Coronavirus

[Stavros]

For those interested in weaknesses in the UK response, this link argues austerity and Brexit have played a role-
https://www.theguardian.com/commenti...crisis-britain

[sukumvit boy]

I'm going to read the New Yorker articles in the morning. Thank you. I'm interested in the subject but don't have a science background so I apologize if I get this wrong. In February I read reports that Remdesivir inhibits viral replication in vitro for the coronaviruses SARS, MERS, as well as Sars-cov-2. This is why, despite the fact that it wasn't a successful Ebola treatment, doctors in China were using it experimentally for Covid-19. That experimental use continued in the United States and there have been promising open label studies, but until yesterday there was no evidence from a controlled trial demonstrating efficacy.

Yesterday the results from a controlled trial performed by NIH were released. The endpoint was statistically significant reduction in duration of disease in people with severe Covid. I think the use of Remdesivir resulted in a reduction in the duration of the disease from 15 days to 11 days (which was statistically significant). It also reduced the mortality rate for the treated cohort but the endpoint was days to recovery. This result means it will likely get approval and be the standard treatment for the time being in patients with advanced disease.

Anyhow, most of the virologists I follow say it looks more like a step forward than a game changer. They claim that anti-virals are often most effective early in the course of illness but that Remdesivir is provided by an iv so it is only used in moderate or serious disease.

The other drug I've read about is Favipiravir, which is a flu drug used in Japan. There are ongoing trials for it and clinicians reported some benefits. I understand it's administered in pill form as well, so if it's shown to be effective in trials there is the potential people can take it at the onset of symptoms rather than once hospitalized.

I know there's been at least one negative study for an HIV combo drug called Lopinavir/Ritonavir. I'm not sure if there are more trials ongoing or that dried up all interest.

There has also been some excitement about the use of monoclonal antibodies, with a company called Regeneron preparing to conduct trials this summer. My understanding is that even if this is safe and effective, these drugs tend to be expensive to produce enough of.

Speaking of vaccines, I would not be surprised if Donald Trump endorses the idea of human challenge studies. Most doctors believe Covid-19 is too dangerous and therefore it would be unethical to perform human challenge trials to speed up Phase III testing for a vaccine. There has been some discussion of this subject among academics recently. I can imagine Trump finding this kind of dangerous shortcut attractive.

Great post broncofan, additionally ,you have got all those details correct. The basic difference between anti viral drugs and vaccines is that vaccines are generally taylor made to stimulate the immune system to produce antibodies against a specific virus whereas anti viral drugs are designed to interfere with the mechanisms viruses all use to replicate their DNA and manufacture their protective capsule.
Remdesivere is what is called a Nucleoside analog ,in the case of Remdesivere it replaces Adenosine (the A in the ATCG bases that are the backbone of the genetic code )when the virus is trying to replicate itself and the replication process fails.
https://en.wikipedia.org/wiki/Nucleoside_analogue

[sukumvit boy]

There seems to be some confusion here regarding the 'common cold' ,flu and corona viruses . The common cold IS usually a Corona virus ,a Rhinovirus or a flu (Influenza) virus. But Covid-19 is a new type or "novel coronavirus".

https://en.wikipedia.org/wiki/Common_cold

[Del06]

Broncofan:"I would not be surprised if Donald Trump endorses the idea of human challenge studies. Most doctors believe Covid-19 is too dangerous and therefore it would be unethical to perform human challenge trials to speed up Phase III testing for a vaccine. There has been some discussion of this subject among academics recently. I can imagine Trump finding this kind of dangerous shortcut attractive."

Perhaps Trump could be persuaded to volunteer.

[Stavros]

There seems to be some confusion here regarding the 'common cold' ,flu and corona viruses . The common cold IS usually a Corona virus ,a Rhinovirus or a flu (Influenza) virus. But Covid-19 is a new type or "novel coronavirus".

https://en.wikipedia.org/wiki/Common_cold

Article in today's Guardian/Observer gives more details on how Covid 19 affects the body and why it is proving to be so difficult to deal with-
https://www.theguardian.com/world/20...ious-mechanism

[filghy2]

Further to previous discussion, this article discusses problems with the IMHE model that has been relied upon by the administration. While it has some advantages in what it can project, the model is not based on standard epidemiological modelling principles and has been very inaccurate - outcomes have generally been outside of the 95% confidence interval for next-day predictions. Other models, which are currently projecting higher death rates, appear to have been more accurate.
https://www.vox.com/future-perfect/2...-ihme-pandemic

[sukumvit boy]

Thanks flighty2, very interesting article about the failure of the existing model and the need to broaden the parameters to fit this specific event . This epidemic is a boon to epidemiology and modelers in that it is so unique in scale,response and in so many other ways and will doubtless lead to more effective modeling in the future.

[filghy2]

The IMHE model prediction has been increased from 72,000 to 134,000 deaths by August, primarily due to many states' premature easing of social distancing restrictions.
https://www.politico.com/news/2020/0...navirus-234377

This article contrasts the handling of the crisis in the US and Canada, which has half the number of cases and deaths relative to population.
https://www.vox.com/2020/5/4/2124275...-trump-trudeau

[Ben]

What Asian Nations Know About Squashing Covid: https://www.commondreams.org/views/2...quashing-covid

[broncofan]

The IMHE model prediction has been increased from 72,000 to 134,000 deaths by August, primarily due to many states' premature easing of social distancing restrictions.
https://www.politico.com/news/2020/0...navirus-234377

What's interesting is that it predicts about 64,000 more deaths in something close to 90 days. There are day of the week effects so today's death totals don't look as bad, but we've averaged close to 2,000 deaths a day for the last two weeks.

Now if we could expect R0 to decrease, this might be a plausible total but it still seems a bit optimistic. New York has gotten its R0 below 1 (according to Cuomo and the numbers are improving) but many states are probably above 1, and some have rising death tolls as they seek to open up. I hope mortality is kept to a minimum but we can't get results without any leadership here.

Maybe a sensible model would look at Spain and Italy's R0 during the period past the peak and use that to model IF we maintain social distance. What real world example would we have of a country opening up regions that are near peak? Not sure. Even when we've shut things down we haven't been super aggressive about it and people for the most part in my neighborhood aren't wearing masks.