Lessons learned from the first six months of COVID-19 – part two

Setting it Straight - Issue #15

Written by Nobel Laureate Professor Peter Doherty

Humanity has been on a very steep learning curve since, reacting to a 31 December 2019 report from the Wuhan Municipal Health Commission that they were seeing an atypical pneumonia of unknown cause, the World Health Organization (WHO) published (5 January, 2020) the first Disease Outbreak Bulletin to alert the public health community and the global media to the disease we call COVID-19. From the outset, both the WHO and the local virologists were primed by the 2002/3 SARS-CoV-1 experience to think that a coronavirus might be involved.

That was confirmed when Chinese investigators isolated the SARS-CoV-2 virus that causes COVID-19 on 7 January and made the gene sequence available globally a couple of days later. Knowing the viral RNA sequence enabled those who already had appropriate ‘platform technologies’ to start right away with the job of making vaccines. It also allowed Mike Catton and Julian Druce of The Royal Melbourne Hospital’s Victorian Infectious Disease Reference Laboratory (VIDRL) that is part of our Institute to add a sensitive PCR (polymerase chain reaction) test specific for SARS-CoV-2 to the more broadly reactive assay established earlier to detect the SARS-CoV-1 and MERS viruses, neither of which caused disease in Australia. Variants of the SARS-CoV-2 PCR are the ‘tests’ that, as we all understand, have allowed the identification of currently infected individuals that facilitates targeted control strategies.

Arriving in Melbourne from China on 19 January, a returned resident very responsibly alerted authorities several days later to the fact that he was symptomatic and could be infected with this new virus. The diagnosis was immediately confirmed by PCR and, by Australia Day (26 January), Mike, Julian and teams had recovered infectious SARS-CoV-2 from him and announced that that the virus would be made available globally to legitimate laboratories. That was important: having fully infectious virus meant that researchers and diagnosticians could, for example, do virus neutralisation tests to measure protective antibodies in serum, screen chemical compounds (small molecules) for possible antiviral effects in tissue culture and challenge immunised animals to test for vaccine efficacy. 

So, here are a couple of very big lessons that those of us who work in science understood but some in government and many in the broader community may not have fully appreciated.

The international co-operation that is essential for all science, and especially for public health science, functioned for COVID-19 from the outset and has, in fact, continued to work. The WHO did its job of alerting responsible individuals and agencies to the fact that there could be a problem, the Chinese gave out the gene sequence as soon as they had it, and our Institute was the first to provide the infectious virus globally for key laboratory tests. Locally, the communication mechanisms between public health professionals and elected officials proved fit for purpose. The Australian government was immediately aware of the potential threat and the Minister for Health, Greg Hunt, made a public announcement on 25 January that we had recorded our index case.

Additional to that, the very big lesson we should all take on board here is that modern science protects and serves us. Though everyone understood that the catastrophic influenza pandemic of 1918/19 was caused by a virus, diagnosis back then was all symptomatic, no human influenza virus was isolated until 1933 and it was only during World War 2 (1939-45) that the first, primitive influenza vaccines were rolled out to protect the troops against the possibility of a repeat pandemic that, thankfully, did not occur. When it comes to SARS-CoV-2 and COVID-19 we had a specific diagnostic test within days and, I will personally be very surprised if large-scale human vaccination is not in full swing by the second half of 2021.

Even so, the big lesson for the public is that, no matter how wonderful the laboratory science, actually getting products out there to protect people is a much more cumbersome process. Ensuring that a novel drug or vaccine is safe and efficacious takes time. Even though regulatory authorities have been comfortable with the idea that preliminary trials in animals and small numbers of human volunteers (Phase 1) can be conducted simultaneously, all that information must be evaluated before any product can be given to substantial numbers of people. Every possible effort is being made to ensure that all participants in large, closely monitored Phase 2 then Phase 3 trials will be protected, or at least safe, following community exposure to SARS-CoV-2.

Much of what had to be done over this first six months of the COVID-19 challenge was just plain hard work. An enormous effort was, for example, made within VIDRL to build testing capacity by helping other private and public laboratories get up to speed. And the Institute is still in the process of evaluating rapid person-side antibody tests that can be used for large-scale serological surveys. The obvious lesson here is that we are protected by having well-funded, high quality public laboratories and Institutions that can rapidly build capacity in the face of any pandemic threat. Next week, I’ll finish my assessment of the lessons we’ve learned so far, to return to that six months from now.