Women of the Pandemic

by Lauren McKeon

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  On O’Brien’s sixth or seventh day of working on the COVID-19 floor, infections specialists from Vancouver Coastal Health visited the centre where she worked. On the day they arrived, the facility was, as had become the new normal, short-staffed. As O’Brien listened to a lecture on proper PPE use, she became more and more upset. Then, she exploded. “We need people,” she told them. “We need bodies.” She peppered them with questions: Are you a nurse? Are you a care aid? Can you work? People were dying, and she knew there were not enough people at the facility anymore to properly take care of them. What did it matter if staff knew the proper precautions if there was nobody there to follow them? “I lost it,” O’Brien said. “I burst out into tears.” She had to leave the room. She came back, of course; there were only two other care aides working the shift with her. She wasn’t about to leave them alone. She wasn’t about to leave anybody alone. Especially the people who were dying. “There was not one person who died alone,” she added. “I made sure of that.”

  When she knew somebody wasn’t doing well, she’d make sure to monitor them. Every half hour, she’d stop her work, go in and check on them, hold their hand, satisfy herself that they were okay. Then she’d run back to whatever she was doing. Then, thirty minutes and back again. She’d do this for everybody whose health had stuttered, looping from person to person, never leaving anybody alone for too long. If her check-in revealed they were getting worse, she’d stay and wait. If it was the end—thirteen people died during the first outbreak and eighty-nine became sick—she’d make sure they didn’t face it alone. It was better, she said, when a person had family in the city, or nearby. O’Brien could call them and they could come in, dressed in full PPE. They were better good-byes, and she could feel the weight lift off her when a person’s son or daughter sat at their bedside, whispering love and reassurance. Not everybody had family left, though, and for those times, O’Brien was there. It wasn’t always peaceful, like in the movies. People call out, they get restless, they do not want to go. O’Brien, who had already seen so much death in her job, felt the sharp difference of dying in a pandemic. “It was so many people in such a short amount of time,” she said. “It was just continual, continual, continual—I didn’t have time to process it.”

  She wasn’t on the COVID-19 floor for too long before she, too, got sick. Her swab test for the virus came back negative, but O’Brien knew there was no way she should keep working. She felt like she had a terrible cold; she felt like she had the virus. By that time, she said, some of the care aides who’d originally tested positive were finishing their quarantines and able to come back to work—“It was almost like we were swapping places.” O’Brien eventually took a total of four COVID-19 tests, with each coming back negative. However, she also knew that sometimes the tests give a false negative, meaning they indicate you don’t have the virus when you do. The reported rate of false negatives ranges between 2 and 37 per cent. A later antibody test, which uses a person’s blood and can show whether they had the virus in the past, came back positive. O’Brien returned to work after about ten days of self-isolation. By that time, she was able to go back to her regular floor, a piece of good news mitigated by the fact that the virus was now on every floor. At least it was now easier to sequester virus-positive patients in their rooms. Easier to stop the spread.

  O’Brien doesn’t see herself changing her job any time soon. Yes, it’s hard. Yes, it’s scary. Yes, it isn’t for everybody. But she knows that, at the end of the day, she can go home. Her clients are home. And, as the daughter of two nurses, she sees it as her duty to help people. To make connections with them. To make their lives better. She wants people to know that a lot of PSWs feel that way—even the ones who got sick, even the ones who, for many reasons, could not work during the pandemic. At her facility, and many others, the staff who were left did the best that they could. It wasn’t that they were all incompetent, or that they didn’t care. They just didn’t have the magical power to manifest being in a dozen places at once. They couldn’t raise the funding for better staffing, supplies, or conditions. It would have been infinitely, unimaginably worse if even a fraction fewer of the PSWs who staffed facilities, homes, and community care across the country weren’t there. Think about that for a second. We know it was bad, and it could have been worse. When I spoke to O’Brien before the second wave in the fall and the re-emergence of the virus in her facility, she worried about what would happen if companies and government didn’t use the infection lull to shore up resources at care homes. “If something like this happens again,” she warned, “the whole system is going to fall apart.” Along with everyone inside it.

  “WHEN WE DECIDE THAT WE, AS HUMAN BEINGS, ARE THE PRIORITY, EVERYTHING ELSE WILL FOLLOW FROM THAT DECISION.”

  Paulette Senior, President and CEO of the Canadian Women’s Foundation

  Nine

  RECOVERY

  Alyson Kelvin cannot simply walk into her Containment Level 3 lab at VIDO-InterVac. First, she enters a locker room, where she changes from her regular street clothes into her scrubs. Then, she enters a secure hallway and a room nicknamed the “clean” change room. There, she preps everything she’ll need to work with that day and changes again into a new pair of scrubs—these ones only go into the lab. Afterward, she enters the “dirty” change room. That’s where she’ll put on all her equipment: special socks, double gloves, and her Tyvek coverall suit. The effect is half marshmallow, half spacesuit. She’ll also put on a hood and helmet that are equipped for filtered air circulation via a hose that hangs from the back of her head like a ponytail and clips into a power pack. The pack feeds the clean, virus-free air and sits around her waist. To Kelvin, the air that flows through the suit is icy, and she usually layers two long-sleeved shirts under her scrubs. Once inside her lab, which, incidentally, she can see into from a square window in her office, the real work begins—that is, helping to build a vaccine that millions see as their road back to normalcy, their quick salvation, and the end point of the global pandemic that drastically, almost incomprehensibly, changed the world.

