inFOCUS: Pandemic pushes medical milestones, advancements to new heights

inFOCUS

MARYLAND (WDVM) — In early 2020, many of us started to hear reports of a virus thousands of miles away described as SARS-CoV-2, or the novel coronavirus, that caused a disease called COVID-19.

It was the first we had all heard of it, but experts already had their eyes on the virus several months before the rest of us. Some of those experts are right here in our backyard, at Johns Hopkins Medicine based in Baltimore.

WDVM’s Randi Bass spoke one-one with Dr. Brian Garibaldi, head of the Johns Hopkins Biocontainment Unit.

“We became aware of the possibility that this was coming back in December of 2019. We had to make sure that our health system was ready and we had to make sure that our supply chains were in place,” said Dr. Garibaldi. “We needed to make sure our surge capacity was there to take care of patients in different levels of isolation.”

“From a practical standpoint, we needed to learn how this virus was transmitted. Could people who were asymptomatic spread the disease? And at first, we didn’t know that,” said Dr. Garibaldi of the early days of the COVID-19 pandemic response.

In the past, the Biocontainment Unit, or BCU, worked to understand and contain some of the world’s most devastating and notorious illnesses, including SARS, Ebola, and smallpox.

Dr. Garibaldi explained how tracking the spread of this new coronavirus was different than tracking viruses and infections we had seen before.

“People were not spreading SARS until they became infectious. So, you could use traditional contact tracing and recognize, ‘This person has a cough. They were in touch with someone else. They probably have it. Let’s isolate them; let’s break that chain of transmission.’ Obviously, now we understand with SARS-CoV-2, a large percentage of infections are transmitted by asymptomatic people, which makes it a lot harder to stop new transmission chains,” said Dr. Garibaldi.

Asymptomatic transmission of the virus wasn’t completely understood by experts or the general public until later in the spring of 2020. Unfortunately, for some people, those discoveries came too late.

“It’s been an unbelievable toll on nursing home patients, [making up] about a third of the deaths [from the virus] in our country. We learned very quickly there were vulnerable subsets of our population who were likely to get ill and to die,” said Dr. Garibaldi.

Discoveries on how the virus was transmitted influenced public health decisions and guidelines, like limited visitation at nursing homes, mask mandates, capacity limits, and social distancing requirements. The need to stop the spread fueled what would become Operation Warp Speed, a federal partnership with private companies to fast-track the development and rollout of a vaccine for COVID-19.

“Everyone talks about mRNA vaccines as being new, but, the technology’s been there for over a decade. Whether or not you could develop a robust immune response to this virus was unknown. Usually, these vaccines are not being developed in response to one of the greatest health crises we’ve seen in a century. I think the speed at which these things were developed and rolled out was proportionate to the need and the urgency,” said Dr. Garibaldi.

When asked about the current stage of the vaccine rollout and how quickly multiple vaccines materialized, Dr. Garibaldi said, “I don’t think there are many people who really believed we would be at this point in a year. We initially said we’d be happy with one vaccine that was 50 percent effective. We now have three that are over 70 percent effective, with two in the 90s.”

While those vaccines were still in development, the medical community tried to focus on how it could use existing drugs to reduce the severity of COVID-19 illness and improve patient outcomes. Though findings appear to be promising at this point, doctors are still studying the use of drugs like Remdesivir, dexamethasone, and Tocilizumab in COVID-19 patients.

As for other approaches to preventing severe illness, convalescent plasma transfusions and antibody cocktails are making headlines.

“[After you have been sick,] you can give those antibodies to another person if they get sick, or before they get sick, to try to prevent disease or from getting severely ill. We still don’t know the role role of plasma is in this pandemic. We’re learning more about it,” said Dr. Garibaldi. “We’ve shifted more to antibody cocktails, more than one antibody, against the spike protein of SARS-CoV-2, that’s the receptor that allows it to enter human cells. We know that they probably don’t work once you’re sick enough to be in the hospital, but they probably do have a role to play in certain high risk groups to keep them from getting sick.”

Scientists and doctors are keeping an eye on several unknowns heading into spring and summer of this year.

“I think we need to be very mindful of these variants. We need to step up our surveillance of where these are and what’s happening in our communities. We’re moving onto studies in children to understand when we can vaccinate kids,” said Dr. Garibaldi. “I think there is hope for optimism and people should know that there is light at the end of the tunnel.”

Though the scientific and medical communities have made major strides in the last year, Dr. Garibaldi says there’s still so much more to learn, and we will likely be learning about this virus and its long-term impacts for years to come.

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