The COVID-19 marathon, in reality it’s more of relay

The COVID-19 marathon, in reality it’s more of relay

The COVID-19 marathon, in reality it’s more of relay.

By Lisa Short

You could be forgiven for waking each morning to feeling overwhelmed that overnight you’ve missed a month’s worth of information about medical advances, vaccine development, infection and death rate statistics, lockdown, easing of lockdown, political and scientific bantering, alternative therapies and all things in between. You’d be right!  To ease the burden here’s a summary of some of the major developments.

A COVID-19 Vaccine

Globally, vaccine FOMO has now emerging as a key bargaining chip in pandemic diplomacy, with China, United States and United Kingdom flexing their investment muscles and intent to share, often dependent on the political mood of some of the most volatile world leaders in history. The UK Government has largely turned a nationalised marathon into a relay by handing the baton to Gavi when it holds the Global Vaccine Summit on 4th June 2020 aimed at mobilising resources to expedite vaccine development with equitable access.

The vaccine teams with the leader’s baton

  • There are 124 candidate vaccines in development globally
  • 10 vaccines designed to prevent COVID-19 are already being tested in people, and another 114 are in development.
  • A landscape list can be found at WHO or GAVI
  • Earliest expectation of vaccine for use is end of the year or January 2021
  • A vaccine will be a valuable tool in assisting in the reduction of spread of COVID-19.

CanSino [Beijing Institute of Biotechnology] 

  • Ad5-nCoV is a weakened common cold virus (adenovirus) genetically engineered to produce the COVID-19 spike protein.
  • Is at Phase 2 trial

Sinovac [Beijing China]

  • CoronaVac consists of a chemically inactivated version of the SARS-CoV-2 virus. This is a very traditional method of creating vaccines and one that historically has proved successful.
  • Is at Phase 2 trial which has already been found to protect monkeys from being infected with the coronavirus.
  • Discussing Phase 3 trials to take place in UK
  • Building a commercial vaccine production plant to manufacture up to 100 million doses of the vaccine per year.

Moderna [National Institute of Allergy and Infectious Diseases (NIAID) USA]

  • LNP-encapsulated mRNA vaccine works on the principle of having the immune system recognise the spike proteins the coronavirus uses to enter people’s bodies. It encodes the instructions for making a spike protein into a RNA molecule that can be injected into patients.
  • Is at Phase 2 trial

Oxford University/AstraZeneca  [United Kingdom]

  • A candidate vaccine, ChAdOx1 nCoV-19, is made from the ChAdOx1 virus, a weakened version of a common cold virus (called adenovirus) that causes infections in chimpanzees, genetically modified so that it is impossible for it to replicate in humans Genetic material used to make the spike glycoprotein, the protein that the coronavirus uses to penetrate people’s cells and gain entry to their bodies, is added to ChAdOx1. Researchers hope to make the body recognize and develop immunity to these spike proteins, therefore preventing the SARS-CoV-2 virus from entering people’s bodies.
  • In Phase 2 trial
  • Phase 3 planned

Ibuprofen as a Treatment for COVID-19 Respiratory Complications

  • A pioneering trial called LIBERATE as a collaboration between London’s Guy’s & St Thomas’ NHS Foundation Trust, King’s College London and the pharmaceutical organisation the SEEK Group has commenced in early June.
  • The trial is using a type of Ibuprofen called Flarin which has a separate composition than the standard version to protect the stomach
  • Researchers believe the anti-inflammatory properties of the drug could treat severe respiratory distress syndrome, in hospital admissions, by reducing inflammation of blood vessels and subsequent blood clotting.
  • This is a good example of how scientific information has evolved during this pandemic as more knowledge is developed. Initially at the onset of the pandemic, there were concerns that ibuprofen would aggravate the infection, but this has since been withdrawn. For simple symptomatic relief of fever, paracetamol is still the preferred option as it has less impact on the stomach.

