coagulation, which is another feature of severe and deadly Covid-19.
So far, there is no published research on rATG or similar heavy-duty transplant drugs for the treatment of Covid-19. “These are very powerful drugs, and there’s a risk you might endanger someone,” Icenogle says. Some doctors have been willing to test out comparatively mild immunosuppressant drugs, and at least one of those — dexamethasone — has worked. But Icenogle says that many in medicine regard the notion of depleting the immune system of a virus-stricken patient as “at least paradoxical, if not crazy.”
He thinks that will change. “We’re gradually coming to the realization that Covid-19 is primarily an autoimmune disease that is triggered by a virus,” Icenogle says. “I submit that eventually we’re going to treat these autoimmune processes with some of our big guns.”
Emory University’s Sanz says he also believes that immune-suppressing drugs, including some that have not yet been tried in people with Covid-19, will prove helpful. “Without any doubt,” he says. “But I think that only some patients will benefit.”
He emphasizes, again and again, that Covid-19 is a heterogeneous disease. It affects different people in different ways. Outside of a vaccine, there is unlikely to be a panacea or a single category of treatment that works for everyone. Still, Sanz says that a better understanding of the disease’s autoimmune facets, coupled with a broader deployment of immune-moderating therapies, could help improve patient outcomes — both in the short and long term.
“I think autoimmunity is part of the story,” Sanz adds. “It’s not the whole story.”
coagulation, which is another feature of severe and deadly Covid-19.
So far, there is no published research on rATG or similar heavy-duty transplant drugs for the treatment of Covid-19. “These are very powerful drugs, and there’s a risk you might endanger someone,” Icenogle says. Some doctors have been willing to test out comparatively mild immunosuppressant drugs, and at least one of those — dexamethasone — has worked. But Icenogle says that many in medicine regard the notion of depleting the immune system of a virus-stricken patient as “at least paradoxical, if not crazy.”
He thinks that will change. “We’re gradually coming to the realization that Covid-19 is primarily an autoimmune disease that is triggered by a virus,” Icenogle says. “I submit that eventually we’re going to treat these autoimmune processes with some of our big guns.”
Emory University’s Sanz says he also believes that immune-suppressing drugs, including some that have not yet been tried in people with Covid-19, will prove helpful. “Without any doubt,” he says. “But I think that only some patients will benefit.”
He emphasizes, again and again, that Covid-19 is a heterogeneous disease. It affects different people in different ways. Outside of a vaccine, there is unlikely to be a panacea or a single category of treatment that works for everyone. Still, Sanz says that a better understanding of the disease’s autoimmune facets, coupled with a broader deployment of immune-moderating therapies, could help improve patient outcomes — both in the short and long term.
“I think autoimmunity is part of the story,” Sanz adds. “It’s not the whole story.”
Updates Of all the lessons we’ve learned from this pandemic, the most significant is how unequal its effects have been
Coronavirus – latest updates
See all our coronavirus coverage
‘The pandemic has been a test of our self-interest, both as individuals and as nations.’ A volunteer in Bhopal has a swab sample taken during trials of India’s Bharat Biotech vaccine. Photograph: Sanjeev Gupta/EPA
If you wanted to run an experiment on Earth to understand human behaviour, the pandemic would be the perfect opportunity. In some people, the virus that causes Covid-19 has no symptoms. In others it leads to deadly disease. The virus pits the healthy against those with underlying health issues, and the young against the old. Infectious diseases can bind us together or drive us apart. Low-income countries know this too well; many face multiple outbreaks of infectious diseases each year. But richer countries such as Britain are still painfully learning that a virus doesn’t just attack the human body: it holds up a mirror to national weaknesses and runs havoc across society and the economy.
Across the world, the pandemic has resulted in a perverse “Hunger Games”, where countries have competed in mortality rate league tables while also trying to save their economies and cope with successive waves of this disease. In February and March, European governments chased down limited PPE stocks, ventilators, oxygen, out-of-stock reagents for their labs, and experimental steroids and drugs. The US was accused of stealing ventilators from Barbados, PPE from Germany and it bought up the rights to remdesivir, limiting the supply available to other countries. At the World Health Assembly in May, governments committed to sharing research products and working collectively to address Covid-19. But when governments were faced with tough decisions about how to share resources, their promises of cooperation broke down.
