What lessons have scientists learned from this situation? What questions do they have yet to answer? This was discussed during an online meeting organised by the Ministry of Science and Higher Education of the Russian Federation, the Russian Academy of Sciences, and the Scientific Russia portal.
COVID-19 has posed serious public health challenges related to shortages of hospital beds and staff, as well as the need to treat an unknown disease: there were no regulations, no clinical recommendations, or evidence base.
All these challenges required flexible solutions and new scientific research , which had never been carried out so quickly before.
“We see how our ideas regarding antiviral therapy, mechanical ventilation, glucocorticoids and anticoagulants have changed over five months. Approaches have been revised amid a complete lack of evidence regarding managing these patients. We focused more on analogies with other viruses and the state of acute respiratory distress syndrome (ARDS), which turned out to be not entirely applicable to COVID-19”, Evgeny Shlyakhto, RAS academician, director general of the Almazov National Medical Research Centre, said.
He cited one of the bright examples of therapy "turns": in January, COVID-19 was treated with Kaletra (a drug designed to treat HIV), and now no one is using it in COVID-19 treatment.
“Initially, we focused on the number of intensive care beds and lung ventilators, but now we see that mechanical ventilation capacities are extremely limited due to the high mortality rate”, Evgeny Shlyakhto stressed.
The academician considers the search for a new strategy to restore lung tissue after a coronavirus infection to be an urgent scientific challenge.
“The damage caused by a cytokine storm will lead to enormous consequences in the form of alveolar fibrosis, respiratory failure and pulmonary hypertension development. These problems are not going to disappear, and we need new scientific approaches to reduce fibro-formation”, he explained.
Shlyakhto is considering peptide-coated gold nanoparticles (LIF nanoparticles), a recent and one of the most promising developments in this direction. Inhaled nanoparticles reduce pneumonia by inducing the transition of the M1 macrophage phenotype to M2 and increasing the anti-inflammatory cytokine.
In general, in his opinion, COVID-19 has shown that the healthcare system needs a new HR policy that implies rejecting doctors’ hyper-specialisation.
“We have always had a huge number of specialists, and there is no one to make diagnoses. As a result, we need different specialists, but with parallel competencies. We cannot make every doctor a resuscitator, but many specialists should have resuscitation skills”, he said.
Super-Spreaders and a Second Wave
According to scientists, closing borders between countries is now pointless, since the virus is so widespread in all countries that transferring it across the border will be of little epidemiological significance.
But they still consider banning or restricting mass events one of the most effective and lasting measures.
Alexander Lukashev, corresponding member of RAS, head of the Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases, explains this by the fact that the key role in the virus spread is played by so-called super-spreaders, people with a high virus titre in the nasopharynx who are in crowded places, infecting a large number of other people.
“We learned this very important lesson from the first SARS outbreak in 2003 when just five people infected half of the rest. If we rule out the phenomenon of super-spreading, we radically change the virus spread dynamics. This observation was confirmed for COVID-19 as well. In this sense, banning mass events plays a huge role”, the scientist explained.
It’s necessary to control the virus spread until there is an immune layer that stops the virus. According to the scientist, up to this point, it is highly likely that there will be a second wave.
“Iran is already facing a second wave. Moreover, if the first wave was at temperatures of +14 degrees, now the virus is spreading at temperatures of +27 degrees”, Alexander Lukashev added.
It's Unprovable Whether It's an Artificial Virus or a Natural One
Currently, the world is actively discussing the virus’ possible artificial origin. However, for scientists who study coronaviruses, that is not the question.
“What happened in 2019 is just a repetition of the regular process that has occurred many times before. An assessment of evolutionary plasticity boundaries suggests that the inserts described in coronaviruses’ genomes are most likely the result of a natural process”, the scientist noted.
On the other hand, he admits that “there are a number of scenarios that are possible, but untraceable”: it is either a “successful” natural scenario propagated in the laboratory, an adaptation of an unknown natural virus or a chimaera of previously unknown natural viruses.
“All of the above is quite logical; any scientist studying coronaviruses’ emergence mechanisms could have got such results in a lab with a sufficient level of safety”, he explained, adding that technology doesn’t yet allow inventing such a virus in a lab, but it’s quite realistic to adapt it.
However, he believes that the results of such experiments cannot be traced at the molecular level. Hence the scientist’s conclusion that it is unprovable whether it is an artificial virus or a natural one.
Gennady Onishchenko, RAS academician, member of the Presidium of the Russian Academy of Sciences, pointed out that the situation with the physical origin of the virus is ambiguous, and the outbreak needs a thorough international investigation.
“The investigation should be based on the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological and Toxin Weapons (BTWC). We will have to return to the mechanisms of differentiating such incidents and find out whether there was any deliberate intent”, the Russian academician stressed.
“BTWC control mechanism ratification has been foiled by the United States. If these mechanisms worked, an international expert group could come to any labs involved in genetically modified work with coronaviruses, without asking anyone’s permission”, he added.
......From my Russian friend who is a medical academician.....
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