Will I die if I get coronavirus infection? Will I get seriously ill? What is the chance I will get infected if I resume my normal activities. Will there be medical care available for me if I get sick? Are their medicines that could keep me from dying if I get sick? These are some of the questions people will have as they look to resume their normal activity after the initial waves of the pandemic.
As we help people make decisions about normalizing their lives we need the medical information to answer need. Most of the medical advice we need to provide people appropriately focuses on their specific risk from coronavirus infection, and unfortunately there is currently little information to answer these questions right now, and although our health system is overwhelmed at this point it is crucial that we do research at this time to be able to answer these questions. Having so many patients at a single time in the pandemic is catastrophic, but provides an un-paralleled opportunity for medical research on COVID-19 infection. This opportunity should not be missed and research should be started immediately and must be continued after the initial pandemic wanes.
The first COVID-19 research priority is to develop an antibody assay. As with MERS, this assay will examine the blood of patients for antibodies (proteins) that show who has been infected with the virus. Antibodies can also document that shows whether a person’s blood can neutralize the virus and are protected (immune) against future infection. These assays let each individual know if they are protected against COVID-19. Individuals with COVID-19 antibodies could rapidly return to normal activities without any restriction whatsoever. These individuals also would be particularly well-suited to provide medical care for COVID-19 infected patients.
In addition, antibody assays need to be quickly run on the entire population to give insights into the risk we have from future COVID-19 pandemics. High frequencies of immune individuals could provide similar protection to COVID-19 as a vaccine campaign and provide assurance that future infections from this virus would not cause a disruption similar to what we are currently observing. Population antibody testing could also provide a basis for predicting the potential success of future vaccines, especially since influenza immunization programs protect ay best 60% or so of individuals.
An important question is whether we predict if someone will get ill from coronavirus? Despite the severity of the current pandemic only 20% of individuals are seriously ill from COVID-19; 80% do well and many don’t even appear ill! This is even true in young people, who have lower death rates but similar rates of hospitalizations. There must be a reason why this 20% gets sick and the answer clearly is in our genes. Variations in the genes of individuals dictate the immune response to COVID-19, and will determine who gets sick vs. who stays well. We can now easily examine and compare essentially all the genes involved in regulating the immune response. Examining these genes could allow us to predict who will get sick with COVID-19, and therefore should take greater precautions or be treated more aggressively for the infection. In contrast, we also would identify markers that predict who will stay healthy with CVID infection. Those predicted to stay well might be assured that they have little personal risk in future pandemics.
One of the most important question people have is will there be a treatment for COVID-19 if they get infected in the future. We need to carefully validate antiviral and immune therapies using the stringent criteria the FDA demands for any approved medication. We particularly need to look at efficacy of these drugs in at risk groups such as the elderly. Two good outcomes come from having validated therapies for COVID-19. First therapies that substantially reduce morbidity and mortality from COVID-19 provide reassurance on the risks from future infections. In addition, if these treatments reduce hospitalization requirements they would assure help manage future COVID-19 outbreaks and make them much less likely to overwhelm health systems.
Taken together these research initiatives will provide individuals a much better idea of their personal risk from coronavirus infection and allow them to make rational decisions about restoring their lives and resuming normal activities. We must not let this opportunity to study COVID-19 infection pass by despite the stress from this pandemic.