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COVID-19 Infographics PPE

Lockdown eases, but the virus has not gone away.

Post originally on instagram

So things are opening up again this weekend (4th of July 2020) in the UK. The lockdown eases.

It is everyones individual choice where they wish to go now and what they want to do – if you are looking for ways to reduce risk while going out and seeing friends, here are some science-based suggestions:

Effective hand washing is still extremely important! Make sure you’re washing frequently and efficiently!

 Masks are still growing in evidence for their effect in slowing disease transmission. When you’re in close contact with people outside of your household, consider wearing one as often as you can!

Check out yesterday’s post for how to put on and wear your mask safely!

If possible, meet outdoors! Respiratory droplets have a reduced risk of reaching the people you’re with if you’re outside – a walk or a picnic are good alternatives to a sit-down meal.

Reduce the number of people you see in short spaces of time. By distancing the different groups you see you can reduce the number of potential infections in a social group.

Do you feel ready for when lockdown eases? Let us know your thoughts – info@thesciencesocial.com

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Blog COVID-19 Guest Blog

The COVID-19 Vaccine Landscape

Written by Miguel Leon Rios
Read about Miguel’s research here:
https://news.liverpool.ac.uk/2019/05/15/becoming-an-expert-investigating-vaccines-against-viral-stomach-bugs/

The COVID-19 Vaccine Landscape

The global COVID-19 pandemic picture is still unclear as the novel coronavirus outbreak shifts constantly around the world. While the number of cases rise critically in South America’s first wave, the UK and European countries have begun to lift their lockdown measures amidst this COVID-19 pandemic. At the same time, South Korea and China, where coronavirus cases seemed to have disappeared, have seen a second wave of infections. However, a common question emerges among this COVID-19 rollercoaster: Will we have a vaccine soon? 

A matter of time 

Timing is crucial in vaccine research. More than five months have passed since the genetic sequence of SARS- CoV-2, the virus that causes COVID-19, which was published on 11th January 2020. This discovery sparked an unprecedented global research effort to develop a vaccine against this disease1, involving next-generation technology platforms and novel approaches with a hope to speed up this process. However, vaccine development involves a multi-stage process of research and testing, which typically takes more than ten years to be completed2 (Fig. 1). Therefore, we must remain cautious in light of a new vaccine.

Fig. 1. Vaccine research and development. Adjusted from The Association of the British Pharmaceutical Industry (ABPI)

What is the current picture?

A recent overview of the global landscape of COVID-19 vaccines by the World Health Organisation (WHO) included more than 140 vaccine candidates from different research groups and developers around the world3. From those, 129 candidate vaccines are under preclinical evaluation, which means a preliminary laboratory exploration but not yet in human trials. On the other hand, 13 candidate vaccines have entered the clinical evaluation stage, which is a three-phase process involving human subjects (Fig. 2). 

Fig. 2. How a new vaccine is developed. Adjusted from The Journey of Your Child’s Vaccine. Centres for Disease Control and Prevention (CDC)

OK, but can we speed up this process?

In terms of vaccine research time we are progressing at super-fast speed in this scenario. Just consider that the first set of COVID-19 cases, a new type of viral pneumonia, were reported to WHO on 4th January 2020 (Fig.3). Two months later, the first COVID-19 vaccine entered first-in-human trials within record breaking time on 16th March 2020. Scientists and international organizations around the world are still racing to produce and deliver a safe and effective vaccine within an 18-month period1-3.

Fig. 3. Source: Word Health Organization (WHO) official twitter account.

So, do we have a vaccine yet? 

From the array of advanced COVID-19 candidates under clinical development, only one promising study has started their phase 3 trial in Brazil4 (Fig. 4). This a non-replicative viral vector vaccine developed by the University of Oxford and the British-Swedish company AstraZeneca5. As we previously described, this candidate works as an inactive vaccine by using a different non-live virus to deliver coronavirus genes into our cells. In other terms, it can´t reproduce itself but it can still provoke an immune response.

COVID-19 Vaccine Tracker
Fig. 4. Coronavirus Vaccine Tracker. Source: The New York Times.

Currently, this vaccine is also moving to Phase II/III in England and will hopefully deliver positive results by next year. A different approach has been employed by The Murdoch Children’s Research Institute in Australia. The experimental coronavirus vaccine, which is currently in phase 3 trial, utilises the Bacillus Calmette-Guerin vaccine6.  The BCG vaccine is made from a weakened strain of tuberculosis bacteria and been widely used since the 1920s to fight TB7.

Researchers expect to observe partial protection against SARS-COV-2 as observed for other diseases7,8.  Only data and results will decide if the remaining vaccine candidates could progress to phase 3 human trials and if this global effort could be translated into a successful vaccine by early 2021. 

