Weekend Reading: The Second Week Edition

Hello from the second week of sheltering in place! San Diegans proved unable to responsibly handle having beaches to visit so our beaches and parks and trails are all now closed. I am very fortunate to have nice, quiet neighborhood streets to walk but a lot of people are not so lucky. I really think the city needs to figure out a way to allow people to get outside. We are in the early days of all of this, so perhaps they eventually will. I am trying very hard to remember that everyone has been thrust into a situation they never expected to be in and that most people are doing their best to manage.

John Scalzi wrote a good post about this moment in time, and how we all need to be patient. We can be sad, and angry, and frustrated and all of those things, too, but we need to be patient. We are in a situation in which the only way to save a lot of lives is to sort of freeze in place as much as we can. The more patience we can all muster, the better we'll all do.

If you read only one link about coronavirus this week, this Ed Yong article is probably the one you should pick. It is clear-eyed about how we got here but also about where we might go next.

Or at least read this part:

Most of us are in Group B. Our duty is urgent and clear.

(Written about the US, but true for many other nations right now.)

Full explanation--> https://t.co/woc4dxfi9r pic.twitter.com/XmRInP7HXt

— Ed Yong (@edyong209) March 26, 2020

I'm seeing a lot of links to various modeling studies about when the peak will be in different states and while I think those are useful, I don't think they are always being shared with the necessary context for average people to interpret them. Like any model, these models are built on a lot of assumptions and extrapolations from what has happened in other areas. There are still many, many unknowns about the virus and the disease it causes. So a model that predicts X number of deaths if we take one course and Y if we take another is probably useful for comparing X an Y, and maybe even for getting an order of magnitude of the two numbers. But it isn't telling us with certainty when the peak number of cases will come and how many people will die.

What we know with certainty is that more people will suffer and more people will die if we don't keep distance from each other. That is also the only part of this that most of us can control. So we're back at patience.

What else can we do? Wash our hands, of course. But also we should probably all be wearing masks when we're out shopping. Here's a post that does a pretty good job (I think) of summarizing the data in an accessible way. Since there is a shortage of masks right now and I believe strongly we should leave the best options to the people most at risk - primarily health care workers, but also I think grocery store workers and people with serious underlying conditions - I have decided to start wearing the cloth masks I bought to help block the dust while cleaning. I wore one for the first time on Thursday, when I went to pick up take out from a favorite local restaurant. I felt vaguely ridiculous but it worked fine.

The key with cloth masks is that they are still single use - you just wash them after use. Are they as good as a N95 mask? Of course not. But I am not getting my face close to a sick person to examine or treat them. I'm just going to the grocery store. I'll still try to stay 6 feet away from other people. The mask, like my use of cotton gloves, is about trying to reduce risk.  Masks also reduce the risk that you'll spread the virus if you are asymptomatically infected, which is a very good thing.

If all of the talk about gloves and masks and wiping down groceries has you feeling a little panicked, you might find this Washington Post article helpful. It explains why we don't need to worry quite so much about those Amazon deliveries, for instance.

Long term, our way out of this mess is through better testing and then through having treatments for sick people and finally having a vaccine.

On the testing front, Abbott has received approval for a new, fast coronavirus test. The good news about this test is that it uses the same machines a lot of doctors and hospitals already have for flu and strep tests, which means it should help ramp up our testing a lot without requiring a lot of new machine purchases. Of course, it still depends on a sample taken with a nasal swab, and those are still in short supply as far as I know.

Here's a story about a company that makes those swabs and how they're responding to the shortage.

On the treatments front: The first place people are looking is at drugs already approved for other diseases, and then at drugs that have at least been through the Phase I safety trials for other indications. Safety trials are important, even in the current situation. If a drug helps treat COVID-19 but kills your liver or kidneys, it isn't really a good thing.

Derek Lowe at In the Pipeline has been writing an excellent series looking at what's being suggested. Here is his latest post, about some lesser known possibilities.

Lisa Jarvis, at C and EN has an excellent write up about remdesivir, Gilead's drug. Like many antivirals, it is probably most effective given early and there has been some talk about using something like this prophylactically, but it is an IV drug so it isn't a very practical option for either of those uses. The only thing I can think is that perhaps there should be a trial of prophylactic use in high risk medical workers. Of course, trials are now getting underway for treatment of patients, and I hope those turn out well - but read the linked article for why most people in the field don't expect them to be definitive.

