A more or less daily journal
of news and analysis
by Ed Loewenton
© 2020 Edward Loewenton
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* testing for new infections - the U.S. has been tragically slow to
get this going.
* Testing for
antibodies show who has recovered and acquired immunity.
Recovered cases may allow us to start getting back to business. Good News on this
Vaccines - when?
* Update 4/9/2020: A link to detailed discussion of
treatment Remdesvir and a vaccine from Novavax
04/06/2020: The Science
of the SARS2-CoV-2 virus
genetics of SARS-CoV-2 and how it should affect everyone's responses
Latest news of treatment: Remdesivir and Hydrochloroquine
* Quick news: You have
an 3 extra months to file Federal and Vermont income taxes. To speed up your
$1,200 one time (?) Federal payment, set up direct funds transfer to your bank and be sure you have filed taxes for either 2018 or 2019.
What comes next?
* When and how can we expect this
* LATEST NEWS!
Gilead's remdesivir OK'd in Europe for compassionate use in COVID-19
2:31 pm, Fri, Apr. 3, 2020. Whether or not this means it is effective as
opposed to just safe is still a question.
The Pandemic in Vermont.
* Worldwide spread
is just getting going:
* New York's cases are
rapidly accelerating - should we keep New Yorkers out of Vermont?
* Vermont's rural culture of mutual help and caring for
each other helps to slow the spread.
* We don't really know how many are
infected; people without symptoms can be infectious carriers.
consequences in small town Vermont.
* Social isolation, flattening the curve to reduce
deaths and give our medical delivery systems time to catch up.
Avoiding contagion: recommended precautions and understanding the virus
Recommended cleaners and disinfectants
* Where and how did COVID-19
start? A quick look.
* testing for new infections and recovered cases may allow a gradual re-start of economy
Vaccines - when?
* Update 4/9: Novavax (NASDAQ:NVAX)
announces that it has identified a coronavirus vaccine candidate,
NVX-CoV2373. A Phase 1 study in ~130 healthy volunteers will launch in
mid-May. Safety and preliminary immunogenicity data should be available in
* Update 4/9: A detailed
discussion on Remdesivir's efficacy and early implementation as a
Testing for active infections
PCR tests, which look for genetic material related to the virus, indicate an
active infection. More widespread testing than is now available would
identify new cases before they show symptoms. Individuals testing positive
could be quarantined, and their contacts traced and tested. This would
greatly slow the spread of the virus. At present, the U.S. still requires
active symptoms of COVID-19 and/or a note from a doctor before a test can be
Some version of
these tests have been in use worldwide since the outbreak started. The U.S.
has been slow to make the supply of such tests widely available. One problem
has been rules that required test kits to be developed by the U.S. Centers
for Disease Control, with a centralized distribution. In Germany, where
early and widely available testing was implemented, a high infection rate
has been accompanied by a very low death rate. Germany has a decentralized
production and distribution of tests. They are currently (April 2) testing
more than 50,000 people a day. South Korea was also one of several countries
that rapidly made test kits available.
What you can do: Call your senators and
representatives, and flood the White House with demands that the U.S.
government immediately implement a unified, national program of testing,
instead of the state-by-state policy that has the states competing for kits
(and protective gear).
Antibody testing will get many of us back to work much faster.
The next step in national and global recovery will be widespread testing for
antibodies. Antibodies are made by our immune system to respond to a
specific pathogen, like a bacterium or virus. If you get sick from a germ
and you get better, you now have antibodies that your immune system created
for the specific invader. Next time the virus attacks, these antibodies are
ready to shut down the infection before it does any real damage.
Scientists believe that antibodies to SARS coronaviruses are retained for a
fairly long time. Recovered patients will likely retain their immunity long
enough for us to develop a vaccine. So far, it does not look like the
SARS-Cov2 virus is evolving very fast, so antibodies, created either by
infection and recovery or a vaccine, will probably remain active for an
extended period, thus protecting the person who has them.