References

  1. Usher AD. COVID-19 vaccines for all?. Lancet. 2020;395(10240):1822-1823. doi:10.1016/S0140-6736(20)31354-4
  2. Thanh Le T, Andreadakis Z, Kumar A, et al. The COVID-19 vaccine development landscape. Nat Rev Drug Discov. 2020;19(5):305-306. doi:10.1038/d41573-020-00073-5
  3. Draft landscape of COVID-19 candidate vaccines. WHO. 2020; June 22. [cited 2020 Jun 23]. Retrieved from https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines
  4. Corum.J, Grady. D and Zimmer. C. 2020. Coronavirus Vaccine Tracker. The New York Times. Available from: https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html
  5. Current Controlled Trials. ISRCTN89951424. A phase III study to investigate a vaccine against COVID-19, [cited 2020 Jun 23]. Available from: https://doi.org/10.1186/ISRCTN89951424
  6. ClinicalTrials.gov. NCT04327206, BCG Vaccination to Protect Healthcare Workers Against COVID-19 (BRACE) [cited 2020 Jun 23]. Available from: https://clinicaltrials.gov/ct2/show/NCT04327206
  7. World Health Organization. BCG vaccine: WHO position paper, February 2018 Recommendations. Vaccine. 2018;36(24):3408-3410. doi:10.1016/j.vaccine.2018.03.009
  8. Caryn Rabin R. 2020, April 5. Can an Old Vaccine Stop the New Coronavirus?. The New York Times. Available from: https://nyti.ms/2JCcTxx 
COVID-19 Research Summaries

Report Summary: Features of 20,133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study

Written by Rebekah Penrice-Randal and Lucia Livoti

Features of 20,133 UK patients in hospital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study 1 was published in The British Medical Journal (BMJ) this week. This report defines clinical characteristics of patients in hospital in the UK, using the ISARIC WHO Clinical Characterisation Protocol. We have written a brief summary to define what this means, discuss the report itself and highlight the key findings to aid public understanding.


What is ISARIC?

ISARIC is the acronym for International Severe Acute Respiratory and emerging Infections Consortium. ISARIC are a global federation of clinical research networks, with a core goal of generating evidence to improve clinical care and public health responses. They provide a “proficient, coordinated and agile research response to outbreak-prone infectious diseases”.

You can follow the study on twitter for more updates: @CCPUKstudy


What is the ISARIC WHO Clinical Characterisation Protocol?

A research protocol is the set of documents that includes the instructions for conducting a study, the participant information sheets and consent forms. A clinical research protocol has to be approved by an independent Research Ethics Committee to ensure patient safety and dignity, and in the UK, by the Health Research Authority to ensure that health care resources are used appropriately.

 The ISARIC WHO Clinical Characterisation Protocol for Severe Emerging Infection (ISARIC WHO CCP-UK) was designed in 2012 to understand the clinical characteristics  of “any severe or potentially severe acute infection of public health interest”.

In other words, the study was set up in advance of an outbreak to ask the “who, what and why” of a new disease. Who is affected means, age, sex, ethnicity and underlying medical problems. What means, what does the disease cause any of: breathing problems, diarrhoea, vomiting, sepsis or bleeding.

The ISARIC WHO CCP allows for the collecting of clinical data and biological samples, and their analysis and processing to be done in a globally-harmonised manner. This protocol has been curated by multidisciplinary experts across the world 2, and employed in response to outbreaks such as:

  • Middle Eastern Respiratory Virus Syndrome coronavirus (MERS-CoV) in 2012,
  • Influenza in 2013,
  • Ebola virus in 2014,
  • Monkeypox and MERS-CoV in 2018,
  • Tick-borne encephalitis virus (TBEV) in 2019 and
  • SARS-CoV-2 in 2020.

The ISARIC WHO CCP has been central to the swift and cohesive research response to COVID-19. As a free, readily available resource it has been instrumental in the standardised collection of samples and data for the COVID-19 outbreak. This in turn has allowed clinical investigation to progress as quickly as possible. Global generic documents can be accessed here. Countries are also encouraged to develop “localised” instructions and seek local research permissions. The documents pertaining to UK protocols are available here.


Definitions:

Cohort: a cohort of patients are a group of individuals affected by a common factor, such as a disease, treatments or environmental factors.

Cohort study: cohort studies are central to the study of epidemiology and are often used in the fields of medicine, nursing, psychology and social sciences.

Comorbidity: presence of one or more medical conditions in addition to the condition being studied.

Epidemiology: the study and analysis of factors contributing to disease and health outcomes. In this case it may refer to the frequency and pattern of COVID-19 infection, risk factors, super-spreader events and study of specific populations. 

Median: the median is defined as the ‘middle’ value of a data set, such that other values are equally likely to be above or below.

Risk factor: a factor that increases an individual’s risk or susceptibility to a disease.


Aim of the study:

  • To rapidly understand the clinical characteristics of people severely affected by COVID-19. Severely affected, meaning those who need hospital care.


Why is this work important?

This work is essential to appreciate the clinical features of patients that present with COVID-19 and identify risk factors associated with poor outcome. It is only through the understanding of such aspects that public policy can be informed, particularly around shielding of vulnerable groups and planning of resources such as oxygen and ventilator provision.   


Who took part?

20,133 hospital in-patients with COVID-19 from 208 acute care hospitals across the UK were enrolled into the study. Clinical data was collected from patients admitted to hospital between 6th February and 19th April 2020. Patient outcomes are described as known on 3rd May 2020, as people admitted on the 19th April need at least 14 days to complete their admission or “declare the nature of their illness”.


