COVID-19 Update III

General Course of the Pandemic

China and Europe continue to report decreasing numbers of cases. Vietnam has earned a gold star; they have done extremely well managing this scourge (in case that you missed the irony, Vietnam’s flag consists of a gold star on a red background). The US, Russia, and Brazil have not been able to induce the curve to take a downward trend, although most experts believe that the US may be heading that way. Nobody knows if the opening of numerous businesses will lead to a surge in cases. Thailand never had a huge spike; more on this later.

Testing

As I said at the last briefing, we have an antigen test that can be collected through a short swab and which offers results within ten minutes, using a highly portable machine. Recently a saliva test has become available. Rutgers University can arrange for you to collect the specimen while being coached remotely by a member of their staff. After collection, you must mail the specimen to them for RT-PCR analysis. Similar to what the popular genetic sequencing sites offer. This method has the disadvantage of having the collection materials mailed to you, and you mailing them back. But you do not have to leave your house to collect the specimen.

I have heard nothing new on the antibody tests. One would imagine that our government might be expending a great deal of effort on finding out which populations were infected, and how strongly their immune systems reacted. No such information has been made public. There are disturbing findings: crew members of the Roosevelt aircraft carrier tested positive after they had twice tested negative. This has also happened in China and Korea. As you can imagine, experts around the world are jumping all over these patients. The likeliest explanation is that inert RNA fragments of the virus were lying around in these people’s noses and throats. That they were not infectious virus; just debris that was left over. We should also remember that a significant percentage of antigen and RT-PCR tests produce false negative results.

Treatment

Nine days ago, there was a report on the internet that said that Regeneron had come up with an antibody that was 100% effective against the virus. I read that they were going to have a press conference later in the day. No such event happened, and the Regeneron web site has had nothing to add. I do not know how this “leak” came about.

Further explanation is in order. There are companies that keep “antibody banks.” Billions of different human immune proteins are preserved for eternity, and new ones are added at intervals. Suppose that you know, from studying the serum of people who have recovered from the virus, what the ideal anti-COVID-19 antibody looks like. You can ask your computer (not the kind that you have at home) to rapidly scan through your antibody stockpile to find a few that may tightly stick to COVID-19. Those few candidates that qualify are further analyzed by artificial intelligence and other means, until the best two or three are selected. At this point you find out, again by AI, if there are a few small changes that you can make in these molecules in order to make them better antibodies. Then you proceed to lab, animal, and human testing. Once the best protein is found, there are (many) ways that huge amounts of this stuff can be made for sale.

The Regeneron web site says that they are testing a combination of three anti-COVID-19 antibodies in humans. Results are not expected for a few weeks.

There has been no further mention of the triple antiviral oral medication regimen, and no additional news on the IV remdesivir studies.

There are still many hydroxychloroquine studies going on. Our president has decided to conduct his own study to determine if hydroxychloroquine can prevent infection. There are no additional participants in his study, so his findings will likely not be significant.

No further mention of high-dose famotidine (Pepcid) IV either.

Back to Thailand: some epidemiologists wonder if the reason that they have done so well is that many people in Thailand rinse their nasal cavities daily. Speaking as someone who suffers from allergies: for years allergists have recommended twice daily “sinus rinses” in order to wash away pollen and irritants from the respiratory lining. These are widely available (Nettie Pot; Neilmed). Since I have to do this anyway, it involves no extra expense for me, but if you have the resources, I see no reason to avoid trying them out.

Vaccines

The two front runners are the Oxford adenovirus vaccine and the Moderna RNA immunization. Moderna garnered a lot of attention this past week (and a bump in their stock price) because some of their healthy volunteers made good amounts of anti-COVID-19 antibody. For the nth time, this is only a Phase one study. These have to be followed by monitoring for safety, tryouts on people who are likely to be exposed to the virus, and inoculations on massive numbers of individuals to assess whether these antibodies that people make prevent disease and are safe. Our secretary of defense promised huge amounts of safe and effective vaccine before the end of the year; enough for all of us and our allies (have we any left?). This statement is irresponsible and ignorant.

In my heart I am most hopeful for the nanoantibody studies (the so-called llama antibodies). I have not heard any news from that source.

It turns out that masks may be more effective than what was initially thought. There is evidence to show that the more virus that you are exposed to, the worse your chances of recovery are. If someone sneezes close to you, masks will not keep all of the virus from getting inside your nose, but they will cut a big chunk of them off. Wear a mask.

In the end, successful reopening of our economy will depend on how many people are too scared to wander into public places. This will not happen until we have solid scientific findings that we can rely on. Patriotic reminders of our constitutional rights to protest do not qualify. Parading with our guns on display will only scare many people off; the same customers that your favorite business desperately needs. If you want to emulate our president, please note that he no longer conducts political rallies, which he loves. If our president were convinced that this virus does not pose any danger, he would be out there conducting rallies in front of thousands of people; shaking hands; posing for selfies. Of course, that ain’t gonna happen. You figure out why.

If you really, really want to help, avoid large crowds, and wear a mask.

Simple advice.