Ebola:

–Super short, because the WHO apparently gave up on reporting case numbers in mid October. Scanning what I can from news reports, there appear to be no new cases. I will follow close to the end of November, and will still be watching through 2021 just in case some of the contacts they know they lost re-ignite Ebola in the DRC. So far, so good on this section going the way of our brief plague section.

Coronavirus:

–Also relatively short because a lot of the news this week falls into the “cannot comment on” category. Again, thank you for your understanding on the following:

1. Pfizer issues press release on vaccine efficacy while Phase 3 study is still on going:

https://www.wsj.com/articles/covid-19-vaccine-from-pfizer-and-biontech-works-better-than-expected-11604922300?st=sag1pe8iafa6lg3&reflink=article_copyURL_share

Please note that may be behind a paywall because that’s how the WSJ rolls, but if you missed the headlines, just DuckDuckGo or Google it.

2. Bloomberg with a follow up on that press release, including expert opinion for context:

https://www.bloomberg.com/news/articles/2020-11-09/pfizer-vaccine-results-leave-questions-about-safety-longevity?cmpid=BBD111020_MKT&utm_medium=email&utm_source=newsletter&utm_term=201110&utm_campaign=markets&sref=6uww027M

3. This the public SEC form 4 for the Chairman and CEO of Pfizer. What it shows is a sale of 62% of his stock in Pfizer the same day their press release hit and shot their stock to the moon. Now, this is perfectly legal (no, really, it is), as the fine green print at the bottom announces this sale was part of a plan to sell this much stock on this date that was adopted in August of this year. That the execution of that plan happened to be on a day they press released the good news of a highly visible, highly watched Phase 3 study for a vaccine for the pandemic, and would thus likely maximize the return on the sale of 62% of the total personal stake of stock, could just be coincidence.

But I will say this much, since it’s a general point. Much of the commentary in the Bloomberg article (number 2 above) could and would have been addressed had Pfizer published these findings. But, going through peer review takes time. You cannot be certain of how quickly and when reviewers will finish their reviews, how quickly and when revisions will be accepted, and finally what specific date the journal will publish–even e-publishing ahead of print. That’s a lot of uncertainty in timing, even if the actual information in that release is more reliable, complete, and vetted.

So, hypothetically, if one were about to sell a large portion of a very large amount of publicly traded stock and wanted to maximize the returns (Christmas shopping season is coming up after all),…

and you, by nature of your job and role HAVE to file plans to sell big chunks of stock like this far ahead of time or be accused of insider trading…

and as a result that massive trade has to execute on one specific date…

well, you might have some worry about all of that timing uncertainty. All the stars would need to align for the data to be ready, the paper to be written, reviewed on time and published on time, to get a top or near top price on that one specific date–if the results were going through the usual publication channel with all that timing uncertainty.

You might worry so much that you might look for ways to better manage the timing, and still get the good news the world is waiting to hear out to the market. You would deserve a top tick price for that, right?

How uncertain is the timing of a press release–in comparison to scientific publication?

Who decides if a press release will be issued, who has final say over its content and final say over the exact time and day it will be released?

Who, I wonder?

4. And obviously…

https://investor.lilly.com/news-releases/news-release-details/lillys-neutralizing-antibody-bamlanivimab-ly-cov555-receives-fda

The BLAZE-1 study is the New England Journal of Medicine paper cited in the “cannot comment on” section from two weeks ago.

–Around the world, the disease is rampant. Japan is now experiencing another spike in cases. Some parts of Europe may have crested, but there are potions that are just getting slammed. Headlines, for instance, that morgues in Milan are having difficulty keeping up. Stateside there are local and regional (state-level) walk backs in re-opening status. For example, in Indiana, there are new restrictions on social gathering size (religious services exempted) at the state level–the exact restriction depends on how active the disease in your county is. For the most part, its still rural counties leading the charge in this new wave. But, while a slower ascent than in March-May, the increase in new cases has been extremely steady and is now creeping back into pockets in Indianapolis and its suburbs. Indianapolis’ mayor, in his continued quest to one up the governor on any shut down due to COVID this year, is ordering schools closed after Thanksgiving and through the middle of January at the earliest, along with new restrictions on bars, gyms, restaurants etc.

Remember a few updates ago when the Indy mayor kept a more draconian and more enforced face mask restriction? We highlighted it as part of the discussion on how a mask appears to help at the personal level, but thus far, evidence from around the globe (including a Lancet publication we mentioned) showed that at the public health level, the impact was minimal on rate of cases and severity? Indianapolis never lifted those restrictions. And lo and behold, a widespread virus that is as contagious as the common cold found its way back in to pockets still in the area that had not been exposed yet.