The Results


Conclusions

The ISARIC WHO CCP-UK is a large ongoing study of patients hospitalised with COVID-19. This study found that the mortality rate was high in those admitted to hospital. Certain risk factors were associated with higher mortality rate such as; increasing age, male sex, and chronic comorbidity, including obesity. This report provides the first clinical insight of hospital patients with COVID-19 in the UK. The data gathered throughout this study will assist decision-making in the management of COVID-19, from patient to nation.

This report acknowledges the 2648 frontline NHS clinical and research staff, volunteer medical students and many researchers, who have worked tirelessly to make this study happen. Thank you to all involved and congratulations from The Science Social.


A note on ‘open access’

Open access journal articles are available to everyone and are not behind a pay wall. This article is freely available to all, if you would like to read the original article click here.

References

1          Docherty, A. B. et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 369, m1985, doi:10.1136/bmj.m1985 (2020).

2          Dunning, J. W. et al. Open source clinical science for emerging infections. The Lancet Infectious Diseases 14, 8-9, doi:10.1016/S1473-3099(13)70327-X (2014).

Thank you to Professor Calum Semple (@tweediechap), an ISARIC investigator and co-author of the original article for permission to write this blog, and for the valuable comments.

All feedback and comments are welcome, get in touch:

Guest Blog

Natural or Nasty? Traditional Chinese Medicine and COVID-19

Written by Heather Darby

COVID-19, caused by SARS-CoV-2, currently has no available cure or vaccine (although not through lack of trying!). At the moment we have to rely on supportive treatments to alleviate symptoms; these can range from taking antipyretics like paracetamol at home to reduce a fever, to mechanical ventilation in intensive care units. It can be scary to face an illness where the only options for patients are to manage symptoms and wait for recovery, so are there any other treatments that could be explored? The Chinese government seem to think so: during the peak of the epidemic in China more than 85% of those treated for COVID-19 in hospitals also received treatment with traditional Chinese medicine (TCM).[1]

What is traditional Chinese medicine?

TCM has been used for thousands of years to treat a whole host of illnesses. It differs a bit from the ‘old wives tales’ you might associate with alternative medicine in that it is based on a theory of ‘syndrome differentiation’; patients are treated according to their individual symptoms, using a holistic approach.[1] This differs from the typical disease-specific treatment offered by conventional medicine, in which the patient’s diagnosis will determine their treatment. TCM can include physical therapies such as acupuncture or targeted exercise, but here we are focusing on herbal medicines, comprised of a mixture of ingredients tailored to an individual’s symptoms. These are usually taken in the form of teas, broths or powders. The Chinese government are currently endorsing a combination of conventional medicine and TCM to treat COVID-19, so could this have any benefit to patients?

Does it actually work?

A huge number of COVID-19 patients in China are receiving TCM. A variety of treatments are in use as each case is taken individually, so there is no standardised “treatment”against COVID-19. One of the more common suggested TCM formulations is Qing Fei Pai Du Tang, a composition of 21 different herbal substances claimed to aid in ‘ventilating the lungs’.[2] This has been widely used in China by COVID-19 patients and is commercially available but contains ingredients which are banned in a number of other countries. The national administration of traditional Chinese medicine claims that after the treatment of a group of 214 patients with this remedy, 60% improved over the course of treatment, with 30% showing stabilisation of their condition.[3] Supporters of TCM claim that remedies can shorten the duration of symptoms by up to 2 days,[4] reduce the chance of illness becoming severe, and provide relief from symptoms such as cough and fever.[5] Usually these claims are supported by anecdotal evidence, for example a bus driver in Wuhan who was admitted to hospital for COVID-19 symptoms. In additional to conventional supportive care he was given a herbal broth, and following a few days of treatment his symptoms subsided.[6] These claims all sound very promising, but how much of this can we believe?

Headline taken from The Economist, 11 April 2020.[6]

TCM makes bold claims about its ability to treat conditions like COVID-19, but how are these claims backed up? As explained above, anecdotal evidence is key in the claims proponents of TCM make. Often individual patients’ recovery after treatment is taken as definite evidence of its efficacy. In the case of COVID-19 in particular, this is suspect as the vast majority of cases resolve quickly and do not progress to severe illness; the patients who are held up as an example of the success of TCM would have likely recovered on their own without intervention. Clinical trials investigating the use of TCM do exist, including those conducted during the 2002-2004 SARS epidemic. However, these trials are frequently funded by those with a vested interest in proving the effectiveness of TCM and are poorly controlled with significant flaws in methodology.[3] While at the time of the SARS epidemic it was claimed that TCM may be beneficial to patients, literature reviews since have shown no difference in mortality between those receiving both TCM and conventional medicine, and conventional medicine only.[3] There are at least 50 ongoing clinical trials examining TCM in China, but again results from these will need to be taken with cation as these are not the double blind, placebo-controlled trails that are the standard in evidence-based medicine.[1]

But it’s just herbs, right? What’s the harm?

