(This is the first part of a two part article series about solving the problem of the Covid-19 pandemic. You can read the second part of the series here.)
We’ve all been assaulted with dozens of different claims over the last few weeks, each predicting something different. Peaks, slopes, smoothing, closures, openings, shortages, case numbers, death numbers.
But what haven’t we heard? Anything clear and certain about when we’ll finally have killed off the last virus particle, and eradicated the disease. It is possible – we did this with the smallpox virus – once a world-wide scourge, with the last known case occurring in 1977 and WHO confirming the disease’s final disappearance in 1979.
Almost as acceptable a solution would be like we have for regular ‘flu – a combination of appreciable herd immunity and immunization such that re-appearances of the virus lead only to limited outbreaks that don’t become fresh pandemics.
It took the world 3,000 years to understand, respond to, control and eradicate smallpox. We’re all hoping to get the coronavirus behind us somewhat faster than that. And that’s the vital thing that has not been clearly discussed or explained – when things will get back to normal. Not everyone appreciates that the present lockdown can not be lifted, even if we have the new case rate down to zero, because as soon as we do that, the virus will reappear, probably from a visitor from another country, or from an undetected still existing case within the US, and we’ll be reliving the madness of March all over again. Asian countries that had essentially zeroed out their infection rates and relaxed movement controls are now discovering this.
So, the huge question is : When will we/can we expect our lives to return to normal?
As introduction to this article, we surveyed the almost 10,000 people who read our weekly Travel Insider newsletter to ask when they thought this might happen. Our readers tend to be well educated, well read, well traveled, senior and successful people, and they’ve also been exposed to a massive amount of commentary by us on the topic of the Covid-19 disease. Here’s how their responses came in :
To our surprise, almost half the replies received were from people expecting things to be back to normal by the end of July, this year. Almost exactly 80% give a date some time this year. Only 20% think it might take longer.
We would desperately love the majority of our readers to be correct. But we can not match their optimism with any realistic basis to support their positivism.
Let’s look at the three different ways in which some type of normalcy can be restored, and when each might come to pass. In order from least desirable to most desirable, they are :
- Some way of safely living with and avoiding the virus
- Treatments that make a virus infection no longer serious
- Vaccines or herd immunity to nullify the threat of the virus
We’ll consider these in reverse order.
Vaccines or Herd Immunity
We are told that a vaccine will take about 18 months to develop and test. We are also told this is the ultra fast-track version – it can more commonly take ten years, or even longer, to get a new vaccine out there and approved.
Some experts concede it may be possible to cut a few more corners and speed up the 18 months – perhaps to 15 months, maybe even less. But the shorter we make it, the more uncertainties remain about the virus, and possibly unexpected side effects. Remember thalidomide – a drug that earned every possible approval, and was deemed so safe it was even available in many countries without a prescription. Tragically, it was recommended, among other things, as a cure for morning sickness in pregnant women. Alas, it caused babies to be born deformed, a surprise because during its trials and testing, it was never tested on pregnant women.
There certainly can be some risk tolerance involved when trying to combat a deadly disease such as Covid-19, but one could hardly say the same about a drug designed for morning sickness, coughs, colds, and headaches.
So these days there is a much more rigorous testing regimen for anything new, hence the typical 10+ year time frame. 18 months is thought to be as compressed a time frame as is prudent.
There’s another wild-card to do with developing a vaccine, too. Covid-19 is caused by a coronavirus, officially known as SARS-CoV-2. It is somewhat similar to another type of coronavirus – the common cold. We’ve never managed to come up with a vaccine for the common cold, so the odds are slightly against us for this new coronavirus, too.
On the other hand, modern vaccine development is totally different to how vaccines were developed back in the 19th and late 18th centuries, even much different than most of the 20th century, and there are many billions of dollars now being invested in coming up with a vaccine for this coronavirus. So it is probable – but not guaranteed – we’ll develop one.
But while the best case scenario is 18 months or a bit shorter, the worst case scenario might see a series of promising trials end up with disappointments and problems, and maybe it takes much longer to finally find a usable vaccine.
