It’s not all doom and gloom.
Here are some more nev developments…
1. Federal Response May Deliver Something
The new FDA has become more responsive to the outbreak recently.
It seems that the reality of provision of services at the provider level is lagging by 5-7 days from when announcements about solutions, products, and services are being made by the White House and other federal agencies.
Notwithstanding that lag, it seems that an increasing supply of testing products and services are finally becoming available to providers in the next few days, with the turnaround of such tests declining.
Federal services also appear to be emerging to support hospitals, including ventilators, masks, PPE and other supplies, and possibly also trained staff from the military. As we have written before, current medical testing is based on medical case confirmation, rather than epidemic containment.
Asymptomatic and unexposed individuals will ultimately need to be tested to establish the extent of the disease in the population, and a 10x increase in testing capacity, and no cost barrier, and much shorter turnaround, will be required to really establish the extent of infection and plan containment.
Other federal services seem to have been promised,and may become available (military hospitals and equipment) potentially mitigating the situation.
2. Warmer Weather Is Coming and Transmission Is Likely to Slow
There has been considerable debate about whether this virus will continue to spread at the same speed when the weather warms up in the spring, or whether it will slow down in the same manner as other respiratory viruses.
It’s still undecided about whether this virus will slow in warmer weather, particularly since cases initially emerged in warm climates as well as the original site in Wuhan. However, it does appear that there has been less propensity to spread in warmer climates, and the most rapid spread has occurred in higher latitude environments.
Other than a climatic difference, it makes no sense that northern Italy is a disaster but the south has been relatively spared, or that northern China was overwhelmed, but the south of that country was also relatively spared. Densely populated tropical countries such as Mexico have had cases, but do not appear to have had rampant outbreaks like more northern climates. .
There is now enough concentration of these cases in these climates that we believe it is reasonable to believe that the virus has a lower R0 (spread capacity) in warmer climates, and that spread will be slower in the spring and summer in the northern hemisphere.
This suggests that the pandemic will slow in the northern hemisphere in the next few months, and accelerate in southern hemisphere climates at the same time. These southern hemisphere climates probably have a month or two to prepare by stockpiling supplies and equipment and relevant pharmaceutical products and training more staff.
3. More and More Previously Infected Individuals Will Be Able to Return to Work
As many leading authorities have suggested, the number of infected individuals in the US is probably 10 or more times larger than the number of reported infections. Most of these individuals have had asymptomatic or mildly symptomatic infections, but are nonetheless likely to be mostly immune to the virus.
Individuals with a documented infection history (or who have seroconverted on an immunoassay – see above) can begin to return to the workforce (with appropriate infection protection precautions in place). These individuals can occupy more of the critical positions in our economy as they recover from their disease and return to key positions.
4. Risk Factors for Severe Complications Are Starting to Be Understood
It is clear that the virus attacks different people differently. For some reason certain individuals and certain families (and maybe certain countries) are at increased risk for infection and death.
Yesterday we noted that ABO blood group antigens appear to be associated with differential risk for infection. There may or may not be a biological basis for the increased risk in blood group A and lower risk in blood group 0.
We already know that older individuals and those with certain pre-existing medical conditions are at increased risk for the complications of COVID-19. Over time we are likely to accumulate more of these patient and biological factors that predispose to the complications of the disease; this accumulation of information will allow us to stratify individuals by risk for complications and then impose differential restrictions and limitations on exposure depending on those risks.
5. Pharmaceutical Treatment Options Are Emerging and Moving Faster Than Expected
While nCoV2 is perceived to be a “supervirus” with features that make it either more dangerous, or more pathogenic in human populations, compared to other viruses, it really isn’t that special (other than being extremely well designed to cause pandemics).
The big issues with this virus are that it’s new, and that means the entire population is unexposed and therefore vulnerable, and that it’s highly infectious. Given those factors, the virus can spread through the population very quickly, and the complications and consequences of infection are likely to be concentrated in a relatively short time period.
This concentration means that the medical and hospital sector is unable to accommodate and treat the complicated cases, thus resulting in significantly more deaths than would otherwise be expected.
After a few months of covid-frenzy, the global pharmaceutical industry is slowly and belatedly catching up to the burden of the disease and its likely permanent place in our galaxy of diseases. Although there is some promise to the first treatments that are emerging, they have by and large not emerged from large bio-pharmaceutical companies, nor have they emerged from their original research laboratories.
Regeneron has committed to a dedicated research effort for coronavirus, and a handful of other companies have made products available from their libraries for public health authorities to test (Gilead’s remdesivir, chloroquine, Kaletra, etc.). However, the largest companies in the industry have so far made only token investments or changes in their priorities and portfolios.
