COVID-19 has claimed close to 50M deaths so far worldwide. With close to 200 million cases globally, COVID-19 still poses a serious threat. Covid-19 vaccines have been proven to be very effective. In this article, we speak with Dr. Sonia Punj, an infectious disease expert and a frontline COVID-19 personnel.
1. Could you please tell our readers a little bit about your background, career journey, and your current role at Brightpoint Health?
Sonia: I grew up in India until the age of 15 when I moved to the United States. Medicine always interested me and especially infections with different bacterias and viruses, though not realizing that I will actually end up in a field surrounded by all the microbes.
I finished my residency at Elmhurst Hospitals which probably provided the initial platform on this journey. Elmhurst NY is probably the most diverse area with as many as ten different cultures/countries represented in the ten block radius of the hospital.
I further continued on as a co-principal investigator on a state-funded project about friends and family returning to their native land with no prophylaxis towards Malaria and thereby actually ending with Malaria.
This was usually due to the misconception of having an inherent immunity towards Malaria when in fact this immunity lasts only upto two years. This perhaps further fueled my interest in the field of Infectious Disease leading to my fellowship at Mount Sinai in the field of Infectious Disease.
2. What are your thoughts on COVID-19? Is it going to be around for a long time (like HIV) and it’s upon individuals to protect them? Or is there going to be a vaccine or a very effective drug soon (say in 6 – 12 months)?
Sonia: COVID-19 is a disease caused by a novel Coronavirus. There had been six other Coronaviruses that have been present to date —4 alpha coronaviruses which are associated with the common cold and two beta coronaviruses causing SERS in 2002-2003 and MERS in 2008.
In 11/2019, a novel coronavirus was found to cause a respiratory illness with a wide range of symptoms from mostly asymptomatic to severe respiratory distress leading to higher morbidity and mortality. Since coronaviruses are RNA based viruses, there’s a high chance of mutation making it somewhat difficult to have a vaccine with long term immunity leaving us more responsible for protecting ourselves.
Coronaviruses or any other viruses do not disappear and are here to stay. However, with mutations over time, they might lose their virulence.
3. Historically, the fastest vaccine got developed in 5 years. In general, vaccines took 11 – 28 years to get launched in the past. Additionally, less than 10% of drug candidates get approved after clinical trials. Can we really expect a vaccine in the next 6 – 12 months?
Sonia: When push comes to shove anything is possible in Science. Today, advances in science have made it possible. In fact, the vaccine developed by Moderna is they have perfect examples of such. In this case, once the sequence of the virus was identified along with the proteins associated, they were able to take the limited sequence alone to inject with the response from the body replicating that towards the virus.
The question is not about the development but the safety of the vaccine. The lengthy time span we see linked to the development of the vaccines is usually linked to their safety and tolerability and that only time can tell us.
4. How effective are the recently approved anti-coronavirus drugs (Favipiravir by Glenmark or Remdesivir by Cipla in India; and 35 such other candidates including a few by GSK, Sanofi, Gilead Sciences, Hetero, Moderna, Takeda,etc.) and/or current treatments? Can they really cure or are they just enough to control the disease?
Sonia: Remdesivir is a nucleotide analog that is metabolized into its active form in the target cells. Here it provides itself as a competitor for the natural ATP substrate of the SARS-COV2 virus. Its active form inserts itself thereby causing delayed chain termination during replication. As such, the virus is not able to further replicate.
Remdesivir was originally designed to target the Ebola virus but was found to be useful towards treating patients with COVID-19 for its compassionate use in the beginning and more widespread use for the sicker patients later on.
The cure is a more relative term in these patients. It’s more a multifactorial approach with attaching the virus combined with controlling the immune response of the body towards the virus which often leads to higher morbidly associated with the virus.
5. It’s a virus. There will be mutations. DNA/RNA vaccines also produce too many false positives. Then there are genetic issues as well. What are the chances of upcoming vaccines and/or new drugs showing success against COVID-19?
Sonia: There are currently 3 major vaccines in phase 3 in the US and one that has officially been approved —SPUTNIK developed in Russia. However, there are already growing concerns about its safety. Vaccine safety can generally take a long time to be established, so being a provaccinator, to be honest, I have some concerns.
This article was published in September 2020. For the latest developments on vaccines, please read this article.
