Luke O’Neill: Scientists have delivered against Covid-19. Now the politicians need to

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The one thing I have always had faith in when it comes to Covid-19 is science. I knew of the massive effort to produce safe and efficacious vaccines. And the many scientists and doctors trying to find therapies to treat people who become sick with the virus.

But as a scientist I felt uncomfortable with endless debates on strategies to live with the virus or to try to eliminate it. Uncomfortable because of insufficient data to be able to come to firm conclusions.

This is not unusual, because to be a scientist is to feel “unrest, turmoil and irritation”, to quote the Massachusetts Institute of Technology news magazine. It is only in robust data that we scientists find comfort. The discomfort is very real for me, at times making me very uneasy.

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Because of the huge complexity of the situation, compelling data that informs us as to what to do is hard to come by. This is not the fault of the scientists involved, as there are so many variables involved. Equally, there are too many unknowns. Scientists have done their best with their recommendations, but there are no easy answers, and it’s the politicians who ultimately have to make the call on what to do as a society in the face of the virus.

One analysis that has emerged is important, given the strength of the data. South Korea is one of the most successful countries when it comes to the virus.

Efficient testing

On January 20th, 2020, South Korea reported its first case of the virus. On January 31st, Spain reported its first case: a German tourist in the Canary Islands.

Both countries have similar populations of about 50 million. As of January 12th, 2021, South Korea has had 1,140 deaths from the virus while Spain has had more than 51, 864.

On a per capita basis, Ireland has done better than Spain, but not that much better, with about 40 per cent of the deaths. Spain, Ireland and most European countries have therefore failed relative to a country like South Korea. The simple scientific question is why?

We have a good idea of the answer. And it wasn’t because South Korea imposed strict lockdowns. It had efficient testing, tracing and containment of the virus that was rapidly deployed ahead of the virus getting out of control.

Timing is everything when it comes to Covid-19. A single day is a very long time when it comes to a virus that can spread exponentially – another scientific fact. South Korea quickly developed the capability to test as many as 20,000 a day at hundreds of drive-through and walk-in testing centres.

The mobile centres conducted the tests free of charge within 10 minutes, with the results being sent to people’s phones within 24 hours. By mid-March more than 270,000 people had been tested. They used mobile technology against the outbreak to help with contact tracing.

It was also able to control its borders, imposing a strict 14-day quarantine on all people entering South Korea (which was strongly discouraged), which is still in existence. The people of South Korea also followed government guidelines with huge compliance.

How did South Korea do it? One reason is it had been through MERS, a virus related to SARS-CoV2. In 2015 MERS had killed 36 people, infected 186 and forced thousands into quarantine in an outbreak traced to a single visitor from overseas. So South Korea knew what to do.

Can Ireland learn from South Korea and our own experience with Covid-19 to date? We’re in the middle of the most damaging period of the pandemic so far. When the current lockdown brings the viral count down to manageable numbers for our health service, which it will, we have an opportunity to show that we’ve learned from our experience with the virus.

Can we improve our test/trace/isolate system to become like the one in South Korea? And if not, why not?

Can we implement universal antigen testing to keep the virus under control, allowing people to go to work normally, and make sure our schools and colleges are safe, lowering the spread of infection? And if not, why not?

The only thing science delivered early in the pandemic were the PCR and antigen tests. Science had done its job when it comes to testing, and it was then up to others to implement that science, which sadly hasn’t happened in a way to prevent the two lockdowns that came after the first one.

The test/trace/isolate regimen would need to be combined with strict border controls and quarantine rules. Why can’t that be implemented? Is it because of Northern Ireland and also because we are in the European Union? This again is not a matter for the scientists.

If the science that has been delivered on testing can’t be optimally deployed, surely the spectacular science that delivered the vaccines and therapies for Covid-19 can?

Three therapeutic approaches have been proven scientifically to help patients. First, an old drug called dexamethasone was shown to lower mortality by about 20 per cent.

Monoclonal antibodies that neutralise the spike protein on the virus were also shown to bring benefits.

Vaccines

And then most recently a drug that blocks an inflammatory cytokine called IL-6 was shown to save about 25 per cent of severely ill patients. All three will make a difference and were found from research that stretches back decades, involving many thousands of scientists, all toiling away. If ever a case needs to be made for funding fundamental research over decades, it is these discoveries.

And then there are the vaccines. The Pfizer/BioNTech vaccine also represents years of research. It’s an RNA vaccine, and the RNA makes the spike protein, eliciting the immune system to make antibodies which will protect against infection when the real virus comes along. The RNA is packaged inside a special tiny bag called a liposome.

By some estimates it took at least 100 scientists working for 10 years to come up with the liposome. Many more were involved in the effort to make the RNA. Again, fundamental science delivered.

Future funding of the kind of basic science that gave rise to these contributions must be seen as insurance against future health problems that might emerge, and also to help in the effort to prevent or find treatments for many diseases that still afflict humanity.

The vaccination programme is the largest in history and brings us great hope, especially as we move towards the summer and move outdoors again.

One of the most important immunologists of all time, Peter Medawar, who won the Nobel Prize in 1960 for his work on organ transplantation said: "Science is the art of the soluble. Good scientists study the most important problems they think they can solve."

Science has delivered against Covid-19 and will continue to do so. It has done a spectacular job. Scientists want to beat the virus as much as anyone else.

Luke O’Neill is professor of biochemistry at Trinity College Dublin. The Irish Times Winter Nights Festival is a series of online talks and events taking place from January 25th to 29th.

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