Meow that’s a theory
Could veterinary medicine could be key in developing COVID-19 vaccine?
In December, my five-year-old ginger, Rocco, came down with feline infectious peritonitis (FIP) — an infectious disease caused by a coronavirus.
FIP is considered 100 per cent fatal. The only question at the vet’s office really, is when to schedule the euthanasia. Generally speaking, that’s sooner rather than later. It’s hard to diagnose FIP, but it usually involves a fever, lethargy, weight loss, a messy coat and either respiratory problems or a swollen belly. What makes it lethal to cats is the intense inflammatory response their immune system launches, which causes damage in the abdomen, kidneys or, less commonly, the brain.
That’s the kind Rocco has. We know this because, in addition to refusing to eat or drink and losing a kilogram, he stumbled and lost his balance when trying to get up, walked with an exaggerated arch and started having trouble making jumps.
Given all the strange tiger and house cat COVID-19 stories out there, you may be wondering if Rocco’s infection is one of those. It isn’t. Although SARSCoV-2, which causes COVID-19, and the feline coronavirus that causes FIP, both descend from the bat gene pool, they are different viruses. For one thing, the cat virus isn’t novel — it’s been around since at least the 1960s.
None of this, I must add, is meant to draw any equivalence between my cat’s saga and the epidemic human suffering caused by COVID-19. Even before the World Health Organization was informed of the novel coronavirus on Dec. 31, 2019, I knew that, no matter how attached I was to Rocco, his problems didn’t register as a serious concern in a world that, at the time, was dealing with: Australia being on fire, locusts invading Somalia and Ethiopia and, closer to home, a serious homelessness crisis in Toronto.
While I was waiting for his diagnosis, I researched FIP, only to discover the world of blackmarket, antiviral cat drugs and a totally heroic online community of people devoted to rescuing cats. It also led me to learning a lot about the power of people working together to help others with their own health problems, lessons we desperately need in the era of COVID-19.
If you have a cat, there’s a roughly 75 per cent chance it has already had this coronavirus and you just never noticed. Most cats are asymptomatic or have mild symptoms and get over it. A combination of genetic factors and environmental stress, however, means a small percentage of cats (roughly one to three per cent) can’t mount an adaptive defence against it (a.k.a. antibodies) and inflammation (part of the innate immune system) kicks into overdrive, doing fatal damage.
You don’t have to be especially good at Google, though, to discover that some cats have survived FIP, despite the fact vets can’t really offer any treatment options. The first FIP survivors were subjects in clinical trials at the University of California Davis school of veterinary medicine, which tested experimental drugs on FIP cats successfully.
These studies are part of a lifetime of research on the feline coronavirus conducted by Dr. Niels Pedersen, distinguished professor emeritus at UC Davis, or, as the cat people call him, “Dr. P.”
More than one drug was trialled, but the one most cat people are interested in is GS-441524, the active biological agent in remdesivir — an experimental antiviral that was developed by a California biotech firm called Gilead Sciences for Hepatitis C. If that name sounds familiar, it’s likely because remdesivir has recently been in the news after studies have demonstrated that moderately ill patients hospitalized with COVID-19 improved after five days on the drug.
The jury’s still out as to whether or not it will really help humans but, its active ingredient, GS-441524, a nucleoside that interferes with RNA replication in viruses, cured 25 of the 31cats in the Davis study. Dr. P. had defeated one of the world’s most stubborn and nasty coronaviruses.
There was just one problem. Namely, that Gilead Sciences, which has a patent on both remdesivir and GS-441524, didn’t want the latter licensed for veterinary use, because it’s in the people drug business, not the animal side of things. We don’t really know all the reasons, but some have speculated that cats with relatively rare diseases weren’t considered a lucrative enough market and, in addition, if anything bad happened to cats on “GS,” (as we’ll refer to it from here on in), it might make getting remdesivir approved for humans more difficult.
The relationship between the two drugs? They’re related, but not identical. Imagine that remdesivir is the finished drug, with enhancements to make the “GS” work better on humans. GS is the raw goods.
Frustrated by the fact that a treatment did exist, but there was no way to access it, I started searching for FIP-GS clinical trials in Canada. I found none but, instead, discovered that, far from being the first person to look for it, an underground market for GS was well-established. Dr. P. says the market popped up in China first, even
before he published the results of his research in February 2019.
Why China? Firstly, because cats, especially pedigreed kittens (which are at a substantially higher risk for FIP infections), are trending there. The cat craze is driven by the young urban set, many of whom call themselves “cat slaves,” and spare no expense on treats, clothes, furniture, acupuncture and spa days, while documenting it on social media. Think there are too many cats on your Insta feed? You should check out WeChat.
This may not be the most “eccentric” thing I have done in my life, but sending a substantial amount of money off into the ether in the hopes that someone would deliver life-saving cat drugs of questionable origin and quality to my door is right up there. At first, I resisted this seemingly desperate move. But there’s something about knowing there’s a potential cure that preys on you. Nobody knows how many people are currently treating their cats with GS, but it’s in the thousands. There are people on every social media platform educating and supporting each other in a massive “citizen science” project to save cats and defeat FIP.
Inhabitants of the “catosphere” help people diagnose FIP, share templates for keeping track of blood test results, help people locate emergency doses and disseminate strategies for injecting cats with drugs at home.
Oh right. Did I mention the treatment involves 12 weeks of daily subcutaneous injections that just about no licensed vet would be willing to do for you, given the shady provenance of the drugs? Worse, depending on the blood work and results, some people have to extend beyond the normal treatment window.
Our final tally was 116 injections, given every single day from early January to late April at more or less exactly 4:30 p.m. in the afternoon.
