Eric Topol (Director & Founder, Scripps Research Translational Institute) joined us at the Festival of Genomics and Biodata 2021 to share his thoughts on the US’ response to COVID-19 and how genomics and digital technologies are vital to combat the virus.
Flying blind
Since its emergence in late 2019, SARS-CoV-2 has rampaged across the globe, causing high mortality rates, pressuring healthcare systems and damaging the global economy. Topol began his talk by laying out the shortcomings in the US’ response to the pandemic describing: “we have been experts on how to fly blind in a pandemic.” He noted specifically that there was no COVID-19 testing for 2 months, inconsistent communication, no rapid home testing, little genomic surveillance and no real-time digital surveillance. Topol heavily criticised the governmental response towards COVID-19 and believes that the economy was prioritised. Nonetheless, Topol hopes that with new leadership the US can get back on track and reform lost collaborations.
Getting control
SARS-CoV-2 has baffled scientists due to its heterogenous presentation. Whilst some individuals end up hospitalised as result of infection, >33% of individuals are said to have no symptoms at all. During his talk, Topol emphasised that asymptomatic individuals represent a huge challenge. He noted that the only way to deal with these individuals is identifying them through testing. Unfortunately, this issue has yet to be effectively addressed. Topol stated that “in order to do better, we need to do better testing.” Specifically, he argued that rapid home testing must be effectively rolled out.
Genomics
In recent months, through genomic surveillance, several SARS-CoV-2 variants have been identified (B.1.1.7, B.1.351 and P.1) that are potentially threatening vaccine efficacy and negatively impacting mortality. Topol emphasised that learning more about the effects of these variants, particularly regarding their effect on mortality and epistasis will be important to gain control.
Whist identifying who is at risk through genomics may be helpful, current GWAS studies have failed to yield significant results. There have been no clear-cut signals that would explain the significant amount of heterogeneity observed amongst the population. Nonetheless, a recent study involving two monozygotic twins (who lived and worked together) found that they presented with divergent responses – one got severe pneumonia and the other got mild symptoms. Although there is no clear explanation as to why the twins got differing clinical illnesses, Topol suggested that immunological and epigenomic influences may have played a key role.
Digital
Digital technologies are continuously emerging and becoming integrated across healthcare and pharma. Topol noted that these technologies will be important to gain as much data as possible on the virus. He specifically referred to the DETECT study which is harnessing wearables to detect COVID-19. For example, changes in sleeping patterns, activity levels or resting heart rate can be early indicators of COVID-19. Topol emphasised that many people now own wearable devices and utilising these digital technologies can be a cost-effective way to track outbreaks of the virus.
A combined approach
It is obvious that the more data, the better. Topol praised ICNARC which provides a report on patients critically ill with COVID-19 in the UK. He reinforced the importance of having not just genomic data but good clinical and digital data. He went on to discuss the value of combining data sources. For example, wastewater surveillance, which in Switzerland has been able to capture variants before they have emerged clinically.
He then discussed the impact of long-covid and how understanding the immunome of people will be vital. To-date there has been no report on what the determinant of long-covid is, which Topol believes is a critical missing link.
When questioned by Vivienne Parry about why Topol believes these combined approaches are not being applied, Topol noted that our thinking is siloed. He argued that there was no excuse to not be embracing rich data and believes that multi-layer data collection is worth the investment (Fig 1).
Registration for on-demand access to watch this talk and all our other talks from the Festival will end on February 12th. Register now.
