COVID Good News Compilation

Hello!  I've been getting a lot of questions (haven't we all) about COVID.  While the vast, vast, majority of the news published and printed and broadcasted is truly awful, (and a lot of that is justified), I've found it very difficult to find positive news on things that could change the tenor and response to the outbreak.  They are out there, but they are hard to find.  The negative news there is plenty of, so I won't be compiling those stories here. 

What do I mean, the tenor and response to the outbreak?   In order to keep the pressure on, media tends to focus on the main message, like mortality statistics and rising case numbers, as well as horribly tragic and terrifying personal tradgey stories.  However,  there are some great things happening - truly inspiring, hopeful things - that have the potential to alter the direction of this crisis and bring it to a much quicker - and possibly less impactful - end.  Regrettably, "hope" doesn't make the same news impact that "fear" does.  So this compilation focuses on "Hope". Please understand that I have used (and will use) the word POTENTIAL.  The articles mentioned here are "green shoots" of grass, in an otherwise barren landscape.  Many of these articles are devoid of the detail that is necessary to understand them in context, so I have tried to summarize them in my own way.   Note, I am not a doctor or epidemiologist, so you can take these articles and read them yourself to determine their value. 

A note about the hopeful information

I am sticking to credible news sources, where the information is published in several sources.  Generally, the optimistic information is in one of a few areas.  First is Testing - which is critical to understand the scope of the virus and controlling its spread. Second is front line therapies - drugs that have the most potential to save lives quickly.  Obviously, a vaccine is a front-line therapy, but we don't have one and one may not be coming for a year. Still, articles that track the efficiacy and trials of the COVID Vaccine will be here.  Third is success stories.  There are not many of these in the US yet, if any, but there are some in other countires, notably China, and they are very hopeful about the impact and duration of the trials we now face.  I'll be updating these as we go, so bookmark the page if you want to follow along.

Stay Strong. 

 

Matt Heisler

COVID TESTING POSTITIVE DEVELOPMENTS

ABBOT LABS RAPID TEST (#1)

ABBOT LABS RAPID TEST (#2)

ABBOT LABS Rapid TEST (#3)

Why it's important

The Abbot Labs Rapid test allows for COVID testing in 15 mintues or less.  More importantly, the testing equipment is already in hundreds of hospitals, and I expect they will sell quite a few more machines.  This has an opportunity to dramatically increase the amount of testing that can be done daily, using a quick test.  It could easily, as the numbers suggest, double the testing capacity in the US, and perhaps even more than that.  It has the potential to test 50,000 people a day as soon as the first week of April, and while that testing will be spread out, could be a enormous increase over time. In fact, this one piece of news could completely solve the test bottleneck in a month or less.

What we don't know

Well, there's a lot we don't know.  We don't know where these machines are (if there is like 1 in NY, that would be bad, for example).  We don't know how fast Abbot can make the machines.  We don't know the error rate on the test.  We don't know how quickly hospitals can staff up people to do 50,000 tests (or 100,000 tests) a day.  These test solve one problem, but what they do is likely move the bottleneck further down the line.  And we just don't know where that bottleneck will show up yet. 

COVID FRONT LINE TREATMENT POSTITIVE DEVELOPMENTS

Currently, there are no (zero) approved front line treatments for COVID, other than providing ventilators for those whose lungs are damaged and can no longer function adequately.   It should be obvious, but if we can get the number of people who require ventilators down, reduce the length of hospital stays, reduce the number of hospital stays, and/ or reduce the number of mortalties to that of H1N1 (swine flu), we will still have a crisis, but a far more manageable one. (H1N1 mortality was about .02%, or .0002. COVID is estimated at 2%, or .02, but many say that is too high and we won't know without more testing).  Key developments in front line treatments can have enormous impacts - if we can find them fast enough and disseminate them quickly enough.

Gilead anti-viral has strong impact in initial study against COVID (4/11)

Why it's important

This is another anit-viral that has been through a (small) clinical trial.  Several larger trials are underway.  This clinical trial was done on the most sick of patients, but still shows promising effects on a large number of patients (68%).     