The pandemic has been a test of our self-interest, both as individuals and as nations. One of the key questions has been what responsibility richer countries owe towards poorer nations, particularly when it comes to ensuring the equitable distribution of a vaccine. Earlier this year, 171 countries pledged to take part in the Covax initiative, which aims to support the development and equitable distribution of 2bn vaccine doses before the end of 2021. But when the first vaccine proved successful, manufactured by Pfizer and BioNTech, richer countries bought up 80% of its doses.
In fact, one analysis by Oxfam found that even if all five of the most advanced vaccine candidates succeed, there would not be enough vaccine for most of the world’s people until 2022. This has always been the case in global health: whoever pays the highest price acquires the research products. The World Health Organization has actively tried to warn against this nationalistic approach, but in the end, words and pledges don’t amount to anything unless they are followed by action. It’s money and power that counts.
The same questions about selfishness can be asked of our commitment to each other at home. What responsibility does each of us have towards our communities? The pandemic has divided families, friends and neighbours over whether they’re willing to bend the rules to accommodate individual wishes, or make sacrifices with others in mind. The mixed reaction to summer holidays reflected this, as some people decided to travel to other countries, with the risk of transporting the virus with them, while others stayed put. In some schools, entire bubbles of children were sent home to isolate because one student in the bubble had been on holiday abroad and their parents had decided not to follow the 14-day quarantine rule.
Families have been split over the question of Christmas celebrations; whether it’s sensible to host multiple families at one gathering, or wait to delay festivities until the spring or summer when a mass vaccination programme is in motion. On many occasions, the virus has forced us to decide how comfortable we each are with particular risks, and to reevaluate others according to their own risk threshold. We may have become closer to some families who share our thinking, and distanced ourselves from others who have different approaches to the pandemic. In comparing our pre- and post-Covid selves, we’re perhaps at risk of overstating how much the pandemic has changed us: instead, it has simply shown each of us who we really are.
There were many bright moments of selflessness in 2020. Many people made huge personal sacrifices – none more so than the health workers who put their own lives at risk to treat patients needing care. Because of their occupation, healthcare workers are seven times more likely to get severe Covid-19 than other workers, and many turned up to work on wards in March and April without adequate PPE, ready to accept whatever came their way. Elsewhere, bus drivers, security guards, social care workers, cleaners, grocery store workers, mutual aid groups, and teachers all put the needs of running society above their own health and welfare. If anything this pandemic should give us cause to reflect who adds value to society and whether we are compensating these roles appropriately.
On the other hand, time and time again in Britain, we’ve seen that it is one rule for some people (the wealthy and powerful) and another rule for others (the rest of us). The government created a loophole in quarantine restrictions that allowed “high value” business travellers to skip the mandatory 14-day isolation period when arriving into the country. Celebrities have hosted private parties while the rest of us have avoided social gatherings and seeing our family and friends. Most memorable of all, the prime minister’s then chief adviser, Dominic Cummings, breached Covid rules but remained in his post.
Of all the lessons we’ve learned from this pandemic, the most significant is how unequal its effects have been. Wealth, it turns out, is the best shielding strategy from Covid-19. As poorer people crowded together in cramped housing, the rich escaped to their country retreats. Two of the largest risk factors for dying from Covid-19 are being from a deprived background and being from a minority-ethnic background, pointing to the underlying role of social inequalities, housing conditions and occupation.
Coronavirus – latest updates See all our coronavirus coverage ‘The pandemic has been a test of our self-interest, both as individuals and as nations.’ A volunteer in Bhopal has a swab sample taken during trials of India’s Bharat Biotech vaccine. Photograp (#295748) · Issues · GitLab.org / GitLab · GitLab
Our society’s recovery from this disease should be centred on building more equal, resilient societies, where people in all parts of the world have access to both protection from the disease and access to research developments. It all starts with government. At the end of a gruelling 11 months, I’m left with Abraham Lincoln’s words in my mind: the pandemic has shown that we need “government of the people, by the people, for the people” – not just government for the wealthy elite. Perhaps that’s the strongest legacy of Covid-19.
• Prof Devi Sridhar is chair of global public health at the University of Edinburgh
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coagulation, which is another feature of severe and deadly Covid-19.