When we have an accurate, rapid, and widely available test for the SARS-CoV2
virus, we can identify all those of who were infected and recovered. These
people can safely return to life as usual. Right now, anyone who was sick,
tested positive for corona virus, and recovered, can probably resume all
Scientists appear to be making rapid progress in developing an
antibody test. On APRIL 3, 2020, the FDA granted Emergency Use
Authorization (EUA) for the qSARS-CoV-2 IgG/IgM Rapid Test, made by Cellex
Company (Durham, NC). This the first antibody test for COVID-19.
The test measures immunoglobulins G and M antibodies against SARS-CoV-2 in
serum, plasma or venipuncture whole blood samples. It measure a the strength
of a patient’s acquired immune response to the virus that causes COVID-19.
The serological test uses only a couple of droplets of blood and a small
strip, similar to blood glucose monitors. Results should be available in
about 20 minutes.
It is available only by prescription.
The FDA warned that it may not be able to detect virus very early in the
course of infection.
A vaccine for SARS-CoV-2 - the end of the pandemic, but
CEPI - the Oslo,
Norway-based Coalition for Epidemic Preparedness Innovations - had already
signed funding agreements with three groups racing to develop vaccines by
the third week of January. Since then, its portfolio has grown to eight,
with more on the way.
The organization has raised $430 million toward its $2
billion funding goal. Norway recently announced it is providing roughly $220
million. The pharmaceutical giants Sanofi, Pfizer and Johnson & Johnson are
working on vaccine candidates.
J&J and Sanofi
are working with BARDA (the U.S. Biomedical Advanced Research and
Development Authority), which will develop vaccines to address U.S.
requirements. These vaccines can also be manufactured outside the United
States and they can contribute to a global solution. However, many the
companies capable of developing a vaccine have had some negative experiences
developing them in the past.
It will take a lot
of government money to support the multi-billion dollar research. Drug
makers “have very clearly articulated that … the current way of approaching
this — to call them during an emergency and demand that they do this and
that they reallocate resources, disrupt their daily operations in order to
respond to these events — is completely unsustainable,” said Richard
Hatchett, CEO of CEPI. The only real expertise in the world to make these
vaccines in quantity in a safe environment is in the private sector.
After developing vaccines, the companies often face a public that has lost
interest in using them, leaving the developers with vast and expensive
unused inventory. Public perception of the costs and burdens on companies
and the commitments of national governments will have to support any
This time around,
governments, especially in the U.S., will have to provide adequate
guarantees to the developers of a successful vaccine. Hatchett say that if
we want vaccines as fast as we possibly can and we don’t want to compromise
safety, i.e. we want to have a rational clinical development program, we’re
going to have to take an awful lot of financial risk, which means investing in manufacturing
capacity for everything, scaling it up right now, and
even beginning full-scale manufacturing before we know if the vaccine even
A lot of platforms are going to fail because that’s just been the
experience with vaccine development.
March 16, 2020: The National Institute of Allergy and Infectious
Diseases (NIAID) is funding a trial of a vaccine called mRNA-1273 at Kaiser Permanente Washington
Health Research Institute (KPWHRI) in Seattle. The open-label trial will
enroll 45 healthy adult volunteers ages 18 to 55 years over approximately 6
weeks. The first participant received the investigational vaccine on March
The vaccine was developed by NIAID scientists
and their collaborators at the biotechnology company Moderna, Inc., based in
Cambridge, Massachusetts. The study is evaluating different doses of the
experimental vaccine for safety and its ability to induce an immune response
04/06/2020: The virus that is causing the COVID-19 pandemic is much
more infectious than its closest genetic relative, the SARS virus that
caused the pandemic in 2003-2004.
During the 2003 SARS pandemic, a total of 8,098 people worldwide became
sick. Of these, 774 died. In the United States, only eight people had
laboratory evidence of SARS-CoV infection. All of these people had traveled
to other parts of the world where SARS was spreading. SARS did not spread
more widely in the community in the United States.
