WHO Experts Urge Caution In Use of Antibody Tests To Determine COVID-19 Exit Strategies; Evidence Points Against Herd Immunity Disease Surveillance 17/04/2020 • Elaine Ruth Fletcher Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Microbiologist Kerry Pollard performs a manual extraction of the coronavirus inside the extraction lab at the Pennsylvania Department of Health Bureau of Laboratories on Friday, March 6, 2020. World Health Organization experts are urging countries to use caution when determining whether to use large scale serological testing as part of their exit strategies from lockdowns. Serological testing identifies whether a person’s blood has antibodies for SARS-CoV-2, the virus that causes COVID-19, indicating that they were exposed to the virus at some point and recovered – if they are not carrying the virus itself at that point. However, “nobody is sure whether someone with antibodies is fully protected against having the disease or being exposed [again],” Maria Van Kerkhove, WHO’s Technical Lead on the COVID-19 crisis told reporters in a Friday WHO briefing. In addition, only a comparatively low proportion of the population may have so far acquired the antibodies. And that means the potential of “herd immunity” to purportedly provide a crude shield of protection for others who have not been exposed, may be weak or non-existent, the WHO experts warned. “There’s been an expectation, maybe that herd immunity may have been achieved and that the majority of people in society may already have developed antibodies,” said WHO’s Emergencies Head, Mike Ryan. “[But] a lot of the preliminary information that’s coming to us right now, will suggest a quite a low proportion of the population have actually sero-converted [with antibodies that can fight the virus]. “I think the general evidence is pointing towards a much lower prevalence so may not solve the problem that governments are trying to solve. And then thirdly, there are serious ethical issues around the use of such an approach, and we need to address it very carefully,” Ryan added. The ethical issues arise because herd immunity is a crude protective tool, which is generally only effective if a large majority of a country’s population has lived through the disease, experts say. And in the case of COVID-19, that would mean accepting the very high death rates that are occurring among older people and those with chronic conditions who fall ill. Added Van Kerkhove, “We also need to look at the length of protection that antibodies might give. Nobody is sure whether someone with antibodies is fully protected against having the disease or being exposed.” Some of the tests also are not sensitive enough and may yield false positives she said, giving people the impression that “they’re sero-positive and protected,” where in fact they may be susceptible to disease, added Van Kerkhove. But the rapid development of serological tests just a few months into the pandemic is “a good thing,” added Van Kerkhove. However with the number of new tests flooding the market, “we need to ensure that they are validated,” she said. New guidance from WHO on the use of serological tests will be released this weekend, according to Van Kerkhove, speaking at WHO’s Friday briefing on the COVID-19 emergency. “I think what we do have is advice for countries to be very prudent at this point,” said Ryan. “And number one, we need to be sure that tests would be used to establish the status of an individual, and there’s lots of uncertainty around what sort of what such a test would be and how effective and how well performing that test would need to be.” Many countries and companies are already looking towards the emergency use of serological tests, including Switzerland, the United Kingdom, Chile, and the US. Roche, the Swiss pharma giant, was the latest biomedical powerhouse to announce they were developing a COVID-19 antibody test, with the aim to roll it out in May. (left-right) Mike Ryan, Dr Tedros, and Maria Van Kerkhove sitting 2 metres apart at the regular WHO COVID-19 Press Briefing UN AIDS Calls For Dramatic Scale-Up of Healthcare Spending As COVID-19 Response Meanwhile, the Executive Director of UNAIDS called for governments to “invest in universal social protection,” and dramatically scale up healthcare spending in response to the COVID-19 emergency. It was the first major statement by the organization on the health emergency. “COVID-19 is killing people. However, the scale and the consequences of the pandemic are man-made,” said Winnie Byanyima, UNAIDS Executive Director, speaking at an event Thursday cosponsored by the Global Development Policy Center and the UN Conference on Trade and Development. Winnie Byanyima Byanyima also drew attention to the economic fallout of the COVID-19 crisis, warning that the poorest populations, facing a triple threat of COVID-19, loss of livelihoods, and climate crises, are those likely to be hardest