This immunologist turned a torrent of data about the early immune responses of SARS-CoV-2 patients worldwide into an accessible data stream.
All of the information is coming out on preprints, realised Duke-NUS immunologist Associate Professor Ashley St John some months earlier, after reading another wave of medical journals for early insights on SARS-CoV-2. And people don’t always know how to evaluate the quality of that data.
Offering preprints of SARS-CoV-2 research papers was how academic journals and researchers responded to the urgency of the pandemic, particularly in its initial stages. These papers skip journal queues and backlogs, making research on the virus immediately accessible to — and actionable for — the medical and research community.
The pandemic, however, triggered a surfeit of medical research papers churned out faster than normal. This growing torrent of data needed a macro-level overview, especially during those early furious months of the pandemic. Too much information would lead to confusion, sending scholars down pointless paths and avoidable dead ends.
And so, St John, who investigates immunity and immune pathology, set out to make all these early insights into the novel coronavirus accessible and verifiable.
“The one thing I could do was go through it all,” reflects St John, who was running other projects concurrently. “I told myself ‘I’ll learn, and I’ll put it all in context.’”
An exacting review
“All” here meant sifting through thousands of preprints and published articles before focusing on the most pertinent ones, which St John and her co-author, Abhay PS Rathore, a then-postdoctoral research scholar from Duke University, systematically reviewed. A robust immune response is vital for determining how a disease develops and resolves, yet there weren’t any reviews on SARS-CoV-2 immune responses then. New work was simply coming out too quickly from labs and hospitals across the globe.
More so, these papers mainly informed their readers that this particular result had been observed in this particular lab, and that these results were (or were not) consistent with those from another lab.
“Many of the early literature was highly descriptive,” remembers St John who is part of the Emerging Infectious Diseases Programme at Duke-NUS. “A lot of these preprints that were coming out of China very accurately described the types of changes in the immune cells that you see. The antibody kinetics and responses, for example.”
A good number of publications since supported those initial findings, St John notes. Her review, then, provided a contextual guide to different ways of thinking about — and intervening against — SARS-CoV-2.
“We’re lucky that these first researchers did it right. So, our review was right,” says St John. “And those that hadn’t been peer-reviewed we made sure to flag them as such in the text.”
St John’s mention of these qualifiers indicates one thing key to her review paper which was published today in the highly influential Journal of Immunology: it was exhaustive and exacting. One of its key observations was that SARS-CoV-2 may have long-term effects on the immune system.
While SARS-CoV-2 patients had varied immune responses, some quite notably had a weakened immune system containing fewer white blood cells even weeks after their hospital discharge. Others experienced inflammatory symptoms such as swelling and pain even after recovering from SARS-CoV-2. And a number of patients were at risk of kidney damage—SARS-CoV-2 particles were present there, potentially provoking similar inflammatory symptoms.
St John’s focus, with the review published, shifted back to potential vaccines and therapeutics. Collaborations with Duke-NUS’ parent university in North Carolina, and with the pharmaceutical industry, were imminent possibilities.