‘Stay positive and test negative’ – the latest in the race to end the Covid-19 pandemic

TRYING to keep a positive attitude while remaining negative for the virus is increasingly difficult for many of us, including myself, writes professor Deborah Briggs in her latest update on global activities to control the pandemic.

Professor Deborah Briggs.

And while Shetland has seen a definite uptick in Covid-19 cases over the past few weeks and the newly imposed lockdown measures in some areas of the UK are disheartening to say the least, there is also some good news to report.

These past few weeks I have been reading scientific updates on the progress of vaccine development, data on treatments for Covid-19 patients in hospital, and news on the effectiveness of various non-pharmaceutical interventions to prevent the spread of SARS-Cov2, the virus that causes Covid-19.

Last week, I also had the unique opportunity to listen to several researchers as they reported on the status of a few of the Covid vaccines that are in the last phase of development.

The effectiveness of non-pharmaceutical interventions – New Zealand’s example of success

Probably, the country that has been most successful at halting the exponential expansion of the pandemic within their borders and rapidly bringing the number of Covid-19 cases to zero is New Zealand. You may well ask how they were able to achieve their goal of zero cases so quickly.

The New Zealand government began by initially closing their borders to visitors from countries with high numbers of Covid-19 cases and implemented non-pharmaceutical interventions very early in the pandemic, including an intensive lockdown.

It is a well-known fact that one of the fundamental pillars required to control an infectious disease (like Covid-19) is to increase testing capacity and decrease the turnaround time to receive test results.

When the pandemic hit their country, New Zealand dramatically increased Covid-19 testing in both symptomatic and non-symptomatic patients. They simultaneously improved turnaround times for receiving test results thus enabling patients that were shedding virus to be quickly isolated thus preventing them from passing the infection on to others.

New Zealand also imposed a 14-day isolation period for returning residents, a measure still in place.

This strategy has prevented both symptomatic and non-symptomatic patients from transporting the virus from one area to another. In summarising their experiences, medical experts from New Zealand reported that most of their cases were linked to imported cases, healthy travellers bringing back the virus, younger adults, and those of higher socioeconomic status.

A glimmer of hope for treatment of Covid-19 – the anti-viral drug Remdesivir

On 5 November the prestigious scientific journal The New England Journal of Medicine published data from the first extensive clinical trial on the anti-viral drug known as Remdesivir.

In very brief summary, researchers heading up this study found that the clinical effect of intravenous administration of Remdesivir was fairly modest. However, they also reported that the time to recovery from Covid-19 was significantly shorter in those patients that received the anti-viral Remdesivir compared to those patients that received a placebo (defined as a harmless replacement substance).

The clinical findings from this study indicated that the timing of the initiation of treatment with the antiviral drug Remdesivir as well as the underlying clinical status of the patient are both important factors in the success of the therapy.

The recommendations for the use of Remdesivir will most likely include a five-day regime for patients in the early stages of severe disease. Although the clinical benefit of Remdesivir was reported to be modest, the time to recovery was significantly reduced in patients with severe illness.

These new data are definitely a step forward and provide some hope in the search to find effective treatments for Covid-19.

Vaccine update: when will an effective vaccine against Covid-19 be available?

Clearly, we are all waiting for news on the availability of an effective vaccine against Covid-19.

Before any new vaccine is licensed for use, all of the data from the manufacturing process through to effectiveness and safety of the vaccine must be reviewed by the responsible UK government authorities. The regulatory agencies that license vaccines have also requested safety data on patients enrolled in clinical trials for two months after Phase III is completed.

This requirement is in place to ensure that all new Covid-19 vaccines are safe as well as effective. In the last part of this report, let’s take a very quick look at two Covid-19 vaccines that are likely to be among the first vaccines licensed for use in the UK.

AstraZeneca Vaccine AZD1222: This vaccine was developed by vaccine experts at the University of Oxford’s Jenner Institute and the Oxford Vaccine Group.

The vaccine is produced by taking a piece of the ‘spike’ on the SARS-Cov2 virus and inserting it into a non-replicating adenovirus that is harmless to humans. This process produces a safe vaccine unable to cause disease in humans.

In clinical trials, this vaccine produced high levels of neutralising antibodies and stimulated other components of the vaccinated subject’s immune system. This vaccine will probably be administered as one dose but that decision has not been confirmed.

It doesn’t look as though data from Phase III will be available before December meaning that the AztraZeneca vaccine is unlikely to be available by Christmas. However, if all goes well, this vaccine may begin to be available to the higher risk groups at least by early to mid 2021.

Pfizer Vaccine BNT162: This vaccine was developed in collaboration with a German biotech company BioNTech.

Very briefly, the technology that they are using to produce their vaccine is to inject an mRNA particle that will relay a message to the vaccinated person’s own cells telling them to, in essence, make the vaccine and thus cause an immune response. This vaccine will probably be administered as a 2-dose series over a one month period.

Pfizer has stated on their website that they will have produced 100 million doses by the end of 2020 and will have 1.3 billion doses available by the end of 2021.

It is important to realise that the implementation of mass vaccination with a licensed Covid-19 vaccine is just one of many steps that are needed to bring the pandemic to a close.

At a bare minimum, we will still need reliable testing and detailed reporting to be in place as well as efficient track and trace systems to stop the spread of the SARS-Cov2 virus.

It is also important to understand that the most ‘at-risk’ groups will be highest priority and the first to receive Covid-19 vaccines. For example, those working in the health care profession will be among the first to receive the vaccine.

That being said, the good news is that there are several Covid-19 vaccines that have entered Phase III, the last stage of development. Looking forward, there should be one or more effective Covid-19 vaccines available by this time next year. That is an absolutely monumental achievement for all that have been involved.

The full articles on the Remdesivir research can be found here.

Professor Deborah Briggs has served as an expert to the World Health Organisation in the field of rabies prevention. She has provided expertise in the field of vaccine production and clinical trials for major pharmaceutical companies and continues to teach an online graduate level course in Global Public Health for Kansas State University. She lives in Bridge End, Burra.

More from Deborah Briggs:

For ‘herd immunity’ to be successful the process needs surveillance

Why face masks are an effective tool against the spread of the Covid-19 virus

Where are we in the development of a Covid-19 vaccine?

Shetland News