There’s also the time to make and distribute billions of doses of the vaccine, and then vaccinate everyone.
So, short answer – 18 months seems about as short as it will be; the best-case scenario end of this timeline. The worst-case scenario stretches out to “never”.
The other part of this answer is the growth in natural immunity by people who have had the disease and recovered – what is sometimes described as “herd immunity”). That remains still very much theoretical too – we are largely assuming that if a person gets infected and recovers, then their body now has developed a “memory” of how to fight that virus for next time. But we don’t yet know this for sure.
We also don’t know if that memory can “fade” over time, or become irrelevant if the virus mutates. Our general belief is the virus mutates slowly, meaning that both natural immunity and a vaccination might last for some years rather than needing to be replaced, every year, with a new vaccination (such as is the case with regular ‘flu, which is not a corona type virus).
The great thing about herd immunity (or vaccination) is that you don’t need to have everyone immunized. You just need to have enough people with immunity so if a virus infection appears, there is more chance the infected person will only transfer their infection to people who are already immune, rather than to people who are not yet immune. In the former case, the infection obviously dies out. In the later case, it obviously grows and spreads.
Because the Covid-19 virus seems to be quite “good” or “efficient” at spreading, we need a fairly high herd immunity to counter that – more than 60% of the population seems to be the general region of estimate at present. For the US, that would be almost 200 million people. To put that number in context, currently we have 400,000 people infected, so we need to grow that 500 times larger. Yet our medical system is already struggling to keep up with an infection rate 500 times less than that needed, and we have already had 13,000 deaths. Multiply that by 500 times and we could be looking at 6.5 million deaths.
Note – there is one possible obscured positive point in the official count of 400,000 Covid-19 cases. Empirical analysis suggests that many more people get a coronavirus infection but never report it because their infection is mild and seems like nothing more than another cough/cold/sore throat. How many more people have been “silently” infected and have those weak infections also built up sufficient immunity for the future? No-one knows for sure, but this is something we will better understand if/when we start testing not just for people currently infected, but also for people who have been infected in the past. Estimates range from as low as maybe there are three times more people who have been silently infected to as high as maybe 15 times more.
This of course would speed our acquisition of herd immunity, but still leaves us a very long way behind the eight-ball at present.
The death estimate is probably too high, but even if we reduced it ten-fold to 650,000, it is unlikely anyone would be willing to accept that casualty rate. We lost 58,169 people in the last major war – Vietnam, and it destroyed our country with pain and grief. Could we countenance losing 12 times as many, and in a much shorter time frame?
So our point about allowing herd immunity is that either it will take a very long time and/or require unacceptable levels of compromises and deaths.
So while this option – vaccination/herd immunity – presents as the only way to ultimately vanquish the virus, it is neither guaranteed nor quick. Until we have a widely available vaccine, we’re going to want to keep the number of cases as low as possible.
Unless, of course…… Which brings us to the second solution.
Treatments and Cures
The “good” thing about this virus is that apparently some people get such a mild version of it they don’t even realize they’ve had it. The “bad” thing is that some people get it so severely they either die, or else have their lungs damaged for the rest of their (now probably much shortened) life. There are reports of heart and brain damage in some cases, too.
There are lots of other bad effects of the virus when it hits someone hard – cost, for example. Weeks of ICU grade healthcare, at American prices, isn’t cheap.
Wouldn’t it be wonderful if we could reduce the impact of the virus so that anyone and everyone (or almost anyone/everyone), when catching it, could simply “take one pill twice a day for a week”, suffer no severe symptoms beyond what you might experience with a cough/cold/sore throat, never need to go to a hospital, spend under $10 on medication, and at the end of the week, be cured.
Just like it can take ten or more years to develop and approve a vaccine, the same is true of a new medication to treat a disease, too.
That is a huge and exciting “but”. What say there is an already developed and already approved medication of some sort that also, by happy chance, helps treat a person with the Covid-19 disease? Then there’d be no need for a decade of testing and trials and worrying about side-effects.
