Saturday, April 18, 2020

Weekend Reading: Another Week Edition

We made it through another week! Honestly, that's what I am focusing on right now: making it through each week. I know a lot of people say that the days all blend together and weekends don't feel like weekends, but for me weekends are definitely different from weekdays. There is no schoolwork to help with, and I shut my work laptop down on Friday evening and don't generally open it again until Monday morning. I still look forward to weekends even if I haven't figured out how to make the best use of them to recharge these days.

Yesterday at lunchtime I thought I might end up needing to work a little this weekend. I had a list of five things I had to get done before Monday and when I stopped for lunch I had done exactly one of them. I'd spent some time on Petunia's math assignment (including looking for something that had a weight marked on it that was less than 5 grams - I eventually found a tube of chapstick that did the trick) and some time helping on a project for a colleague who has bigger child schooling challenges than I do. These were the right things to do but I still needed to do the items on my list. Luckily, I had a burst of productivity after lunch. I had to stay at my desk a little longer than usual, but I still got to close down my work laptop for the weekend before I went to make dinner.

Anyway, let's have some links.

In self-promotional news:

In case you missed it, I wrote up the last trip my husband and I took before everything shut down. It was fun, but a little weird.

Also! Last week the latest Annorlunda book came out. Nontraditional is a wonderful collection of stories about the students Nan Kuhlman taught in a small town community college, and how they (and she) got second chances in life. This was a terrible time for a book release but once it became clear how terrible it would be it was too late to change the release date. I've really struggled to find reviewers for it which makes me sad because it deserves more readers. If you're looking for something to read, give it a try!

In coronavirus news:

Obviously, read Ed Yong's latest in which he tries to get us all to think realistically about what comes next.

Remdesivir has been in the news a lot this week. It is a small molecule made by Gilead that inhibits viral proteases polymerases (ugh sorry about that slip - I was still caffeinating when I wrote this). It was tried against Ebola without much use, but there is in vitro data indicating that it is a better inhibitor of the SARS-CoV-2 polymerase than the Ebola polymerase, which is encouraging. Here's a nice summary of that research.

Derek Lowe at In the Pipeline has a good summary of what the various leaks and signs about remdesivir tell us so far. Spoiler: not much. I can't find it now, but I also saw someone tweet out a notice from that the more informative trial with a placebo arm is extending the size of its treatment group. That often means that the effect size being seen in preliminary data is not large and therefore the trial team thinks they need a larger sample to get meaningful statistics. But we're all just reading tea leaves and we won't know anything until the trials actually report.

One thing that is a bit puzzling to me is that all of the trials seem to focus on relatively late stage disease - i.e., once a patient is hospitalized. I guess that might be because remdesivir has to be given by IV and hospitalized patients make that mode of delivery easier. But most of what we know about antivirals for respiratory illness indicates that they are most effective if given early (e.g., Tamiflu is most useful if given within 48 hours of the onset of symptoms) and there is encouraging data in monkeys based on early administration of remdesivir.  We are also sadly learning what populations of patients are most likely to progress to hospitalization and so I wonder if anyone is planning a trial in which those patients are treated with remdesivir early, with an endpoint of reduced hospitalizations.

But trial design is not my field of expertise and the people designing and running trials right now are not stupid. I assume this idea has also occurred to them and that there is a reason we're running the trials we're running.

There have also been some encouraging reports about repurposed drugs that target the "cytokine storm" that can occur in very sick patients. No trial readouts yet or even the sort of leaks and tea leave readings like we're getting on the remdesivir trials, but anecdotes coming out that some of the drugs may be beneficial.

I don't know if I posted a link to this before, but Matthew Herper published a good overview of the potential treatments for COVID-19 in March. If you'd like a better understanding of what treatments might become available, that is a good place to start.

I have seen a lot of angry tweets about the fact that we're all staying home to buy time and our government does not seem to be using that time to ramp up testing. I agree that is very frustrating, but better testing is not the only thing we're buying time for. We're buying time for more trials to complete so that we know which, if any, of the currently available drugs are beneficial. We're buying time for the efforts underway at various biotech and pharma companies to move other treatment options into the clinic.

Also there was some good news this week about swabs, which are one of the limiting components for a testing strategy. More validated swab materials and the less invasive swab collection method now approved by the FDA could both speed up testing.

So basically, we're all staying home to buy time for good science to be done. We want to accelerate things, but not rush them. We need to understand the detection limits of the tests. We need to know which drugs have a potential benefit that outweighs the risks from any side effects.  We need the vaccine safety trials to have time to complete. We need the science to be done and done well.

I thought it might be helpful to share one of the little things that has been helping me be OK with staying home:

My husband and I really enjoy the silly British quiz show 8 out of 10 Cats Does Countdown. We find the episodes on YouTube. Here's a randomly chosen episode. In searching for that I discovered that it might actually be available on Amazon Prime, too. I'll have to check that out.

But those shows are long and we don't always want such a long show at the end of the day. So we were happy when the YouTub algorithm alerted us to the existence of Jimmy Carr's Little Quiz of the Lockdown. It is a short nightly quiz and it has been a good way to unwind before bed. Here's a compilation of a week's worth of entries, but we tend to watch them one or two at a time.

And in other news... here are the things that made me smile this week:

This story is quite something:

Also a great story:

Look at these cute birds!


How cool are these flowers?

Here's your bunny of the week, from Carl Bovis who usually tweets wonderful bird pictures:

Happy weekend!

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