I've been thinking about #COVID19 the last few days. I do not speak for my employer or anyone else. A few thoughts. First, the West Coast clearly already has COVID19 in circulation, and testing will demonstrate that, so early numbers will jump up quickly regardless of how fast
the virus spreads. Second, we've built a world that is massively efficient and also quite brittle. Our political animosity, our estrangement from neighbors, our loss of emotional resilience all can serve as non-medical amplifiers of disease. Building resilience and drawing on
wells of goodness and sanity are important for us to weather what will likely be a painful 2-3 months in USA. We are at high risk for tragedies of the commons as people horde, speculate, and attempt to profiteer AND as people attempt to score political points or stigmatize .
vulnerable groups. Both left and right are susceptible to this risk. I'm horrified by the orange man in the white house, but I also know many of the government workers on the case, and these are smart people doing good work. So in addition to trying not to touch my face and
washing my hands more, my reaction to COVID19 involves trying to pitch in where I can and also trying to think well of my neighbors and of the people who disagree with me politically. Third, enough with the masks already. The N95 masks are necessary to keep the healthcare
system afloat, and we need that system to help us all. Hording them is like refusing to get vaccinated--puts the community at greater risk for no real advantage to you. The simple surgical masks are really just for people who are already sick, to limit their contagiousness.
Fourth, it's such a privilege to be alive and to have access to our shared strength as human beings. I'm in awe every day of the fact of conscious life. We can do hard things. There is more to us than our consumer spending and our nominal health utility.
We can work with and love each other in times of apparent crisis. Fifth, there are always tragic tradeoffs. No plan or set of plans will ever be perfect. Pointing out that plans are imperfect is less useful than helping us understand the tradeoffs involved and then working .
to minimize ill effects. We will almost certainly need to pay more money to our health departments, CDC, etc. If head of CDC asks for something, we should in general support them and encourage our elected officials to support them. If Gilead Pharmaceuticals should request
exemptions from bureaucratic red tape to test remdesivir, we should not accuse them of malfeasance but should embrace a rapid pragmatic rollout of an RCT. We cannot BOTH meet all the usual startup barriers for trials AND answer the question while COVID19 is actually happening.
Safety monitoring, yes, absolutely. But I would indemnify against lawsuits, I would adopt EFIC without community consultation, I would waive local IRB (ie cIRB only), and I would use one-page simple contracts with the sites. I would be glad to be randomized without my consent
in this pandemic circumstance. It's part of the debt I owe to humanity. And once we have confidence at a p 0.1 level for efficacy and no safety concerns, then open it up under compassionate release. I'd be fine with that (again, tragic tradeoffs). We could wait for an actual
indication until next coronavirus season, where we could do a more usual confirmatory trial, once there's some immunity in the population, the vaccine is in play, etc.
Sorry to have run on. Just some thoughts as we enter a time that will stretch us and test our moral mettle.
Sorry to have run on. Just some thoughts as we enter a time that will stretch us and test our moral mettle.
