HJNO Nov/Dec 2020

HEALTHCARE JOURNAL OF NEW ORLEANS I  NOV / DEC 2020 25 the innate immune system produced by unrelated vaccinations, could in- crease resistance to SARS-CoV2. A trial testing this concept with BCG (Bacil- lus Calmette-Guérin, an attenuated TB vaccine) is ongoing in Australia, and a similar trial using the MMR vaccine is underway at LSUHSC. e. Test early and often – and sequence. Besides masks, isolation of infected pa- tients is the best defense against trans- mission. The temporal dynamic of vi- ral shedding is well understood, with a mean incubation period of 5.2 days, ac- tive shedding beginning 2-3 days before symptoms, peaking at symptom onset and continuing for 14-21 days thereafter. Asymptomatic cases make up at least 40 percent of the total, and these cases are a major factor in transmitting the infec- tion. Hence, identifying infected indi- viduals through testing is paramount to reduce transmission. In the early days of the pandemic, the availability of testing reagents was limited. Even today, long turnaround times decrease the useful- ness of testing programs. The ideal test would produce results within hours or minutes with high sensitivity and speci- ficity. Polymerase chain reaction (PCR) for one to three viral genes is the current gold standard, but the sensitivity of dif- ferent PCR tests varies, andmutations at PCR primer sites can complicate detec- tion with some one-gene tests. PCR was never envisioned as a high-throughput technique, and even under the best cir- cumstances it is a bottleneck. Next-gen- eration sequencing (NGS) was designed as a high-throughput technique and has the major advantage of simultaneously diagnosing the presence of virus and de- termining its genetic sequence, thereby potentially identifying new mutations. Antigen tests that detect virus proteins rather than viral RNAare also a promis- ing strategy. Repeated testing at regular intervals with isolation of infected indi- viduals will be necessary for the fore- seeable future. Lucio Miele , MD, PhD, professor and chair of the Department of Genetics, and assistant dean for Translational Research at LSU Health New Orleans School of Medicine, is also associate director of LSU Health New Orleans Stanley S. Scott Cancer Center. He completed a fellowship at the NIH and worked at the FDA as acting chief of the Laboratory of Cancer Cell Biology. Miele’s research focuses on breast cancer genomics, experimental therapeutics, precision medicine and breast cancer disparities. He has been continuously funded by the NIH for more than 20 years, and he is site principal investigator for the “All of Us” precision medicine initiative. Miele has authored over 235 peer-reviewed publications, and he regularly chairs review panels for NIH and NCI. Conclusions A safe and effective SARS-CoV2 vaccine is obviously highly desirable, but rapid success is not assured, and an abrupt end of the pandemic in unlikely. Even assuming a highly effective vaccine is identified, a multiyear immunization campaign and perhaps periodic vaccine redesigns will be required. SARS-CoV2 will likely establish itself as an endemic pathogen in the human population. We must be prepared to adopt multipronged strategies of containment, prevention, improved diagnosis and treatment to face this emerging threat. This may involve significant, long-term changes to the way we live, learn, work and travel.