Since this is going to be a post about the coronavirus, let’s start off with this PSA: wash your hands. These viruses have a lipid envelope that is crucial to their structure and function, and soaps and detergents are thus very effective at inactivating them. It’s fast, it’s simple, and it’s one of the more useful things that any individual can do under these conditions.
OK, either tomorrow or Friday I hope to do a post on all the things that are going on in the biopharma industry for a possible coronavirus treatment. But this morning I need to talk about what’s *not* happening. What’s not happening is the advent of any drug, vaccine, antibody or anything else in time to keep this epidemic from becoming a very big problem. That’s because it is already a very big problem, and because there is no way that we’re able to get anything pharmacological off the ground fast enough to keep it from getting even bigger.
And “getting even bigger” is very likely what’s going on right now. Not that we know much, because the US has been very slow in testing patients, for a number of reasons that do no credit to anyone involved. Here is the situation as of March 2 (see table at right). Note especially the “tests per million people” column, and also note the asterisk next to the US number. That’s because that pitifully small number is actually as of March 1, and that in turn is because as of March 2 this statistic was removed from the CDC’s web site. The agency says “Now that states are testing and reporting their own results, CDC’s numbers are not representative all of testing being done nationwide” and fair enough, but perhaps as a national center focusing on disease control they could track and aggregate such numbers? As the other countries on that list have managed to do? Update: President Trump now seems to have fixed the blame for the low US testing rate on the Obama administration. So that’s all sorted out.
The US numbers for testing, then, are extremely low and now obscure. The US numbers for total people infected are also not anywhere near reality, as became obvious this past weekend, when the sequence of the virus from the second US fatality was sequenced. It was clearly related to the virus from the first case (reported on January 19 in the same county in Washington state), descended from it in a way that makes it almost certain that the coronavirus has been spreading undetected among that population for weeks. As Trevor Bedford (Fred Hutchison center) of the team doing this work said on Twitter, “I believe we’re facing an already substantial outbreak in Washington State that was not detected until now due to narrow case definition requiring direct travel to China“. There are now at least two separate transmission chains in the Seattle area, and Bedford himself told Stat that “January 1 in Wuhan was March 1 in Seattle”. It’s hard to say he’s wrong. And remember, 11 other states (as of yesterday) are reporting cases.
Meanwhile, as anyone who knows anything about drug or vaccine or antibody development knows, we are many months away from the quickest possible proven intervention (more on this in the promised post). No amount of rah-rah is going to affect that, but unfortunately that’s what we’re getting from a lot of people who should know better. One of those people is HHS Secretary Azar. Yesterday here he was in front of the cameras. I quote his exact words:
“. . .got to hear from actual bench scientists, who within three days – within three days – developed a potential vaccine for the novel coronavirus, and they reported some really important news to the President. That yesterday the Food and Drug Administration authorized the entry of that vaccine into Phase I safety clinical trials. . .”
Azar really leaned on the “within three days” part, but that is of course the least of everything involved. The previous work on coronaviruses (such as SARS) and the use of modern sequencing technology immediately suggests “potential” vaccines in this case, which is great, but it’s not anything like a rate-limiting step. Making a big deal out of that is misdirection and public relations. The director of the FDA’s CBER has already said (correctly) that “The development of a vaccine is not going to prevent a pandemic here“. That is the truth, and we’d better be ready to deal with it and act accordingly. In case anyone thinks I’m just a disgruntled political opponent of the current administration, keep in mind that I have over the lifetime of this blog ripped into previous FDA commissioners, Democratic and Republican officeholders, foreign government officials, and more biopharma spokespeople and press releases than I care to count for just this sort of overpromising. Hype is hype.
But the entire summit meeting with President Trump and other officials with the drug industry on Monday was surreal. No one expects the president – any president – to understand drug and vaccine development. It’s not their job. But here come some politics: Trump hardly understands any subjects whatsoever, while at the same time claiming vast areas of expertise. The entire meeting featured him misunderstanding (again and again) what people were trying to tell him, that it was going to be months and months and months (at best) before a vaccine of any sort could be tentatively said to maybe exist, much less be ready to deploy in a large population. Read that last link; it sums it up better than I can. Every time you think something is getting through to Trump on this subject, it turns out that no, it didn’t take. Anthony Fauci of the National Institutes of Allergy and Infectious Disease is an extremely competent and accomplished immunologist and his expertise in virology (through his work with HIV), epidemiology, and public health issues is very substantial indeed. But we are putting his talents to work by having him attempt, over and over, to drive what should be simple concepts through the president’s skull.
This administration has demonstrated again and again that it just wants this whole epidemic to go away. Fine, so does everyone else. But that’s not going to happen. The odds are very high that we are going to see a substantial increase in coronavirus cases as we come to terms with the fact that it is now and has been spreading through the US population. Wishing that this were not the case is a foolish, dangerous waste of time. We need straight talk on this from the highest levels of the government, and we need the people with expertise to be able to speak their minds as they see fit. I know that Richard Feynman’s quote from his appendix to the Challenger disaster gets trotted out a lot, but when has it applied more than now:
For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled.