HALIFAX—Canadian researchers across the country have received funding to help spur their fight against a global pandemic.
As nations grapple with the spread of COVID-19 , work is underway to diagnose and treat the novel coronavirus, to limit its scope and to effectively deal with its fallout.
The Star spoke to researchers from Halifax, Edmonton and Vancouver who are each doing their part.
Dr. David Kelvin
• Professor, Department of Microbiology & Immunology, Dalhousie University
• Rapid Research Funding Grant: $1 million
• Research: Triage device to indicate which patients are likely to have a more severe case of COVID-19
In the midst of a worldwide coronavirus pandemic, Halifax researcher Dr. David Kelvin is trying to make his way to the centre of Europe’s biggest outbreak. If he gets there, he has no idea when — or if — he’ll make it back.
Kelvin, a professor in the microbiology and immunology faculty at Dalhousie University, is going to Italy because that’s where the data is. He’s just received a $1-million cheque from the government to help expedite his search for a method of triage for patients diagnosed with COVID-19.
That method requires him and his team to identify biomarkers that will indicate if a patient is likely to have a mild or serious case of the novel coronavirus.
The goal is to identify patients who are likely to need hospitalization and/or critical care earlier, and to ease the strain on emergency room doctors by filtering the patients more likely to have mild infections from those whose cases will be more severe.
On the phone from Toronto, this week, he was putting together supplies to take to fellow researchers in Italy. There are problems just finding a way to get there — Air Canada joined British Airways as the latest airlines to announce they will no longer fly into or out of Italy. And with the country extending its emergency lockdown measures nationwide, it’s difficult to see how he’ll get back home anytime soon. In a worst-case scenario, he might be stuck in Italy for the duration of the lockdown.
But Kelvin seemed unfazed at that prospect. He was more interested in talking about his research.
Currently, when a patient tests positive for coronavirus, there is no efficient way to tell how sick they might become.
About 80 per cent of patients testing positive for coronavirus go on to develop a mild illness. Of those, 20 per cent will develop a severe case of the disease, and of those, five per cent would develop the most severe cases.
“In China, at the peak of the epidemic, emergency room doctors would face thousands of people, literally, in one day. I have a picture of a thousand people lined up to get into an emergency room,” he says.
“During that period of time, they have to make an assessment of A) who’s infected with the virus, and then B) whether the individual should be hospitalized and C) if they should be hospitalized and receive ICU admission.
“The problem is that, as we found out through the Wuhan experience, there aren’t enough hospital beds and there aren’t enough ICU beds for the people who are lined up to get into emergency rooms.
“So there has to be some kind of priority ranking for the people who would have the most severe illness and identify them at the earliest stages so that they could be placed in the most appropriate care.”
Kelvin is part of the COVID-19 Research Network, a global network of scientists from China, Italy, Spain, Morocco, Sudan, Egypt, Ethiopia, Cote d’Ivoire, Mozambique, Vietnam, the U.S. and Canada.
Their hope is to make those crowds more manageable.
They can do that by looking for biomarkers for immune proteins. The body produces those proteins when its immune system attempts to fight off a virus.
If they can correlate a certain set of immune proteins to patients who have the more severe forms of COVID-19, and they can test for the presence of those proteins, then scientists will be able to tell with reasonable confidence whether a particular patient will have a severe form of the disease, in which case they might need to be hospitalized, or the milder form, where hospitalization is unnecessary.
The question Kelvin is trying to answer is this: What immune proteins tend to be present in people who develop the most severe cases of COVID-19? And how can we test for them?
“What we’re trying to do is identify a set of biomarkers that can specifically identify those individuals who are at the highest risk for developing the most severe illness, so that you can intervene earlier with those patients … and improve the chances of their survival,” says Kelvin.
The hardware to do this already exists. The two candidate devices can return test results in a matter of minutes, and they are inexpensive enough that they can be used to help doctors make decisions in places that have limited resources.
Essentially what Kelvin’s team needs to do is to calibrate those devices for the immune proteins produced in the wake of a coronavirus infection.
To do that requires data in the form of people who have already been stricken with COVID-19. Hence Kelvin’s travels to — and hopefully from — outbreak zones in Italy and Wuhan.
“The global effort will give us large numbers, but it also gives us something else,” he says. “The populations around the world are diverse. We find that there are socio-economic differences, and there are also genetic differences. So what we want to know is, in each population where there’s an outbreak whether the biomarkers are similar or different.”
Kelvin says he hopes to have his tests ready for approval in three to four months.
Dr. Chris Le
• Professor, Faculty of Medicine, University of Alberta
• Recent Rapid Research Funding Grant: $800,000
• Research: Tool for fast, early and accessible diagnosis of the coronavirus
Dr. Chris Le knows all too well that a delayed coronavirus diagnosis can cost a life.
In January, two of his friends in Wuhan, China were infected with the coronavirus.
“One of my friends was infected, and she was diagnosed very early. She was admitted to hospital and treated and she recovered and was discharged. She was fine. That was great,” he says.
“But there was another, my friend’s older brother, who wasn’t diagnosed until much later, when the symptoms became very severe, including pneumonia. And at that point, he had a very difficult time to fight and in the end, he lost the battle against COVID-19.