Malaria Drug Hydroxychloroquine

  • The controversial drug Hydroxychloroquine has been tested and reviewed as a treatment for COVID-19 and does NOT save lives and is NOT a treatment for COVID-19.
  • The drug has immediately been removed from the University of Oxford’s UK’s Recovery trial, which ran one the world’s largest trials shows on the drug of 11,000 patients with Covid-19.
  • The trial results showed 25.7% of people taking hydroxychloroquine had died after 28 days. This compared with 23.5% who were given standard hospital treatment.

Madagascar’s artemisia-based tonic Covid Organics

  • There is as yet, no evidence Covid Organics is a cure for COVID-19. 
  • On 22 April, Rajoelinalaunched Covid-Organics, an artemisia-based herbal drink developed by the Malagasy Institute of Applied Research to allegedly prevent and cure COVID-19.
  • The tonic was tested onfewer than 20 patients. Data from the study has not been made available.
  • On 23 April the National Academy of Medicine of Madagascar (Anamem) released a statement that the effectiveness of Covid-Organics in preventing and treating Covid-19 had not been adequately tested.
  • WHO recognises that traditional, complementary and alternative medicine has many benefits and Africa has a long history of traditional medicine and practitioners that play an important role in providing care to populations. Africans deserve to use medicines tested to the same standards as people in the rest of the world. If therapies are derived from traditional practice and are natural, establishing their efficacy and safety through rigorous clinical trials is critical.
  • WHO is working with Africa and Madagascar for medicinal plants such as Artemisia annua that are being considered as possible treatments for COVID-19 to be rigorously tested for efficacy and adverse side effects.

The Scientific Advisory Group for Emergencies [SAGE]

There is only one government appointed SAGE  for the United Kingdom for reputable and credible information and who provides scientific evidence to the Government from its various expert groups.

Other breakaway and informal groups have taken on similar names and are not government authorised.

SAGE is responsible for ensuring that timely and coordinated scientific advice is made available to decision makers to support UK cross-government decisions in the Cabinet Office Briefing Room (COBR). The advice provided by SAGE does not represent official government policy.
Science is an evolution of thinking and discovery based on what is known at any point in time. Science does not have all the answers and nor do all scientists agree. Different perspectives and approaches are based on interpretation and research and all scientists expect their work to be peer reviewed and collectively over time to arrive at the best known conclusion. It is not infallible. Science and advice changes as we learn more. Wanting all the answers, regardless of how urgent it is, is not the same as having them or knowing them or even being able to discover them.












The vaccination race for COVID-19: A marathon update.

The vaccination race for COVID-19: A marathon update.

The vaccination race for COVID-19: A marathon update.

by Lisa Short

The development of a safe, effective and widely available Vaccine for COVID-19 as a tool which can contribute to the control of its spread and ultimately enable lifting of social and economic restrictions that have crippled globalisation has been called a race against time by many of the leading scientific communities around the world1. In reality it is more of a marathon with over 120 vaccines proposed across the world and 6 currently in clinical trial, another about to start and just on 70 in pre-evaluation stages2. The incredible speed and resources attributed to achieve this marathon start must be recognised in association with the time it would normally take a vaccine to reach this stage which can be 2 to 4 years3

The unprecedented public health emergency created as a result of COVID-19 is clear. What is still not clear is the conclusive source and the origin of the virus, how it transferred from its host [also not conclusive] and why the world wasn’t prepared with robust pandemic planning on the back of a flu like pandemic being known as the greatest single global threat for more than 10 years. These issues do not change the fact that conducting research and vaccination development even under these trying times is still linked to “a moral obligation to learn as much as possible, as quickly as possible”1. Patience as they say is a virtue, but with the global catastrophic impact of COVID-19 it is also in very short supply. The CSIRO states this is a very complex task, and ‘we really are pushing our science to the limits of global knowledge’7.

Some of the Scientific Challenges

Scientists face are overcoming a number of key challenges in this marathon of Olympic proportions, under extreme pressure of demand by a world wanting life as the once expected it to be.

The first relates to how the virus that causes COVID-19, SARS-CoV-2 gains entry into the cells of a person.  This entry door occurs via the angiotensin converting enzyme (ACE)-2 receptor. Put simply the virus attaches itself to a particular enzyme that converts a protein in the blood and enters much like a guest to an uninvited party. However, the real problem occurs when it comes to testing a proposed vaccine, because the two animals usually involved in the trial process – rats and mice – lack the ACE-2 receptors that virus attaches to.

