26 July 2020 – Sunday – #105

Covid-19 curtailed my travel plans for 2020. I wasn’t alone. As Covid-19 continues on and on, my travel plans continue getting smaller. I’m not alone in this, either.

In March, Mom and I were discussing when I could visit her later in the year. By the middle of the lockdown in April, it wasn’t looking so good for any 2020 travel to the US with nearly all international flights grounded. When Spain lifted lockdown restrictions, I decided my safest bet was to think smaller, to use the rest of 2020 to explore Catalonia and nearby cities like Madrid and Valencia.

To paraphrase an old saying, when you make plans, Covid-19 laughs.

Covid-19 is back in Spain. Cases rose after the restrictions were lifted. A lot. Last week Barcelona reverted to Phase 2 of the lockdown relaxation. I cancelled a trip to Sitges and reduced my 2020 travel plans once again, limited now to the exploration of my new hometown. I”m still not sure what I’ll do about a planned trip to Canet de Mar next weekend. It’s a small city where friends live about an hour by train up the coast from Barcelona.

So far the Covid-19 resurgence here doesn’t look nearly as bad as Israel’s second wave or the extended first wave in the US. It’s not clear, though, whether Spain is on the brink of a second wave or just hasn’t got its public health act together. Public health seems to know where the outbreaks are taking place, which is a big step forward from March. My opinion is that with some quick staffing of public health tracers, Spain can get the lid back on the Covid-19 jar.

The resurgence is closing the doors of hotels and restaurants before Spain’s travel industry had a chance to reopen them completely. Catalonia’s already depressed hotel reservations dropped 20% after France asked its citizens to forgo Spanish beach vacations. The UK has imposed a 14 day quarantine on travelers from Spain, effectively shutting down a fifth of Spain’s tourism

We should know next week whether the macro orders to revert to Phase 2 are compensating for the lack of case-by-case tracers. Covid-19 will let Spain know.

This week is a strange juncture of bad Covid-19 news and good Covid-19 news.

The bad news is that the US, the country with the world’s dominant economy and the world’s best science, technology, and high tech resources, has screwed up its Covid-19 response royally while smaller countries, countries Trump referred to as “shithole” countries, have had among the best responses. Think countries like Vietnam and Rwanda.

The bad news is that Covid-19 is spreading through the less developed world and overwhelming many of the largest less developed countries. Think countries like India and Brazil.

The bad news, and the reason this is a strange juncture in the Covid-19 timeline, is that all the good news probably won’t change Covid-19 outcomes meaningfully until the end of 2020 (for therapies) or the end of 2021 (for vaccines). In other words, the relentless bad news of Covid-19 will be with us for a year or more.

The good news seems very good right now. Bill Gates summarizes vaccines and, to a lesser degree, therapeutics in this interview.

Bill Gates summarized current state of Covdi-19 vaccines and therapies.

On vaccines, the good news boils down to the very low regulatory approval bar of 50% efficacy for the first Covid-19 vaccines. That moves some health benefit into the market early, but probably means multiple Covid-19 vaccine shots until a second, more effective generation of Covdi-19 vaccines hit the market, presumably in 2021.

The big caveat, of course, is that even though the candidate vaccines are generating the kinds of immune system responses scientists expect from a vaccine (antibodies and T-cell), we don’t know for sure that any of the candidates provoke the right immune system response to immunize for Covid-19. With 20+ vaccines in human trial, large numbers are working in everyone’s favor.

Assuming the anti-vaxxers don’t throw a wrench in the works, that means the US and EU could have enough vaccine to achieve herd immunity later in 2021. The rest of the world probably achieves herd immunity after that. We need herd immunity everywhere to thwart Covdi-19.

On a related note, the good news is that herd immunity will happen, I’m going to note (without citation because I’m being lazy) that it looks like, regardless of what you may have seen about Covid-19 antibodies dropping off, patients’ T-cells are doing the expected things to establish long-term immunity. That means Covid-19 herd immunity is likely with vaccinations. The best proof I have for this is that immunologists aren’t running around like chickens without heads saying we can’t achieve herd immunity. They are saying the opposite.

The good news in the Covid-19 therapeutic landscape falls into two basic categories, monoclonal antibodies and repurposed drugs.

