Nurses are heroes of the COVID-19 crisis. May 12 is International Nurses Day, which commemorates the birthday of Florence Nightingale, the first “professional nurse.” The World Health Organization also named this year the “Year of the Nurse” in honor of Nightingale’s 200th birthday.

To nurses everywhere, this day and this year have great significance. Nurses, who are being recognized as heroes, have long awaited recognition as health care professionals in their own right and not ancillary to physicians. It’s wonderful to be recognized now in the context of coronavirus, but nurses have always been at the forefront – during war, epidemics and other times of disaster.

I have been a nurse for 40 years and a nurse practitioner for 17 of those years. An active clinician, researcher, scholar and educator, I currently serve as dean of the Solomont School of Nursing at the University of Massachusetts Lowell. Throughout my career, nurses have typically been relegated to a secondary role, and if mentioned at all, we are described as assisting doctors. Nurses today are still asked why they didn’t become doctors instead. Aren’t we smart enough?

Many people don’t realize that nursing and doctoring are entirely different professions with different purposes. We are proud to work alongside doctors and other health professionals, but we have never worked behind them. Not all nurses work at the bedside, but we all touch the lives of patients.

Many nurses have doctoral degrees. They conduct research that advances the quality of patient care. Nurses change health care policy. For example, nurses play a significant role in health care reform and advise Congress on proposed health care rules and regulations. They also guide organizations regarding health care technology and care coordination and sit on executive boards of health care organizations. Nursing is both an art and a science.

The role of the nurse has evolved, but some things haven’t changed. Nurses have always cared for the sick, the well and the dying. We promote health and prevent illness. We interpret what is happening so that patients understand it. We are there for the entire patient experience from birth to old age, from wellness to illness, and throughout age and illness toward a peaceful and dignified death.

Our history provides many examples.

In 1854, Florence Nightingale brought 38 volunteer nurses to care for soldiers during the Crimean War. The cause of the conflict focused on the rights of Christians in the Holy Land and involved Russia, the Ottoman Empire, France, Sardinia and the United Kingdom. Male nurses provided care as far back as the Knights Hospitaller in the 11th century. But prior to Nightingale’s involvement, male and female nurses consisted of untrained family members or soldiers who cared for the ill and infirm.

Nightingale was the first to organize nurses and provide standardized roles and responsibilities for the profession. As such, she is credited with founding modern professional nursing. She was also an expert statistician, collecting data on patients and what did and didn’t work to make them better. Nightingale and her nurses improved sanitation, hygiene and nutrition. They provided care and comfort. Their work had a major impact on the survival of soldiers.

The American Civil War in the 1860s brought thousands of trained nurses to the battlefront, risking their lives to care for soldiers on both sides of the conflict. The most famous were Dorothea Dix, an advocate for indigenous populations and the mentally ill; Clara Barton, founder of the American Red Cross; and Louisa May Alcott, the author of “Little Women.”

Nurses again answered the call with the yellow fever epidemic of 1878, rushing from all over the country to Tennessee. The epidemic ultimately killed 18,000 people, and many nurses died while caring for the sick.

The U.S. recruited more than 22,000 trained nurses to treat Americans overseas and back at home from 1917 to 1919 during World War I. The war brought death from combat to about 53,000 Americans, while about 40 million civilians and military died worldwide. Time after time, nurses have left the warmth, comfort and safety of their homes to care for others.

Nurses were also among the millions who died from the 1918 influenza pandemic. Fifty million people died worldwide. This pandemic is probably most comparable to what we are experiencing today with COVID-19. But epidemics, such as polio, off and on from 1916 to 1954; the global pandemic of influenza A, 1957-1958; swine flu, 2009-2010; Ebola, 2014-2016; and Zika, 2015-2020, have also required constant nursing care.

I remember the AIDS pandemic, which began in 1981. I was a visiting nurse and saw many patients in their homes, from homeless shelters to penthouse apartments. Everyone suffered not only because of the physical and mental effects of the disease but also because of the stigma. People, even their families, were afraid to touch patients, kiss them or be near them. It was a lonely time for these patients. I watched them deteriorate and die. Nurses were often the only ones to hold the hands of these patients, so they wouldn’t die alone.

Nurses were also there during 9/11. They were among the courageous first responders who risked their lives to save others. Many have chronic diseases because of their exposure to Ground Zero.

Every year, nurses are voted first among the professions the public trusts the most, according to Gallup. We work hard to earn and maintain that trust. You will find us caring for people in their homes, in public health departments, in nursing homes and skilled care facilities, in rehabilitation hospitals, in prisons and correctional institutions, caring for the mentally ill and providing health care advice over phones and computers. Nurses work wherever there are people.

What do we ask in return? It’s simple. We don’t consider ourselves heroes, but we do deserve respect. Public images of the nurse in a sexy uniform or as a handmaiden to a doctor are wrong and insulting. We are professionals. Once the COVID-19 crisis is over, please don’t forget that we are always here for you. Always have been. Always will be.

Leslie Neal-Boylan, Dean of the Solomont School of Nursing, University of Massachusetts Lowell

This article is republished from The Conversation under a Creative Commons license. Read the original article.

I, like many Americans, miss the pre-pandemic world of hugging family and friends, going to work and having dinner at a restaurant. A protective vaccine for SARS-Cov2 is likely to be the most effective public health tool to get back to that world.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, cautiously estimates that a vaccine could be available in 12 to 18 months.

I am a professor of microbiology and immunology and study how the immune system develops. I think Dr. Fauci’s estimate is an optimistic one, but possible.

Traditional vaccine development is a long and complicated process. Only about 6% of vaccine candidates are eventually approved for public use, and the process takes 10.7 years, on average.

