and health care and other frontline workers will be among the populations to be vaccinated initially in Canada.

“Globally, a huge challenge will be to overcome vaccine nationalism,” Hankins says.

McGill researchers are focusing on community outreach to help ensure access to a COVID-19 vaccine for those who may need it most. “For a vaccination strategy to be effective there has to be wide acceptance and access to the vaccine in the entire community. We want to make sure there are no barriers in receiving the vaccine for people at higher risk and in less affluent neighbourhoods,” says Sheppard.

Individual and collective actions matter

Each individual’s ability to overcome pandemic fatigue and minimize transmission and infection risk through hand-washing, physical distancing, mask-wearing and other preventive measures will continue to be essential in controlling and ending the pandemic in Canada, the United States and around the world until and once effective vaccines are available.

“What we do individually and collectively really counts in learning to live safely with COVID-19 now and over the long-term. Individual decisions you make to protect yourself and those around you make a huge difference,” says Hankins.

Canada quickly mobilized its public health and research capacity as an emergency response to the pandemic but, like most other countries, failed to adequately prepare for this crisis. What do we need to do now to better prepare for future pandemics?

“Canada needs to invest in pandemic preparation as a national security issue. It’s as fundamental as our natural resources and the military,” says Sheppard.

McGill’s School of Population and Global Health has an opportunity and responsibility to be a leader in developing the public health and scientific capability to be prepared for future pandemics. “I see this as a clarion call for our new school—together with other public and private health partners—to harvest the lessons from this crisis and begin laying the foundations for massively more effective pandemic readiness: there is no time to waste!” says Evans.

Multi-pronged pandemic solutions

The action plan for successfully overcoming and ending the current COVID-19 pandemic must be multi-dimensional. Equitable and effective distribution of vaccines locally and globally will be a key part of the solution. But only in combination with individual risk management, rapid, widespread testing, better treatments, and a good understanding of the extent and duration of immune protection conferred by vaccines and exposure to COVID-19 for different population groups.

“Success isn’t defined by eliminating or eradicating the virus. The virus will be with us for a long time and outbreaks are inevitable. Success is defined by preventing an outbreak from becoming a pandemic. We need to act on what we know works and invest in science and systems know-how to do better. I’m excited McGill’s contributing on so many fronts and I’m confident Canada can up its game as a global leader in pandemic readiness,” says Evans.

 

 

October 14 2020

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