EPISODE 1– Fighting COVID-19: Researchers Racing to Save Lives

Due to the extraordinary nature of the COVID-19 pandemic, the significant health risks, and the considerable economic consequences already being felt around the world, we need to be nimble and act decisively to support urgent frontline research. Now more than ever, it’s important we unite around a common mission.

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Mission: Healthy People & Healthcare Systems, Disease detection, Diagnosis,

Rhys Waters 0:00

Welcome to the Beyond Research podcast, brought to you by Research Nova Scotia.

Stephanie Reid 0:09

Today our CEO Stefan Leslie had the opportunity to visit Dr. David Kelvin's lab at Dalhousie University in Halifax, Nova Scotia. Dr. Calvin is an infectious disease expert with an international research program that carries out studies around the world. His team of researchers is currently focused on COVID 19.

Stefan Leslie 0:32

I'm Stefan Leslie, and I'm sitting with Dr. David Kelvin. And we're here to talk about all his work in support of the COVID-19 Coronavirus. I'd like to start off by just asking you to tell us what you do here.

Dr. David Kelvin 0:44

I'm in the Department of Microbiology and Immunology, but we have multiple research sites around the world. We have a team in China, we have a team in Italy, and of course, the team here in Dalhousie. We're very interested in emerging infectious diseases and as you well know, there's an emerging infectious disease outbreak right now, COVID-19. And we're very, very interested in finding solutions to this crisis.

Stefan Leslie 1:14

And I know this is a very fast moving event and here we are sitting on the 17th of March and who knows what it will be like, you know, in a week's time, but can you tell me what would it look like if we walked into a hospital or a health care facility in say, Italy right now, what would I be looking at?

Dr. David Kelvin 1:33

Northern Italy has been the longest in this crisis period right now and it's really only about three weeks. The ambulances never stop. The ER rooms are overcrowded. There are insufficient number of hospital beds to accommodate all the people who need hospitalization. The really severe patients, there isn't enough ICU beds and sadly, there isn't enough equipment there to actually intubate people, help them breathe. So I would say, we would all be alarmed, we would all be shocked. And these health care facilities, these hospitals are the best in Italy.

Stefan Leslie 2:24

Now to the best of this is, of course, asking you to predict the future, but were people to take this seriously or if people continue to take this seriously and self impose these management measures to manage the spread as best we can, do you believe we can avoid the fate that you just described of Italy?

Dr. David Kelvin 2:46

The big problem of a pandemic is that the population is naive to the emerging infectious disease and we're naive to the virus, this new virus. So nobody has immunity, so if we avoid it today, and say the United States is filled with disease, we will be a pocket, a reservoir of naive people who any new outbreak could come in here and wreak the same havoc as anyplace else. So yes, we may avoid it today. But that's why I said we need a sense of urgency because we're buying the time. Let's get the vaccine rolled out. Let's get the immunotherapeutics understood. Let's find out what the pathology is. Let's find out what we can today, so that this precious time that we've bought now, we can implement that in the future.

Stefan Leslie 3:43

So that brings us to your research and so if we are to get a better understanding of what your research does, how can pursuing the questions that you have, begin to unpack what might have happened in Italy and how in the future we can imagine a different path for the healthcare system here or indeed anywhere else if faced with a similar crisis?

Dr. David Kelvin 4:12

Okay, I sort of go back a little bit, it's not very long, it's about eight weeks ago. Because of our work in China, we have many colleagues in Wuhan and one of our colleagues in Wuhan works in the ER room. And he called us are very alarmed that they had insufficient PPE (personal protection equipment) to actually deal with the surge of patients who were coming to the hospital. And he did send us some photos. There was a group of 1000 people outside of the ER room and they had been experiencing that for about 10 days. So this large number of patients that comes forward, you have to make rapid decisions and determine who gets the few hospital beds that are available, and who gets the few ICU beds, which are in extremely short supply. And you can see just from what we talked about in Italy, that this is a major problem for healthcare. So how do you make the decisions? Well, the ER room Doc's or the Doc's don't have sufficient time to go through a lengthy procedure to determine who should get hospitalized and who would not get hospitalized, and that will impact who can survive and who can't survive. So what we thought we would do is try and look at biomarkers and try and devise a system where we could use biomarkers to rapidly assess who was going to have a mild case of illness, who was going to have a severe case of illness, and who would have a very severe case of illness, so that we could prioritize those patients and determine who should have the best opportunity to get the hospital care or ICU slots that were available.

Stefan Leslie 5:19

Can you explain what a biomarker is?

