A clear look at medical science
Moderator: Kaila Colbin, co-founder Boma Globa; founder Boma New Zealand
Live from: Christchurch, New Zealand
Start time: 7:00 p.m. local time
Siouxsie is the head of Auckland University's Bioluminescence Superbugs Lab. Siouxsie explains that New Zealand’s Prime Minister announced Saturday a four-level alert system and today announced we would move to level three and by Wednesday level 4.
Siouxsie has been working with cartoonist Toby Morris to develop shareable images to understand the epidemic. The epidemic curve shows how infections change over time following three phases. Covid-19 is infectious for three days before people show symptoms. The virus is spread through droplets.
Why do curves go down? You eventually run out of people who are susceptible. 70-80% of people are susceptible. But you can change the curve by stopping people moving around and spreading the virus. This is what China has done. This is flattening the curve. It’s important not to let the curve go higher than the capacity of the health care system, because in that case, more people will die. China responded by increasing the capacity of the health care system.
You can, with behaviour change, spread out the number of people infected to keep it below the capacity line. If we take collective action, we can stop chains of transmission. Actions taken now are reflected in what happens in two weeks time.
Flatten the curve is not as good as stopping transmission. The amazing thing about at the end of the world is that we are one of the last places to start getting cases. As other countries started to develop issues, lots of Kiwis started to come home and we’ve seen exponential cases, but the vast majority of them have come from overseas.
A week ago, people who came home were required to go into self-isolation. But people who arrived before could still be transmitting the virus. Our Prime Minister said she would take action as soon as we had community transmission, which is what she did today. She has acted fast - probably two weeks faster than other countries. If NZ can get on top of it, will we have to stay shut down until there is a vaccine. I guess we’ll see in four weeks time whether we were fast enough and then we rely on the rest of the world.
Prof David Murdoch explains New Zealand is busy planning for four weeks at home.
There are plenty of examples where vaccines play a critical role in other epidemics - Hepatitis A is one example. Influenza is another example. Measles is an example where outbreaks come when the vaccine programme breaks down.
David understands there are 35 vaccine candidates. Some clinical trials are underway or will start soon. “It’s amazing when you think that four months ago we didn’t even know this virus existed,” David says. He explains we are still 12-18 months from having a vaccine ready and available. Why does it take so long? “This is extraordinarily short compared to what it used to be,” David says.
There are typically six phases of vaccine development.
There are other factors that have to be taken into consideration as well and many other steps to introduce into a population at a country level - including funding and logistics.
David was involved with the introduction of pneumococcal vaccine into Nepal. It was developed in wealthy countries for strains in wealthy countries where most of the benefit was in poorer countries. We all want an effective vaccine but will it go to all the countries that need it? The Coalition for Epidemic Preparedness and Innovation was established to help solve this issue of equality.
Q. Is there any concern that we won’t have a vaccine in 12-18 months?
There is still a lot of uncertainty. We should have some evidence soon from the ones that are going to clinical trials.
Q. Is there compassionate use for using for some people before it’s been through regulatory control?
It will still have to go through safety trials.
Q. Once we have a vaccine, what is your estimate for how long it will take to manufacture and distribute?
David says he is constantly surprised at how things are speeding up.
Q. What do we know about the lifespan of the virus?
It’s an enveloped virus. It’s an RNA virus. Based on work with SARS, it was estimated could live on some surfaces for up to nine days. 10 days ago, there was a study that showed it could survive on copper for 4 days, on cardboard for 24 hours and on other surfaces for three days.
Another study showed that after cleaning the virus was cleaned.
Q. What is the correct way to clean surfaces? Do we still have to clean surfaces in lock down?
Alcohol-based cleaners are anti-viral. You can use cleaning products with bleach. The really important thing about cleaning is that you must let the solution sit for at least 10 seconds. If you just spray and wipe you don’t give the active ingredient time to do the job.
Q. How do scientists collaborate?
It’s a complex process with many different skill sets required. It’s very difficult for one organisation to do it by themselves.
