FAMILIAR FOE
Lucia Davis ’04 | Prior to the onset of the COVID-19 pandemic, Dr. Mehri McKellar ’87 was focused on HIV prevention and treatment, working in the Durham, N.C., community on testing and prevention with pre-exposure prophylaxis, including in syringe exchange sites.

“And then, all of a sudden,” McKellar says, “this happened.” Now, she’s spearheading COVID-related research studies. An infectious diseases physician and associate professor in the Department of Medicine at Duke University, McKellar is uniquely qualified for the role, thanks to her extensive experience in clinical research with HIV and setting up studies for testing new antiretrovirals. 

“Most of us [in infectious diseases] have dropped our day-to-day research to jump into COVID,” McKellar says. Patients who are long-term survivors with HIV have written to her, McKellar shares, saying the atmosphere during the current crisis feels very similar to the panic everyone felt back in the early 1980s, when no one really knew what was going on.

“No one knew how exactly [HIV] was transmitted, and there were no good treatment options or cures,” McKellar says. She worries about the PTSD the current pandemic is triggering in her patients, adding that she sees the parallels. “There’s the stigma, of course, and people are stressed – and then we’re being asked to stay away from everyone.” McKellar has observed other parallels between the current pandemic and the HIV crisis. “It’s the same now with COVID and the mad rush to find effective treatments,” she says. “We find ourselves in another battlefield with a new disease. It’s exhausting, but I think we have the tools to defeat this, including the intent and ability to design randomized clinical trials to identify the right medications for treatment and prevention.”

McKellar is especially distressed by a second parallel to the HIV crisis; both diseases are disproportionately affecting African Americans and the Latinx community. “More than 40 percent of new HIV infections in the U.S. occur among African Americans, and yet they represent only 13 per- cent of the country’s population,” McKellar notes. “In Durham, the vast majority of patients hospitalized with COVID are black, and we are starting to see a sharp rise among Latino/Hispanic persons.”

In order to self-isolate, you have to have a steady paycheck and stable housing, McKellar adds, noting that both diseases are impacted by socioeconomic factors. “Those who suffer from poverty, racial discrimination, lack of access to healthcare and, now, the inability to socially or physically distance themselves are at the highest risk,” she says. “It’s very disturbing to me.”

Of course, when it comes to treating and testing for COVID-19, there remain many unknowns. “Everyone is so mystified by this disease,” McKellar says, “We’re finding new presentations of it almost daily, which I find extremely nerve-wracking.” Still, McKellar is heartened by expedited approval processes for research studies and the FDA waiving prior certifications for development of diagnostic testing. There is hope in one fact; COVID-19 is a potent but survivable disease.

“The thing that’s always important to report is that we do have successful discharges,” she emphasizes. “The majority of patients leave our hospital alive.”

CHANGE AGENT
Ian Aldrich | Nick Apostol ’66 doesn’t consider himself an inventor. “I just take things that are already out there and put them together in a way so that people go, ‘Why didn’t I think of that?’” he says. Put another way, Apostol doesn’t limit his imagination. Over his half-century business career, the 73-year-old has pioneered major advancements in computer technology, the airline industry, and recycling. 

But his latest turn may be his most important. As CEO and owner of Advanced Biological Technologies International Inc., a supplier of environmentally friendly products that includes disinfectants, sterilizers, and medical detection devices, Apostol and his team are on the production front lines of fighting COVID-19. The core of the company’s business initially was set up to produce disinfectants using sodium chlorite-based formulas. Made in China, these one- and 20-gram tablets turn water into powerful oxidizing sterilizers and purifiers for household and industrial uses to wipe out 99.9% of germs, bacteria, and fungi – including the very building blocks of the novel coronavirus. Apostol wanted to have a U.S.-based production, so he turned to Puerto Rico, a center for pharmaceutical manufac- turing, and took advantage of the numerous tax benefits available there.  

