Covid-19 Will a vaccine save us?
Tony Allen-Mills ,of London’s Sunday Times, speaks to scientists about the progression of Covid-19, the best response to it by different countries, and what a vaccine will mean.
Among the presents around Peter Openshaw’s Christmas tree 12 weeks ago was a strategy board game named Pandemic. Players take the roles of disease-fighting specialists seeking cures for plagues before they spin out of control. You win the game by ‘‘saving humanity’’.
A few days later the game turned real for Openshaw, 65, who is professor of experimental medicine at Imperial College London (ICL) and one of Britain’s foremost specialists on the behaviour of deadly viruses.
He had bought the Pandemic game for his son as a joke, but on checking Twitter after Christmas, he spotted a string of alarming messages about a mystery outbreak of viral pneumonia in the Chinese city of Wuhan.
Peter Horby, an Oxford University expert on infectious diseases, tweeted that the outbreak was ‘‘one to watch’’. Sir Jeremy Farrar, director of the Wellcome Trust research charity, added that ‘‘any cluster of severe respiratory infections (is) a real worry’’.
As luck would have it, Openshaw’s ICL research group was working at that moment on a question that would suddenly become central to the fight against Covid-19, the newly identified coronavirus disease that is rapidly turning into one of the most destructive health crises of the modern age.
‘‘Our main focus has been on trying to work out why people have such variable effects when struck by these viruses,’’ Openshaw said. ‘‘We have been infecting normal adult volunteers with different viruses, particularly the pandemic influenza and common cold viruses, trying to find out why some people are not affected at all, others have an infection but it’s not very symptomatic and some show clear symptoms of infection.’’
Within days, Openshaw was spending ‘‘all my waking and sleeping hours’’ gathering information on the new coronavirus. In addition to his ICL research work, he is one of the leading figures in a littleknown network of British epidemiologists who have been quietly preparing for another pandemic since the swine flu outbreak of 2009-10.
Set up with the help of the Wellcome Trust and the Medical Research Council, the group known as Isaric (International Severe Acute Respiratory and Emergency Infection Consortium) prepared what Openshaw described as ‘‘sleeping protocols’’ to ensure that researchers were ready to meet the challenge of any dangerous new virus.
A decade later that moment has arrived, the Isaric group has been activated and the full weight of British science is being brought to bear on the Pandemic board game challenge that no longer sounds quite so lighthearted: ‘‘Can you save humanity?’’
Last week Openshaw talked at length about the spread of Covid-19, the alarming behaviour it is displaying, the efforts of governments to contain it, the prospects for a vaccine and the mistakes we are in danger of making.
What is known about the new virus?
Openshaw’s first task was to build up a clinical portrait of Covid-19. ‘‘What did this resemble? Was it behaving like flu or more like Sars [severe acute respiratory syndrome, caused by another coronavirus that emerged from China in 2003]?’’ he said. ‘‘What were its unique clinical characteristics? Why was it causing so many serious cases to appear in hospitals in Wuhan? Was it mostly affecting lungs? Why was there such a high mortality rate? Who was most at risk? All those questions became very pressing.’’
The search for answers was unexpectedly assisted by what some saw as a breakthrough in Chinese transparency. Unlike in the Sars pandemic, when detailed information was slow to emerge, Chinese scientists soon started sending data-rich reports to the world’s leading medical journals, The Lancet and the Journal of the American Medical Association.
‘‘They were producing articles within days,’’ said Openshaw. ‘‘Well written, detailed, and they didn’t seem to be holding back.’’
What the Chinese data revealed was not so encouraging. ‘‘It was immediately clear this was not a rapid illness,’’ said Openshaw. ‘‘Illness was developing in different stages and there was clearly a presymptomatic phase after exposure. It turns out to be about five days.
‘‘Then, once symptoms start, they often start gently or insidiously. People may develop a bit of a non-specific malaise and a cough, grumbling on for a week or so. It’s only then it becomes clear who is going to recover and who will be bitten hard by the next phase, characterised by inflammation of the lung, this viral pneumonia that seems to develop.’’
What worries scientists is that the human immune system may be contributing to that inflammation, instead of getting rid of it. And in a high proportion of cases requiring intensive care, the virus seems to affect other organs and systems.
‘‘Unusually this seems to affect the heart and maybe the blood vessels,’’ said Openshaw. ‘‘A proportion of people go on to get viral myocarditis [an inflammation of the heart muscle] and that seems to be an element in quite a portion of deaths. This particular virus goes on to cause mischief outside the respiratory system while continuing to cause inflammation in the lungs themselves.’’ All this helps explain why older people with underlying health conditions affecting the lungs or heart have emerged as the most at risk.
Who has done best in controlling the spread?
‘‘It has been very interesting to see the way in which different political systems have handled this type of outbreak,’’ said Openshaw.
‘‘With a very regulated society like China, where people are used to complying with government orders, you can imagine how it’s possible to knock a virus like this down. In societies where sociability is absolutely embedded, it’s more difficult.’’
Last year he visited Singapore, ‘‘a very authoritarian but quite science-based society’’, which responded to the Sars epidemic by building a state-ofthe-art, 330-bed National Centre for Infectious Diseases. ‘‘It was one of the most impressive