An Optimist's Guide to Recent COVID-19 Research
“Table for two?” It feels good being seated once again at my favourite local restaurant and I’ve never had a better excuse to spend my money now that I am officially ‘Eating Out to Help Out ’. The smell of food and the chatter of strangers in conversation around me is what I’ve been craving.
It has been nearly 3 months since the UK began to emerge from lockdown. Despite the tables being carefully set 2 meters apart and my waiter smiling at me from behind a visor, life is beginning to feel normal again.
I’m distracted by a sinking feeling when I think of the spikes in coronavirus cases being reported in cities around the world after easing of lockdown restrictions. What if it all happens again? I know I’m not alone in thinking this. With the threat of a second wave looming over us it is easy to feel pessimistic about the upcoming winter.
My name is Ffion, I’m 25 years old, and COVID-19 came crashing down on me in the middle of my PhD studies at King’s College London. I work in a research lab in the Department of Immunobiology. You’d usually see me in my white lab coat, pipette in hand, running experiments to probe the function of a type of white blood cell called regulatory T cells which protect us against autoimmune diseases.
But since March I’ve been working from home and although I feel lucky to have kept my source of income, prickles of tension run up my spine when I contemplate what another lockdown might mean for my PhD. Like many people, I’m also experiencing waves of apprehension about the future following this pandemic (e.g. financial insecurity and feeling powerless to help loved ones).
One of my coping strategies has been to keep up to date with the ever-evolving coronavirus research. In this blog, I would like to share some recent research updates which have made me feel optimistic that we are now better equipped to deal with future outbreaks and that our efforts to contain the virus have not been in vain.
The Great Vaccine Race
From the first experiments in test tubes to the sharp scratch at your GP surgery, the journey of developing vaccines typically takes up to a decade of research. But with the pace of coronavirus research being repeatedly described as ‘unprecedented’, the first vaccine arrived in human trials in mid-March, just over two months after COVID-19 was declared a pandemic. Since then another 36 candidates have begun clinical trials in the hope of becoming the first preventative coronavirus therapy in humans.
Some critics have expressed concerns that if safety is not prioritised over speed, this could endanger lives and fuel vaccine scepticism. But bodies such as the World Health Organisation and the Coalition for Epidemic Preparedness Innovation (Cepi) are overseeing the COVID-19 vaccine developments to ensure that rigorous safety testing is upheld.
All these vaccines share the common goal of stimulating a pre-emptive immune response against coronavirus so that the immune system will be ready to fight off the virus when it’s encountered again. But the vaccines in trial are all slightly different in terms of the biological building blocks they contain which can trigger immune cells to recognise and attack the coronavirus.
DNA/RNA vaccines use coronavirus gene sequences as these building blocks. These vaccines contain genetic material from the coronavirus which is used by our own cells to produce coronavirus proteins. These proteins can then trigger a protective response from our immune system against the virus.
New drugs are put through to 3 main phases of clinical trials before they are approved for use in humans. The phases are put in place to ensure that the drug is safe (phase I) and effective compared to any existing treatments for a disease (phase II+III). The drug is tested in increasing numbers of people with each phase and it must pass each phase to progress to the next one. On the 27th of July an RNA vaccine developed by Moderna and the National Institutes of Health entered its third phase of clinical trials.
Another promising candidate in the limelight is ChAdOx1 nCoV-19, developed by the University of Oxford and AstraZeneca. This is a viral vector vaccine which uses a harmless virus to actively deliver the coronavirus genetic material into human cells, and again this material can be used to make coronavirus proteins. This vaccine has passed its Phase I trial and is now in Phase II/III trials to test whether it is effective enough to prevent coronavirus in the general population.
Another method is to use coronavirus proteins themselves as the vaccine’s building blocks; an approach used by Anhui Zhifei Longcom’s vaccine which is currently in phase II clinical trials.
Historically, vaccines have had notoriously high failure rates in early stages of testing. Indeed, it has been 36 years since HIV was identified as the cause of AIDS and there is still no vaccine to protect against this virus.
But I feel encouraged that there is a wide variety in the design of the coronavirus vaccines in clinical trials. In my view, this variety makes it more likely that one of these strategies will succeed. But it is also important to remember that the first vaccine will not necessarily be the best vaccine, so don’t be disheartened if these early candidates fail, as there will be many more to come.
Long-term immunity to coronavirus: how long is a piece of string?
