COVID19 

Most countries including India and USA are moving from a stage 1 (imported cases) to stage 2 (community transmission) of this pandemic . The drastic measures employed at this time are to prevent progression of community transmission to uncontrolled increase in cases, which could overwhelm medical systems globally (China, Italy, Iran are recent examples of the beginning of this stage). These approaches are to prevent rapid spike in cases but rather a shorter prolonged peak of cases, which allows health care professionals react and contain the spread of COVID19. The disease seem to transmit from person to person by droplet and contact transmission and carries a mortality of 1-2%. Mortality seem to peak rapidly with age for those over 50 years, especially among those with comorbidities (high blood pressure, diabetes, immune suppression, lung diseases). 

Vaccines 

In today’s age of technology, it is very easy to sequence the new virus and make candidate vaccines (aka pieces of the virus that seem to be important for its division). However, we will need to perform clinical studies using these vaccines to demonstrate safety in humans and then efficacy in infected patients. This will take time and likely take a year to complete (https://www.statnews.com/2020/03/11/researchers-rush-to-start-moderna-coronavirus-vaccine-trial-without-usual-animal-testing).

If they are found to be effective, then we could make vaccines in large quantities to provide immunizations for all, especially the most susceptible patients. If the virus sticks around the world like influenza, then it is possible it will mutate and become a challenge for vaccinations. 

Therapies 

Currently there is no specific treatment for COVID19. We only provide supportive care (oxygen, breathing support, IV fluids, nutrition etc). There are several agents being tested for severely sick patients on a compassionate basis. This does not mean they are approved treatment with proven efficacy. These include specific antiviral (remdesivir made by Gilead Sciences, with a broad activity against RNA viruses like COVID19, influenza medications), malaria medication (chloroquine), HIV medication (protease inhibitor, that may disrupt COVID19 virus), and anti-inflammatory medications  such as antibody to human cytokine interleukin-6, (that can prevent inflammation and lung damage). Of these remdesivir is being tested in a clinical trial by NIH to show efficacy in severely sick patients with COVID19.  However, this trial will not provide results until about a year. (https://www.niaid.nih.gov/news-events/nih-clinical-trial-remdesivir-treat-covid-19-begins).

 Unanswered questions 

Are people without symptoms contributing to the transmission?

Is the virus going to be seasonal (like influenza, which means it will move to colder countries over time, but remain with us like influenza)?

What makes older people susceptible to severe disease?

Will the virus change over time (mutate) like influenza and make vaccinations more challenging?

Can we develop a direct antiviral agent that can be effective in treating all patients?

Can we develop a treatment cocktail that may prevent deaths from severely infected patients until we have specific treatments are available? 

Shyam Kottilil MD, Ph.D

Director, Division of Clinical Care and Research

Chief, Division of Infectious Diseases

Institute of Human Virology

University of Maryland School of Medicine