Despite the lack of evidence for the efficacy of holistic treatments like TCM, many people are still tempted to try them because they are presumed to be ‘natural’ and therefore safe. Aside from not being proven effective, they can also be harmful. TCM is very poorly regulated in most countries; in the UK, TCM is monitored by the medicines and healthcare products regulatory agency (MHRA) but they aren’t actually tested before being put on the market. Instead, manufacturers are relied upon to accurately declare the contents of their products.[7] One research group in Australia set out to test how reliable this information was. 26 different TCM formulations were purchased over the counter and examined for three key areas of non-compliance to the standards needed for legal sale: presence of undisclosed animal DNA, presence of heavy metals (lead, arsenic or cadmium), and adulteration with pharmaceutical products.[7]

Their results were, frankly, frightening, 92% of the TCM remedies tested contained some form of contamination not disclosed on the ingredients list.[7] Half the tested samples contained DNA of an animal not listed, ranging from snow leopard to rat. Ingredients derived from endangered species like leopard and shark are often added deliberately for their perceived therapeutic benefits, but others such as rat, mouse and cat DNA could indicate serious contamination issues during manufacture.[7] The number of TCM formulations containing heavy metals was also concerning. More than 75% of the 25 tested samples contained at least one heavy metal, with 15 exceeding the recommended daily dose. Several samples even contained more than 10 times the maximum daily dose of lead![7]

Other research has indicated that up to a quarter of TCM formulations contain undeclared pharmaceuticals, but another  study found that the true number could be closer to half.[7] More than 50% of tested samples contained at least one pharmaceutical adulterant, many of which were at clinically significant doses.[7] One such TCM contained six pharmaceutical products at doses which would normally require a doctor’s prescription, including amoxicillin and warfarin. None of these were mentioned on the label, and the interactions of a medicine containing analgesics, antibiotics, stimulants and antihistamines aren’t certain.[7] As well as proving potentially dangerous to patients, pharmaceutical adulterants can distort the data from any clinical trials of these TCM formulations. It is very likely that any TCM product containing a clinically relevant dose of an undisclosed pharmaceutical would outperform a placebo, so this gives false data about the efficacy of the TCM formulation itself.[7] These pharmaceuticals are often added to give the desired effect without being listed as part of the formulation of the TCM, so it is very difficult for patients to know what they are getting.[7]

Adapted from Coghlan et al, 2015.[7]

Overall, all but two of the 26 formulations tested were non-compliant with standards posed by Australian regulations, which are very similar to UK MHRA standards.[7] It is concerning that these so-called medicines, which could actually pose a serious health risk in some cases, can be commercially available without a transparent ingredients list. Given TCM formulations are being given to patients ill with COVID-19, it is possible for them to cause harm. Holistic treatments marketed as ‘natural’ can have sinister effects or ingredients, so it is extremely important to discuss any alternative therapies with a doctor.

So why are we talking about it?

Although TCM may be ineffective or even dangerous, some ingredients could hold promise for treatments of viral infections including COVID-19. Natural products can be isolated from plant extracts that make up TCM remedies; some of these possess real therapeutic benefit. For example, artemisinin is a current frontline therapy used in the treatment of malaria. In 1971, Chinese scientist Youyou Tu extracted this compound from wormwood, a traditional remedy for fever, and found it was able to cure malaria in mouse and primate models.[8] She later won a Nobel prize for her work. Another example is the finding that an extract from the common TCM ingredient liquorice root, known as glycyrrhizin, showed activity against a strain of coronavirus isolated during the SARS epidemic. When present in very high concentration (4000mg/L), glycyrrhizin was able to fully inhibit viral replication.[9] This seems promising, but the mechanism for this isn’t fully understood and a lot more research is needed before any compound derived from TCM could be used as a treatment for SARS-CoV or indeed COVID-19.

TCM and other holistic therapies are clearly very divisive. Some wholeheartedly believe in their power, having heard anecdotes of miraculous cures. Others write it off completely due to the lack of good science or reliable evidence of its effectiveness. In truth, there is likely to be some benefit to investigating TCM as a potential treatment for COVID-19, just perhaps not in the way it would traditionally be applied. A huge number of potential drug candidates in the form of natural products may be present in the ingredients that make up TCM formulations. For these to be useful as medicines in the fight against COVID-19 and other viral infections, there needs to be rigorous testing, valid and reliable clinical trials, and thorough and transparent regulation of emerging treatments.

References

[1]- Fung, Y. F. and Linn, Y. C. 2015. Developing Traditional Chinese Medicine in the Era of Evidence-Based Medicine: Current Evidences and Challenges. Evidence-Based Complementary and Alternative Medicine. 2015, article no: 425037 [no pagination].

[2]-Active Herb. 2020. The Official TCM Formula That’s Successfully Treating COVID-19 Patients In China. [Online]. [Accessed 11April 2020]. Available from: https://www.activeherb.com/blog/the-official-tcm-formula-thats-successfully-treating-covid-19-patients-in-china.html

[3]- Yang, Y., Islam, M. S., Wang, J., Li, Y., and Chen, X. 2020. Traditional Chinese Medicine in the Treatment of Patients Infected with 2019-New Coronavirus (SARS-CoV-2): A Review and Perspective. International Journal of Biological Sciences. 16(10), pp1708-1717. 

