COVID-19: Facing the Challenges Ahead

“COVID-19 is more than just the common cold. It represents a perpetual challenge for which we have to be perpetually prepared,” stated Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAD), in his keynote lecture at the July 2020 AACR virtual meeting on COVID-19 and cancer. Dr Fauci has been Director of NIAD for 36 years.

“Dr Fauci’s impact goes beyond the medical field. His combination of scholarship, leadership, and his tireless work ethic have established him as a beacon of knowledge and truth,” stated AACR President-Elect David A. Tuveson, MD, PhD, FAACR, Director, Cold Spring Harbor Laboratory Cancer Center, NY.

Coronaviruses were thought to be responsible for the common cold, but were later identified as the cause of 3 pandemics—SARS-I (severe acute respiratory syndrome) in 2003, MERS in 2013, and the current SARS-Cov2 (or COVID-19) in 2020. In all 3 pandemics, the coronavirus originated in bats. SARS-I was passed from a bat to a civet cat to humans, and MERS was passed from a bat to a camel to humans.

SARS-I was eliminated purely by public health measures, not by drugs or vaccines, Dr Fauci said. MERS was mainly well-controlled, but cases continue to smolder in Saudi Arabia, he noted. According to the Centers for Disease Control and Prevention, since 2004, there have been no reported cases of SARS in the United States.

Many Questions Remain Unanswered

Although SARS-Cov2, the cause of COVID-19 disease, is phylogenetically close to SARS-I, it is distinguished by being far more contagious, Dr Fauci said. At the time of his keynote lecture, COVID-19 accounted for almost 14 million cases globally and 583,000 deaths, “with no end in sight,” he noted.

More has become known about the novel coronavirus as the pandemic continues to rage, but there are still many questions that remain unanswered.

For example, the primary route of the novel coronavirus’s transmission is respiratory from person to person, and transmission occurs in enclosed spaces where people are in close contact.

More recently, however, Dr Fauci explained, “there is also considerable interest in aerosol transmission, which would have an impact on spread closer than the 3 feet to 6 feet for respiratory transmission.” It is not known if infected animals can transmit COVID-19 disease.

Flulike symptoms are the hallmark of the novel coronavirus, but the virus can have unusual manifestations, including loss of taste and smell, gastrointestinal disturbances, thromboembolism, a syndrome in children resembling Kawasaki disease, as well as various other symptoms.

Wide Spectrum of Disease

“Of all the viruses I have dealt with, I am impressed by the extraordinarily wide spectrum of disease ranging from asymptomatic to mild [in bed for a few days], more severe [in bed for a few weeks with postviral syndromes], to hospitalization and intensive care, need for ventilation, and death,” Dr Fauci said.

He emphasized that an estimated 25% to 40% of COVID-19–infected individuals are asymptomatic, but the impact of false-positive test results on this finding is not known. The vast majority of cases of COVID-19 are mild to moderate, whereas approximately 14% of cases are severe and approximately 5% are critical.

“The case fatality rate is 2.3%, but this is likely below 1% if you account for the high percentage of asymptomatic infected individuals,” Dr Fauci pointed out.

Older adults and people of any age with underlying comorbidities are at highest risk for COVID-19 infection. Male patients are more likely than female patients to die from COVID-19. It is well-known that COVID-19 disproportionately affects the hospitalization and death rates of minorities in the United States.

Impact on Cancer-Related Deaths

One important aspect of the intersection between COVID-19 and cancer is the number of delayed screenings for common cancer. One study estimates that there will be in excess of 10,000 deaths that result from breast and colorectal cancers in patients who delayed screening or who had no screening at all.

The reliability and availability of COVID-19 tests have been called into question in numerous reports. Testing for the virus includes molecular tests using genetic material, antigen tests to detect proteins from the coronavirus (a more recent test), and antibody tests to detect proteins in blood made in response to infection with the virus.

Current evidence supports the use of remdesivir and dexamethasone for the treatment of COVID-19. There are more than 1000 studies of potential therapies for the virus, including broad-spectrum antiviral drugs, convalescent plasma, repurposed drugs, anti-inflammatory agents, host modifiers, immune-based therapies, and monoclonal antibodies.

For useful information, a regularly updated document that includes COVID-19 treatment guidelines is available at www.Covid19treatmentguidelines.nih.gov.

Vaccine Candidates in Clinical Trials

A number of vaccines that fall into 1 of 3 main vaccine platforms are under investigation, including a messenger RNA (mRNA)-based approach (Moderna, Biotech/Pfizer); adenovirus vector vaccines (Oxford University/AstraZeneca, Janssen, Merck); and protein subunit vaccines (Novavax, GSK Sanofi).

Phase 1 and phase 2 clinical trials assessing several of these therapies have been completed. The mRNA-1273 vaccine entered phase 3 clinical trials at the end of July, and the other vaccines have also embarked on clinical trials.

Various reports of a potential vaccine before the coming elections have stirred controversy and debates among politicians and scientists.

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