COVID-19: Give Me Some Good News!
by Raywat Deonandan, PhD
Epidemiologist & Associate Professor
University of Ottawa
(I add my credentials to these COVID-19 blog posts in case they get shared. I want readers to know that my opinion is supposedly an educated and informed one)
As the full extent of the present pandemic is finally being digested by most people, a feeling of dread has settled on many. My last post described the likely outcome of this crisis, which possibly did not do much to lighten that feeling.
So today I want to focus on some of the promising developments that might get us out of this mess faster than anticipated.
Maybe We’re All Wrong
If you’re paying attention, you might be aware of the public debate between two prominent population health scientists. John Ioannidis argued that the extreme measures being taken by so many governments are not supported by the evidence, that the CFR (case fatality rate) is actually lower than that being widely reported, and that when all is said and done, the global death toll for COVID-19 will be comparable to that of the flu. He argues, essentially, that our current strategy is untenable and ultimately destructive, for no real purpose.
Marc Lipstitch responded that while our evidence is indeed poor (we don’t know the disease’s true incidence rate, CFR, or infectivity), there is sufficient data to know that we have to do something. In other words, the risk of not undergoing drastic social distancing is too awesome to accept.
Now, clearly I hold with Lipsitch’s position. But now is not the time for scientists to have egos. I pray to all the gods in the pantheons of all religions that we are wrong, and that COVID19 will only take as many lives as we would have expected during the flu season. If the price of me being wrong is that I will be mocked for the rest of my career, oh how I will happily pay that price.
So, in short, it’s possible that we are wrong, and that this thing will not be as bad as we are projecting.
Vaccines are Being Trialled!
As of today, at least three vaccine candidates are well along the development trajectory. At least one of these is already in Phase I trials in Wuhan, China.
With the “full court press” on by the biotech industry, there is healthy expectation than a workable vaccine will be ready in 1-2 years.
I posed the question on social media of whether antibodies could be isolated from recovered COVID-19 patients to develop an immunoglobulin serum, a sort of “borrowed immunity.” My smarter “wet lab” scientist friends presented some of the scientific barriers to this solution.
But it’s still being pursued, for example by Takeda Pharmaceuticals. But even though this is a faster process, it too will take 12-18 months to weaponize at an industrial level.
Regeron is another company frantically working on an antibody serum. They plan on starting clinical trials in the summer, which once again means it enters the “market” in 1-2 years.
Attempts to find treatments and outright cures for COVID-19 are nothing short of heroic. Some promising candidates have already emerged.
Remdesivir was developed as one of the treatments for Ebola, but was not selected due to other candidates being more effective. But now remdesivir is having its moment. The drug targets an enzyme called RNA polymerase that is used by many viruses to copy themselves. But it does not specifically target the virus that causes COVID-19.
Remdesivir seems to have cured at least one man. It’s now undergoing multiple clinical trials around the world to see if its promise is scalable to the mass public.
Chloroquine is an anti-malarial drug that’s been used safely on humans for decades. Several countries, most notably Cuba, have been using it for weeks to treat COVID-19 patients. The drug’s variant hydroxyquinone has shown success in concert with an antibiotic. But true chloroquine is an option for many, with dosages being explored.
Unfortunately, news of this promise ha already triggered panicked buying of chloroquine, starting to make it unavailable for hospitals.
Speaking of Cuba, they have also shown success with interferon. If you’re as old as I am, or older, you might remember interferon as the wonder drug that pops up every few years as the miracle cure to cancer, HIV/AIDS, Ebola…. everything. That’s because interferon is a wonderfully flexible drug that works with your immune system to make your cells release a protein that prevents viruses from replicating.
Several trials are underway to test various formulations of interferon as a COVID-19 therapy, including one called Synairgen, which is an inhaled version.
Good old-fashioned vitamin C is routinely mocked by physicians as a treatment for anything. But a subculture of scientists are cautiously bullish on the potential for megadoses of vitamin C (ascorbate) to treat various viral infections. It remains to be seen if COVID-19 is one such infection.
As a treatment, the theory is that ascorbate reduces the dreaded “cytokine storm”, which is when, in response to the infection, your body releases a storm of inflammatory measures. Those measures then block the ability of the alveoli in your lungs to put oxygen into your bloodtsream. The storm is how a respiratory disease like COVID-19 usually kills you. (See table 1 in this paper for some evidence of ascorbate mitigating the cytokine storm in non-COVID19 instances.)
Here’s an unofficial report on a trial from a hospital in Shanghai on the uses of very high dose ascorbate on the treatment of serious COVID-19 cases. These are not peer-reviewed, confirmed data, so caveat emptor. And keep in mind that this does not mean that your daily vitamin will protect you. This anecdotal report describes enormous doses of intravenous ascorbate.
At least three clinical trials, like this one, are underway in China to see if these reports can be observed under strict experimental conditions.
Other promising drugs currently under trial include favipiravir and lopinavir combined with ritonavir, all antivirals. The WHO has deployed an ambitious set of trials to test these drugs in the shortest time frame possible.
Any Other Innovations?
Another way to get the pandemic under control, inasmuch as that means allowing people to go back to their daily functions, is to implement WIDE SCALE rapid testing, akin to what South Korea has been doing.
The Koreans were able to rapidly mass-produce hundreds of thousands of test kits, and now test 20,000 people each day. The idea is that people are out and about in something resembling normalcy (but not really), but are frequently tested. If they test positive, they must immediately be quarantined, and their contacts traced.
This is not an ideal solution, but it allows their society to keep functioning by providing very good epidemiological data to the planners who can better control outbreaks. Like everyone else, their plan is to maintain this “new normal” while they wait for a vaccine.
Already, scores of companies are producing new testing approaches. An Ottawa company has been developing a portable testing kit that precludes the need to send swab samples back to a lab.
A new test that can be implemented in hospitals and surgeries renders results in 15 minutes. Imagine a new normal that allows you to go to the dentist, but the dentist requires this 15 minute test to know if they need to “gown up” first.
Other rapid antibody tests are rushing to the market. Some even allow at-home testing for the consumer. Imagine a scenario where people can know their disease status before going out into the world. That would preclude the need to isolate everyone.
What Does This All Mean?
In the words of legendary Epidemiologist Larry Brilliant, “Everybody needs to remember: This is not a zombie apocalypse. It’s not a mass extinction event.”
The crisis before us is not necessarily a medical crisis. It’s a health systems crisis. That means it can be managed with the right strategy, resources, and political will.
So don’t lose hope, fellow humans. An army of nerds is coming to save us.