  Every vaccine has the same starting point, said Kelvin. First, you have to know what the pathogen is—not such an easy task with an emerging virus, or a mutating one. After the virus is sequenced, however, the question of how to develop a vaccine, and which type is the best, can have multiple answers. As Kelvin put it, “Vaccines teach your immune system what to be ready for.” And the lesson can change depending on the virus or bacteria. While every vaccine itself is pathogen-specific, there are several different approaches to getting there, each known as a vaccine platform. The most common and historically used ones are called classic platforms.

  One such immune system prepper is called a live attenuated vaccine—when the virus itself can be weakened and used. Live attenuated vaccines have been employed to fend off everything from the rotavirus to measles, mumps, and rubella. Another long-chosen germ-fighting method, the inactivated vaccine, starts with a killed version of the virus or bacteria. The polio shot, flu shot, and hepatitis A vaccine all fall under this classic platform. If a weakened or deactivated version of the pathogen cannot be used, a virologist might instead break apart the virus or bacteria to use different pieces of it, including its protein, sugar, or capsid. Subunit vaccines, for example, contain only the antigenic parts of a pathogen—their unique protein or glycol-protein markers. Sometimes, these antigens stay the same, and sometimes, like with the flu virus, they mutate (which is why a new flu vaccine must be developed and disseminated every year). Then there are toxoid vaccines, like the tetanus shot, which, as the name suggests, use the toxins produced by certain bacteria to elicit immunity in a person’s body.

  Health Canada approved its first COVID-19 vaccine, developed by Pfizer-BioNTech, on December 9, 2020. A few weeks later, on December 23, it approved its second, this one developed by Moderna. By January 2021, the federal government secured a
ccess to 80 million doses, with the opportunity to buy more of both, if needed. The first shipments of each began arriving that same month. Both vaccines need two doses to be effective, and while both also require cold storage, Pfizer’s only remains stable at a bone-chilling -70 degrees Celsius—preventing it from being shipped to certain remote Canadian communities that lacked capacity to store it. Such limitations are some of the reasons why researchers don’t stop developing vaccines after the first one works. Plus, we have an entire planet to vaccinate, and need a whole lot of shots to do it. Unique restrictions exist the world over.

  As of mid-October 2020, the WHO estimated there were 198 SARS-CoV-2 vaccines in development worldwide, with 44 of them already in clinical evaluation. Many of them, like most of the vaccines currently in use worldwide, are using classic platforms. “However,” as a July 2020 article in Nature Materials noted, “certain limitations are associated with several of these platforms that make them less amenable to fast vaccine production in a pandemic.” Some would require growing massive quantities of SARS-CoV-2; others, extensive testing for safe use. Neither option is especially attractive when thousands of people are dying and an entire planet has been put on pause. That’s why, when it comes to SARS-CoV-2, many researchers quickly began developing solutions under next-generation platforms that have, to date, not been widely used on humans. While they come with their own potential pitfalls—namely, that they haven’t been around long enough to be tested for long-term safe and effective use—they can be developed on a significantly truncated timeline and are generally easier to manufacture on the necessary millions-plus scale. These competing risks and benefits are another reason why scientists are tackling the vaccine solution from numerous angles and not putting all their needles in one biohazardous bucket. In her first year at VIDO-Intervac, Kelvin worked on three different platforms at once, two of which point to the possible future of vaccines—that is, if the world keeps producing possible global pandemics, which it sadly seems likely to.

  One such next-gen platform is called a viral vector-based vaccine, which is based off the same platform as the Canadian-made Ebola vaccine. They work by inserting an incomplete segment of genetic material from the pathogen in question into a harmless virus that doesn’t cause disease. Inside the body, this Frankensteined genetic material is then translated into proteins that activate the immune system response. This type of vaccine is also highly immunogenic, meaning one dose is often enough to do the trick. The other newer models that have risen to prominence in the fight against COVID-19 are called genetic platforms, which, as the name suggests, use a virus’s own DNA or RNA to deliver the genetic template for a pathogen’s antigens into the body. Both the Pfizer and Moderna shots are messenger RNA (mRNA) vaccines, which essentially send a harmless “recipe” for making coronavirus spike into our bodies, prepping our immune system response. Similarly, the vaccine Kelvin is working on uses the DNA for the coronavirus spike. Once inside the human body, it travels into a person’s cells, which in turn start making spike, allowing immune cells to learn what it looks like and to elicit antibodies. Those prepared antibodies are then ready to encapsulate and bind around SARS-CoV-2 when it enters the body, blocking it from infection and effectively neutralizing the virus. Think of it as a microscopic game of “Say Uncle.”

