CROI 2020: Special session on COVID-19

Simon Collins, HIV i-Base 11 March 2020 :

The special session on coronavirus at CROI yesterday is posted for open-access on the CROI website. [1]

The 75-minute overview includes four talks and a Q&A at the end.

A few selected key points include:

• The highest risk of more serious illness and outcomes (risk of dying) are older age (80>70>60 years old), and having other health conditions (heart, lung/breathing, diabetes, cancer). The risk of the most serious outcomes is 5 to 30 times higher than with seasonal influenza (‘flu’).
• Implications for people living with HIV are not currently known, other than as for the general population. One speaker included low CD4 as a possible caution. [Note: Due to lack of evidence so far a low CD4 count has not been included as a risk in the recent UK (BHIVA) statement]. [2]
• Transmission is largely from microdroplets in air from someone during the infectious period (generally from 1 day before symptoms to average 5 days, but up to 14 days after). These can remain infectious on hard surfaces for an unknown time (possibly hours) which is why hand-washing and not touching your face is important.
• Best ways to minimise risk of infection include washing your hands more carefully and frequently and not touching your face.
• Soap and water is better than hand sanitisers (and more readily available).
• Best candidate treatment (so far) is remdesivir (a Gilead compound). This has good activity against a range of viruses in in-vitro studies and is already in at least four large randomised studies.
• Studies with candidate vaccines are expected shortly – within two months of the virus being isolated – fastest time for vaccine development.
• The response in China after the first cases were reported was probably much faster than it would have been in the UK. This included:
  –  Within four days of the first reported cases, the suspect source was identified and closed (a seafood market).
  –  Within a week, the new virus was identified (SARS-CoV-2).
  –  The viral sequence was then shared with WHO and on databases in the public domain for other global scientists to use.
  –  Within three weeks of the first confirmed cases, Wuhan and 15 other large cities in China were shut down as part of containment measures.
• One of the questions after the main talks asked whether SARS was now extinct. The answer explained that SARS is a bat virus, and only 50 out of about 1300 species of bats have been studied so far. So SARS is very likely still around.