Even with this mediocre effort, we are seeing a trickle of medicines already coming to market or into late stage trials. These include the recently announced chloroquine (which is empirically conferring benefit in other markets) and its cousin hydroxychloroquine, and also Gilead’s remdesivir, and Fujifilm’s similar favipiravir (Avigan).
Regeneron has already announced that they have advanced the timeline of their antibody cocktail by three months, and we expect boards and research management at major pharma companies to start to make announcements about major investments in this area in the coming weeks.
By mid-summer, we would expect there to be a host of treatment ideas being advanced for this virus. In this context this virus does not seem particularly difficult to solve, unlike, for example HIV that had many unique and challenging features in its first years after its identification. Just like HIV, we expect the pace of innovation to accelerate, but on an even more rapid trajectory than for HIV in the 1980s.
We believe that by the beginning of May we will have a number of treatment options available to reduce the severity of complicated cases of COVID-19, potentially reducing the mortality significantly from an expected long-term rate of ~1%. If these treatments are effective, they could reduce the burden of severe cases in ICUs, shorten the duration of disease and treatment, and reduce the rate of infection transmission.
6. Convalescent Plasma Is Being Actively Developed
Can the plasma from individuals who have recovered from COVID-19 could be used to transfer immunity against the virus to highly symptomatic or high-risk individuals?
We now hear that this is being studied, developed,and discussed.
Historically one of the best ways to treat or protect high risk individuals is by transferring the immunity (immunoglobulins) from individuals who have recovered from the virus to those who are affected.
Various companies are now looking at such approaches, and the availability of an immunoassay should make such identifying donors and then preparing such products significantly easier. We would expect such a product could be available and approved in a matter of weeks, should it prove effective in preventing complications of the disease.
7. New Testing Technologies and Providers Are Emerging
The second reason we are becoming more positive is the progress that is (finally) being made in testing. More and more vendors are developing or providing PCR-based direct viral tests,and the bottlenecks for testing and results are reportedly declining.
Having more tests that offer faster turnaround and put testers at less risk will allow a lot more tests to be done and will give a more complete picture of the state of the epidemic. The early evidence that an immunoassay can be developed for COVID-19 is also very encouraging – having a validated immunoassay will make testing much easier and more widely available.
An immunoassay would in many ways have more positive impact on restoring the economy than even the direct viral test. The availability of an immunoassay also suggests that there is durable and consistent protection against the virus after exposure, or at least after infection.
Once an immunoassay is available it can be administered at many more points of care, and the result can be provided in a matter of hours,rather than days, and administered at many more points of testing.
After a relatively slow start,the US diagnostics industry, hospitals, and testing laboratories have started to catch up with this pathogen and pandemic, by deploying new tests and testing systems into the market and potentially increasing the number of tests and the understanding of the extent of the disease (and removing the continuing bias in the total infectee population estimates).
8. Social Distancing Should Have Effect in 40-45 Days (based on China)
The first reason we are becoming more positive is that we have learned that the social distancing measures being implemented are likely to slow new case numbers within 40-45 days.
We have seen the transmission numbers in China fall to single digits in most provinces outside Wuhan, and even though the social controls in China are much more restrictive than those imposed in the US, we expect the transmission rate in the US and most other western countries to also fall in a similar timeframe (i.e., by the end of April or 40-50 days after real social distancing).
Some more good news:
- GM is going to convert some manufacturing plants to build much needed ventilators
- 3M has doubled production of masks to help fight the coronavirus, to 1,000,000 per month
- Amazon is hiring 100,000 workers for their warehouses to help meet demand
- Walmart is hiring 150,000 workers to help meet demand
- 1,000 retired and private New York City doctors and healthcare professionals have volunteered to assist in helping those infected with the coronaviruses, bringing the total healthcare workers there to 10,000
Hopefully they will find a cure soon, not just because of the economic crisis, but because of the lives that can be saved.
Yes, there is so much information on the Internet that it is impossible to find the essence, especially since most of the data contradicts each other, it is not clear what to believe and what not to, I would prefer now to stick to the restrictions and hope that all this will soon be over!
For a non-US perspective on the coronavirus, here’s an interview from Professor Kim Woo-joo of Korea University Guro Hospital.
He mentions his credentials early in the interview/ Bascally, he’s been through all the recent outbreaks. Highly recommend watching the video until the end.
Spend enough time on the internet and you’ll find a whole host of contradicting perspectives which depending on how agreeable you are, can all sound logical! This is now so much worse with this pandemic.