A paper published by researchers in my department hit the headlines a few weeks ago. Naturally, I was keen to read up on the findings, but when I read the title my heart sank.
The research led by Dr Katie Doores related to coronavirus antibodies — small proteins which our immune cells produce to help fight off the virus. Distressingly, the research showed that these antibodies diminish dramatically within months after a person recovers from coronavirus.
The media reacted with horror. This finding suggested that the immune system may forget how to tackle coronavirus just months after an initial infection, meaning a person could become repeatedly unwell and pass on the virus. This would also spell bad news for vaccine trials as triggering immune memory of viruses and bacteria is the basis of vaccination . Our immune systems must remember how to eliminate the virus after vaccination to stop us falling ill from it again.
But the good news is that antibodies are just one component in the complicated system which equips us with long-term immunity to diseases. The cells which produce these antibodies and allow your immune system to react rapidly to bugs that have made you sick in the past are called memory B cells and memory T cells, and these can survive for decades after exposure to some diseases (e.g., measles).
Evidence now shows that coronavirus-specific memory T cells are detectable in the blood after coronavirus infections, and in some studies these memory cells could be detected in people without symptoms.
It is too early to know how long a person is immune to coronavirus after an initial infection, but this data showing that coronavirus memory T cells do exist gives me hope that these cells could persist longer than the coronavirus antibodies analysed in the above-mentioned study.
I remain optimistic that gaining long-term immunity to coronavirus may be possible, but only time will tell.
Months of working from home and being separated from loved ones has inevitably tested our emotional endurance. I think it’s crucial to answer one question to ward off lockdown/social distancing fatigue: was lockdown really worth it? Well, new data from Italy answers this question with a resounding yes.
Northern Italy saw coronavirus cases soar in March and so it was hoped that lockdown would prevent its spread to other regions. A survey carried out by Italy’s Health Ministry and National Statistics Agency has highlighted clear regional differences in the proportion of people who have coronavirus antibodies. In Lombardy in Northern Italy, 7.5% of the population were estimated to be positive for antibodies, compared with only 0.3% in Sicily in Southern Italy.
This proves that their lockdown was effective in stopping the spread of the virus from the centre of the outbreak in Northern Italy to the rest of the country. Also, while Lombardy imposed lockdown when the coronavirus outbreak in the region was well established, lockdown in Sicily was imposed when there were very few cases in the region and this early lockdown clearly prevented more people from contracting the virus.
Ultimately this shows that our efforts to adhere to lockdown rules in the UK have not been in vain. In addition, a recent outbreak in Herefordshire was successfully contained through strict testing and self-isolation procedures.
I feel reassured that we are now better equipped to respond to local outbreaks than earlier this year.
Beyond Vaccines: keeping the immune system in check with drugs
Although vaccination is seen as the holy grail of coronavirus treatments, tackling this pandemic will also require effective drugs to help people make full recoveries if they do become ill with the virus.
Researchers now know that some of the worst symptoms experienced by patients who end up in intensive care are actually caused by their immune cells over-reacting. If a person’s immune system runs completely out of control while trying to clear an infection this can cause irreversible damage to their lungs and other organs.
Anti-inflammatory drugs are now being trialled to moderate the immune response towards the virus, with the aim of reducing the likelihood of people ending up with life-long tissue damage.
Early-phase clinical trials of old, effective drugs, such as Dexamethasone and Interferon-β, are both showing promise as drugs which keep the reins on the immune system during active coronavirus infections.
If these drugs are successful, people who do end up in hospital this winter could be more likely to survive than those who were admitted earlier this year.
To conclude, I urge you to see past the grim headlines attempting to predict the future of this pandemic.
It is too early to answer some of the most pressing questions, so we must focus on the positives that we are certain of: the number of coronavirus-related deaths in the UK are at their lowest since before lockdown, there are promising new vaccines being trialled every day, and localised outbreaks are being managed efficiently.
For now, treat yourself to a bit of normality whether that’s a meal at your favourite restaurant, like me, or an appointment at your local hair salon.
Take the optimist’s approach. Things will get better in time.
NOTE FROM THE EDITORS: A huge thank you to Ffion, for sharing with us this lovely blog. Ffion Harris is an Immunology PhD student at King’s College London, whose research focuses on immune cells which protect against autoimmune diseases. It is so important for us to stay positive about the future and the search for a vaccine, and Ffion explains so well in this blog today exactly why we have so much to be optimistic about. Thank you, Ffion!