So far, there is no published research on rATG or similar heavy-duty transplant drugs for the treatment of Covid-19. “These are very powerful drugs, and there’s a risk you might endanger someone,” Icenogle says. Some doctors have been willing to test out comparatively mild immunosuppressant drugs, and at least one of those — dexamethasone — has worked. But Icenogle says that many in medicine regard the notion of depleting the immune system of a virus-stricken patient as “at least paradoxical, if not crazy.”
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He thinks that will change. “We’re gradually coming to the realization that Covid-19 is primarily an autoimmune disease that is triggered by a virus,” Icenogle says. “I submit that eventually we’re going to treat these autoimmune processes with some of our big guns.”
Emory University’s Sanz says he also believes that immune-suppressing drugs, including some that have not yet been tried in people with Covid-19, will prove helpful. “Without any doubt,” he says. “But I think that only some patients will benefit.”
He emphasizes, again and again, that Covid-19 is a heterogeneous disease. It affects different people in different ways. Outside of a vaccine, there is unlikely to be a panacea or a single category of treatment that works for everyone. Still, Sanz says that a better understanding of the disease’s autoimmune facets, coupled with a broader deployment of immune-moderating therapies, could help improve patient outcomes — both in the short and long term.
“I think autoimmunity is part of the story,” Sanz adds. “It’s not the whole story.”
coagulation, which is another feature of severe and deadly Covid-19.
So far, there is no published research on rATG or similar heavy-duty transplant drugs for the treatment of Covid-19. “These are very powerful drugs, and there’s a risk you might endanger someone,” Icenogle says. Some doctors have been willing to test out comparatively mild immunosuppressant drugs, and at least one of those — dexamethasone — has worked. But Icenogle says that many in medicine regard the notion of depleting the immune system of a virus-stricken patient as “at least paradoxical, if not crazy.”
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He thinks that will change. “We’re gradually coming to the realization that Covid-19 is primarily an autoimmune disease that is triggered by a virus,” Icenogle says. “I submit that eventually we’re going to treat these autoimmune processes with some of our big guns.”
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Emory University’s Sanz says he also believes that immune-suppressing drugs, including some that have not yet been tried in people with Covid-19, will prove helpful. “Without any doubt,” he says. “But I think that only some patients will benefit.”
He emphasizes, again and again, that Covid-19 is a heterogeneous disease. It affects different people in different ways. Outside of a vaccine, there is unlikely to be a panacea or a single category of treatment that works for everyone. Still, Sanz says that a better understanding of the disease’s autoimmune facets, coupled with a broader deployment of immune-moderating therapies, could help improve patient outcomes — both in the short and long term.
“I think autoimmunity is part of the story,” Sanz adds. “It’s not the whole story.”
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Updates Of all the lessons we’ve learned from this pandemic, the most significant is how unequal its effects have been
Coronavirus – latest updates
See all our coronavirus coverage
‘The pandemic has been a test of our self-interest, both as individuals and as nations.’ A volunteer in Bhopal has a swab sample taken during trials of India’s Bharat Biotech vaccine. Photograph: Sanjeev Gupta/EPA
Fri 25 Dec 2020 08.00 EST
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If you wanted to run an experiment on Earth to understand human behaviour, the pandemic would be the perfect opportunity. In some people, the virus that causes Covid-19 has no symptoms. In others it leads to deadly disease. The virus pits the healthy against those with underlying health issues, and the young against the old. Infectious diseases can bind us together or drive us apart. Low-income countries know this too well; many face multiple outbreaks of infectious diseases each year. But richer countries such as Britain are still painfully learning that a virus doesn’t just attack the human body: it holds up a mirror to national weaknesses and runs havoc across society and the economy.
Across the world, the pandemic has resulted in a perverse “Hunger Games”, where countries have competed in mortality rate league tables while also trying to save their economies and cope with successive waves of this disease. In February and March, European governments chased down limited PPE stocks, ventilators, oxygen, out-of-stock reagents for their labs, and experimental steroids and drugs. The US was accused of stealing ventilators from Barbados, PPE from Germany and it bought up the rights to remdesivir, limiting the supply available to other countries. At the World Health Assembly in May, governments committed to sharing research products and working collectively to address Covid-19. But when governments were faced with tough decisions about how to share resources, their promises of cooperation broke down.
