Whether the COVID-19 epidemic is declared a pandemic or not, it is clear that the situation we are currently experiencing must be considered with the utmost seriousness. The SARS-CoV-2 coronavirus does not care whether it is the cause of a pandemic: in less than two months, it has spread to several continents. A disease is considered to enter the pandemic phase when it is transmitted in a sustained, effective and continuous manner, simultaneously within more than three different geographic regions. We may therefore have already entered the pandemic phase with respect to COVID-19. But this does not mean that we are condemned to death: the fact that a virus causes a pandemic does not reflect its lethality, but only its transmissibility and geographical spread.
One thing is certain: fear, on the other hand, has indeed entered the pandemic phase. For the first time in history, we are experiencing a real-time epidemic. We are on an information infusion: all over the world, the media are informing us in real time about the evolution of the epidemic, several times a day, seven days a week. We are kept informed of every new case live. The fact that the coronavirus has mutated three times in Brazil has even made headlines!
I insist, we have a serious problem. However, we must remember that one of the first victims of the coronavirus will have been the economy. While it is important to report on developments, it is also important to focus on positive information. And there is good news too: here are ten pieces of good news about the coronavirus.
1. We know what causes the disease
After the description of the first AIDS cases in June 1981, it took more than two years to identify the virus causing the disease, HIV. Concerning the new coronavirus, the first cases of severe pneumonia were reported in China on 31 December 2019. By 7 January, the virus responsible had already been identified. By Day 10, its genome sequence was available.
We already know that it is a group 2B coronavirus, which is the same family as SARS, and we have given it a name: SARS-CoV-2. The disease it causes is also called Covid-19. This new virus is related to a bat coronavirus. Genetic analyses have confirmed that it is of natural origin, that it emerged recently (between late November and early December), and that although viruses adapt by mutating, the frequency of mutation of SARS-CoV-2 is not very high.
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2. We know how to detect coronavirus
3. In China, the situation is improving
The extensive control and isolation measures imposed by China are bearing fruit: the number of cases diagnosed on a daily basis has been falling for several weeks.
In other countries, detailed epidemiological monitoring is under way. Outbreaks of the new coronavirus are very specific, which may make it easier to control them. This is for example the case in South Korea or in Singapore.
4. 81 % of cases are mild
The disease causes no symptoms or is mild in 81 % of cases. In 14 % of cases, it can cause severe pneumonia and in the remaining 5 %, it can become critical or even fatal.
5. People heal
The media sometimes tend to report only on the increase in the number of confirmed cases and deaths. Nevertheless, the majority of those who have been infected are cured. Indeed, there are 13 times as many recoveries as deaths, and this proportion is increasing..
6. Children are (almost) unaffected
Only 3 % of the cases involved youth under 20 years of age, and the mortality in persons under 40 years of age is only 0.2 %. In children, the symptoms are so mild that they may go unnoticed.
7. The coronavirus is easily inactivated
The virus can be effectively inactivated by cleaning up for a minute surfaces contaminated with a solution of ethanol (62-71 % alcohol), hydrogen peroxide ("hydrogen peroxide" at 0.5 %) or sodium hypochlorite (0.1 % bleach). Frequent hand washing with soap and water is the most effective way to prevent transmission.
8. There are already more than 250 scientific papers on the new coronavirus
It's time for science and cooperation. In little more than a month, 164 articles mentioning the terms Covid-19 or SARS-CoV-2 have been referenced in the PubMed bibliographic database, which is a reference for biomedical sciences. Many other publications have also been referenced in as yet unreviewed item repositories. This preliminary work deals with vaccines, therapies, epidemiology, genetics and phylogeny, diagnostics, clinical aspects, etc. They have been developed by about 700 authors from all over the world. It is cooperative, shared and open science. In 2003, when SARS occurred, it took more than a year to get half the number of papers. What is more, this time most scientific journals left their publications on the coronavirus open access.
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9. Prototype vaccines already exist
Our ability to design new vaccines is spectacular. More than eight projects targeting the new coronavirus have already been set up. Proposing a prototype vaccine goes very fast. Some groups working on vaccination projects against viruses similar to SARS-CoV-2 have only had to redirect their research towards this new virus. However, development has been slowed by the need for tests to assess the toxicity or potential side effects of candidate vaccines, as well as their safety, immunogenicity (ability to induce an immune response) and the effectiveness of the protection they provide. It may take several months or years to develop a marketable vaccine, but prototypes are already being developed.
An example is Moderna's 1273 mRNA vaccine, which consists of a messenger RNA fragment that produces a protein derived from the surface glycoprotein S of the coronavirus. Moderna had previously worked on similar prototypes for other viruses such as Human Respiratory Syncytial Virus (HRSV), human metapneumovirus, parainfluenza virus type 3, influenza A(H7N9), cytomegalovirus, Zika virus, or Epstein-Barr virus.
Inovio Pharmaceuticals announced that it is working on a synthetic DNA vaccine targeting the new coronavirus. Called INO-4800, it is also based on the virus' surface glycoprotein S gene.
For its part, Sanofi will use its recombinant baculoviruses platform to produce large quantities of the surface antigen of the novel coronavirus.
The "vaccine group" at the University of Queensland, Australia, has announced that it is already working on a prototype using a technique called "molecular claw" . This new technology consists of creating chimeric molecules capable of maintaining the original three-dimensional structure of the viral antigen. This makes it possible to produce vaccines in record time, using the virus genome.
Another biotech company, Novavax, also announced that it is conducting work on coronavirus.It has a technology to produce recombinant proteins assembled into nanoparticles that, with their own adjuvant, are potent immunogens. In Spain, the group of Luis Enjuanes and Isabel Sola of the CNB-CSIC has been working for years on vaccines against coronaviruses.
Some of these prototypes will soon be tested in humans.
10. More than 80 clinical trials involving antivirals are underway.
Vaccines are preventive. In the immediate term, it is important to develop treatments to care for people who are already sick. More than 80 clinical trials to evaluate the efficacy of coronavirus treatments are ongoing. These are antivirals that have been used for other infections, are already approved and we know they are safe.
Remdesivir is one of those antivirals already tested in humans. This broad-spectrum antiviral, still under study, has been used against Ebola and the coronaviruses SARS and MERS. It is anadenosineanalogue. When incorporated into the viral RNA chain, it inhibits its replication.
Chloroquine is another candidate. This antimalarial drug has also been shown to have potent antiviral activity. Chloroquine is known to block viral infection by increasing the pH of the endosome (a kind of small spherical structure bounded by a membrane), which is necessary for the virus to fuse with the cell, thus inhibiting its entry. It has been shown that this compound blocks the new coronavirus in vitro. Chloroquine is already being used in patients with coronavirus pneumonia.
Lopinavir and Ritonavir are two protease inhibitors used as antiretroviral treatment in the fight against HIV, whose final maturation they inhibit. Since the protease of SARS-Cov-2 has been shown to be similar to that of HIV, this combination has already been tested in patients with coronavirus.
Other proposed tests include some based on the use of oseltamivir (a neuraminidase inhibitor used against the influenza virus), interferon beta-1b (a protein with antiviral function), antisera from people who have already recovered, or monoclonal antibodies to neutralize the virus. New therapies using inhibitory substances have also been proposed, such as baricitinib, a drug already approved for the treatment of rheumatoid arthritis that may be effective against the coronavirus has been identified through artificial intelligence.
In 1918, the influenza pandemic killed more than 25 million people in less than 25 weeks. Could such a situation happen again today? Probably not. Indeed, never in our history have we been better prepared to fight a pandemic.
Ignacio López-GoñiProfessor of Microbiology, University of Navarra