The Need for a Global Network to Cope with Pandemics from Studies of the COVID Infection

The current situation with Coronavirus Disease 2019 (COVID-19) shows that countries are not well prepared for global pandemics. And it can be just the tip of an iceberg. Risk for future pandemics is imminent given global travel and the interconnected world that we live in today. In addition, global warming poses a real danger of future pandemics; there are many ancient never-before-seen viruses discovered locked up in glaciers, which might be released due to glacier melting. So how prepared is the world? On first glance, the recent and ongoing pandemic created a need for coordinated information and mechanisms to respond to the outbreak across health sectors. With the 2009 H1N1 pandemic and the Ebola outbreak in 2014, weaknesses emerged in global responses, necessitating clear needs for improved management of global public health emergencies.⁽¹⁾ To strengthen the capacity for outbreak preparedness, several organizations and governments readjusted their priorities. The World Health Organization (WHO) has adopted a model to execute a strategic and operational role in a health emergency under the formal mechanisms of the UN system (https://www.who.int/docs/default-source/coronaviruse/srp-04022020.pdf?ua=1). The model outlines the public health measures that the international community stands ready to support all countries to prepare for and respond to what is referred to as 2019-nCoV (novel coronavirus). Most importantly it stated the goal of prioritizing research and innovation to fast track and scale-up research, development, and the equitable availability of candidate therapeutics, vaccines, and diagnostics.

The Centers for Disease Control and Prevention (CDC) established The National Respiratory and Enteric Virus Surveillance System (NREVSS) (https://www.cdc.gov/surveillance/nrevss/index.html). This laboratory-based system monitors temporal and geographic circulation patterns (patterns occurring in time and place) of respiratory syncytial virus, human parainfluenza viruses, human metapneumovirus, respiratory adenoviruses, human coronavirus, and rotavirus. In this surveillance system, participating U.S. laboratories voluntarily report weekly to CDC the total number of weekly aggregate tests performed to detect these viruses, and the weekly aggregate positive tests. They also report the specimen type, location, and week of collection. NREVSS allows for timely analysis of data to monitor viral outbreaks and its circulation patterns or transmission rate.

Perhaps what is further needed is a more holistic approach. For example, phenotypes are the measurable biological, behavioral, and clinical markers of disease. The combination of phenotypic data from electronic health records (EHRs) and clinical data repositories with dense biological data has enabled genomic and pharmacogenomic discovery, a first step toward precision medicine.⁽²⁾ Computational methods for the identification of clinical phenotypes from EHR data will advance our understanding of disease risk and drug response and support the practice of precision medicine on a national scale. By the same token, digital health solutions, based on telemedicine concepts, meet the challenges and ethical hurdles for long-term implementation of strategies to decrease the risk of infection and track disease progression.^(3,4)

A pragmatic solution to this problem is to build a global network that encompasses both biomedical and social networks for first responders, doctors, scientists, vaccine developers, governments, etc. Biological networks can, for example, determine the interaction between proteins.⁽⁵⁾ The relationship between illnesses and biological factors can be mapped using disease networks.^(6,7) And social networks and transport networks are used to make a model of diseases within a population.⁽⁸⁾ Ideally, WHO is mandated to collect and disseminate ongoing infectious diseases. The current pandemic suggests an extended system may be needed. This type of network would need to provide 100% coverage (including all rural and remote areas), reliable and highly secure connectivity to collect, transmit, and store all Big Data 24/7 and immediately provide that data to specialists in any geographical point. Consequently, this strategy and approach needs an investment in a global data-collection network that can be reached by any health care worker at any place in the world. The network needs to ensure free flow of that data across borders to interconnect specialists from different countries, because right now, we live with national health care systems that look inward toward national populations, with less of a focus on integrating what is happening with the outside world. Such a network would help in early detection and reporting for epidemics of potential international concern enabling rapid response capability to and mitigating the spread of an epidemic. All that data will be critical for governments (provide security and managements), scientists (develop new vaccines), doctors (provide health care services), medical sensors, and equipment manufacturers (develop new equipment), and of course citizens (clear data, information, and immediate help).

