ONE YEAR LIVING WITH SARS-COV-2: PROGRESS ON PREVENTION AND TREATMENT
The First Webinar series, “Updates on COVID-19 Vaccine”, was held on Saturday, April 10, 2021, at 08.00-12.00 WIB. This webinar is supported by INA-RESPOND and partners and is free of charge for all participants. Participants will receive IDI SKP and an electronic certificate.
Presentation materials from speakers can be downloaded by clicking on their presentation and name below:
- Rapid (and Precise) COVID-19 Vaccine Development (and Discussion) by Dr. Barney Graham, PhD
- COVID-19 Vaccine Safety Considerations by Dr. dr. Erlina Burhan, MSc., Sp.P(K)
- Indonesian Government Vaccination Plan by dr. Siti Nadia Tarmizi, M.Epid
- Virus Mutation and Vaccine Implication by Prof. Dr. Pratiwi Soedarmono, Ph.D., Sp.MK
- Vaccination on a specific population (autoimmune, pregnant women, chronic disease, COVID-19 survivor) by Prof. Dr. dr. Iris Rengganis, Sp.PD-KAI
- Vaccination and Public Health Implication (traveling, vacation) by dr Iwan Ariawan, MSPH
COVID-19 pandemic caused by the new beta-coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been around for one year. It has proven to be one of the greatest challenges modern medicine has ever faced. The COVID-19 symptoms started in December 2019 with four atypical pneumonia cases in Wuhan, China, connected to a local seafood market, the Huanan Seafood Market. The disease heavily affects the world, with a total number of cases and deaths reaching 100 million and 2 million, respectively, as of the end of January 2021. Previous knowledge of its coronavirus outbreak predecessors (SARS-CoV and MERS-CoV) is not enough for the authorities, clinicians, and researchers to handle this new virus. Therefore, it is crucial to understand the virus’s unique characteristics and impact on the human body. This is very important for choosing the ideal treatment, vaccine, and control measure, and they may help prevent future pandemics.
SARS-CoV-2 is a new virus, and we are still learning how it behaves. The virus originally came from a wild animal, most likely, a bat. It then jumped into humans via an animal host, probably pangolin. Later, we found that humans could infect other animals like mink, and then the virus spilled back to humans with some genetic changes. The main transmission mode is via respiratory droplets; however, transmission via air and contact (fomite transmission) is still debatable. The pathogenesis of SARS-CoV-2 is not clearly understood yet. The virus is mainly using angiotensin-converting enzyme 2 (ACE2) receptor to invade the human cells. However, a recent discovery has found that entry co-factors on the surface of host cells, such as serine protease TMPRSS2, protease furin, and a protein called the neuropilin-1 (NRP1), can increase SARS-CoV-2 infectivity and may become potential targets for future therapeutics. The mystery continues as to how SARS-CoV-2 interacts with different organs, how it causes various clinical features and severity, and how long the survivor will retain their acquired immune-memory response to the virus. The involvement of overactive immune response -the so-called cytokine storm- and hypercoagulability is found in severe cases, but the exact mechanism is still unknown.
The trials to find an effective yet feasible treatment such as re-purposed drugs to block the virus, anti-inflammatory agents, passive immune-therapy agents, and other treatments (e.g., immune-modulators, anticoagulants, vitamin and mineral supplements, and respiratory support devices) are needed. However, there has not been a cure for COVID-19 yet. One re-purposed antiviral Remdesivir, which the FDA has approved, only suggests a modest to no benefit for patients. The passive immune-therapy attempts have successfully fought against similar COVID-19 viruses such as SARS-CoV and MERS-CoV to reduce the viral load and disease mortality. Currently, the main passive immune-therapy methods that have been used are convalescence plasma transfusion from COVID-19 survivor, hyperimmune intravenous immunoglobulin, and monoclonal antibody candidates. The benefit from passive immune-therapy is still under investigation. However, it seems that it is performed best in early COVID-19 disease progression.
The worldwide endeavor to create a safe and effective COVID-19 vaccine in less than one year is very historical in humankind’s lifetime. A handful of vaccines now have been authorized for use worldwide; many more remain in development. More than 82.5 million doses in 59 countries have been administered, and scientists must prepare to face the outcome. The Antibody dependent-enhancement (ADE) issue and anecdotal shreds of evidence of some viral genomic mutations might influence those vaccine candidates’ efficacy and safety. Three new worrying variants have been identified from United Kingdom (B.1.1.7), South Africa (B.1351), and Brazil (P.1) with multiple spike mutations. They appear to be more infectious and might have the immune-escape ability. Although the variants are observed not to affect disease severity, the high transmission will threaten medical care capability and give the virus higher chances to develop further mutations. Over 380,000 virus genomes were sequenced in just one year to help scientists get real-time data about the evolution and work together to solve the problem.
While the are no powerful drugs and approved vaccines to combat this disease, some public health protocols such as wearing a mask and physical distancing still seem to become the best approaches against the pandemic. Experience sharing from other countries that have successfully controlled this pandemic is also very important for public health learning. Genomic surveillance needs to be optimized as a tool that helps drive public-health decisions quickly. Surveillance needs to be widespread, standardized, and embedded in national pandemic-prevention programs.
While these on-going uncertainties in every aspect of COVID-19 are unavoidable, however, the explosive information about this virus must be filtered according to evidence-based medicine principles to avoid pseudoscience and fraud. In answering those challenges, the Indonesia Research Partnership on Infectious Diseases (INA-RESPOND) is planning to conduct a monthly webinar about COVID-19. INA-RESPOND is a multi-center clinical research network for infectious disease managed by the National Institute of Health Research and Development (Indonesia) in collaboration with the National Institute of Allergy and Infectious Diseases (United States) at designated Indonesian medical faculties and their teaching hospitals. As a network research organization focused on infectious disease, we also have a responsibility to provide comprehensive updates and recent evidence of COVID-19 to clinicians, researchers, and public health authorities to help tackle this disease.
The purpose of the INA-RESPOND COVID-19 Webinar is to:
- Provide current updates on COVID-19 epidemiology, virology, pathogenesis, treatment, and vaccine development.
- Discuss strategies and experiences from other countries that regarded successfully controlling the COVID-19 pandemic.
The INA-RESPOND COVID-19 Webinar will be held once a month for four months, starting from April to July 2021.
- National Institute of Health Research and Development (NIHRD), Ministry of Health, Indonesia
- INA RESPOND Study Site Team
- INA-RESPOND Secretariat
- General participants