A hopeful antidote

The good news is that an antiviral treatment effective against the new coronavirus could start to be available in as little as three months and could be tested on some local coronavirus patients even sooner. The bad news is that every other warning and caution against the potentially deadly virus still applies and will continue to apply for the foreseeable future.

There is more good news though. The antiviral is remdesivir, a drug that has previously been used to help combat Middle East Respiratory Syndrome, also known as MERS, and Severe Acute Respiratory Syndrome, or SARS viral infections and is thus already produced, with some stockpiles available, and known to be safe. 

The three-month timeline for remdesivir’s availability as an anti-corona virus agent is the informed projection of David Topham, a University of Rochester Medical Center virologist and immunologist whose local laboratory is one of five in New York State involved in researching COVID-19, the new coronavirus rapidly spreading to pandemic proportions. His lab is tied into a national and global network of researchers studying the disease.

Topham’s is not a lone voice. Previous research has shown Gilead Sciences’ remdesivir, an investigational nucleotide analog with broad-spectrum antiviral activity, to be effective against a variety of coronavirus strains. Clinical trials to test its potency as an agent to rein in COVID-19 are already underway, the pharmaceutical research quarterly Drug Target Review reported this week.

Topham projects starting tests of the antiviral’s effectiveness against COVID-19 locally as soon as a month from now. That’s when he expects coronavirus cases to start appearing in the Rochester area, making test subjects available. 

Not a vaccine

To be clear, an antiviral is not a vaccine. A vaccine that would protect those inoculated against COVID-19 infection is at least a year away, Topham says. An antiviral like remdesivir is an agent that can help fight the virus after individuals become infected. Whether it might also provide some residual, short-term preventive effect remains to be seen. If it does, that effect could last only a matter of days or weeks but could last longer, Topham says. 

At this point, much is unknown about COVID-19. The virus was first detected in Wuhan, China, in 2019. The World Health Organization on Feb.11 coined the name COVID-19. There are several types of human coronaviruses, some that cause mild respiratory tract afflictions. COVID-19 is a new disease, not previously seen in humans.

Topham, whose experience as a virologist and immunologist stretches back two decades, sees the global research community’s response to COVID-19 as outpacing its past efforts to delve into and combat SARS, MERS and swine flu.

Fresh off a March 3 conference call with global research colleagues, Topham says, “I’m feeling that we’re getting accurate information out of China and out of other parts of the world as well.” 

That communication is important because the wave of COVID-19 infections, have now spread to every continent save Antarctica. Chinese researchers have the longest experience with the new strain, since it first appeared there last December.  

One thing that is known, says Topham, is that COVID-19 has a downside past pandemic viruses did not exhibit: People infected with COVID-19 broadcast the disease during a five-to-seven day period before they begin to show symptoms, whereas flu sufferers become infectious only after they start to sneeze, cough and grow feverish. 

That trait has helped COVID-19 spread rapidly and for the time being makes its further spread virtually inevitable and its future containment potentially problematic.  

Preventive response

Preventive measures local officials including Monroe County Executive Adam Bello and Monroe County Public Health Commissioner Michael Mendoza recommended this week—including washing hands regularly, avoiding touching one’s face and when possible avoiding public spaces—will need to be followed, Topham advises.

Area colleges, universities and schools frequently post updates on their preparedness for an outbreak in Rochester. The University of Rochester has established a Coronavirus University Response team while Nazareth and St. John Fisher College announced an at-home quarantine for those returning from study abroad programs in Italy. The State University of New York is currently arranging chartered flights from South Korea, Italy and Japan to New York Stewart International Airport in the coming days, state officials say.

Rochester Regional Health is monitoring the situation as well, enacting additional protocols and procedures for its employees, patients and communities. 

“As the situation develops, we remain in tight collaboration with the county and state health departments and remain ready and adaptive should COVID-19 reach our region,” said Robert Mayo, chief medical officer for Rochester Regional Health, in a statement.

Rochester Regional Health’s telemedicine service Care Now is preparing to expand access so that symptomatic patients can consult physicians remotely, minimizing contact with others.

Patients served by the RRH network who come down with viral infections are urged to call their primary care provider. In some cases, they will be told they can remain at home and obtain on-going medical advice through Care Now.

Late last month Gov. Andrew Cuomo announced $40 million for the New York State Department of Health to hire additional staff and procure equipment and any other resources necessary to respond to the pandemic. Rep. Joseph Morelle, who was in town last weekend, underscored the need for precaution and preparedness.

General information posted by responsible media has so far been accurate and has closely reflected what the scientific community has determined, although some tweaks may slightly alter the picture, Topham says. Older individuals and others with less robust immune systems are indeed thought to be likely to be at greater risk of suffering serious consequences, he says. 

It has not yet been determined whether some older individuals could have residual immunity from previous infections from other less virulent coronavirus strains. If that turns out to be the case, an effect like that of the 1918 Spanish flu epidemic, which mostly claimed relatively young and healthy individuals, could surface. Whether such an effect would be significant or a statistical blip cannot now be known. 

Another upside of a sort: Topham believes the widely forecast 2 percent or higher mortality rate now believed to be the toll COVID-19 is taking is probably too high. That is because reliable testing is not yet in place to identify coronavirus sufferers who aren’t showing symptoms or those who only show mild effects and may not seek treatment. If the ratio of those whom the virus kills to an accurate count of all those infected were computed, Topham believes, the mortality rate could be significantly lower. 

Still, that would be cold comfort to the dead, whose numbers would remain the same wherever the ratio fell. In the end, says Topham, even if efforts to stay COVID-19’s advance come to little or naught, a balance would be most likely achieved sooner or later. 

As more and more sufferers survived encounters with the virus and developed resistance to COVID-19, the pathogen would find fewer receptive hosts. The virus’s numbers would plummet, and its spread would effectively be contained, Topham explains. 

The same effect, known as herd immunity, would of course kick in much sooner with an effective vaccine, which would be a far more preferable outcome.  

Herd immunity contained the bubonic plague, a 14^th century pandemic known then as the Black Death that struck at a time when neither the existence of the microbes that caused the disease nor the means to contain them were known.  

Over the roughly four years it took for herd immunity to do its work in Europe, as many as 100 million died and, historians now say, it took the region’s economies and societies 200 years to recover. 

Will Astor is Rochester Beacon senior writer.