The pandemic has been a test of our self-interest, both as individuals and as nations. One of the key questions has been what responsibility richer countries owe towards poorer nations, particularly when it comes to ensuring the equitable distribution of a vaccine. Earlier this year, 171 countries pledged to take part in the Covax initiative, which aims to support the development and equitable distribution of 2bn vaccine doses before the end of 2021. But when the first vaccine proved successful, manufactured by Pfizer and BioNTech, richer countries bought up 80% of its doses.
In fact, one analysis by Oxfam found that even if all five of the most advanced vaccine candidates succeed, there would not be enough vaccine for most of the world’s people until 2022. This has always been the case in global health: whoever pays the highest price acquires the research products. The World Health Organization has actively tried to warn against this nationalistic approach, but in the end, words and pledges don’t amount to anything unless they are followed by action. It’s money and power that counts.
The same questions about selfishness can be asked of our commitment to each other at home. What responsibility does each of us have towards our communities? The pandemic has divided families, friends and neighbours over whether they’re willing to bend the rules to accommodate individual wishes, or make sacrifices with others in mind. The mixed reaction to summer holidays reflected this, as some people decided to travel to other countries, with the risk of transporting the virus with them, while others stayed put. In some schools, entire bubbles of children were sent home to isolate because one student in the bubble had been on holiday abroad and their parents had decided not to follow the 14-day quarantine rule.
Families have been split over the question of Christmas celebrations; whether it’s sensible to host multiple families at one gathering, or wait to delay festivities until the spring or summer when a mass vaccination programme is in motion. On many occasions, the virus has forced us to decide how comfortable we each are with particular risks, and to reevaluate others according to their own risk threshold. We may have become closer to some families who share our thinking, and distanced ourselves from others who have different approaches to the pandemic. In comparing our pre- and post-Covid selves, we’re perhaps at risk of overstating how much the pandemic has changed us: instead, it has simply shown each of us who we really are.
There were many bright moments of selflessness in 2020. Many people made huge personal sacrifices – none more so than the health workers who put their own lives at risk to treat patients needing care. Because of their occupation, healthcare workers are seven times more likely to get severe Covid-19 than other workers, and many turned up to work on wards in March and April without adequate PPE, ready to accept whatever came their way. Elsewhere, bus drivers, security guards, social care workers, cleaners, grocery store workers, mutual aid groups, and teachers all put the needs of running society above their own health and welfare. If anything this pandemic should give us cause to reflect who adds value to society and whether we are compensating these roles appropriately.
On the other hand, time and time again in Britain, we’ve seen that it is one rule for some people (the wealthy and powerful) and another rule for others (the rest of us). The government created a loophole in quarantine restrictions that allowed “high value” business travellers to skip the mandatory 14-day isolation period when arriving into the country. Celebrities have hosted private parties while the rest of us have avoided social gatherings and seeing our family and friends. Most memorable of all, the prime minister’s then chief adviser, Dominic Cummings, breached Covid rules but remained in his post.
Of all the lessons we’ve learned from this pandemic, the most significant is how unequal its effects have been. Wealth, it turns out, is the best shielding strategy from Covid-19. As poorer people crowded together in cramped housing, the rich escaped to their country retreats. Two of the largest risk factors for dying from Covid-19 are being from a deprived background and being from a minority-ethnic background, pointing to the underlying role of social inequalities, housing conditions and occupation.
Coronavirus – latest updates See all our coronavirus coverage ‘The pandemic has been a test of our self-interest, both as individuals and as nations.’ A volunteer in Bhopal has a swab sample taken during trials of India’s Bharat Biotech vaccine. Photograp (#295748) · Issues · GitLab.org / GitLab · GitLab
Our society’s recovery from this disease should be centred on building more equal, resilient societies, where people in all parts of the world have access to both protection from the disease and access to research developments. It all starts with government. At the end of a gruelling 11 months, I’m left with Abraham Lincoln’s words in my mind: the pandemic has shown that we need “government of the people, by the people, for the people” – not just government for the wealthy elite. Perhaps that’s the strongest legacy of Covid-19.
• Prof Devi Sridhar is chair of global public health at the University of Edinburgh