Update: October 7, 2020
Second Wave Signals Urgent Need for COVID-19 Vaccine
With a second wave of SARS-CoV-2 infection threatening many corners of the world, the need for an anti-COVID-19 vaccine becomes ever more urgent. Up until now, vaccine development has always taken years to complete, a timeline that the world cannot afford in the face of over 35 million infections globally as of now, and climbing. Despite the naysayers who maintain there is no way a viable vaccine is just around the corner, there is reason to believe that a vaccine against COVID-19 may not be that far away.
For starters, advances in the science of vaccine development have greatly sped up scientists’ ability to bring candidate vaccines rapidly on board. RNA vaccines such as Modern’s mRNA-1273 vaccine, for example, were brought to clinical trials within months of the virus itself being genetically sequenced. There has also been a massive cooperative effort on the part of industry, academia and governments to hasten the delivery of a vaccine, the kind of cooperation that has never before happened, or at least not on such a global scale.
Canada, for one, recently joined the COVAX Facility, a collective initiative designed to help guarantee equal access to a COVID-19 vaccine when one becomes available. According to the World Health Organization (WHO), over 170 economies are already participating in discussions on how to proceed with this initiative and help speed up the development and manufacture of not one COVID-19 vaccine but as many as possible.
Canada itself has earmarked some $220 million to this end and pledges to secure up to 15 million doses for citizens at home. Of course, the US has signalled it is not interested in contributing to any global initiative towards vaccine development. On the other hand, the US has committed approximately $10 billion to help industry develop and produce their own candidate vaccines through its “Operation Warp Speed” program.
The White House administration has similarly signed contracts to purchase 800 million doses from industry and many more after that as soon as industry has a vaccine they are ready to sell.
COVID-19 Challenge Trials
Apart from global logistics, there are simpler strategies that may help speed up the development of a COVID-19 vaccine as well. For example, so-called “challenge trials” are now being advocated by 1 Day Sooner, a non-profit group that is trying to get countries, including Canada, to allow industry to conduct human challenge trials in an effort to hasten vaccine development.
The concept behind a challenge trial is simple: volunteers agree to be vaccinated with a candidate vaccine, after which they are purposefully infected with the virus a few weeks later. This, they claim, will shorten the time required to assess whether a vaccine is effective or not against the virus. So far, only Britain appears to be ready to allow challenge trials to take place in young volunteers, with intentions to test the vaccine currently under development by the Imperial College in London.
However, challenge trials have been used in vaccine development before, and those who argue in favor of the approach rightly predict that the earlier the world can get their hands on a vaccine, the more lives will be saved. And don’t forget that a number of large-scale clinical trials are continuing to progress, with the promise that a vaccine could be proven safe and effective by the end of 2020.
COVID-19 Vaccine Development in the US and China
Pfizer, for one, has indicated that it could have data ready for review by the Food and Drug Administration (FDA) by the end of October. If their vaccine is approved, Pfizer has announced that they would be capable of distributing hundreds of thousands of doses by the end of the year. Two other companies — Moderna and AstraZeneca — are both in late-stage clinical trials as well, with promising results from Phase II trials reported earlier this year. Meanwhile, the state press in China maintains that hundreds of thousands of Chinese citizens have already been vaccinated with a vaccine from CNBG, the country’s largest vaccine manufacturer.
CNBG has neared the end of its own Phase III trial in which two different versions of its candidate vaccine have been tested in 31,000 volunteers, none of whom reportedly experienced any serious side effects. The company has apparently already filed an application to have its vaccine approved by China’s regulatory agency; while not yet approved, this slight omission hasn’t deterred many government officials and pharmaceutical executives from being immunized against SARS-CoV-2 with the CNBG vaccine.
Paradoxically, China now has so few COVID-19 cases that the company had to carry out its Phase III trial in countries in South America, among others, where the virus is still raging. Pushing hard to bring a vaccine to clinical trials and beyond risks engendering public mistrust, so efforts to speed up vaccine development may still backfire. Bearing this in mind, nine leading pharmaceutical and biotechnology companies — all front runners in the COVID-19 vaccine race — have signed a pledge that they will only seek approval for their vaccine if it is proven to be safe and effective. But the markets are already on board.
A recent analysis indicated that approximately 40 percent of US stock market gains are linked to hopes that a vaccine will be produced against the SARS-CoV-2 virus — so investigators are clearly expecting a breakthrough in the near future.
And with little sign that the SARS-CoV-2 virus is letting up, the world itself has a vested interest in speeding up the delivery of an effective vaccine.
Progress on the COVID-19 Treatment Front
Meanwhile, progress is being made on the treatment front as well. A meta-analysis of seven clinical trials published in the Journal of the American Medical Association showed that the administration of systemic corticosteroids reduced mortality at 28 days by one-third compared with standard-of-care among critically ill patients.
