COVID-19 Update XII

General Course of the Pandemic

Cases in the United States have reached the 70,000-daily plateau. Although the bulk of the new cases reside in Arizona, California, Texas, and Florida, this apparent skewing is likely due to the fact that these are the most populous and urbanized states outside New England. Most experts agree that it is only a matter of time before the rural areas become enmeshed in the sticky web that this has become. I already see sporadic stories from relatively isolated areas in Kansas and other “rural” states detailing the misery that is generated when half of the people that you know are in danger.

Many states have agreed to pass mandatory mask ordinances. A few remain resistant. The reason these governors give for refusing to concede the obvious is twofold: “The people” will know what is best for them, and “The people” want to keep their freedom to choose. So far, they have not rescinded the mandatory use of seat belts, or the requirement that every vehicle stop at a red light. But you never know; they may surprise us.

Last week we discussed that it was only a matter of time before the death count rose. Right on schedule, we have seen a sharp rise in the number of casualties. Again, please remember that it is not only the dead that we should mourn. There are tens of thousands of individuals that have survived, only to enter an alternative universe where it is hard for them to comb their hair every morning. How, as a nation, we intend to nurse these people back to health remains a problem that is barely mentioned by federal authorities. It took two years, on the average (before Covid-19), for social security to adjudicate disability claims. Can these people remain without a salary, or health insurance, for that long? I have read nothing; I mean nothing, on what the plans to deal with this issue are.

Scientific data that shows the value of wearing a mask accumulates. Two Missouri hair stylists that unknowingly exposed 143 customers to their virus wore masks while at work, as did most of their customers. There was no contagion reported. Another study that used a mannequin’s head powered by an atomizer showed that even a handkerchief placed over the mannequin’s “mouth” proved effective at limiting the distance that particles traveled when expelled. Of course, a cloth mask with a good fit worked even better.

Small outbreaks in China, Australia, Spain (Catalonia), and South Korea have precipitated prompt response from their authorities. Vietnam is still, by far, the world leader in safely handling the outbreak. Africa and every country south of Texas is suffering.

Testing

My wife got tested last week because she had fever, muscle aches, and gastrointestinal issues. It took five days for her results to come back. These delays are the rule for the past month. Which means that, from a preventive standpoint, getting tested is useless. A few weeks ago, Dr. Fauci mentioned that the government was looking at grouping tests: running ten samples on one test, as they do in China. Just yesterday I read that maybe they would start doing this with four specimens at a time. This approach will only work in areas where the virus is not very prevalent yet. It is beyond my understanding why we have not pursued antigen testing with more vigor. Although antigen tests are only about 80% accurate, they cost less than five dollars each (as opposed to $100 for a PCR), and results are available within minutes. We could afford to open schools and test children daily because they use saliva or a cheek swab. Also, no reason as to why they have not pursued testing sewage, which is cheap and screens hundreds of people at a time.

I listened to a TED talk today that mentioned Ginkgo Bioworks. A fascinating story of bioengineering. They are going all-in on Covid-19 testing; the CEO thinks that within 2-3 weeks they will be able to run 500,000 tests a day using their PCR technology. They have recently received more than a billion dollars in venture capital funding. No mention of what they intend to charge for their tests.

Treatment

The major story here is that there is not enough remdesivir to go around, even for the wealthy countries. Forget about Africa and the Middle East. As I mentioned before, the Regeneron monoclonal antibody results are due to be published soon. The promise that there could be a safe and effective oral treatment was probably not founded on reality. No recent upgrades on the llama nanoantibodies.

Vaccines

The study on the Oxford/ Astra Zeneca vaccine was published today on The Lancet. This study was done in Wuhan. The vaccine starts with an adenovirus, which is a common virus that causes respiratory symptoms. The viral DNA is manipulated so that, when it enters a human cell, it is forbidden from making copies of itself. They have found a way to take the Covid-19 virus and strip it of part of its RNA; the one that codes for the “spike” protein. They take this RNA and piggyback it onto the adenovirus DNA. Then they inject the mix into some very trusting people who feel well.

This approach was tried on Ebola. I am not sure how it worked. My understanding (I could be wrong; have had no time to check on this) is that no vaccine that uses this technology has ever been licensed. In any case, all people who were so inoculated developed good antibodies against Covid-19. We do not know if this will translate into preventing or decreasing the severity of the infection. Two encouraging signs: there was also a good T cell response (Helper T cells help, as their name implies, to augment immune responses), and seven out of eight ferrets treated with this vaccine avoided infection even when the virus was flushed up their noses.

The Chinese Army vaccine also published their results today. Not as good an antibody response, and a higher frequency of side effects, but no worry: they will start immunizing their troops in August. There are advantages to a totalitarian regime, if only they incur to the scientists and higher-ups. As far as the unfortunate Chinese Army conscripts… Hey, they have a job, right?

I cannot overemphasize how cautious we need to be about this vaccine issue. There has been so much money (and effort) poured into this quest, that people in the middle of this project may ignore warning signals because they so desperately want (need?) this to work. If the majority of the population decides that they will not agree to getting the vaccine, it will not work no matter how safe and effective it is (see recent measles cases in the US). If politicians decide that launching a not fully tested vaccine is going to help them in the elections, we may be told false information about it, and launch it they will, most likely shortly before the elections, too much fanfare.

Stay tuned. Wear masks. Be generous.