General Course of the Pandemic
There is nothing here that you do not already know. In the US, soon there will not be a single family that has not been affected by this virus, either directly or because someone they know has been infected. Europe shows signs of decreasing infections, although severe restrictions remain in place for businesses and individuals. The Far East has done relatively well in the past month. Australia has done away with its lockdown in its most populous province. Vietnam is still the world leader in good outcomes.
Mask mandates, or lack of them, remain political maces, to be swung at will against people who do not agree with each other. One Danish study suggested that maybe they were not as helpful as most experts think they are, but the study is flawed because it relied exclusively on self-reporting of data, which is not considered scientifically sound.
Large gatherings among family and friends is now the largest contributor to new cases. “Large” means more than five people. The US is undergoing a national “Am I doing the right thing” debate when it comes to people deciding what to do for Thanksgiving. My advice: do nothing that you may not be thankful for three weeks from late November. There is no law against eating turkey in April.
Testing
The biggest news, by far, is the approval of a home PCR test. The company, Lucira Health, says that the test will be priced around $50, and will only be available with a doctor’s prescription. PCR tests are highly accurate, over 95%. Results will be available within 30 minutes and can be read by the patient (who must then report the results to the doctor). I wish that it were cheaper, and available to all who want to self-test. Still, a great advance.
Antigen testing has gained adherents in Europe. First Slovakia, now Madrid have purchased millions of these. Most experts feel that antigen testing should only be used in high-prevalence areas (almost all the Western Hemisphere now), preferably on people who have been exposed, or those who have symptoms. I feel that these are needlessly tight restrictions, but I am not the expert.
Treatments
I have not seen any more information on ivermectin, which showed promising results in a few small trials.
Monoclonal antibodies have been approved under emergency authorization, but only for infected people and not for prevention.
Washington University researchers are pursuing bigger trials of fluvoxamine, which prevented serious complications in a small trial of infected individuals.
The allure of ivermectin and fluvoxamine is that these are medicines that have been around for a long time. They have two huge advantages: they are inexpensive (both available in generic form) and we have used them for long enough to know what the side effects are. The disadvantage is that we desperately want these medicines to work. It is human nature to have a strong tendency to believe what we want to believe, therefore we often ignore minor inconveniences that try to steer us away from what we want to be true, such as reality. Researchers must be incredibly careful to avoid another debacle like we had with hydroxychloroquine. Facts; just the facts.
A recent commentary in The New York Times reminds us that remdesivir is not as effective as its maker claims that it is. I think that most doctors are aware of its limitations.
Vaccines
You would have to be a hermit not to have heard about the Pfizer and the Moderna vaccines. I have a bias here, because the technology used to develop the messenger RNA (mRNA) used in them was developed by an immigrant, a female one at that. Her work was ignored for a decade. The German (Bio N Tech) / Pfizer vaccine is the child of two Turkish physicians who moved to Germany as children, and the Moderna product also owes its success to immigrants. Maybe we should make it easier for smart people to study and work in this country. Just a thought.
The mRNA technology is relatively new. Although people have been trying to develop an effective cancer vaccine from mRNA for years, it is far from a reality. No mRNA product has been approved for use in humans. These vaccines will be a big step.
The Pfizer vaccine reported results first, most likely because their schedule requires that the two injections be given three weeks apart. The Moderna vaccine asks us to get jabbed four weeks apart, thence the week delay in the Moderna result reports. The Pfizer product requires super freezers that will only be available in large cities. It will be hard to move this vaccine to rural areas. The Moderna vaccine can be frozen in most medical freezers.
We expect both companies to ask for emergency approval soon. I read that in 4-6 weeks we may see the first use in patients (other than those who participated in the studies).
The Oxford vaccine reported that older people developed a robust immune response to its injections. This vaccine uses a neutered adenovirus; the SARS CoV-2 genes are piggybacked onto it. Again, no vaccine that uses adenovirus as a “vector” has been approved yet.
Many people worry that there will not be enough vaccine for all humans. It is likely that, with more than 100 companies rushing to produce their own vaccine, there will be plenty to go around. The issue will come down to cost: whether the wealthy nations will want to supply free product to the poorer ones. It would make sense to do so, because the goal is to make everyone immune so that this virus is eradicated, like we did with smallpox.
I read a study today that says that people who came down with Covid-19 produced lasting antibodies; they also had persistent memory T and B cells. Memory cells are partly responsible for keeping us immune to some diseases (such as measles) for life. It would be great news to find out that either catching the disease or taking the vaccine would immunize us for life. For now, this is just a dream.
Pictured: Parque Picasso, a few steps from my front door.
