– Marco Carvalho
Without an effective vaccine or antiviral drugs that can lighten the impact of SARS-CoV-2, the current pandemic might go on for another two or three years, Joseph Kam Kai-man claims. A Catholic, and specialist in clinical microbiology, the researcher at the Stanley Ho Center for Emerging Infectious Diseases says that herd immunity is not a solution to the public health crisis in which the planet is plunged and warns that an economic recovery will not happen without sacrifices and without strict self-discipline.
Did the world underestimate this new coronavirus? We have seen a delayed response in most of the European countries as well as the United States. The world, it seems, didn’t learn anything with China and Asia…
Right, right. We haven’t gone through the Spanish flu outbreak, back in the 1920s. Most of us were not yet born at the time and our generation didn’t have this sort of experience, of facing a major pandemic amongst ourselves. I quite expected that this underestimation would happen, because people didn’t really know what was going to happen. Any sort of estimation would have been based on what we experienced before, like the swine flu or SARS, in the case of Hong Kong. These are probably much more mild, in the sense, that the way they spread and the mortality were very limited. It is not the case this time. We are experiencing a worldwide pandemic, which, none of us – including doctors or epidemiologists – really knows for sure what is happening.
You were mentioning SARS in Hong Kong. Did the SARS outbreak in 2003 prepare Hong Kong and Macau for this kind of situation?
Yes. Seventeen years ago, most of us were already quite used to wearing face masks, washing our hands or doing other cleaning procedures. We were even used to some sort of home confinement, quarantine or whatever you want to call it. The community, at large, is more receptive to this kind of measures, so it was easier for us to adopt them now. Most people were very easily convinced about what they should and shouldn’t do. Hong Kong and most of the Asian countries – China, South Korea, or even Taiwan – were more ready to gear up and to prepare for this pandemic than other countries, which did not experience SARS 17 years ago.
How does this new coronavirus compare with the SARS coronavirus? You were saying that the SARS coronavirus was kind of mild when compared to this one…
Yes. What we call the transmissibility, the ability to spread among the community is much more powerful. The degree of dissemination among the community is, I think, at least ten times – some people even say it’s one hundred times – more powerful than the SARS virus. Back then, we witnessed only a very limited SARS spread in Asian countries and now, what we see is that this new coronavirus has spread almost to every country. The degree of spread is much faster and the extent is also much broader, given this present-day ease of air and land travel, when compared with 17 years ago.
One of the main issues with SARS-CoV-2 is the fact that some of the people that transmit the virus don’t show any symptoms. Is this a major issue? Can it delay the control of this pandemic?
Yes. We know this from other diseases, like measles. We know that patients infected with measles may not have symptoms when they start spreading the virus. This is something that we witnessed before with other viruses. We didn’t see, nevertheless, this sort of behavior with SARS. At that time only those patients that developed symptoms were spreading the disease. This is something that we have seen with other viruses, but we did not expect to see with a coronavirus, having in mind the biased experience that we had with SARS before. Nevertheless, we knew it happened with other viruses, so I cannot say that it is that strange to me. We do know that some viruses have different behaviors during the disease period.
Do you think it will be possible to “flatten the curve,” to reduce the number of infections without a vaccine or some sort of treatment?
It is very difficult. If we borrow from the experience we have with other viruses – let’s say, measles or mumps – we only managed to reduce the disease when vaccines were created. Without a vaccine, we are left to natural immunity, but I doubt it can be a solution to this pandemic. We would need a lot more people to build what we call “herd immunity.” For this to be possible a very long time is needed and a lot more people would die before we could attain it. So, this solution is not practical. A whole different thing is the antivirals and antiviral treatment. We do have very effective antiviral drugs for HIV; we can use them to prevent HIV from spreading. We don’t have any to treat this new coronavirus. We don’t have a good drug. People are trying different things – chloroquine, ribavirin, and others – but, up to now, there is no really good or effective antiviral treatment. So, I would expect that the virus will keep spreading by itself if we don’t put up enough safety or isolation measures.
Nevertheless, in Europe and the United States, Governments are easing lockdown measures. Are we rushing into a disaster? If we look back to Spanish Flu, one hundred years back, the so-called “second wave” of the pandemic was way more lethal than the first one…
Oh, yes. If we borrow from the experience of the Spanish Flu, then we need to have in mind a second wave. Nevertheless, if we look at the Hong Kong experience or at the Taiwan experience, we didn’t really have a lockdown, you know, as the United States, most of the European countries or even China did. In Hong Kong, at least half, or even more, of the businesses – the banks, the shopping outlets – remained open. The only things that closed were the schools and mass gathering events – like music concerts or big conferences – were cancelled. In my opinion, that should be a stepwise approach, rather than to decide there is a lockdown or no lockdown. I think it should be a gradual approach. If we refer to the Hong Kong experience, then the lockdown is probably too much. We didn’t really go into lockdown. We still have our banks operating, most of our offices, they are still working: sometimes working from home, sometimes with half of the people working and the other half at home. Those countries in lockdown, they should be gradually opening up and adopting a more conscientious approach. I think, in part due to the damage to the economy, the politicians are very worried, but, as you said, the second wave can always come in. There’s still no vaccine, no good antivirals, we don’t have anything. We need to be very careful, once we open up.
