Can phages help COVID patients? We’ve been hearing chatter about this subject from the phage community over the last few days, so we’ve decided to start the conversation here and keep it going. What, if anything, can the phage community do to help with the COVID-19 crisis?
Bacterial infections associated with many flu patient deaths; this may also be true for COVID-19 patients
This week, Dr. Julie Gerberding, MD, the former CDC director and current Chief Patient Officer and executive vice president for strategic communications, global public policy, and population health at Merck, wrote an article for STAT News about the problem of secondary antimicrobial resistant (AMR) bacterial infections (also known as co-infections) in the context of COVID-19. She talks about how AMR bacterial co-infections will likely complicate treatment of COVID-19 patients, and how patients at high risk for AMR infections are the same ones at high risk of COVID-19.
She highlights a review on influenza research that showed that secondary bacterial pneumonia was detected in 29-55% of mortalities associated with the 2009 flu pandemic. This review also refers to a study that showed that the majority of deaths from the 1918 flu pandemic likely resulted from secondary bacterial pneumonia (though of course, the latter occurred before antibiotics were discovered).
Then she discusses a recent report from this month in the Lancet, which looked at COVID-19 patients in two hospitals in China, and found that 1/7 patients hospitalized with COVID-19 had secondary infections (including 50% of those that died). This study also found that 100% of patients who died of COVID-19 had sepsis, though it was not determined whether this sepsis was viral or bacterial.
- To what extent are patients around the world with COVID-19 dealing with secondary bacterial infections?
- To what extent is the sepsis being seen in COVID-19 patients caused by bacterial infections?
- Are bacterial strains infecting COVID-19 patients antibiotic-resistant?
- Which bacterial species are the biggest problem for COVID-19 patients with bacterial secondary infections? (Note that Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus are reported as the most common bacterial culprits in influenza co-infections)
- Can phages help these patients?
- Even if phages could help, are healthcare professionals too busy stemming the flow of COVID-19 cases to have time for experimental compassionate use therapies?
- Would regulatory agencies be open to considering compassionate phage therapy treatments for COVID-19 patients? (Would they have the bandwidth to do so?)
- Are phage labs open, or would they be willing to open, to help source and/or screen phages for COVID-19 patients? Would phage companies be willing to do the same? Of note, TAILΦR, the phage therapy service center at Baylor College of Medicine, is still open and working to provide safe, characterized phage cocktails to physicians for treatment of patients. They have not yet been approached on behalf of any COVID-19 patients, but would be open to this possibility if asked (personal communication with Dr. Austen Terwilliger, Director of Operations at BCM Tailor Labs).
Let us know your thoughts
- Do you know clinicians who are thinking about how to treat these secondary infections? (Feel free to connect them with us, if so)
- Is your lab open right now? Would you be willing/able to help source and/or screen phages if we ended up determining there was a need? (This goes for now and in the future, given the likelihood that COVID-19 is not going to disappear, even if we do get a handle on it in the short term)
Looking ahead, making plans
Even if not now, while things are out of control, perhaps in the future, when COVID-19 is still present but clinicians have more time per patient, phage therapy may be a viable option for some of these patients. So even if this doesn’t become a rapid, emergency-level phage community effort right now, we think it’s worthwhile to start talking about how we as a community of phage professionals could set ourselves up to accept COVID-19 patient bacterial isolates, develop phage libraries against these pathogens, and possibly help coordinate compassionate phage therapy treatments for eligible patients.
Join the conversation: phage.directory/slack
If you’d like to help, or you have thoughts, please join our Slack workspace, phage.directory/slack; we have a channel called #covid-amr dedicated to this topic and would love to hear from you.
Check out our Wiki, “COVID AMR & Secondary Infections” (https://phage.directory/covid-amr), where we’re tracking articles, posts, threads and other resources around this topic.
*If you’d like to add links to the collection, that would be great! Use this link to download Notion (https://phage.directory/notion) (we get credits when you use our link!), then email firstname.lastname@example.org, and we’ll give you edit access.