How can pharma help us out of lockdown?

A short piece of genetic code, whose only mission in life is to make more copies of itself, has bought entire countries to their knees and killed thousands of people across the world. With no drugs or vaccines approved to treat coronavirus, Richard Staines asks how testing could help to bring the outbreak under control.

After only four months, it’s clear that 2020 will be remembered as the year that the world ground to a halt because of the coronavirus. The SARS-CoV-2 virus is a string of genetic code that, at just under 30,000 base pairs, is a tiny snippet compared with more than three billion base pairs in the human genome.

But it is wreaking havoc, changing society overnight as millions of people have been forced into quarantine, with disastrous consequences for economies and jobs.

The world watches the death count mount inexorably with each day that passes, and all eyes are on the effort to find a vaccine or treatment for this new pandemic scourge.

With the country paralysed and those at the very top of government stricken, in the UK there is seemingly no way out of the current situation.

Even if the lockdown measures help to prevent the disease from overwhelming the NHS, any relaxation of the rules risks a further spike of cases.

Analyst Mark Brewer, who heads the life sciences team at finnCap, said: “We can expect more fluctuations as time goes on and unless a vaccine or effective treatment is released, there appears to be no ‘exit strategy’ to coming out of lockdown.”

The simple piece of genetic machinery that is coronavirus has disrupted healthcare across the world, with hospitals struggling to keep pace with large numbers of patients presenting with serious respiratory symptoms.

It’s also shown the lack of investment in drugs that could be used against emerging viral threats, something that Novartis’ CEO, Vaz Narasimhan has already alluded to.

This combination of underinvestment in intensive care equipment and research into drugs and vaccines means countries are resorting to non-pharmaceutical measures – lockdowns and limits on peoples’ activity – to manage the disease.

Uzma Choudry, an early stage investor from Octopus Ventures focusing on “The Future of Health”, said: “The pandemic has demonstrated across different geographies the blind spot and the vulnerability in our healthcare systems – the level of investment in drugs all the way through to the ability to manage the pandemic within your community.”

While the measures are showing signs of helping to manage the outbreak in the UK, there is only so much that the economy will be able to take.

Brewer said: “In any case, ‘flattening the curve’ and social distancing in order to reduce the spread of disease will help to prevent the NHS from being overrun, saving many lives in the process.

“It also gives the country time to prepare and increase NHS ICU capacity and hospital beds, such as with the conversion of the ExCel Centre in London into the temporary Nightingale Hospital.”

The expectation is that the pharma industry will come up with solutions that could rescue us from the current untenable situation and bring the virus back under control.

Much of what we know about SARS-CoV-2 comes from scientists in China, who were able to elucidate the virus’s genetic code a few weeks after it emerged in December last year.

By the end of January, the code had been published freely online for researchers to study, along with in-depth clinical analysis of the symptoms of the disease and how the virus attacks the body.

Pharma quickly responded and there are now dozens of antivirals and vaccines in development – but despite every effort to expedite clinical trials it will take months or years to complete them and for regulators to make decisions.

Testing troubles

Experience from countries such as South Korea has shown that in the absence of vaccines or antivirals, testing can be an effective way to control the virus once cases have passed their peak.

Track and trace strategies can be used to isolate people who may have come into contact with those who test positive, and there is also the possibility of identifying people who have had the virus, and are immune because they have antibodies in place to fight it off.

In the UK, there is a well-documented shortage of tests and health secretary Matt Hancock has issued a call-to arms to all pharma companies to try and improve testing in the UK.

The country has been relatively slow to bring in mass testing for coronavirus and at the time of writing had the ability to test 14,000 people day with NHS workers, those in hospital, care homes or prisons prioritised.

In contrast, Germany was able to conduct 50,000 coronavirus tests daily at the beginning of this month, with plans to keep increasing this number.

Part of the problem has been that the 3.5 million fingerprick tests ordered from China have turned out to be too unreliable to use.

These were a key part of the government’s strategy and would have given an indication about whether people had been exposed.

Tom Keith-Roach, president of AstraZeneca UK, said the company has joined with GlaxoSmithKline and the biotech Novocyte to create a new diagnostics centre, which could provide a sizeable proportion of the capacity needed to hit Hancock’s target.

Even though diagnostics is not usually an area where AstraZeneca has worked, the company decided to respond to the government’s call for thousands more tests every day.

But the COVID-19 crisis has seen pharma companies rapidly retool and rethink their priorities and AstraZeneca is no exception.

The plan is to start with tests for the presence of the virus itself, and then follow that with antibody tests that will show whether someone has been exposed and has recovered.

In the short term the virus test, using polymerase chain reaction (PCR) technology, will allow patients to be triaged correctly and those with coronavirus isolated to prevent the infection spreading.

It will also be important to identify front-line workers in the NHS who are infected, described by Keith-Roach as “the real heroes” of the fight against COVID-19. This will allow rapid treatment of front-line staff, helping them recover from the disease and helping the NHS function during this critical time.

Once the virus test is in place AZ hopes to get the antibody test quickly up and running, identifying those who have been exposed and developed only mild symptoms before recovering, thus allowing them to get back to work.

By the end of the month AZ hopes to be processing up to 30,000 PCR virus tests per day, with the antibody test validated at the beginning of May.

The plan is to get a “similar scale” of antibody tests processed every day by the end of May, said Keith-Roach.

While the coronavirus has exploited the weak points in health systems, and exploited societal trends such as mass global travel to spread, Octopus Ventures’ Choudry points out that it is now time to use knowledge of genetics to hit back at the short but deadly piece of code that is SARS-CoV-2.

AZ will also be providing support for other national testing centres in Milton Keynes, Alderley Park, and Glasgow.

Dozens of drugs and vaccines are in development, but it’s unlikely that many of them will work as so many clinical trials end in failure.

With antivirals or vaccines months or even years away, testing, combined with the remarkable powers of the human immune system to fight off viruses it has already encountered, could be the quickest way out of the COVID-19 nightmare.

“The advancements in genomics mean that we can quickly come up with key biomarkers and start developing diagnostics tools,” Choudry observed.