The 'Pain'demic of uncertainty

“Black Death” (Bubonic Plague of 1346-53) wiped out half of the world’s population. AIDS, during its extended run without a plausible treatment, claimed 36 million lives. 100 million died in the worst viral pandemic in modern history that happened exactly 100 years before the current crisis. The covid toll so far has been 2.4 million. So what makes it such a big deal? It appears its impact on global travel, business, and livelihood in the interconnected world has spooked us like never before. The best bet to resume global confidence lies in a 0.5ml solution containing the mRNA which codes for the Covid virus spike glycoprotein (the knob-like structure you see protruding out of the Covid virus in illustrations one can find everywhere around us).

This article will look into the various approaches to the Covid response focusing on the story of the vaccine, what went wrong with the Candian rollout, and what impact it will have on our future.

Approaches towards Covid response

Social distancing

About 105 years before the super spreaders of Covid there was a notorious disease spreader who made social distancing a buzzword in New York. Her name was Mary Mallon and she was at that time considered as "the most dangerous woman in America". Mallon was presumed to have infected 51 people with typhoid, and three of those illnesses resulted in death. She was maniacally pursued by the health authorities but she was notorious to change her name and address. Researchers believe that the true death toll could have been higher,

In 2019-20 the social distancing approach has taken the shape of phone apps, robotics, and electronic surveillance. China has been routinely using service robots in hospitals. Japan even has a mascot for quarantine and it's called ‘Q” and you can see him in their airports. In Israel a spyware company has created a software that takes two weeks of mobile-phone tracking information from the infected person (the incubation time of the virus) then matches with location data collected by national mobile phone companies that pinpoint citizens who were in the patient’s vicinity for more than 15 minutes and are vulnerable to contagion. Many Covid apps since then have emerged and I am sure you might be having one of those in your phone as well.

But certain things still rely on old-world common sense. Authorities in Bangladesh & India started stamping travelers who arrived at the international airport. Indelible ink was used and any violator who disregarded the quarantine was promptly isolated by the authorities. Also, in some of the poor countries in the world people who had no access to extra room for isolation came out with novel solutions like ‘Tree to quarantine’ to make sure their dear ones stayed safe.

Masks

China, the home of COVID-19, SARS has been the epicenter of a far more deadly disease in the year 1910. The fatality rate of COVID-19 in Canada is approx 2.6%. The Manchurian Plague of 1910-11 had a fatality rate of 100%!! 

The name to be remembered in this section of the article is Dr. Lien-Teh Wu. The Chinese Imperial Court brought him to head its efforts in dealing with the Manchurian Plague. He was born in Penang and studied medicine at Cambridge, UK. After conducting an autopsy on one of the victims, Wu determined that the plague was not spread by fleas, as many suspected, but through the air. A very unpopular opinion during those times. Expanding upon the surgery masks he’d seen in the West, Wu developed a hardier mask from gauze and cotton, which wrapped securely around one’s face and added several layers of cloth to filter inhalations. His invention was a breakthrough, but some doctors still doubted its efficacy.

Once Dr. Wu was confronted by a famous French Doctor of that region, Gérald Mesny. He explained to him his theory that the plague is pneumonic and airborne. The French Doctor is said to have replied sarcastically ‘What can we expect from a Chinaman?’ And to prove this point, Dr. Mesny continued to attend the sick in a plague hospital without wearing the mask created by Dr. Wu. Dr. Mesny died 2 days later due to the plague. Dr. Mesny’s death shocked the medical community and as a result, support for the face mask quickly increased. After 7 months of vigilant quarantine treatment, and mask-wearing, the plague was under control.

Dr. Wu’s approach ignited interest in this field. The multinational corporation 3M produced a specialized PPE in 1972. This single-use respirator, called the N95 mask, used similar technologies like a gas mask to produce a mask composed of lightweight synthetic materials to capture microscopic particles. The N95 masks were used primarily for industrial applications (in factories for cleanup and hazardous work) before being modified to assist medical professionals in the 1990s. In the current era, the Centre for Disease Control (CDC) recommends that healthcare workers wear the N95 mask when in contact with patients with infections that are transmitted from inhaling airborne droplets, like tuberculosis, SARS, and COVID-19.

Airport Screening

It has been discovered that the viral pandemics so prevalent on earth millions of years ago could not reach Australia just because of its geographical isolation. Without air travel, Covid would have NEVER expanded across all the continents

There was a considerable difference in the approach shown by the countries towards regulating air travel. Look carefully at the 2 pictures below.

2 Airports. Same Time Stamp. Beijing and Chicago in March 2020.

Israel started barring foreigners who had visited at-risk countries from Feb 17. India’s first coronavirus case was reported on January 30. The first airport screening measure came on January 17, when the Ministry of Health announced that international travelers arriving only from China will be screened with thermal scanners. The UK started screening air travelers on January 22.  