[4]- Ren, J. L., Zhang, A. H., and Wang, X. J. 2020. Traditional Chinese Medicine for COVID-19 Treatment. Pharmacological Research. 155, article no: 104743 [no. pagination].

[5]- Xu, X. W. et al. 2020. Clinical Findings in a Group of Patients Infected With the 2019 Novel Coronavirus (SARS-CoV-2) Outside of Wuhan, China: Retrospective Case Series. The bmj. 8235, article no:2020;368:m606 [no pagination].

[6]- The Economist. 2020. Fighting it the Chinese Way: China Backs Unproven Treatments for COVID-19. [Online]. [Accessed 14 April 2020]. Available from: https://www.economist.com/china/2020/04/11/china-backs-unproven-treatments-for-covid-19

[7]- Coghlan, M. L., Maker, G., Crighton, E. et al. 2015. Combined DNA, Toxicological and Heavy Metal Analysis Provides an Auditing Toolkit to Improve Pharmacovigilance of Traditional Chinese Medicine (TCM). Scientific Reports. 5, article no: 17475 [no pagination].

[8]- Tu, Y. 2011. The Discovery of Artemisinin (Qinghaosu) and Gifts from Chinese Medicine. Nature Medicine. 17, pp1217-1220.

 [9] Cinatl, J. et al. 2003. Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus. The Lancet361, pp2045-2046.

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Blog COVID-19

“SARS-COV-2 was already spreading in France in late December 2019” – A Scientific Perspective.

Written by Charlotte Rigby

“SARS-COV-2 was already spreading in France in late December 2019” – A Scientific Perspective.

A French study has recently made the claim that SARS-CoV-2, the causative agent of COVID-19, was detected in France on December 27th after re-testing samples from patients diagnosed with unknown pneumonias. A single sample, belonging to a French man, tested positive for SARS-CoV-2 DNA multiple times by PCR.

Figure 1: The original paper published in ‘International Journal of Antimicrobial Agents’.

Does this explicitly mean he had COVID-19?

Not necessarily, however, more evidence is required before drawing any final conclusions. The claim is based on a PCR experiment which suggested segments of the SARS-CoV-2 genome were present in this sample. False positives can occur in this type of experiment. The investigators compensate for this by running the PCR twice. Other methods the investigators could have used to further validate this claim include are viral genome sequencing, use of phylogeny to study how closely related this viral genome is to others that the science community have sequenced and finally serology, to detect antibodies that would have been produced by the immune system during infection.

Sequencing is the process of determining the sequence of nucleotides within DNA or RNA. Knowing this can mean the virus can be compared to ‘reference genomes’ of other viruses to see if there is a match. This sequence can also be used to construct phylogenetic trees which show the evolutionary relationships between organisms, including viruses. The more closely related the virus is the more similar it usually is. These methods would show that the virus was present in the sample and also confirm where the virus belonged on the evolutionary tree, allowing scientists to pinpoint whether this virus was closely related to the viruses observed at the beginning of the outbreak.

Finally, serological evidence would prove that infection had occurred. Serological evidence is based on antibodies, a protein produced during the innate immune response to neutralise pathogens. The presence of RNA doesn’t necessarily mean infection (see the recent stir created by RNA being detected in dogs for example), antibody production does as it proves an immune response was mounted. Scientists would require a blood sample from this patient, many different tests can be performed but for SARS-CoV-2 it’s likely a simple colour change test would be used – similar to a pregnancy test(1).

Figure 2: Methods for validating identities of infectious diseases.

So, should we discount the study?

No, we shouldn’t. A result is still a result and knowledge of this is important. However, when information isn’t communicated well, or an incomplete picture is presented a wave of misinformation can occur. It’s important now more than ever to think critically about information and our sources of information. Ultimately, this is what the Science Social is about – communicating science with non-scientists and encouraging critical thinking.

Have any questions about the content covered today? Drop us a message on any of our platforms.

References:

1.        Amanat F, Stadlbauer D, Strohmeier S, Nguyen T, Chromikova V, McMahon M, et al. A serological assay to detect SARS-CoV-2 seroconversion in humans. medRxiv [Internet]. 2020 Jan 1;2020.03.17.20037713. Available from: http://medrxiv.org/content/early/2020/04/16/2020.03.17.20037713.abstract

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Blog COVID-19 Virology

Viral Disease Emergence: Separating the Fact from the Fiction

Viral diseases have shaped human history. A sudden emergence has the power to cause huge social changes, like ones we’re currently experiencing. But how do they do this? What causes a virus to jump, or ‘spill over’ into a new species?

What is an emerging virus and how do they emerge?

An emerging virus is a virus which has entered a new population where it previously didn’t exist or is expanding its geographical range. Global disease emergence is increasing for many reasons and we’ll discuss why this is occurring and why most emerging viruses that normally infect animals are now infecting humans.

