JOHN DWYER. TRUMP DECLARES THAT HE IS CONVINCED WE NOW HAVE A DRUG TO TERMINATE THE EPIDEMIC

As I write Boris Johnson has just locked down the UK and ordered police officers to enforce the lockdown. Almost simultaneously Donald Trump has declared that there is a “great weariness” among Americans for this social distancing business and he wants it to end in two weeks.

In a remarkably irresponsible press conference, even by Trump’s standards, he declared that the economy was tanking and Americans needed to get back to work. After all, “Those doctors would close the world if they could”. He opined the epidemic “with this China virus” would be over soon. America has a disaster on its hands with the number of infections still climbing dramatically and the Nation’s health professionals desperate for masks, ventilators and hospital beds for so many who are critically ill. Governors are locking down States in a frantic effort to slow the spread of the disease and yet the president wants to get back to business as usual with the emphasis on business. After all he noted “People get killed on the road every day and we still keep driving” You couldn’t make this stuff up!

He then turned his attention to what he described as the “game changer”,the drug hydroxychloroquine. Loads of the stuff will be available in New York within a few days he told his TV audience. Trump is convinced that this will cure a COVID infection despite warnings from scientists that there is, as yet, little evidence to support this contention. Nonetheless he seems to believe its immediate use would allow America to return t normal life. I thought we might examine his claim that China was responsible for the COVID epidemic and take a closer look at the prospects for hydroxychlooquine as a “game changer”

Who is to blame for this COVID19 pandemic?

The Chinese of course, says Trump as he adopts the term “Chinese virus”. His contention, which is wrong, has fuelled an outburst of very disturbing racism and soured the relationship between the US and China. For their part the Chinese say they think the US military may have created the virus in a laboratory and deliberately brought the virus to Wuhan Province. This also is nonsense. The world’s leading scientific journal “Nature” asked the seven most prominent virus laboratories in the word to study the genetic make up of the COVID-19 virus. Any human engineering would necessarily leave a biological fingerprint . All seven found no evidence of human manipulation. So who is to blame?

I am going to“name names” here for there is a capricious “woman” involved —“Mother Nature” The Chinese are not responsible for the arrival of COVID-19 nor were the Saudi Arabians responsible for the Middle East respiratory syndrome coronavirus (MERS-CoV).

Viruses do not leave fossils for us to study but almost certainly viruses have been with us from the beginning of the evolution of genes with their coded instructions (RNA and DNA). In one sense viruses are primitive because they cannot reproduce themselves. They need to invade a cell that can do this for them. They command the infected cell to reproduce the invader. Viruses don’t much care what sought of cell it is, humans, animals and plants are all satisfactory. For invasion viruses need to apply evolutionary principles constantly using a “trial and error” approach to change their surface structure to find a key that will open the door to a cell in which they can reproduce. As in many cases the unwilling host cells will eventually find mechanisms to protect themselves therefore viruses must keep finding new host cells.

We know that Bats are a common species that “host” corona viruses. Using the approach outlined these viruses can mutate while in their Bat host and we have seen that process allow corona viruses to jump to birds for example .So where did COVID-19 come from?

Most scientists studying the question think the following is the most likely scenario. It is similar to the origin stories for a few other recent coronaviruses that have wreaked havoc in human populations. In the case of SARS, we contracted the virus directly from civets while it was from camels in the case of Middle East respiratory syndrome (MERS). In the case of COVID-19, it is likely that the animal was a bat, which transmitted the virus to another intermediate animal (possibly a pangolin) that brought the virus to humans. We know that in pangolins, Corona viruses can develop the “hooks” that are present in the distinctive coronas we can all see in electron microscope photos of the virus. It is these hooks that allow them to bind to human cells. We also know that in human cells corona viruses can mutate to include on their surface a biological “can opener” to prise open the cell they wish to invade. No humans were to blame for the creation of the COVID-19 virus.

Certainly the Chinese government deserves strong criticism for the way it handled the emergence of COVID infections. Cases of respiratory disease with features seen in the SARS epidemic were noted by Chimes doctors in November 2019. It is understandable that initially there were a number of possibilities as symptoms are non-specific but enough cases were being seen to have Chinese doctors raise the suspicion that another SARS like virus was circulating. China’s initial harsh treatment of those reporting their findings was despicable. Doctors were forced to lie to the public. The main “whistleblower” died from a COVID infection at the age of 35. Chinese authorities felt the virus was being transmitted to humans from animals and they so reported to the WHO on December 8, 2019. We know that by then evidence of human to human transmission was available with at least 200 cases identified before the Chinese told the world this grim news on January 21,2020.

Can Hydroxychloroquine be used to prevent or treat COVID-19 infections?

Naturally the race is on to try and find drugs that could prevent or treat COVID-19 infections. A vaccine is still some 18 months away. Hydroxychloroquine is a decades old drug that has been used to treat Malaria and some of the symptoms suffered by patients with “Lupus” and rheumatoid arthritis, serious autoimmune disorders. Some 86 trials of various drugs are underway around the world and one with promise, but nothing more at the moment, involves the use of hydroxychloroquine. Laboratory studies have revealed that in the test tube the drug interferes with the entry of the COVID virus into cells.

In France researchers gave the drug to infected patients and found that the drug was “efficient” in clearing upper airways from the virus in three to six days in most patients. But the researchers only treated 26 patients in the study — a tiny sample size. As a result however, and appropriately so, six international well-resourced studies are underway. Dr Tony Fauci, director of the US National Institutes of Health, who is trying to get evidence based views accepted by a reluctant President, warned him that the evidence at the moment for hydroxychlorquine was “thin and anecdotal” and if used widely outside of controlled trials could produce very misleading impressions given that the infection in most cases is self-limiting. Hydroxychloroquine can cause headaches, dizziness, and diarrhoea, so it’s not something that doctors should prescribe without evidence for likely benefit. However I have heard that a number of Australian doctors are providing the drug to family and friends as prophylaxis and such non-evidence based prescribing could leave us with a shortage of the drug .I suspect that after Trump’s statement today there will be a rush by Americans to get hold of the drug and what dangerous confusion has he created with his claim that there will be no need to continue social distancing in two weeks?

Here we also have a crucial two weeks ahead of us. We will find out if Australians are embracing with determination the imperative that is social distancing and adhering to the sensible restrictions now in place. If at the end of those two weeks we have not had near universal implementation of the social distancing we need (unlikely I am sorry to say) we should follow the UK and lock ourselves down. Observations today suggest that many shops whose services are anything but “essential” are still operating. Maximum pain now for maximum gain will in the end result in less suffering and fewer deaths Failure will in all likelihood see us plunged into the utter misery and despair that has gripped much of Europe and indeed the US.

Professor John Dwyer, Immunologist and Emeritus Professor of Medicine UNSW

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Professor John Dwyer, Immunologist and Emeritus Professor of Medicine at UNSW

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