Coronastream: a Churchillian moment

Posted on July 2, 2020   by Dr Tim Inglis

In this special blog series, medical microbiologists led by Dr Tim Inglis summarise some of the research that will be essential to inform COVID-19 countermeasures. Find out more about the project in Dr Inglis' Editorial 'Logic in the time of coronavirus', published in the Journal of Medical Microbiology.

As we pass the midpoint of the year, the Greek chorus is asking, 'How much longer is this going to go on for?' Many parts of the world are through the worst of the pandemic and starting to emerge from their cocoons. However, in the last few days the figures from Melbourne sound a note of caution to those who long for pre-COVID 19 normality. Even in those fortunate places where local transmission has ceased, the battle is not over yet. And for those who like to draw parallels with the Second World War, this is their opportunity to dive into the stock of Winston quotes: 

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

In view of this pandemic’s obstinate tenacity, the Coronastream blog will change gear this week, and switch to a monthly format to enable long term sustainment. The next entry will therefore appear in early August.
Until August, stay safe.

Congruence: using C-reactive protein in COVID-19

Insights into the use of C-reactive protein as a diagnostic index of disease severity in COVID-19 infections

C-reactive protein (CRP) is raised in COVID-19 and predicts a poor clinical outcome. In this paper Professor Jan Potempa and colleagues provide a helpful guide to using CRP in the management of patients admitted to hospital with COVID-19. In particular, they recommend using CRP to assess disease severity.

Consistency: the 'second wave'

Can we please stop talking about a second wave of COVID-19?

The upward trend in daily cases noted in Melbourne raises concern that COVID-19 is getting out of control as public health restrictions begin to ease. In this thoughtful article for The Conversation, Dr Jeremy Rossman argues that we should stop using the ‘second wave’ analogy to describe the COVID-19 pandemic evolving epidemiology.

Three main reasons:

  1. The pandemic is not a force of nature we’re powerless to resist
  2. The first phase of the pandemic is still in progress
  3. SARS-CoV-2 is not influenza virus

Cumulative dissonance: intercity progression

General model for COVID-19 spreading with consideration of intercity migration, insufficient testing and active intervention: application to study of pandemic progression in Japan and USA

The occurrence of small outbreaks and sporadic cases of COVID-19 where public health restrictions have been lifted shows the limits of our ability to predict when, where and how to relax restrictions. Professor Choujun Zhan and colleagues developed a susceptible-exposed-infected-confirmed-removed (SEICR) model to predict COVID-19 progression between cities, and applied their model to data from the USA and Japan.

Using March 2020 data, they predict that 70% and 90% of reductions in the number of infected persons could be achieved with a ten-fold increase in active intervention. For those responsible for interrupting transmission across state and national borders, this paper holds some useful insights.

Curtailment: possible role for live attenuated vaccines

Could an unrelated live attenuated vaccine serve as a preventive measure to dampen septic inflammation associated with COVID-19 infection?

Australia’s outgoing Chief Medical Officer predicted this week that our international borders would probably remain closed until we have a vaccine. Noting the expected lead time to introduce an affordable, effective and safe vaccine for COVID-19, the search is on for partial, interim solutions.

Fidel and Noverr’s commentary in mBio suggests that stimulation of protection against the more serious consequences of SARS-CoV-2 infection by myeloid-derived suppressor cells (MDSC) could be achieved by live attenuated vaccination with the like of MMR. They note that BCG is being used in COVID-19 trials and that trained innate immunity persists for around one year, so that use of a live attenuated virus vaccine to boost would be most effective during the active phase of the pandemic. At present, this is a working hypothesis and makes no claims for prevention of infection. 

Picture of the weekVictoria’s COVID-19 upturn

Quote of the week:

I'm actually of the mind right now, I think this [COVID-19] is more like a forest fire. I don't think that this is going to slow down. I'm not sure that the influenza analogy applies anymore. I think that wherever there is wood to burn, this fire is going to burn. And right now we have a lot of susceptible people.
Michael Osterholm, 21 June 2020