We are in a battle the likes of which the world has not seen for a century. Over 36 million Americans – more than 1 in 10 people in the United States – have been infected with Covid-19 and over 200 million people worldwide. New and more infectious variants have brought U.S. infection rates to their second-highest levels of the pandemic.
To bring as many people as possible through this pandemic alive and healthy, it’s time to borrow from military thinking and deploy a defense-in-depth strategy. We need to prevent infections, treat the infected, and heal the bodies of patients suffering long-term effects.
The first line of defense should be prevention. Masks, lockdowns, and social distancing slow the spread of the virus. While social distancing did not extinguish Covid-19, it did buy valuable time for doctors and scientists to learn how to treat the symptoms of this new and deadly disease – and time to develop and deploy several vaccines that dramatically reduce mortality and infection rates.
The hard truth is that prevention alone isn’t enough. Reluctance to accept vaccines, eagerness to return to social contact, and variants that are more infectious than the original Covid-19 virus mean that many people continue to encounter the virus – and once it’s in your body, it’s too late to put on a mask or get a vaccine.
We need second and third lines of defense.
We believe modern medicine can do more to fill the gap in our Covid defenses – the days after infection, but before an ICU visit becomes necessary. Decades of research into how viruses infect and affect human cells point to several areas where we can and should find medications that interfere with Covid-19’s attack on the body.
Right now, the second line of defense is the human immune system, all on its own. Patients who test positive for Covid-19 are instructed to self-isolate while they tough out the disease at home. Those with mild cases remain infectious for about 10 days after the onset of symptoms and have detectable viral loads in their gastrointestinal tracts for 25-30 days. Those with severe cases seek hospital care, where they compete for scarce ICU beds. Heroic efforts by healthcare professionals have helped improve treatments marginally over time – pronation, remdesivir, high-flow oxygenation and monoclonal antibodies improve survival rates among severe cases.
We believe affordable, abundant antiviral treatments would open an important new front in the battle against Covid-19. We should fight Covid inside every infected person.
Ideally, a Covid treatment would be made available to every patient who tests positive, similar to the way bacterial infections are treated with a short course of antibiotics. Reducing the viral load inside each Covid-19 patient would give each individual patient a better chance of survival. Reducing the severity and duration of infection would reduce the potential for transmission to others. Research to provide treatments meeting this description should be streamlined and prioritized.
Every Covid-19 case is a threat, not just to the infected individual, but also as the source of new Covid variants. Each time the virus copies itself, there is a small chance an error in the process will produce a variant copy, with new traits and characteristics. Many of these variants will be weak or equivalent to existing Covid-19 strains. Yet the risk remains that more infectious, more deadly variants will emerge. It is also possible that variants will evade or bypass antibodies from past infections or vaccinations. Either of these possibilities would be a dramatic setback for the fight to eradicate Covid-19 – and as millions of infected patients produce billions of copies of the virus, small probabilities add up. Given enough chances, it is all but inevitable that more infectious, more deadly, breakthrough variants will emerge.
Antiviral treatments would help deny the virus opportunities to undergo these mutations by reducing both the number of patients and the number of viral replications within each patient.
Perhaps more importantly, an antiviral treatment approach offers a more stable defense in the face of future variants. Vaccinations work by teaching the human immune system to recognize proteins on the surface of viruses. That recognition depends on the virus staying the same. Changes to the virus could change the shape of these proteins and make it unrecognizable -- meaning vaccinations may lose efficacy as new variants emerge. Booster vaccinations responding to new variants may help, but will tend to be a reactive measure, lagging behind many variants. variants.
Antiviral treatments instead focus on the human biological processes that the virus uses to reproduce itself. Viruses enter human cells and hijack their equipment – something like a burglar who breaks into a business to use their photocopier and steal their shipping labels. By analogy, vaccines teach the body to recognize the burglar, while antiviral treatments reinforce the doors and windows, slows down the photocopier and limits the number of shipping labels. While this analogy is imperfect, the important point is that the processes targeted in antiviral treatments are parts of the business, not the burglar. The known, stable parts of human biology targeted by antiviral treatments are less susceptible to abrupt changes as new variants emerge.
The third line of defense needed is for the battle’s walking wounded – the patients suffering from Long Covid.
Large-scale studies suggest a quarter of those who survived their fight with the disease will suffer lingering symptoms – implying nine million Americans are already affected. Pain, difficulty breathing, hyperlipidemia, malaise and fatigue, and hypertension are the most common symptoms.
Patients with severe cases are most at risk – 50 percent of those hospitalized by Covid-19 report Long Covid symptoms. In the 30 days after dismissal from hospitals, these patients are 46 times more likely to die than patients not hospitalized.
Patients who had asymptomatic cases are not exempt – roughly 19 percent of asymptomatic cases experience Long Covid symptoms. We don't yet know whether breakthrough cases – patients who contract the virus despite prior vaccination – will see similar rates of Long Covid.
We have every reason to believe that millions of Americans survived their fight with Covid, only to find that fight was not over. Even as businesses and restaurants reopen, many Long Covid patients find it difficult or impossible to return to life as usual. As Covid variants continue driving new infections, the number of Americans suffering long-term ill effects will rise.
Despite the clear, foreseeable threat to the ongoing health of millions of citizens, the United States lacks an organized national response to Long Covid. Our understanding of the prevalence, characteristics, and physiological roots of Long Covid symptoms remains fragmented. There is no central body to coordinate or fund researchers who hope to heal those afflicted, ease the suffering of those we cannot cure, or provide protection to current and future Covid patients.
The Biden Administration can and should act immediately to fill this coordination gap. The United States should convene a commission to study Long Covid, share information, and appropriately plan for the long-term burden that Long Covid will put on these patients and their healthcare providers.
Building a defense-in-depth strategy to fight the Covid-19 virus and its variants before, during and after each invasion of a human host is the right way to reduce the duration and the human impact of the pandemic. Prevention measures – masks, distancing, and vaccines – deny the virus the opportunity to spread. Antiviral treatments now under development would help individuals heal faster, reduce transmission, and reduce the opportunities for mutation. And coordinated focus on Long Covid impacts would improve the odds that any individual infected with Covid can return to a normal, healthy life.
Together, these efforts will bring forward the day when Covid patients no longer fill ICU beds, and social lives no longer inspire fears of deadly or crippling infection.
You can see here our 10-part plan to disrupt the pandemic within 180 days.
Chris Galliano is the CTO of Skymount Medical Group. He combines invention and social ethics with technical analytical thinking, communication, and teamwork. Chris is the former Executive Officer of Space and Naval Warfare Systems and has 20 years of experience in architecting complex enterprise systems.
Dr. Kishor M. Wasan has published over 240 peer-reviewed articles and 280 abstracts in the area of lipid-based drug delivery and lipoprotein-drug interactions. He has won many prestigious awards and is a fellow of the American Association of Pharmaceutical Scientists and the Canadian Academy of Health Sciences. Most recently, Dr. Wasan served as the Dean of the College of Pharmacy and Nutrition at the University of Saskatchewan from August 2014 to June 2019.