It's been seven months since the first case of COVID-19 was diagnosed in Virginia, and the number of deaths due to coronavirus is no longer rising here thanks to a new understanding of the virus and several new treatments.
Bill Petri is a professor of medicine at UVA – specializing in infection disease. He says there’s been real progress in how we treat cases of COVID.
“I’ve actually been working in a special pathogens unit and treating patients with COVID-19, and the two big advances are first dexamethasone, which is a prednisone-like drug that’s anti-inflammatory, and that’s been shown in a large study in the United Kingdom to reduce mortality by almost a third. The other drug that’s been shown to be effective is Remdesivir.”
UVA took part in a clinical trial showing that anti-viral medication helped patients recover in an average of 11 days – down from 15.
We’ve also gotten better at predicting who will have a bad case of COVID. In general, men have it worse than women, people with chronic conditions like diabetes, asthma, high blood pressure and obesity are at increased risk, and Petri says age remains the number one factor.
“If you’re 80 years old, you’re 100 times more likely to die from this than if you are 50.”
UVA researcher Allie Donlan is looking at the next promising predictor of dangerous COVID cases – the way our immune system functions and how we can stimulate it to do better. Also under investigation here and at Virginia Commonwealth University, whether injections of antibodies like those we produce naturally after an infection, could protect people who’ve been exposed to the coronavirus.
As we wait for results of that study, Dr. Gonzalo Bearman, Chief of Infectious Disease at VCU, says our best bet remains changing behavior.
“If we were able to do things such as wear the masks, respect social distancing and wash our hands, we would probably have an 80-90% reduction in SARS-COV 2.”
UVA’s Director of Medical Intensive Care, Dr. Taison Bell, adds there is less concern around virus particles on things like groceries, mail and door knobs.
“Person-to-person spread is what we think is the predominant mode of transmission. Surface to the face or mucosal membrane transmission is still possible in theory, but we do think that it’s more like spread in close human interactions.”
And that’s especially true inside.
“Indoor spaces, poorly ventilated spaces and small spaces where people are in closer contact are going to be higher risk, so the direct opposite of all of that is outdoor spaces, able to be apart from each other, and nothing’s vented greater than the outdoors – fresh air.”
But as it gets colder, Dr. Bearman says, our problems with COVID may increase.
“COVID-19 is far from over. In fact there’s a high risk things could get worse this winter as the temperature drops, as people are moving indoors, and as other respiratory viruses will be in the community, and that includes influenza.”
Which brings us to the subject of vaccines.
Dr. Petri says the odds for a safe and effective vaccine winning FDA approval by year’s end are good.
“There are four vaccines now that are in phase three clinical trials, and so we’re just in the position now of waiting to see how well they work.”
The FDA will probably act under its emergency use authorization – a process established for situations like the one we face with COVID-19.
“Normally, volunteers in a vaccine study would be followed for 12 months for any potential long-term side effects before a vaccine is approved, but that will not happen for these vaccines," Petri explains. "That data will continue to be collected, so they’ll still be following those volunteers out for 12 months, but when you have 600 people a day who are dying in the U.S. from this infection, you don’t want to withhold a vaccine that appears safe and effective.”
He’s confident in part because studies in laboratory animals were encouraging, but we don’t know yet how long a vaccine will provide protection.
At VCU Dr. Bearman, says it’s unlikely to provide lifetime immunity.
“This is not going to be a vaccine like mumps, measles, rubella or even smallpox or polio vaccines. It’s probably best to think of a vaccine for SARS-CoV-2 like an influenza vaccine – one which is seasonal or has to be repeated with a certain amount of frequency. The other thing to mention about the vaccines is that what vaccine producers are looking for is at least 50% efficacy in preventing infection, so that means it’s not 100% effective – only 50%.”
He adds that in cases where a vaccine didn’t prevent infection, it might at least lessen the severity.
Another concern is public trust. One survey showed 40% of Virginians are not planning to get the vaccine – at least not right away. For those who are willing, another question arises. Will they have access? Dr. Petri thinks so.
“Every year tens of millions of doses of influenza vaccine are being delivered, and of course everybody who’s listening to this should be getting that influenza vaccine right now, because we all want to protect each other from the flu also. There is a distribution system that’s in existence that can be utilized for this, and the U.S. government has already contracted with the biggest vaccine distributor to assist with getting this vaccine out there in 2021.”
But will there be enough to go around? That depends on whether vaccines being studied turn out to be safe and effective. If so, Petri says, we’ll be good to go.
“One of the really good things is the federal government is funding not only research and development but manufacture of vaccines, and so some of these vaccines are getting manufactured right now – even before it’s known whether they’re effective.”
If not, they’ll be thrown away, and dR. Bell says we should be prepared for that possibility.
“I think the vaccine is not going to be the end of all of our troubles unfortunately. We are still going to have to keep up with social distancing, hand hygiene, trying to be more outdoors than indoors. My hope is that the vaccine will be very effective, but nothing is ever 100%.”
In addition to vaccines in phase three – being tested on thousands of people -- three research teams at the University of Virginia are in earlier stages of vaccine development.