  Genetic vaccines offer one big advantage: once the solution is cracked, they can be produced very quickly and at high, consistent quality. That’s because the genetic strands used in the vaccine can be made synthetically, based on viral sequence information alone. In other words, manufacturers don’t have to worry about their ability to culture the virus. That isn’t the case for the third vaccine Kelvin is working on, which is a protein-based vaccine. With it, researchers are again using a spike-targeted approach. The spikes they’ve created are non-infectious; the rest of the disease isn’t there—think, a toothless vampire. Again, once the isolated spike is inside the body, it will learn what the protein looks like and have a jump-start on its defence. These types of vaccines carry their own unique risk, as there is no guarantee that immunological memory will be formed for future response. They take longer to produce. That’s because virologists actually need to make the protein themselves, taking the time to culture cells in a lab. They then have to purify it and run quality control to make sure it can be injected into somebody and do what it’s meant to. In each case, Kelvin uses an animal susceptible to SARS-CoV-2—this time, ferrets—to evaluate the vaccine candidates and conduct a battery of tests. She knows a vaccine is on the right track once the ferret is completely protected and can no longer be infected with the virus.

  A lot of people have asked Kelvin if she does feel pressured to, well, save the world. It isn’t that she feels no pressure at all, she told me, but mostly she just feels like she has to do her job. “It’s what I do,” she added. “I was trained to do this. It’s almost automatic.” She knows that there are many vaccine researchers out there, and if her vaccines aren’t the ones that ultimately make it into production, one or many of theirs will. Those researchers are learning from her, and she is also learning from them. All around the globe, women are showing up and doing their jobs, putting their brilliance and their collective brain power toward ending the pandemic. So, Kelvin will keep showing up to work, too. She’ll put on all her protective gear every morning, and at the end of the day, she’ll take it all off again. Afterward, from the “dirty” side, she’ll place her scrubs in an autoclave—which she described as a “big sanitation oven”—and take them out from the “clean” side, where they’re then washed and put back into circulation. She’ll go to her hotel room and eat and read medical research and call her family. Eventually, in August, they will join her in Saskatoon, where they’ll live for a year. And every day, she’ll keep doing her part to return the world to normal.

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  In April, Cecie Elnicki agreed to participate in two possible upcoming COVID-19 vaccine trials. She’d previously volunteered with the same company conducting the trials, Manna Research, for a potential vaccine against the dangerous, hospital-acquired Clostridioides difficile, or C. difficile, bacteria, and also, a few years before that, for both a shingle vaccine and a flu vaccine. The media attention that followed her decision seemed to surprise her. One of her daughters was a frontline health worker during SARS, and the same daughter’s husband was now working in a critical care unit. They were doing their bit during the pandemic. This was her way of doing hers. She didn’t see herself as a hero, and despite some interviewers’ attempts to push her to say otherwise, she didn’t see her decision as dangerous, either. She saw it as a sign of hope—and as a way to further medical progress. She thought back to her C. difficile trial and how it could save lives. She was only too glad to say yes again, but also, she stressed, it wasn’t that big of a deal. Elnicki joked that she only shared a single concern when contacted: after hearing that one of the candidates came from the U.S., she quipped, “It doesn’t have any disinfectant in it, does it?”

  For all her modesty, people like Elnicki are a vital part of vaccine development, and especially so when that development is unlike anything previously attempted. Public health experts and virologists both widely agree the pandemic won’t end until we have a vaccine. But what that means is more complex than many might realize. Under non-pandemic circumstances, vaccine development takes years, or even decades, making it an expensive, painstaking process. Attrition is high, and multiple candidates are often discarded before a vaccine is licensed for use in humans. Because of this, developers usually obey a set of established steps, checks, and balances, all in the same precise order. After animal trials are complete, human ones begin, following three distinct phases. The first vaccinates a small group of healthy people, who are monitored for adverse reactions. If the vaccine passes the first phase, it will next be administered to hundreds of subjects, where it will be evaluated for efficacy. The final phase stretches the net out to thousands,
tracking participants to find out what happens when they naturally come into contact with the pathogen and determining whether it works at a group level. And not only does the vaccine have to work, it has to have the ability to be mass manufactured, all without losing quality or pushing the price point too high.

  The slow and patient progress of these tried-and-tested steps, however, makes little sense in a pandemic. That’s why researchers worldwide developed a new paradigm under SARS-CoV-2. They wouldn’t dare skip steps—a certain disaster—but they decided they could do them all at once, without waiting to see if the traditional first step was successful. For example, in some cases, animal trials and phase 1 clinical trials have been happening in parallel. Kelvin, for instance, has continued her animal testing to determine the various candidates’ safety and efficacy, even as her colleagues have sought government approval to begin human trials on some of those platforms, or have already started on others. In certain instances, developers also began early manufacturing scale-up and commercial scale processes before ascertaining whether the vaccine had concrete clinical proof of concept. Such concurrent work is undertaken at considerable financial risk; if a vaccine fails a step, the sunk cost may be much, much higher than usual. Complicating it all further, most of the next-generation platforms have never been licensed for use against any pathogen and, therefore, have never been manufactured at a large scale. Meaning, not only are vaccine developers taking a chance on whether the platform is viable, they’re also taking a chance on whether it can be made on a significant scale. And even after all these problems are solved, countries still have to convince enough people to get the vaccine.