1,289,380 cases have been identified worldwide as of April 6 at 11:30 AM EDT,
along with 270,372 recovered and 70,590 deaths.
The new virus is approximately 98% identical to the original SARS-CoV of
2003; both are believed to have originated in bats.
The big difference with the SARS2 virus is the little spikes that cover the
surface. These spikes allow the virus to connect to the target cell and
break through the cell membrane. Like similar viruses, SARS2 needs to find a
substance in the host cell to accomplish this. Several human organs,
including the lungs, intestines, and liver, and heart contain an enzyme
called Furin, which binds to the viral spikes and provides this
function very effectively. SARS-CoV and coronaviruses in the same family do
not have the same furin activation site.
People most likely to develop severe forms of COVID-19 are those with
pre-existing illnesses and the elderly, according to data from China in
February. While less than 1 percent of people who were otherwise healthy
died from the disease, the fatality rate for people with cardiovascular
disease was 10.5 percent. That figure was 7.3 percent for diabetes
patients and around 6 percent for those with chronic respiratory
disease, hypertension, or cancer. About 1 percent of cases overall have
been fatal so far.
SARS2 virus is a more efficient and powerful pathogen. It takes much less of
it to successfully overwhelm a naive host's immune defenses than previous
viruses. This is why it is spreading so quickly.
can also cause an
exaggerated immune response, which can be life threatening. Some
people—especially the elderly and sick—may have dysfunctional immune
systems that fail to keep the response to particular pathogens in check.
This could cause an uncontrolled immune response, triggering an
overproduction of immune cells and their signaling molecules.
More on this topic.
Because this new virus is such a perfect predator, the calls for continued
distancing and the use of masks must be heeded. You can spread the virus by
talking and breathing, not just sneezing and coughing. Six feet is enough
distance for the droplets of saliva and mucus in everyone's breath to fall
out of the air, although dry mists of finer particles (aerosols) can
spread it farther than that. For this reason, it is also important
to wear some kind of mask to keep your breath, sneezes, and coughs close to
Masks don't do very
much to protect you. They protect other people in your general
vicinity. You can infect others even if you feel fine and have
no signs of illness. especially if you come into close contact with anyone
who goes out in public, or has a high risk job (police, medical, food
stores, social service, corrections and inpatient medical services),
WEAR A MASK if you are anywhere close to other people!
does the virus travel in the air? Perhaps this will convince you. Read
All about masks!
The complete genome and structure with nice illustrations (if you really
want to know):
Treatment: medicines to kill the virus and treat the
An effective drug that
gets people out of hospitals faster will help reduce the burden on
health care systems. Knowing there is something that can aid people who
do get sick could also help countries feel more comfortable reopening
their economies. In a way, effective therapies can buy the world time
before a vaccine is approved. The two most widely discussed candidates
have been Choroquine & Remdesivir,
CDC report on
Choroquine & Remdesivir
Remdesivir is an
investigational intravenous drug with broad antiviral activity that
inhibits viral replication. It is currently in trials worldwide. Some
patients have experienced nausea, vomiting, rectal bleeding, and
elevated liver enzymes.
has been used to treat Malaria and autoimmune disorders such as
rheumatoid arthritis, lupus, and psoriasis. Few, relatively small trials
have been conducted to evaluate its effectiveness in treating COVID-19,
indicating that it is effective. It can produce a large number of
potentially serious side effects.
Chloroquine has been used for malaria treatment ; hydroxychloroquine is
used for treatment of rheumatoid arthritis and lupus. Both drugs have
in-vitro activity against SARS-CoV, SARS-CoV-2, and other coronaviruses,
with hydroxychloroquine having relatively higher potency against
Hydroxychloroquine has been
administered to hospitalized COVID-19 patients on an uncontrolled basis
in multiple countries, including in the United States. One small study
reported that hydroxychloroquine alone or in combination with
azithromycin reduced detection of SARS-CoV-2 RNA in upper respiratory
tract specimens compared with a non-randomized control group but did not
assess clinical benefit (improvement in blood oxygenation and reduction
of fever). No large controlled clinical trials have been done.
