Welcome Note: -
Welcome old and new subscribers. This is the new version of the health and life-science policy newsletter started by Shambhavi Naik. We have new contributors on board. They are Priyal Lyncia D’Almeida, Harshit Kukreja, and Ruturaj Gowaikar. We will also be expanding our coverage to include Health systems and climate & environmental issues as well.
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Frozen Fever
-Ruturaj Gowaikar @RuturajGowaikar
The world is amidst a pandemic caused by a virus whose origins are zoonotic in nature. It is not the first time that pathogens have crossed the species barrier leading to new diseases. Ebola, AIDS, swine flu, anthrax are some of the examples of viral pathogens, present for millions of years in animals, infecting humans leading to novel diseases.
The reasons these diseases crossed the species barrier and spread rapidly range from domestication of wild animals in human history, increased interaction between regions of the world historically isolated from major population centres, to increase in human population in general and high levels of urbanization. Various governments and intergovernmental organisations have set up Pandemic/ Epidemic intelligence hubs after the emergence of Sars-CoV 2. These hubs are meant to detect emerging infectious diseases beforehand, and model disease spread to help contain such infections.
There is another potential source of novel infectious diseases, viruses frozen in the permafrost of the poles and glaciers of the world. Global warming related accelerated melting of these frozen masses of water can potentially lead to release of the viruses and lead to novel diseases of humans, animals, or even plants and crops.
Two areas of concern come to mind where human activity or settlements are close to melting permafrost or glaciers. These are the Arctic permafrost and Himalayan glaciers. Novel as well as known viruses (anthrax and smallpox) are thought to be trapped in the Arctic permafrost. There have been outbreaks of viral infections in the Arctic over the past few years. This adds another dimension to the effects of global warming. The 2016 anthrax outbreak that killed 200,000 reindeer and one human in Siberia has been linked to perma-frost melting. The outbreak of skin lesions caused by a newly discovered Orthopoxvirus called Alaskapox in Alaska is also being linked to melting permafrost in that area.
Along with viruses, heavy metals, especially mercury is known to be trapped in the permafrost. Leaching of such heavy metals might also lead to human health issues through either direct contact or through bio-accumulation via sea-food.
The European Union (EU) published a document in October 2021 called “A stronger EU engagement for a peaceful, sustainable and prosperous Arctic” . This document talks about the implication of melting Arctic permafrost on geopolitics, biosecurity, digital connectivity, energy and critical mineral supply security etc. But what stands out is the specific focus on the threat of novel infectious diseases. India being a member of the Arctic Council with two field research stations in the regions should take active interest in the bio-security aspect of this document. The lessons learned in this region can be applied closer home to melting himalayan glaciers.
The himalayan glaciers are melting due to global warming. Moreover, 33 viruses were discovered in Tibetan glaciers out of which 28 were novel! Tibetan glaciers feed major river systems. In the Indian subcontinent major population centres and agricultural areas are along these river systems. A novel disease outbreak in this part of India will have a long lasting impact.
India should invest in projects similar to pandemic/epidemic intelligence hubs, disease modelling and add emergence of novel diseases to its climate and meteorological research as well.
A Possible key to abortive infections in COVID 19 ?
-Harshit Kukreja @harshitk43
A recently published study in Nature points out a protein that can offer possible clues to how certain people can abort the COVID 19 virus before sero-conversation. In simpler words, it means that the T cells clear COVID 19 infection before clinical manifestations (subclinical infections) appear.
This study will help us understand COVID 19 and the body's immune response to the virus better. Only an initial partial manuscript of the study has been published.
The Study
The study included 60 Health Care workers in England who were monitored weekly by RT-PCR every week for 16 weeks. Out of 60, 20 had T cells that had multiplied, a possible indicator that the body's immune system is preparing for infection. 19 of these also had increased levels of interferon alpha-inducible protein 27(IFI27) which is a part of a group of small proteins that play key roles in host antiviral adaptive immunity. (Adaptive immunity is the immunity the body acquires over time)
The authors of the study propose that IFI27 might be an early marker of SARS-CoV-2 infection. They also suggest that this data is evidence for what they call "abortive infections" ("meaning that the virus made an incursion into the body but failed to take hold"). These 60 people didn't become seropositive despite being known for likely exposures.