How long do you think we will have to live with this new coronavirus? In Hong Kong, SARS was eventually controlled after a few months. Can Covid-19 become a recurrent pathology, like influenza?
We are now four or five months into this pandemic. My opinion is that it will not go away, as the degree of transmissibility is very high. As I mentioned, it is about ten times or even one hundred times that of SARS virus. It will be almost like influenza. It will be circulating between countries, until we come up with a good vaccine or antiviral. We cannot use the SARS experience this time and hope that in two or three months’ time everything will be back to normal. I am a bit more pessimistic. I would say that we will have to live with this virus for one or two years down the line or even three years. We will have to change our mode of living. We won’t be able to watch football matches or go to music concerts with a few thousand people. We will have to avoid a lot of those mass gatherings and when we take part in any sort of gathering, we will have to wear a mask, to remain at a safe distance of six feet and so on. We have to change our mode of living if we want to gradually switch back to normal. This process will go on for years, not months. During this time, we will have to modify our mode of living and the way we look at airplane travelling, mass gatherings and social distancing. We have to keep this kind of procedure at least for one or two years.
You were talking before about a reliable treatment. You were saying there are already some antivirals, mainly related to HIV and AIDS. You are a specialist in the study of AIDS. In the beginning, people were quite excited about some of these antivirals, some of these solutions. Can they help to treat this new coronavirus? Or not?
I am not sure. I am waiting for some of the clinical trials to understand what they are using. This is a completely new virus and we really didn’t have any really good research before. Honestly speaking, we missed quite a few opportunities when we had SARS. All the antivirus research was stopped because people were convinced that the SARS virus would not come back, so there was no more research to develop antiviral drugs for the SARS-CoV virus. We had to start almost everything over again. Time is not on our side, I must say. We have to test for quite some time before we can get a good antiviral. It might take some years. Let’s say, for HIV, it took us almost, what? Ten years? Or eight years. With HIV, as you know, there was a huge investment since the 1980s and the 1990s into antivirals, before we could find AZT or 3TC. If we use the example of HIV, it will take a lot of money, a lot of people, a lot of investment and a lot of time to get a good antiviral treatment.
The same goes for a vaccine. There’s a lot of effort put into the possibility of finding a vaccine, but it won’t probably be available any day soon….
Exactly. We also talked about a SARS vaccine. SARS surged 17 years ago and we are still talking about it. The same goes to an HIV vaccine. We have been talking about the HIV vaccine for thirty years now or maybe 35. We can still talk about it, but to get a really good vaccine is very difficult, I think. People are trying to expedite, to speed up the procedures, the bureaucracy and other things, but I think that even the scientific side still has many hurdles to go through. People are talking about human trials by the end of this year or early next year, but personally I am not very optimistic.
Following the SARS outbreak, seventeen years ago, Stanley Ho – the casino kingpin of Macau – helped to create the Stanley Ho Centre for Emerging Infectious Diseases. You work there. How did the work done by you and your peers, during the last decade or so, help Hong Kong to prepare for this epidemic outbreak?
We still try to keep things going on. We have an annual scientific meeting, usually with two-three hundred people coming to our CEID Center and we also have an annual conference, so that scientists and investigators can meet together. We send our proposals, our research grant proposals to the Hong Kong government, as well as to other funding partners and I think that there are quite a few good research lines. We do have quite a few things to offer, despite the fact that we don’t actually receive a lot of support from many of them.
You were saying that you are quite pessimistic about the next few years. Economic recovery is the biggest issue. How will this change the way we used to live, the way we used to travel.
I think that the impact will be very great. The airlines, most of them, probably 90 per cent, already grounded their planes, so the airlines and the international travel will be much more limited and then I think that we will have to rely on things like internet communication a lot. Many people now only have the internet as their last resort. The only way they can meet is in cyberspace rather than face to face. I think we will have to live with this for quite some time. I have mentioned before about mass gatherings: watching football matches or going to music concerts or even going to Church. We will have to change our mode of gathering, even inside the Church. Even in the Vatican, they only have small size gatherings in Saint Peter Square. We will have to change almost everything from what we used to do and think about how we are going to adapt in these few years.
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