Meet the Newfoundlander leading Canada's COVID-19 clinical trials

COVID-19 poses a significant threat to anyone unfortunate enough to be hospitalized with it. Critical cases can be admitted to the intensive care unit and possibly hooked up to ventilators but currently there is nothing that doctors and nurses can do in the way of anti-viral treatments.

This is particularly concerning in a province like Newfoundland and Labrador with an older population and high incidence of chronic disease, since COVID-19 shows worse outcomes for those demographics.

But amid all the suffering and uncertainty, one Newfoundlander is trying to pick up the pieces and leadthe charge to find treatments for hospitalized COVID-19 patients.

Dr. Srinivas Murthy is co-chair of the World Health Organization's clinical research committee on COVID-19. He is an associate professor in the Faculty of Medicine at University of British Columbia, as well as a critical care and infectious diseases physician at B.C. Children's Hospital in Vancouver.

Murthy's research focuses on infectious disease, clinical practice and clinical trials, and global health.

Murthy grew up in St. John's, attended Prince of Wales Collegiate, and completed his undergraduate degree at Memorial University. He was awarded the University Medal for Academic Excellence in Biochemistry. Murthycompleted his Doctor of Medicine at McGill University in Montreal and his residency at Boston Children's Hospital through Harvard Medical School. He has also worked on the frontlines for a number of infectious diseaseoutbreaks, including work on Ebola in Liberia, West Africa.

Currently, Murthy is leading the Canadian contingent of the World Health Organization's recently launched Solidaritytrial, which recruits COVID-19 patients for anti-virals in clinical settings. Some 83 countries are involved in this project.

Q. Can you tell us a little more about the current work you are doing with respect to the drug trials?

I am helping the World Health Organization implement their Solidarity trial in Canada. This is a multi-national effort to run a clinical trial across borders, so that recruiting as many patients as possible can help the world learn as much as possible, as fast as possible. This is a unique trial, in that many countries are rolling it out simultaneously, and its name is apt, whereby every country is aiming to help out each other by participating.

Q. Do you have some sense of a timeline for the development of cures or vaccines for COVID-19? How long might it be before the virus is under control or no longer a threat?

It's unlikely we'll find a cure. What we might find are drugs that have a small to medium effect on how people do once they get infected. At the same time, proving a drug is ineffective is still very useful, since it will prevent people from using things that might be harmful. If we do find treatments that are effective, we should know in the coming months. A vaccine is a separate story it likely won't be less than a year until there's a useful vaccine, and it's difficult to say how protective that vaccine will be. The last part of that question when the virus is under control is impossible to predict. Lots of people have tried with models to say when things will settle down, but nobody is sure, and we'll have to see how this all plays out.

Q. What are some of the key issues or concerns for effective and ethical trials at this time?

I think it's important to understand that we need to do these to learn what works, and what doesn't work. Having treatments randomly assigned may seem odd when you have a life-threatening infection, but it's really the only way that we can understand what works, and what's safe. Another important issue is that anything we study must be available after the study. If something is found effective and is only available in a couple of doses around the world, there's really no point in studying it.

Q. How safe are the trials? What is the profile of patients the trials will recruit?

All of the drugs currently being tested have been used for other diseases, and have good safety data to back them up. Also, we'll be closely monitoring for adverse events or side effects through the trial and with hospital teams. We're confident in patient safety. Any adult who's hospitalized with COVID-19 is eligible to participate in the trials.

Q. There is lots of discussion of flattening the curve and the impacts of physical distancing in Canada. Is it too early to make any claims to success in this regard? When might we know if it is working?

We've seen, at least in B.C., some signs of all of our physical distancing starting to work, with case counts starting to stabilize. This tells us that what we're doing is working, at least for now. So, we know what works. The big question, then, is how do we know when to stop, and how to stop, our physical distancing? That's a bit more tricky, and there's not really any clear strategy from other countries.

Q. What are some risks in easing restrictions? Without wishing to get too far ahead of present concerns, can you offer some comment on a possible second wave or subsequent waves?

The possibility of a second wave is definitely real, whether after we lighten restrictions or in the fall, if this is a seasonal virus that prefers cooler temperatures. We'll need to be super-vigilant for how that goes, since it's difficult to start and stop interventions like school closures, stay-in place orders, and playground closures.

Q. Specific to Newfoundland and Labrador, which has a small number of cases relative to other Canadian jurisdictions but a high number of infections per capita, are there any important differences to consider? Should smaller or more rural regions and communities approach physical distancing any differently than, say, large urban centres like Toronto or Vancouver?

I think the principle of physical distancing is one and the same. The problems with smaller regions is that they may not have the public health infrastructure in place, i.e., testing, contact tracing, etc. Clear networks of referrals for patients and samples need to be in place for rural regions so that there isn't chaos when a cluster of cases happens in a small place.

Q. Newfoundland and Labrador is among the oldest provinces with respect to median age and has a high incidence of chronic disease. What kinds of impacts might such factors have on the spread and severity of the virus and of COVID-19?

What's clear is that age and chronic disease are risk factors for worse outcomes. Not exclusively, since young/healthy people can definitely get sick. But still, the elderly and ill seem to do worse. Clearly, the factors you mention should definitely heighten vigilance, but there's not much difference in the containment strategies in that regard. Everybody needs to be cautious right now.

Q. What are some moral and ethical dimensions of the pandemic from the perspective of global health? Are there one or two examples of such ethical issues you care to elaborate on?

This is a major issue that we really need to be thinking about. The biggest concern I have is that every country gets an "only for itself" type perspective, as we've seen with some of the battles over masks and personal protective equipment for health workers. The amount of these materials available for the poorer countries of the world is vanishingly small, and they can't afford to outbid rich countries. At the same time, if we don't control the virus everywhere, we don't really control it anywhere. So, we really need to remember that we're all in this together, and that what happens in sub-Saharan Africa is important in this outbreak. Also, if we end up getting a vaccine or a treatment that's effective, making sure that it's not hoarded in rich countries but equitably delivered around the world will be absolutely crucial.

Q. What are things that average Canadians can do to help people in other parts of the world?

Of course, there are a number of charities and aid groups that are actively working in other parts of the world. I don't want to give a specific recommendation, but people can seek out a number of different options there. Letting their MP know about how it's important that Canada continue to be outwardly focused, and not retreat to protectionism, is crucial. This needs to be solved with the global community.

Q. What is one thing you wish people were more aware of with respect to this pandemic?

That this will take a while to go away completely.

Q. Is there a reserve of hope or inspiration you draw from in a time of so much suffering?

How we're all working together to get through this very difficult period. The physical distancing policies are a huge sacrifice, both personally and economically. And they're in place to allow our hospitals and health system to function as well as possible, so that more people who get infected can survive. That people are willing to do that gives me hope that we're in this together, and that we're all willing to make sacrifices to keep each other healthy. Also, this pandemic has taught us a great deal about how we structure our society and our health system, and where things need to change. We can see this as an opportunity to implement those required changes. There's a great essay by Arundhati Roy in the Financial Times, where she described this pandemic as a portal to a new world, one that we have to build by choosing to fight for it. And I think we can. But we need to foster that movement now so that when this pandemic is over, those changes can be put in place so that we protect each other better and our system is more equitable.

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