What we don't know

We don't know the right dosing amounts or whether the therapeutic value will work with the most vulnerable, or how large the theraputic value will be.  We don't know if it will help those who aren't as sick, or if it will alter mortality rates (initial indications are that it will, but the study was too small to say for certain). It sounds like many of these questions will be answered by the end of April.

 

Nitric Oxide as a front line treatment for coronaviruses (SARS and maybe COVID)

Why it's important

This is a very promising article on how the nitric Oxide - and perhaps viagra - might allow the lungs to increase function and airflow and hit the corona virus where it hurts.  Currently being investigated, but has the opportunity to become a front line treatment for first responders and those who are sick *very* quickly.  Previous studies showed promised against the last corona virus, SARS.   

What we don't know

We don't know the right dosing amounts or whether the therapeutic value will work with the most vulnerable, or how large the theraputic value will be.  The article goes in to large detail about the gaps in information we have. 

Japanese Flu Anti-viral

Why it's important

This is a very promising article on how a previously approved (in Japan) anti-viral has a clear therapeutic effect.  The numbers are quite staggering - and promising - for improving front line treatments for the virus.  Average "sick" time went from 11 to 4 days, which has all sorts of promissing repurcussions.  If you can cut the the average sickness time, you might also cut the hospitalization time, which frees up ventilators, and the whole works. 

What we don't know

We don't know the right dosing amounts or whether the therapeutic value will work with the most vulnerable, or how large the theraputic value will be.  We also don't know if it will cut mortality, although if the effect is as big as claimed, I would be surprised if it did not.  As noted previous, if you can cut mortality by 80%, you change the whole complexity of the virus impact on society, as it becomes a more "traditional" type of health problem (many people may not believe that, but it's true). 

Vaccine six months away (October timeline)

Why it's important

A roll out of an effective and safe vaccine would rapidly be able to protect those who are the most vulnerable and be able to protect everyone else as well.  A large vaccine program would extinguish the current pandemic, although pockets of the virus would still pop-up..  

What we don't know

Even in the US, the scale and roll out of such a program would be massive and first of its kind.  But the US isn't the only place that this would be needed.  You'd need (potentially) billions of doses in order to control outbreaks world wide, and there are likely to be lots of issues with who gets teh does when, both intra country and across countries.  It would be better if there were good front line treatments in place before while the vaccine ramps up.

Plasma Anitbody Treatments

Why it's important

With a vaccine off in the distance, it would be a gamechanger if we can either protect the sickest patients or protect those who must be exposed - like nurses and doctors and other responders.  It should be remembered that 98% (and likely much higher) of all people exposed survive, and their blood has antiobides that "recognize" the virus.  They are now immune (as far as we know, but it is likely), and their antibodies can be transfered (via infusions) to healthy people who very likely either won't get sick, or won't get as sick.  

What we don't know

Lots! We don't know how effective such a treatment will be.  Will it protect 50% of the people who get the treatment and have them get 50% less sick?  Or 90% of the people who get the treatment get 20% less sick? Efficacy aside, we also don't know how quickly the antibodies can be gathered and infused to people.  Can we do 100 a day?  1000? 10,000?  Can the blood from one individual work for 100 people? So the scope of how widely this can be dissemintaed is the real question here. 

Obviously, if 90% of the people get 50% less sick, that would be HUGE.  Such an impact could halve the mortality rate, or even reduce it more than that. If 10% of the people get 10% less sick, than it probably won't have much of an impact.  However, there is reason to be hopeful: These treatments have had very good efficacy historically.

Anitbody Testing

Anitbody Testing #2

Why it's important

Note that there are two types of tests that are important for COVID.  The first is testing for the VIRUS.  Then there is testing to see if you've already had the virus, by testing antibodies.  This article is about the second.  It is hugely important!  Those who have already been exposed probably can't get sick again - or give it to others directly.  Knowing who is exposed means you need to quarantine fewer people.  The quickest way back to normal will probably follow along the expansion of antibody testing, so any news in this area is worth watching.  

What we don't know

We don't know how accurate the test is, how fast it can be rolled out, and how many tests can be done a day.  All of those are TBD.

DYSON VENTILATORS

Why it's important

The current estimates show that we are going to be short of ventilators.  Anything that can be manufactured quickly (and cheaply) and is effective will dramatically increase the health care systems capacity to take care of the sick. 

