Atlantic magazine says that in May 1997, a 3-year-old boy had a health problem that seemed to be a cold. When her symptoms - sore throat, fever, and cough - lasted for six days, he was transferred to Elizabeth Hospital in Hong Kong. There his agony got worse, and he started suffocating. Despite intensive care, the boy died.
After the doctors were confused about his rapid deterioration, they sent a sample of sputum to the Chinese Ministry of Health. But the standard test protocol was not able to fully determine the virus that caused the disease. The chief virologist decided to ship some of the sample to colleagues in other countries.
And at the US Centers for Disease Control and Prevention in Atlanta, he remained mine for a month, pending his role in a slow process of antibody match analysis. The results ultimately confirmed that this was a different type of influenza, the virus that has killed more people than ever before. But this type is unprecedented in human history. The H5N1 virus, or "bird flu", was discovered two decades ago, but what was known was that it only infected birds.
Then in August. Scientists have sent distress signals around the world. The Chinese government quickly killed 1.5 million chickens (due to protests by chicken farmers). Other cases were closely monitored and isolated. By the end of the year there were 18 known human cases. Six people died.
A global response was successful, and the virus was not detected again for years. Partially, the containment was expected because the disease was very severe: it was manifested in those who were clearly infected and severely suffering from it. The H5N1 bird flu death rate is about 60 percent - and if you catch it, you will likely die. But since 2003, the virus has killed only 455 people. In contrast, mild (regular) influenza viruses kill an average of less than 0.1 per cent of the people they infect, but they are responsible for hundreds of thousands of deaths each year.
Severe illness caused by viruses such as the H5N1 avian influenza virus means that infected people can be identified and isolated, or they die quickly. They are not left feeling ill and spreading the virus. The new Corona virus (known as SARS-CoV-2) that has spread around the world can cause severe respiratory disease. The disease (known as COVID-19) appears to have a death rate of less than 2 percent, which is significantly lower than most outbreaks that have dominated global news. The virus has sounded the alarm, not because of the low death rate, but because of the virus itself.
Corona viruses are similar to influenza viruses in that they contain single strands of RNA. Four corona viruses usually infect humans and cause colds. It is believed that these have evolved in humans to double their spread - which means disease, but not death. In contrast, the previous two new outbreaks of Corona virus - SARS (severe respiratory syndrome) and MERS (Middle East respiratory syndrome, which was named after the place where the first outbreak occurred) - came from animals, as is the case with bird flu (H5N1) ). These diseases were fatal to humans. And if there are mild or asymptomatic cases, then they are very few. If there were many of them, the disease would have spread widely. Ultimately, both SARS and respiratory syndrome in the Middle East killed less than 1,000 people.
Already it is reported that Virus Covid-19 [New Corona] has killed more than twice that number. Due to its strong mixture of properties, this virus has its different characteristics from those that attracted global attention: it is fatal, but it is not very fatal. Makes people sick, but not in predictable, and identifiable ways. Last week, 14 Americans were confirmed infected on a ship in Japan despite being relieved - the new virus may be more dangerous because, apparently, it may not cause symptoms at all.
The world responded with unprecedented speed. The new virus was identified very quickly. His genetic tape was serialized by Chinese scientists and shared worldwide within weeks. The global scientific community has exchanged genomic and clinical data at unprecedented rates. And work on the vaccine in full swing. The Chinese government enacted exciting containment measures, and the World Health Organization declared an emergency of international concern. And all of this happened in a short time it took just to get to know the H5N1 virus in 1997. Yet the outbreak is still spreading.
Harvard Professor of Epidemiology, Mark Lipsic, hesitates about what he says, even for epidemiology. He started twice in our conversation saying something, then he stops and says, "Actually, let me start again." So, surprisingly, one of the points he wanted to correct was exactly: "I think the likely result is that the virus will not be able to contain at the end."
Containment is the first step in responding to an outbreak. In the case of Virus Covid-19, it seems that the possibility of epidemic prevention (albeit unreasonable) began within days. Beginning in January, China gradually began to cordon off large areas, and eventually to mold about 100 million people. People are prevented from leaving their homes, and they are guided by drones if they are caught abroad. However, the virus has now spread to 24 countries.
Signs of illness
Although such measures are ineffective - relative to their heavy social and economic cost, at least - the campaign continues to escalate. Under political pressure to "stop" the virus, the Chinese government announced last Thursday that officials in Hubei Province would go to homes to check people for fever and look for signs of disease, and then send all possible cases to quarantine camps. But even with ideal containment, the spread of the virus may be inevitable. Because testing people who already have a very severe illness is an inappropriate strategy in that people spread the disease without feeling unwell and keep them at home.
Lipsic predicts that over the next year, about 40 to 70 percent of people around the world will be infected with the virus that causes Covid-19. But he conclusively makes clear that this does not mean that all of them will suffer from serious diseases. "Many of them are likely to have a mild illness, or they may not experience symptoms," he said. As with the flu, which often threatens the lives of people with chronic health conditions and the elderly, most cases pass without medical care. (In general, about 14 percent of people with the flu do not have symptoms).
