CROI 2020: COVID-19 Special Session

Last Tuesday, March 10, at a conference in the United States on retroviruses and opportunistic infections (CROI 2020), a special session was held on the novel coronavirus and the condition known as COVID-19. 

Four reports were presented on key aspects of the epidemiology of the virus, the reasons for its spread, as well as methods of treatment and prevention.

Note: The situation is rapidly developing. All facts and figures in this article were correct at time of presentation on March 10th 2020.

As the moderators of the session noted, the COVID-19 is a new disease but has already in a short time affected the lives of tens of thousands of people. Currently, the number of infected is estimated at around 126,000 and infections have been reported in more than 100 countries.

What is the background?

The session started with a presentation from Dr. Zunyu Wu, a leading specialist of the Center for Disease Control and Prevention of the PRC. The virus was first noticed in December 2019, in the Chinese province of Hubei.

The World Health Organisation (WHO) and other countries were notified of the threat of a new virus on January 3, and on January 20, COVID-19 was added to the list of diagnosed diseases. Isolation measures in response to the spread of the virus began to be undertaken by countries on 23 January.

Initially experts on the ground did not immediately notice the extremely high transmission rate of COVID-19. Dr. Wu said it took the virus only 30 days to spread from 14 Chinese districts to over 1,300 districts.

Who is most affected?

Epidemiologists have not observed a noticeable difference in the impact of the virus on women or men. The vast majority of cases (94%) are recorded in the age group of 22 - 79 years.

That said, people over the age of 70 appear to be at a much increased risk of death from COVID-19 compared to those in younger age groups.

This is largely due to the fact that the most common predictors of severe COVID-19 include arterial hypertension (the largest number of critical cases), diabetes, cardiovascular and pulmonary diseases.

The experts currently consider the following groups to be high-risk:

• Persons over 70 years of age.
• Persons with comorbidities that include: CVD, diabetes, chronic respiratory diseases.
• Persons with suppressed immune systems (but not those living with HIV on treatment)
• Pregnant women

What are the rates of infection? How severe might it get?

The mortality rate for COVID-19 is estimated to be in the range of 0.5 to 3.5%, while the same rate for seasonal flu is 0.1%.

The clinical prognosis for the disease, expressed by several specialists at the session, is almost identical:

• 40% - mild
• 40% - moderate
• 15% - severe
• 5% - critical
  
  
• 10-15% of mild and moderate cases become severe
• 15-20% of severe cases become critical

What is the development time? How long will it last?

• From the moment of infection to symptoms: 5-6 days
• From symptoms to recovery in mild cases: 2 weeks
• From symptoms to recovery in severe cases: 3-6 weeks
• From symptoms to death in the worst cases: 2-8 weeks

It is also important to note that COVID-19 is able to be transmitted as soon as 24 hours after infection. In the case of mild to moderate forms of the disease, the virus continues to be transmitted for 7-12 days, in severe cases - more than 2 weeks.

How do we curb the epidemic?

According to experts, in order to reduce the total number of new cases of COVID-19, even before the availability specific antiviral drugs and vaccines, measures should be taken to:

• Intensify the identification of people affected by the virus and their contacts
• Isolate new cases and ensure quarantine
• Research & develop a detailed description of the disease and the preparation of people for anti-epidemic measures.
  
  

Speaking about people with HIV, Dr. John T. Brooks of the CDC pointed out the need to follow a series of recommendations:

• Ensure an adequate supply of drugs (at least 30 days)
• Inoculate against influenza, pneumococcus (in line with local guidelines).
• Develop a clinical care plan if the person is isolated
• Constantly maintain social contacts, but remotely

Treatment & Vaccines

Touching on the topic of treatment, the drug Gilead remdesivir is currently recognised as the best candidate for the role of drug therapy in COVID-19. It has demonstrated good antiviral activity in in-vitro studies and is already being tested in at least four large randomised trials.

The development of candidate vaccines is also underway.