Another challenge to be overcome of vaccine development in general lies in identifying a standardised neutralising antibody titre, which is designed to test whether being vaccinated against an infection will neutralise exogenous exposure to a virus, and thus offer seroprotection. And in that mix of ‘challenge’ is that the virus being tested hasn’t gone through generic change. In the case of SARS-CoV-2 there has been evolution, but fortunately not in the manner in which it enters cells through the ACE-2 receptors. 

Who’s winning the marathon and where are the other runners placed?

US based company Moderna, based in Massachusetts, is the current front runner leading Phase 1 trials in conjunction with the National Institute of Allergy and Infectious Diseases. On 18th May 2020 Moderna released the first findings of its trial for mRNA-1273 the first SARS-CoV-2  vaccine to be tested in people. Findings indicate the vaccine seems to be safe, and stimulated an immune response against the virus where antibodies were generated in the trial volunteers, and were also able to stop the virus from replicating in human cells in the laboratory. The levels of antibodies in the blood of the trial volunteers were similar to those previously detected in recovered COVID-19 patients. These successes pave the way for the larger Phase 2 and Phase 3 [July] stages of the vaccine development. Tal Zaks of Moderna has cautiously indicated said that if these stages go well, the vaccine could be widely available by the end of this year or early next year.

Running second in the marathon is the University of Oxford. It has found its recent trial was not  effective in stopping six rhesus macaque monkeys from becoming infected with the coronavirus. albeit none of the vaccinated monkeys developed pneumonia. This is good news in that it suggests the trial may offer some protection against severe symptoms of COVID-194. The progress of this trail continues, for the Oxford vaccine candidate just three months after the genetic sequence of the coronavirus was released for study.

In Australia the Coalition for Epidemic Preparedness Innovations (CEPI), which has funded four consortia one of which is led by The University of Queensland (UQ) in conjunction with the CSIRO are looking to move to Phase 1 dosing in June 2020. This follows Melbourne researchers from the Doherty Institute mapping immune responses from one of Australia’s first novel COVID-19 patients, showing the body’s ability to fight the virus and recover from the infection7.

Congratulations and accolades must go to the University of Queensland (UQ) who in 3 weeks created this vaccine candidate for SARS-CoV-2 , in part because of excellence in pre-existing knowledge and research.

Other universities including the Imperial College London and companies like Johnson & Johnson, Pfizer and GSK (GlaxoSmithKline) are discussing starting phase one trials in September 2020.

Vaccine Manufacture

Once efficacy and safety is finalised the race to the finish line must also include the final impetus to ensure the world has sufficient facilities to produce the vaccine. Pharmaceutical company AstraZeneca has announced it will develop, manufacture and distribute the successful  vaccine around the world. However, to do this they will need to ensure scaled production without critically affecting the supply of other vital vaccines. Oxford Biomedica and Cobra Biologics are conducting similar approaches to scaling their capacity.

In this regard the he UK government is powering ahead launching a vaccine taskforce to coordinate scale-up efforts and has funded a £14 million industry-led vaccine manufacturing group with a fast-tracked a £65 million Vaccines Manufacturing and Innovation Centre (VMIC). Australia to the contrary lacks the physical facility capacity to produce the vaccine numbers required and may need to look to overseas to conduct the task.

Other Interesting Developments 

No Olympic marathon would ever be complete without a few surprise delights and contributing factors. The development of treatments for COVID-19 will occur quicker than a vaccine, mainly because they are based on what scientists and medical staff already know.  For these reasons scientists from the United Kingdom have called for wider screening of existing drugs to see if they might work against SARS-CoV-2. Many of these being developed and the drugs already approved for use fall into a group of drugs called antivirals and target virus’s in people who already have an infection. Healthline10 publishes a good account of those approved already for use or under consideration.

