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Could the Latvian population have specific genetic traits that reduce the effects of COVID-19, and will a vaccine be safe?

We invited Professor Ludmila Vīksna (pictured), the Head of the Rīga Stradiņš University (RSU) Department of Infectology and project manager for the national research programme approved by the Latvian Council of Science, for a talk to discuss these and other issues.

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Let's start with the project that you are heading. Where did the idea come from?

I can't name one person as the sole author of the idea for this project. It was the worrying situation caused by COVID-19, as well as previous experience made researchers from a variety of fields, as well as physicians and biologists, feel that there is need for extensive research. The epidemic made it clear that researchers must come together and agree on undertaking research projects determining what can be studied in Latvia and what must be done in international research. Lack of knowledge requires answers that can only be reached through research.

Afterwards, formal bodies such as the Ministry of Education and Science, the Ministry of Health and others carried out the projects’ preparatory work by setting tasks and objectives, as well as doing the bureaucratic work by announcing a call for proposals, engaging experts and also providing funding. Relatively large groups of researchers took part in the call and independent experts, including well-known international specialists evaluated the applications. Consequently, RSU received a fairly large number of projects, including medical and biology-based studies.

How will the project be implemented? What will you study?

Our project is extensive and includes several smaller and more targeted, or focused studies. Regarding the group of researchers that I have been assigned to lead, I would say that this study is of particular importance to patients because we will be studying the clinical picture by determining and understanding patients' complaints, and examining the potential severity of the course of disease for different groups of people. We are also investigating whether the Latvian population has any specific immunogenetic factors that might explain the current limited spread of the disease in Latvia. We are also planning to study the antibodies that are formed in humans to fight against the virus. There will also be a socio-demographic survey in which we will interview both patients and medical staff: we are going to determine whether COVID-19 patients have other infectious diseases at the same time, and their frequency.

One section, the Solidarity Trial, was initiated by the WHO, and is dedicated to Latvian and international scientists studying the use and effectiveness of certain medical products. Our colleagues at the Latvian Biomedical Research and Study Centre are also examining the virus itself along with its mutations. Some researchers are collaborating with other countries to research vaccines because developing a vaccine is only possible in large countries with significant resources and experience as this research requires virology institutes with state-of-the-art equipment and large teams of researchers. Despite this we have been invited to participate, given the high qualifications of Latvian researchers, and our colleagues’ ideas have received support to conduct further research.

Could it be that our country's population possesses certain genetic traits that might prevent the virus from spreading as widely as it has in many other parts of the world?

We know for sure that this is the case with other diseases. We hope to be able to find possible immunogenetic specificities. When we were preparing the project application, we chose those research sections that matched our experience, and we already have know-how in the field of genetics. We have determined the protective and risk genes for humans regarding diseases such as tick-borne encephalitis, the hepatitis C virus, or HIV. COVID-19 would be the next pathology to be studied that would provide us with the opportunity to compare the results of the research with what we already know about patients with other diseases.

Many international colleagues ask whether it is just a coincidence that we are surviving this epidemic so well, or whether it’s the government's proactive approach and public discipline, or whether there is something special in our genetics. We will also look at whether we differ from people in other regions, which would explain the relatively small number of people diagnosed with COVID-19.

How would you describe the expected results of the project?

We hope to be able to provide patients with even better organised healthcare services, but, above all, we will understand the way in which the disease is developing and know what biochemical or other types of indicators could be considered as markers determining a milder or more severe course of the disease. As long as we do not have medicine that directly targets the virus, we can provide pathogenetic treatment to patients by affecting specific stages of the disease. If, for example, a patient displays a pulmonary pathology, we treat it, but if the markers shows that a patient has kidney problems, we can already start treating their kidneys, thus significantly easing the course of the disease and, of course, reducing risk of mortality.

We will also look at the effects of the disease. There are diseases that one recovers from with practically no negative consequences. And then there are those diseases that can completely change your life even after recovery due to permanent damage to the organs or your system. We therefore plan to carry out so-called dynamic monitoring, which could be taken over by healthcare institutions after the project ends.

Our group intends to write guidelines for how to act in certain situations, which patients to hospitalise, who can be treated at home, how to conduct medical examinations, how often and what medications to use, how to follow the course of the disease as well as other recommendations.

COVID-19 is an epidemic that has affected the entire world, so it requires cooperation with international partners. How would you describe this cooperation?

To begin with, the amount of available information is enormous, yet it is often contradictory and not always reliable. For this reason, we have included a meta-analysis of literature in our part of the study. This method for discerning valuable sources is rarely used, but we need to be clear about what information can and cannot be relied on. Because if we choose the wrong approach and base our research on publications that are erroneous, sloppy, or unverified, it can lead to wasting a whole part of the research, along with funding and human resources. I would like to add that library specialists from RSU have provided us with a lot of help in selecting literature.

Information is also exchanged through personal contacts, but currently researchers from different countries are not very quick to trust one another. This is partly due to reports by the World Health Organisation that, for example, started off by recommending a certain medicine then withdrawing the recommendation. In my opinion, in six months or a year, when the set of proven and reliable scientific materials is larger and when several independent groups of researchers have come up with the same results, then the current mistrust will start to fade away, but still I believe that researchers should always be prudent.

Some countries want to jump into action as soon as possible: they already have successful results and a vaccine. Is that normal?

This is unacceptable in science, but unfortunately it still happens. Even the scientific journal The Lancet has published and subsequently withdrawn several articles. Medical history is full of conflicts, such as the one between American and French scientists on HIV: they are still arguing about who was the first to discover or detect the virus. In practical terms, we mostly rely on, use, and analyse guidelines that are developed in countries using a large number of patients.

I would like to conclude with a question that is not directly linked to the project, but rather about the general impact and spread of COVID-19. What is your assessment of the current situation? 

I still believe that Latvia has managed to keep its head above water in this epidemic. Whichever perspective we choose, we have behaved very well during this time. As an infectologist, I can say that we will still be actively dealing with COVID-19 for the next two or three years. Then we will learn to live with it. I am not very optimistic about a vaccine, and I would be very reluctant to administer a vaccine that has not undergone lengthy testing. The fact that it does not currently produce any side effects and that it has developed antibodies to COVID-19 does not mean that it will continue to do so in the future. What is more, we do not know what side effects the vaccine might produce over the years. Theoretical proponents of vaccines have already stated that they will not administer it to children and adolescents, which shows that they also have some concerns. So we have to consider what the greater evil is: a disease whose course we have studied, or a vaccine whose possible future side effects remain unknown.