Back in July I wrote about How To End Covid. Two months later, a lot has changed. Just this week, the United States passed 200,000 Covid deaths, making the novel virus the third leading cause of death, behind only heart disease and cancer. While our patience with social distancing and the disease in general has certainly worn thin, science has pressed on and made several important advances and discoveries over the last few months. Here’s a list of the biggest updates to my July article.
1. Remdesivir may actually work; ICU Survival Rates are increasing.
Nine months into the pandemic, we’re starting to finally get a good idea of just how deadly Covid is and how much it will spread before it is finished. In recent months, intensive care unit (ICU) survival rates have improved, meaning fewer people who are admitted to the ICU with Covid are dying. This is not because Covid is getting less severe; its predicted death rate has leveled out at about six times that of seasonal influenza. Instead, healthcare teams have simply gotten better at treating patients with Covid.
Remdesivir is an antiviral agent first investigated for Ebolavirus, for which it was not proven to be effective. When talk of using it for Covid started, I was bearish on its potential. A failed drug being repurposed for a new disease out of the blue? Seemed unlikely to me. Thankfully, for us, that might not be the case.
Remdesivir now has a little more evidence showing its potential effectiveness in treating Covid-19. In May, a randomized controlled trial was published that showed a small, but statistically significant decrease in time to recovery. Then, in August, an open label randomized trial seemed to show a benefit in the remdesivir treatment groups. However, this trial did have some considerable design issues and questions about the statistical methods chosen. This was enough for the FDA to expand the emergency use authorization (EUA) for remdesivir to all hospitalized patients with Covid-19. Other strategies, like using dexamethasone in patients with covid who require supplemental oxygen, have also caught on. However, we don’t yet know all of the caveats to these strategies. For instance, the same study showing benefits for dexamethasone also showed that it made patients worse if they did not require oxygen.
There is still much more research to be done, but there is hope on the horizon.
2. Vaccines are progressing, and companies are pledging not to “jump the gun.”
Today, a SARS-nCoV-19 vaccine from Johnson and Johnson entered into Phase 3 trials, the final step before it can be submitted for FDA approval. This makes the 10th vaccine to cross this threshold. At least two other vaccines are well underway in phase 3 trials and states are already proactively devising distribution plans.
See the New York Times’ COVID Vaccine Tracker here.
Also, amidst fears spurred on by the accelerated nature of the development process and promises from the President for a vaccine by election day, a group of drug companies developing coronavirus vaccines took a joint pledge to “stand with science” and ensure that a vaccine is not distributed that has not been proven safe and effective. In addition, the FDA is publishing stringent new guidelines it will use when evaluating any coronavirus vaccine, indicating that the agency will not bow to political pressure from the Trump administration to push through an unsafe vaccine.
I have been asked if I would take the vaccine myself once it is approved. Given my knowledge and experience in biostatistics and literature evaluation, I would want to first evaluate the final clinical trials leading to its approval, but provided that study shows no big red flags, I would have no issue with it. There is a misconception here that “operation warp speed” is bypassing safety standards in order to get a vaccine approved more quickly. That is not the case.
Usually, a vaccine progresses through clinical trials in a linear path. It starts in small in vitro studies in a lab (phase 1) before moving on to small studies in humans and animals (phase 2) before finally being tested in larger human studies (phase 3) and post-marketing studies after drug approval (phase 4). In this case, phase 3 trials were simply started along side some of the other phases, and the FDA essentially “started its paperwork” sooner.
Vaccines aren’t like other drugs or biologicals. There is far less variability and unpredictability in how the body will respond to them. Changing the actual antigens inside the vaccine doesn’t change how the body responds to the excipients and adjuvants that carry those antigens into the body. This is why every year the influenza vaccine is able to be completely reworked, and no one is concerned about each year’s flu shot being “untested” and “unsafe.” In short, as long as the trials themselves are conducted appropriately, the accelerated path of the coronavirus vaccine is nothing to be concerned about by itself.
3. Masks are very effective at reducing viral spread, protecting both the wearer and those around them.
We now have enough evidence to conclusively state that masks work. A new study showed that universal masking greatly reduced transmission of Covid. Cotton masks, surgical masks, and non-vented N95 masks all substantially reduce the distance droplets travel during coughs, sneezes, and talking/breathing.
See the Mayo Clinic’s face covering overview here.
See the article from the Washington Post here.
Despite this evidence, many states and jurisdictions have not required masks to be worn in public. Consequently, the places without widespread mask usage are also some of the fastest growing areas for Covid activity.
There is also evidence that the severity of coronavirus infection is related to the degree of exposure, meaning the longer you are exposed, not only are you more likely to get the disease, but you’re also more likely to become more sick. Face coverings can’t prevent 100% of viral particles from spreading, but they greatly reduce your exposure and give you body much more opportunity to fight it off.
Think of it like this. It’s a sunny day but there’s one small dark cloud floating in, releasing a few raindrops as it passes. You’re not really at risk of getting soaking wet; the few drops will evaporate away quickly. But then, a large thunderstorm overtakes the sky, and the rain pours down. Luckily, you have an umbrella! The umbrella prevents you from getting soaked from head to toe, but on your way in, your socks and shoes still get pretty wet despite your umbrella. Face coverings work like the umbrella. First, it’s best to just stay away from the rain (Covid exposure) all together, but if you must be in the rain, an umbrella (face covering) is going to save you from getting totally drenched in a downpour.
If you’re not already wearing masks in public, and you want to see the end of Covid, please start wearing one!
(Bonus) Everyone is tired of this.
This has been an exhausting year. I had big ears already, but I think they stick out even more after all this time wearing a mask everyday. I’m tired of carryout instead of dining in. I’m tired of feeling stuck at home. I hate the uncertainty and financial instability it has brought on for everyone. Healthcare workers and other essential workers are tired of constantly being in harm’s way, though most of us have kind of gotten used to it, but it doesn’t mean we like it. There’s a lot we still don’t know, but one thing is for sure;
I can’t wait for this to be over!
Is there something I missed in this Covid update? How are you handling 6 months of lockdown? Let me know in the comments. Don’t forget to like, follow, and share!