And it is not just Lipsic who believes this virus will continue to spread widely. The emerging consensus among epidemiologists is that the most likely outcome of this disease is a new seasonal disease - the fifth "chronic" Corona virus. With the other four, people are not known to develop long-term immunity. If this case follows suit, and if the disease remains as severe as it is now, the "cold and flu season" may become "the cold and flu season and Covid 19 together."
At this point, it is not known how many people are infected. As of Sunday, there were 35 confirmed cases in the United States, according to the World Health Organization. But Lipsic's estimate was "very dangerous" when we spoke a week ago (based on "multiple assumptions that have piled on top of each other," he said) that 100 or 200 people in the United States were injured. This is all it takes to spread the disease on a large scale. The prevalence rate depends on the prevalence of infection in moderate cases. On Friday, Chinese scientists in the medical journal JAMA reported a clear case of the virus spreading asymptomatic, from a patient whose chest scans were normal. If this finding is not a strange anomaly, the researchers conclude, "Prevention of Covid-19 infection will be difficult."
If Lipsic's estimates are not consistent with the exponential value, it will not likely change the general diagnosis. "Two hundred cases of influenza-like illness are difficult to detect during the flu season - when you are not testing this. But it will be really good to know sooner rather than later whether or not this is true. The only way to do this is to test," Lipsic said.
People test
Initially, doctors in the United States advised not to test people unless they had gone to China or were in contact with someone diagnosed with the disease. Over the past two weeks, the Center for Disease Control and Prevention has said it will begin screening people in five US cities, in an attempt to give an idea of how many cases already exist. However, tests are still not widely available. On Friday, the Society for Public Health Laboratories said only California, Nebraska and Illinois had the ability to test people for the virus.
With little data, the issue of diagnosis is difficult. That is why the concern is that this virus cannot be contained - it will continue indefinitely - and therefore the global race to find a vaccine is inevitable, and this is one of the clearest strategies to save lives in the coming years.
The share prices of a small drug company called Inovio rose more than twice last month. In mid-January, there were reports that the company had discovered a vaccine for the new coronavirus. Although technically inaccurate, these allegations have been echoed in many news reports and like other medicines, vaccines require a long test to see if they really protect people from disease and safety. What this company and others have done is to make a copy of the virus's RNA that could one day act as a vaccine. Although it is a promising step, describing it as a discovery is similar to announcing a new surgery after sharpening the surgical scalpel.
Although genetic sequencing is now very fast, making vaccines is as much an art as it is scientific. It involves creating a viral sequence that creates confidence in the immune system’s memory without triggering an acute inflammatory reaction that, in turn, may cause symptoms. (Although the flu vaccine cannot cause the flu, the CDC warns that it may cause "flu-like symptoms"). Reaching this desired point requires testing in laboratory models first, in animals, and ultimately in humans. One simply cannot send billions of viral genes to all parts of the world for the purpose of injecting everyone with them at the moment of discovery.
Enofeo is far from the only biotechnology company to build a chain that strikes that balance. Other companies include Moderna, CureVac and Novavax. This issue is followed up by academic researchers at the Imperial College of Science, Technology and Medicine in London and other universities as well as federal scientists in several countries, including scientists at the National Institutes of Health in the United States.
Find a vaccine
Anthony Fushi, president of the American National Institute of Allergy and Infectious Diseases, wrote in the Journal of the American Medical Association (JAMA) in January that the agency was working at an unprecedented speed to find a vaccine. During the SARS epidemic in 2003, researchers moved from obtaining the genetic sequence of the virus to the first stage of a clinical trial of the vaccine within twenty months. Anthony Fushi also wrote that his team pressed that timeline to shrink to just three months for other viruses, and the new Cornna virus said: "They hope to move faster than that."
New models have emerged in recent years as well, which make promises to accelerate vaccine development. Among them is the Alliance for Pandemic Preparation (CEPI), a coalition launched in Norway in 2017 to fund and coordinate the development of new vaccines. Its founders include the governments of Norway and India, the Bill and Malinda Gates Foundation and the Wellcome Charity Fund. The group’s money is now flowing to Innovio and other biotechnology startups, which has spurred companies to engage in risky businesses to develop vaccines. For his part, Richard Hatchett, Group CEO, shares Anthony Fushi in his primary vision for the schedule that the Covid-19 vaccine is ready for the early stages of safety testing in April. And if all goes well, tests may start in late summer to see if the vaccine really prevents the disease.
timetable
And if all goes well, Richard Hatchett expects that it will take anywhere from twelve months to eighteen before the initial product is considered safe and effective. Richard said the schedule represented a "significant acceleration compared to the history of vaccine development." But he is also unprecedented ambitious. He added: "Even the suggestion of such a schedule at this stage, it must be considered very ambitious."