The study finds no direct causal link between the discussed interferons and "abortive infections". The authors failed to specify how all healthcare workers taking adequate precautions against the spread of infection are considered to be fully exposed. They also use other pre-pandemic London and Singapore cohorts which may show confounding errors. There is also a question of the small size of the cohort.
Why is it important?
The study can point to better points of therapeutic intervention and help us manage the virus better. It can also lead to helping develop prophylactic measures to stop clinical infections from developing. Interferons are already used to treat various cancers such as leukaemia, melanoma, AIDS-related Kaposi's sarcoma and virus infection such as Hepatitis B and C.
Read More:
1. https://www.nature.com/articles/d41586-021-03110-4
2. https://www.nature.com/articles/d41586-021-03110-4
COVID-19 pills: A game-changer?
-Priyal Lyncia D’Almeida @LynciaPriyal
Merck & Co Inc. and Pfizer have recently developed antiviral oral medicines for COVID-19. These pills have shown promising results when tested on individuals with COVID-19 that are at a higher risk of serious illness. Over the last year, the COVID-19 vaccinations have been the main topic of discussion. On November 5th, Pfizer released results demonstrating that when delivered within three days of infection, its COVID-19 pill, called Paxlovid, reduced hospitalisation and mortality by 89% in non-hospitalised, high-risk individuals that were infected by COVID-19. Although this is only an interim analysis, the findings of this study were so promising that an independent oversight committee suggested that the company submit its data directly to the Food and Drug Administration (FDA) in the hopes of obtaining authorisation for emergency use as early as possible.
However, a month earlier on October 11th, 2021, Merck and Ridgeback also published results on their own investigational antiviral pill named Molnupiravir and submitted their data to the FDA. The interim analysis of the Phase 3 study showed that Molnupiravir decreased the risk of hospitalisation or death by approximately 50% in comparison to mild or moderated COVID-19 patients administered with placebo. On November 5th, 2021 the United Kingdom became the first country to approve Molnupiravir for the treatment of mild to moderate COVID-19 infection.
Merck and Pfizer's oral antivirals appear promising in conjunction with other therapeutic alternatives such as monoclonal alternatives and the COVID-19 vaccinations. At the moment, there is no simple treatment for COVID-19 infections and these pills could potentially fill that void, thus relieving the burden on patients and an even more overburdened healthcare system. Pfizer and Merck have both indicated that the pills were tolerated by individuals enrolled in the trial and had very few side effects. However, both medications have characteristics that may limit who can use them.
Despite the effectiveness of the drugs that have been demonstrated in the initial studies, we need to address some of the concerns regarding these pills. One of the concerns is that theoretically, we know these medications should work against all the known COVID-19 variations including the Delta variant which is highly transmissible. Although the targets of the two antivirals are very different, investigators still have to demonstrate that these pills function against these variations. Studies by Merck show that Molnupiravir is effective against the delta variant and other variations including the gamma and the mu variations. Concerns regarding the possibility of these drugs resulting in the emergence of vaccine-resistant COVID-19 mutations are also being raised. Another concern is also if the drugs could potentially lead to off-target effects. Although the drug is designed to interact exclusively with the virus's genetic material, there needs to be a thorough consideration on what could happen if it mistakenly interferes with human genetic material as well.
Currently, FDA is reviewing the data submitted by the companies and the decision will soon be out. However, the decision on approval should be made by weighing the benefits and the potential risks associated with the pill and not being pushed in hurry. If the pills get approval, they could potentially be a game-changer in our fight against the COVID-19 pandemic and could be instrumental in decreasing the overburdened healthcare system. However, we will have to wait for the FDA's decision and find out.