part from its new name, nothing really happened in the last week. New confirmed cases per day remained high, seemed to decline somewhat until it became clear that there was shortage of testing capacity. Definition adapted, and then the numbers of infected patients in the affected Chinese regions exploded. So, one question answered from previous blogs: it’s big in China and we may (still) not know everything that is happening there (or in some other countries).
In the meantime many scientists boarded a plane to WHO in Geneva to discuss the research that is needed. Some stayed at home to work on their HORIZON2020 submission with a research response towards the SARS-CoV-2 outbreak. A call opened on January 31st, and closed on February 12th!
The list of prioritized studies that WHO put on their website was:
- the natural history of the virus, its transmission and diagnosis;
- animal and environmental research on the origin of the virus, including management measures at the human-animal interface;
- epidemiological studies;
- clinical characterization and management of disease caused by the virus;
- infection prevention and control, including best ways to protect health care workers;
- research and development for candidate therapeutics and vaccines;
- ethical considerations for research;
- integration of social sciences into the outbreak response.
Not very surprising topics, but the one prominently put forward last week was “infection prevention and control, including best ways to protect health care workers”. The description of the first 138 COVID-19 patients in a Wuhan, see, smashed the reality of this outbreak in our face: 43% of the acquisitions had occurred in the hospital, both among patients and healthcare workers. Not all admitted patients had been recognized immediately as COVID-19 infected, and not all infection prevention measures were 100% effective. Easy to say, “that won’t happen in my place”, but I am not that confident. Simple things, like running out on masks, gowns and other protective clothing are real risks, if a similar outbreak size reaches us.
So, how to protect healthcare workers? A vaccine or another preventive medicine may not be ready in time (and if, who gets first?). Leaves us with out-of-the-box solutions.
This is one option: Bacillus Calmette-Guérin (BCG) was developed as a vaccine against tuberculosis, but many studies have shown its ability to induce potent protection against other infectious diseases: the so called non-specific effects. There are actually 3 RCTs in children and adults in which BCG reduced either mortality or respiratory tract infections with 38%-80%, and this was not due to protection against tuberculosis. The non-specific beneficial effects of BCG vaccination are due to epigenetic and metabolic reprogramming of innate immune cells such as myeloid cells and NK cells, leading to an increased antimicrobial activity, a process termed ‘trained immunity’, see.
BCG is widely available, cheap and safe, and this truly is an out-of-the-box idea, brought to me by Mihai Netea.
My question to the infection prevention society readership of this blog: Would a RCT with BCG among healthcare workers be 1) warranted and 2) ethically justified during a COVID-19 pandemic? Please cast your vote below:
If you already replaced healthcare workers by macaques, you might also consider intravenous BCG vaccination, see.