Several monoclonal antibodies for Covid-19 started phase 1 trials earlier this month. Big pharma production goals are tens of thousands or low hundreds of thousands of doses by the end 2020. Those are small numbers compared to Covdi-19 vaccine doses, but the main application is for people who are, or who are suspected of being, sick, not for the 60%+ of the population needed for herd immunity.

The repurposed drug category is much less predictable than monoclonal antibodies. In addition to the antiretroviral Remdesivir and the corticosteroid dexamethasone, which both are being used currently for Covid-19 cases, a new study shows that inhaled interferon significantly improves Covid-19 outcomes. Separately, a retrospective study shows that intravenous immunoglobulin (IVIg), a drug used for immune system disorders, improves Covid-19 outcomes in severely ill patients. I don’t mean this list to be exhaustive. UCSF, for instance, started a program in March to identify candidate drugs for re-purposing. That means there are probably many other studies coming to fruition in the next months.

So, there is the good news. It looks like the treatments and vaccines are coming. We even know about when they will arrive, which is better than my travel planning. That’s great unless Covid-19 complacency sets in. It will be easy to say, hey, why bother with lockdowns when there will be better therapeutics in six months.

Trump already gave an example of how he uses Covid-19 complacency in last week’s interview with Chris Wallace. After Wallace lists many incorrect statements Trump made about when Covid-19 would go away, the two men have this exchange.

TRUMP: I’ll be right eventually. I will be right eventually. You know I said, “It’s going to disappear.” I’ll say it again.

WALLACE: But does that – does that discredit you?

TRUMP: It’s going to disappear and I’ll be right. I don’t think so.

WALLACE: Right.

TRUMP:  I don’t think so. I don’t think so. You know why? Because I’ve been right probably more than anybody else.

Fox News, “Transcript: ‘Fox News Sunday’ interview with President Trump,” 19 July 2020.

Trump’s Covid-19 argument always has been that it’s going away, so why deal with it? It’s an excellent con because people want to believe they don’t have to change their Way of Life. Trump’s Covid-19 argument will resonate more when he notes a vaccine is around the corner. If nothing is done until the vaccine comes, he fails to mention, more people will die.

The implication of Trump’s insidious argument is that, after you’ve lost 150,000 American lives, what’s another 150,000 while we wait for a vaccine? “It’s going to disappear.”

I want to end today with a few Big Thoughts on Covid-19. What triggered this big thinking, in part, was a New York Times article in which the author describes how Covid-19 has replaced any notion he had of hope with a sense that the best he could hope for during Covid-19 is to explain what happened. Covid-19 has forced him to contemplate his death every day. That has changed his perspective on life.

Covid-19 is a truth teller. It reveals truths about our society, our morals, our institutions. As we reach this weird juncture where the end is in sight, but the Covid-19 pandemic is still raging, here is a short list of topics that Covid-19 asks us to consider.

  • Capitalism and Free Markets. Capitalism has failed in many ways during Covid-19. Here are a few examples. Covid-19 created enormous spikes in demand for PPE, ventilators, and other equipment that free markets couldn’t supply. Hospital bed supply ran out. Moving work space from office to homes created discontinuities in supply chains and shortages of not only, as everyone remembers, toilet paper, but also food. The employment discontinuity broke food and housing markets. The structure of US markets failed to allocate correctly medical care, housing, and food people need to live. If the economy isn’t working to help people live in the middle of a pandemic, who is it working for?
  • Democracy, especially US Democracy. The US democracy has a single point of failure in the executive. The executive ordered measurably among the worst Covid-19 responses in the world, a response that provided few standards, little guidance, and almost no coordination. Administration decisions consistently drove up costs by asking states to bid against each other. The allocation of responsibility for reopening to US governors didn’t come with the standards (including enforcement) they needed to make good decisions. Governors formed regional councils when the federal government failed. How did the US governmental system lead to one of the worst Covid-19 responses in the world? If the government isn’t there to protect residents during a pandemic, why is it there?
  • Media and Misinformation. I don’t have time. In a nutshell, traditional and social media are creating an epidemic of misinformation. Why?

This weird juncture between good news and bad news is a critical time to evaluate these topics. The world will face more Covid-19 type of discontinuities. Pandemics are increasing with higher human population and climate change. Then there’s climate change itself, whose scale will put the Covid-19 pandemic to shame. I don’t know how the world addresses these issues, but they are issues that we will face again soon.

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