And the storm rages on

COVID-19 is exposing all our vulnerabilities, and it’s not done with us yet

By Dr. Jason Kindrachuk

It’s mid-November and I’m spent. It’s been a horrendously long eleven months now focused solely on COVID-19 day in, day out.

I’m not a frontline healthcare worker (our heroes of the pandemic), just a virologist living in the middle of the scenario that we’ve talked about in roundtables and seminars throughout my career – the emergence of a new pandemic virus that exposes all of our vulnerabilities: no underlying immunity, no therapeutics, and no vaccines. The one that would test to the limits our healthcare capacity and public patience to an everchanging situation.

The last few days have been eerily reminiscent of my days in Liberia running diagnostics during the West African Ebola epidemic in 2014. I remember a day where my teammate and I processed about 140 blood samples in our makeshift containment lab and ran the PCR tests to check for virus. Nearly all were positive.

That feeling of emptiness and defeat has hit me hard again recently as the data from across Canada continues to provide a pretty bleak picture of what winter 2020 might look like as cases, hospitalizations, and fatalities all continue to climb. There are signs of clearing on the horizon, but we have to get through the storm first.

The moment

Reflecting on COVID-19 to ‘the date’ when all of this became a focal point in my life is quite easy: New Year’s Eve 2019.

The vastly more talented Dr. Kindrachuk (a.k.a. my wife) was fast asleep as our toddler had been fairly rambunctious during the holiday break, leaving me to peruse social media instead of watching yet more 2019 retrospectives. I came across a fairly non-descript tweet about a SARS-like illness that had been identified in a cluster of patients in Wuhan, China.

This was one of those ‘hairs standing up on the back of your neck’ moments. Severe acute respiratory syndrome coronavirus (SARS-CoV) – the virus that causes SARS – had disappeared 15 years ago nearly as quickly as it had emerged, leaving many to ask if and when it might reappear.

As an emerging virus researcher, these moments are akin to a spit-take. I ended up in a thread with Dr. Meghan May, an emerging virus expert at the University of New England. SARS? Really? Maybe a highly pathogenic influenza virus? Something just felt different about this. By early January we had our first glimpse of what this was: a new virus called  SARS-CoV-2. 

Eleven months equals one decade

I have often said that the past eleven months have felt like a decade. This is really quite true from two perspectives.

Firstly, it’s been a LONG eleven months of living through the ebbs and flows of the pandemic. It has felt like a decade in all that we have encountered. But it’s also been a period where our understanding of this new virus has been arguably unmatched in human history.

From January to now, we have identified what the virus is, the likely origins of the virus, how it behaves, how it’s transmitted, and where it goes in our body when it’s transmitted. We’ve isolated the virus from infected humans and distributed those samples across the globe, enabling myriad infectious disease researchers to identify how this virus interacts with our cells during infection. We have created models of infection in animals that have allowed us to test vaccines and therapeutics that have and will continue to save lives.

Most importantly, in 11 months we’ve gone from first identifying a new virus to sitting on the cusp of the licensing and approval of multiple vaccines for this virus. In addition, there are dozens of COVID-19 vaccines in clinical trials and many in pre-clinical development.

As a comparative, it has taken well over a decade for a vaccine to be approved for the other virus I devote most of my research life to: Ebola virus. This is an unparalleled moment in our history where the worldwide research and clinical communities have come together so quickly to mount a united response to a global public health crisis. 

But it’s just the flu… isn’t it?

It’s not.

I cannot stress those words enough at this point.

If we look at this strictly from a numbers perspective and consider fatalities alone due to COVID-19 (more than 1.33 million deaths and counting), we are in comparable territory to the 1957 and 1968 influenza pandemics (about 1.1 million and 1 to 4 million deaths, respectively), and have far surpassed the range for seasonal influenza fatalities (300,000-600,000 deaths annually).

Of course, this only accounts for January to November 2020 in regards to COVID-19. 

The United States Centers for Disease Control and Prevention recently published updated data analytics demonstrating that patients hospitalized with COVID-19 had a 5-times greater risk of dying following hospitalization than those with influenza and were at increased risk for 17 respiratory and non-respiratory complications resulting from infection. These have been more pronounced in vulnerable and underserved communities which have been disproportionately affected by the virus.

Transmission rates appear to be higher for COVID-19 than influenza viruses meaning that each infected person is able to spread the virus to a larger number of people. In addition, the infectious period – the time in which an infected person can transmit the virus – appears to be longer than that found for influenza. 

Concerningly, this extends further into the pre-symptomatic period (the period prior to development of symptoms) for COVID-19 as compared to influenza, meaning that we are able to transmit the virus undetected for a longer period than influenza.

This has made contact tracing and epidemiological analysis exceedingly difficult for this virus as that longer period of transmission prior to symptom development increases the opportunity for an infected person to spread the virus before realizing they themselves are infected.

This also exposes an underlying weakness for us in regards to COVID-19: the lack of underlying immunity, vaccines or therapeutics for this virus. In addition, there are a growing number of reports regarding long-term health complications across COVID-19 patients of various ages.

This is an aspect of infectious diseases that is often lost in discussions where we focus on primarily on what the disease ‘looks like’ during acute illness or how many fatalities occur and neglect the longer-term health issues that survivors face.

With COVID-19 we are still trying to understand what these long-term issues encompass and how long they persist. Where the emergence of influenza in 1918 resulted in a century of data regarding influenza transmission, clinical disease, and therapeutic options, with COVID-19 we have had to start quite literally at square one. 

Where do we go from here?

I’m writing this a day after the announcement that a second vaccine – the Moderna mRNA vaccine – was reported to have 94.5 per cent efficacy in patients, building off the prior announcement from Pfizer reporting that their mRNA vaccine had 90 per cent efficacy. In addition, the Moderna announcement gives some hope as far as distribution limitations due to cold chain storage that would impact vulnerable communities across the globe.

This is a ray of light in an ocean of darkness right now.

Is this an overly dramatic way of describing the situation? Perhaps. But this is coming on the heels of the escalating situation in Manitoba, where my primary laboratory and faculty appointment are located.

My family and I moved to Saskatoon in mid-July 2020 to help lead COVID-19 research efforts at the Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac) as part of a partnership between the University of Manitoba and University of Saskatchewan.

There had been 330 total cases of COVID-19 in Manitoba on the day we left for Saskatchewan. Today there have been over 11,000. At the start of October there had been 20 fatalities; the addition of seven today puts the new total at 179.

There will be an end… eventually

Yes, a vaccine or vaccines look like they are on the horizon and will inevitably help get us through this crisis. The harsh reality though is that we are sitting in mid-November and have months to go until any vaccine is estimated to reach the general population.

So, we now have to weather the storm of the second wave of COVID-19 across Canada and find a way to do the things that we know reduce transmission: distancing, hygiene, decreasing time in enclosed spaces in close proximity, and masking. 

As someone that grew up in Saskatchewan, I tend to be cautiously optimistic but acutely aware that we have a long way to go. 

Dr. Jason Kindrachuk is an Assistant Professor in the Department of Medical Microbiology & Infectious Diseases, University of Manitoba, and holds a Tier 2 Canada Research Chair in the molecular pathogenesis of emerging and re-emerging viruses. His research focuses on the circulation, transmission, and pathogenesis of emerging viruses that pose the greatest threat to global human and animal health. Dr. Kindrachuk actively participates in training young investigators for careers in infectious disease research as well as with public outreach through the media to help provide informed knowledge dissemination.