Hardly anyone alive today, especially in high- income countries, has ever seen anything quite like COVID-19, with its effects not only on our health but on our social lives and the economy. We were born after the 1918 H1N1 flu pandemic which infected over a third of the world’s population and killed 20–50 million; we were fortunate that H5N1 ’bird flu’ transmits so poorly from person to person; and we were lucky in 2009 that a new strain of H1N1 (so-called ‘swine flu’) caused only mild illness in humans.
But as we (and many film producers) have long known, there has always been the possibility of another virus arising that is easily caught and which causes serious disease and even death—and now we have one. Not flu this time, and not HIV or Ebola, but a corona virus—the kind of virus that can cause the common cold, but is also responsible for diseases like SARS (Severe Acute Respiratory Syndrome). If there is good news it is that COVID-19 is a less serious illness than SARS; the bad news is that the virus is transmitted much more readily, such that each newly infected person passes the disease on to 2.5 others. The significance of this is obvious, and we have all seen the exponential curve that, by lockdown and social isolation, we are trying to flatten.
But we can’t stay in lockdown for ever—how do we get out of this as quickly as we can, minimising deaths but also minimising the damage to our economy and to our mental health? The only way is science. Antiviral therapies and vaccines are being developed, but we don’t yet know how long this will take or how effective they’ll be. In the meantime we need data: first we need to know who is infected, because if you are infected you can pass the virus on. This involves analysing nose and throat swabs for genetic material from the virus. The technique scientists use, called the polymerase chain reaction, is well-established, but it is time-consuming and has to be done in a laboratory rather than at home. Three mega-labs have been set up to do the work, with equipment and reagents being provided by many university labs. And smaller institutions, like the Francis Crick Institute where I have my own lab, have also begun testing programmes.
We also need to know who has been infected in the past, and might therefore be immune to COVID-19, at least for a while. This assay, which detects antibodies to the virus, is harder to set up because it requires a more bespoke solution, but as soon as it becomes available (and it may be by the time you read this) it should be possible to do a test at home and get the result in 10–15 minutes.
With the two types of test results in hand we can use modelling approaches to work out how many of us might be immune to COVID-19 and how to limit the spread of the disease. There will be uncomfortable aspects to any exit strategy. We may need to impose intermittent lockdowns based on the ability of the health system to cope with subsequent waves of infection; we may need to use an app that will identify the contacts of any carriers who will then perforce be placed in isolation for two or three weeks. These approaches will be difficult, but in a country like the UK they will work. In poorer countries it will be another story, and the worst is yet to come in sub-Saharan Africa and South Asia.
But let me end on a positive note. I have been struck, throughout the pandemic, by the way scientists are working together. Researchers are dropping their normal projects to help with polymerase chain reaction tests, to donate equipment and reagents, to do epidemiological modelling, to test drugs old and new for their effect on COVID-19, to make sure their results are made accessible as quickly as possible, and, quite simply, to muck in wherever they might be useful. And others are playing their part too, running large-scale emergency programmes to train community health workers, keeping our transport system working, looking at how we can build a more sustainable future after COVID, and using 3D printing facilities to make face visors for health workers, to take just a few examples. It will take a long time to recover from COVID-19, but if we work together the world might be a better place.
Professor Sir Jim Smith, FRS, FMedSci, is Director of Science at the Wellcome Trust and Senior Group Leader at the Francis Crick Institute. This piece was first published in The Latymerian, the magazine of Prof Smith's old school, Latymer Upper School in London.