Tuesday, May 26, 2020

Little Things and a Big Thing Go Together

Environmental & Science Education
History of Science
Edward Hessler

I've been thinking about our confidence in achieving a technological fix quickly--a "one and done" COVID-19 vaccine. Perhaps it is just me but it has been nagging at me from when a vaccine was first talked about. This seemed then and still does a very tall order.

President Donald Trump, with the announcement of "Operation Warp Speed"to develop, manufacture and distribute hundreds of millions of doses of COVID-19 vaccine by the end of 2020. (my emphasis) appears to me convinced that this will happen. It will be over and life can go on. This struck me as an even taller order.

While the biomedical scientists working on it are very clever so is COVID-19. We do have a leg up since we know some of the details, including the COVID-19 genome signature. It is very likely that much more would be known about the virus for some talented scientists have devoted their research career to studying it but funding has been variable, in a "boom or bust." cycle.

An immunization is certainly a lot easier than the very low tech practices of social distancing, wearing face masks, avoiding crowds, washing our hands thoroughly and frequently and not doing all the things to which we've grown accustomed, to slow the rate of the spread, among them attending movies, sports, theater, solemn to celebratory observances, dining out with friends and family, the pleasant smell and buzz of coffee shops, and festivals, all places where we are close--cheek to jowl--to one another. Friends and strangers. And felt comfortable doing this. All were routine and part of living.

Health reporter Helen Branswell wrote a splendid piece about the need for COVID-19 vaccines (note the "s," not one vaccine) but adds a caution. This will take "a little luck and a lot of science." (my emphasis)

Ms. Branswell interviewed a number of experts who think that the vaccines under "development may be more like those that protect against influenza--reducing the risk of contracting the disease, and of experiencing severe symptoms should infection occur." The flu vaccine, e.g., in years when it is on target provides 50% protection but in years when it is not it is effective 30% or less.

Branscomb writes "Ideally, vaccines would prevent infection entirely, inducing what’s known as “sterilizing immunity.” But early work on some of the vaccine candidates suggests they may not stop infection in the upper respiratory tract — and they may not stop an infected person from spreading virus by coughing or speaking." 

Vincent Munster, chief of the virus ecology unit at the Rocky Mountain Laboratories  National Institute of Allergy and Infectious Diseases (Hamilton, Montana), was one interviewed and stated "If we push the disease from pneumonia to a common cold, then I think that’s a huge step forward.'”

The essay is short and you should take a look here--there are details that are important!

In a related essay written for the Washington Post and reprinted in the Minneapolis Star Tribune, historian of medicine and technology (Princeton), Heidi Morefield worries, correctly in my view, that the search for a vaccine could also distract us. If anything is true, we are easily distracted. According to her there "are many low tech-measures, that are more certain to save lives and tame this pandemic."

Morefield points out the obvious successes of two vaccines--polio and smallpox but other efforts have eluded us for years, e.g., a vaccine for malaria and HIV/AIDS. And these are where low tech measures come into significant play. For malaria, think insecticide treated bed nets. For HIV/AIDS antiretroviral drugs have been available since 1987 to the point  "that contracting the virus is no lonager a death sentence."

Morefield's essay also provides fascinating details about the history of the search to find effective and safe malaria and HIV/AIDS vaccines.Her essay is a short lesson in history.

The search for a vaccine requires an "and," namely an investment in "robust public health infrastructure and the testing and contacting methods that have long been proven to curb epidemics." Health care workers must have access to medical supplies, including drugs "to mitigate the virus's sprad."

This two-pronged approach has way too many benefits and both are necessary. 

Actions we take have consequences. The positive one(s) wanted also come with negative ones. The socioeconomic costs, not only in the short term but also in the long-term, some of which will be permanent, which have resulted from adherence to social distancing cannot be denied. I make no attempt or can I to describe the pain and agony in so many lives which have resulted.

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