Ebola

–Other than several thousand miles, there is not much differentiating the outbreaks in the DRC and Guinea right now. Both are still under 20 confirmed cases each; new cases are popping up sporadically, and as near as I can tell in known transmission chains. Vaccine is available in both locations and rings have been established vaccinating those in close contact with the known cases. Both have lost at least a few people to follow up though, and at least in the case of Guinea, there are 4 lost contacts suspected to have crossed borders to neighboring African countries. Spread to geographic neighbors is thought to be high risk at the moment, but no cross border cases reported thus far. Both locations are reporting “community resistance” to vaccination and follow up efforts, and at least in the case of the DRC, despite having an outbreak there very recently, do not have adequate isolation facilities nearby for safe treatment of known cases. Just another day in the Democratic Republic of the Congo. Both outbreaks are likely to roll along for at least a little bit, although vaccination appears to have been fast and furious, and should hopefully still contain both outbreaks quickly.

Coronavirus

–Thanks to those of you who wrote after seeing the news yesterday. But again, this is news I cannot comment on:

https://investor.lilly.com/news-releases/news-release-details/lillys-bamlanivimab-and-etesevimab-together-reduced

–In other treatment news this week, GSK and Vir have an antibody treatment that showed strong Phase 3 results and will likely be submitted to join antibody based treatments already available from other manufacturers. Thanks also to those of you who sent news reports you saw of Merck’s latest inhibitor. That indeed did post positive phase 2 data, suggesting it is efficacious. Unclear yet if they will be allowed an EUA off of the Phase 2, or if that will wait for Phase 3 studies which are getting started. The Merck inhibitor was compared to TamiFlu in some of those reports, in that both are pills with a molecule that blocks viral replication. You can take the Merck inhibitor at home, versus the antibody treatments which need to be provided by IV infusion. That’s about all I can say about those.

–As a reminder, because this did come up a couple times this week, because I work in the industry there are very strict limits on what I can say about drugs from my employer or others, even though this is a discussion with friends and family for general information about news and articles in the SARS-CoV-2 pandemic, and not AT ALL medical advice. You should always follow the recommendation(s) of your physician, and use any medication according to its label and under the guidance of a healthcare professional.

I don’t write press releases. If you have questions about a specific medication, my employer, and the other companies mentioned, have hotlines listed on their websites for questions from patients, physicians/healthcare providers, and/or investors. Trust me, there are legions of people whose entire job is to man those phones and address those questions, waiting to talk to you!

Yes, I am a co-author on the peer reviewed scientific publications for the clinical studies for the treatments my employer has brought forward. Even so, there is a “corresponding author” listed on every peer reviewed scientific publication. I am NOT the corresponding author for these studies. If there are questions about them, please direct them to the corresponding author at the address mentioned in the publication in the footnote by their name. Any time I have mentioned “no comment” and “despite the byline” in some sense or another in updates past, this is why.

This is the most heavily regulated industry on Earth–but there’s a budget for research that dwarfs the NIH and doesn’t condemn me to spending half my time writing grants and hoping for the best. I’ve heard outside consultants tell us they thought making airplanes was highly complex, with long product cycle timeline, safety is paramount, and high degree of regulatory difficulty–right until they were asked to look at the pharmaceutical industry.

There are reasons I am being deliberately vague and doing a lot of “no comment” in these early sections on this kind of news, and thank you for your understanding.

–Alright, on the rest of the news this week…

–In the US, cases continue to fall across most of the nation. Again, some local variance, and Texas has not a’sploded yet, so good signs there. We’ll also see if there is any post Big Ten Basketball Tournament and post March Madness bump in Indiana numbers as the month progresses.

That said, the rate of decline in new cases is dropping. If there is an effect of the novel, more contagious variants, that may be it. They will first level the curve, and if re-infection is a problem in particular, start to tilt it back up. Again, we should know by the end of the month, April-ish if that is a real threat.

The biggest problem the virus has, at least in the US, and probably many other places in the world too, is that it is running out of susceptible hosts. The New York Times this week was quoting actual epidemiologists (unlike me and my envelopes) estimating that 40% of the US has either had COVID and recovered (with immunity) and/or been vaccinated. I still think that is a low estimate, but the point is that herd immunity is creeping closer. Barring a virus that can re-infect a large percentage of people already immune to SARS-CoV-2, this is the kind of epidemiology curve you would expect. The rate of new cases starts to fall and keeps falling as the virus runs out of susceptible people to infect. Again, the selection pressure on the virus will in general to be more contagious, but generally less severe, because it has to be fast and sneaky to maximize the dwindling opportunities to infect new hosts.

–Speaking of which, I have not seen an update on South Africa’s known 4,000 reinfections. Again, if our South Africa reader has seen or heard of an official calculation of B.1.351’s (variant first ID’d in South Africa) reinfection rate, that would be very helpful!

–Regardless, the end game is likely nigh. Even the CDC, as I am sure you saw, released guidelines this week to the effect that those who are successfully vaccinated can pare back on social distancing requirements. That will probably be uneven, especially where businesses are concerned. It is a litigious society, and a business that drops distancing too fast, but then has an employee fall sick from a case acquired at work may still be at risk. Big chain businesses operating in multiple states will also be a little challenged in their internal decision making. Say, for example, you’re a big box retailer with stores in Texas and California. Cali still has restrictions. Texas has lifted them. Do you lift restrictions in ONLY your Texas locations? Can you communicate and enforce that effectively? Or is it easier to just keep the most restrictive locale’s rules in place across ALL your locations until everyplace is comfortable enough to re-open–since you will get in trouble for being not social distanced enough in a restrictive locale, but NOT for being excessively cautious in an opening locale (other than perhaps some annoyed customers)?

