Saturday, March 28, 2020

Covid-19 Scenarios Updated 3/28/2020



Across my posts I've been trying to scenario plan based on the variables I see as most predictive of disease and social trajectories.

I identified several key disease variables:
1. Viral Susceptibility to UV

2. Viral Mutation rate

3. Human Susceptibility to Re-Infection due to limited antibody production and/or viral mutation

4. Human Susceptibility to Worsening Reactions with Subsequent Infections due to, for example, a "cytokine" storm unleashed by virus hijacked immune system

5. Human Response - e.g., support for people losing income, medical support, etc.


LESSONS LEARNED SO FAR

1. Viral susceptibility to UV is high but not sure if warm weather enough to beat it back

2. Viral mutation still unknown. The virus has been described as having a metaphoric "code-repair" function but an Icelandic study allegedly (I cannot verify as its non-English) has already documented minute changes in this minute RNA plague.

3. SOME GOOD NEWS Human susceptibility to reinfection - There is growing research that we produce enough antibodies to prevent infection short term (months at least) and that babies born to exposed mothers also have antibodies.  However, inflammation may result and make us more susceptible to other diseases.

4. UNKNOWN Worsening disease conditions either from later re-infection to mutated virus or to viral dormancy. Dormancy is another problem that is emerging as critically important.  Yet, we don't have full understanding of dormancy given we are in the early crisis stages of this disease outbreak.

5. HEROISM and a NATIONAL CLUSTERF_ _ _! The POLICY response in the US has been disastrous. However, the nation's health care providers (and supporters), food supply workers, sanitation workers, etc. have labored heroically. Maybe they should be the ones running national policy!  


WHAT REMAINS UNANSWERED? DORMANCY & LONG-TERM REINFECTION?

Here is the best article I've read on the DORMANCY problem (like chicken pox and herpes):

Cherian, Dona & Chaudhary, S. B. (2020, March 10). Coronavirus: What does a COVID-19 recovery mean for you. Gulf News. Available https://gulfnews.com/uae/coronavirus-what-does-a-covid-19-recovery-mean-for-you-1.1583824222405


OTHER RESOURCES

MedCram @MedCramVideos ·Mar 23 https://twitter.com/MedCramVideos/status/1242185137678200834 Coronavirus Quick Video Update 42 with Dr. Seheult: Immunity to COVID-19 and is Reinfection Possible? https://youtu.be/q4P91VrfPGw


Antibodies in infants born to mothers with covid-19 pneumonia. Journal of American Medicine (2020).  https://jamanetwork.com/journals/jama/fullarticle/2763854?guestAccessKey=94dea2dd-6b19-4d8d-89ce-10be3f51ab11&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=032620

Wednesday, March 25, 2020

Potentially Good News on Covid-19 - Animal Study Predicts Acquired Immunity


I saw this study last night:

COVID-19 Reinfection Not a Concern, Monkey Study Suggests March 23, 2020 https://www.genengnews.com/news/covid-19-reinfection-not-a-concern-monkey-study-suggests/

Now, a collaboration of Chinese scientists has dug deeper into whether or not reinfection with SARS-CoV-2 is possible with a small monkey study. The team looked at whether or not non-human primates, rhesus macaques, can become reinfected with SARS-CoV-2. The work was posted on the preprint server bioRxiv on March 14 in a paper titled, “Reinfection could not occur in SARS-CoV-2 infected rhesus macaques.” Their conclusion: there may be no reason to worry about reinfection.

My worst case scenarios were based on the possibility of re-infection.

This study - albeit limited because of the small sample size and limitations of animal models - still offers considerable hope.

If we can acquire immunity, we will be able to manage the biological aspects of this challenge, albeit with great human cost and suffering.

Even that suffering can be reduced significantly with an adequate social response that prioritizes our collective well-being and especially assists our most vulnerable populations.

There is hope, if only we can get our collective act together.

Majia

Monday, March 23, 2020

Interesting Interview on Coronavirus Trajectories



Amy Gunia (March 23, 2020) Will the Coronavirus Ever Go Away? Here's What One of the WHO's Top Experts Thinks. Time, Available Yahoo: https://www.yahoo.com/news/coronavirus-ever-away-heres-one-094824995.html

...What do you think the coronavirus pandemic will look like six months from now?

I expect we will be emerging—still with disease in various parts of the world—but we should be emerging from a bad wave of this disease across a large swathe of the planet. The challenge is we’re going to be back into the flu season. And one of the big questions is, are we going to see a surge of it again at that period?