hit by the crisis. “COVID-19 is expected to wipe out the equivalent of 195 million full-time jobs,” said Byanyima. In a related development, Gavi- The Vaccine Alliance, was awarded a US$ 30 million grant by Netflix magnate Reed Hastings to support the organization’s ongoing vaccine work, in the shadow of COVID-19. “Global immunisation is vital to ending this terrible pandemic and Gavi’s hard-fought gains in this area will help prevent more lost lives and livelihoods,” said Hastings in a press release, about the donation by the Reed Hastings and Patty Quillin Foundation, named after him and his wife. “We hope that our contribution will help those most in need, but also to inspire other businesses, entrepreneurs and organizations to join in this urgent effort.” The support comes at a particularly significant moment, since over the past week, humanitarian aid groups as well as African health leaders have expressed concerns that other vital disease control activities, including immunizations could be harmed, by the recent suspension of funds by US President Donald Trump to the World Health Organization. The donation is the first private sector contribution towards Gavi’s Sixth Replenishment drive, which aims to raise at least US$ 7.4 billion in 2020 to immunise 300 million children and save 8 million lives over the coming five years. European Union Submits WHA Draft Resolution Supporting COVID-19 Intellectual Property Pool While so far no vaccine exists for COVID-19, the debate over how to ensure equitable access to any new therapy continued to accelerate, following the European Union’s publication Wednesday of a Draft World Health Assembly Resolution calling for a global intellectual property pool of COVID-19 drugs, vaccines and diagnostics. The European Union proposal calls on WHA member states to explicitly support the creation of a voluntary pool of intellectual property rights for COVID-19 technologies. If adopted, the proposal would pave the way for WHO to actively coordinate such an activity along with the UN-supported Medicines Patent Pool. The 74th WHA is scheduled to meet May 17-23, although there has been no announcement so far of whether the meeting might be held virtually or be delayed, due to the continuing lockdown measures in Switzerland, which has had some 25,000 reported cases so far. In an op-ed published this week in The Lancet, two lead negotiators of last year’s landmark World Health Assembly resolution to increase drug and R&D cost transparency, Luca Li Bassi and Lenias Hwenda, came out in support of the EU call. The call was first launched by the Costa Rica government in an open letter to WHO Director General Dr Tedros Adhanom Ghebreyesus in late March. “We urge Member States who adopted the World Health Assembly 72 Resolution on “Improving the transparency of markets for medicines, vaccines, and other health products” to formally support the request from Costa Rica’s Government,” wrote Li Bassi, former director of the Italian Pharma Agency and lead negotiator of the 73rd World Health Assembly “transparency resolution”, and Hwenda, chief executive officer of Medicines for Africa, in their comment. The EU draft resolution called for international actors, NGOs, and private industry, to “work collaboratively at international level to develop, test and produce safe, effective, quality diagnostics, medicines and vaccines for the COVID-19 response, and to facilitate the equitable and affordable access of people to them, including through voluntarily pooling their intellectual property for all COVID-19-related medical interventions.” The EU move came just a week after World Health Organization Director General Dr Tedros Adhanom Ghebreyesus himself welcomed the initiative to pool IP rights for COVID-19 diagnostics, vaccines, treatments, and data, along with the Medicines Patent Pool. Rights holders would submit patents and other rights voluntarily to the new COVID-19 pool, which can then license those rights to other manufacturers to increase access to research, data, and blueprints needed to ramp up production of COVID-19 technologies. Still, more steps must be taken to “make sure that the resolution adequately reflects the Costa Rica proposal, which has already been endorsed by a number of Member States, including the Netherlands,” Jaume Vidal, senior policy advisor at Health Action International told Health Policy Watch. “That means a COVID-19 technology pool hosted and managed by WHO based on non-exclusive – and not geographically limited – licensing.” Still, the move is “a welcome first step by the European Union to achieve a collective solution, within a multilateral framework, to a global pandemic,” said Vidal. World’s Largest COVID-19 Drug Trial Set To Begin in the UK Meanwhile, the UK was set to launch the largest ever randomized controlled trial that aims to systematically compare several of the leading COVID-19 therapies to see how well they perform. Those