“Know your enemy,” is perhaps one of the most well-known proverbs, often quoted by military buffs and corporate leaders alike. And yet in the face of the COVID-19 pandemic this ancient saying by the strategist and philosopher Sun Tzu, takes on a vital and important meaning. The virus that causes COVID-19 present many mysteries, and new reports of its effects and transmission seem to surface daily. There is so much yet to learn about this virulent pathogen.
In this context, the formation of the “Biobanque Québécoise de la COVID-19” (BQC19) / COVID-19 Québec Biobank, a provincial biobank initiative, on April 1 was an essential and strategic move. A task force made of clinicians, scientists, ethicists and operation experts created a medical, ethical and physical framework to collect samples of the patients it has infected, to enable researchers across the country – and indeed, around the world – to better understand the specific properties of the disease, how it spreads, and why it seems some people are more susceptible to it than others.
Since its inception, the BQC19 has been running at full speed, according to Dr. Vincent Mooser, Director of its Executive Committee, and a Canada Research Excellence Chair in Genomic Medicine of the Faculty of Medicine at Ă山ǿĽé. “Recruitment of participants has been growing steadily since we began,” he explained, referring to the over 350 samples gathered from patients who have agreed to take part. Although almost 25,000 cases have been reported in Quebec, only a small portion of those are being treated in one of the nine hospitals that are members of the BQC19 program. The hospitals taking part in the biobank are:
- Centre hospitalier de l'Université de Montréal
- Ă山ǿĽé Hospital Centre
- Douglas Mental Health University Institute
- Centre hospitalier universitaire Sainte-Justine
- Centre intégré universitaire de santé et services sociaux CIUSSS du Saguenay—Lac-Saint-Jean
- Centre hospitalier universitaire de Quebec – Université Laval
- Centre hospitalier de l’Université de Sherbrooke
- Institut universitaire de cardiologie et de pneumologie de Québec
- The Jewish General Hospital
One of the key protocols that BQC19 has enacted is the collection of samples on a set schedule. Patient tissues are gathered when they enter the hospital (termed Day Zero) and on Day Two and Day Seven. “This is important for us to understand the dynamics of the virus,” explains Dr. Mooser. “It is these dynamics that will make the disease predictable. It will also help us ask questions about the serology, for example, and why some people may produce antibodies for the virus while others do not.”
The gathering of samples, however, has posed another issue: how to ensure that all researchers have fair and transparent access to its data and samples. In response, the BQC19 is working with FRQS on establishing an independent data and samples Access Committee, a panel that has no direct connection to any members of the biobank’s Executive Committee. It is an essential step to preserve the academic integrity of the unit and to avoid any conflict of interest that might position more research in one field than another. The need for this independent committee is a sign of BQC19’s success thus far: the number of requests for samples is increasing dramatically, and Dr. Mooser underlines the need to handle this efficiently, equitably and ethically.
Dr. Mooser admits it has been a particular challenge to harmonize the systems of nine different hospitals around the new protocols required to set up this biobank initiative. “Each hospital has its own agenda, its own set of priorities,” he concedes. “But the cooperation has been proceeding well.”
Discussions are underway to develop a larger, decentralized and federated biobank system at the national level, which fits with the Canadian government’s announcement last week of the formation of the COVID-19 Immunity Task Force. According to Dr. Mooser, such initiatives are in progress in countries around the world, notably in the United Kingdom, France, Germany and Japan. The BQC19 is having talks with these efforts as well: “By working together with these groups, we increase our power and the chances that we make important discoveries.”
The decision of BQC19 to also focus on long-term follow up is a competitive question as well, as it distinguishes the initiative from other international peers that do not focus on this long-range aspect of the disease. Looking ahead, Dr. Mooser stresses the biobank is by no means a one-time exercise that will be dismantled once a vaccine for SARS-CoV-2 – the virus that causes COVID-19 – is found.
“This is a long-term investment. We want to also have the capacity in the future to follow-up with survivors,” says Dr. Mooser. “Does this disease have long-term impact on cardiac health, for example, are survivors still infectious and what is their serology response? These are the kinds of questions we need to be able to answer.”
“COVID is not the last pandemic,” he concludes. “Having built up this network, we need to continue to leverage it to fight future infections, whatever they may be.”