Chloroquine is know to have a long list of potentially serious side
effects, including back, leg, or stomach pains, darkening, blistering,
peeling, or loosening of the skin, problems with vision such as
difficulty in focusing the eyes and possible eye damage, chest
discomfort or pain, irregular or pounding heartbeat, and potentially
serious problems including heart failure (high doses), hair loss,
diarrhea, permanent loss of visions, and many more.
Chloroqine trials in France:
In a small French clinical trial of COVID-19 patients, 70% of 20
patients treated with hydroxychloroquine had a significant reduction in
the virus within 6 days compared to 12.5% of untreated controls. A
Chinese study conducted in 30 patients showed no significant differences
between patients treated with 400 mg per day and controls (N=15).
A study was conducted at the University
Hospital Institute Méditerranée Infection in Marseille, France. 80
patients patients received treatment with hydroxychloroquine and
azithromycin (to control opportunistic bacterial infections). 81.3% of
patients had favourable outcome and were discharged. The study reports
that adverse events were rare and minor.
This study did not include a control
group treated with placebo, and as such is only a proof of concept.
Controlled clinical trials, China
The study was small and limited to patients who were mildly or
moderately ill, helped to speed the recovery of a small number of
patients who were mildly ill from the coronavirus, doctors in China
reported this week. earlier reports from France and China drew criticism
because they did not include control groups to compare treated versus
The new study, of 62
patients with an average age of about 45, did have a control group. None
of the treated group became severely ill, vs 4 in the control group.
This resuslt may be due to Hydrochloroquine's ability to dial back the
immune system, which is why it is used for autoimmune disorders. Severe
immune reactions are involved in the worst coronavirus cases, resulting
in organ damage and death.
(April 2020), the world should get the first results from a clinical
trials in China. The drug is designed to interfere with the process the
virus SARS-CoV-2 uses to make copies of itself. The resulting copies of
the virus lack their full RNA genome, so they can’t go on to replicate
themselves or infect other cells.
Results from the China studies could signal whether the drug is
effective. Results may come as soon as mid-April. The primary goal is to
show that the drug is better than placebo at improving symptoms - fever,
respiratory rate, oxygen saturation and alleviation of cough - within 28
days. Patients must do 20% better on remdesivir than placebo for the
drug to be successful.
improvement is measured with a six-point scoring system ranging from
hospital discharge (a score of 1) to death (a score of 6). In order to
count as someone who responded to the drug, a patient must improve by at
least two points. Patients can remain hospitalized at the end of the
28-day period of the clinical trial but still improve enough clinically
— no longer needing intubation or supplemental oxygen, for example — to
count as a responder.
antivirals are most effective if they are given soon after a person is
infected. This allows them to slow the replication of the virus while it
is still at low levels. If a treatment is given too late, and the virus
has had a full chance to proliferate, it’s possible that the cascade of
health consequences cannot be stopped.
problem: Remdesivir may be more effective if given early, but since it
is given intravenously, it may be easier to administer in a hospital
after patients are already very sick. How and when to treat is still a
In the U.S., clinical trials
are underway with severely and moderately ill goups. Completion date of
study estimated in May, 2020, but may be available in April.
Remdesivir was rapidly pushed through clinical trials due to the West
African Ebola virus epidemic of 2013–2016, eventually being used in at
least one human patient despite its early development stage at the time.