Exactly like what the evidence in the Lancet paper suggested was probably going to happen.

New York City is also threatening new restrictions. Here is the rise they are concerned about, presented with their own graph:

–Now, in fairness, hospitalization rates in some of the currently affected places are quite high. Milan, Italy for example. Some hospitals in rural parts of Indiana are dealing with high capacity. In fact, the current census for COVID is higher now, statewide, than during the March-May peak. Available ICU beds, again at the state level in Indiana, are starting to be squeezed–in fact, more so than they ever were in March-May. It’s sheer force of numbers at this point.

–The challenge now is that I think efforts at re-introducing restrictions will be difficult, if not impossible to enforce. Credibility has been the first casualty of COVID for far too many institutions. Small business surveys in the US show that many of them are still barely managing, and will view this as a question of survival. I would expect citations to become more common (assuming that the rank and file police will give more than lip service to enforcement) and legal challenges to those citations to become more common. I would also expect loopholes to be found, similar to the long running loophole of bars in Utah. You can’t get alcohol at a bar in Utah–but you can if you are a member of a club, so the bars would famously have membership forms you signed as you walked in.

For example, you may soon be walking into the First International Church of Denny’s to get your grand slam on, where you will be celebrating the eucharist of the Holy Pancakes as part of your religious observances.

Verily, my brothers and sisters, did He say “Let there be bacon” and He saw the bacon, and it was good.

–So are some of these still efforts in “appearing” effective as opposed to being actually effective? I think that will be the net effect in a lot of places–even if they are probably justified in places like Milan right now. Again, I am on board with WHO guidelines on lockdowns. They are necessary if the local/regional hospital system is approaching an overwhelmed status–but should be reserved for that level of emergency. How close you are to that will vary. How close your leaders think you are, and how much they want to be perceived as effective, will vary even more.

–Yes, new treatments may help–but tougher for me to comment on those now under FDA rules. Thank you for understanding.

–So keep that month supply of food handy. There may be additional, and still quite random, re-lockdown or partial lockdown effects to be had.

–Continue to be prudent with your social distancing. Remember that your risk of contracting coronavirus, at this phase, is still very much a local one. There are definitely places with a lot more activity. There are places with a lot less activity. The nationwide survey of hospitalization from the CDC’s COVID-NET is 75% of the big July peak, and about half the even bigger April peak. In fact, in the last week or two, the hospitalization rate is dropping again. But not in Indiana. And not in other parts of the upper Midwest and Big Sky. And definitely not in Maine, which is leading the rt.live Rt table right now.

–Net activity in the US is lower in this third “ripple” wave from the big one in March-April–but is sustained spread and still finding plenty of pockets of susceptible hosts out there. High activity at the local/regional level continues to drive what you are seeing in the headlines now–coupled with ever increasing numbers of tests.

–I still think this puts us on pace for the far end of the “UFC based” herd immunity calculations–which are into 2021, unfortunately. An anecdotal promising sign is that I am running into a LOT more people here who have told me they have had a positive test X months ago or Y weeks ago. There -is- a critical mass of those people we will hit, and when we do, new cases will plummet like a rock because the virus will run out of available susceptible hosts.

–Re-infection continues to be vanishingly rare, given the millions and millions of confirmed cases worldwide.

–Phase 3 data on the mRNA vaccines is coming soon, and we’ll have more to say about how those work when that comes.

–Life in the time of Coronavirus:

“It’s bam-LA-niv-ah-mab“

It’s also a generic name. Drugs have a generic name and a trade or brand name, like acetaminophen is the generic of Tylenol (the trade, or brand name). There is not a lot of choice on the generic name. That “–mab” part in particular HAS to be on the end by law, because it’s a monoclonal antibody. The generic name tells us physicians a little bit about the drug, and thus, how it should be working. Another example is abemaciclib, whose brand name is Verzenio. The “-ib” end of the generic tells you that it’s a small molecule inhibitor.

Bamlanivimab will get a brand name at some point, I’m sure. It will be just as “science-y” sounding as the examples above, but probably a little easier to pronounce.

Probably.

–Your chances of catching coronavirus are equivalent to the chances “Black Betty” is now stuck in your head.

–Your chances of catching ebola are equivalent to the chances that you are upset by this.

<Paladin>