6. What should common people do to protect themselves against COVID-19?
Sonia: All basic recommendations that probably should have been in place but have so much more meaning to them. General precautions include hand hygiene which entails at least 20 seconds of hand-washing with soap reaching all surfaces on hands including between fingers.
Also, keeping physical distancing by avoiding crowded places, avoiding unnecessary crowding, large gatherings should be practiced by all and especially those at risk such as Elderly and pregnant women.
Children though largely asymptomatic can play a role in being asymptomatic carriers and hence hand hygiene is probably one of the most important practices to be followed.
7. Are there any specific symptoms (or biomarkers) to diagnose COVID-19? How can common people distinguish COVID-19 from seasonal flu?
Sonia: While presentation can vary from being asymptomatic to morbidly sick and sharing many symptoms with the common cold, and seasonal allergies, patients with COVID19 generally tend to present with fever, lack of appetite, increased malaise.
These symptoms generally tolerable in otherwise younger, healthy populations are more worrisome when present in the elderly with other comorbidities like heart disease, lung disease or kidney. Here they tend to add extra demand on the organs leading to worsening outcomes.
8. The UK, the Netherlands and few other countries tried to experiment with “Herd Immunity”. Is it a practically good option?
Sonia: Herd Immunity is a concept involving the development of indirect protection towards an infectious agent by having a sufficient percentage of the population developing immunity. This can occur through a vaccine or an actual infection. Illnesses such as Measles and mumps that are also RNA-based are probably good examples. Since most of the people have either had it at one point or are vaccinated, we don’t see a breakthrough (to a large extent).
I believe it worked in the Netherlands because there wasn’t a large population, to begin with. Though there wasn’t much of a lockdown, there was physical distancing, hand hygiene, and the wearing of mask where it made it possible to work.
In contrast, in the UK due to delay in earlier mandating of these strategies, there was an initial surge of cases that later flattened once these preventative strategies were put to practice. Lately due to a large impact on the economies, many of these restrictions have been put to ease. This has led to the fear of the so-called “second wave”
9. We need masks, sanitizers, ventilators, beds, medicines, PPE, etc. They can be produced and/or exported. But, what should Governments do to create a healthcare & medical taskforce?
Sonia: While the above-mentioned resources provide a great backup and relief to the tiring medical/healthcare professionals, the main onus should lie on the general population to take steps towards protecting themselves and others.
With strategies that help us work towards ending the HIV epidemic where Treatment acts as Prevention, (TasP), let me go one step further the in this case its the prevention that is the mainstay for treatment. If you take measures to prevent spread for yourself, you are preventing it for others as well.
10. In the pharmaceutical sector, Cardiovascular and Cancer verticals get most of the limelight (funding, media coverage, etc.). With COVID-19, do you think there will be more students, researchers and investors focusing on Infectious Diseases?
Sonia: Well as an Infectious Disease Specialist I can only hope that this COVID-19 pandemic, along with the one in our hand for the last 30 years (HIV), has increased appreciation towards the field of Infectious Disease. This pandemic had highlighted how a simple microbe can bring the whole world to a standstill.
11. You are from core Medicine background (MBBS/MD). You could have gone into any other verticals. What made you interested in Infectious Diseases despite the fact that infectious diseases are more common in developing nations and not in developed nations like the US?
Sonia: As I described above I have a passion for infections even as a child, especially given I grew up in India for the first fifteen years of my life. This was further fueled by my involvement with Malaria research.
During my residency, I learned that I enjoyed primary care where I formed a long-term relationship with my patients. Taking care of the HIV population provided me with a platform where I could do both. Focus on Primary Care as well as Infections that can happen to anyone but are more common in a person with HIV.
12. In general, Biosciences receive a lot of criticism as it’s a pretty hardcore research-oriented field, too competitive, less pay (at least in the first 7 years), and lack of social attention or media glamour (unlike Software, Data Science, Investment Banking, Management Consulting, etc.). Is COVID-19 going to motivate more high school students to take up Biomedical Sciences, Biotechnology, Biology & Medicine?
Sonia: Sure, but today, the field of Medicine has changed entirely than before. While COVID-19 might have helped in bringing biomedical sciences to the limelight, passion to pursue in medicine remains the basics. If you don’t have this inherent passion, no matter how bright the lights might be, it will be short-lived.