What’s important to remember is there are no singular reasons for viral disease emergence, and we might never know what occurred to cause a disease to break into new populations. But there’s many ways this can happen, ranging from the virus’s genetics all the way through to human-environment interactions. Here we’re going to focus on RNA viruses as these are the viruses which most commonly cross species barriers1. Let’s start with the genetics first.


Genetic

Enzyme Errors

RNA viruses contain an enzyme called RdRp. This enzyme replicates RNA. RNA is a form of genetic code like DNA, so it encodes genes. However, RdRp is prone to making mistakes, it might miss a base, it might use the wrong one and its common for this to happen. This means a virus can be produced with different properties, this can range from being able to target a new cell type to replicating faster. One case where this occurred was during the 1918 Spanish Flu, where a mutation allowed the virus to replicate in tissues outside the respiratory tract2.

A picture containing clock

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Figure 1: Replication of RNA with mutation highlighted in yellow.


Reassortment of segmented genomes

Reassortment is the process where genetic material might get ‘mixed up’. When a cell is infected with two different but closely related viruses there’s a chance this might occur. Think of it like mixing your favourite drinks. It could work, and you might have a new flavour, or it might not! It’s easier for segmented genomes, so the genetic code is in multiple segments and is common in viruses like influenza. H1N1 is an influenza virus which is made up of bird, pig and human influenza strains3.  

A close up of a logo

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Figure 2: Viral co-infection of two viruses (A and B). Inside cell shows 2 different genomes, with reassorted virus containing genomes of both virus A and B having egressed.



Recombination of RNA genomes

Recombination is a random event which occurs when RdRp, the enzyme which makes new RNA, falls off the genome its copying onto a different one. It ultimately will produce an RNA genome which is a combination of two different viruses. This is another common event and many virus families have evidence of this occurring, including Herpesviruses, HIV and even Coronaviruses4,5

A close up of a map

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Figure 3: Recombination of RNA genome in 5′ to 3′ directionality.


Environmental

Changes in weather

Climate change isn’t only impacting our weather, it’s also changing disease distributions through temperature but also causing changes in host territory. Ultimately this changes how we interact with hosts of viruses as well as their biology. For example, Japanese Encephalitis Virus (JEV). This virus is carried by mosquitoes, so a higher temperature alters host territory as well as allowing for mosquito development to occur where it didn’t previously. This is because mosquitos have a minimum temperature where development will occur, and for the mosquito which carries JEV its 22-23 °C. However, viral diseases can have a minimum transmission temperature, and JEV has one of 25-26 °C. If more countries have temperatures above this range, then the virus can be transmitted in new populations. What this all means is as global temperatures rise it’s very likely countries will experience diseases they haven’t previously6


Bush meat and live animal markets

Consumption of bush meat and live animal markets remove natural barriers in place, meaning that close contact between animals and humans now occurs. Outbreaks may occur due to consumption of an animal which died of a disease, and not of more natural causes. This is how Ebola outbreaks have started before. However, it is important to consider the socio-economic conditions found within regions where consumption of bush meat occurs. Protein sources in these regions can be expensive and the local population may not have the choices we do7. Reducing disease emergence from live animal markets can be done safely by reducing inter-species interactions, essentially handling the animals less and making the markets less crowded. However, it could also be done through limiting the days of operation8.  

Korea, Wet, Market, Meat, Seafoods, Vendor, People
Figure 4: Wet market in South Korea. Source: Stocksnap, Pixabay.



Changing land use and farming practices

Deforestation of land for farming and urban development is forcing disease hosts to come into closer contact with humans, one example where this is occurring is Australia. Here, horse farms are traditionally where fruit bats reside however urbanisation has resulted in loss of the natural habitat, forcing greater interactions with the human population9.  

So, there we have it. Several mechanisms on how viruses can emerge into human populations. But what about SARS-CoV-2? Well, the jury’s still out. Though early cases were linked to a seafood market many weren’t, indicating the source of the virus likely wasn’t here. In the meantime, scientists will be hard at work hoping to solve many puzzles, including this!  If you have any questions about what was discussed drop us a message below or on Facebook, Twitter or Instagram and we’ll get back to you.


For more information on the origins of SARS-CoV-2 read our blogpost breaking down a Nature paper by Dr Jordan Clark here

For more information on viral disease emergence check out ‘Spillover’ by David Quammen. 


References:

1.J Woolhouse, M. E., Adair, K. & Brierley, L. RNA Viruses: A Case Study of the Biology of Emerging Infectious Diseases. Microbiol. Spectr. 1, 10.1128/microbiolspec.OH-0001–2012 (2013). 

2.Taubenberger, J. K. The origin and virulence of the 1918 ‘Spanish’ influenza virus. Proc. Am. Philos. Soc. 150, 86–112 (2006). 

3.Vijaykrishna, D. et al. Reassortment of pandemic H1N1/2009 influenza A virus in swine. Science 328, 1529 (2010). 

4.Fleischmann, W. J. Medical Microbiology. (University of Texas Medical Branch, 1996). 