therapies will include a hydroxychloroquine + azithromycin combination that showed initial results in a French trial; a combination of two antiretroviral drugs used in HIV treatment, lopinavir-ritonavir; and low-dose dexamethasone, a type of steroid used in a range of conditions, typically to reduce inflammation. The so-called RECOVERY trial, which has been set up in the United Kingdom at unprecedented speed, has recruited over 5,000 patients from 165 National Health Service hospitals in a month, and is hoping to have initial results as early as June. However, Peter Horby, professor of emerging infectious diseases and global health at Oxford University, who is leading the trial, warned that there is “no magic bullet” for COVID-19. As for hydroxycholoroquine, which has even been touted by political leaders such as Trump, Hornby stressed, “There is in-vitro evidence that it is inhibitory against the virus [in the lab]. But I haven’t seen any sound clinical data.” Other drugs will be added to the trial later. Enrollment in the trial has been offered to adult in-patients who have tested positive for COVID-19 in NHS hospitals, and who have not been excluded for medical reasons. Patients joining the trial will be allocated at random by computer to receive either lopinavir-ritonavir or dexamethasone, or no additional medication. This will enable researchers to see whether any of the possible new treatments are more or less effective than those currently used for patients with COVID-19. Global COVID-19 Death Toll Increases as China Revises Figures For Wuhan – Has Implications for Mortality Rate Estimates Globally In China, officials announced a revised death toll from COVID-19 in the original virus epicenter of Wuhan, adding 1290 more deaths to the tally – for a total of 3,689 in Wuhan and 4,636 in China as a whole. The revisions have implications for COVID-19 death toll estimates more broadly, insofar as worldwide baseline mortality estimates, which have hovered around 3.4%, according to WHO, were largely based on Chinese data, which had the largest proportion of cases so far, where the disease also ran its term. More recently, however, death rates in some countries, such as Italy, soared as high as about 10%, while they have been below .02% in other countries that took measures early, such as Norway, New Zealand, Iceland, and Israel. Experts have underlined that death rates are influenced not only by population age, but also quality of hospital care that seriously ill people receive, and reporting patterns. The changing figures are likely to further fuel the fires of criticism over China’s reporting on the pandemic. While US President Donald Trump has been the most outspoken, lashing into the WHO in particular over being “China-centric” other western leaders have also now chimed in with criticism leveled directly against China for downplaying or covering up the virus emergence in the early stages, losing valuable time and laying the groundwork for its widespread circulation in China and ultimately globally. On Thursday, Dominic Raab, the foreign secretary of the United Kingdom said that there would be “hard questions” for China on handling the crisis, as did French president Emmanuel Macron, who criticised the lack of transparency in data. Their comments came after a damning Associated Press report that stated China sat on important information about the virus spread for six days between January 14-20. According to notices on Chinese University websites, schools have received instructions that “papers related to virus tracing should be managed strictly,” and must be reviewed by the college’s own academic committee, and submitted to the National Academy of Sciences before submitting for publication in formal academic journals. Scientists largely believe that the virus first originated in bats, then passed to humans through an intermediate host, potentially through a pangolin, an animal that may have been illegally traded at a Wuhan wet market. As China clamps down on research over the virus origins, debate is growing around the theory that it may have first infected humans in a Wuhan virology lab situated close to the wet market. To a certain extent, these previously unaccounted-for deaths can also be attributed to a focus on treating cases rather than reporting deaths during the early stages of the pandemic, as well as many people dying at home and delays in data collection from various sources. In addition, authorities have also bounced back and forth in terms of how they counted confirmed cases. Total cases of COVID-19 as of 17 April 2020, with active case distribution globally. Numbers change rapidly. Nordic Countries and New Zealand Join Chorus Decrying US Move to Suspend Aid To WHO Despite the new criticisms being leveled against China, international opinion continued to run strong against the recent US decision to suspend aid to the WHO ostensibly for being too