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Dr. Eleftherios Mylonakis Speaks to TNH about Coronavirus

BOSTON – Dr. Eleftherios Mylonakis, Charles C.J. Carpenter Professor of Infectious Disease at Brown University, spoke to The National Herald about the coronavirus. In terms of prevention he said “vaccines are in early clinical evaluation and additional vaccines are in the process of moving to clinical study” and he added that “the scientific community is making an unprecedented effort to provide some much needed solutions.”

Dr. Mylonakis is also the Chief of Infectious Diseases at Rhode Island Hospital and the Miriam Hospital and Director of the COBRE Center for Antimicrobial Resistance and Therapeutic Discovery. He is Assistant Dean for Outpatient Investigations and Director of the Center for Outpatient and Longitudinal Medical Research at the Alpert Medical School of Brown University and Professor of Molecular Microbiology and Immunology. He was previously Attending Physician of Infectious Disease at Massachusetts General Hospital and served as an Associate Professor at Harvard Medical School. Dr. Mylonakis studies host and microbial factors of infection and the discovery of antimicrobial agents. His research encompasses both clinical and laboratory studies and the use of mammalian and invertebrate model hosts systems to identify novel antimicrobial compounds and the elucidation of evolutionarily conserved aspects of microbial virulence and the host response. He has eight patents, edited five books and has written over 350 articles in the peer-reviewed literature.

Dr. Mylonakis is also a practicing physician who sees clients at the hospital.

Speaking about the COVID-19 he said “it is a challenge that extends beyond the confines of medicine, challenging the economy, as well as the cohesiveness of societies, and our own humanity. The virus is most likely a zoonosis, most likely derived from bats and through steps that are unclear at this time found its way to humans. The transmissibility of the virus (called SARS-CoV-2) that causes the disease COVID-19 is many times higher than influenza. The rate of transmission, the lack of immunity, the severity of the infection, along with failures in handing this situation resulted in the pandemic we are in now.”

 He emphasized that “communicable diseases spread from person to person through the social contact network, and human movement and contact patterns affect disease spread. Understanding this network and the way people interact with each other is crucial for modeling epidemics, and using detailed data of their movement and interactions can help model and forecast disease spread. This is depicted by the clinical situation in the United States that is highly variable. Health systems had to adapt to the pandemic and it appears that the virus was in the United States many weeks before it was originally thought and had taken a stronghold to certain large population centers. Mathematical modeling has been able predict overall trends over time, but has had challenges to accurately simulate human mobility and forecast disease spread in real time.”

He added that “we have had a number of challenging situations and the scientific community is making an unprecedented effort to provide some much needed solutions. Clinical manifestations of COVID-19 range from asymptomatic or mild infection to severe forms of disease that are life-threatening. Interestingly, recognized risk factors for severe disease and death include advanced age and chronic conditions such as chronic lung disease, cardiovascular disease, diabetes mellitus, and hypertension. Moreover, chronic conditions like diabetes, heart disease and hypertension are associated with COVID-19 severity.”

Dr. Mylonakis explained that “the clinical presentation includes many different aspects that we are still learning. For example, thrombotic events (blood clots) are very common and probably more than what was initially reported. Endothelial shedding and thrombosis in vessels and cardiac inflammatory changes are reported as we are still learning about the pathogenesis.”

Speaking about the infection he said that “the diagnosis of the infection and the number of asymptomatic cases is still unclear. Even the duration of antibodies and the level (titer) of antibodies that confer immunity has not been established yet.”

As far as therapies are concerned he said “the pandemic has highlighted the lack of effective therapies readily available to address this viral infection and the excessive immune response that it can cause. COVID-19 is associated with what is known as a cytokine storm syndrome in some patients, a condition hallmarked by excessive activation of immune cells. This immune response appears to cause severe complications.”

In terms of drugs’ availability he said “Remdemsivir is an antiviral that has attracted considerable attention. So far studies are underpowered or have no control group. Three larger studies are in progress and should be coming out the next few weeks. A number of immune-modulators and other antivirals studies are going on but they are in early stages or there is nothing exciting so far. Also, monoclonal antibodies and hyper-immune globulin studies are progressing but plans are for early fall and mid-summer, respectively. Convalescent serum is now also used. Still, preliminary data and the amount of antibody is not standardized. Hyper immune serum with established concentration of Abs should be available in a few weeks.”

He emphasized that “regarding prevention and the future projections, interventions are essential in controlling an epidemic. Such interventions include social distancing, voluntary self-isolation, increased screening, closure of schools and workplaces, cleaning and disinfection of public spaces, and promoting of hand hygiene and respiratory etiquette. Also, when available, screening of contacts, vaccination, and other interventions can also help contain such micro-epidemics. However, available infection prevention resources during an emerging epidemic are limited and subject to logistical constraints. As a result, health agencies have to prioritize interventions to certain areas and groups of the population and they are unable to follow the transition of an epidemic in real time.”

Dr. Mylonakis thinks that “even though social distancing measures have helped us ease the challenge to the health system, the economic ramifications cause calls to expedite the re-opening of the economy. In order to move to the next phase, there are a number of components that need to be in place. Including, a sustained reduction in cases for two weeks or more, local hospitals that are prepared to sustain the surge, and high testing capacity that includes monitoring of all confirmed cases and their contacts. Moreover, understanding and monitoring the number of asymptomatic cases in the community and the long term sequelae of the infection also need to be studied further.”

He believes that “overall, we should expect having some better understanding of treatment agents, but we need a variety of options, including monoclonal antibodies. At the same time, widely available testing and strong public health capabilities to track cases and contacts will be needed as we try to reopen the economy, even if some parts cannot fully return to normal. Until we build herd immunity (hopefully with a vaccine that provides long term immunity) we should expect a non-linear progression with potential setbacks at, but hopefully, only at the local level.”

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