Scientists have discovered the pandemic-causing coronavirus is unique in short-circuiting the safest way our immune system kills off a virus, which could have implications for treating COVID-19 with interferon.
Interferon describes a family of proteins produced by the body’s immune system in response to an invading viral infection. As the name implies, interferon interferes with the virus’s ability to copy itself.
Interferon drugs are made in the lab and were used for years to treat hepatitis, a liver infection, as well as other diseases that involve the immune system, such as multiple sclerosis and some cancers.
In May, researchers in Hong Kong published the results of their Phase 2 trial on fewer than 150 people who were admitted to hospital with mild or moderate COVID-19. Participants were randomly assigned to a combination of potential antivirals, including interferon, or placebo injections for two weeks.
The findings lent support to the idea of continuing research efforts, including in Canada, to investigate interferon in larger, blinded trials designed to find more definitive answers.
Dr. Jordan Feld, a liver specialist at Toronto General Hospital and senior scientist at U of T, previously used interferon to treat people infected with hepatitis. He’s now leading a Phase 2 clinical trial to test a targeted form of the drug, called peginterferon lambda, in injections compared with saline placebo injections.
“It’s kind of like a stealth virus,” Feld said of SARS-CoV-2, the virus that causes COVID-19.
In this photo illustration, a replica of SARS-CoV-2 is placed next to test tubes with samples of blood being tested for COVID-19. (Robin Utrecht/SOPA Images/LightRocket/Getty)
Normally, when interferon in the body’s white blood cells responds to a viral invader, the interferon sends out a flare signal so nearby cells will work to stop the virus from copying itself or replicating if they, too, should be invaded.
In ferrets infected in the lab (a common animal model for studying respiratory viruses), healthy human lung cells, and in people with COVID-19, doctors and scientists say it seems like the natural interferon “flies under the radar” of the immune system and isn’t activated the way it should be.
Feld said the idea behind giving interferon medications is to provide the body with what it should be making to fend off the infection.
The potential therapeutic approach gained scientific backing last month when a study published in the journal Cell showed a “striking” feature of SARS-CoV-2 infection.
Ben tenOever is a Canadian-born professor of microbiology at the Icahn School of Medicine at Mount Sinai in New York who led the Cell study and has been flooded with e-mail requests from researchers the world over to test experimental drug compounds against the virus.
TenOever said every cell that gets infected has two major jobs:
Fortify its defences and those around it with a “call to arms” mediated by interferon, like sending out an emergency flare for the immune system’s first responders.
Send a “call for reinforcements” for a longer-term response by releasing proteins called chemokines.
Most viruses block both of those roles.
What makes SARS-Cov-2 unique is it blocks the call-to-arms function from interferon only.
Reinforce call to arms with drug?
“Treatment with interferon or drugs that induce interferon, the main character in the call to arms, is probably beneficial,” tenOever said.
“The secret is to do it early,” he said, when people have a mild cough and test positive for the virus and haven’t developed respiratory distress.
But there could also be mild side-effects.
When we’re fighting off a flu virus, blame interferon for feeling so crummy, feverish and achy as your immune system kicks into high gear.
Likewise, interferon drugs, could also lead to flu-like symptoms for a day or two.
Individuals enrolling in COVID-19 clinical trials of interferon based in Toronto, Hamilton, Ont., Harvard in Cambridge, Mass., Stanford in California, Johns Hopkins in Baltimore and elsewhere will need to weigh whether that (potential) shortfall is worth the (potential) payoff of protection from the deadly damage and delivers key answers that only their participation can offer.
Dr. Jordan Feld says the idea behind giving interferon medications is to give the body back what it should be making to fend off COVID-19. (CBC News)
TenOever said what the enormous scientific interest in the publication shows is an incredible demand for biosafety Level 3 labs like his during the pandemic. Without that lab capacity, the fear is that medical researchers won’t be able to run all the experiments they need to do to guide vaccine efforts.
Matthew Miller is an associate professor of infectious disease and immunology at McMaster University who isn’t involved in the clinical trials or studies.
Miller said interferon is what cells use to try to kill off the virus by themselves.
“Its sort of the preferred route,” Miller said, adding interferon is also the safest way for the body to get rid of a virus.
Miller called tenOever’s paper “an important first step in understanding how our body is responding to this particular new virus.”
Speed up recovery
Dr. Sarah Shalhoub, a transplant infectious disease physician at Western University’s medical school, studied the use of interferon to treat another coronavirus infection called Middle East Respiratory Syndrome or MERS.
While interferon hasn’t yet panned out to fight MERS, Shalhoub is optimistic for COVID-19.
“Patients that received interferon beta clear their viruses faster and the duration for hospital admission was also significantly lower,” Shalhoub said of the Hong Kong findings last month.
“It was encouraging in that sense that there might be an effective therapy that’s available on the market that can be repurposed.”
Shalhoub was quick to add a caution. Since no one in either the drug or placebo group died, the mild infections and response to them are difficult to interpret without more research.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
