Stanley Perlman, M.D., Ph.D.: Insights From a Coronavirus Expert on COVID-19 | The Drive with Peter Attia #117

Key Takeaways

  • Coronavirus is a family of viruses grouped together because of their similar replication strategy, microscopic appearance, and other related patterns
  • Coronaviruses are unusually large in terms of RNA
  • SARS-CoV-2 is unique because it’s a mixture of common cold coronavirus in terms of high transmissibility with the severity of SARS-CoV-1 in lungs
  • “This virus is never going away. There’s nothing about this virus that suggests it’s ever going away. So now the question is how we coexist with the virus.” – Peter Attia

Introduction

Dr. Stanley Perlman, M.D. Ph.D. is a professor of microbiology and immunology as well as Chair of immunology at the University of Iowa. Dr. Perlman has researched coronaviruses for nearly 40 years.

In this episode of The Drive, Dr. Perlman provides background on various types of coronaviruses and compares previous coronavirus outbreaks with the current COVID-19 pandemic.

Host: Peter Attia (@PeterAttiaMD)

What is a Coronavirus?

  • Coronavirus is a family of viruses grouped together because of similar replication strategy, microscopic appearance, and other related patterns
  • “Corona” refers to appearance under an electron microscope where coronas of sun or crown are visible
  • It was first identified in the 1930s or 40s from chicken
  • Coronaviruses are large in terms of RNA but it’s unclear why they have so much genetic material
  • Coronaviruses infect across species and are found in humans, animals, reptiles, etc.
  • Types include the common cold, SARS, MERS, SARS-CoV-1, SARS-CoV-2
  • Coronaviruses have the ability to cause demyelination which is what we see in multiple sclerosis
  • There is generally seasonality associated and we see a rise in winter/early spring

SARS, 2002

  • SARS (AKA SARS-CoV-1) first appeared in 2002 and was effectively eliminated
  • Emerged as a respiratory disease in southern China and was found to be coronavirus derived from the live animal market
  • Likely bat virus that spread through other animals and eventually human handlers, then across humans
  • R0 of SARS is officially 2-3 so a single person can infect 2-3 people
  • SARS-CoV-1 was different than SARS-CoV-2 because you weren’t contagious until you were visibly and obviously ill so it was clearer to contain by isolating people with respiratory illness
  • SARS-CoV-1 also differed in that it couldn’t bounce back and forth from animals to humans

MERS, 2012

  • MERS was identified in camels decades prior to humans and presented as a common cold
  • To this day we’re not sure how it jumped to humans and why it only infected humans in the Arabian Peninsula and not other regions (i.e., North Africa or Africa) with camels
  • In humans, it presented very similar to SARS in that it’s a deep lung disease
  • R0 of MERS is estimated around 0.65 but it has previously spread in hospitals so is possible to transmit human-to-human
  • We still see a few cases annually but it’s still contained in the Arabian Peninsula

SARS-CoV-2, 2019

  • The previous coronaviruses remained geographically confined so there was a question about how widespread SARS-CoV-2 was going to be when we heard about it in China
  • SARS-CoV-2 is unique because it’s a mixture of common cold coronavirus in terms of high transmissibility with the severity of SARS-CoV-1 in lungs
  • The ease with which the virus transmits is what’s making numbers so huge
  • Lethality is not necessarily high, but the denominator is so large because of transmissibility that we have a lot of people dying from it  

COVID-19 Immune Response, Herd Immunity, & Treatment

  • The innate immune system doesn’t seem to do much against SARS-CoV-2
  • Exposure to other coronaviruses may offer some protection against SARS-CoV-2 but there is no concrete evidence
  • We don’t know a lot about T cell response in the common cold because they usually go away in a few days so resources have not been poured into studying
  • We’re likely to see an antibody response that wanes over time, but we are not sure of the exact period
    • This could also mean if a vaccine is developed, we will need periodic boosters
  • To fight COVID-19, it looks like we need a specific (IgA) response, which also seems to wane over time

Herd immunity  

  • Herd immunity means if there’s a virus that’s contagious, you have to have most people be resistant to the virus
  • We haven’t had to consider herd immunity in other coronaviruses because they generally go away on their own – but that is not the case with COVID-19
  • For common viruses, herd immunity is around 60-70% to protect the general population
  • You’re still susceptible to the virus but it’s less likely you will get sick
  • The higher the R0, the higher the need for herd immunity

Treatment & therapeutic options

  • There doesn’t appear to be much genetic drift in SARS-CoV-2 which is good because this makes vaccine development more plausible
  • “There’s really no evidence so far that says this virus has changed in a way that makes it unlikely a vaccine will work, unlikely that a previous infection will protect you from a second infection–there may be reasons why it won’t, but it won’t be because the virus is changing.” — Stanley Perlman
  • The goal of a vaccine will be to confer enough immunity to prevent transmissibility and protect an individual from severe pneumonia
  • For more effective treatment, we need biomarker staging for the disease to assess correct therapy for each level
  • Ideally, we will develop biomarker staging for the disease to assess correct therapy for each level
    • We can do this by taking samples from people every few days and putting in machine learning model, then see at what block of markers appear and treat accordingly
  • “This virus is never going away. There’s nothing about this virus that suggests it’s ever going away. So now the question is how we coexist with the virus.” – Peter Attia

How Can We Prepare for a Future Pandemic?

  • Preemptive NIH funding is tricky because we have to make a compelling case for a pandemic that doesn’t exist while not draining resources for things that we are facing  
  • The argument that it’s ridiculous to have $3 billion aside for virus that doesn’t exist yet, but we also need to hedge our bets  
  • We need to consider “no regret” moves – such as technological infrastructure for contact tracing, backstock of PPE, reagent to run tests once tests are available, etc.

Drive with Dr. Peter Attia : , , ,
Notes By Maryann

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