If the coronavirus had to come, this was the best time

Life during an epidemic may seem miserable, but even this crisis will end one day. In the meantime, science gives hope.

“Although the disease is particularly serious for groups at risk, hope is more justified than ever,” says Professor of Anatomy Seppo Parkkila from Tampere University.

“If some society is ready for a pandemic and able to survive it, it is Finnish society today,” Parkkila notes.

Finland has well-functioning public institutions, which citizens trust and whose instructions they take to heart. They include a public health care system that functions well despite some shortcomings, an independent judicial system, and schools at different levels.

“Information technology has developed to the point where schools and higher education institutions are able to provide distance education smoothly. Had this crisis occurred with the SARS virus in 2003, teleworking would not have been possible to this extent,” Parkkila points out.

Even during constraints, society is functioning well. Together with a sense of proportion, it is one of the most important conditions for defeating the virus. Things could be so much worse.

Hong Kong flu was encountered in primitive conditions

The last time a major pandemic hit Finland was from 1968 to 1969. At that time, the influenza virus, dubbed the Hong Kong flu, killed more than a million people worldwide and more than a thousand in Finland. More than ten years earlier, an influenza virus known as the Asian flu, had killed about 1,800 Finns.

The passage of time and changes are slow and fast simultaneously. The Rolling Stones, which still tours the world and whose members are at high risk for the coronavirus, had been touring the world for almost a decade when the Hong Kong flu hit. During the career of one band, the healthcare systems of many countries have radically evolved, and such development have also happened in Finland.

“In Finland, there are currently 30 doctors for 10,000 citizens. The corresponding figure in 1950 was 4.9 doctors and in 1965 just 7.7,” says researcher Minna Harjula from Tampere University, a specialist on the history of health care.

“In proportion to the population, Finland’s number of doctors was the lowest in Europe in the mid-1950s, and it only reached the level of other countries in the 1970s,” Harjula says.

The hospital reform made Finland a top country

Measured by the number of doctors, Finnish health care in the 1960s was at the same level as that of India or South Africa today. There are top hospitals, but a significant proportion of people are virtually excluded from the health care system.

During the Asian and Hong Kong flus, municipal doctors and public health nurses were the core of Finnish health services. According to law, each municipality had to have a municipal doctor and those with more than 8,000 inhabitants had to have two. There were only about eight hospital beds per a thousand inhabitants compared with fourteen in neighbouring Sweden.

“In practice, one-fifth of the rural population residing ‘beyond Kuopio’ was completely without municipal doctors at the time, and in the 1960s as many as one-fifth of municipal doctor positions were vacant. Most doctors worked in cities. For example, there were no specialists in all fields in the province of Lapland,” Harjula describes the situation.

It was not until the construction boom of general hospitals in the 1970s that Finland began to be ranked among the top countries in medicine. At the same time, health centres evened regional and social disparities in access to care.

Intensive care, which is currently much featured in the news, had only begun to develop in Finland into its own speciality of anaesthesia and intensive care in the 1960s. Intensive care equipment, methods and know-how have developed dramatically since the 1960s.

“The importance of intensive care in the treatment of the Covid-19 disease caused by the coronavirus is essential because some patients will inevitably develop serious complications. Some need help with breathing, some have impaired heart or kidney function, and some develop sepsis,” Parkkila notes.

The aim of the containment measures is to keep the number of patients so small that there are enough beds in intensive care units. However, even modern intensive care cannot save all patients.

 

Mapping the whole virus in four months

Thanks to information technology, researchers’ detective work is faster than ever. The first news of the discovery of a new coronavirus in Wuhan, China, came in late December. As research data on the behaviour of the virus accumulated, it was found that the infections had already begun in November. When the epidemic arrived in Finland, only four months had passed.

“It is a short time in medicine but even shorter in microbiological research,” Parkkila says.

However, researchers are already able to know what the structure and genome of the SARS-CoV-2 virus are and which mechanisms it uses to infiltrate cells. In the eyes of society accustomed to exceptional circumstances, the pace of research is painfully slow, but from the scientific point of view, the work has been surprisingly fast.

“I am an optimist. So many resources and money are now being invested in researching the virus and the development of drugs and vaccines that we will eventually defeat it. Now the question is just about time, that is, how much more time are we able to gain with other efforts,” Parkkila explains.

Several international research groups are working on a vaccine, and exceptionally, the role of states in the development of vaccines, which is usually led by private pharmaceutical companies, is unprecedentedly strong.

“A vaccine is the main means to fight the virus. We will have it next autumn at the earliest, but probably not until next year. Faster help can probably be found in medicines,” Parkkila says.

Artificial intelligence may help to find the right medication

There has never been a better time to develop medicines. When the Covid-19-related epidemic of SARS raged in 2003, pharmaceutical and life science research were practically living in a completely different era, even though it is only seventeen years since then.

“Information technology development has completely transformed research. We are talking about an entirely different world,” Parkkila notes.

Parkkila is especially hopeful about the so-called virtual screening. In virtual screening, molecular structures and operating principles are encoded in digital form. When data on the coronavirus was encoded, supercomputers and artificial intelligence started to search for a perfect match in the “molecular Tinder”.

The method allowed researchers at the University of Basel to screen from the nearly 700 million molecules in the molecular library eleven molecules, which are possibly ready to work against Covid-19.

“A person or a research group would simply not have been able to do that in the past,” Parkkila mentions.

Previous development work in the pharmaceutical industry, which has been done a lot in recent decades, is also on the side of people. For example, arthritis drugs and, with quite promising results, chloroquine, which is also used for the treatment of malaria, have been tried against Covid-19. If an existing drug is found to be effective, the greedy world market is ready. In this way, research can also help countries whose less developed social systems and health care are not prepared to cope with a pandemic.

“The advantage is that the approval of a medicine already in the market could be faster because it has already been found to be safe and can be deployed quickly. It is just a matter of reliably proving that the drug is also effective against this new virus before its large-scale use can begin,” Parkkila adds.