In the end, though it didn’t depend on when you implemented the screening but how you took the precaution forward. Both Australia and the US banned air travel to China on Feb 1, 2020, but we all know what different paths the 2 countries took afterward. The Australian relied heavily on science experts and even banned interstate travel to become a Covid success story.

I have a first-hand experience of the confusion that prevailed due to a lack of clarity on air travel regulations. I was at the London International Airport (No, not Heathrow, this in Ontario and we have the doppelgangers of all the major cities in the world!). I had checked in my luggage and while I was waiting to board the plane I saw the address of Quebec Premier where he talked about instituting a 2-week quarantine on travelers. There was still no clarity from the Ontario or Federal Government but just because of a gut feeling I got all my family’s luggage pulled out before it went into the belly of the aircraft. We got the same cab which we took to the airport and on the way back the driver wanted me to talk about what he called was the world’s shortest vacation! My hunch was vindicated 2 days later when Ontario declared a state of emergency!

The incredible story of the Covid Vaccine

From different non-medical maneuvers now let’s move to the real deal. The story of the fastest human vaccine in history. Let’s look at all the 3 major vaccines in circulation- Moderna, Pfizer, and AstraZeneca.

Moderna

 On Jan 12, 2020, China publicly shared the genetic sequence of COVID-19. CEO of Moderna read an article about the coronavirus in Wuhan, which was quickly spreading throughout the region at the time. He immediately reached out to the Vaccine Research Center at the U.S. National Institutes of Health (NIH). What caught his interest was that Covid was an RNA virus and Moderna has been working for a long time on mRNA technology, a very risky proposition to begin with. Instead of the time-consuming use of a dead or weakened virus-like, they do in traditional vaccines this vaccine used mRNA which coded for the protein that Covid virus used to attach to the human cell. 

The pandemic was a blessing in disguise for Moderna since it accelerated their licensing process and investors poured money into their effort like never before.

Pfizer

Pfizer, a US-based company was partnering with a german company BioNTech for an influenza virus vaccine using mRNA technology. They quickly switched their focus from Flu over to Covid. Then Pfizer did something that was considered very risky by their competitors at that time: It began the manufacturing process, purchasing the materials needed to produce millions of vials of vaccine. By doing all this they had an early start over their counterparts. Pfizer purchased glass vials, tubing, raw materials at a large scale behaving as their vaccine is already approved. The CEO of the company had frequent spats with his production head as tried to push him for more quantity on a more tight time schedule. This necessitated an expansion at their Belgium based factory which badly hit the delivery schedule and left countries like Canada in a disarray. 

The big disadvantage of Pfizer is Antarctica like temperature requirements for storage. The reason behind it is that the mRNA nanoparticles are stabilized by a lipid that requires low temperature otherwise the mRNA degrades very rapidly. It is due to this reason Pfizer’s vaccine does not look like a long-term player since the new candidates are going to improve rapidly on this requirement.

Astra Zeneca

AstraZeneca’s vaccine is a brainchild of 2 researchers based at Oxford University, UK. They started their work immediately after the viral genome was released by a Shanghai virologist. They took the common cold virus that infects Chimpanzees, re-engineered it to make it harmless, and introduced genetic material of the coronavirus. This is then introduced in humans for the immune cells to attach them. This vaccine is ‘fridge stable’ hence it is easy to transport. What makes AstraZeneca different from the other 2 companies is that it made this vaccine available to low and middle-income countries by licensing the technology to other vaccine makers. We will revisit this licensing agreement later in the article.

The Vaccination Campaign

There are 10 approved vaccines, 21 are in phase 3 and around 225 candidates are between preclinical and phase 2 stage

The countries producing their own vaccine are only a handful- the US, UK, Germany, China, Russia, and India. China leads the pack with 6 vaccines in Stage 3 and beyond. But when it comes to the production magnitude India is ahead by a long shot. Even before Covid India was a manufacturing powerhouse accounting for 60% of the world's vaccines. The AstraZeneca alliance with an Indian company, SII will produce 1 billion doses within a year which will be distributed to lower and middle-income companies as part of the vaccine alliance. In addition to it, India will produce 700 million doses of a homegrown vaccine and also will shortly see the launch of a DNA-based vaccine as well. Russia’s Sputnik was also an early entrant in the vaccine race & Russians are producing more than 1 billion doses for countries around the world.

The Candian Dilemma

For a country of Canada’s research and development lineage which already has access to production facilities of all the major Pharmaceutical giants & world’s class Universities, the vaccine rollout has exposed some fault lines in the system. Canada lags behind countries like Chile and Morocco while the US has a vaccinated population that is almost 1.5 times Canada’s total population. 

