So where are we now in the #COVID19 crisis at the end of its fourth month. First, treatment. So far, pretty much everything is either still really equivocal or has failed. Remdesivir, kaletra, (probably) hydroxychloroquine, etc. either failed RCTs or are marginal. 1/
It’s possible that some of these aren’t actually terrible in some niche applications, or if given very early, but we can’t yet detect an effect from any of the proposed drugs in vivo reliably. This is of course problematic. 2/
There are a bunch of vaccines in development, and some of them are even in early phase trials. None is going to be ready in a few months, and it doesn’t look like anyone is planning human challenge trials so I don’t think any of them is showing up for mass use very quickly. 3/
RTPCR testing scale, at least in the US, remains woefully insufficient. It is not yet the case that anyone showing symptoms can be tested anywhere at will. The necessary contact tracing infrastructure is also not yet really a thing for that part of test-and-trace. 4/
Commercial lateral flow antibody tests seem unreliable, certainly too unreliable for population-wide tests, and not even very reliable for individual use. ELISA tests are, surprisingly, also of quite variable quality, though some seem quite good. None are yet widely available. 5/
Some attempts at population sampling have occurred. Because of both problems with the antibody tests and methodological errors, none yet seem particularly reliable. We therefore are fighting this with insufficient data. 6/
Some parts of the United States have managed to dramatically slow transmission, but the methods used to do this (shutting down much of the country) seem unsustainable, and not just because too many people still think death is superior to inconvenience. 7/
Ultimately the economic damage, even in a very rich country like the United States, will see a lot of people start going hungry, and even the best states are not very good at the decisions here, and lack test and trace infrastructure to reopen. 8/
Some bright points at this point include significant improvements in treatment protocol since the start, substantially better understanding of the disease, a few things (like convalescent serum and ultimately moncolonal antibodies) that probably will work to treat bad cases. 9/
All in all, though, the response so far has not given one real hope that this is going to be past us quickly. The experience in places like New York City has also shown us just how deadly this thing can be once it takes hold. 10/
All in all, I’d say that we’re nearer the start of this than the end, and that even after months, the response is still pretty mediocre. I give our civilization a gentleman’s C- at best; if this had been a slate wiping disease (say a 50% fatality rate) we’d have gotten an F. 11/
We’ll see if things improve in coming months, but this is already probably one of the bigger challenges our civilization has faced in a long time, and one of the more embarrassing failures in a long time, too, even though we knew this might happen. 12/12