Even if this ideal estimate of one year is achieved, the new product will still require manufacturing and distribution. Where one of the important considerations is whether expansion of the basic approach is possible with the goal of producing millions or billions of doses in the coming years, Richard said. Especially in light of the existing emergency, if the borders are closed and the supply chains stop, the distribution and production may be quite logistically difficult.
Anthony Fuchsia's initial optimism seemed to have dented. Last week, he said the vaccine development process was "very difficult and frustrating." Despite all the progress made in basic sciences, it is not possible to move forward with the production of an actual vaccine without extensive clinical testing, which requires the manufacture of many vaccines and carefully monitor their results on people. Ultimately, the process could cost hundreds of millions of dollars in funds that are not owned by national health institutes, universities and startups. They also do not possess production facilities and technology to manufacture and distribute vaccine widely.
Vaccine production has long been subject to investment from one of the few global drug giant. Fushi expressed his regret at the Aspen Institute last week because of the lack of "progress" of anyone and the commitment to make the vaccine. He said, "Companies that have the necessary skills to do this will not stand idly by and enjoy a ready-to-work facility when it is needed." Even if they do, taking over a new product like this could mean heavy losses, especially if demand falls or if people choose, for complex reasons, not to use the product.
Pharmaceutical industry
The manufacture of vaccines is very difficult, expensive and high risk, to the extent that drug companies that started in the eighties incurred legal expenses due to the alleged damages resulting from the use of vaccines, which led many companies to stop making them. In order to stimulate the pharmaceutical industry to continue producing these vital products, the United States government has offered to compensate anyone who claims to have been infected by a vaccine, which has continued to this day. However, drug companies generally found that investing in daily medications for chronic conditions is more profitable. Corona virus may be a particular challenge because, in essence, it is like influenza viruses, it contains mono RNA strains. As with influenza, this viral group is likely to undergo a change in its makeup, so vaccines may need to be continuously developed.
"If we put all our hopes for the vaccine as the solution, we are in trouble," said Jason Schwartz, an assistant professor at Yale School of Public Health who studies vaccine policy. Jason believes that the best scenario is to develop this vaccine too late in terms of making a difference in the current outbreak. The real problem is that preparedness for this outbreak had to take place over the past decade, that is, since the outbreak of the SARS epidemic. "Had we not set aside the SARS vaccine research program, we would have had a lot of this foundational work that could be applied to this new closely related virus," Jason said. However, as with the Ebola virus, government funding and the development of the pharmaceutical industry faded once the emergency situation became clear. "Some early research ended up on the shelf because that outbreak had ended before the vaccine needed to be developed severely," Jason added.
Politico Magazine reported on Saturday that the White House is preparing to request one billion dollars from Congress for emergency funding to respond to the Corona virus. If this request is fulfilled, it will coincide with the same month that President Donald Trump issued a new budget proposal that is seeing a cut in key elements of the pandemic preparedness, which is funding the CDC and the National Institutes of Health and Foreign Aid.
Production of vaccines and medicines
These long-term government investments are important because producing vaccines, antivirals and other vital tools requires decades of serious investment, even when demand is declining. Market-dependent economies often struggle to develop a product for which there is no urgent need and to distribute products to the places they need. The Alliance for Epidemic Readiness innovations has been described as a promising model for stimulating vaccine development before the emergency begins, but there are skeptics about this group. Whereas, last year Médecins Sans Frontières had written a scathing open letter saying that the model did not guarantee equitable distribution or affordability. The alliance later updated its policies to prioritize equitable access, and Manuel Martin, medical innovation and access counselor for Doctors Without Borders, said last week that he was now cautiously optimistic. "The alliance for pandemic preparedness innovations is very promising, and we really hope it will succeed in producing a new vaccine," he said. However, Manuel and his colleagues "are waiting to see how the coalition's commitments for pandemic preparedness innovations will be applied in practice."
These considerations are not only important as a humanitarian and charitable work, but also concern that it is an effective policy. Delivering vaccines and other resources to the places where they will be most beneficial will be essential in order to prevent the spread of the disease on a large scale. For example, when the H1N1 flu virus broke out, Mexico was severely infected. In Australia, which was not exposed to this, the government banned exports from its pharmaceutical industry until the Australian government's requests for vaccines were completed. The deeper the world closes, and the more self-sustaining it becomes, the more difficult it is to make a realistic assessment of the risks and distribute tools effectively, tools that range from vaccines, respirators, food and hand-cleaning fluids.
Iran, Italy, and South Korea are among the countries reporting fast-growing numbers of people living with the Covid-19 virus. Many countries have responded to this by attempts at containment, despite the questionable efficacy and potential harms of historically unprecedented Chinese repression. While some containment measures are appropriate, widespread travel bans, city closures and resource storage are not realistic solutions to a disease outbreak that persists for years. All of these measures involve risks themselves. After all, some responses to the epidemics will require opening the borders, not closing them. At some point, it will be necessary to abandon expectations that some areas will survive infection with Covid-19 virus, and for this reason the disease must be seen as everyone's problem.