Thoughts on Covid

[Paul123456]

Or rather, what I’m watching out for!

A vaccine is clearly not a short term solution. It appears likely there will be a vaccine but not a given. Hence world can’t wait in lockdown without destroying economies.

Our best hopes for a quick return to the ‘new’ normal are therefore game changing therapeutics, successful testing/tracing and the big unknown, herd immunity.

Re therapeutics, Covid appears to attack in multiple ways - primarily viral pneumonia and/or cytokine storm but also low blood/oxygen levels (when lungs appear okay) and blood clotting.

Gilead’s Remdesivir has received a lot of press (and stock market) attention for its early USA trial results but this is an anti viral drug and intravenous (hence a problem to administer early). It does not directly impact the cytokine storm which appears the most lethal part of Covid. Perhaps a more interesting drug is Tocilizumab which targets the cytokine inflammatory response. This has shown efficacy in early French trials and together with Remdesivir, is currently being trialed in the UK. 🤞

There are other exciting treatment options in trials and you have to hope that by the time we are threatened with an autumnal 2nd wave there will be significant advances and reduced mortality rates. We have all the best medical brains in the world working on this so imo just a matter of time, especially re the cytokine storm which appears relatively simple - how to dampen down the IL-1 and IL-6 over reaction?

The most interesting card to fall is herd immunity. What % of the population already been infected and how many of these actually have immunity. To date antibody testing has been too unreliable to test accurately. My very limited understanding is that test should cover Immunoglobulins A, G and M. The early test don’t.

Stephen Powis said yesterday that his best guess was approx 10% of London have been infected but Prof Friston said day before that California data indicated nearer 50% herd immunity. He was immediately contradicted by another Independent Sage’ scientist who said New York, which has been harder hit, was only 25%!

Then we have Sweden, who are targeting herd immunity with much more relaxed lock down measures than the rest of Europe. They have significantly higher mortality rates than Norway but way below Imperial College’s prediction of 40,000 by now. Remember it was Imperial’s 500K prediction for the UK that trigged panic lockdown.

We should get a much clearer idea within next month as the new more accurate antibody tests are quickly rolled out and Europe starts to emerge from lockdown.

Obviously c. 50% UK already infected would be fantastic news but judging by the body language of ministers and especially Govt’s Medical Advisors, I fear the 10% more likely.

But this doesn’t explain why Swedish mortality rates (eg Stockholm) appear to be stabilising when should be rising......

[Dovme]

Interesting article on Sweden model

japantimes.co.jp/opinion/20...

[socrates_8]

Cheers Paul...

Naturally hoping you and yours are staying safe & well...

Yes, one might think w/ all the best minds at work that a vaccine is just around the proverbial corner... I do hope that such is the case also, of course...

I do however suffer from a cynical perspective concerning our global paradigm, almost regardless of the cost... Naturally, I do want to be mistaken...

However, there have been other very serious contagion outbreaks in the past... Some are mythically sharpened by conspiracy theories, of course... Nobody likes to dwell in such spaces, myself included...

Nevertheless, I rather prefer to rely upon your heady optimism, and a feeble hope that humanity might learn a lesson or two after all the dust has finally settled...

Best wishes, and thank you for your illuminating Post buddy... erudite as always...

Steve

[MPort]

Hi Paul, I appreciate your logical musings on the possible futures with this virus. I am now subscribed to the Office of National Statistics and I think I get insight and some tiny measure of relief from looking at the figures. As Steve says there have been other pandemics. Below is the result of a Google search. None of them caused a lock down of society. No doubt due to lack of transperancy and communication. I wonder if our 'greater' transperancy and huge levels of communication is actually not helping the situation. I don't even remember the Hong Kong flu! Mairead

Worldwide Influenza Pandemics

Pandemic InfluenzaOutbreak-Finish TimeDeath toll

Russian Flu1889–18901 million

Spanish Flu1918–192050 million

Asian Flu1957–19581.5 to 2 million

Hong Kong Flu1968–19691 million

[Paul123456]

But Covid-19 is different because so infectious? The overall mortality rate may be less than 1% but not if Health Services overwhelmed. Plus lockdown buys time to evaluate new therapeutics options and boost Health Services capacity, including PPE.

Some are now saying that we should have followed the more relaxed Swedish model. However imo this hinges on a high % of asymptomatics with immunity. If UK currently only c. 10 - 15% as our Medics appear to think, then could have been disastrous. If 50%, then we probably should have followed Swedish model.

Antibody testing will give a better idea. If herd immunity is proven, will those countries that locked down early, hence very few cases compared to the UK, struggle to keep R under 1 as they emerge from lockdown?