Covid-19, five years on: A look back at UNamur's major role in the pandemic

"As early as December 2019, I followed very closely what was still just an alert about cases of atypical pneumonia, in China, and spreading rapidly", recalls Benoît Muylkens, Director of the Department of Veterinary Medicine and member of the NARILIS Institute (NAmur Research Institute for LIfe Sciences). "And on January 17, I realized that control of the epidemic had been lost and that this was a potentially serious disease. Fortunately, as early as February, the German reference laboratory shared the genetic map of the virus. Virology research logistician Damien Coupeau and I immediately began searching for genetic sequences of interest and ordering material."

Then the latter had an idea: why not mobilize the many molecular biology laboratories found in all the country's universities, to support the overwhelmed clinical analysis laboratories? "To carry out a PCR test from a nasal sample, it was necessary to extract the virus's RNA first, explains Benoît Muylkens. "Now, in clinical analysis laboratories, this step was carried out by expensive machines, and required products that were in short supply at the time. "What followed was "an absolutely crazy week" in which the researcher, with the help of all good will and the support of the relevant authorities, set up a logistics platform, from the receipt of samples to encoding, including the extraction of viral RNA "by hand", i.e. via techniques tried and tested in research laboratories and requiring only "some reagents and a centrifuge", as well as a certain amount of know-how. At cruising speed, this project named SANA, endorsed by the five Faculties, has delivered up to 500 tests per week, with a total of 10,000.

While today, the SANA project no longer has a raison d'être, its influence can still be felt. "It hasn't been talked about much, but two new variants of the blue tongue virus, which affects sheep and cattle, emerged this summer, with very serious consequences, says virologist. "Because of our work on SARS-CoV-2, we're much more organized and we've been instrumental in identifying the virus in animals."

In the summer of 2020, as Covid-19 vaccines begin to emerge from laboratories and the tension over PCR testing has eased, pharmacology professor Jonathan Douxfils, a member of the NARILIS Institute, has, for his part, already been several months into the CRO-VAX project, which aims to determine whether a person has been infected with SARS-CoV-2, via, not a nasal swab, but blood. "The idea was to see, by measuring antibodies, whether people had developed immunity to the virus, and what the quality of this immunity was", he summarizes.

Then, with the arrival of vaccines in early 2021 and for two and a half years, the CRO-VAX project expanded to test the serological response of vaccinated individuals. "Our results showed, even before the first vaccines, that they should be done recurrently", he explains. "In fact, SARS-CoV-2 is a rapidly multiplying virus at respiratory level. From then on, it's important that our first line of defense, which are antibodies, are permanently present on the battlefield. With the development of new viral variants, our studies have shown that the efficacy of vaccines diminishes with each new strain, and that a booster is necessary."

Named Covimoa, the aim of this study was to develop an alternative to PCR tests. "These tests have a number of disadvantages: they are expensive, very cumbersome from a logistical point of view, and the assessment of viral load is highly dependent on the quality of the nasal swab", the researcher points out."Conversely, blood is homogeneous, and the Simoa platform makes it possible to detect certain proteins or viral antigens in it with very high precision. Our tests were therefore able to determine, by estimating the viral load, whether the infected person was likely to require rapid admission to intensive care."

For all that, and despite the good results of these two studies, Professor Douxfils regrets that they have not had a greater societal impact. "Everyone did their best in a context of crisis, and there's no question of pointing the finger at anyone", he tempers. "But I think the Belgian state would benefit from listening to and involving the players who have worked on this disease." For his part, Professor Douxfils and his teams intend to draw on the lessons learned from this crisis: "It has undoubtedly made us grow, and today we are turning our attention to other pathologies, such as influenza viruses and the syncitial virus, responsible for bronchiolitis."

A total of 33 million doses of vaccine were injected in Belgium. Many of them in the huge vaccination centers that have sprung up across the country, such as Namur Expo, run for a time by Dr. Dominique Henrion, also a general practitioner and teacher in the Department of Medicine. The doctor saw a tremendous opportunity: to understand the reasons behind the choice to vaccinate, at a time when the anti-vax phenomenon was gaining momentum, and becoming louder in the media every day.

With nearly 11,000 respondents, this study highlighted several elements. "The first conclusion we can draw from it concerns the fact that no socio-economic profile can predict whether a person is pro, hesitant or anti," states the doctor. "But above all, our study has shown that the most influential person on a person's choice remains the GP. Much more so than anyone else."

An insight that Dr Henrion intends to share with his students, even as he takes part in the training of future general practitioners. "We must insist on the attitude and the true role of influencer that these practitioners will have with their patients", he believes. "For, beyond the simple cachet of trust that GPs can have, this study also reveals the importance of their attitude. Too many practitioners remain in a reserved attitude, without involving themselves in the advice they give. But giving personal information, such as the fact that you've had your family vaccinated, speaks volumes. And above all, verbalizing this vaccination advice can have a real impact on patients' choices."

For the doctor, "practitioners too often doubt the broad medical knowledge they hold, under the pretext that they are not experts in every field. It's a question of posture! That's why it's important to keep talking about the results of this study, which are rich in learning."

Today, five years after the start of the pandemic, the emergency has passed, but SARS-CoV-2 is still with us. Research continues, first and foremost to better understand how our own immune system reacts.

When the virus penetrates one of our cells, it dumps its RNA into it. "The cell then has tools at its disposal, enzymes capable of inducing mutations in this viral genome, in order to render it inoperative and thus slow down the development of the infection, the researcher points out. "We've been working on these enzymes, for several years, via other more common viruses, such as adenoviruses. But we are fortunate, at UNamur, to have a category 3 laboratory that enables us to work on SARS-CoV-2 and broaden our skills."

This research is also aimed at gaining a better understanding of this strange pathology known as Covid long. Indeed, a significant number of people who have contracted Covid-19 continue to suffer from various symptoms, such as severe fatigue, breathing difficulties, or neurological symptoms such as mental fog and pain.

Early on, UNamur researchers Nicolas Gillet and Charles Nicaise, Professor in the Department of Medicine and President of the NARILIS Institute, collaborated on this subject to better understand its causes, particularly in the brain. "There are several hypotheses on this subject. Given the variability of the disease's symptoms, it is most certainly a multifactorial phenomenon", thinks Charles Nicaise. "For our part, we have chosen to focus on the autoimmune aspects of the disease."

The hypothesis envisaged by the researcher, and confirmed by initial results, involves patients' antibodies directed, not against the virus, but against its own cells.

In the coming months, Professor Nicaise hopes to go one step further, by discovering the cells or proteins targeted by these antibodies, in order to better understand the pain for which they are responsible. The fight goes on.