Dr. David Kelvin 5:21

Well, in your peripheral blood, you you have 1000s of proteins, and on a daily basis some will go up, some will go down. But when you have an infection, some of those biomarkers will go extremely high. So what we wanted to do was look at the biomarkers that are associated with an infection, and see if some of the biomarkers told us a story, or a footprint or a signature for those people who are mild, those people who would become severe, and those people who would become very severe.

Stefan Leslie 6:56

So we hear a lot these days about flattening the curve, which if I understand correctly, it's about delaying the spread so that the burden on the health care system diminishes because you spread out the demand over a longer period of time. But your research sounds like it is addressing another important way, by being able to identify those who are going to be most severely affected, and those who would be presumably able to care for themselves, perhaps through isolation. So are these the two major elements that are required to address this kind of crisis? Both ensuring the spread is delayed, but then knowing how to deal with it onceit is here?

Dr. David Kelvin 7:40

Well, the spreading or flattening the curve is in theory, a really good idea. And and I'm all for it, so that not only can we help deal with allocation of the resources over an extended period of time, and allow for us to meet the demand on a daily basis, but also it gives us a chance to develop future therapeutics which may come online and help out later on down the road. So actually see, flattening the curve has a multipurpose strategy behind it. The problem is, theoretically, that's a great idea. But practically we just don't know right now. And we have to be prepared for eventual outcomes. And we think that what we're trying to do with biomarkers may assist doctors in the ER. There's a second benefit to doing the biomarkers as well. The biomarkers may uncover the the reason why people have severe illness. And it may give us an early indication on how to treat those people and develop new therapeutics to actually address what the underlying cause of severe disease is. So our program, we think can have a dual benefit. One is that early assessment of patients and allocation of hospital beds, but also we think it will play an important role in diagnostics and administration of therapeutics.

Stefan Leslie 9:24

So can you tell me a little bit about how the urgency of this research works? So we're in the midst of a crisis where a lot of people think about the delivery of health care but tell me about the importance of beginning to look at or continuing to look at these questions and how that will set us up in the future to manage these sorts of things.

Dr. David Kelvin 9:45

That's a good point. Unfortunately, if we were able to turn the clock back we probably should have a standing army of infectious disease soldiers, that is people who are conducting research and all the time, year round. And so that when a crisis like this develops, we're very well prepared. I'm not saying that Canada wasn't prepared. The lessons from SARS certainly taught us a lot. And I think that Canada as a nation, did the best job they could in being prepared. But better infrastructure, better funding infrastructure, I think is what we want to try and achieve. We want to be prepared for these eventualities. And we want to have a complete army ready to respond, not something that we're going to have a patchwork ad hoc system, even though I do agree that the Canadian government has been really great in applying research funding, in a need to be basis. But ideally, I'd like to see us be more prepared on the research front by a steady stream of funding that allowed us to complete these activities at a very high level and be prepared.

Stefan Leslie 11:12

So the funding that you received most recently from the Canadian Institutes of Health Research gave a real push to some of this work. But you've been publicly discussing how additional funding can really help. So tell me about how the additional support that you hope to receive and hope to continue to receive over some time, how does that affect your ability to do more work, or better work or reduce the uncertainty in the work that you're doing?

Dr. David Kelvin 11:45

The initial $1 million grant that we got from CIHR is really great. And I think I look on it as a an initial investment. But we have a global team, we have 26 investigators, we have 16 different countries, and we're trying to spread that million dollars over a long, long distance. Two of the countries that are involved in our research program are Italy and Spain, and Italy and Spain right now are in very, very bad shape. So while we think this is really fantastic, we recognize that this is going to be a war, it's something that's going to be with us for I look on two years at least. And we need many things, we need therapeutics, we need vaccines, we need research on who to vaccinate and how well they uptake the vaccine. There are many, many questions. There are hospitals or health care workers. So there there are many issues that have to be addressed. And while the initial bolus of funding from CIHR is really great, and I can't stress how important it is for them to recognize that research plays a strong role in combating this crisis. But also, we need to recognize that extended funding is going to help us through each stage of this epidemic. And for example, we're just seeing the initial stages now. We don't know if there's going to be a first wave or second wave of this disease, and how can we be better prepared, or what is the disease all about? Are there therapeutics that we can use? So we need to learn as much as we possibly can today. And then we need to sharpen our focus on how to take all of that information, and reposition ourselves for a second wave. It's just like a war. So we should be prepared. And then second, all of the additional research will require additional support. And we look on as the government and the public, our partners in trying to find solutions to these problems. So I love doing outreach programs. I love interacting with the public, helping them understand what we do, helping them understand the crisis and giving them information that they can better manage their own lives and feel safer in what they do.

