On March 31st I wrote some of my requirements for when I would consider that we have moved past the initial wave of badness. I didn’t make any predictions at the time, just a list. I thought I would go back and check myself and see where we currently stand. I added a star in front of the things that have occurred:
Numbers:
1. *Decreased hospitalization rates. Of course, that depends on geography and “hotspots”. However, if we think about it on a national level, when we see 2-3 days in a row with declining hospitalization numbers; that would be huge.
This has happened.
2. *A change in the ratio of positive tests to actual tests performed. I can’t find that published anywhere, but since we continually ramp up testing numbers we will continue to see more cases. I’m searching for the ratio widening as a sign we have hit a plateau of positives.
Already happened.
3. Real time mortality numbers <0.5%.
We are not there yet; but we are now seeing real data that is finding the mortality rates <2%. This also speaks to the previous warnings about using the Case Fatality Rate in the middle of the outbreak. We must force ourselves to remember that warning.
4. The geography becomes predictable so that we will know how the wave travels.
Nope.
I do feel the need to comment on this report about the “travel” of the virus. (
https://www.latimes.com/california/story/2020-05-05/mutant-coronavirus-has-emerged-more-contagious-than-original) A couple of points: 1. This does not in any way imply that the virus is more dangerous, only that it potentially changed how contagious it is. 2. This is basically data already known from previous Oxford gene mapping. 3. I’m seriously done looking at anything that is put out in non-peer reviewed sources; even if it comes from incredibly respectable scientists. The post about monoclonal antibodies was published in one of the few journals considered the gold standard of peer review, Nature. I fully trust the peer review process to weed out conjecture vs. science.
Therapies
1. *A well-done scientific report on an antiviral medication currently in use that is “re-purposed” for COVID and shows positive results in mortality or ventilation rates.
Absolutely. It seems like every day there might be another coming online (
https://www.bioworld.com/articles/434562-cyclacel-pharming-repurpose-drugs-to-fight-severe-respiratory-symptoms-of-covid-19)
2. *A discovery that a humanized monoclonal antibody currently on the market actually works against COVID making a trial immediately possible.
That came out just yesterday. (
https://www.nature.com/articles/s41467-020-16256-y) This is a HUGE deal. I personally think it is actually a bigger deal than either remdesivir or even a vaccine.
3. A well-done report that a medication “combination” really works to reduce viral load regardless of symptoms.
Not there yet.
4. *An initial vaccine trial shows promise.
I’m not sure I would say promise just yet, but stuff is seriously happening. An interesting combination of repurposed approaches and vaccines comes in the BCG world. (
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31025-4/fulltext) For those not failure with the BCG vaccine, it has historically been used as a vaccine for tuberculosis; but not in the US. There appears to be some evidence that previous exposure to the vaccine impacts the way you react to COVID. It is an incredibly interesting approach to immune modulation.
5. *The antibody infusion trials currently underway report initial positive findings.
Small series. We haven’t seen the bulk of the data, but what we have seen is encouraging.
Supplies
1. *We report our first “glut” of product such as PPE or ventilators.
Done.
Biology
1. Someone reports that they have figured out the infectivity/viral load issue so that we can answer the “asymptomatic carrier” question and know if you are positive and contagious or not.
Not happening yet. However, this whole asymptomatic carrier has fallen off the headlines of late. I think everyone just assumes everyone is infected.
2. Someone reports a well-formulated pathway as to why exactly the lung disease is so much worse with this coronavirus.
Much evidence has emerged about the inflammatory response, but still no firm answers.
3. *Reports surface about real risk profiles that give details, not just “older with co-morbities”, but a real risk assessment profile that also can figure out who is going to progress to hospitalization when they are at day 2 of symptoms.
Issues such as diabetes, uncontrolled hypertension, obesity, and poor general health has emerged.
Testing
1. In home testing becomes available for anyone to purchase.
They released one in the UK and there are several out there, but none has really passed the FDA.
2. *The 15 min turn around test becomes the standard at every hospital, office practice, or testing site.
Getting there. Just about.
3. *We roll out widespread antibody testing to not only figure out who has already been infected and recovered, but also those who can donate serum and antibodies to cure others.
Done.
4. Someone develops an ability to spray a surface and “see” if there is virus and any surface.
Not yet.
5. Somebody develops a great model and app that can literally track in real time where potential hotspots are developing so that we can jump all over them and squash any outbreak larger than 3 people.
Multiple tech solutions are already gaining speed on this, especially Kinsa Health.
Social
1. *We have enough testing in place that we can start to allow key industries to roll back to work in an extremely thoughtful, monitored, and methodical manner. This will occur in some cities but not others, some streets but not others.
Happening.
2. *Restaurants will allow diners to sit, but only in limited numbers at first, and the same way as above.
Yep.
3. Schools will be allowed to have limited class size in person, based on testing.
Discussions are now beginning.
4. Airline travel picks up, domestically at first, then internationally. Testing will occur (not screening) prior to boarding and prior to leaving the gate area.
Not yet.
5. Bars reopen..
Nope
6. Finally, concerts and sporting events occur again.
Not even close.
7. Last milestone, we have 100% vaccine compliance for the next decade
We shall see.
I am reposting this list, 5 full weeks after the original post, as a reminder. It serves to remind me that there was a time when we truly didn’t know if this was ever going to end. We can easily choose to look our current struggles with reopening through the lens of fear and discord being sold by the media. It drives outrage and panic; that is what sells. Or, we can choose look back on where we stood 5 weeks ago and realize that 12/25 of the things on this list have already happened. (Since the next decade of vaccine compliance isn’t really going to be know for awhile, let’s say 12/24) That means we are halfway there. In fact, I would contend that I could have counted more positive movement in my analysis.
Just like we were trying to stay hopeful and motivated 5 weeks ago, in the midst of what appeared to be a never-ending hell; we also need to be reminded of how far we have come. Things are better. The curve has flattened. I know that some people will immediately state “yes, but we can’t give up now” or “once we let people out, we are all going to die again.” As I have said in the past, being diligent and paying attention are not the same things as being panicked and anxious. Of course we must be careful; but to only be reminded that there is more work to do without briefly stopping to be happy for the efforts we have made and the things we have accomplished doesn’t serve anyone except those that are intent on keeping the seeds of panic and fear well nourished. We are winning this battle. We will emerge from this safely. Look how far we have come. Take a moment, take a breath, turn off the news, and be thankful for what we have accomplished.
Even by some, I thought, normal people. Anyone else? I did a search for that word and got nothing so apologies if it’s been covered. I’m not linking it.
