It’s not often ‘virus-slayers extraordinaire” like Professor Peter Piot fall victim to a historically unique version of a global virus – one which very nearly killed him.
In his own jocular words, ‘after I made the life of viruses miserable for several decades, a virus got me,’ (his team co-discovered the Ebola virus and developed a successful vaccine for it, plus he’s an AIDS research pioneer). Three months ago, Prof Piot developed splitting headaches and extreme exhaustion, ironically struggling to get an NHI C-19 test in London before securing it privately. He tested positive and was admitted to the University College London Hospital, the first patient to be diagnosed with C-19 and interstitial pneumonia, with a hyper-immune response. After discharge, he arrived home in tears of relief, and promptly developed atrial fibrillation and fibrosis on the lungs, conditions which he says now seem to be slowly clearing up, though he expects some lung-scarring.
The guest on a popular webinar last Thursday (June 4th), part of a series hosted by Discovery Health in conjunction with Medical Brief, the Desmond Tutu HIV Foundation, the SA Medical Association, the SA Private Practitioners Forum and the Unity Forum for Family Practitioners, Prof Piot had his audience of some 1 500, mostly clinicians, enthralled, not only for sharing his ‘inside out’ learning experience, but for his expertise and opinions on the virus, which has eluded all mitigation therapies and so far, a vaccine.
“I’m glad I had Corona and not Ebola, although I read a scientific study that concluded you have a 30% chance of dying if you end up in a British hospital with COVID-19. That’s about the same overall mortality rate as for Ebola in 2014 in West Africa. That makes you lose your scientific level-headedness at times, and you surrender to emotional reflections,” he confessed to webinar facilitator Professor Linda-Gail Bekker, the deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Diseases and Molecular Medicine at UCT.
C-19 can affect multiple organs
Prof Piot, described in the Financial Times as, ‘the Mick Jagger of Microbiology,” told his audience that, “Many people think COVID-19 kills 1% of patients, and the rest get away with some flu-like symptoms. But the story gets more complicated. Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives. The more we learn about the coronavirus, the more questions arise. We’re learning while we’re sailing. That’s why I get so annoyed by the many commentators on the side-lines who, without much insight, criticise the scientists and policymakers trying hard to get the epidemic under control. That’s very unfair.”
He said that, coming from the HIV tradition, he’d seen how people living with HIV played a big role, especially in South Africa, something almost total absent with COVID-19 where public discussion centred on data and flattening the infection and mortality curves. His experience of being infected and the publicity it generated completely changed his perspective as feedback from those with similar, until then rare symptoms, began pouring in.
Strongly backing the use of all-purpose oxygen versus ventilators for treatment, he said it was vital to address patients with symptoms similar to his, “who fall between those who have a bit of a flu which is over in 5 days or week and those in the 1% bracket who’ll die – plus there’s the belief that infected people over 70, (he’s 73), will die soon anyway. I want to show what’s in between, which has been hugely neglected, because we think this is a respiratory virus which mainly affects the lungs.’
Prof Piot described the virus as, “nasty – it goes into your whole body.”
He said it caught the world by surprise, with those countries most affected by the H1NI and SARS pandemics, (Hong Kong, Singapore and South Korea), faring best as their populations proved compliant with masks, hand hygiene and social distancing and response systems in place. In stark contrast, political C-19 denialism among political leaders, best exhibited in Brazil and to a lesser extent in the USA, was akin to the Mbeki AIDS denial years in South Africa.
Like practicing a fire drill as hospital burns
The analogy he used in describing global preparedness and most C-19 responses was one of a hospital practicing a fire drill as it burnt down. A firm advocate of investing billions in preparedness around health care infrastructure, and therapeutic and vaccine research protocols, Prof Piot said the biggest challenge was that it was not obvious what the return on investment was in the absence of a pandemic. Manufacturing ancillary products such as millions of glass vials, was also a challenge. He’s a firm advocate of solid, peer-reviewed clinical trials, and stresses that any therapy or vaccine with even a one percent serious side-effect would harm millions in a global pandemic such as the coronavirus.
Of the actual pandemic he said; “The same thing could happen again in 40 or 50 years-time. It’s a bit like San Francisco talking about the ‘Big One,” (an earthquake), destroying the city sometime in the future.”.
Stressing preparedness, he said that for C-19, finding an anti-viral therapy, (AVT), quickly and using it as a pre and post exposure prophylaxis was vital, while the use of both AVT and immune-suppressants early on would be hugely effective. However, if used too late these would have no impact. He said the development of two vaccines for Ebola was ‘great news,’ but for C-19, testing seemed to be extraordinarily difficult to organise, with it being rationed in the United Kingdom, something he had a direct, traumatic experience of.
“This is simply bad policy. Government institutions only test symptomatic people. Yes, we know how many uncertainties there are. Asymptomatic people can transmit the virus; it’s probably very contagious two days before symptoms show, and yet they deny access to testing and centralise it! Testing should be in pharmacies and at point-of-care. We also need a system with rigorous quality assurance and validation of those tests, which complicates life,” he added.
He said herd immunity was misunderstood. It only worked if a minimum level of individuals were rendered immune through vaccination. For example, with measles, this meant 90% of a population had to be vaccinated in order to protect the unvaccinated. Protecting the vulnerable while exposing the younger, less infection-prone to the virus seemed like a sensible strategy, yet Sweden’s herd-immunity policy left them with the biggest C-19 mortality in Europe.
“We’re no longer in the Middle Ages – we shouldn’t let the natural course of an infection go. There’s no way that by some miracle, one fine day it will disappear. As long as there are susceptible people in the world, the virus will look for people – a virus’s very reason for living is to find a host!” he added.