When the COVID -19 pandemic story is written I am pretty sure the survivors will learn:
- Playing politics with the facts kills people
- Lack of testing had profound impacts on mortality and the economy since we are flying blind without it
- A robust federal government response saves people
- A robust response cannot be done on the cheap
- On demand fulfillment can lead to shortages in critical material such a protective gear for medical staff; so stockpiling at the federal level is the best way to cover all the states
- Failure to act early no just saves lives, it can help avert economic disaster
- Trump’s and Republicanism’s war on science and government contributed heavily to what is going on
Since we all probably agree on that, this post brings some thoughts about where things might go on the therapy side. Three areas to watch for are 1) improved treatment of symptoms, 2) anti-viral therapies, and 3) vaccines. (Word or warning — I am not an MD — so this is my take based on my ongoing experience/exploration).
First, I think we are going to see some positive news on the anti-viral front. This may be our best chance of a nearer term complete solution. As opposed to 1918, medicine has seen success in the development of anti-viral therapies dealing with things like flu or Hepatitis C. HIV shows how challenging a complete cure it is, but in this age, there are computing solutions that can screen huge number of compounds for likely candidates that might work against COVID-19. While the news will cover it like it is one or two heroes that find the one cure, there are groups all over the world searching and testing compounds. Because the effort is high, we cannot rule out something coming and more the reason to try to “flatten” the curve. By far the easiest solution is an existing approved compound showing efficacy because then the safety information may be well known. I am guessing that Trump is responding to news in this area when he talks about progress soon; but over promising and under delivering erodes trust and gives false expectations that might prevent people from taking the actions they can. Even if a compound is identified it there is basic drug metabolism, safety, and dosing to be identified.
Second, the impact of COVID-19 is in part created by the body’s reaction to the virus. Controlling the body’s reaction will lessen the severity of symptoms. This frequently seems like the medical community adapting their care strategy or experimentation with existing medications off label. We may also see new therapies that target the symptoms created by the virus. This may be incremental and start somewhat anecdotally, but hospitals do track outcomes and look for best practices on their own. We have been seeing these type of things coming out in the news.
Third, a vaccine may offer the cheapest long term solution. While I think this may be a longer path, but it is good to realize that there are multiple strategies for creating vaccines so against there may be multiple paths to success. Vaccine testing is a multi-step process that starts with safety and looking for an antibody response. Vaccines may also take multiple doses to reach full effect and they must be tested to demonstrate their effectiveness. Hence, I think this may be down the line a bit.
I am hoping for some good progress sooner and wanted to share the reasons I think no one should give up. It has already been too little too late and if that applies to you, I am very sorry — I know how alone that can make one feel.
If there is anyone not taking this seriously at this point — flattening the curve might help more people get to a cure not just get preserve our medical resource.