Honestly, could be a good opportunity for smaller businesses which can adapt better and more quickly to their local rules.

–Also been hearing much more activity of other businesses starting to draw up plans for what they will look like as restrictions end. Do they need all that office space? Who doesn’t need to be back into the office, or nearly as often, and can be just as effective from home? Anecdotally, at least here in the middle, I have been shocked to encounter actual traffic during morning or afternoon commutes more and more lately. Granted, it’s still the kind of traffic I would have called light or low average back in the day. But it’s been awhile, and honestly, didn’t miss it any…

–I am quite cool with the rest of you working from home. That’s just the kind of selfless I am, folks! At least when it comes to your car on the road : )

–Also had a few people mention they tried to go out to restaurants to eat in the last couple weekends (as restrictions in Indianapolis itself have lifted a bit) and were shocked, shocked, that there were waits of over an hour on weekends again!

–That kind of speaks to the zeitgeist right now though, doesn’t it? Maybe it’s just the algorithms messing with me, but I’ve run into a few articles or headlines discussing the ennui of the present moment, and anxiety or depressed mood. After all, we’re coming up a on year now from when the lockdowns started in earnest many places in the world. I’m sure it was equally odd at this time during the Black Death and the Spanish Flu pandemics. You’re in the this weird spot where the bug is still moving, clearly, but not as bad before, and for the first time, the sun really is breaking through the clouds. So thoughts are turning to “back to normal”–but what is normal? For a year, normal has been very different from what normal was before. And normal next year is likely to look different from 2020 AND 2019. What is that new normal?

Here is where a good writer would some fantastic metaphor to capture this mood. Here is where a great writer just nails it, and the metaphor is so perfect, it clicks immediately and you know exactly what they mean.

Tragically, you’re stuck with me writing this, and I’m struggling. In some ways, I suppose, trying a new shoe is the best analogy. It doesn’t fit like the old shoe which was well-worn, and comfortable, and you liked it. You knew what to expect from that shoe. Then the entire sole fell off that pair and here you are in the store, shoe shopping, not because you really wanted to, but because now you HAVE to get a new pair of shoes. So you try on something pretty similar to the original pair, but it looks a little different. It’s not broken in. You take the first few steps in it. It’s not quite comfortable. You KNOW it’s different, but if I asked you, you couldn’t say quite how, or would be a little vague. “Well, it’s a little tighter on the ankle.” Or “Not sure about the new stripe they added to the side of this one.” Or “color’s a little different.” And really what you’re trying to do with those practice steps is figure out if this is a shoe that will work, once it’s used to you, and you are used to it. Do I give these a shot, or do I try on another pair? That’s what you’re thinking right now.

Yeah. Shoe store metaphors.

I’m James fookin’ Joyce over here.

Anyways. I think a lot of the practical will sort itself out. You’ll figure out where you work, and how you best work there. You may have figured out with the pause to reassess we’ve spoken about before that an entirely new direction is what you need, and you’ll find it. You know what it’s like to have taken some degree of interaction with friends and family for granted. You may have found you were better off NOT seeing certain people so often. Others, the public safety enforced separation has made clear you need to make more emphasis capitalizing on the time you do have. After all, by the time you are 18, you have spent 95% of the time you will ever spend in person with your parents. You played with your friends and your siblings growing up for the last time at some point. None of you knew it at the time though.

It’s why I still give piggy back rides to the kids at bedtime when they ask. One of them, sooner rather than later, will be the last one. And we won’t know at the time which one it is.

That’s the pinch at the ankle though, isn’t it? The part of this new shoe you’re starting to try on that feels different than your old pair of shoes?

In the before time, the long, long ago, way back in March of 2020, you knew what the world was like. You knew where you would be going and what you would be doing that day. You knew the grocery stores would be stocked whenever you got there, and that most goods you needed and wanted would be there when you needed them. You could travel anywhere in the world you wanted, as long as you could get yourself there. All of that had such inertia that you could safely bet on the world being that way.

If you didn’t know before, you know now that whole edifice is far more fragile than you thought. Think of how many people had to confront for the first time what happens if the truck with the groceries doesn’t show up. What if you couldn’t do the holidays with your family the way you always did. What if you couldn’t see your friends. How do you fix key parts when the only supplier is halfway across the world and suddenly, the boat doesn’t arrive. How there is far less redundancy in the system than you thought, and what happens to you if there is a failure in a critical system that makes the way you live most days work. What institutions and leaders really are capable of leading through crisis, and still have your trust.

And look at how little it took to rip the illusion of the inexorability, the inevitability, of that old world away. One tiny little virus, a cousin of the common cold, with a mortality rate just above a bad flu, but a vicious hospitalization rate, particularly early on. We’re coming up a year on this tomorrow.

Yeah. I think that’s what doesn’t feel quite right yet in the new pair of shoes, at least not for many people. And they can’t quite put it into words, that feeling. That malaise. That ennui. It’s different. It hits different. It’s not comfortable and known, but it’s right beyond what they can describe.

We’re going to have to walk around a bit, really put some miles and experience in, to get used to this new fit.

These aren’t the shoes you had on before.

You’ll get used to them though.

–Wanna know a secret?

I think you’ll wind up liking this new pair a whole lot better ; )

–Your chances of catching Ebola are equivalent to the chances that between credible accusations of pedophilia against Prince Andrew and now racism against other unnamed members of the Royal Family, there is not another new low for the House of Windsor out there somewhere.

–Your chances of catching coronavirus remain decent but falling. Soon they will be equal to the chances Prince Andrew ever takes the FBI up on the opportunity to sit down and clear the air about that whole Epstein business.

<Paladin>