We've known about coronaviruses for decades. They cause 20% to 30% of the common cold. They also caused very severe illnesses like SARS a number of years ago, or a form coming out of the middle East called MERS, which is a particularly lethal coronavirus infection.
So these respiratory viruses have been around with humans for a while. In fact, if you go back to Florence in the 1400s with the plague, or hantavirus in London in the 1500s, we've been sitting around infectious disease pandemics for eternity. That's part of our existence.
We already have a defense system in our bodies that deals with viruses you and I get all the time. That's why many patients out there probably had coronavirus and didn’t even know about it. They get infected and their immune system shuts down viral replication, so the virus doesn't really become a disease. It just becomes an asymptomatic infection, and then they clear the virus.
Other patients, for reasons we don't understand, get a very severe respiratory and vascular illness, and then a whole body illness that may land them in the hospital and maybe on a ventilator.
When you or I get infected by coronavirus, one way we try to eliminate it is by making antibodies against that coronavirus in order to clear the virus from our body. And that forms the basis for treatment of those patients who can't clear the virus themselves. Can we boost their immune system by giving them an antibody against the virus – similar to the one that you and I would generate if we were to clear it? That's the basis of antibody-based treatments.
The other way you could potentially treat the virus is by actually seeing where the virus has specific targets – which are only coded for by the coronavirus genome and not by the human genome – that you could inhibit with a drug. For instance, there's an enzyme called a polymerase, which allows the RNA of the virus to replicate. If you could inhibit that polymerase specifically, then the virus can’t actually replicate to form more viruses, and the infection would be gone. So those are antiviral therapies.
In some patients with severe illness, the body has an unusually strong immune reaction to this disease. And it turns out that later, when you're on the ventilator, when your lungs are filled up with fluid, one of the main culprits is not so much the virus at that point, but an overactive and dysregulated immune system.
Normally, you have an immune system to get rid of things, but if it overshoots, it becomes a problem. And that's where immunosuppressive drugs could come into play, because they actually turn down the immune system in order to treat a disease. So there really are two forms of treatment: antiviral therapy, and then immunosuppressive therapy later on.
Roche is partnering in consortiums across the globe, in industry and governments and hospitals, to see how we can complement what others are offering. And we've been doing this all at the same time the pandemic was coming, flattening out and rising again.
It could come back seasonally, just like influenza. Roche has experience in dealing with pandemics and epidemics with influenza, and that’s one of the reasons companies are coming to us to ask for assistance and collaboration in developing their medicines. Now more than ever, partnerships are essential.
Read James Sabry’s thoughts on the future of medicine
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