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Crisis Talk — with virology expert professor Peter Openshaw on why post-Covid offices must adapt

openshaw
By Silas Brown
06 May 2020

As Western societies begin to contemplate life returning to some semblance of normality, the financial industry is working out how best to balance the understandable desire to get back to how things were before the crisis with the very real threat of a new and more deadly wave of coronavirus brought on by a mass-return to offices. GlobalCapital’s Silas Brown spoke with Peter Openshaw, a specialist in immunology and virology and professor of experimental medicine at Imperial College, about the transmission of Covid-19 and how banks, investors and companies can reduce the risk of infection.

Openshaw is president of the British Society for Immunology. He delivered the Croonian lecture at the Royal College of Physicians on influenza pandemics in 2013. He has been a member of the Scientific Advisory Group for Emergencies (SAGE), the scientific body that advises UK governments.

Imperial, and in particular its modelling of viral infections, has played a key role in the government’s response to Covid-19, including advising it on the severity of the lockdown and how the country emerges from the many restrictions across business and society that have been in place since mid-March.

GlobalCapital: People in finance would be interested to hear the risks of spreading the virus in the day to day work they do, and therefore how their way of working may be different in the future. Banks, investors and companies have thought about different ways to minimise the risk when returning to work. Staggered shifts, keeping employees at least two metres apart, closing staff canteens and minimising hot desking: will any of these ideas actually help? 

Peter Openshaw: We need to understand a lot more about how the virus is transmitted. At the moment there are still uncertainties and still a difference of opinion about how we should try to reduce transmission.

Everyone accepts secretion on the hands is one of the main methods in which transmissions may occur in the workplace. If you touch someone’s hand and then they put that hand into their eyes, or up their nose or in their mouth — that’s risky.

But the picture is cloudier when it goes beyond hand transmissions.

There was an intensive investigation of a transmission chain in southern Germany, one of the first examples of coronavirus in Europe. An employee from China visited a factory in Munich in late January 2020, which led to infection of nine people. A really detailed study of how they became infected was performed by a team of virologists, immunologists and anthropologists who interviewed each person in the chain to understand how transmission could have happened.

In one transmission, the only thing they could find is that the two parties were sitting back to back at neighbouring tables in the factory canteen. One of the two turned around and said ‘Could you pass the salt?’; perhaps their hands touched as the salt was passed. They weren’t even facing each other, so just that contact seems to have been enough to pass on the virus. It seems unlikely that direct inhalation of mucus spray was involved.

We think some transmission can be due to a spray of contaminated spittle during conversation, but there are still very few studies that really explore exactly how transmission happens. In the original wet market transmission in Wuhan, nobody quite knows how it happened. Was it a market vendor excreting virus in his or her mucus, contaminating shoppers as they passed through the market? Was it something consumed in the market? Nobody quite knows.

What seems certain is that this new virus (SARS-CoV-2) is more easily spread than the original SARS coronavirus back in 2002. This virus seems to multiply better in the mouth and nose, whereas the original SARS virus grew better in the lung and guts. If this one is better adapted to the upper respiratory tract, it’s more likely spread by coughing, sneezing and maybe even talking or singing close to someone.

Talking?

Talking is controversial. As I talk right now, fine droplets are coming from my tongue, lips and throat which are accumulating on the computer screen. Every few months you’ll find that unless you wipe your screen it’s coated in a fine coating of dried oral mucus which sprays out while you talk. Especially if you are shouting at the screen.

You will have been at a party where you are talking to someone over the noise and you feel a bit of spittle going into your eye or landing on your face or lips. That seems a very plausible mode of transmission.

So what are the best ways of minimising the risk of that?

Some form of facial covering that prevents that spittle, even a piece of cloth. It doesn’t need to be an N-95 surgical mask — something suitable for bio-terrorism incidents. The covering doesn’t need to be a fine filter. The size of particle you need to prevent is not as small as a virus, or even a bacterium. Just the size of spittle. All of this is me speculating, based on first principles. What’s needed is proper controlled studies.

