A commenter provides an overview of the news:
What follows are the opinions of one observer — a non-clinician, at that — about the pandemic we’re experiencing, gleaned almost entirely from open-source material. This is a snapshot; people who are paying close attention will already know most of what I relate.First, the bad news.Epidemiological models have stayed in the news, particularly the one from Neil Ferguson at Imperial College London. A simpler interactive model by Gabriel Goh was linked by Tomas Pueyo in his widely-discussed Medium piece. Few of the key parameters are known with adequate precision, but the overall message remains about the same when they are varied: this pandemic is going to be bad. Millions of people are in the Grim Reaper’s crosshairs. Older is worse, existing health problems are worse. In the U.S., the patchwork of state and local social-distancing measures halfheartedly endorsed by President Trump will not flatten the curve.The sweep of the virus can be grasped through the work of John Burn-Murdoch at the Financial Times, Coronavirus tracked: the latest figures as the pandemic spreads. Not paywalled, and updated daily from Johns Hopkins data. Inspired by Burn-Murdoch, “Wade” keeps four interactive graphs updated at his backwards webpage 91-DIVOC. Find the region where you live, toggle between linear and logarithmic scales to see how it is faring compared to the hot-spots in the news. It’s sobering.
If you want to dig deep on models, one place to start is Phillipe Lemoine’s March 21 blog post, Are we headed toward an unprecedented public health disaster? Lemoine lives in Paris and focuses on likely future trends in France, but his lengthy analysis is applicable to most of the developed world, excepting only South Korea, Singapore, Taiwan, Japan, parts of Northern Europe (perhaps), and a few other places.If you’re on the fence about masks in public: it diminishes the risk to others from the mask-wearer’s coughs and sneezes, it demonstrates social solidarity, and it may modestly protect the wearer. In that order. Practical tips from Stanford University’s Dept. of Anesthesia in a regularly-updated PDF: Addressing COVID-19 Face Mask Shortages (key tip: virus on re-usable masks is killed by 30 minutes in a 160 F oven). I found this via Matt Bell’s 3/23/20 article Masks work! Wear them! The same day, polymath psychiatrist Scott Alexander wrote the long-form post Face Masks: Much More Than You Wanted To Know.
An MD colleague is on the front line, caring for patients in a big-city hospital’s Intensive Care Unit. He offers a measured dissent: “Masks don’t need to be worn [by people who] are not in routine contact with sick (or potentially sick people). SARS-CoV-2 [seems to spread] by contact rather than droplets (esp. as pertains to the asymptomatic folks). Masks should be conserved for healthcare providers… continue to practice social distancing and hand washing.”And on to some good news.* Testing capacity continues to expand. In particular, Abbott has launched a 15-minutes-for-an-answer molecular diagnostic on its popular ID Now point-of-care platform (18,000 installed units in the U.S., 50,000 kits a day by April 1, says Bloomberg News). Kits are shipping (or will soon ship) for high-capacity automated systems by Hologic, Roche, Abbott, Cepheid, and others. These machines form the backbone of the testing infrastructure of public-health, hospital, and private clinical laboratories, worldwide.* Antibody tests are now the missing link. These are different, using blood rather than a throat swab. They reveal if you have been infected, and whether or not you have developed immunity to the SARS-CoV-2 virus. Judging from other members of the coronavirus family, immunity is unlikely to be complete and permanent — but that’s a problem for another day. Reuters covers recent developments in this 3/25/20 article, U.S. companies, labs rush to produce blood test for coronavirus immunity, and distributor Henry Schein Inc. announced the availability of hundreds of thousands of point-of-care tests, starting Monday. Perhaps with these tools, the epic fail in the U.S. and most of Europe on contact tracing can be belatedly reversed.* I remain skeptical that a vaccine to SARS-CoV-2 can be brought to the clinic in the next two years: side effects are going to be a major concern. Virologist Peter Kolchinsky knows much more than me, his March 23rd piece in City Journal is much more optimistic: A Cure for the Common Misconception: Covid-19 vaccines are possible, but we need a public-health mindset to make the most of them.* Lastly, and … possibly … most significantly, Didier Raoult’s team at IHU – Méditerranée Infection in Marseilles has updated their experience with hydroxychloroquine and azithromycin. Last night, they posted a preprint of the paper by Phillippe Gautret et al. “Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study” is available for download as a PDF from this page at the hospital’s website. Like their March 17th report of their first six patients treated with this combination therapy (now published), this one is a rush job.This report is on IHU’s treatment of 80 Covid-19 patients (the prior 6, and 74 additional). On admission, the NEWS illness severity scores were Low for 69, Medium for 4, and High for 2.. As with the earlier manuscript, there’s a frustrating lack of detail on the clinical course of these patients that should have been in the Supplemental Information. Yet Raoult’s top-line claims are clear:* Hydroxychloroquine/azithromycin therapy lowers viral load rapidly. Figure 1:
* When infectious virus particles rather than viral RNA are measured, the drop is even more dramatic. If substantiated, this means that after 5 days of hchlor/az therapy, patients are much less contagious. (This is new: to my knowledge, Raoult is the only one routinely performing the cumbersome assay of infectious viruses on clinical samples in a study like this.)* More patients on hchlor/az recover, and they can be discharged faster. Few need to advance from general-ward beds to ICU beds and ventilator support. From Table 3: at publication, 65 had been discharged, 14 remained hospitalized, and 1 died. 3 had been transferred to the ICU, where 1 remained.* Hchlor/az is unhelpful (or marginally helpful) for critically ill patients.So these are the wondrous results of an uncontrolled trial, incompletely presented in a non-peer-reviewed preprint by a group that is the foremost champion of that particular strategy. By themselves, they cannot be persuasive. My ICU connection has first-hand experience with administering this combination, and he isn’t convinced by this paper.In the press, Raoult has been praised and savaged in equal measure. Yesterday, City Journal essayist Theodore Dalrymple profiled the “highly distinguished, if eccentric, microbiologist who touts a treatment for Covid-19,” A Time For Gurus. For a less generous take in Science magazine, see Charles Piller’s article of the day before, ‘This is insane!’ Many scientists lament Trump’s embrace of risky malaria drugs for coronavirus.So… it comes down to this question: will independent investigators confirm Dr. Raoult’s findings, or will they wither under scrutiny by disinterested parties? A trickle of answers should start coming over next week or so, in the form of early results from ongoing trials, including a massive, scattershot observational trial in New York.My own intuition is that Raoult is onto something very important, the most promising development at an otherwise grim moment. If most sick people can be kept from needing ventilators — if health care workers can be protected from the virus — then the entire picture would change drastically, and much for the better. Is this opinion influenced by hope? It is.I will close with a few more chits in the Good News department: some other therapies seem to be showing promise in early reports, such as remdesivir, the anti-arthritic Tolicizumab, and plasma transfusions from people who have beaten the virus.Stay safe.