I feel safe in assuming, reader, that you're probably feeling saturated by all things coronavirus-related. I am too. So why am I reviewing an event dedicated to the topic?
While we may all be fatigued from what feels like a coronavirus overload, in-depth scientific information on the biology of the virus has to me felt lacking. Death rates, lockdown adjustments and speculation make headlines, while the science is limited to Boris' soundbites about 'following the evidence'.
Thankfully, some are seeking to ensure that detailed information is available in a more easily digestible format. The Royal Society of Medicine recently hosted an online webinar featuring three researchers working on coronavirus research. The format was straightforward, with 15-minute talks from each speaker, followed by questions.
I must confess that I initially sat at my computer with a slight sense of dread at being faced with the prospect of yet another video meeting. But as soon as our new normal of inevitable accidentally-muted mics and screen sharing difficulties were dealt with, I was immediately hooked.
The first speaker was Professor Michael Worobey, who approaches the virus from an evolutionary ecology perspective. His work in the past has focused on the emergence of HIV in Africa, so he is strongly positioned to comment on the current crisis. He focused his talk on the emergence, and initial spread, of SARS-CoV-2, particularly in the United States.
It was interesting to hear the initial phase of the virus presented as a distinct, detailed timeline, and also to notice the remarkably short gap between emergence and genome sequencing. I can't help but be struck by how quickly a huge number of genome sequences have been produced and shared, something which would have been unimaginable even 20 years ago, thanks to the advent of modern sequencing technology.
We begin with bats, as has often been the case in public discussions on the topic, but intricate details like the phylogeny of the virus in relation to its close relatives and when it might have diverged from its most recent ancestor were new to me. Talk of haplotypes and tracking specific mutations through time was a continuing theme throughout this seminar. Each haplotype is a specific strain of the virus bearing a unique identifying mutation, which allows them to be distinguished from one another and therefore tracked.
In this talk, the power of genomics in untangling the chaos of this pandemic rapidly becomes apparent. Professor Worobey takes us through how they unpicked the puzzle of the initial spread of the virus in the US using genomics. Detailed explanations of the nature of the mathematical models used go over my head, but retrospective sampling of 'flu' patients which revealed cryptic circulation of the virus before it was thought to be present in the US, and highlights (again via analysis of haplotypes) that the real source of America's current infection was not from China at all, but instead Europe.
Dr Kari Stefansson, CEO of deCODE genetics based in Iceland, steps in next, to tell us the story of his country's response to the virus. This was the highlight of the seminar for me.
Dr Stefansson highlights how Iceland has been an unusual case through this pandemic, with a mere ten deaths on record as of the date of this seminar – a shockingly low number. How was this achieved?
Iceland, through deCODE, has taken an extremely aggressive test and trace approach, but kept schools, shops and borders open, with screening beginning early – at the end of January.
Again highlighting the power of genomics in this crisis, Iceland sequenced the genome of the virus recovered from all 804 diagnosed patients.
The research revealed interesting trends. Despite the relatively low mutation rate of this coronavirus, the large number of infections still manages to produce lots of diversity, with some 700 haplotypes in Iceland alone. An interesting by-product of this, which Dr Stefansson highlights, is the emergence of region-specific haplotypes. Much like ancestry tests people take, viral haplotypes can be correlated to geographical regions and so the area a haplotype comes from can be diagnosed. Using this logic, the country soon realised that the main source of its infection was the UK.
Clever use of haplotyping also allowed Dr Stefansson and his team to show convincingly that child-to-parent transmission is far lower than the reverse, which I found fascinating, given the current restrictions on schools opening here.
Dr Stefansson then delved into a point that is probably on the minds of many, but is only superficially discussed: why does the pathology of the virus differ so much between individuals? Their data seems to suggest no strong link with viral haplotype, and I feel teased, as he offers no firm answers, only speculation that is likely to be a combination of both variety of viral haplotypes and the diversity of patients' genomes.
The final speaker is Professor Jonathan Heeney, Cambridge pathologist and founder of vaccine start-up DIOSynVax. Professor Heeney seeks to enlighten us on the nature of immunity to a virus such as this and clarifies the notion of herd immunity, so commonly discussed in the media.
Particularly striking takeaways are that despite the epidemic, prevalence of COVID-19 antibodies in the population is low. Professor Heeney presents convincing evidence that the antibodies to this virus are short-lived, which seems like a potentially devastating blow to our hopes about herd immunity, which he goes so far as to call a high-risk strategy.
Professor Heeney further urges caution about the vaccine development strategies that are ongoing. Evidently, there is a desperate need for a vaccine, and to relax the long-winded regulations seems a logical approach, one lauded in the media. But Professor Heeney is not convinced this is wise, citing very reasonably the dangers of a poorly designed vaccine, such as antibody-dependent enhancement, a feature of other coronaviruses.
I am slightly disappointed by what feels like a plug for his own company at the end, but I understand the impulse given his clear distrust of current vaccine development programmes. I am left with any sense of hope I had for a vaccine soon dashed, and hopeful that his confidence in his own company's strategy is well-placed.
Overall, I was deeply impressed by the clarity and insight provided by these speakers in the brief episode. At the end of the talks I regretted that our current cabinet hadn't found their way here, paying close attention, and trying to learn from and act upon some of the insights offered.
In an answer to a question from the floor, Dr Stefansson expressed his amazement that the UK didn't take a 'track trace test' approach – pointing out, damningly, that we have the universities, talent, equipment and the money. He doesn't say so explicitly, but it's obvious that the missing element is leadership. We need to listen to experts like those speaking here and act on the wealth of evidence they are amassing.
Sadly, the Royal Society of Medicine does not currently have this event available on their YouTube channel, but if this webinar is anything to go by, I highly recommend seeking out anything COVID-related that they have produced.