COVID-19 Q&A: Immunities, Vaccines and More

The Focus on Finding a Long-term Solution Has All Hands on Deck

Hana Akselrod, MD, MPH, Assistant Professor
in the Division of Infectious Diseases at The George Washington University
School of Medicine & Health Sciences.

August 28, 2020

We asked experts at GW Hospital to educate us about COVID-19 – from immediate concerns today to the future impact of the disease and ways to stop the spread of the virus. Here to discuss vaccines, research and more is Hana Akselrod, MD, MPH, Assistant Professor in the Division of Infectious Diseases at The George Washington University School of Medicine & Health Sciences.

Other Q&As include microbiologist Sanjay B. Maggirwar, PhD, MBA, discussing how the virus enters and impacts the body, and pathologist Antonia R. Sepulveda, MD, PhD, addressing testing goals and practices.


Q&A with Hana Akselrod, MD, MPH

This Q&A was originally conducted in late March/early April, and updated in early July.

Q: How has your role changed in the setting of the COVID-19 outbreak?

Since the initial reports of this disease came out of China at the close of last year, infectious disease experts around the world – including my group of ID faculty at George Washington University – have rallied in an unprecedented effort to decode the genetic code and structure of the virus, determine who is most at risk and what strategies can lessen the impact, try to repurpose old drugs and therapies to treat it, and begin the development of new drugs and vaccines.

Q: How are providers and staff supporting patients during COVID-19?

We have an all-hands-on-deck effort that has been building up across the hospital, clinical practices, and university, starting in January, which seems like a very long time ago. Literally everyone – from institutional leadership to every medical and surgical department to every type of nursing and ancillary support staff – is involved. We have everybody from senior department chairs to first-year students coming forward to help. Many can perform telemedicine to help keep vulnerable patients out of the Emergency Department or be called upon to back up another department. We are all out of our comfort zones and facing the unknown here, but we are doing it together.

Q: What research is underway at George Washington University Hospital on COVID-19, and what does it entail? What are the unique goals and challenges?

Currently the main categories of research include:

• Developing diagnostic tests to detect SARS-CoV-2 and study the immune response to it
• Setting up a registry of current and recovered patients
• Studying how COVID-19 affects people living with specific medical conditions including HIV
• Offering new investigational treatment options to hospitalized patients

We will be participating in vaccine research as well. We are also investigating what social factors and disparities put some people or populations for higher risk of COVID-19, and how we might work with the Washington, DC communities to mitigate this.

Q: Why are vaccines important, and why does it take time to create them?

Vaccines or immunizations expose the immune system to a partial or weakened form of a pathogen in order to “teach” the body to recognize it without incurring the more dangerous symptoms of the disease. They are an indispensable tool in the fight to prevent contagious and deadly diseases such as measles, influenza and COVID-19. Developing a safe and efficacious vaccine takes a long time because of the complexities of the immune response. Once created, the vaccine must be proven safe, produced in large volumes, and distributed widely, starting with the people who are at highest risk. Regarding a vaccine, there are multiple potential vaccine candidates in development, but it is a long process to test and produce a vaccine safely. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, forecasted 12-18 months from the start of research in early 2020 as a reasonable timeframe.

With regard to drug development, the shortest path, even an imperfect one, may be to repurpose a drug that already exists. That is why so much of the research coming out has featured older drugs such as hydroxychloroquine, lopinavir-ritonavir (an HIV medication), or remdesivir (an antiviral medication that was originally studied for Ebola). There is no guarantee that these older treatments will work well. And with any new drug, we must ensure that it can be tested adequately, given safely, and made accessible and affordable to the people who will need it most.

Q: How do immunities work in terms of protecting people from being re-infected? Why can some viral illnesses be caught more than once?

When a person gets a viral infection, the body goes into defense mode. At first, the infection activates a non-specific inflammatory response, which helps fight the pathogen but also can be quite destructive in its own right. The immune system then starts to produce antibodies, which are designed to seek and attach themselves to a specific virus, ultimately neutralizing and tagging it for clearance. Once that immune memory is developed, in theory it will quickly mobilize in the event of repeat exposure to the same virus again. However, not everyone may be able to form or reactivate that immune memory perfectly, and some viruses mutate quickly. This may impact protection against future infection. It’s not known how often antibodies that are specific to a certain virus can help defend against a similar one as well.

Q: What lessons can we take from this pandemic?

The lessons of this pandemic, which are spelled out in human lives right now, are:

• Respect nature and give wild animals their space, as they are from where new diseases like COVID-19 derive.
• Invest in early-warning systems and preparedness.
• Trust medical and scientific experts, strengthen public institutions, promote transparency and objectivity in decision-making, and reward collaboration; these are required to get us out of this crisis.
• Notice who suffers disproportionately from epidemic disease, and take action to protect them. As we are learning about COVID-19, and as we know from other epidemics before this, doing this may require us to confront prejudices and inequities that have been embedded in our society for a long time.
• Remember we are interconnected by our networks, supply chains, and collective immunity (or lack thereof). To the virus, our rifts are doorways and our blind spots are breeding grounds. We need to look after the entirety of our society.

Hana Akselrod, MD, MPH, is an expert in infectious disease and Assistant Professor in the Division of Infectious Diseases at The George Washington University School of Medicine & Health Sciences. Working collaboratively with the primary teams at GW Hospital, she has been the infectious disease consultant for many of the hospital’s COVID-19 patients, including recovered patient Francis Wilson, whose story was shared on CNN ↗ and in many other local and national media outlets.

In addition to her work on COVID-19 and in medical education, she conducts research on HIV as part of the DC Center for AIDS Research (CFAR) and DC Cohort Longitudinal HIV study.