Cardiff University in Wales has also led the world in antibody transfusion treatments for severe COVID-19 symptoms. Through transfusion of antibodies from plasma patients can increase their capacity to fight the infection themselves.

In another research paper produced in Canada on 2 May 2020, by the University of British Columbia it has been observed that by the time SARS-CoV-2 was first detected in late 2019, it was already pre-adapted to human transmission and there is a lack of definitive evidence to verify or rule out adaptation of the virus  in an intermediate host species11.

What does all this mean?

There is still so much we don’t know about SARS-CoV-2, including its origin, source and exact time of appearance in humans. We do know it’s very new to its human host and for that reason only we don’t know yet how it will behave. A vaccine is still at best months away. Whilst a lot of criticism has been directed globally at the World Health Organisation and governments around the world in their responses to the management of the pandemic, and even in their pandemic preparedness, rightly or wrongly it will take a globally collaborative approach  to develop a vaccine and treatments for COVID-19. Political banter does not achieve this end goal. Working together in the fastest and most efficient way does. Concurrently, new processes and infrastructures that develop ways for the people of the world to live, work, travel and enjoy life with resilience to any pandemic are paramount.




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1   Royal Australian College of General Practitioners

2    World Health Organisation

3    The History of Vaccines: College of Physicians Philadelphia

4   New Scientist Update 18 May 2020

5   Centre for Infectious Disease & Research Policy


7   NatureMedicine

8   The Conversation

9   Cardiff University

10 Healthline

11 University of British Columbia

The Lancet COVID-19 Resource Centre

The Lancet COVID-19 Resource Centre

To assist health workers and researchers working under challenging conditions to bring this outbreak to a close, The Lancet has created a Coronavirus Resource Centre. This resource brings together new 2019 novel coronavirus disease (COVID-19) content from across The Lancet journals as it is published. All of their COVID-19 content is free to access.

The Lancet began as an independent, international weekly general medical journal founded in 1823 by Thomas Wakley. Since its first issue (October 5, 1823), the journal has strived to make science widely available so that medicine can serve, and transform society, and positively impact the lives of people.

Over the past two centuries, The Lancet has sought to address urgent topics in our society, initiate debate, put science into context, and influence decision makers around the world.

The Lancet has evolved as a family of journals (across Child & Adolescent Health, Diabetes & Endocrinology, Digital Health, Gastroenterology & Hepatology, Global Health, Haematology, HIV, Infectious Diseases, Neurology, Oncology, Planetary Health, Psychiatry, Public Health, Respiratory Medicine, Biomedicine, Clinical Medicine), but retains at its core the belief that medicine must serve society, that knowledge must transform society, that the best science must lead to better lives.

Access this free resource by clicking HERE:

The difference between the Coronavirus disease and the Virus

The difference between the Coronavirus disease and the Virus

by Lisa Short, International Keynote Presenter | Ambassador | Strategic Advisor 

What is coronavirus disease (COVID-19)?

Coronaviruses (CoV) are a large family of viruses that cause illness in humans and many animals. These illnesses range from the very mild common cold to the more rare and sometimes severe diseases such as Middle East Respiratory Syndrome (MERS) caused by the Middle East respiratory syndrome coronavirus (MERS‐CoV), and Severe Acute Respiratory Syndrome (SARS) caused by SARS-associated coronavirus (SARS-CoV).

Coronaviruses under a microscope look spherical and appear to be surrounded by a spiky array thought to look like a ‘corona’, or crown-like shape, hence the name coronavirus.

Coronaviruses are zoonotic, meaning they are transmitted from animals to people.  The transmission can be through direct or indirect contact, through vectors like fleas and ticks, and through food or waterborne pathways.  

Detailed investigations found that:

  • first infected humans in the Guangdong province of southern China in 2002
  •  first infected humans in Saudi Arabia in 2012.

The primary host in both cases is believed to be bats.

Several known coronaviruses are circulating in animal reservoirs that have not yet infected humans. 

A novel (new) coronavirus (nCoV) not previously seen in humans was reported after an outbreak of a set of respiratory symptoms causing illness, particularly a pneumonia in a number of people in Wuhan, China in December 2019.  The new strain of coronavirus was formally identified on 7 January 2020 as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is genetically related to SARS-CoV that caused the SARS outbreak in 2012, but not the same.  