Preliminary results were promising and it was used in the emergency
setting during the Kivu Ebola epidemic that started in 2018 along with
further clinical trials, until August 2019, when Congolese health
officials announced that it was significantly less effective than
monoclonal antibody treatments such as mAb114
https://en.wikipedia.org/wiki/MAb114 and REGN-EB3.
https://en.wikipedia.org/wiki/REGN-EB3. The trials, however, established
its satisfactory safety profile.
journal pre-print (not peer reviewed) offered online March 9, 2020, 3 of
the first 12 U.S. patients in the U.S.were treated in January, 2020,
with Remdesivir. There was not a “clear temporal association” between
treating patients with remdesivir and improvements in oxygen
requirements, fever, and viral results, compared with hospitalized
patients who did not receive the investigational drug. Data regarding
drug efficacy is inconclusive.
Gilead has been ramping up production
of the drug since January. It now has 1.5 million doses, which is enough
for 140,000 patients. They have cut production times by as much as 50%,
but end-to-end manufacturing still takes about six months. The The
company’s goal is to have 1 million treatment courses available by the
end of the year.
comes next: How will COVID-19 end?
consensus is emerging regarding the ultimate course of the COVID-19
Pandemic: before the waves of infection will recede, a critical number of
humans will have to be removed from the pool of available hosts worldwide.
This can happen through infection and either the death of the patient or
recovery with acquired immunity, or the development and global
implementation of an effective vaccination program.
Leung, Dean of Medicine at Hong Kong Univ and founding director of the WHO
Collaborative center for infectious diseases, has made a rough
calculation that the spread of the coronavirus will not stop until at least
half the global human population has either been sick and acquired immunity,
dies, or been successfully vaccinated.
Ed Yong, in
The Atlantic , 3/25/20, writes:
"Even a perfect response won’t end the pandemic. As long as the virus
persists somewhere, there’s a chance that one infected traveler will
reignite fresh sparks in countries that have already extinguished their
fires. This is already happening in China, Singapore, and other Asian
countries that briefly seemed to have the virus under control."
Under these conditions, there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.
The first would have been a fast,
perfect response, wheres every nation works simultaneously to
bring the epidemic under control.
According to Dr. Michael Levy, professor of epidemiology at the
University of Pennsylvania College of Medicine, if everyone on the
planet had observed with absolute perfection all the social distancing,
shutdown of all activity, testing and quarantine, and disinfecting that
we are even now still struggling to get used to, the problem could have
been over in two weeks. Too late for that.
Given how widespread the coronavirus pandemic is, and how badly many
countries are faring, the odds of worldwide synchronous control are
nearly zero at this point.
The second is that the virus does what past flu pandemics,
especially the Spanish Flu of 1918, have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting. But it would also
kill many millions of people, and destroy the healthcare systems
worldwide. The United Kingdom initially considered this herd-immunity strategy,
but reconsidered when models revealed the dire consequences. President
Trump essentially supported this plan [3/25], but is now (4/3)
supporting an extended shutdown.
The third scenario - what we
are doing now - is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced.
It is the longest, most expensive, and most complicated.
There is a fourth scenario -
development of a cure or treatment - that will reduce the severity of the disease
number of deaths until we reach herd immunity.
One good candidate
is Gilead Corporation's (GILD) Remdesivir, an antiviral drug which
has been successfully used to
treat Ebola. Early indications are that it is effective. [update
4/4/2020: Remdesivir is useful in treating Ebola, but not as
effective as two other treatments that have been used.] Gilead is the company that developed successful treatments
for HIV and a 12-week cure (not just treatment) for hepatitis.
Distribution of Remdesivir has been approvde for compassionate use for
COVID-19 in Europe.
President Trump has said that
Hydroxy Chloroquine, a medicine with potentially dangerous
side effects that is in widespread use to treat malaria, is a
"beautiful" treatment for COVID-19. This idea has been widely
discredited by the medical community.
However, there is one clinical study, conducted in France, indicating
the efficacy of Chloroquine to treat COVID-19.
A treatment will not by itself shorten the pandemic or reduce the total
number of people who get infected, but it will save lives.