5.Su, S. et al. Epidemiology , Genetic Recombination , and Pathogenesis of Coronaviruses. Trends Microbiol. 24, 490–502 (2016). 

6.Wu, X., Lu, Y., Zhou, S., Chen, L. & Xu, B. Impact of climate change on human infectious diseases : Empirical evidence and human adaptation. Environ. Int. 86, 14–23 (2016). 

7.Kurpiers, L. A., Schulte-Herbrüggen, B., Ejotre, I. & Reeder, D. M. Bushmeat and Emerging Infectious Diseases: Lessons from Africa BT  – Problematic Wildlife: A Cross-Disciplinary Approach. in (ed. Angelici, F. M.) 507–551 (Springer International Publishing, 2016). doi:10.1007/978-3-319-22246-2_24 

8.Karesh, W. B., Cook, R. A., Bennett, E. L. & Newcomb, J. Wildlife trade and global disease emergence. Emerg. Infect. Dis. 11, 1000–1002 (2005). 

9.Plowright, R. K. et al. Urban habituation, ecological connectivity and epidemic dampening: the emergence of Hendra virus from flying foxes (Pteropus spp.). Proceedings. Biol. Sci. 278, 3703–3712 (2011). 


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Written by Charlotte Rigby.

COVID-19 Infographics Q&A

The Science Social Q&A III

It’s question and answer time again! Here are some more of the questions we’ve been sent recently – if you have questions you want answered, message us or tag us in a post and we’ll add you to our next post!

ℂ𝕒𝕟 𝕪𝕠𝕦 𝕤𝕡𝕣𝕖𝕒𝕕 𝕥𝕙𝕖 𝕧𝕚𝕣𝕦𝕤 𝕨𝕚𝕥𝕙𝕠𝕦𝕥 𝕜𝕟𝕠𝕨𝕚𝕟𝕘? 🦠
Yes, you can – stay home whenever you are able!

𝕎𝕙𝕪 𝕒𝕣𝕖 𝕚𝕟𝕗𝕖𝕔𝕥𝕚𝕠𝕟/𝕕𝕖𝕒𝕥𝕙 𝕣𝕒𝕥𝕖𝕤 𝕤𝕠 𝕕𝕚𝕗𝕗𝕖𝕣𝕖𝕟𝕥 𝕓𝕖𝕥𝕨𝕖𝕖𝕟 𝕔𝕠𝕦𝕟𝕥𝕣𝕚𝕖𝕤? 📊
Tons of factors come into this, including population demographics, data reporting style and testing methods – it’s not necessarily anything to do with how patients are being treated.

𝕎𝕙𝕒𝕥 𝕥𝕪𝕡𝕖 𝕠𝕗 𝕤𝕠𝕒𝕡 𝕤𝕙𝕠𝕦𝕝𝕕 𝕀 𝕨𝕒𝕤𝕙 𝕞𝕪 𝕙𝕒𝕟𝕕𝕤 𝕨𝕚𝕥𝕙? 🧼
Any soap you can get! COVID-19 is caused by a virus, not bacteria, so antibacterial soap isn’t needed to get rid of it.

𝕎𝕙𝕒𝕥 𝕡𝕣𝕠𝕕𝕦𝕔𝕥𝕤 𝕔𝕒𝕟 𝕝𝕒𝕣𝕘𝕖 𝕗𝕒𝕤𝕙𝕚𝕠𝕟 𝕓𝕣𝕒𝕟𝕕𝕤 𝕒𝕔𝕥𝕦𝕒𝕝𝕝𝕪 𝕞𝕒𝕜𝕖? 👕
It depends a bit on what hospitals are willing to accept, but scrubs are simpler than masks – so they’re a good place to start if a manufacturer isn’t qualified to make complex medical equipment.

𝔻𝕠𝕖𝕤 𝕌𝕍 𝕝𝕚𝕘𝕙𝕥 𝕜𝕚𝕝𝕝 𝕧𝕚𝕣𝕦𝕤𝕖𝕤? 🌞
Yes – but the type of UV light used to kill microbes in a lab is also VERY harmful to humans. It’s absolutely not something people should be trying to replicate at home.

Find more Q&As here:

COVID-19 Infographics

It was all an overreaction, the coronavirus peak.

Scientists are suggesting that the UK and USA are approaching, if not in, the peak of COVID-19 cases. 📊

Once this time comes, and infection and death rates go down it’s going to become very easy to argue that lockdowns and social distancing were never needed, because “see! It wasnt that bad after all!” 🚫

Remember ❗ the WHOLE REASON it “wasn’t that bad” is because we took these measures to stop the spread.
Not to mention that thousands HAVE lost their lives, and it is unfair to write those people off into history with no second thoughts.

When you see arguments about reopening economies, the impact that shutdowns will have into the future, and questions about whether it was all worth it, remember that we NEEDED to flatten the curve of cases for our communities to survive. 👬👭👫

Please, continue to follow government advice on staying at home and reducing contact with other people. When we do ease restrictions, remember to continue being mindful of your interactions and behaviours.

🧼 Second waves of infections are a high risk, and could overwhelm the medical structures we have worked so hard to protect.🏥 Stay at home, protect the NHS, and save lives.