The source of the novel coronavirus is believed to be of a recent natural animal origin between mid to the end of November and December 2019. Scientific analysis showed that the backbone of the new coronavirus’s genome most closely resembles that of a bat coronavirus discovered after the COVID-19 pandemic began. However, the region in the genome that binds ACE2 resembles a novel virus found in pangolins, a strange-looking animal sometimes called a scaly anteater.

Whilst NOT conclusive, the most likely scenario is that the new coronavirus evolved in its natural hosts, possibly bats or pangolins, its spike proteins then mutated to bind to molecules similar in structure to the human ACE2 protein, thereby enabling it to infect human cells. This scenario seems to fit other recent outbreaks of coronavirus-caused disease in humans, such as SARS and MERS.

On February 11, 2020 the World Health Organisation (WHO) officially named the disease caused by this novel coronavirus COVID-19. COVID is the abbreviation for coronavirus disease and the number 19 refers to the fact that the disease was detected in 2019. 

Since 13 January 2020 a test to detect the virus has been available.

On 11 March 2020 COVID-19 was declared a pandemic by WHO based on the objective assessment of global spread of disease across three different geographical regions at the same time. It does NOT mean that COVID-19 is more deadly – it is an acknowledgement of its global spread.

How is COVID-19 spread?

The virus can spread from person to person through:

  • close contact with an infectious person (including in the 24 hours before they started experiencing symptoms)
  • contact with droplets from an infected person’s cough or sneeze
  • touching objects or surfaces (like doorknobs or tables) that have cough or sneeze droplets from an infected person, and then touching your mouth or face

COVID-19 is a new disease, so there is no existing immunity in our community. This means that COVID-19 could spread widely and quicklyAgain, this does not mean that COVID-19 is more deadly – it is an acknowledgement of the rate of speed and breadth of community spread. Good management of infection transmission means existing infrastructure and support services will not exceed capacity. 

What are the symptoms of COVID-19?

Symptoms can range from very mild illness to a serious illness.

The most common symptoms of COVID-19 are:

  • Fever 
  • Sore throat 
  • Dry cough 
  • Fatigue
  • Shortness of breath

In more severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. 

There have been a large number of cases that are asymptomatic who have reported a sudden and profound loss in the senses of smell and taste.

What are the COIVID-19 tests?

What are the COIVID-19 tests?

by Philip Ingram MBE

Some see a perceived lack of testing as the latest stick to beat the government up with the current COVID-19 crisis. The perception that is being left with the general public and with healthcare workers is that testing will provide some magic solution to the crisis.  The reality is, being blunt, it won’t; being more accurate, each test has its strengths and weaknesses and no one test is the complete answer, they will only help our understanding of the spread of the infection and help keep us safer.

The current test, which is the one being scaled up, is an ‘antigen’ test. Antigens are molecules capable of stimulating an immune response in the body and that immune response is the start of the production of antibodies.

The antigen test requires a swab to be taken, usually from the back of the throat.  That swab then needs to be sent to a laboratory where the antigen is scientifically amplified and compared with a reference to see if it is what they are looking for.  This test, called the Polymerase Chain Reaction (PCR), often referred to as real-time PCR (rt-PCR), or the quantitative PCR (qPCR) test, requires trained laboratory technicians, specialist equipment and time for each test, as well as an administrative burden matching tests to results and informing individuals of results.

The current PCR test is an excellent technology but leaves a window as it misses some early cases, at times not detecting infection until a period post symptoms, even though the person can be highly infectious during that time. The test is also manpower and equipment limited, needing people to take samples, technicians and scientists to process and interpret the tests and staff to deliver the results.

Of course, a negative test one day does not mean the individual could not become infected the next day, and this is why it is essential the complimentary Antibody test is further developed and rolled out to identify who has had the infection.