Why did Canada not produce its own vaccine? Well to enable that there has to be a detailed network of existing vaccine production infrastructure and specifically a lot of investment in mRNA tech which was clearly lacking. The federal government did announce funding support of 173 Mn $ to Quebec-based Medicago which plans to make the vaccine in North Carolina. Another company, Calgary-based Providence Therapeutics which is using a plant source for its mRNA vaccine has started human trials in Toronto. The CEO of Providence stated last week that he has asked the Federal Govt for a $150 million investment against which he plans to produce 50Mn doses of the vaccine but he has received no response till the day I wrote this article. Meanwhile, Manitoba has announced it will purchase 2 million doses of this vaccine. Then there is another candidate from the University of Saskatchewan.

Leadership and quick decision mechanism are pivotal when you are facing a crisis of this scale. There has been a lot of unexpected and at times understandable lack of communication between the different levels and departments of the government especially when it came to lockdown law enforcement. To compound the administrative misery the Minister of Innovation, Science, and Industry, Mr. Navdeep Bains decided to quit his post right in the middle of the pandemic. It was like a Minister of Foreign Affairs quitting right in the middle of the war leaving an important Ministry in disarray.

But to the Government's credit, it came up with measures like CERB, CEWS, CEBA to help the beleaguered small businesses, unlike the US where no such support was extended to the employers and employees. 

Many countries that are not producing their own vaccine are still doing a great job in securing access for their citizens. Israel is a very good example of this. Even though they do not produce any vaccine of their own they started their vaccination program on Dec 9 and have so far vaccinated 60% of the population. Their success partly came from striking a deal with Pfizer to be first in line for the vaccine in exchange for supplying critical data on the shot’s effectiveness. So where did Canada lack when it came to securing access from outside?  

In the beginning, Canada appeared to have vaccine-acquisition under control. The Chinese pharma company CanSino had developed promising vaccine candidates, and Ottawa struck a deal to have it undergo human trials in Canada, with Canadian laboratories free to reproduce and manufacture the shot.

But only a few after Prime Minister Justin Trudeau announced the arrangement, the deal was terminated due to China’s apparent decision to block customs clearance of its vaccine to Canada. Whether it was an act of political retaliation related to Huwaei corporation, a logistical decision based on the decrease of Covid cases in Canada at that time, or a combination of both, China has come under criticism for shortchanging Canada as it continues to send the same vaccines in large numbers to countries closer to its political bloc.

Due to its reliance on China, Canada is lingering at the back of the line on orders when it comes to Pfizer & Moderna. It wasn’t until August 5 that Canada announced a plan to secure doses of the Pfizer and Moderna vaccines, and as of this week both companies have delivered a mere 1.2 million doses to Canada, with further deliveries delayed. In the U.K., by contrast, 10 million people have gotten their first vaccine dose as of Feb. 3, including 90 percent of the over-75 population in England, which has significantly blunted the deadliness of the pandemic. Canada is wary of approaching China and Russia due to understandable reasons. There was an initial reticence to approach India because of political compulsions, but better sense has prevailed and a channel has been opened in case there are continued delays from Pfizer and Moderna. 

The future Impact

The impact of this pandemic has been multidimensional.

It is literally changing all perceptions and conventions on their heads. I mean who would have thought the real estate in downtowns of big cities like Toronto, New York would crash massively by 30-40% or the same would rise by the same margin in the suburbs. Who would have thought something like Pandemic insurance be of such immense value one day?

The economic impact of the crisis is still unraveling. An estimate by the CFIB last summer said one in six or 181,000 businesses were at risk of going under as a result of the pandemic. With more than 50,000 businesses already closed in 2020, around 20% of private-sector jobs would be at risk.

The lost man-hours will impact elective surgeries, non-Covid hospital care for years to come. The same goes for every sector. The slowdown in the construction sector has affected real estate already. The interruptions in export-import channels will drive up commodity prices as well.

The human cost for people like me who could not attend the final moments of a loved one is beyond any number or percentage point. Everything else dwarfs in front of that loss which can not be compensated!

But thankfully there is a big silver lining in all this. The stock market rally shows everybody thinks this is a transient episode. Everyone has been talking about the V-shaped economic recovery. Japan's economy which has been a laggard for a long long time is surging like never before.

In Spite of the delay in vaccine delivery, the next few months will blunt the damage once the consignments start to roll in. This might be a good place to mention that Canada has led the world in per-person spending on Covid related measures. Therefore, when the vaccines come there will be a flood as Canada has so far ordered 400 million doses from a total of seven vaccine suppliers.

For healthcare professionals, another important impact is the change in people’s attitudes towards health. There are more conversations on matters related to health in public space. Also, there is a general appreciation towards the continuous care provided by professionals dentists when most of the medical clinics have been operating via telemedicine and hospitals have been reducing intake due to obvious reasons.

After all the doom and gloom, the coming months promise to bring some post-pandemic boom.

But one thing is for sure that this world belongs to microorganisms. 

They were before us, they will be after us. 

They are everywhere. They can even grow inside Nuclear reactors. Our body has more viruses than actual genetic material. 

We only survive because they don’t mutate enough to kill us all. 

It is their world and we are just living here on rent!