Test which would check for the presence of antibodies against SARS-CoV-2 were okayed by the Indian government on April 4, 2020
As the novel coronavirus disease (COVID-19) pandemic continues to test all pillars of society — governance, healthcare, supply chain and human resilience — scientists and healthcare workers have risen up to the challenge.
As of April 5, 2020, more than a million positive cases for COVID-19 had been recorded in the world.
As predicted by experts, owing to a befuddled handling of initial testing and stay-at-home orders, the United States is following Italy’s trajectory of poorly controlled spread. Looking for examples to follow, South Korea came through as the most prepared in handling the insidious pandemic. How did it do it?
South Korea tested most people per capita free of cost and effectively traced and quarantined the infected or exposed.
While the US took over in the total number of tests conducted, it was South Korea that tested most—one in 142 people. The US, so far, has tested one in 786 despite having the highest number of COVID-19 cases in the world. It is important to note that the testing rate varies by big margins within the US.
India needs to test on a much larger scale — our population is 25 times that of South Korea. The number of cases is still surprisingly small, with just over 3,500 confirmed positive and 109 dead as on April 6, 2020. To most experts, the numbers could be much more.
While testing is being ramped up steadily, there are laboratories that could be running tests but are not doing so in full capacity. Which is to be expected because India is in a long line with the richer contenders to acquire international testing kits.
“The developers of tests, antivirals and vaccines need to be given a free-hand. They need to be offered full support and greater incentives to accelerate their programs. In the US, regulatory delays created significant hurdles in responding to the epidemic. India cannot afford to repeat the same mistake,” said Vinay S Mahajan, immunologist and pathologist from Harvard’s Brigham and Women’s hospital.
Along those lines, the Department of Science and Technology has identified projects for swift funding, while Centre for Cellular and Molecular Platforms (C-CAMP) in partnership with United Nations Health Innovation Exchange (UNHIE) started a technology accelerator to help breakthrough innovations reach commercialisation.
Making headway, a team of scientists led by Souvik Maiti and Debojyoti Chakraborty at CSIR- Institute of Genomics and Integrative Biology(IGIB) designed a paper strip based assay which can provide results in an hour.
Other critical serological tests, which would test for the presence of antibodies against SARS-CoV-2, were okayed by the Indian government on April 4, 2020. Patients with influenza-like illness with symptoms like cough, cold, low-grade fever or sore throat and living in one of the clusters of COVID-19 will considered for the test.
Hope is close. Academic institutes and pharmaceutical companies are racing towards multi-pronged ways to combat COVID-19.
Both previous Beta-coronaviruses — SARS-CoV-1 that led to Severe Acute Respiratory Syndrome outbreak in 2002 and MERS-CoV— are zoonotic, ie, they can jump between species. SARS-CoV-2 is also zoonotic and possibly jumped from pangolins, according to experts.
The novel coronavirus has many similarities to other viruses.
One of the first drugs to enter phase III clinical trials in China was antiviral Remdesivir (Gilead Sciences), originally developed to treat Ebola. It blocks the RNA-dependent RNA Polymerase (RdRp) required for viral replication. Trials are ongoing in China, Korea and the US, with some results expected this month.
Among other known antivirals that potentially reduce the spread of virus in patients are Lopinavir and Ritonavir (sold together as Kaletra, by AbbVie), in combination with influenza drugs like Favipiravir and Oseltamivir are being tested in three-five trials in China.
Drugs previously approved for diverse indications are also currently in clinical trials. Chloroquine, an antimalarial drug shown to be a broad- spectrum antiviral as well as an immunomodulator, has been anecdotally shown to be effective against SARS-CoV-2.
Its relative safety (we have decades of experience in using this drug) and cost effectiveness could be important for developing countries, even if clinical evidence of its effectiveness is not available yet.
Another broad class of drugs is biologics. These are a little expensive to manufacture, but Indian manufacturers have caught up in this sector.
Biologics like antiviral antibodies would, in effect, neutralise the virus. They can be made by cloning an important class of antibody producing immunoglobulin genes to make monoclonal antibodies from recovered patients. Some of these are already in production by Vir Biotechnology, Regeneron and others in the US.
Convalescent serum from recovered patients, called passive antibody therapy, containing polyclonal antibodies has been used in previous epidemics such as Ebola. The US Food and Drug Administration (FDA) approved early trials for cell therapy for COVID-19 using another type of immune cells called Natural Killer (NK) cells, by the company Celularity.
Actemra, another FDA-approved biologic to treat rheumatoid arthritis, was approved for off-label use by the Chinese government for patients with SARS-CoV-2 pneumonia.
The epidemic can be brought under control with an effective vaccine. Unlike previous epidemics, there are at least a dozen vaccine approaches that are being attempted in parallel.
A messenger RNA-based vaccine developed by Moderna was the first to enter a clinical trial in collaboration with National Institute of Allergy and Infectious Diseases. Even if testing and production take a year, it would be the fastest any vaccine has been brought to the market in history.
On March 24, 2020 Prime Minister Narendra Modi announced a 21-day lockdown, legitimately the only practical measure to control the epidemic. Now, we need parallel strategies and planning to address how to mitigate the fall-out on the marginalised sections of society.
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