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o add to that uncertainty, although vaccine candi
dates are able to raise potent antibodies in animal studies and in humans, none of them have been shown to protect infection of the nasal passages in animal studies. That raises the very serious question of whether they will actually prevent the entire disease, some diseases, or no diseases. The safety and efficacy of a vaccine is also a critical issue since they are used for fully healthy people. A COVID-19 vaccine may be used for many billions of people, so it must be extraordinarily safe.” When it comes to COVID-19 treatments, which ones so far have you seen that are most promising? ”For seriously ill patients, the treatments that seem to reduce mortality are medical practices, like proning patients by putting them on their stomachs, managing intubation and ICU care more carefully, and moving people as quickly as possible from ICU to step-down facilities. Using tools that are currently available, those simple processes have made a significant difference in survival, reducing the death of patients that require intubation in ICU care from about 80 or 90% to about 50 or 60%. There has been some success in using existing drugs, such as anticoagulants. If used properly, these can substantially reduce the mortality of ICU and intubated patients by as much as 80%. This would drop mortality from 80 to 25 or 30%, which is a very dramatic reduction. The use of dexamethasone, which has been modestly successful in reducing deaths from 80% to 60% or 60% to 30% depending on the situation, and the use of a combination of drugs – kaletra, ribavirin, and interferon – can also reduce the number of deaths of severely ill patients. There are very few drugs that make any difference in retarding the early stages of infection and preventing people from progressing from early to late stage.” Azidothymidine (AZT) was a failed cancer drug that sat on the shelf for twenty years before you proved its effectiveness against HIV. On what shelf do you think we will find the treatment for COVID-19? ”Effective treatments for COVID-19 were developed as treatments for SARS and later for MERS. Those include drugs that affect heat enzymes and processes the virus needs to replicate. It is a great tragedy that those drugs stayed on the shelf and were never stockpiled. Had the protease inhibitors, helicase inhibitors, and other antiSARS drugs been stockpiled, nobody needed to have died from this infection. It would have been entirely preventable by stockpiling drugs, and many people like myself pointed out that should have been required. Unfortunately, all countries have failed in their duty to protect their people from coronavirus infections by not stockpiling drugs. It is ironic that exactly those drugs that inhibit SARS and MERS also inhibit the COVID virus. They never passed the safety standards, were never put through clinical trials, and were never stockpiled. If there is a single greatest failure in anticipation that could have made the biggest difference, it is the failure to stockpile anti-SARS drugs, which would have stopped COVID cold.” How can we be better prepared for a new pandemic or a new wave of this one? Describe your dream scenario? ”Biologists understand most of the potential threats from the natural world. In the future, we should have drugs stockpiled to protect ourselves against those threats in the same way as we have drugs stockpiled to protect ourselves from what we regard as bioterrorism. I myself have developed drugs that are currently stockpiled by the U.S. government to protect us from bioterrorist attacks. We should realize that nature is a far greater terrorist. If we didn’t realize it before, we should realize it as a result of the COVID pandemic. Additionally, every country should make sure they have a fully functioning and coordinated public health service, capable of creating policy and implementing that policy at a national, regional, and local level in an integrated fashion. We should also encourage our biopharmaceutical industry to develop classspecific drugs that are capable of effective treatment of the biological threats that we currently perceive.” What can we do today to fight this virus that we could not do, or not do so quickly, during the HIV/AIDS pandemic? And vice versa? ”For HIV/AIDS, we were blessed by having 30 to 40 years of intense research on retroviruses. That was motivated by the understanding that retroviruses may be involved in treating cancer in humans. Without the foreknowledge of these viruses, we would have been helpless for a decade or more in the face of the HIV epidemic. Unfortunately, there has not been the same kind of focus on coronaviruses, despite our experience with SARS and MERS. There was a high level of support for a very short period of time in the study of the coronavirus immediately after those outbreaks, but that support quickly evaporated when the outbreaks ended. Therefore, we were left with a vastly incomplete picture of the nature of this virus. NORDICLIFESCIENCE.ORG 77