“Business has been nuts since winter,” says Apostol, a Florida resident, who has lived part-time in Puerto Rico since 1974. “Everyone is trying to get their hands on disinfectants.” Apostol gravitates toward making things simple. And, in the coming months, his company is working with MQ Inc., a New Mexico high-tech company, and hoping to roll out a series of groundbreaking test kits that will quickly and easily identify whether someone is infected with COVID-19. One of them is akin to a basic pregnancy test strip that identifies whether the user is sick with a highlighted “yes” or “no.” Another one in development is a patch that turns a certain color if the tester is ill. Both are inexpensive, user-friendly, and – if they get FDA approval – could easily become prolific and a real game changer, says Apostol.  

“In this country, we’re barely testing three percent of the population,” he says. “We need to be at 50 percent. We need accurate testing every day, everywhere. It has to be easy and quick. What we’re doing right now is archaic and takes too long, not to mention costs too much.”

And the consequences of that, he fears, will be dire come autumn, when COVID-19 reemerges in possibly a more powerful way. “In August or September, I think we’re going to see a variation with the common everyday flu virus,” he says. “We’re going to have to be much quicker in our ability to detect these things. We can’t wait three or four months to come up with some system to allow us to detect it. We need a system that’s a lot more agile. And that’s what I’ve dedicated myself to.”

LOOKING TOWARD THE FUTURE
Taylor Schreiber ’98 is co-founder and CEO of Shattuck Labs, an immuno-oncology startup he founded in 2017 with Josiah Hornblower ’94. The physician is also the developer of several research breakthroughs in the field of immunotherapy. As such, he’s had a front-row seat to various processes around vaccine trials and protocols. Alumni Horae contributor Ian Aldrich caught up in early May with Schreiber by phone from his home in Durham, N.C., to talk COVID-19, hopes for a vaccine, and the chances of a second, stronger outbreak later this year.

What do people often get wrong about vaccine development?
There’s a terrible amount of misinformation out there. Just this week, people are realizing that what was being touted about with hydroxychloroquine was baloney. Now, the same is being said about vaccines, about how we’re going to have one in a year. It’s great that companies have started these massive vaccine programs. [But] when you start a vaccine like this, you have to figure out how to make it, how to get it into clinical trials, who the right patients are, and how to monitor those patients. So, when people talk about having a vaccine a year from now, what they’re really talking about is that we will know in about a year whether or not a vaccine in testing has induced an immune response against SARS-CoV-2 antigens. But you will not have a clue whether that immune response will actually protect someone from infection. You can have something on the market, and given the way the government is politicizing these things, I wouldn’t be surprised if there was an effort to put a vaccine on the market based on that immunogenicity data alone, but honestly, it could be sugar water at the end of the day. You won’t know if it will protect people.

What do you make of some of these states deciding to reopen?
I think the ones reopening early are going to pay for it, unfortunately, with patients’ wellbeing. You just have to see what happened in Singapore, Sweden, and now even South Korea to know that. And, even now, with infor- mation out of China being limited, we’re seeing the same thing in Wuhan. The lessons we have on what we can control come from South Korea primarily, where they use intensive QR code contact tracing methods to isolate potential exposures right away.

Are we then likely to see another wave of COVID-19 later this year?
It could actually be worse than what we’re experiencing now if there’s too much of a relaxation of some of the social distancing guidelines and overall precautions. I think schools are going to have a tough time reopening and it’s only going to take an outbreak at a school somewhere for people to be home again. The impact that will have on people trying to get work done will be difficult to manage the longer it lasts, not to mention all these kids who are trying to learn. I anticipate that we will continue seeing recurrent waves of infection into the middle of 2021.

Do you anticipate greater support for public health measures to protect us from future outbreaks?
Absolutely. If you just look at what’s happening in the macro economy, the industry that is surviving the downturn the best is biotechnology and pharmaceuticals. We were wholly unprepared for something like this and it just highlights the need to create better medicines and create better stockpiles for medicines and equipment that protect us from these sorts of pathogens.