„Politicians have seen it as a beauty contest — how many tests are done — without a proper understanding about the results,“ Middleton said. The good news is that the technology is improving, and better, more rapid tests are coming along, he added.
Austrian geneticist Hans Lehrach, of the Max Planck Institute, thinks it’s time for a completely new way of testing.
„This requires a different approach to testing as landing a man on the moon required a different approach than hot air balloons,“ Lehrach said.
Lehrach’s idea is that governments could test everyone in a given country or in the EU for five consecutive weeks by genetic sequencing. If countries did this, they could effectively eliminate the virus in that area.
It would require citizens’ and governments’ buy-in — literally. But so far, governments have been slow to take on this new testing approach.
„Whatever we do will not be for free,“ Lehrach said. But he argues that this approach would eliminate the virus from the targeted area and allow people to go back to restaurants and work knowing „that everybody they meet is free of the virus.“
Contact tracing
If there’s one immediate priority that governments should invest in for the short term, it’s contact tracing, argues Clare Wenham, assistant professor of global health policy at the London School of Economics.
“The countries that are able to resume normal life — Hong Kong, Taiwan, South Korea — they … have the infrastructure to be able to do really granular and effective contact tracing,” Wenham said.
This requires an effective application and staff who can “join the dots.”
“When one person gets infected, [the tracers] can notify who they’ve been in contact with, and reach the people that weren’t on the app for whatever reason. A bank of staff that can do that last mile,” she said.
Numerous European countries are trying to do this already, including the U.K. and Germany. But they’re running into two problems. Many of these apps aren’t interoperable across borders, so their effectiveness at fighting major public health problems is not known. And many people are afraid of signing up.
“For a lot of Europeans, it’s not a natural thing to have the government tracking everything on your phone and your movements,” said Wenham.
Assuring people that their data is safe, and not being used for any other purposes — for example to be sold to third parties — is key here, Wenham added.
„This is a dataset that would be rich for selling,“ she said. „You need to make sure that you have that data security.“
Finding a cure
One major advantage that therapies have over vaccines is that they’re easier to test — and therefore faster to bring to market.
David Salisbury, an associate fellow at Chatham House and former director of immunization at the U.K.’s Department of Health, explained that this comes down to the comparative ease of setting up clinical studies for drugs.
„You test [an] antiviral in people who’ve got the disease, and you hope to see that those that you treat with the antiviral get better and survive better than those who have a placebo or an alternative treatment,“ Salisbury explained.
„With a vaccine, you’ve got to show that it stops people actually getting infected,“ he said. „So it has to be administered in a place where the virus is circulating, and administered in extremely large doses.“
This means vaccine developers are constantly racing to roll out clinical trials in places where the virus is still on the rise. Recently, the University of Oxford and AstraZeneca launched a new wing of its phase 3 clinical trial in Brazil because that’s where the „epidemiological curve is still rising.“
But regardless of whether and when a vaccine is developed, therapies are necessary, say experts.
“We need drugs before we get a vaccine,“ said Nick Cammack, COVID-19 therapeutics accelerator lead at the Wellcome Trust. „We need drugs while we have a vaccine … and we need drugs after we get a vaccine, because even for conditions that we currently have vaccines for you still have breakthrough cases.“
The first line of defense is coming from repurposed drugs, he noted at a webinar organized by the Wellcome Trust last week. These are medicines already developed to fight other diseases and are now being tested to see if they help patients.
The two medicines that have been in the spotlight — remdesivir and hydroxychloroquine — fit into this category. However, evidence of their efficacy is, at best, spotty.
Remdesivir, an antiviral developed to fight Ebola by drugmaker Gilead, has shown it can moderately shorten the duration of the disease. Malaria drug hydroxychloroquine promised some early hope but has since failed to pay off, with a major British trial declaring negative results.
In the medium term, antibodies can also be applied as a therapy, Cammack noted. Plasma from people who have already recovered from the disease carries antibodies against COVID-19. If it’s injected into patients that are currently sick, it can give the immune system a boost to help fight the virus.
The problem: You’re limited by the amount of recovered patients you can gather plasma from.
An alternative approach is monoclonal antibodies, which are designed and can be mass-produced in a lab. U.S. drugmaker Eli Lilly has brought its monoclonal antibodies to phase 1 trial together with AbCellera, and expects results at the end of June.
„In the next six to nine months we will know if monoclonal antibodies that are specific for COVID-19 show safety and efficacy,“ Cammack said. „There’s much excitement around them as potential treatments.“
Specific antiviral medicines to target COVID-19 — likely to be small molecule drugs — are further away and require a number of trials.
Public health
Beyond the measures noted above, experts argue, policymakers need to keep up basic public health work that has become routine since lockdowns started: Washing hands, wearing a mask and keeping distance.
„If [people] are underpinning activities in a country by protecting themselves by social distancing, that’s already a major step forward,“ Heymann said.
One of the most important tools for politicians is clear communication, especially considering that the public needs to trust that these measures — testing, contact tracing, drugs and a vaccine, if it’s found — are safe.
Trudie Lang, professor of global health research at the University of Oxford, said that this was a lesson first learned from Ebola that’s being learned again now: Public health measures are only as effective as the amount of trust the public has in them to work.
“What messages to use? How to gain public trust?” Lang said, also at the Wellcome webinar. „In the absence of drugs and vaccines, these are things that we are left with.“
And even if we get a vaccine or an effective treatment, one of the clearest messages from public health officials might be that the virus is here to stay.
“This virus is not going to go away. Period,” the World Health Organization’s David Nabarro told the BBC. “We don’t have a vaccine and we don’t know we’re going to develop one … so we’ve all got to learn to live with this virus.”
Source: politico.com
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