We’re back!

First, Ebola:

–There have been no new confirmed cases since the end of September.  The Ebola Treatment Centers were empty as of last week (this week’s update is a little slow, but nothing breaking on the wires either).  In fact, although there is nothing specific in the WHO data, the overall mortality among the confirmed cases dropped preciptiously to 37%.  This drop is coincident with some of the new Ebola specific therapies getting used there over the last 4 weeks or so, and although early, is a promising sign (and I say that as a personal opinion only–I have no personal stake in those drugs).  That said, there are still a number of contacts there were lost to tracing, and many cases were still being treated in the community, and not at Ebola Treatment Centers.  We’re a few weeks from the usual incubation period plus some for calling an end to the outbreak–I would give it a few extra weeks just because of the potential that some of those lost contacts are off triggering new transmission chains that have not been detected yet.  Cautiously optimistic we will be closing this chapter soon.  Vaccine plus effective treatment means that future Ebola outbreaks are much more likely to be contained too.

Coronavirus:

–First and foremost, it’s been a busy week for things I cannot comment on.  I will list the obvious ones below, and again, thank you for your understanding:

Remdesivir, Hydroxychloroquine Effectiveness in WHO Phase 3/4 Study:https://www.who.int/news/item/15-10-2020-solidarity-therapeutics-trial-produces-conclusive-evidence-on-the-effectiveness-of-repurposed-drugs-for-covid-19-in-record-time

Astra-Zeneca’s vaccine was given the go ahead to restart trails in the US.

Regeneron SARS-CoV-2 antibody cocktail press releases results in early, mild/moderate disease before patients are in the hospital:
https://www.fiercebiotech.com/biotech/regeneron-s-covid-19-antibody-cuts-medical-visits-phase-2-3-trial?mkt_tok=eyJpIjoiTmpBMFltTmhPR1UyTldOayIsInQiOiJlWGRHRFlQNjhOSEVOXC84ZE8wcEMrZXdFeFZ5SEFLZHVhd1FsdFJkRDdnejh2Q3ZiQXNOaUhrMllPQnEweXpLTExMXC91WkJUXC9TNjA3WWR3eUFwK29oWWJENDlKeFBFbHZsc2RYQVV4VG1NRW5ONThOYzkwSldNcVwvNW5RS2hMUkIifQ%3D%3D&mrkid=698583

NIH discontinues Eli Lilly SARS-CoV-2 antibody monotherapy in already hospitalized patients in ACTIV-3 Study run by NIH: https://www.fiercebiotech.com/biotech/lilly-s-covid-19-antibody-fails-trial-hospitalized-patients

Eli Lilly SARS-CoV-2 monotherapy antibody publishes results in early, mild/moderate disease before patients are in the hospital in the New England Journal of Medicine: https://investor.lilly.com/news-releases/news-release-details/data-lillys-bamlanivimab-ly-cov555-covid-19-outpatients

Comments by others: https://twitter.com/SquawkCNBC/status/1321412117485015048

Eli Lilly agreement with US government to supply SARS-CoV-2 antibody:
https://investor.lilly.com/news-releases/news-release-details/lilly-announces-agreement-us-government-supply-300000-vials

New England Journal of Medicine paper for Eli Lilly SARS-CoV-2 monotherapy antibody results in early mild/moderate disease before patients are in the hospital mentioned above.  Despite the by line, all questions should be addressed to the corresponding author: https://www.nejm.org/doi/full/10.1056/NEJMoa2029849?query=featured_home

Comments by others.  I would encourage you to always read past the headline–some of the most interesting content is often found in the middle to the end of anything you come across on the internet like this:
https://endpts.com/a-p-value-of-0-38-nejm-results-raise-new-questions-for-eli-lillys-vaunted-covid-antibody/

–You may find this to be a useful refresher from a previous update:  https://gonerambling.com/ebola-and-coronavirus-update-03-sep-2020/#MeInHoney

–I was finally able to take some actual, bona fide vacation for the first time this year over the last two weeks.  Sure, things were a little touch and go when I left.  Cases on the rise in the US, particularly more rural areas, and across the globe, Europe especially.  But the timing seemed alright.  After all, we are all familiar with prudent social distancing measures and even with the colder weather across much of the globe keeping contacts a little closer, you guys, and the rest of the world, were minding the shop and keeping things….uh….keeping things…. sorry… I’m just catching up on headlines here coming back…seems France is locking down again….  So you guys were keeping things contai–…..Germany too….  cases in the Midwest remain quite high…  You know, you guys could keep things contained while I was out. Keep the glowing embers from becoming tiny little actual fla–….  China has a new focus of cases…  Wisconsin is triggering additional hospital capacity in some places again…  South Korea has a new focus….  Utah is triaging ICUs…  Yeah. 

Tiny little. 

Actual. 

Flames.

You know guys…  I’m not upset.  I’m not.

I’m just disappointed is all.

Just kidding : )

Not about the headlines.  Those are all real. 

But yeah, there may be something to the idea of colder weather forcing closer contact, coupled with less vitamin D from the ol’ sun, and the glowing embers are small flames.  In fact, most states are now above 1.0 on the Rt tracked by rt.live.

BUT… a lot of that is still driven by focal areas with VERY high activity.