The only remaining concern would be to establish if it really/truly does help treat the Covid-19 disease. If it is cheap and seems to work, even if only sometimes, then you’re looking at a very simple cost/benefit equation. Cost – a few dollars. Benefit – possibly saving a person’s life, saving $250k+ of medical treatment, clogging up the healthcare system and preventing other people with other problems from getting life-saving treatments, too. Downside – if it doesn’t work, all you’ve done is waste a few dollars.
There are a number of drugs that are showing promise when it comes to treating Covid-19. It is true that none of these drugs have been subjected to bullet-proof rigorous multiple double-blind clinical trials of large numbers of patients, in varying stages of the disease and from different demographic groupings, and so on and so forth.
But, who cares? If it might work, why not try it? I surely would. If there’s a drug with no serious side-effects, then it is a simple case of “Heads, you win (ie you’re cured); tails, you don’t lose (ie you’re now worse off than before)”. No downside other than the disappointment of failed false hope, and plenty of upside – quick easy affordable cures.
Unfortunately, our medical profession and its regulators are very conservative and totally fail to recognize this blindingly obvious reality. Plus, the fact this concept was endorsed by our President has caused many people to automatically disagree without pausing to consider anything other than the source of the recommendation, even though he was merely echoing the reality of a growing body of partial tests/trials and observed results, all around the world.
If you’re facing the possibility of death by Covid-19, would you still refuse to accept a treatment that might speedily cure you, just because you hate President Trump? More to the point, if you’re a doctor, would you refuse to allow a patient to try a drug that has no relevant side effects, just because you hate President Trump? Sadly, the answer to that question often seems to be yes.
Most recently, the CDC – a group that should be hanging its head in abject shame and sorrow for their dysfunctional approach to the virus infection, and for the damage to the nation thereby caused – showed their vindictive narrowmindedness by taking down the dosage information on their website for hydroxychloroquine, to make it gratuitously harder for people to know what level of dosage should be considered. Fortunately, the dosage information can be found with only a little bit of Google searching, including, ahem, on my site.
We are not doctors, but are enthusiastic about the apparent potential of several different drugs and their associated doctor recommendations – the chloroquine group of drugs in particular, either alone or in conjunction with Azithromycin (and maybe with Zinc Sulphate too), plus the latest interesting treatment discovered in Melbourne, Ivermectin. These drugs all have the benefit of being low cost and generally recognized as safe and having been in use for other purposes for years or even decades.
There are many other treatments also being experimented with, although some of the others involve more exotic and less common drugs, and more complex treatment regimes (as compared to simply swallowing a pill once or twice a day for a week or less). They are also more expensive and not so readily available in quantities of many millions of doses.
We expect that before too long, the growing clamor of new findings supporting the use of some of these drugs will finally become sufficient to allow the medical professionals refusing to acknowledge their existence to finally come around to prescribing them. For now, if you really want them, you may have to “doctor shop” to find a decent doctor willing to help you.
If any one of these treatments is even half as effective as some people are hailing them to be, it could be a total game changer, freeing us from most or all the current curse of the coronavirus that is hanging over all our heads. If you’re like me, you find yourself inevitably wondering, any time you feel any ache or pain or general unwellness, is this the precursor to Covid-19. That’s not a nice way to start every new day.
How long might it take until we find an existing drug that will treat Covid-19, making it less harmful and zeroing out its potential lethality? Somewhere between zero time (if you believe in the efficacy of some of the currently cited drugs) and never. There is no guarantee that any existing drug might have a relevant anti-viral capability to diminish the severity of the coronavirus. But maybe one of the current likely candidates might finally be accepted as truly doing what its supporters are already claiming it does.
To finally get an official blessing is likely to take a month to six months, followed by however long it will take to then manufacture the drug in the needed quantities for general use. Even the chloroquine drugs, which are currently the tenth most commonly prescribed drug in the US (so tell me again why the official medical regulators are so worried about it?) have gone from abundant supply to scarce, worldwide, as a result of the promise shown by it. The US was gifted 31 million pills (or possibly courses of treatment – the statement was unclear) of hydroxychloroquine just a week ago by two drug companies, but it is not releasing those 31 million units to general pharmacies.