Looking further into the future, what do you anticipate? Will COVID-19 ever disappear?

... Are we going to get into a period of cyclical waves? Or are we going to end up with low level endemic disease that we have to deal with? Most people believe that that first scenario where this might disappear completely is very, very unlikely, it just transmits too easily in the human population, so more likely waves or low level disease.



Sunday, March 22, 2020

More Covid-19 Scenarios and a Universal Income


The Financial Times has a very good article covering a study produced by the UK's Imperial College modeling the covid-19 disease trajectory:
Chelsea Bruce-Lockhart, John Burn-Murdoch and Alex Barker (March 19 2020) The shocking coronavirus study that rocked the UK and US. The Financial Times,
https://www.ft.com/content/16764a22-69ca-11ea-a3c9-1fe6fedcca75
This model predicts spring and fall (November) peaks for infection.

The model's full assumptions are not detailed in the FT article. Here is the link to the executive summary of the study https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-update-epidemic-size-22-01-2020.pdf

The lead researcher, Neil Ferguson, argues that HERD IMMUNITY is not going to work with this pandemic and that SUPPRESSION is the only option.

See additional discussion here: https://www.ft.com/content/7e56cf84-6a9e-11ea-a3c9-1fe6fedcca75

That means that we as a society are going to have to figure out very fast how to make quarantine work without undue suffering and civil unrest.

Unfortunately, our "repressive" state apparatuses are too likely to invoke POLICING but what we need now is a UNIVERSAL INCOME to protect people from economic collapse.

We will descend into chaos if we don't provide sustenance and support for the people.

And we need EFFECTIVE RISK COMMUNICATION.

Most people will listen and respond to well-argued, well-substantiated reasoning when delivered by people that are trustworthy and are perceived as expert and well-intentioned.

Where is that crisis communication now? We need a lot more of it.

We must put into place NOW, while we can, the INFRASTRUCTURE that will allow us to make it through this trial.

Cooperation and mutual aid are key to our future.


Thursday, March 19, 2020

COVID-19 Scenarios


A few days ago I posted my predictions for coronavirus scenarios here.

Today, Yahoo has an interesting article on disease trajectory scenarios here:
Adriana Belmonte (19, March 2020). Coronavirus: Infectious disease expert details 3 scenarios for the U.S. Yahoo Financehttps://www.yahoo.com/finance/news/coronavirus-expert-3-scenarios-for-the-us-151836934.html

….How will the coronavirus play out in the U.S.? According to Penn State University infectious disease expert, Maciek Boni, it depends on which scenario the country finds itself in.

“One of them is the Chinese scenario, where we do put together social distancing, a measure that’s so extreme that we do manage to suppress it within a month,”

Boni said on Yahoo Finance’s The First Trade. “But at that point, we’re not out of the woods yet and we don’t know what the endgame is, because when you lift those suppressive measures, the virus is able to come back.”



“Scenario two is if the virus is able to transmit successfully during the summer,” Boni explained, “then the current epidemic wave that we’re just at the beginning of — people are talking about this being over in a few weeks but it’s ... not almost over at all. So if the virus can transmit in the summer, we’re going to see an epidemic wave that lasts through the summer, possibly to the end of the summer.”

….Then there is scenario three: if the virus cannot transmit successfully during the summer. “We’ll see lower transmission in the summer, which would be really fortuitous for us, because it will give us time to prepare for the second wave that will come in the winter,” Boni said.

“It might start in October, November, when school gets back into session and when the winter turns down again,” he added. “And then we’d have a major epidemic wave the following winter. So it’s probably 12 months of hardship for all of us.”

The three variables I see as most predictive of infection are these:

1. Viral susceptibilities to UV radiation and mutation tendencies

2. Degree of human susceptibility to re-infection - especially when viewed in context of viral mutations

3. Nature of human biological responses to re-infection - do re-infections wear down immune system? Do re-infections result in worsening biological effects?

HUMAN AGENCY WILL MAKE THE DIFFERENCE


That said, the SOCIAL response by government, business, civil society and everyday people will by far have the greatest impact on outcomes.

WE NEED TO WORK TOGETHER, AND THROUGHOUT, WE MUST ENABLE AND PROTECT OUR MOST VULNERABLE - Our response now will shape our future.

