#COVID-19 - What we didn’t know we didn’t know

Most of us probably reckon that we know plenty about the novel coronavirus, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan or COVID-19, whether we wanted to or not. But do we?

Coming right up are five things that nobody knows for sure just yet, just to put things in perspective as we go about our homes, or occasionally visit the shops in masks and gloves, in this ‘new normal’.

Knee-jerk national lockdowns to stamp on the spread of COVID-19 seem to be working, but the economy and social interactions are limited for now.

Citizens everywhere are - perhaps prematurely in most cases - asking about exit strategies in general and when restrictions will start being lifted in particular. Some countries are sending kids back to school, some are reopening certain shops…it is not an EU-wide strategy and it all, quite frankly, can seem a bit random from anyone taking an overview.

It doesn’t help that even our scientists - supposedly advising Europe’s governments - have pretty substantial gaps in their understanding of all the aspects of Covid-19.

A core issue is a lack of data....

Clearly what we have to rely on is data, data and more data, whether through testing, enhanced use of genomics, and so on. But this of course requires pan-EU member state cooperation and co-ordination as well as interoperability for exchange purposes, in order to help answer these questions as quickly as possible.

For EAPM’s part, we have proposed from the onset that systems in the EU need be interoperable to allow better data flow. It’s good to note that our own MEGA+ initiative, as well as the European Health Data Space, are key ongoing initiatives aimed at making such goals reachable. 

Let’s take a look at some of the biggies…

Reinfection and/or immunity

OK, you had the virus, you came out the other end. Are you immune or can you be reinfected? Also, would you still be able to infect others? 

These are big questions. It doesn’t help that there have been reports from South Korea that people can become reinfected. Which makes the idea of “immunity passports” a bad joke.

How the virus spreads

Right, well we all know that respiratory droplets are the main suspects here. However, is it really possible to become infected by touching a contaminated surface before touching your face? If it is, how long can the virus survive on different surfaces?

The World Health Organization (WHO) doesn’t know, writing: “It is not certain how long the virus that causes Covid-19 survives on surfaces. Studies suggest that coronaviruses may persist on surfaces for a few hours or up to several days.”

When tracing and breaking up chains of infections, this makes a difference, making this question important for assessing which safety precautions can slow the spread of the virus.

Meanwhile, masks? Don’t even go there. Who knows, right?

Effects of the weather. Are there any?

America’s President Donald Trump, in an early stroke of his own particular style of ‘stable genius’, suggested in February that warmer weather in (some parts of) the US, due in April, could make it easier to battle the pandemic.

Well, temperatures are already warm in some parts of the world, and still the virus spreads.

As it happens, sources in the US said today that sunlight, humidity, et cetera might be good for zapping the virus, but we don’t know for sure. It happens with the flu, but this is not the flu.

Who’s most vulnerable?

We know that COVID-19 is more deadly to older people and those with underlying health conditions, but we’re not sure why.

The WHO writes: “While we are still learning about how COVID-19 affects people, older persons and persons with pre-existing medical conditions appear to develop serious illness more often than others.”

Teenage and young adult deaths have been connected to the novel coronavirus, although those are exceptions. But we are not sure why some young and healthy people die from the virus, yet most have only mild symptoms.

How does the virus kill?

This seems to be more about how the infection sometimes becomes lethally dangerous.

Age and underlying health issues are two reasons, and certain scientists believe how much virus a person is exposed to during infection may affect the seriousness of the illness.

On top of this, genetics could be important to response - good or bad - but which genetic variants increase or decrease the risk remains a mystery.

Health care besides and beyond COVID-19

So here we are in the eye of the COVID-19 storm. However, other illnesses are still ongoing for many EU citizens, and a lot of our people are suffering due to resources being shifted.

In some countries, even chemotherapy has been suspended temporarily and, meanwhile, many patients are missing key appointments due to the practical difficulties of travel during lockdowns.

It is not just cancer patients, either. Many of those with diabetes, neural diseases, sight issues and more are also experiencing the thin end of the wedge at the moment. 

Coming up soon is the EU’s new health programme, which the Commission plans to present next month. EAPM will be closely following this, alongside our core partners and various MEPs in the European Parliament. We are also working with these multi-stakeholders on optimal/minimum testing.

During the Germany Presidency of the EU, which begins on 1 July, this will be a key area of focus. This is not least because a special task force of three of Germany’s cancer organisations have expressed concern that focusing on Covid-19 could put early diagnosis of cancer at risk.

Gerd Nettekoven, chairman of the Cancer Aid Foundation, has said: “In principle, oncological therapy in Germany during the COVID-19 pandemic has so far been secured and we have not seen any threatening supply shortages for cancer patients.”

But he went on to say that with the care system “noticeably stressed” the resulting restrictions “may have negative effects for cancer patients”. 

And Michael Baumann, who is Chairman of the Cancer Research Centre, said that “suspension of early detection and clarification measures can only be tolerated for a short period of time, otherwise tumours might only be detected at an advanced stage with a worse prognosis”. 

Latest on testing

Spain has said it is planning large-scale antibody testing for COVID-19 to try and figure out what percentage of the population has contracted the virus.

The country’s health ministry plans to work together with regional authorities to check 36,000 households, which should help to determine who, if anybody, has developed an immune response.

Over in the UK, 18,000 people are due to be hired to help with contact tracing, as part of its “test, track and trace” plans. Among several questions raised by scientists, however, is how under-the-cosh local public health systems will manage to support it all.

And finally, vaccines…

 Three European biotech companies (namely Italy’s ReiThera, Germany’s LEUKOCARE and Belgium’s Univercells) will cooperate to develop and manufacture a novel adenoviral vaccine against Covid-19, with clinical trials pencilled in for summer.

Any COVID-19 vaccine is, of course, going to be costly. Very. Some in the know suggest that the cost of developmentwill run into billions of euros. For example, the Coalition for Epidemic Preparedness Innovations has put the cost at $2 billion without manufacturing costs.

Will the EU pay? Who knows right now?

Meanwhile, the International Association of Mutual Benefit Societies wants any EU public funding for a vaccine be tied to accessibility clauses.

This is to make sure that citizens can can actually get their hands on it. 

“Intellectual property deserves a specific attention as they maintain prices high, which mechanically prevents access,” the Association says.

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