The wild card in this whole game
is the likelihood - the eventual certainty - that 21st century medical
science will develop an effective vaccine. There are a number of
biotech companies working on vaccines, each with their own novel
Novovax (NVAX) is working on
vaccines for viral diseases, including the flu, with a technology that
allows rapid production more quickly.
British Tobacco Company's (BAT/BTI) U.S. subsidiary, Kentucky
BioProcessing (KBP, is developing a novel plant-based vaccine for
COVID-19, and is now in pre-clinical testing. According to BAT, "if
testing goes well, BAT is hopeful that, with the right partners and
support from government agencies, between 1 and 3 million doses of the
vaccine could be manufactured per week, beginning in June."
We are hearing that we need to prepare
for an extended period of restrictions on social contact and the gathering
of people, with attendant social and economic consequences. . The
numbers suggest that the contagion in Vermont is still just accelerating. The global
epidemic has spread like ripples on a pond when a stone is thrown in. Cases
in China, presumably the point of origin, are declining, but the incidence
of new infections in the U.S. is still accelerating.
Unlike ripples in a pound, the pattern of global spread has been shaped by
patterns of modern transportation, readiness of national and local
governments to respond rationally and with determination, and population
density, distance from the center of origin, and distance from other centers
of infection. Realistically, number of cases reported in other nations may
also depend on the the effectiveness of local healthcare and the candor of
For example, Chad, in North
Central Africa, reports an incidence of only 3 cases, a rate of .22 per
thousand population. Who can tell how many more are carrying the virus, and
who are not showing symptoms - yet.
Vermont's tally of 90 or so cases (as of March 24) is among the lowest in
the U.S., corresponding to our very low population density. Most of those,
of course, are in Chittenden County. Lamoille county, as of yesterday, was
reported to have identified just 2 cases as of 3/24. Our neighbor New York
State reports 25,665 cases as of Tuesday 3/24; 15,000 of those are in New
It is not clear why Vermont, the next door neighbor of the most
affected state, remains among the least affected. Much of it is due to our
very low population density, but the proximity offers an increased risk
whose effects we just have not seen yet. It is possible that some
restrictions on travel to and from New York, especially the metropolitan
areas, would be wise, if legally questionable.
A greater part
of Vermont's success so far must be due to our readiness to understand the social
requirements of the moment, and to accept the our responsibilities as
citizens to carry our share of the burden according to our resources and
abilities. This is especially true in rural Vermont, where there was neither
hesitation nor complaint about accepting the requirements of social
distancing, both social and economic. There have been so many offers from
groups and individuals to help those in particular difficulties, and
businesses are finding innovative ways to keep their customers supplied with
necessities and keep their businesses, on which we depend for much of the
local economy, alive and ready for the time when we can return to life as we
have known it.
It must be noted that during
this phase of the pandemic, while the number of reported cases is still
rising, reported cases will be lower at any given time than the actual
number of infected and contagious individuals. The incubation period - the
time between catching the virus and beginning to have symptoms of the
disease - ranges from 1-14 days, most commonly around five days. People
without symptoms can spread the disease through close contact with others.
As of March 24, reported cases in Vermont are increasing in
a greater than linear fashion. It is clear that the future course of the
pandemic is not subject to wishful thinking.
The measures we are taking to slow the spread are causing unprecedented
economic distress, on a scale that can only be mitigated by the power to
print money, which, fortunately, the United States Government possesses.
Recent government data showed initial unemployment claims earlier this month
grew faster than they did at any point during the Great Recession. James
Bullard, president and CEO of the Federal Reserve Bank of St. Louis said on
Sunday that he believes unemployment could hit 30% during the second quarter
of the year. During the Great Depression nearly a century ago, unemployment
peaked around 25%. Congress is close to passing legislation that will
relieve the worst of the immediate economic concerns.
