Jason Kindrachuk, PhD: Understanding SARS-CoV-2 in an Emerging Virus Context

Segment Description: Jason Kindrachuk, PhD, professor of viral pathogenesis at the Medical Microbiology Department of the University of Manitoba, situates the virus which causes COVID-19 in the context of past coronavirus outbreaks. This is part 1 of a 3-part interview.

Interview Transcript (modified slightly for readability):

Contagion®: Hey, thanks for our viewers joining us. I'm Grant Gallagher and I'm sitting down with Dr. Jason Kindrachuk. We're going to be talking about a lot of different issues to do with the microbiology of SARS-CoV-2. Dr. Kindrachuk, what is your background with coronaviruses and how has it impacted how you've thought about acting on this pandemic?

Kindrachuk: My background is in emerging viruses as a whole, trying to understand the molecular pathogenesis as well as the circulation and spillover of these viruses.

My first introduction to the coronas was with MERS, so 2013 and 2014, when we started to see it spreading across the Middle East.

We jumped in with both feet to understand what this virus was and whether or not there were any countermeasures that we could identify very quickly to fight against this. I continue to work on all emerging viruses.

That includes things as straightforward as outbreak and pandemic preparedness. When SARS-CoV-2 emerged that fit perfectly into my wheelhouse.

Contagion®: I saw on Twitter that you were involved in coordinating supplies. Could you briefly touch on what that's entailed?

Kindrachuk: We know here at least in Canada, and you've been impacted in the US, there are shortages on supplies, because we have a lot of people going to hospitals and healthcare networks all at the same time. Things as basic as gloves, surgical masks, N-95 respirators, infrared thermometers.

We didn't really see a strong coordinated effort to do this either at the provincial or regional levels in Canada. So myself and a few other people here at the University of Manitoba created a network to be able to try and identify and distribute supplies, both locally as well as regionally.

We're in the middle of that. We haven't quite had the case loads of other regions in Canada or the US, but we see cases are increasing. We want to be as prepared as possible.

Contagion®: Could you start us off by comparing and contrasting the biology of SARS-CoV-2 with the closely related SARS-CoV-1 and other coronaviruses like MERs?

Kindrachuk: We're starting to get a better idea of what this virus is, keeping in mind that we're still just months out from when this really first emerged. We understand now, from the standpoint of sequencing, this virus is somewhat close to SARS coronavirus, to the original SARS-CoV. In terms of looking at its phylogeny, it shares some similarities to that.

Also based on sequence analysis, what we've been able to surmise is that the likelihood is that this virus, much like SARS and MERS, or was postulated for those, likely spilled over from bats. We know that it is a respiratory virus that attacks the cells in the respiratory tract, it looks for the ACE-2 receptor much like SARS-CoV does.

But we know as well that it spreads very quickly. As compared to SARS, the spread of this virus has far exceeded that. And we're now in the midst of a pandemic.

Contagion®: SARS certainly caused suffering in clusters of outbreaks, including in your native Canada there was the outbreak in Toronto, that had that tragic blow-up there, but overall, not the kind of spread that we saw with this. Do you have a sense of why that is? I know that this has a lot of asymptomatic carriers, for example.

Kindrachuk: I think that's a large part of it. We're still learning about the transmissibility of this virus. Hindsight is going to be 2020. When we finally go back and start to understand how much of the population was actually infected, as opposed to those that were confirmed or deemed probable based on diagnostics.

I think a lot of it is the fact that it seems to be quite transmissible, but we have this large contingent of patients that appear to be able to spread the virus even in the presymptomatic phase. And that makes it difficult for us to trace and understand where this virus is going to. From a containment aspect, it's just been monstrously difficult to get this thing under control.

Contagion®: I was reading an article, and there was some concern about the heightened risk to doctors involving the chance of a density of viral exposure, in a way that is considered similar to dynamics with HIV.

That makes me think to the Wuhan quarantine, where you did have familial spread and things like that. And the concentration of burden on the health system.

Do you have any sense of whether that increased viral dose is going to be impactful? I'm not sure if it would be the severity of infections or the likelihood of becoming infected.

Kindrachuk: It's a great question. I was on a Twitter thread discussion about this last night, with a couple of other PhDs. What we've seen is that certain viruses have this correlation between the amount of viral inoculum that is found during the course of infection, as compared to overall disease severity.

We saw some of this in SARS with health care workers that were working with patients in very close proximity, in particular patients that needed to be intubated. Or people that needed to do bronchoscopy.

If you're right in close proximity, you have the possibility that somebody could release small particle aerosols that can be picked up in a short distance, and also a high viral load because you're right at the source.

I don't think the data has really come out yet from COVID-19, to say what that link is for healthcare workers. But certainly we're watching and it is still a testament to why we really need personal protective equipment for our frontline health care workers, because even if it's just a risk at this point, we want to try and minimize the severity of disease in those folks as much as possible.