mechanism of heart damage likely varies from person to person .
Understanding how heart injury occurs could help cardiologists decide whether they need to focus on treating the heart specifically during COVID-19 illness or whether nonspecific inflammatory control would be sufficient to shield the organ from the ravages of COVID-19 .
“ There ’ s always a challenge in understanding whether the presence of small amounts of virus in the cells of the heart muscle is directly causing their destruction or whether their destruction is more of an autoimmune phenomenon ,” Newton-Cheh says . “ I do not think this has been resolved despite decades of research since the 1990s documenting the presence of viral genomes in cardiac cells in the setting of myocarditis .”
The long game of pathogenesis research
The accumulation of knowledge over the past year , coupled with a realistic understanding of the limitations of human nature , has yielded a new realization : The notion that SARS-CoV-2 will one day vanish may be magical thinking , Alter and Knipe say .
Many experts now agree that the virus is here to stay and that our best chance for a return to some semblance of normality may be to subdue , rather than eradicate , the virus by achieving a level of herd immunity , preferably through a vaccine rather than natural infection . For pathogenesis research there is really no endgame . “ Even when you have a vaccine , even when you have a therapy , even when you have a diagnostic test , pathogenesis doesn ’ t end . Ever . Because we know this virus is not going to completely go
away anytime soon ,” Alter says . “ Human behavior dictates that , unless everybody accepts the vaccine , the virus is not going to go away . On top of which , we know that there are other coronaviruses lingering in nature that are waiting to have their chance .” It ’ s a point that Knipe returns to again and again . “ History teaches us that we just don ’ t know where the next pathogen might come from , so we can ’ t take our eyes off the ball . We have to use what we have learned about SARS-CoV-2 and use this knowledge to continue basic science research into other pathogens .”
But there is an even more fundamental reason for the work to continue , Alter and Knipe said : To sustain this never-before-seen intellectual collaboration sparked by the journey to understand the mechanisms of COVID-19 and to maintain the intellectual interactions with fellow scientists from both academia and industry and from disciplines as diverse as systems biology and computational biomedicine , pediatrics and epidemiology , genetics , cardiology , radiology , neurology , endocrinology and more .
“ MassCPR had this vision of bringing together epidemiology , therapeutics , diagnostics , clinical medicine , and more to create these pillars of fighting a disease ,” Alter says . “ Now , imagine if we did the same for every other disease . Imagine doing this for breast cancer , for Parkinson ’ s . Just think about what we could accomplish if we could form these Manhattan projects .”
Ekaterina Pesheva is director of science communications and science media at Harvard Medical School .
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