Although the Midwest and Big Sky continue to see lots of cases, areas threatened with “bed’s taken” overwhelmed healthcare systems remain state level and often much smaller.  Again, that’s the big threat for COVID mortality–the virus, as we covered extensively before I went on vacation, is generally only a direct threat to very specific categories of patients.
Indiana remains illustrative.  New cases and overall positivity rate are higher than the June/July peak and getting close to March-May (the big peak).  But there are 500% more tests being run now per day than in March-May (where we already know we were not capturing nearly as many of the mild or asymptatic cases that are still a large majority of what is being detected).  Marion County (Indianapolis) and its surrounding suburbs, the most populous part of the state, have barely budged in terms of positivity rate in the last 4 weeks, and only recently started a slight upturn.  It’s “rural county of the week” that is getting hammer timed–and the ones blowing up before I left for vacation two weeks ago are starting to come down.  New hot spots have popped up to take their place.  The other more populated places in Indiana, the northwest counties that are suburbs of Chicago and the moderate sized towns and cities in the north are budging north in positivity, but only very slightly, and only very recently.  

–That said, there are a lot of glowing embers/small fires around right now.  Is re-lockdown the answer?  Like the WHO said, unless you are imminently worried about the healthcare system being overwhelmed and need to buy time, probably not.  Only a few places are really close to that point.  Indeed, even as new cases have risen, the death rate, even as a lagging indicator, has barely budged.

For example, Sweden is finally being impacted by the new case surge across Europe.  Yes, this is disappointing for “have we hit the magic herd immunity number yet”.  I had hoped we were closer too.  We may still be looking at the later back of the envelope estimates of time-to-herd-immunity inferred from data including UFC COVID screening results that we made here:  https://gonerambling.com/coronavirus-ebola-and-bubonic-plague-update-09-jul-2020/#UFC_Epidemiology

Yet, Sweden’s death rate has barely budged.  Same for Indiana, especially when adjusting for number of new cases per week.

Indeed, the world death rate has not been increasing as precpitously as new cases these past several weeks.

This again argues that treatment has gotten better and/or the dominant strain is very contagious but less deadly.

But there are still pockets of unexposed patients that the virus has yet to find, and is still finding.

–Will lockdowns still happen?  Well, clearly in parts of the UK (parts of Wales were limited to “purchases of essential goods only”), and Germany and France at least.  Just remember, for the political class, the perception of effectiveness is as important as being effective–if not more so.  A lockdown looks like you are “doing something,” and drastic (“leading in time of unprecedent crisis”).  It may even be effective in disrupting the transmission of the virus, especially if strictly maintained for several weeks.  But, that does come at economic cost, and possible political fallout from angered citizens (I would say the risk of the latter is rising as the year has gone along–much more difficult to get buy in at this point).  I don’t know where the next lockdown will be announced or by whom, but I suspect at least a few politicians will still pull this lever going forward.

–What other takeaways can we draw from the resurgence in new cases?

Well, Russia has had more cases than its May-June initial wave.  It’s still unclear how many people in Russia got their vaccine, despite its approval in that country back in August.  If the answer is “a lot of people” got the vaccine there, I haz questions about its efficacy.  If the answer is “not a lot of people got the vaccine there”, I also haz some questions about its August announcement.  Really hasn’t been much of a peep about it since.

Waning immunity in the population?  I doubt it.  Again, mostly because high concentration urban centers that got hit hard in Mar-May are not getting hit particularly hard now, even worldwide.  New York City had some pockets, but is not taking off like a rocket (so far as I am aware).  We covered Indianapolis.  Same for many other hard hit states and cities.  So take the recent report from a UK study of waning antibodies with a grain of salt–as we have discussed a lot, antibodies may not be the main mechanism of immunity, and the T-cell response may matter more.  And that has shown durability in other cousins of SARS-CoV-2.

Great Memorial Day Experiment, riots, mass protests and Sturgis rallies all causing huge outbreaks?  That’s getting awfully hard to argue.  You have seen take offs in populations and pockets that have NOT been doing those things now.  You did not see as many embers/flames earlier when there was much angst about these.  Almost as if virus is gonna’ virus, and we’re here until herd immunity and/or effective treatment +/-  vaccination.

–In silver linings, flu season is off to a slow start here in the states.  But it’s very early.  Stats are here:  https://www.cdc.gov/flu/weekly/#ClinicalLaboratories  but main thing to know is that labs reporting positive for flu A or B (0.3%) is about 1/3rd of last year at this time, and this is consistent with more mild flu seasons this year in places around the world that have already had their flu.

–In socioeconomic musings, with lockdowns starting again in big European economies at a minimum, there may well be supply chain knock ons.  I don’t think you need to race out and horde (and what temporarily falls off shelves will be tough to predict), but again, hold onto that canned food supply just in case.  Stateside, still a good idea, although at this point, since everyone seems to expect post-election shennanigans, I’m almost expecting that NOT to happen on the principle that the universe seems to work perversely in that way.  Still, if states/cities/regions try new lockdowns or measures, or post-election rioting holds up the trucks carrying the food, you at least have the downside covered.

And part of your Thanksgiving shopping done already if disruptions don’t actually materialize.

–Your chances of catching Ebola are, sadly, equivalent to Kanye being sworn in as President of the United States this coming January.

–Your chances of catching coronavirus are equivalent to the chances that you are going to be really, really glad when the election happens already–especially if you are one of our European readers logging onto the Internet these days to your daily pop up and banner ad reminders to vote. 

<Paladin>