But these are not traditional times. Researchers around the world are innovating the process of vaccine development in real time to develop a vaccine as fast as possible. So how close are we to a vaccine?

A step-by-step process

Vaccines prevent disease by boosting a person’s natural immune response against a microbe that they have not encountered before. There are a number of different types of vaccines in development for SARS-CoV-2 and they fall into three broad categories: traditional killed-virus vaccines, protein-based vaccines and gene-based vaccines. No matter the type, every single vaccine candidate must go through the same vetting process before it can be put into use.

Once researchers have developed a potential candidate, they begin the first step of testing in laboratories, called preclinical studies. Scientists use laboratory animals to examine if the candidate vaccine induces an immune response to the virus and to check whether the vaccine causes any obvious medical problems.

Once a vaccine is proven safe in animals, researchers begin human testing. This is where the federal Food and Drug Administration begins to regulate the process.

Phase 1 studies test for safety and proof-of-concept. Researchers give a small number of human volunteers the vaccine. Then they look for medical problems and see if it induces some sort of immune response.

In Phase 2 studies, researchers give the vaccine to hundreds of volunteers to determine the optimal vaccine composition, dose and vaccination schedule.

The final step before a vaccine is approved by the FDA for broad use is a Phase 3 trial. These involve thousands of volunteers and provide data on how good the vaccine is at preventing infection. These large trials will also uncover rarer side effects or health issues that may not show up in the smaller trials.

If in any of these phases a vaccine candidate appears to be ineffective or cause harm to people, the researchers must start over with a new candidate.

After a vaccine candidate successfully completes these clinical trials, a medical regulatory panel in the FDA looks at the evidence, and if the vaccine is effective and safe, approves it for general use. Experts estimate that the whole process costs between US$1 billion and $5 billion.

But approval is not the only hurdle. As has been demonstrated by the severe lack of coronavirus testing, easy and fast production of a test or vaccine is as critical as having one that works.

Both clinical efficacy and ease of production must be considered when asking how long until a vaccine is ready.

Current promising candidates

As of April 30, 2020, there were eight vaccine candidates currently in Phase 1 (or joint Phase 1/Phase 2) clinical trials and 94 vaccines candidates in preclinical studies.

Three of the eight are traditional vaccines that use inactivated or killed virus. Two of the others are protein-based vaccines that use a modified cold virus to deliver the protein that will stimulate the immune response.

The final three vaccines in Phase 1 or 2 trials, and the only two in the U.S., are gene-based vaccines. To me, these seem like the most promising.

Gene-based vaccines contain a gene or part of a gene from the virus that causes COVID-19, but not the virus itself. When a person is injected with one of these vaccines, their own cells read the injected gene and make a protein that is a part of the coronavirus. This one protein isn’t dangerous by itself, but it should trigger an immune response that would lead to immunity from the coronavirus.

Gene-based vaccines come in DNA form, like the vaccine in Phase 1 clinical trials from Inovio Pharmaceuticals in the U.S., or in RNA form, like the vaccine in a simultaneous Phase 1/Phase 2 trial from the German company BioNTech and the vaccine in Phase 1 trials from the U.S.-based Moderna.

No gene-based vaccines have ever been approved for human use, but DNA vaccines are used on animals, and a few were in clinical trials for the Zika virus.

In the past, researchers have struggled to develop DNA vaccines that produce strong immune responses, but new techniques look promising. RNA vaccines tend to be more effective in animal studies but have also required innovations before human use. It may be that the time of gene-based vaccines has arrived.

Another benefit of gene-based vaccines is that manufacturers would likely be able to produce large amounts much faster than traditional vaccines. DNA and RNA vaccines would also be more shelf–stable than conventional vaccines since they don’t use ingredients like cell components or chicken eggs. This would make distribution, especially to rural areas, easier.

Still a long road to implementation

The three gene-based vaccines and the five other candidates face many challenges before you or I will be vaccinated. The fact that they are in Phase 1 and 2 trials is encouraging, but the very point of clinical trials is to reveal any problems with a vaccine candidate.

And there are a lot of potential problems. The preclinical results in laboratory animals might not translate well to people. The level of immune protection might be low. And people may react adversely when injected with the vaccine.

Any coronavirus vaccine could also produce a dangerous reaction called immune enhancement, where the vaccine actually worsens the symptoms of a coronavirus infection. This is rare, but has happened with past vaccine candidates for dengue fever and other viruses.

So, how long before we have a vaccine against the COVID-19 virus?

No vaccines have made it through Phase 1 or Phase 2 trials yet, and Phase 3 trials generally take between one and four years. If researchers get lucky and one of these first vaccines is both safe and effective, we are still at least a year away from knowing that. At that point manufacturers would need to start producing and distributing the vaccine at a massive scale.

It is unclear what percent of the population would need to be vaccinated against SARS-CoV-2, but in general, you need to immunize between 80% and 95% of the population to have effective herd immunity. Depending on what the virus does in the coming months, that might not be necessary, but if it is, that’s 260-300 million people in the U.S. alone.

Researchers are doing everything they can to develop a vaccine as fast as possible while still making sure it is effective and safe. Manufacturers can help by preparing flexible systems that could be ready to produce whichever candidate gets across the finish line first.

If everything goes well, Fauci’s 12- to 18-month prediction may be right. If so, it will be thanks to the tireless work of scientists, the support of international organizations and manufacturers all innovating and working together to fight this virus.

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Marcos E. García-Ojeda, Professor of Molecular and Cell Biology, University of California, Merced

This article is republished from The Conversation under a Creative Commons license. Read the original article.