So, why are we shutting down our economy? The explanation is that we have to
"flatten the curve", that is, the steepness of the rise in cases, which is
to an extent mirrored by the steepness of the decline. Slowing the
interaction of people slows the spread of the virus, so that the number of
new cases increases along with our ability to care for infected patients.
With a flatter curve of rise and fall in infections, the emergency lasts
longer, but more patients survive, fewer are infected, and the health care
delivery systems do not collapse into chaos, which could come with its own
set of economic problems. Allowing business as usual would result in many
more people getting sick sooner, surely enough to completely overwhelm our
medical systems. This would result in a maximum number of deaths.
Beyond maintaining social distance, we can
shorten the epidemic by keeping ourselves and our surroundings clean.
A virus, unlike a bacterium, cannot survive
outside a living host. Viruses are destroyed by energy in the form of heat
and electromagnetic radiation such as light. Corona virus can survive on
surfaces from a few hours up to several days, longest in a cool, dark place.
Like other microbes, it survives longer on smooth surfaces like plastic and
metal than on porous surfaces such as cotton or unfinished wood.
Keeping things clean is one way to slow the spread of COVID-19. Mostly, that
means lots of soapy hand washing, laundering clothes when you believe you
have had a direct exposure to someone who is sick, and keeping surfaces at
work and home clean with recommended cleaning products, and avoiding direct
contact with other people if you are not certain of their health status.
Generally, keep a six foot distance from other people.
The Corona-19 virus is comparatively large, and does not remain in the air
for an extended time, but settles onto surfaces. Keeping six feet away from
others allows the virus to settle out of the air, and reduces the likelihood
of infection by direct inhalation. However, it may be present on surfaces
that have been exposed to individuals sick with the virus, whether they show
symptoms or not.
The novel coronavirus is
thought to be spread primarily by people and their respiratory droplets --
think coughs, sneezes, spit, and even talking and breathing. While it's possible that people who touch
surfaces or objects contaminated with the virus and then touch their mouths
or eyes can also become infected, this may not be the main way the virus
spreads, the CDC said. So disinfectant wipes can only go so far.
The EPA has provided a
list of products recently approved
as surface cleaners effective against the Coronavirus.
It must be said that, as long as there remain reservoirs of COVID-19
infection anywhere, the disease may spread again among those who have not
been previously infected. Hopefully, by that time we will have developed a
vaccine to forestall a future epidemic. There are crash programs of
development, with some American companies leading the way with promising
drug candidates. Success is not months away, as the President suggests, but
may come within the year. We have flu shots for the annual variety (did you
get your flu shot this year?!), and COVID-19 will become, more or less,
another variety of flu kept in check by modern medicine. The worldwide incidence of
COVID-19 must be reduced below a threshold, after which time the virus will
once again exist only in its original wildlife hosts.
interaction between humans and wildlife has created epidemics in the recent
past, notably the Ebola epidemic of a few years ago, which may have come
from bats consumed as food. Viruses and hosts can evolve together so that
the hosts do not get sick or die. Bats seem to be a significant reservoir of
viruses with which the bats can live, but are deadly to people. "Bush meat"
(Africa) or "wet" markets (China and elsewhere) sell captured wild animals
that are often carriers of exotic diseases against which humans have no
defenses. This is generally a consequence of extreme poverty and economic
inequality. People who are starving will do desperate things to survive.
In the case of the Coronavirus, it seems that the virus may have started in
bats, then infected Pangolins (an armadillo-like creature), which were sold
in "wet markets" in Wuhan, China, the origin of the current epidemic.
Remdesivir was rapidly pushed through clinical trials due to the West
African Ebola virus epidemic of 2013–2016, eventually being used in at least
one human patient despite its early development stage at the time.
Preliminary results were promising and it was used in the emergency setting
during the Kivu Ebola epidemic that started in 2018 along with further
clinical trials, until August 2019, when Congolese health officials
announced that it was significantly less effective than monoclonal antibody
treatments such as mAb114
however, established its safety profile