Living with the enemy – part 1

Returning to work in a post-COVID-19 world

As the statistics are beginning to show decreases both in new cases and a reduction in hospital deaths, it’s only natural that we are all starting to think about returning to work and reverting to our normal lives.

In an ideal world one of three things would need to be in place to allow the optimal easing of a lock down.

  • Availability of a vaccine
  • Availability of a VALIDATED serological test to determine immunity
  • Availability of a (repurposed) drug to treat patients

A vaccine is the ideal exit solution.  In this scenario the population could be vaccinated, and we could all return to a life very much like before COVID-19. The timeline touted for a vaccine is 12-18 months and there are several vaccines that have been able to sprint into clinical trials that are challenging patients with the spike protein (S-protein) of the virus. There is always the possibility however, that a vaccine may not be found.

Nucleic acid tests are relatively simple to perform, there are several clinical testing platforms that can run such a test.  They confirm that a person is currently infected.  A serological test confirms the presence of antibodies specific to a pathogen (antigen or epitope) in the blood.

The value of a serological test over the current diagnostic nucleic acid tests, is that it would tell you if someone has been infected and has an immune response which might be protective.  If it was possible to confirm that someone was protected, they could be issued with a “immunity passport” and allowed to return to the workplace. We may be fortunate and have a validated test ready for launch in 6 months.

A faster route is to find an existing medicine that has proven safe in clinical use that is effective against the virus or its effects.  This process is call drug repurposing.  Already there are repurposing initiatives that are entering clinical trials.  The first results will come quickly. The key is to make sure that these trials are carried out as true randomised clinical trials (RCTs) so that the results are objective and robust.

Any lifting of restrictions will need to be data driven so that we monitor any increase in community transmission that would lead to an increased load on the NHS.