Jul 16 2020

Some COVID-19 News

As the pandemic goes into its 5th month in the US it’s important that we do not suffer from pandemic fatigue. As I wrote previously, this is a marathon, not a sprint. In the US all indications are that we are failing, miserably. As of right now the world has suffered 13.7 million cases of COVID-19 and 587,000 deaths. The US has had almost 3.5 million of those cases, and 137,000 deaths. These numbers are certainly underestimates. While most other industrialized nations are winding down their cases and safely returning to life as normal, cases continue to rise in the US and are spiking in some states.

The bright side of this story is the massive scientific effort to study this virus and understand how to prevent and treat it. The science has been steadily progressing, and it is now clear what we need to do to stop the pandemic. All that is required is political will. Here are some very recent studies that reinforce what we now know.

First – masks work. They really do.  They protect the wearer a little bit, and they protect other people a lot. This is because the virus is spread mostly in small droplets of fluid that are directly spread from one person to another. When you talk to someone, you are spraying them with these tiny droplets. When you wear a mask, this is mostly blocked. To add to the data that masks work, a recent study looked at infection rates among health care workers at MGB hospital. They found a dramatic decrease in infection rate once universal mask wearing was mandated.

The pushback against maskwearing seems particularly irrational. We are in the middle of a deadly pandemic. Wearing a mask is a small sacrifice that is a courtesy to those around you, mostly to minimize the chance that you infect them. Not wearing a mask is essentially a choice that your personal liberty is so important, you won’t bring yourself to take a small measure that will reduce the chance that you kill other people with your germs and perpetuate the broader pandemic.

What about social distancing? That works too. The one advantage, if you can call it that, of lack of leadership at the federal level is that we are essentially conducting 50 experiments in the US. We can then compare outcomes and correlate that with policy As the linked recent study shows, states that adopted lockdown early had far better outcomes than states that did not. We are now also seeing that states that opening up too early or too much are seeing a resurgence of cases.

The evidence also shows that there may be diminishing returns. This, I think, is just math. There is a general phenomenon in medicine, reflected in research, that the lower the risk or severity of a disease at baseline, the less potential for benefit for any intervention. The less common a disease becomes, the less it will seem that interventions are effective at preventing it. So pretty much any progressive intervention mathematically will appear to have diminishing returns, as each incremental additional step will have less net benefit, because there is less room for benefit.

So it makes sense that social distancing has a big effect over no distancing, and then progressively longer and stricter rules have progressively decreased benefit. But to be clear – the data shows social distancing works. There are returns, they just level off with progressively greater restriction. This does mean we need to look for the sweet spot of maximal relative benefit.

What this current data show is that, in the first two weeks, there is a strong linear relationship between intensity of isolation and benefit in terms of reduced spread. After two weeks, the relationship softens. There is still a benefit, but it levels off with greater intensity. The data also shows that early lockdown is important. It also highlights the fact that lockdowns will produce a second wave, meaning that they will only delay the inevitable, unless opening up is paired with testing and contact tracing. Overall it’s a pretty clear prescription for how best to manage this pandemic.

What are the prospects for a treatment or a vaccine? Looking good, actually. There are too many studies for me to go into detail on the vaccine prospects, but I will just give the overall summary – there are many labs working on vaccines, and many of those are doing well in animal and preliminary trials. Some are now progressing to the final stage of large clinical trials with people, and we could get results by the end of the year. If these results are positive, then we are probably looking a 1-3 months to ramp up production and distribution. So, optimistically, we may be seeing mass vaccine programs by the Spring. Some of the vaccines look like they need two doses, so you may need a second shot a month after the first.

Meanwhile – get your flu vaccine. One of the worries is that a real second wave of the pandemic will strike in the Fall, just as the flu season is starting in the Northern hemisphere. Part of the goal of preventive measures is to flatten the curve, to keep hospital systems from getting overwhelmed (like they are in some of the states that are spiking in the US). Even an average flu season will add to hospitalizations, demand for respirators, and for general medical resources. The flu is never fun, but this is not a year when you want to get the flu. Get the vaccine.

Overall doctors are getting better at managing COVID-19. Steroids for severe cases and remdesivir, for example, are treatments which do improve outcomes. There are more in the pipeline. For example, a type of heparin, an already approved drug, was found to bind tightly to the SARS-CoV-2 virus. We need clinical trials to see if this will reduce viral activity and improve outcome, but it’s promising.

We are also learning a lot about the immune response to COVID-19 and why some patients have mild illness while others become critically ill. Hopefully this will lead to further treatments.

So there is legitimate reason for optimism coming out of the tremendous amount of scientific research being done. But this is tempered by the sad showing overall we have made in managing this crisis. This pandemic is not even close to being over. We can’t lose our patience and our perseverance now.

No responses yet