Ebola—two new cases have now become 6 since April 10th.  They have already identified several hundred contacts, many of whom are vaccinated, but follow up has been frankly terrible due to the ongoing security situation in the DRC.  They have 6000 doses of vaccine in country, but WHO is warning that getting more will be difficult due to the coronavirus pandemic.  A significant flare is not out of the question.

For coronavirus:

—Bad news all around on the treatment front.  Gilead’s resdemivir has Phase 3 data from the aborted trial in China leak.  Since that is now public, I can say what was on the WHO’s website showed no difference from standard of care.  Because it stopped early, it did not have enough patients to be definitive and other studies with the drug are on going.

—Hydroxychloroquine continued its schizophrenic data pattern, as a VA study showed no benefit.

—All of that is a real shame, because if we had a treatment that could keep people out of the ICU or get them out quickly, this becomes a -whole- lot easier to deal with.

—Otherwise, you are left hoping for dwindling enough cases and herd immunity to return to some kind of normal (a flattened curve).  As we have been over many times, that is an imperfect trade off between the risks of significant economic disruption (and knock ons like risk of starvation, unable to afford treatments for other conditions etc) and risk of some amount of people dying of disease or lack of access to hospitals crammed to the gills with coronavirus patients.  Since the full CFR of SARS-CoV-2 is still an estimate, and deaths from secondary economic effects just a prediction with some serious error bars around it, that’s a tough call to make.

—Hence, re-opening will be in fits and starts.  You should expect situations like Singapore, where cases have re-exploded, and China, where rumblings of city level re-lockdowns persist.  They are going to happen. Some states are going to re-open, only to close again.

—And everyone is out in deep water here.  As an example, I know a midwest state whose governor’s office contracted with a consulting firm for pandemic quarantine exit planning—because, unbeknownst to
me, such experience…exists?  Regardless, it’s a contracting firm that turns out to have been set up and run by someone you have -definitely- seen on TV giving interviews about the pandemic.  But has somehow neglected to disclose this potential conflict of interest, or leveraging those interviews for exactly this kind of business. 

Would it surprise you to know they are a former highly titled government official?

<Identifiable details of a particularly ill-advised plan redacted–for now>

—Again, if you have not read “First, The People,” the must read article from last week, do it.  There are more outrages you can add.

—There is an entire class of “leader” out there who got where they are by cronyism.  If there is any benefit to this crisis, it is that it clarifies who those leaders are—that we might work on removing them.

—There are far too many “leaders” willing to make promises entailing sacrifices that -they themselves- will not have to make.  Far too many.  That’s how you get buyback scandals and trillions for the stock market, but $1200 of your own money for you.  Taleb’s “Skin in the Game” is excellent reading if you are out of Netflix this quarantine.

—One presidential election ain’t gonna do it.

—Which institutions still have your consent?

—Back to the science, antibody tests are out there suggesting asymptomatic disease is pretty widespread.  This is good news, and you know we have been expecting this.  It’s why I now expect the CFR will ultimately land between flu and 1%.  THAT SAID, be leery of some of these antibody tests. 

Take all serology tests reported in the news media with some salt for right now.

Hopefully at least one is accurate.  Because -that- test, showing high herd immunity, or an effective treatment, is what gets us back to work.

—And yes, if these high prevalence rates for antibodies (50x or so number of infected cases in some reports) hold up, it is -entirely- possible that the world was treed by a chihuahua.  I still think it’s less likely that’s the case, but it’s still very possible.  And it goes to show you how important the right, and rapid, diagnostic really is so decisions get made with the best possible information.

—Regarding all the meat packing plants and inspectors affected by COVID-19 and the USA Today article suggesting more are out there.  Yeah, close quarters warehousing and processing like that will be a risk.  Again, hold that 1 month supply until you need it, or you definitely -don’t-.  Biggest risks, at least in the US, are to distribution of food, not its production.

—And yes, we are getting some of the samples from <one particular pork plant in the news>.  We’ll do what we can to get it re-opened.

Your chances of catching Ebola are all but zero, though growing.

Your chances of catching the ol’ corona remain quite high, although trending down for most on this list.

<Paladin>