By Vivian Ho, Ph.D.
James A. Baker III Institute Chair in Health Economics
Kirstin R.W. Matthews, Ph.D.
Fellow in Science and Technology Policy
Heidi Russell, M.D., Ph.D.
Department of Pediatrics and Center for Medical Ethics and Health Policy
Baylor College of Medicine
In the 10th week since Covid-19 was declared a pandemic, states continue to relax restrictions, while reports are emerging of some states publishing misleading statistics, in order to support loosening their lockdowns. As mobility increases throughout the country, we consider factors that may help or hinder our efforts to return to normalcy.
By the Numbers
As of Friday, May 22, data from the COVID Tracking Project showed that the 7-day average (smoothed) number of new U.S. daily cases remained almost the same at 22,570 compared to 22,544 a week earlier. This unvarying statistic is discouraging, given that smoothed cases had fallen 15% the previous week. The percent of cases testing positive fell from 6.7% a week earlier to 6.2% last Friday, although the 394,296 tests for the nation still lie well below the target of 900,000 tests per day. Here in Texas, the smoothed number of cases fell 12% from 1,048 on May 15 to 921 last Friday. The state has corrected its testing data after misleading statistics were noted last week. Testing remained flat over the week, with 22,317 tests on May 15 and 22,525 last Friday.
On Thursday, the Advisory Board posted a summary of multiple scientific studies describing variations in infectiousness among Covid-19 patients. One study estimates that about 10% of infected individuals lead to 80% of the spread. This finding supports recommendations to limit gatherings to fewer than 50 people, to limit the potential effects of a superspreader. A 2019 study found that some healthy people exhale more droplets than others when they talk, some of which was explained by their speaking volume. Other research finds that Covid-19 patients are most infectious for a brief period of time, which means entering a high-risk setting during that period could cause a superspreading event.
Further reading of the summary leads us to believe that the scenario in which a Covid-positive person interacts with others matters just as much as the viral load of the individual. For example, one expert stated that there have been reports of outbreaks at places where people typically shout or sing, like choir practices or Zumba classes, while places like Pilates classes have not been associated with outbreaks. “Maybe slow, gentle breathing is not a risk factor, but heavy, deep, or rapid breathing and shouting is,” she said. Another yet-to-be-published study out of Japan found people are nearly 19 times as likely to become infected with Covid-19 indoors when compared with outdoors.
Accelerating Covid-19 Treatments
Hundreds of therapeutics are in preclinical or clinical development for treating Covid-19 patients. But as of May 24, only the antiviral drug remdesivir has been shown to be effective in reducing the length of hospital stays, and only from 15 to 11 days. Former FDA commissioners Mark McClellan, Scott Gottlieb, and their collaborators propose a comprehensive set of actions to substantially shorten the time and increase the capacity for bringing safe and effective treatments to market at scale. Their report lays out a hyper-parallel path for promising therapeutics that replaces and augments the usual highly sequential drug development process. Action on these reforms now would lead to much faster progress on clinical testing and manufacturing that would yield safe and effective therapies months before a vaccine is available. Acting on these recommendations could mean the difference between successfully reopening the economy versus going into lockdown again if a second wave of the coronavirus occurs.
In Search of Immunity
Several weeks ago, we noted that those who recovered from Covid-19 would have antibodies in their blood that would make them immune to the disease. However, scientists don’t know how long immunity lasts. A CDC study, expected to launch in June or July, will test samples from blood donors in 25 metropolitan areas for antibodies. Testing will occur monthly for 12 months, then one more time at 18 months. The study will measure the prevalence of Covid-19, and should also help scientists better understand whether the immune response to Covid wanes over time. Meanwhile, Sweden’s attempt to achieve herd immunity with lax lockdown measures has failed miserably. As of late April, testing showed that only 7.3% of residents had developed antibodies to the virus, and the country’s mortality rate is the highest in Europe and 10-fold higher than neighboring country Norway.
Covid-19 Vaccine Update
This week, Moderna announced preliminary results from their vaccine that showed it caused an immune response in patients during their Phase 1 clinical trial. The Moderna vaccine is based on synthetic RNA that encodes for a protein found on the surface of the SARS-Cov-2 virus. While the results are promising, many scientists were critical that the data is extremely limited:
- only eight patients from the 45-person trial were reported to have developed an immune response;
- no information on the other patients; and
- data was presented in a press release, not a scientific article with associated data.
There are several top candidates moving through the clinical trial process.
- Moderna has already been approved by the FDA for a Phase 2 trial and anticipates starting Phase 3 in July.
- The University of Oxford is conducting a Phase 1 clinical trial and anticipates starting a Phase 2/3 clinical trial next month.
- Inovio anticipates results from their Phase 1 trial to be available in June and hopes to start a Phase 2/3 clinical trial by late summer.
Of note, all three companies are using novel technologies and have yet to bring a vaccine to market before.
Multiple media sources reported President Trump’s announcement that he had been taking hydroxychloroquine, perhaps because two White House staffers recently tested positive for the coronavirus; he said on May 24 that he has “finished” the regimen. A study published on Friday found that the drug is associated with higher mortality among hospitalized patients and led to higher rates of abnormal heart rhythms.
A recent article by a group of women researchers highlighted the lack of female voices—scientists and other scholars—quoted in the media about Covid-19, underlining the gender disparity in science as well as the public’s perception of who a scientist is. This observation is particularly poignant, as this blog post is authored by three women scholars.
A report from the Well Being Trust and Robert Graham Center predicts an additional 68,000 deaths from suicide and drug or alcohol abuse because of pandemic-related unemployment and social isolation. The United Nations released international recommendations for policy changes including ensuring access to mental health services, which require substantially higher funding.
Measles outbreaks were increasing internationally prior to the pandemic because of decreased immunization rates. The CDC reported approximately 21.5% fewer vaccinations were delivered from Jan-April 2020 than in the year prior and a precipitous drop in children up-to-date on all immunizations. As the health care systems reopen, increasing vaccination rates is a priority.
Finally, we were drawn to Fortune magazine’s account of Challenge Seattle, an alliance of CEOs from 19 of the city’s largest employers. Seattle made the first announcement of a U.S. death from Covid-19 on February 29. Companies across the country have stepped up in the midst of the pandemic, contributing food, PPE, hand sanitizer and financial assistance to families in need. Challenge Seattle’s response was unusually well organized, including frequent meetings between Seattle’s infectious disease experts, public health officials and corporate leaders. Fierce competitors Amazon and Microsoft acted in concert on work-from-home policies and protocols for essential workers. Their senior managers helped organize the state’s medical supply distribution center. Costco’s CEO sourced 40,000 N95 masks from China in 24 hours. Alaska Air put a fleet of airplanes at the city’s disposal to transport medical supplies. Nordstrom lent its tailors to another Seattle firm that revamped its factory to churn out surgical masks. We live in an era when government is starved for resources, while corporate America controls much of the nation’s wealth. Business leaders can and should do more to work with each other and with nonprofits and public officials to address the pandemic. Our best minds can speed our path through this crisis if they work together.