Blog Virology

Bats and Viruses

The 17th of April marks International Bat Appreciation Day. This is because bats begin to emerge from hibernation at this time of year. Despite all the bad press bats get, especially in light of the coronavirus outbreak, they actually play an important roll in nature.

Bats are insectivorous creatures, and reduce the number of many annoying insects. Did you know a bat can eat up to 1000 mosquitoes in an hour?!

Bats are fascinating mammals. Unique in several ways, including their ability to fly, they also have a harmonious relationship with many viruses that can be devastating to humans. 

https://images.theconversation.com/files/313184/original/file-20200202-41495-ndlo4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1200&h=1200.0&fit=crop

Viruses such as Ebola virus, Coronaviruses (e.g. SARS), and Hendra virus are examples of Zoonotic viruses that are found in bats. Zoonotic is the term for viruses that jump species barriers or “spill over”, i.e. from bats to humans. These viruses often cause no physical symptoms in bats, and due to their lifestyle of roosting in large colonies, can spread easily through large populations. 

Wynee and Wang (2013) from CSIRO Australian Animal Health Laboratory, Geelong, Australia, released an open-access article in PNAS asking whether bats are friends or foe. They remind us that bats are just as diverse as the viruses that infect them. The picture below, also found in their article shows different species of bats, and electron microscope images of the viruses that can infect them (1).

“Bats are diverse, as are the viruses that infect them.

The Chinese horseshoe bat (ARhinolophus sinicus) is one of many Rhinolophus sp. that are a natural host of SARS-like coronaviruses (B; scale bar 100 nm). The spectacled flying fox (CPteropus conspicillatus) along with other Pteropus sp. are reservoirs for the Australian Bat lyssavirus (D; scale bar 100 nm). A number of African fruit bats including Hypsignathus monstrosus (E) have been found to host Ebola virus (F; Ebola Reston, scale bar 200 nm). The Malayan flying fox (GPteropus vampyrus) is the natural host of Nipah virus (H; scale bar 200 nm). All four pteropid Australian bat species including Pteropus alecto (I) have been found to carry Hendra virus (J; scale bar 200 nm).”

https://doi.org/10.1371/journal.ppat.1003651.g001

The reasons for why bats can tolerate these viruses are not fully understood, but there are some characterised differences in their immune system response that are thought to account for this (2)

One relatively well supported hypothesis for the underlying reason is due to their flight, which puts a large amount of stress on the body. Evidence suggests that they have managed to deal with this stress by the evolution of an altered immune response, which then allows the bats to control viral replication whilst minimising any counter-productive over response (3)

All of this is great for bats, but becomes a problem for us when these viruses jump into the human population. Our immune systems respond differently to bats, and this results in the diseases we see. So, what can we do?  

To some, the obvious response may be to exterminate wild bat populations. Even without considering the obvious moral objections to this, it would also be counter-productive for many reasons. Bats are incredibly important to ecosystems, playing crucial roles in pollination, insect control, and seed dispersal (4)

In order to reduce the chances of spill over events, it is important to look at the ways that human activity brings us into more frequent contact with bats, such as deforestation and the possibility of bats passing diseases to us via animals in our food supply chains. We can then find ways to minimise these.  

In the meantime, researchers can learn a lot from the differences between the immune system response of humans and bats, in order to identify ways in which ours is not effective in tackling viruses. (2)

We should appreciate these wonderful mammals, understand the ways they can be dangerous, and learn to live alongside them whilst minimising contact. It will suit both us and them!  

https://i.pinimg.com/originals/b2/e3/98/b2e3989557c230febf0b46c69c0969ab.jpg

References: 

1: Bats and Viruses: Friend or Foe? – Wynne & Wang, 2013

2: Innate Immune Responses of Bat and Human Cells to Filoviruses: Commonalities and Distinctions – Kuzmin et al, 2017 

3: Novel Insights Into Immune Systems of Bats – Banerjee et al, 2020 

4: Education to Action: Improving Public Perception of Bats – Hoffmaster et al, 2016 

Written by Ben Jones
COVID-19 Infographics Q&A

Coronavirus and 5G… Lets do this.

Recently we were asked why so many 5G-related conspiracies had been popping up. Such as, “Does 5G really cause coronavirus?”…

The short answer to this is we don’t know, because these conspiracies are not founded in science 🔬

However, new things can be scary when you don’t understand them❗ And the appearance of a brand new virus at the same time as an increase of new technology could understandably be confusing and frightening.

So here is our quick and easy breakdown of what 5G is! 📲
5G is just like 4G, 3G and 2G before it – they’re 𝕣𝕒𝕕𝕚𝕠 waves, a type of energy that isn’t known to cause damage that leads to cancer.

The potential impact of radio waves on cells would just be like a burn, but this would need energy FAR higher than your phone could ever reach! 🔥

COVID-19 is caused by a virus, a coronavirus named SARS-CoV-2 🦠 which transmits through droplets that you let out when you sneeze and cough. Nothing to do with technology, just a bug passing between people the usual ways! 5G, does not cause coronavirus.

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