COVID-19 Update IX

General Course of the Pandemic

The United States continues on a hyperbolic path that is likely to continue for months. The three most populous states in the union (and I use that term very loosely) have record increases in cases, hospitalizations, and ICU bed use. It is as bad as it sounds. It seems a certainty that there will be overflow contagion into other parts of the country.

Because there is more than one manufacturer that makes tests, and because the criteria for whether to accept a test as “Accurate” are not well defined, there is the likelihood that many of the negative tests that we see are early positives. Our CDC head recently said that the number of infected people could be as high as ten times what we are recording. If you are thinking of “herd immunity,” disassociate yourself from that pipe dream. Even if Dr. Redfield’s estimate is accurate, this “positivity” would mean 20% of us are or have been infected. Not nearly enough to qualify as a herd.

Other than Europe, China, and Southeast Asia, the rest of the world seems on the edge of a cliff. The emerging African Middle Class has been shattered. Poverty and a sense of hopelessness will multiply. No remedy in sight. International efforts to help are feeble and not well coordinated.

Testing

See the paragraph above. Not only is it impossible to tell which tests are responsible for how many cases; it is extremely difficult to get a test done in the areas that most need them. Five months after we got the news that we needed to prepare, the country remains paralyzed like the proverbial deer in the headlights. The federal government stopped funding several test sites, leaving the states with some money and all responsibility. Countries that have a tenth of our know how and financial resources are feeling sorry for us. One positive side effect of this epidemic may be that we will no longer be branded as capitalist imperialists. We are objects of pity. And dread: the EU has extended the ban on travel from the US (to be fair, we also ban them).

Treatment

Nothing exciting on this front. Remdesivir remains the only medicine that has shown an effect, and it is minimal. It involves IV administration for five days. Gilead, the makers of this drug, recently announced that they will charge $2,000 for a five-day course for Medicare patients; $3,000 for private insurance. For a medication that barely cleared the bar as an effective therapy; that was already developed and did not entail hundreds of millions of dollars in research expenditures. People wonder why the pharma industry is so maligned.

Vaccines

Clinical trials continue. We keep getting reassurances that provided that an effective vaccine is found, it will be available and affordable to all. A new technology to develop RNA vaccines has come up; it has generated a fair amount of excitement. The caveat: we have no idea if any of the vaccines in development will help to prevent illness. And if they do, we do not know how long this immunity will last.

Some researchers are looking into unrelated vaccines in order to enhance what we call the innate immune system. Let us use polio vaccine as an example. It is given by mouth; it is extremely safe. Some experts feel that a dose or two of polio vaccine will place our immune systems on an enhanced alert mode, so that we will be primed to crush anything that comes knocking at our door, even if it is not polio. An oversimplified explanation, but it will do. Of course, we have little if any polio vaccine in the US because this disease has been largely eradicated in developed countries. We would have to go to some poor country, the kind that our president once referred to as “___holes” and beg for some of the stuff they have.

The social consequences of the lockdown will soon be felt in devastating force. Hundreds of thousands of people are due to be evicted from their homes on July 1. There was an order to prevent evictions, but the law forgot to cover rent payments. In other words, on July 1 people will have to come up with four months’ worth of rent, instead of one. Landlords have been filing eviction notices in court since April. The federal order only said that people could not be evicted; not that papers could not be filed. If something is not done quick, we will have hundreds of thousands of newly homeless people wandering about. I will give you one guess; one; as to how upset they will be.

As you may have gleaned, I am very discouraged. Six weeks ago, I was optimistic as to where all of this was going. It seems that someone in a position of leadership read the textbook on how to deal with pandemics, and then did the opposite of what was recommended.

Hang tough. Watch more movies. Tip generously.

Bonus round: The verb “to glean” comes from the medieval practice of allowing impoverished peasants to sift through whatever wheat was left to lie on the fields after the regular harvest. This was an important source of nutrition for people who had nothing. Late in the 19th century some landlords decided to charge for this privilege, which provoked strong protests. One wonders why Jesus said something about camels going through the eyes of needles before rich people were allowed into Heaven.