pro-Beijing. The latest statements came from a group of five Nordic countries and New Zealand’s former prime minister, Helen Clark. “We as Nordic ministers for development cooperation are convinced that the work of WHO is essential during these critical times. Evaluation of their work will come later. Now is time for more international cooperation and solidarity – not less,” said the statement on behalf of Finland, Denmark, Sweden, Norway and Iceland, in a tweet posted by Norweigian Minister of International Development, Dag Inge Ulstein. “The decision of the US government to defund WHO is disastrous,” Clark tweeted. “WHO is working to turn the tide on COVID-19; it is not responsible for a President ignoring advice which could have seen a fast USA response & saved thousands of lives. This is no time for a blame game.” The decision has already been roundly criticized by other global leaders and heads of state including: UN Secretary General Antonio Guterres, European Commission Vice-President Josep Fontelles, and billionaire health philanthropist Bill Gates. US President Donald Trump announced on Tuesday the country was putting a halt on funding while the administration conducted an investigation into WHO’s handling of the coronavirus crisis, criticising the organization for alleged missteps in the early days of the pandemic. The WHO Staff Association released a letter to Dr Tedros on Thursday supporting the WHO’s pandemic response in light of the suspension of US funding to the organization. “We regret that our Organization has been the target of unhelpful verbal attacks and threats, while we are in the midst of this health crisis,” said WHO headquarters personnel in a heartfelt letter. “WHO HQ’s personnel wish to join with individuals and other organizations around the world, in expressing our full support to our colleagues working tirelessly on the frontlines of this pandemic, and to you, Dr Tedros. “This pandemic has shown us that rapid transformational change and remarkable international collaboration are possible… We stand by your statements that this is the moment for all of us to rise to the challenge of collaborative leadership.” Trump Unveils Plan For Phased Reopening Amidst Concerns About Insufficient Federal Support For Critical Testing; Bolsonaro Replaces Health Minister President Donald Trump issued broad federal guidelines outlining the reopening of the country on Thursday April 16. The 18-page document, titled “Opening Up America Again” lays out a three-phase approach to relaxing social distancing measures, depending on the trends in new cases and new deaths. The Trump guidance comes even as states such as New York extend the shutdown of non-essential businesses to 15 May, and issue rules for wearing masks in public. Ultimately, the power to reopen rests in state governors’ hands. Health officials have stressed the need for increased testing before Americans can safely return to work — following reports that the federal government will curtail funding for coronavirus testing sites. State officials have expressed that states will not be able to ramp up testing without federal support. Democratic House and Senate members have also urged him to wait for testing to become more widespread before announcing measures for reopening the economy, as has the Infectious Diseases Society of America. The United States has the highest number of confirmed COVID-19 cases and deaths globally, with over 650,000 confirmed cases and 33,288 deaths. Brazilian president Jair Bolsonaro removed health minister Luiz Henrique Mandetta from his position on Thursday. The President has received widespread criticism for repeatedly dismissing the severity of the coronavirus pandemic, calling it “just a little cold” and making highly publicized visits to crowded public spaces without protective gear, Mandetta, who has been at odds with the president’s views, has advocated for large-scale social distancing measures and quarantines. On the day he stated that the worst of the pandemic was yet to hit Brazil, Bolsonaro told religious leaders, “this issue seems to be going away”, thus creating confusion for people over who to listen to. However in a recent survey, some 76% of respondents were in favour of the health minister’s response to the pandemic, and less than 30% trusted the president’s approach. Mandetta’s replacement Nelson Teich, an oncologist and healthcare executive, shares similar views in recently published articles, where he too endorses scientific social-distancing and isolation measures.Brazil currently records more than 30,000 confirmed cases with almost 2,000 deaths although Edmar Santos, Health Secretary for Rio de Janeiro, estimated that the real case count was much higher due to under-testing. Gauri Saxena and Grace Ren contributed to this story Image Credits: Twitter: @WHO. Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. 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