Stefan Leslie 14:28

And there has been a lot of information that's been shared with the public on how to manage the spread. Newspapers, online TV, there's been a very consistent message certainly in Canada about how people can help stop the spread. What would you say to people about how they can help on the research side as well? So it's not just about managing this particular spread, but how can people participate in supporting the research efforts that you may be doing or others?

Dr. David Kelvin 14:57

Well, one is to try and know a little bit more about the research activities that are taking place and kind of look at it, it's our responsibility as well to reach out to the public to help them understand what we're working on, what the benefits are, and also how, as the public they can actually engage and participate in some of these recent research activities. For example, part of our research activities involve patients and when a patient goes to the hospital, they will be asked if they want to participate in a research study. And we need those patients to participate, because that's the only way we're going to get samples and information to benefit the patients down the road. So there are many different levels that the public can interact with us. But I kind of look at it as they are partners in moving forward.

Stefan Leslie 15:59

David, how did you get into this work to begin with this? You've been at this some time. But where did this all begin for you?

Dr. David Kelvin 16:06

Well, we had been interested in infectious disease many years ago, and we had been studying HIV. One of the reasons I was interested in HIV, is it was really my first experience with an epidemic, pandemic. So we were trying to understand the immunology of HIV at the earliest stages of infection. And we were working in Toronto, and there was an outbreak of a new emerging infectious disease that originated in China and that was SARS one.

Stefan Leslie 16:38

I remember that well. And so can you tell me how your work that related to SARS prepared you for this? So this was, what 15 years ago or so. So how is it that you built on that work to arrive at where we are today?

Dr. David Kelvin 16:53

Well, we knew nothing about SARS back then. And in fact, as a global population, we were quite naive, and ill prepared. Because here was an acute infectious disease that started and was recognized in China, just by a few reports here and there. It spread to Vietnam and in Vietnam, there was a relatively large outbreak, but it was still unknown to the rest of the world, except for you know, a couple of reports. And then within a matter of weeks, it spread globally. And when it's spread, it infected not only the general public, but healthcare workers. And when health care workers go down, then everybody suffers because they can't look after the people who are sick. And you have a major, major problem on your hands.

Stefan Leslie 17:48

This is a bit of a family affair for you. Can you talk about your your daughter's role in this as well?

Dr. David Kelvin 17:53

Well, Alison, my oldest daughter, several years ago fell in love with doing research and through twists and turns we've formed this partnership and this partnership, we've been working together for about 10 years. And she's an assistant professor here at Dalhousie University, and her activities are in modeling infectious disease. So she's presently in Saskatoon working at the high containment facility there and she's working on COVID-19. And she's trying to model systems, animal systems to test out vaccines, antivirals and understand the pathogenesis of the disease. But I don't want to end there. Nikki, my wife, she's very important as an editor for journal of infection in developing countries and assists me in editing multiple manuscripts. And in addition, my son manages the website for our Canadian Coronavirus Research Network. And I have another daughter who's in California, who also manages a community website to bring information to the community on COVID-19.

Stefan Leslie 19:09

Well we're lucky to have the entire family work on this,

Unknown Speaker 19:13

Yes, I'm lucky to have a family that's committed to the cause. We're a national international team working on this and the real key here is what role does Nova Scotia have to play in the very fact that we only have a handful of cases here, whereas there's five cases of really severe people in one ward in in Sastry, which the city is about the same size as Halifax. So, what what is our role? We are in the luxury position of being able to function normally right now. So we better use every moment we have to do what we can to be prepared and assist all the people who can't do it. So we do have a very important role. And I think everybody has to have the sense of urgency here and not be lay back and say, we're okay, because that was the mantra in the United States.

Stefan Leslie 20:15

Thank you very much for your time. I know you're busy. And this is moving quickly and appreciate all the time we've taken to answer questions today. Thanks a lot.

Dr. David Kelvin 20:23

Thank you.

Rhys Waters 20:25

To find out more about this podcast and the research featured in this episode, visit researchns.ca. My name is Rhys Waters, and we will see you next time

Featured Guest:

Dr. David Kelvin is a Professor of Microbiology and Immunology at Dalhousie University in Halifax, Nova Scotia. Dr. Kelvin is an infectious disease expert with an international research program that carries out studies around the world. His team of researchers is currently focused on COVID-19.