Here’s what is known about coronavirus as of March 30, 2020
La Jolla resident and District 1 San Diego City Council member Barbara Bry posed coronavirus questions from her constituents to two experts during an online COVID-19 panel on March 30, 2020. La Jolla Institute for Immunology structural virologist Erica Ollmann Saphire and Seattle pulmonary-disease specialist Thomas Martin met virtually with Bry over the Zoom app.
Some of the news was even good.
Saphire reported about 40 vaccines in development using different strategies — some trying to inactivate the virus, others to use pieces of it or just the genetic material that encodes the virus. Researchers are also trying to repurpose drugs approved for other diseases, she noted. And, two weeks ago, Saphire’s own team received $1.73 million from the Bill and Melinda Gates Foundation to search for antibodies that can treat the virus.
“You would make thousands, maybe millions, of different kinds of antibodies across our population which, with fingerprint-like recognition, could seek out, attach to and inactivate that virus,” Saphire explained. “You can deliver those as a drug if you find the very best.”
Another group of scientists, Martin added, is working on ways to dampen the host’s inflammatory response to COVID-19. At first, this was thought to permanently damage the lungs, causing fibrosis and scarring for the rest of a patient’s life.
“The good news is that the lungs heal,” Martin said — at least for the patients who survive and who didn’t have underlying lung disease. “And that’s actually very good news. When you do pulmonary-function testing on survivors, the lungs are remarkably normal, so that it doesn’t have to cause respiratory disability.”
Injecting blood plasma from recovered patients into patients suffering from the virus, or who haven’t caught it yet, offers another glimmer of hope.
“From a scientific standpoint, it’s possible that plasma can be a benefit,” Martin said, noting the FDA just approved it as an investigational drug. “The message here is that we’re not ready to give plasma to (just anyone) yet. It’s a major thing when you start transfusing people with somebody else’s plasma. But there is room to give it to people who are really ill.”
And one fear the experts definitively laid to rest is whether the virus has been mutating. It hasn’t, Saphire said.
“Viruses normally do that in response to immune pressure, and we have not exerted any as a species yet. So it’s not getting any more virulent or infectious. Therefore, the rate of people who recover without any treatment is still about 80 percent,” she said.
Of course, most of the news about the novel coronavirus was still very bad.
Martin repeated what we’ve all heard over and over since late January — that of the 20 percent of COVID-19 patients requiring hospitalization, more than half will wind up in an ICU fighting for their lives. (This is why social distancing was enacted — to flatten the curve so that America’s supply of respirators won’t be overwhelmed by its supply of patients likely to die without them.)
And a vaccine is still about a year off, Saphire said. So the only other thing likely to stop COVID-19’s spread is herd immunity. This happens when enough of a population develops antibodies to provide a “firebreak” to a contagion, Saphire explained, estimating that 60 to 70 percent of Americans (200 million of us) would need to survive COVID-19 to trigger this response.
“That’s a lot of people to get infected and recover, and right now, we have 160,000 known cases and maybe there’s 1.6 million unknown,” Sapphire said. “There’s a big difference between 1.6 million and 200 million people. So it’s going to be a relatively long and painful process to build up that herd immunity.” (Two hours after the meeting concluded, news broke of the 3,000th confirmed U.S. coronavirus death.)
It’s still so early in this fight, at least half of the questions Bry asked received answers starting with “We don’t know yet.”
Regarding whether people can catch COVID-19 a second time, Martin replied: “The problem with antibody response is that some of them are lifelong — like after the measles vaccine — and some of them are relatively short-lived, and we don’t have enough information yet to know what kind of antibody response this disease is generating.”
Saphire pointed out some new research studies showing that laboratory animals resisted reinfection 28 days after they survived.
“So we think that if you have been infected and survived in this outbreak, you might not get it again in this outbreak,” she said. “But we have other data from studying the common-cold coronaviruses — SARS-CoV-1 and MERS — and the really disappointing thing is that, for coronaviruses, immunity doesn’t last. You’ll get that common cold again in a couple of years. And the level of the antibody against SARS-CoV-1 and MERS tends to decrease quite a bit after a year.”
Also currently unknown is whether the spread of COVID-19 is seasonal and wanes in warmer months.
“The best answer is maybe yes, maybe no,” Saphire said. “The maybe-yes is because our immune system is seasonal. There’s something really fundamental and powerful about the way our cells change by the seasons — these innate circadian rhythms that are so important to our physiology and also our immunology. If you think about viruses like the flu, they peak in November, they decrease in April, every single year. Same thing with rubella and even rotavirus.”
The “maybe-no,” Saphire said, is that newly emerging viruses “are completely unpredictable.” (She noted that MERS “came out more in the summer months.”)
Even some questions about how to avoid contracting the virus had no concrete answers.
For example, when Bry asked if she should be afraid to pick up a box of cereal from a grocery shelf, Saphire replied: “It depends on how much things are handled” — which of course is something the consumer can never know.
“Really common surfaces like shopping-cart handles and buttons on a keyboard — a lot of people have touched those,” Saphire elaborated. “So if you want to be really careful, you can just wear your gardening gloves to the store and take them off when you get back to your car. And be careful not to touch your eyes or face.”
Both experts came out solidly in support of face masks, however, undermining a popular theory that virus droplets are too small to be stopped by them.
“I was very disturbed to hear physicians on TV actually say that masks don’t work,” Martin said. “That is misinformation and it’s a misunderstanding of how the virus spreads ... (Masks) are highly effective at trapping droplets, even down to very small sizes. If you’re exposed, they present you from inhaling those respiratory aerosols.”
Full-on N95 masks offer the most protection, Saphire added, although those should all be funneled right now to doctors treating COVID-19 patients, who need more of them to avoid getting sick and being taken off the front lines.
“But the really great thing about any mask at all is that it keeps your respiratory drops in,” Saphire said. “So, even if you don’t cough or sneeze, you’re protecting other people from you, and it keeps you from touching your nose and mouth, which we do all the time.”
Both doctors also stressed the benefits of washing hands vigorously and often. Martin called it “the best anti-viral.”
After the meeting, Bry posted it as a video to facebook.com/BarbaraBryD1