So, for this alternative solution to the virus, we are forced to conclude we really don’t know what to expect or when, but we optimistically hope some positive answers might start to be more broadly accepted in the next three months or so, and with treatments available for all in the next three months following.
Living Safely With the Virus
And now for the third of our options. The good news is this is something that could be done immediately. The bad news is it scores highest on the impact scale.
The lockdown most of us are enduring, to a greater or lesser extent at present, is not sustainable. We need to come up with an approach where the “cure” isn’t worse than the problem, because currently the lockdown “cure” shows signs of creating more harm to our society and economy and lives than may the virus itself.
More good news. There are ways we can get better at this.
I cover this in detail in the second part of this two part article about controlling the coronavirus pandemic. Please continue reading about this here.
6 thoughts on “How We’ll Finally Win the Covid-19 War”
A solid analysis. The trade offs are challenging.
There is an unfortunate reality, every drug has affects — the good ones are called benefits and the bad ones are called risks. Hydroxychloroquine isn’t a risk free drug. It can affect vision. It can cause liver problems especially in people taking blood pressure medications (a non-trivial part of the over 50 population). It can cause problem with “regular” drinking (which I’d bet is somewhat more common today). Seems like heart issues could happen — that seems much less studied.
I personally am assuming we have had lots of mild and “not terrible” cases. It would seem very hard to determine if any of the drugs mentioned were given to someone with “not terrible” case whether they improved because their body was already fighting the virus or because of a drug.
Many (many!) years ago I did programming work for a large college funded to evaluate clinical trials for cancer drugs (chemo). I basically produced survival rate charts for various drugs, drug combinations, and other variables. The goal was producing large enough samples to get reasonable confidence. There were numerous cases of a very promising drug having a significant death rate at say 3 years and a drug which looks terrible at 1 year, having incredible results at 5 years (so an early negative impact on a few and many having great benefits). I remember two things very clearly — unexpected effects (positive and negative which sometimes took years to figure out why) and very difficult conversations about how long to keep a double blind trial going (either because the drug was working so well that it was unfair to withhold it from others; or the risk was becoming too great for those on the drug. Balanced against would the survival curve change in 6 more months).
I’m not suggesting cancer drugs and virus drugs are the same thing. Just this is complex, there are always trade offs as there is no perfectly safe drug (although for years everyone thought aspirin was)
Well said. Couldn’t agree more.
There is a growing body of thought that it is not the cytokine storm that kills people but rather people are developing hypoxia due to the corruption of red blood cells by the SARS-2 Coronavirus, which is why hydroxyclorquine (and other malaria drugs) seem to be effective in treatment. Unfortunately, because the HDC was touted by Trump as a POSSIBLE treatment, it has become the first ever “Deplorable Drug.”
A layman’s description:
A little more science based:
Thank you very much for this. I’d like to add my recommendation to reading the first of your two linked articles. It is regrettable and puzzling that Medium deleted what seems to be an excellent post that provides an entirely new dimension of insight into the virus and how to treat patients.
This is the guy who wrote it : https://twitter.com/agaiziunas
Very good pieces, as usual. I agree with much of it, which must make it good ;<)
Just one point about your discussion of natural herd immunity. You note that we only have 400,000 cases today compared to the possibly 200 million needed for good herd immunity. I believe from what I have read several places, and I believe that you have noted in previous articles, that the real number of cases is probably much larger than the 400,000 “confirmed” cases. Possibly 10x more. And we are growing at over 20,000 confirmed cases per day, which could mean up to (or beyond) 200,000 new cases daily.
Assuming that new confirmed cases keep tapering off we still might have a total of 5-10 million cases by the end of this month. Still well below your 200 million number, but not so seemingly impossible as is starting at 400,000 cases. Just a bit of optimism that natural herd immunity might eventually save us.
Yes, absolutely. I’ve updated the piece to reflect that omission.
I’m not entirely sure if a very weak infection makes for a sufficiently strong level of immunity in the future, although hopefully that is the case. You might say “if the infection is very weak, who cares”, but the answer to that sensible question is that a person with a weak infection can still pass a strong infection on to someone else. The weakness/strength is more in the sense of how each person reacts to the virus.