By the way, if you saw stories about Gilead getting an orphan drug designation for remdesivir and the stories were framed as this being done for pricing reasons... the actual reason was to speed the regulatory process. They were trying to figure out how to get to larger scale distribution as quickly as they could and have withdrawn that status now that the FDA has other ways for them to do that.

$GILD asks to FDA to waive orphan drug designation. Says it only asked for it to speed drug submission.

So no, this was not them trying to rip people off. Whole statement here. pic.twitter.com/Zt9JBJ9R7g

— Matthew Herper (@matthewherper) March 25, 2020

You may have seen news stories about Mt. Sinai in NYC trying plasma treatment - basically, treating patients with the plasma of recovered people. Here's a tweet about a very small, preliminary test of that in China (you can click through to get to the JAMA article if you'd like):

*Preliminary* #COVID19 study in @JAMA_current
- 5 critically ill pts. on mechanical ventilation
- All treated w/ convalescent plasma w/ #SARSCoV2 antibody
- In 4/5, SOFA score⬇, viral loads⬇, ARDS resolved
- All 5 stabilized, 3 at home
* Need an RCThttps://t.co/bBoI74f7jD pic.twitter.com/wazw3yKcVm

— Rishi Wadhera (@rkwadhera) March 27, 2020

There are people working to isolate antibodies from the blood of recovered patients, too. The idea there is to find a really good one (i.e., one that is strongly neutralizing against the virus), and then make that particular antibody at scale to give as a drug. Note that any antibody drug is going to be an IV drug, too. Here's a tweet from a researcher at The Broad Institute in Boston who is working on this.

Study of 206 monoclonal antibodies against #SARSCoV2 isolated from 8 #COVID19 patients. Some antibody clones are highly effective at neutralizing live SARS-CoV-2 virus in cells, suggesting that we now know human antibody sequences that would be effective COVID-19 drugs. (1/2) pic.twitter.com/tZ8g1jadQc

— David R. Liu (@davidrliu) March 27, 2020

I know some biotechs are working on this, too - one has put out a call for recovered patients here in San Diego to volunteer their blood.

I found this thread about what an experienced infectious disease science journalist did and did not predict very useful:

Many people now pointing to old articles (incl. one from me) saying: It’s all there. And others saying: No-one could have predicted #covid19. So I just want to be very clear about what I personally as a journalist covering this beat for years expected and didn‘t expect. A thread

— Kai Kupferschmidt (@kakape) March 27, 2020

New Zealand has gone to a shelter in place order similar to ours here in California. There is a campaign there to put teddy bears in your windows for kids out walking with their parents to find. I find that delightful.

Still in NZ, this article on how feijoas can get you through lockdown made me laugh because I think feijoas are terrible and they are just about the last thing I'd want to stockpile to get through lockdown. My husband would probably agree with the article, though. As for me, I am eyeing the avocados coming into season on our backyard tree and thinking guacamole is going to get me through. Every time I go to the store, I buy tomatoes, jalapenos, and cilantro... and two bags of tortilla chips.

 Last week, I said I'd try to find non-coronavirus articles to share. This one about a bank in Italy that accepts cheese as collateral is several years old, but fits the bill!

This made me smile:

Social distancing Day 12: Today my kids wanted me to wear my wedding dress at lunch & I couldn’t think of a reason not to pic.twitter.com/2snMmwxuGq

— Curtis Sittenfeld (@csittenfeld) March 24, 2020

So did this:

I got a big kick out of this restaurant’s whimsical response to having no diners—in this time of take-out and delivery only. @nello_nyc pic.twitter.com/lZcPryqzl9

— Gretchen Rubin (@gretchenrubin) March 27, 2020

Here's your bunny:

pic.twitter.com/30HVQoNVND

— うさぎ島の写真bot (@rabbit_isle_bot) March 28, 2020

Have a good weekend, everyone! Do whatever you can to build up your patience for the long road ahead of us. For us that means putting out our hammock and walking around our neighborhood. Also probably some more guacamole.