Prevention can also be helped by distance. We recommend two metres — most spittle drops out after a metre, so some countries are recommending that. Obviously, if you are sitting next to somebody and there’s a gentle movement of air from them to you and you are sitting next to each other for a few hours, I would think there could still be transmission even if you are two metres apart — it depends on the air circulation in the office. To reduce the risk, facial covering and liberally available hand sanitiser are sensible precautions.

It is fair to say that guidelines, whatever they are, will be broken, knowingly or unknowingly, repeatedly across the working day. The challenge, I suppose, is working out whether that’s OK.

Passing in the corridor is inevitable and so too sharing telephones, touching door handles or flushing the loo. If you are sharing keyboards, you should have a cleanable cover, or a spray cleaner. I would guess that having some sort of sanitising spray or gel before and after touching door handles is important.

But what could help is a lot of intensive PCR (polymerase chain reaction) testing for the virus. The plan is that frequent testing for both the virus and the antibody (taken from a blood sample) will start soon on all Imperial College staff. We think this will reassure our staff and give masses of information that will help prevent spread.

However, about 40% of transmission is from people who don’t know they have it. About 20% are pre-symptomatic, so they will display symptoms in a day or two. Another 20% are carrying the virus and it is multiplying without causing them any harm. That adds up to 40%.  

Routine screening using viral detection by PCR would pick up many of those who are transmitting virus and is something which might be offered in the workplace. The cost of that could mount up but you would spot the introduction of the virus in the office in time to isolate and contact-trace.

Travel and client meetings abroad are key for financial markets. How risky are these activities? Might that part of working life have to change for a long time?

Getting back to where we were in international travel and meetings is hard to imagine, until we have a vaccine.

If anyone with any financial influence can encourage investment in vaccines, it’s well worthwhile. That’s the only exit strategy that many of us can see to getting us back to where we were before the pandemic.

Vaccines typically take 10-20 years to develop. We’re hoping this vaccine could possibly be ready for scale-up towards the end of this year. Once a vaccine can be made in millions of doses, we can see ourselves getting back to work normally. But we need to have vaccines that work for anyone who needs it, anywhere in the world.

Is it likely that one pharmaceuticals company will find the vaccine or cure on its own? Would this then be the intellectual property of that company? What mechanisms would there need to be to ensure that it could be rolled out as fast as possible and be made affordable for poor countries?

Vaccines are not made in a vacuum but by a team. You need a village to bring up a child, you need a worldwide community to make a vaccine. At the moment there’s a trend in pharmaceuticals to get together and share knowledge and resources and expertise and IP.

For example, GlaxoSmithKline has got a range of really good adjuvants that make vaccines more potent. Some companies don’t have that but do have a great protein, so companies can form alliances on that basis. It’s too important to be just looking for your own company profits and we have witnessed a good trend towards sharing. We cannot make and deliver vaccines at scale in academia — industry is the only way to do that.

More broadly, and finally, what is so different about this coronavirus that has thrown the whole world into disarray, when other epidemics have not?

The thing which has completely taken us by surprise is the diversity of clinical presentations and syndromes Covid-19 is causing. We initially thought it was a virus that gave you a cough or sometimes viral pneumonia, but now we know it does all sorts of other things. It is causing widespread clotting disorders — not just deep vein thrombosis but thrombi in vessels in lungs and the heart. It is causing a surge in acute diabetes: previously healthy people with very high blood sugars.

In children, there is an inflammatory condition called Kawasaki disease. Nobody quite knows the cause of that but it’s an inflammatory condition where blood vessels become inflamed and children develop inflammation in their mouths. There has been a big increase recently, which we assume is triggered by Covid-19.

As the days go by, we discover new twists in the tale. It’s a virus that’s turning out to be particularly vicious. Until we have a vaccine I don’t think elimination is really in prospect, but a lot can be done with widespread testing, contact tracing and isolation in all cases.

The only end game I can see is that there is an effective vaccine or vaccines — but we are not there yet.

By Silas Brown
06 May 2020