Experts Urge Collaboration on Research on Coronavirus (COVID-19)

Leading experts on microbiology and infectious diseases met at the University of Toronto recently to discuss possible solutions to Coronavirus (COVID-19), with some participants emphasizing the need for Canadian researchers to collaborate with each other in the race to find a way to diagnose and treat the disease.

The panel featured experts including Professors Samira Mubareka, Allison McGeer, Matthew Muller, Beate Sander and David Fisman.

“We can’t fight this alone,” said Mubareka, an assistant professor in the department of laboratory medicine and pathobiology at U of T and a microbiologist at Sunnybrook Health Sciences Centre. She said working in a cross-disciplinary manner on battling the spread of COVID-19 is crucial.

“I know when you have a short time frame to address critical research needs, it’s hard to bring together a multi-disciplinary group if you’re not already working as a network, but going forward, that’s going to be absolutely key,” she said.

Members of the Faculty of Medicine’s department of laboratory medicine and pathobiology organized the panel on February 14.It included dozens of experts in microbiology, infectious diseases, virology, infection prevention and control, epidemiology and public health.

In terms of future research objectives, Prof. Allison McGeer said randomized clinical trials are needed in outbreak settings.

“First of all, we did not do a great job in Canada with organizing the research into SARS. . .we can do better both with the flow of information and with the publication of results,” she said.

Observational studies have “real limitations,” she said.

“[We did] probably all we could do during SARS, [but] we really need to try to hold out this time, if we can, for randomized clinical trials,” said McGeer, who is a professor at U of T’s Dalla Lana School of Public Health and in the departments of medicine, and laboratory medicine and pathobiology at U of T. She is also director of the infectious diseases epidemiology research unit at Mount Sinai Hospital, Sinai Health System.

Prof. Matthew Muller said researchers are keenly interested in the transmissibility of COVID-19, and what the fatality rate is for those who contract the virus. The hope of containment of the virus still exists, he said.

“I think the big question on my mind right now is about the epidemiology of this infection. Is this going to be a mild SARS, or a bad flu?,” said Muller, an associate professor of medicine at U of T and the medical director of infection prevention and control at St. Michael’s Hospital, Unity Health Toronto.

“I think that’s really critical . . . people very logically interpreted this as another SARS outbreak at the beginning, but now we now have increasing information it’s not behaving like that.”

Muller said right now in Canada a “containment mentality” exists around the virus, but that could change, depending on the circumstances. Controlled trial data as soon as possible is critical for progress in research, he said, to see what type of impact possible treatments may have.

He also said from an infection control perspective, there is an immense amount of interest about whether a vaccine can be developed. “From a research perspective, any information about if and when a vaccine [is available] would be important,” he said.

“There is going to be a huge push for therapeutics . . . there is a huge pressure to treat people when they are deteriorating, regardless of whether the treatment you give them is beneficial or harmful.”

Mubareka told the group the phenotype of transmission for COVID-19 is very different than Middle East Respiratory Syndrome (MERS). There are also differences from SARS, she noted.

“These are things that could be answered experimentally,” she said.

Reverse genetics could be used to understand COVID-19’s transmission phenotype, she said. A transmission model for COVID-19 needs to be established in the long-term, she added.

“I think we need to start working on this now because these things take time, and there are a lot of failures before there’s success,” she said. She also said researchers need to understand whether bats are the reservoir and whether an intermediate host, like palm civets for SARS and camels for MERS, was involved.

“We need to remember the bat is not the culprit here. It is human encroachment on their ecosystem that’s the problem,” she said.

Prof. Beate Sander urged the group to keep different health care systems across the world in mind when developing possible solutions, like point-of-care diagnostic tools.

“If it works here, I think everyone [wants to see] if it will work in a different setting just as easily as here,” said Sander, who is an associate professor in the Institute of Health Policy, Management and Evaluation at U of T’s Dalla Lana School of Public Health, and director of population health economics research at Toronto General Hospital Research Institute, University Health Network.