But Rocco was back to doing his acro-cat balance beam “catwalk” routine on the banister on Day Six — a day that, without the GS, would have probably been euthanasia day.
That joy helps get you through the bad shots and “injection sores” — a reaction to the medicine that creepily comes up through the skin and, on occasion, gets infected. That means buying cat sweaters, so they can’t scratch or lick the sores, as well as hot towel soakings and administering antibiotics, all of which, on top of the stress of sourcing hard-to-get meds, makes the treatment close to a full-time job. I was, essentially, a cat slave.
My devotion, however, is nothing compared to the army of self-trained volunteers who offer their time and expertise on the catosphere. Not only do they give advice and support at all times of day — someone even messaged me on Christmas Day to ask how Rocco was doing — they actually manage to keep the black market honest (ish), just through constantly keeping track of all the kitties’ progress. In late January, a bad (diluted) batch of medicine was discovered (the brand I, in fact, used) a cluster of cats started declining. That’s the power of surveillance and frequent testing.
Of course, I’m not just talking about cats anymore. Vigilant surveillance such as testing and tracing haven’t been aggressively applied yet in Ontario to control COVID-19, even though epidemiologists have been shouting it from the rooftops since the beginning. When it comes to novel and rare diseases, information in key, and most physicians simply don’t have all the answers, which is why online platforms such as Patients Like Me are so successful. Informed people working online together to solve health problems can be surprisingly powerful.
It’s an online community that resembles what early technooptimists hoped the internet would be, before things went south and Cambridge Analytica, 8chan and Breitbart took over. Did I mention that the catosphere is stacked with women? Probably just a coincidence.
Although the moderators of the forum do try to keep conversations about kitty treatment, instead of speculation about the relationship between the two coronaviruses, it comes up. Nobody in the catosphere, for example, was surprised when COVID-19 turned out to be more than a respiratory illness and, instead, caused other problems, such as vascular, kidney and neurological damage or even the loss of appetite.
In early January, one of the cat people jokingly suggested people try GS for treating COVID-19. And, sure enough, in late January, it turned out that Gilead was dusting off its shelved antiviral, remdesivir, and offering it up for clinical trials. I asked Dr. Pedersen if he was surprised to see GS make its appearance in the unfolding COVID-19 story. He told me he was surprised it wasn’t considered earlier.
Dr. P. didn’t mean earlier in the COVID-19 timeline but, rather, in a more general sense. Human infectious disease researchers had long known that a zoonotic virus was a likely scenario in the next pandemic. So, since vets do a lot of work on coronaviruses, it might have been a good idea to pay a little attention to what was going on there.
It’s not even the only drug Pedersen used to battle FIP-a protease inhibitor yielded good results, as well. At the end of May, it was revealed that drug would also be trialled for COVID-19.
As Heather MacDougall, a historian at the University of Waterloo who studies our responses to contagious diseases said to me: “This is our third deadly coronavirus in 20 years, (referring to SARS-CoV-1, MERSCoV and SARS-CoV-2). It’s time to talk to the vets.”
“We’ve been dealing with the coronavirus diseases in swine, poultry, calves, dogs, cats and other domestic and exotic species for decades,” noted Dr. Pedersen. “It’s like people are surprised when a bat virus suddenly gets into humans? We know this. We’ve seen it happen in other animals.”
Despite the wealth of work done by vets on coronaviruses, Pedersen explained the veterinary schools’ contributions to this body of research had generally been overlooked.
There’s a glimmer of hope that we’re starting to address this knowledge gap in Canada, at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, which started as a veterinary lab in 1975. It’s been trying, unsuccessfully, to get funding to develop a vaccine that would work on all coronaviruses for some time. Now that COVID-19 has become a problem for human animals … well, they’ve got money.
I asked Pedersen if the disconnect came from the idea that veterinary research is often regarded as the toy department of medical sciences, or if it was because we still view humans as fundamentally separate from (and superior to) animals in ways that don’t bear out in real life. Both, he said. Plus money.
It’s still too early to know if Gilead’s remdesivir will work on humans like GS does on cats. My friends in evidence-based medicine say it’s low-quality evidence at this point. It’s also possible medical researchers and vaccine makers won’t be able to apply many of the lessons learned from animal coronaviruses to humans. But there are precedents to support Pedersen’s position that ignoring relevant veterinarian research is like doing work with blinders on.
Fifty years ago, veterinary researchers had connected the papilloma virus to cancer in horses and other animals, and there were some successful vaccines.
But in the 1980s and 1990s, the centre of gravity in basic cancer research shifted to the oncogene theory — a gene that could cause cancer. Tumour virology fell out of favour, and vaccine research was shunted to the margins. The veterinarians were right all along, however, and we now have HPV vaccines.
On a larger level, COVID-19, a zoonotic disease, should be a sharp reminder that any notion that we’re separate from the animals is illusory.
How’s Rocco? Well, it’s only been four weeks since his last shot and FIP relapses have been known to happen anytime up to three months after treatment ends, so we won’t have any answers for a while.
For now though, he’s great. He’s gained back all his weight and can run, jump and walk. These are important markers, Dr. P. said, in terms of predicting if a neuro cat will make it to the point they’re considered cured.
And, if we don’t make it that far, it will be a very sad final chapter for all of us, of course.
But, as Dr. Pedersen said to me, “We cannot save them all, but there is no shame in that if we gave it our best.”
Rocco Fluffernutter will be posting daily updates about his progress on Instagram @roccosismondo.
If you have a cat, there’s a 75 per cent chance it has already had this coronavirus and you just never noticed