SOURCES

 
Apoorva Mandavilli (Feb. 29, 2020). They recovered from the coronavirus. Were they infected again? The New York Times https://www.nytimes.com/2020/02/29/health/coronavirus-reinfection.html

Wan, Y., Shang, J., Sun, S., Jai, W., Chen, J., Geng, Q, He, L., Chen, Y., Wu, J., Shi, Z., Zhou, Y., Du, L., Li, F. (2020). Molecular mechanism for anti-body dependent enhancement of coronavirus. Journal of Virology, 94 (5) e02015-19; DOI: 10.1128/JVI.02015-19. https://jvi.asm.org/content/94/5/e02015-19

Monday, March 16, 2020

The Coronavirus Panic - Good News and Bad News


The good news is President Trump met with the nation's food producers/distributors and there is a plan to keep the food coming despite "unprecedented demand":
Fares, Melissa & Baertlein (2020, March 15). Factories shift operations in scramble to restock supermarket shelves. Reuters. https://www.reuters.com/article/us-health-coronavirus-retail-usa/factories-shift-operations-in-scramble-to-restock-supermarket-shelves-idUSKBN2121AN

As the fast-spreading coronavirus continues to alarm consumers across Europe and the United States, Trump held a phone call on Sunday with 30 executives from grocery stores including Amazon.com’s Whole Foods, Target Corp (TGT.N), Costco Wholesale Corp (COST.O) and Walmart Inc (WMT.N). Trump Administration official Larry Kudlow assured television news viewers that U.S. supply lines were “working pretty well.”
“The grocery supply chain is not going to shut down,” said Doug Baker, who leads crisis management for the Food Marketing Institute (FMI), the trade group representing food retailers and wholesalers.
...
“Manufacturers have also started allocating goods so they can ensure equal distribution across the country,” Baker said. U.S. retail giants such as Walmart Inc, Publix and Kroger Co (KR.N) have set restrictions on purchases of toilet paper, Lysol sanitizing wipes and other in-demand products.
Walmart, which gets more than half its U.S. revenue from grocery sales, has given store managers authorization to manage their inventory, “including the discretion to limit sales quantities on items that are in unusually high demand,”

The bad news is that some people feel that vulnerable life is not worth protecting:
Nick Brown, Brad Brooks (2020, March 16). Fear and loathing bloom as American tempers fray in coronavirus crisis. Reuters. https://www.reuters.com/article/us-health-coronavirus-usa-mood/fear-and-loathing-bloom-as-american-tempers-fray-in-coronavirus-crisis-idUSKBN2133VW

...The most concerned include parents of young children with severe health conditions. Among them are the Raatz family of Oviedo, Florida.

Their 8-year-old daughter, Ella, has multiple risk factors because of a neurodevelopmental disorder, epilepsy and a primary immunodeficiency.

“People just don’t seem to care about people who might be vulnerable,” said Becky Raatz, Ella’s mother. “Some people are not taking it seriously – when I see the photos of the people cramming into the bars, I can’t believe it.”
It may be that people cramming into bars are simply denying their own mortality, but in doing so they are inadvertently increasing risks for us all.

Of course, I understand why some people see such a gap between the response and the alleged risks, which often are trivialized as less than 1-2 percent of infected.

However, the case of Italy has shown us very clearly a major problem arising with the pandemic: Hospitals become overwhelmed and ordinary services disrupted by onslaughts of very sick patients.

Flatten the curve if you can by implementing social distancing.

Wishing you all well....




Sunday, March 15, 2020

Time to "Hunker Down More" to Flatten the Curve #Covid19


Time to "hunker down more":
Chiacu, D., & Shalal, A. (2015, March 2020). U.S. coronavirus death toll hits 62 as Americans urged to hunker down more. Reuters, https://www.reuters.com/article/us-health-coronavirus-usa/u-s-coronavirus-death-toll-hits-62-as-americans-urged-to-hunker-down-more-idUSKBN2120RY

“I think Americans should be prepared that they are going to have to hunker down significantly more than we as a country are doing,” Dr. Anthony Fauci, the nation’s top infectious diseases expert, said on NBC’s “Meet the Press.” Elderly people and those with underlying conditions need to be especially cautious.

....Asked whether he thought U.S. authorities should impose a 14-day lockdown to try to stop the spread of the virus, Fauci said: “You know, I would prefer (that) as much as we possibly could. I think we should really be overly aggressive and get criticized for over reacting.”
It's on my agenda.