What we don't know

We don't know if these ventilators are effective and if hospitals will use them.  We do know that he is hopeful they will be available in early April. If he can make 15,000 in two weeks, he can probably make 60,000 in another month. 

Chloroquine

Chloroquine #2

Why it's important

Choloquine is a drug that is used to treat malaria, and is used for some other purposes. It is already FDA approved, and a generic with multiple manufaturers, so if it is an effective treatment, it can quickly be manufactured and dispersed to protect those at risk who have contracted the virus.  Again, if 90% of the people on the drug get 80% less sick, it is a total game changer. 

What we don't know

We don't know if it will be effective.  Clinical trials are underway.  This could be a huge, huge, development, or a much more modest one.  The early France data is much to small for any definitive conclusions, but it is hopeful.

Low Cost Ventilators

MIT recently open sourced a low cost ventilator that manufactures could adopt. 

Why it's important

The current estimates show that we are going to be short of ventilators.  Anything that can be manufactured quickly (and cheaply) and is effective will dramatically increase the health care systems capacity to take care of the sick. 

What we don't know

We don't know if these ventilators are safe, if anyone will manufacture them, and if hospitals will use them.  All of that is TBD. The article is pretty clear that this is probably a "if you have no other choice" option, however, recent notes about ventilation patients suggest that may be changing. 

MASK STERILIZATION

Why it's important

Hospitals are using a huge number of masks in order to protect staff.  Previously, hospital protocol was to dispose of the masks, which meant that you needed new masks - but there wasn't enough manufacturing.  Now there is a process where the masks can be cleaned and reused, which will greatly reduce the manufacturing requirements, and greatly increase the number of responders who have safe equipment. 

What we don't know

We don't know how quickly these sterlizers can be disseminated, and how many masks can be cleaned.  The numbers are promising though.  

BCG Vaccine may offer partial Protection against COVID

BCG VAccine #2 - 10X protection

BCG Protection - what we don't know (detailed breakdown of the issues with many current studies.)

Why it's important

Some countries in Asia (and around the world) have mandatory TB vaccination.  Preliminary data suggests that those with the BCG vaccine offers protection to COVID, as the mortality rates in those countries seems to be better.  Notably, South Korea.  Several studies are underway. We do know that the USA doesn't have mandatory vaccination for TB, which is not good. The good news here especially is that if there IS a link, the vaccination could be widely disseminated as fast as they could make it, and there are manufactures for this vaccine, so that could happen relatively quickly (months, not years).  The latest articles suggest that the BCG vaccine offers 10X the protection against the virus.  That would be an enormous finding, and it is worth noting that this is a relatively easy study to do, as somone has already put together a certain amount of BCG evidence.

What we don't know

The current data is still too small to draw definitive conclusions, but more studies are underway.  Also, there are many trials going on to see if you can measure effectiveness against certain populations (particularly the elderly).  We don't know exactly how long it would take to get millions (and likely tens of millions) doses just to protect the "at-risk" population. Also, note the third link.  He notes many issues with the current BCG data set, and highlights why it isn't straigthforward to assume it's a useful thing (although he calls the hypothesis hopeful.)

 

COVID PROGRESS AND SUCCESS STORIES

4/6 -New Cases, New Admissions, and Deaths all down in NY

Syracuse has an excellent web page showing the current trends for NY.  It is worth noting that new admissions has fallen by 67%.  This may be temporary, or it may be significant, but it is certainly encouraging.  

Case Trends in Hard Hit Countries

The New York Times has a good graphic that show logarithmic rates of new cases.  Skipping over the math, what you want is to see the trendlines flattening out.  This happened in China, to the point where they have few cases to report each day.  You'll see on the graph that Italy, the US, and France have just started to flatten out.  Hopefully, as social distancing and lockdowns enter their thrid weeks, we'll see significant flattening this week. 

COVID Death Rate Less than Earlier estimates

The updated study says the death rate from Covid is about half what the current estimates are, as more accurate asymptomatic carriers are included in the data.  .66% as opposed to 1.6% or the commonly cited 2.0% .  The flu fatality rate is .1%, making COVID about 6x more deadly.  (But again, this is good news, as the expected mortality rate is cut in half with this study.)