The IP gets very complicated.
Q. Do you have a concern that covid-19 will increase inequities?
Yes, but hopefully it is something that can be managed.
Q. Are our pets likely to be carriers?
There was one pet who was reported to have it. But a pet could be a surface.
Q. Why is washing hands so effective?
It’s because of the droplet spread. If we touch a surface and touch your face, you give it a portal into your body. As an envelope virus, soap dislodges the virus but also soap can disrupt the envelope and kill the virus. Hand sanitiser is ok, only if it has alcohol in it - at least 60%. Washing hands is much better.
Q. How do we know if we have a common cold or if we need to be tested?
Toby and Siouxie made a chart that compared the symptoms. The major symptoms are a fever, breathlessness and dry cough. But there have been others who have had not had these symptoms or have had other symptoms. It’s crucial that you stay home even if you have cold symptoms. Clinicians will decide if it’s appropriate for testing because testing will become a big deal.
Q. What are the limitations of the test?
The virus has an envelope and RNA genetic material inside. The first stage is taking a sample - a swab from the back of the nose or deeper in the lung. From the sample, they have to extract the genetic material using a kit. Then you do a genetic test. In New Zealand, we don’t have a huge supply of the swabs because they come from Italy. Tests are used for other things so testing for other diseases may have to stop. We owe a huge thanks to the technical people who have ramped up testing.
Q. Do we have any indication of how vaccines may interact with people living with other diseases?
David says those who are immunocompromised are more likely to get severe - and potentially life-threatening - disease.
Siouxsie says one-third of the world has latent tuberculosis and covid-19 could re-active that in some countries.
Q. What does this mean for other disease treatment?
Siouxsie says we might see a decrease because we’re doing so much handwashing.
Q. Could all the cleaning be creating a superbug?
Siouxsie says we know that antibiotic superbugs are a looming issue. The world is running out of antibiotics. The process is natural - bacteria mutate. It will depend on how good we are at sanitising. If we don’t kill them, we might make more resistant organisms. Let’s focus on getting through this one.
Q. The difference between bacteria and virus?
Siouxsie - It’s like the difference between a phone and an app. The phone is more like a bacteria. A virus is like an app - it doesn’t do anything until it gets loaded into a cell and then it uses the machinery of that cell to make lots of copies of itself. Two very different life forms. That’s why antibiotics kill bacteria whereas they don’t work against viruses. Antivirals interfere with the virus’s ability to attach to the cell.
We don’t have many antivirals and there’s been a race to develop them. Resistance happens in viruses too. They can mutate and become resistant. We are at war with a foe that can evolve much faster than we can. “Part of me thinks we’ve been living in an incredible golden age.” SARS was easy to stop because they had a fever early on so people were isolated and it ran its course and we haven’t seen it since.
Q. What about chloroquine as a treatment?
It was used to treat malaria. There is some evidence that it may have some activity against the virus. Well designed trials are critical. New Zealand signed up as a place where study trials will happen.
Q. Could a bacteria load itself into a virus?
Yes, but not this one.
Q. What is the best way to help others without spreading the virus?
This is why it’s good to know how long it is viable on surfaces. One option is if it’s a canned good, that you just leave them for several days. Virus should no longer be viable. Or spray it with alcohol.
Q. How do you get people who still don’t think this is a big deal to understand the seriousness?
Siouxsie - It’s probably a question for psychologists. There are going to be people who don’t think it’s an issue until it happens to them. I don’t understand it.
Q. Do we know what the NZ curve looks like?
It depends on whether cases are contained or if they transmit to household. We hope that in four weeks, we’ll have a handle on all cases. David - To date, the curve was taking a sinister look. It was tracking like other countries. The announcement today was justified.
The next couple of weeks will be hard. There’s going to be more cases. But what happens now, we will have the benefit of in two weeks time. I’m grateful we have a prime minister that has acted much faster than other places.
Q. Observation from the UK that some people were losing the sense of smell.
Unusual presentation. Haven’t seen numbers on how common it is.
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