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COVID-19: Q&A on SARS-CoV-2, how it compares to previous coronavirus outbreaks and how hard it will be to develop vaccines and drugs

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Trine K. Tsouderos HRI Regulatory Center Leader, PwC US March 06, 2020

HRI spoke with virologist Vincent Racaniello, Higgins Professor of Microbiology and Immunology at Columbia University’s Department of Microbiology and Immunology, about SARS-CoV-2 and COVID-19. Racaniello also is the host of the long-running podcast devoted to viruses, “This Week in Virology,” which has been covering the emergence of SARS-CoV-2 and COVID-19.

Health Research Institute (HRI):

How is SARS-CoV-2 different from SARS-CoV or MERS-CoV, other coronaviruses that caused serious illness in people? Infection with SARS-CoV was first reported in 2003, but after 2004, according to the CDC, there have been no reports of SARS. MERS emerged in 2012, but after an initial flurry of cases, there haven’t been very many and they have stayed mostly contained within the Middle East. How is this different?

Vincent Racaniello, Higgins Professor of Microbiology and Immunology at Columbia University’s Department of Microbiology and Immunology:

The main difference is that with SARS, people got really sick. And these sick people tended to be hospitalized, and there the infection could be controlled. Peak virus shedding for SARS-CoV is at the peak of disease. So you’re not walking around, and that was why it was easier to contain SARS. There weren’t a lot of asymptomatic infections.

MERS-CoV continues to infect people in the Arabian peninsula, with the virus typically, but not always, coming from camels. The chains of human-to-human transmission are short, and eventually the virus stops transmitting until another camel-to-human transmission occurs.

With SARS-CoV-2, it’s different. Eighty percent of infected people are walking around. And that is why we are getting community spread.

HRI: How do we keep all of this in perspective when every new confirmed case is being reported in the media?

Vincent Racaniello: The fatality rate is 2% [Editor’s note: One day after HRI and Racaniello spoke, WHO reported that 3.4% of people with reported cases of COVID-19 have died]. But it could be that we are not diagnosing a lot of infections. The denominator is likely much bigger. Two percent to 3% is just not realistic. And it seems to depend on age. If you are younger than 60 years old, the rate, even as we know it, is less than 1%.

Over 80 [years old] skews the whole thing. Some countries like South Korea have had thousands of infections, but less than 1% have died. That tells us that quality of healthcare also plays a big role in how severe the disease is.

It’s important to keep this in perspective. We have had 15 million cases of the flu. These are huge numbers, but nobody is screaming pandemic.

With SARS-CoV-2, it’s different. Eighty percent of infected people are walking around. And that is why we are getting community spread.

HRI: Will it be very challenging to develop therapeutics to fight SARS-CoV-2?

Vincent Racaniello: No, it is not any harder than with any other virus, except they will have to work in [more restrictive Biosafety Level 3].

You can do some initial antiviral screening; that is quite easy. We should have been doing this, making broadly acting SARS inhibitors after the initial SARS outbreak in 2003. But then the disease went away.

HRI: How about creating a vaccine?

Racaniello: It’s pretty straightforward. There was an experimental MERS vaccine that had been used in camels. There was an effort to take from that and repurpose for this one. It should not be hard. There are a dozen or so companies working on this. It will just take time.

It has to be safe; some are doing phase 1 trials for safety; they are not even testing for efficacy yet. It will take a few months, and then you have to line up efficacy phase 2 trials. By then, of course, the virus could disappear. With Zika, we had lots of vaccine candidates and then Zika went away.

That said, it does appear this is a human virus that will be with us. Over time, we will have more population immunity. It will make it milder and inhibit transmission. So we won’t see the same outbreaks like we are now.

Unlike the influenza virus, which changes significantly over time, coronaviruses don’t. One vaccine could last 50 years.

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

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Senior Manager, Health Research Institute, PwC US

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Erin McCallister

Senior Manager, Health Research Institute, PwC US

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