1/ Covid (@UCSF) Chronicles, Day 244
One of the features of this stage of Covid is that we’re seeing more areas in which two or more complex issues influence one another. Today, I’ll cover a few of the most interesting ones – issues for which Venn diagram thinking is useful.
One of the features of this stage of Covid is that we’re seeing more areas in which two or more complex issues influence one another. Today, I’ll cover a few of the most interesting ones – issues for which Venn diagram thinking is useful.
2/ The big one, of course, is the explosion of cases and hospitalizations around the U.S. – coming alongside a flood of positive news regarding vaccines. It feels like we're watching a Covid split-screen; on one screen a horror film, on the other a feel-good rom-com.
3/ Now that we’re looking at a pandemic that may be all-but-gone by fall (and an economy that may spring back), the case for fast, vigorous action to flatten the curve is even stronger. Obviously, the politics are hard (see: Michigan), but the right calls seem easier to identify.
4/ Let’s turn to the vaccine news, which just gets better each day. tinyurl.com/y4xoebr8 Just in the past 2 weeks we’ve learned that two vaccine candidates – @pfizer & @moderna_tx – are 95% effective in preventing Covid cases, across different age & risk groups. Breathtaking.
5/ There’s still more to learn, but we now know that these vaccines work in preventing both mild & severe cases, & that they're safe, other than 1-2 days of unpleasant side effects. And there’s new evidence that indicates that immunity may last for years. tinyurl.com/y5t9fsao
6/ At 95% efficacy, I’m far more confident that we’ll hit the mark (~70% of people taking the vaccine) to achieve herd immunity – and do it humanely, with vaccines… in contrast to the Scott Atlas way, a culling-the-herd horror that would cost hundreds of thousands of lives.
7/ Another interesting Venn diagram is between monoclonal antibodies & vaccines. In the swirl of vaccine news, not much notice was paid to FDA's approval (via EUA) of Lilly’s monoclonal Ab. tinyurl.com/y3f6oqth Approval is also expected for Regeneron’s (& Trump's) Ab cocktail.
8/ Monoclonals are tough both to manufacture (Lilly/Regeneron are ramping up) and to give tinyurl.com/yyqo4s6v Pts will need to be dx'ed fast, set up to get an IV infusion, & given the Abs (takes 1hr, then 1hr hour of monitoring), all within a day or so. Logistically, tricky.
9/ I can’t see patients getting their antibodies in a busy ER; few will want more contagious Covid patients than necessary. True, big hospitals have infusion centers, but they’re filled with immunocompromised cancer pts, or pts with other diseases taking immunosuppressive drugs.
10/ So, to make this work hospitals will likely need new monoclonal infusion centers. It's doable (we’ve done it @ucsfhospitals), but it’s complex & costly. I won’t be surprised if some hospitals see the vaccine news as a reason not to do what it takes to stand up such a center.
11/ But won’t it take 6-8 months for vaccines to be broadly available? Yes, but those who should get monoclonals (elderly pts & those w/ major co-morbidities) will also be first up for vaccines, most likely before March. This will narrow the window for monoclonal use even more.
12/ (By the way, we’ll cover both vaccines and monoclonals at @UCSF Dept. of Medicine grand rounds tomorrow, live @ noon Pacific for UCSF-ers, posted ~7pm @YouTube. Speakers: @DrPaulOffit of @Penn on vaccines, @annieluet of UCSF on monoclonals & other therapeutics.) 
13/ Another Venn diagram: the Covid surge & the flu. I’ve never been too worried about this nexus, since the same precautions that prevent Covid (masks, handwashing, distancing) also prevent flu. And, while flu vaccine isn’t anywhere near 95% effective, it does work fairly well…
14/ …and the Covid scare has increased the flu vaccination rate. In fact, we’re seeing pretty low rates of flu so far tinyurl.com/yayzl8ve We’re not out of the woods, but I’m fairly confident we can take Flu/Covid Twin Pandemic scenario off our overflowing 2020 bingo cards.
15/ Speaking of flu, “Covid is like the flu” is a lie that has cost too many lives. But MAKING Covid like the flu may be what it takes to return to normal. As I’ve said before, we don’t wear masks, close schools, etc during flu season, though flu leads to ~40K deaths/year in U.S.
16/ In other words, we “tolerate” those flu deaths & live “normally” despite them. The good news, then, is that we don’t have to eradicate Covid to get to normal. Rather, we need to sustainably cut the case rate via a vaccine, & cut the mortality rate in those who do get Covid...
17/ …to a point that Covid is, in fact, like flu in terms of overall risk.(To be clear: it’s not that way today, or ever in 2020.) Again, w/ 95% effective vaccine, & therapeutics that have halved Covid's death rate, it’s reasonable to expect a “like-the-flu” state by fall 2021.
18/ More news overshadowed by vaccines: this wk FDA approved 1st home Covid test tinyurl.com/y4eet4tq Unlike monoclonals, these tests will have lots of runway, since testing will remain central to our strategy until we hit vaccine-induced herd immunity, hopefully by mid-2021.
19/ We may be entering a world of immunity passports, where you need to demonstrate that you’ve either been vaccinated or that you're currently virus-free to gain entry into indoor spaces, including schools, businesses, or entertainment venues. So testing will remain important…
20/ …especially rapid tests that quickly tell if you’re contagious – tests @michaelmina_lab has been advocating for mths tinyurl.com/ybtulu96 Now that we have such tests, rolling them out will be key part of a national strategy to safely open things up once this surge abates.
21/ “National strategy” brings us, inevitably, to Trump. Science has done its thing: producing tests, therapeutics, & now vaccines in record time. With all this good news, how could we screw things up? Because now the hard, thankless work begins – developing and executing a plan.
22/ The Trump team’s track record here is miserable, as it has been on All-Things-Covid, with the notable exception of Operation Warp Speed. Think about prior efforts to distribute tests, PPE, remdesivir, ventilators – plans that either didn’t exist or were managed incompetently.
23/ The Trump team needs to share its plans (if there are any) for the distribution of tests & vaccines, and to work with the incoming Biden administration to make the handoffs seamless. Getting this right will prevent millions of Covid cases & hundreds of thousands of deaths.
24/ And the successful execution of a vaccine distribution plan will be the one Trump Covid legacy of which he can be proud.
Unfortunately, if past is predictor, we should have low expectations for the next 63 days, hoping only that the darkness will lift on January 20th. /end
Unfortunately, if past is predictor, we should have low expectations for the next 63 days, hoping only that the darkness will lift on January 20th. /end
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