“This is quite personal to me as well. They’re not just numbers — how many people. Each number is a person somewhere.”
Le, a professor and researcher at the University of Alberta’s Faculty of Medicine, has just received a rapid funding grant for some $800,000. He’s working on a way to speed up the diagnosis process for COVID-19.
It’s research he’s familiar with — his team has previously developed technology for detecting toxic environmental substances. He’s now working on adapting that technology to work on detecting the coronavirus.
He hopes to reduce the time it takes doctors to make a diagnosis, especially in limited-resource settings, and in doing so, help patients get treatment earlier, thus saving lives.
Currently the test for coronavirus is resource-heavy and requires specialized equipment. Results for each test come back in about four hours.
Coronavirus is an RNA virus. That means at the heart of the virus is a strand of ribonucleic acid. This differs from the more familiar DNA (deoxyribonucleic acid) in that it is, in this instance, single-stranded, as opposed to the classic double-stranded coil of the DNA molecule. The test for coronavirus is essentially a test for the presence of its specific RNA molecule.
In the current coronavirus test, which Le calls the “gold standard,” a swab is taken from the nose or throat. Then the virus is deactivated and its RNA is extracted.
However the amount of RNA in the sample is much too small to be detected — it has to be “amplified.” This is done by duplicating it several times.
It takes time and specialized equipment to extract and duplicate the RNA. Le’s test would negate the need for specialized equipment and training. His technology would reduce the test to something that could be performed in resource-limited settings — perhaps a doctor’s office or a community centre, for a rural village.
The steps are essentially the same as the current test, but Le’s work is designed to keep the process in one tube and eliminate specialized equipment.
The results would be clear: The contents of a test tube changing colour on the one hand, or a strip, like a pregnancy strip, with two lines on it for a positive result.
And at a comparable cost, Le’s test would deliver results in one hour, rather than the four it currently takes.
With testing going on concurrently with development, Le believes he can have his diagnostic tool ready for approval in about three months.
Other tests for the coronavirus are simultaneously being developed, and Le expects that in the not-too-distant future doctors will have a number of testing tools at their disposal.
“I think you will see more than one diagnostic map that will allow for faster detection and maybe some screening including triage.” he says. “So this way, people can focus resources on true positives, and have faster earlier diagnoses.”
Dr. Srinivas Murthy
Associate professor, Faculty of Medicine, University of British Columbia
Rapid Research Funding Grant: $954,936
Research: Clinical trial on whether antiviral medication originally designed to treat HIV is effective against COVID-19
Some doctors believe HIV medication could treat COVID-19, the novel coronavirus that doctors have not yet found a cure for.
One B.C. researcher has received nearly $1 million from the Canadian government to administer the drug to hundreds of COVID-19 patients in a clinical trial.
The drug, called Kaletra/Aluvia, kills viruses.
“It’s an antiviral medication,” said Dr. Srinivas Murthy, a clinical associate professor at the University of British Columbia. “It was designed to kill HIV and it may be effective against COVID-19 infection. We don’t know yet.”
The challenge? Murthy and his team need to reach COVID-19 patients before public health officials are able to control the outbreak. Clinical trials require a certain sample size in order to be viable and Murthy says he is aiming to reach about 400 hospital patients this time around.
But Canada has less than a hundred confirmed cases of COVID-19 so far — and only one in ten patients are sick enough to warrant hospitalization — so if Murthy and his team are not able to begin administering the drug soon enough before officials ultimately stop the spread of the virus, the trial could be a flop.
That’s what happened during the Ebola and H1N1 outbreaks, said Murthy. Research infrastructure prevented doctors from starting the trials right away — clinical trials need to get approval from university ethics boards and the public health agencies before getting the green light — and by the time they received permission, there were too few patients.
Murthy said he is a few weeks out from beginning the COVID-19 trials.
Still, he hopes health officials will be able to stop the spread of the disease as soon as possible.
“That’s the best case scenario,” he said. “But worst case scenario, we’re ready to learn new things.”
This is how the trial will work.
If you are hospitalized with COVID-19, you will receive what doctors call supportive care — like fluids and oxygen — no matter what. But a researcher will then approach you and ask whether you want to participate in a randomized trial where some patients receive the trial drug and some do not. If you agree, researchers will collect information on your recovery and use that data to determine whether the drug is effective or not.
Conducting this kind of research during a pandemic is difficult, because of widespread “public anxiety,” said Murthy.
“Even randomized trials, which under normal medical circumstances people usually readily accept, can become intolerable,” he said.
“During a pandemic, people tend to want everything, even if (the medication) is not proven.”
Eventually Murthy said his team may turn the trial into a double blind study where patients do not know whether they receive the trial medication or not. But for now they are forgoing that in order to get the trial up and running as quickly as possible.
Murthy said the plan is to use the $954,936 federal grant to conduct clinical trials at up to 40 hospitals throughout Canada and to reach at least 400 patients. Then, his team will share the findings with hospitals around the world.
“We have the infrastructure to do these clinical trials,” he said. “Places without those resources do not and they’ll be looking to us for those signs and evidence to inform what they do.”