One of the major lessons from the current ongoing pandemic is that disproportionate effect on certain demographics, ethnicity, and age groups, which was not observed either with influenza or with severe acute respiratory syndrome (SARS) virus. Thus, why not expand integration of serological responses to viruses in general including from diverse populations? Recent congressional legislation enacted in response to the COVID-19 pandemic includes an emergency appropriation of $306 million to National Cancer Institute “to develop, validate, improve, and implement serological testing and associated technologies.” An outcome of this initiation, the Serological Sciences Network (SeroNet) stated goals and objectives that include identifying and advancing research opportunities to characterize the immune responses elicited by SARS-CoV-2 viral infection. In broad terms, these opportunities will contribute to the understanding of the mechanisms driving serological, humoral, and cellular immune responses to the virus; determining host, genetic, and environmental modifiers of the immune response; determining the serological correlates of disease pathogenesis and protection against future infection; and defining access, communication, and implementation barriers related to SARS-CoV-2 serological testing. Of course, this initiation also contributes to the overarching strategy for learning more about how many people have been infected with SARS-CoV-2, how it is spreading through the U.S. population, and the basis of policies to retard its spread. The information is also important to vaccine development if the stated goal of vaccines is to emulate the efficacy of convalescent plasma antibodies observed in some patients.

In addition, computer immunology is needed more now than ever before. Artificial immune systems (AISs) simulate the behavior of the natural immune system having several strengths that can well integrate with network analysis approaches as already mentioned.⁽⁹⁾ The immune system has been viewed as a social network in that it functions through effective collaboration and communication.⁽¹⁰⁾ Like the COVID pandemic, the global prevalence of diabetes is on the rise, and the clinical, social, and economic health burden arising from this epidemic is aggravated by a significant comorbidity of diabetes with neuropsychiatric disease, particularly depression.⁽¹¹⁾ As such, diabetes is a comorbidity factor with viral infection⁽¹²⁾ and the immune system is a regulator of metabolic homeostasis.⁽¹³⁾ Advancements in technology have allowed us to expand the application of novel biomarkers into an EMR database. For example, key factors for the successful clinical applications of pharmacogenomic data include the development of clinical guidelines to guarantee consistent interpretation and prescribing practices, in addition to evidence-based information databases and the appropriate educational programs for decision making. Likewise, serology can define the biomarkers of disease progression and immunity that can be coupled with the genetics of an immune response,⁽¹⁴⁾ to facilitate and distinguish the identification of symptomatic from asymptomatic COVID-19 patients, for example, and provide information on rates of reinfection.

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy is soliciting articles detailing the response to SARS-COV-2 and SARS-COV-1 infection. Defining mechanisms associated with immune responses to SARs underscores the progression of disease associated with SAR infection and critical to developing therapeutic options. The purpose of this solicitation is to highlight immune research having the goals of identifying and characterizing the immune responses elicited by viral infection; understanding the mechanisms driving the serological, humoral, and cellular immune responses to viral infection; determining host, genetic, and environmental modifiers of the immune response; and determining the serological correlates of disease pathogenesis and protection against future infection. Topic areas can include eliciting mucosal responses that might contribute to the cytokine storm as a pathogenic mechanism, the dynamic range of glycosylation of the virus that affects the immune response, correlates of spike protein mutagenesis and response, antibodies in immunodiagnosis strategies, the dynamic range of repertoire diversification, antibodies in passive and active immunization, and epitope mapping associated with innate and adaptive immunity. Importantly the journal will extend the topic area to AIS strategies and approaches. Submitted articles can take the form of original research, short reviews, commentary, and position articles. All articles will adhere to the journal guidelines that now include statement of competing interest, and clarification statement of author contribution. For detailed information on article submission, please see our website (home.liebertpub.com/mab).