01 Jun 2020
There is no simple, straightforward exit strategy for COVID-19 yet, but rest assured: we’re in great hands.
By Dr Damien Brown, a public health registrar with the Doherty Institute. He has previously worked as a clinician with Medecins Sans Frontieres and the Royal Flying Doctor Service, and is the author of Band Aid for a Broken Leg (Allen & Unwin, 2012).
As a clinical and public health doctor, I’ve been recruited to work with a Melbourne-based team of experts with their COVID-19 work. There is no simple solution for dealing with this pandemic - not without a vaccine. But rest assured, this is not a battle being waged by politicians and bureaucrats. The best scientists and thinkers around are guiding this fight, and they’re searching for ways out of it for all of us.
Three times a week, twenty of us gather on Zoom (a few weeks ago it was in a conference room, squeezed between eight floors of research laboratories). It’s an impressive ensemble. Among us is a Nobel Prize laureate, an Order of Australia recipient, a virologist, immunologist, statistician, data scientist, communication coordinator and business advisor, and several infectious diseases specialists and epidemiologists. As the junior in the group, this feels to me like a ringside seat to the epic gladiatorial showdown of our time.
Some eyes are a little bleary, having been attending late night Zoom meetings with overseas counterparts, and a couple of attendees step out partway to take calls from the country’s chief medical decision makers. It’s consequential stuff, but there’s no ego in the room. Not these weeks. Every reasonable idea is considered. No one underestimates the urgency of solutions, or the impact of not finding one, for the population’s lives. This is collaboration at its best.
The technology is mind bending. The virologist updates us on the genetic sequencing they’re performing on several hundred samples each week. Our laboratory can now tell whether someone contracted the virus from cases related to a wedding, or from infected colleagues at work, by looking at the virus’ genes. This means less guesswork, and will make it easier to determine how and where Coronavirus is spreading - an essential aspect to controlling it.
Even the test to determine whether someone has Coronavirus at all is a small marvel - a technique that involves removing the genetic material from the virus, cycling it through chemical processes, and creating up to a billion copies. This allows the initially tiny quantity of material to be identified - no small feat when you consider that the virus itself is 1000x smaller than the width of a hair, its genetic material an evasive noodle somewhere inside that microscopic soup bowl.
Testing is also being developed to sample our wastewater for the virus. Soon, health departments may be able to identify areas of our cities in which the virus is being spread, via testing of sewage systems, before patients even present for healthcare. This means that potential clusters of spread could be contained earlier.
Another virologist updates us on vaccine research. Ours was the first lab in the world, outside of China, to grow and share the virus—a crucial step in vaccine development. The process is part lucky-dip in trialling the right components, and part tightrope walk: the vaccine will need to make our immune systems recognise and destroy the virus (and to remember how to do this for years), but not respond so aggressively that our immune system damages our own bodies. As something that will be given to billions, safety is a huge priority, which means thorough testing. This is why it’ll be at least 12-18 months away. Producing enough will be the next issue.
The backing from most leaders has been heartening. Our modelling has informed a lot of the Australian government’s response so far - a huge responsibility, but one that’s been shared and considered. I’ve watched this being undertaken by a team of epidemiologists, using supercomputers, with questions and assumptions being constantly refined and re-modelled. It’s seriously complex stuff, and after this meeting the group immediately began modelling the next phase: how we continue to navigate our way safely out of this.
So, how do we get out of this? It’s the trillion-dollar question. This isn’t a simple trade off between sparing the economy versus saving lives. There’s a straight line between economic downturns and deaths from a multitude of other causes - to say nothing of the social consequences. Our current situation is untenable for much longer. But opening everything again too quickly will take us back to square one: a scrambled lock down to avoid a tsunami of illness, overcrowded hospitals and deaths, as recurrent waves of infection spread.
The answer is going to be a combination of trade-offs and difficult decisions. The technology above will provide a lot more options, though - we’ll be able to diagnose earlier, contact the exposed almost immediately, predict clusters with modelling, and quarantine smaller groups of people in less damaging ways (a neighbourhood, say, rather than a whole country). Newer tests will show who has immunity, allowing them to safely help open the economy and provide services. Health systems are meanwhile able to build their capacity to cope with surges in cases, while more effective treatments are trialled.
Thousands of experts in labs all over the world are having similar conversations, every day, trying slightly different variations, all mindful of the severe impact of these restrictions on everyone’s lives. A way out is the top priority. As Louis Pasteur, the 19th century pioneer of disease control, once said: chance favours the prepared mind. There’s definitely an element of chance with all this, but these people are prepared.