This is a much simpler test using a sample of blood taken from a finger pin prick and it is then put into a device like a pregnancy test kit, but the chemistry on the test stick is designed to look for antibody.  Antibodies (sometimes called immunoglobins (IgM and IgG)) are proteins produced by the body over the course of a week or two in response to an infection and are there to fight the infection. Each antibody is designed to recognise a specific part of the cause of the infection (the antigen), lock onto it and stop it replicating thereby fighting the infection.

With the antibody test, a solution is added, and the blood sample moves up the test paper stick, interacting with the chemistry on the stick and giving an indicator that the antibody is present.  This will tell someone that they have had the COVID-19 disease in some form and only takes a few minutes to carry out. It does not indicate early infection or necessarily that an individual currently has the infection.

There are other tests currently being offered to the fight against COVID-19 that will complement the PCR antigen and the antibody test. This test is similar in its physical form to the antibody test, but the chemistry is very different.  It detects a key very early marker of the activation of the immune system in the body produced from the very early stages of the infection. This happens as the infection enters the body and is active as the body produces certain ‘help’ molecules. A marker that has been identified, following a great deal of research activity into HIV and earlier SARS infections is called neopterin.

The neopterin test does not specifically identify that an infection is COVID-19, but it does detect that someone is suffering from an activation of their immune system and, as such can detect infection at a much earlier stage in the disease than any of the other tests. It is a very simple to use and understand lateral flow test (as a pregnancy test) and can be used and interpreted by health workers and the general public, requiring no specialist support. It is projected to be non-invasive by using only a small sample of saliva, with the test results showing a positive result with a red line in a few minutes only if the individual is suffering a current viral infection.

This new test is not yet part of the governments offering but would complement the other two allowing the resource and time-consuming PCR test to be used only on those who have a positive indication of a viral infection and, critically, detecting those that are too early in the course of infection to be detected by the PCR or antibody test. It could also be used much more frequently as part of a wider screening programme as it can be self-administered, self-interpreted and produces rapid results and allow more informed self isolation, thereby reducing cross infection, potentially dramatically.

What is important is that the strengths and limitations of each type of test are known and understood and that a range of complimentary tests are available to maximise the collection of results that will rapidly let the health system and public understand the risks.

This article was written by Philip Ingram MBE with the assistance of Professor Colin Self BSc, MB, BChir, PhD, DSc, FRSC, FRCPath who has developed the Neopterin test. Please use the contact us page if you want further details.

Where did COVID-19 come from?

Where did COVID-19 come from?

Where did COVID-19 come from?

Here conspiracy theories abound, as the reality is the origin of SARS-CoV-2 is only a scientific assessment. However, based on over 50 years research into coronaviruses and that the international scientific community is quick at checking and commenting on all of the relevant works and studies in the scientific community, their current assessment is probably accurate; it is certainly extensively peer reviewed.

The World Health Organisation (WHO) situation report of 21st January 2020 said that on 31st December 2019, the World Health Organisation’s (WHO) China office heard the first reports of a previously unknown virus behind a number of pneumonia cases in Wuhan, a city in Eastern China.

On 11 and 12 January 2020, WHO received further detailed information from the National Health Commission China that the outbreak is associated with exposures in one seafood market in Wuhan City.

In February nature magazine reported that, “Chinese scientists suggested, on the basis of genetic analyses the prime suspect was the scaly ant eating pangolin.  However, it then went on to say that scientists have now examined that data and say that although the animal is still a contender, the mystery is far from solved.

Other animals that are known as host of various coronavirus strains are Bats and they, like the Pangolin, were sold live in the Wuhan market.  MERS and SARS were originally corona viruses hosted on bats, so it is now thought that they are the most likely contender.

Apportionment of its source is made slightly more conspiratorial by the fact that Wuhan is the site of China’s only facility designated at Biosafety Level 4 (BSL-4) and is known as the Wuhan Centre for Disease Control (WHCDC).  It was constructed in 2004 following the SARS emergency to conduct research into countering such viruses.  Level 4 facilities are designed to stop the escape of even the smallest particles, so accidental escape is highly unlikely. Despite sensational speculation in some press circles, there is no evidence in the scientific community that the COVID-19 disease is a result of WHCDC activity.