Tuesday, March 17, 2020

Surviving the Coronavirus: Part 2

In the first post of this series, I discussed the potential harm that might be inflicted on us by the coronavirus, described several strategies for fighting back, and described a Machiavellian approach for reducing deaths in the US from more than a million to less than one hundred thousand. The entire post presumed the availability of neither a vaccine nor an effective treatment. I predicted I would discuss those issues in my next post, and it looks like I was correct, at least about discussing vaccines and treatments. Well, at least about discussing treatments. I will do that soon, but first ...

I published my first post in this series on 15 March 2020. The next day (16 March 2020, for mathematically resistant among you),  Imperial College of London published its 20-page, 31-author paper, "Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand." The 31 authors also described the grave nature ignoring the virus, estimating a  potential, unmitigated death toll of 2.2 million for the US and 510,000 for Great Britain. The 31 authors are, of course, arguing (as I did) that we should mitigate the impact of the virus.

Just as I did, the Brits described two basic approaches to mitigating the virus. First is what they call the suppression model, what I called the early mammal hunker down strategy, what China seems to have pulled off in the real world. The suppression model involves extreme measures in identifying and isolating each and every possible case. The Brits recognized not only the social cost of such extreme measures, they recognized, as I did, a fundamental problem with the strategy. The government needs to keep its populous hunkered down and suppressed until a vaccine arrives, since the population did not develop herd immunity as 0.77% of them died off.

The second strategy identified by the Brits, the one they call mitigation, is what we Yanks are calling "flatten the curve." The Brits studied five mitigation scenarios, ranging from what I'll call "those who show symptoms should just stay home" to "kinda like what the Yanks are doing right now." The Brits estimated, for each scenario, how many hospital beds would be required. The most aggressive mitigation scenario, the "kinda like what the Yanks are doing right now" scenario, was the best at flattening the curve. (Yea! We're number one.) Even those results, however, were quite disturbing. (Uh oh.)
Perhaps our most significant conclusion is that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK and US healthcare systems being exceeded many times over. In the most effective mitigation strategy examined ... the surge limits for both general ward and ICU beds would be exceeded by at least 8-fold under the more optimistic scenario for critical care requirements that we examined. 
Yikes!
So how many of us might, uhm, er, uh, succumb?
In addition, even if all patients were able to be treated, we predict there would still be in the order of 250,000 deaths in GB, and 1.1 - 1.2 million in the US.
Yikes!
So what do the 31 authors suggest we do?
We therefore conclude that epidemic suppression [China, early mammal hunkering down] is the only viable strategy at the current time. The social and economic effects of the measures which are needed to achieve this policy goal will be profound. Many countries have adopted such measures already, but even those countries at an earlier stage of their epidemic (such as the UK) will need to do so imminently.
Yikes!
So how long would we have to be hunkered down and suppressed, as in  China?
To avoid a rebound in transmission, these policies will need to be maintained until large stocks of vaccine are available to immunise the population – which could be 18 months or more.
Holy Cow!
A year and a half of Chinese-like suppression / enforced hunkering OR more than a million of us die.

While I don't disagree with their numbers, I politely suggest that the 31 authors have overlooked another strategy, one I've been hinting at during my previous writing on this subject. We need an effective treatment for coronavirus, and we need it toot friggin' sweet.

Fortunately, there is good news, very good news, out there. 

There are several safe medications already available for other illnesses that have a pretty good chance of working on the coronavirus. I'll give a brief description of the two leading contenders, beginning with my top pick ...

From Wikipedia, Chloroquine is a medication used to prevent and to treat malaria in areas where malaria is known to be sensitive to its effects. [...] Common side effects include muscle problems, loss of appetite, diarrhea, and skin rash. Serious side effects include problems with vision, muscle damage, seizures, and low blood cell levels. It appears to be safe for use during pregnancy. [...] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. It is available as a generic medication. The wholesale cost in the developing world is about $0.04. In the United States, it costs about $5.30 per dose. [...] In late January 2020 during the 2019–20 coronavirus outbreak, Chinese medical researchers stated that exploratory research into chloroquine and two other medications [to be named herein later] seemed to have "fairly good inhibitory effects" on the 2019 novel coronavirus. [...] On 19 February 2020, preliminary results found that chloroquine may be effective and safe in treating COVID-19 associated pneumonia. [...] The Guangdong Provincial Department of Science and Technology and the Guangdong Provincial Health and Health Commission issued a report stating that chloroquine phosphate "improves the success rate of treatment and shortens the length of patient’s hospital stay" and recommended it for patients diagnosed with mild, moderate and severe cases of novel coronavirus pneumonia.

Regarding that precious malaria drug, from "An Effective Treatment for Coronavirus (COVID-19)"
Recent guidelines from South Korea and China report that chloroquine is an effective antiviral therapeutic treatment against Coronavirus Disease 2019.  Use of chloroquine (tablets) is showing favorable outcomes in humans infected with Coronavirus including faster time to recovery and shorter hospital stay.  US CDC research shows that chloroquine also has strong potential as a prophylactic (preventative) measure against coronavirus in the lab, while we wait for a vaccine to be developed.  Chloroquine is an inexpensive, globally available drug that has been in widespread human use since 1945 against malaria, autoimmune and various other conditions.

The runner up, so far, is ...

From Wikipedia: Lopinavir/ritonavir [...] is a fixed dose combination medication for the treatment and prevention of HIV/AIDS. It combines lopinavir with a low dose of ritonavir. [...] It is taken by mouth as a tablet, capsule, or solution. [...] Common side effects include diarrhea, vomiting, feeling tired, headaches, and muscle pains. Severe side effects may include pancreatitis, liver problems, and high blood sugar. It is commonly used in pregnancy and it appears to be safe. [...] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. The wholesale cost in the developing world is $18.96 to $113.52 a month. In the United States it is not available as a generic medication and costs more than $200 for a typical month supply as of 2016. [...] Lopinavir/ritonavir has been studied for its anti-coronavirus activity. As such, in late January 2020, Chinese medical researchers began exploratory research considering a selection of 30 drug candidates, three of them, remdesivir, chloroquine and lopinavir/ritonavir, seemed to have "fairly good inhibitory effects" on SARS-CoV-2 in cell culture. Requests to start clinical testing were then submitted. Trials are ongoing.

Regarding that precious HIV drug, from "COVID-19 Drug Therapy — Potential Options":
Therapies evaluated in human clinical trials during previous coronavirus outbreaks [...] Lopinavir; ritonavir in conjunction with ribavirin [an anti-viral drug] and corticosteroids [...] 21-day adverse outcome rate: 28.8% for historical controls and 2.4% for treatment group.

At the moment, it seems as if the only thing standing between the lofty, large-brain humans and the lowly, no-brain coronavirus is the rapid, widespread distribution of an effective treatment. Existing malaria and HIV drugs look promising as treatments. The malaria drug looks like it might even prevent infection.

So ...

Stay calm and keep flattening the curve until our government cuts through the red tape and makes plentiful an effective treatment / prophylactic.

We gonna get through this.

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