Based on this data, the WHO issued new treatment guidelines recommending that corticosteroids become standard-of-care for patients with severe and critical COVID-19 infection. Eli Lilly in turn announced that it has proof-of-concept data from an interim analysis of the BLAZE-1 clinical trial evaluating its neutralizing antibody, LY-CoV555.
As the company reported, results from its randomized, placebo-controlled Phase II study showed that its primary endpoint — change in viral load at day 11 — was met for one of the three doses of the antibody tested in symptomatic but not hospitalized COVID-19 patients. BLAZE-1 investigators also reported that COVID-19-related hospitalization rates, as well as visits to the emergency room, were reduced by over 70 percent in patients treated with LY-CoV555 compared with placebo controls.
LY-CoV55 is a neutralizing monoclonal antibody directed against the spike protein of SARS-CoV-2. In so doing, it blocks viral attachment and entry into human cells, thus potentially preventing, as well as treating, COVID-19. Lilly also announced that when used together with Gilead Science’s Veklury (remdesivir), Lilly’s JAK inhibitor, Olumiant (baricitinib) reduced time to recovery in patients hospitalized with COVID-19.
In the ACTT-2 trial, baricitinib, at a dose of 4 mg, plus remdesivir, reduced median time to recovery by approximately one day compared with remdesivir alone. Recovery was defined as patients being well enough to be discharged from hospital. Baricitinib is a JAK1/JAK2 inhibitor which is already approved for the treatment of active rheumatoid arthritis.
And Regeneron’s own antibody cocktail also reportedly reduced viral loads and improved symptoms in non-hospitalized COVID-19 patients. The trial is part of a larger program spearheaded by Regeneron in which the company’s own antibody, REGN-COV2, will be tested in both the treatment of hospitalized patients and for the prevention of infection in those who have been exposed to the virus.
REGN-COV2 is a combination of two monoclonal antibodies designed specifically to block infectivity of the SARS-CoV-2 virus.
Update: September 14, 2020
“Vaccine Nationalism” Could Prove the Undoing of COVID-19 Containment
Tension is mounting as nations big and small jockey around industry to ensure they are first in line to access a vaccine, should one prove to be successful against COVID-19.
By the end of August, the World Health Organization (WHO) counted 33 vaccine candidates in some stage of clinical trial evaluation. What’s at stake is nothing short of a world full of people who’ll need not one but likely two shots of a vaccine to bring the pandemic to a halt. The price of that prize is incalculable.
In the meantime, WHO Director-General, Tedros Ghebreyesus feels that “vaccine nationalism” may prove to be the undoing of the potential to halt the spread of COVID-19. As he sees it, the only way to use an effective vaccine is to use it fairly among those who need it the most. Countries that are now queuing up to ensure they get a vaccine first threaten to undermine that goal.
The United States isn’t among the 78 high-income countries who have signed onto a global vaccine allocation plan that guarantees members access to a large portfolio of vaccines as is currently promoted by WHO. Instead, Washington has handpicked five companies as being the most likely to come up with a vaccine by their target date early next year. In return, these companies have promised some 300 million doses of a vaccine in an initiative the White House has called “Operation Warp Speed.”
These companies include Moderna, a US biotech company which has formed a partnership with the National Institute of Allergy and Infectious Diseases (NIAID), Oxford University who has partnered with AstraZeneca, and Johnson & Johnson, Merck and Pfizer. Novavax announced it has joined the COVID-19 vaccine team supported by “Operation Warp Speed” in July.
And in truth, the companies the White House picked were pretty savvy as several are current front-runners in the race to develop a vaccine.
Moderna’s COVID-19 Vaccine
Moderna, for one, recently reported positive results in older adults between 56 and 71, as well as those 71 years of age and older, who reportedly mounted levels of neutralizing antibodies against the SARS-CoV-2 virus after two doses of its vaccine that were comparable to those seen in younger adults.
The company’s candidate vaccine, mRNA-1273, is a synthetic messenger RNA that encodes the stabilized SARS-CoV-2 spike protein. As of July, the company and its federal partner stated that it is on track to supply between 500 million to 1 billion doses a year at a dose of 100 µg now selected for their Phase III trial. In early August, the federal government in Ottawa also secured an agreement with Moderna to provide up to 56 million doses of its vaccine upon approval.
University of Oxford and AstraZeneca COVID-19 Vaccine
The University of Oxford/AstraZeneca partnership, in turn, is testing a viral-vectored coronavirus vaccine that again expresses the spike protein of SARS-CoV-2 virus. Already in Phase III clinical trials, interim results from their Phase I/III COV001 trial showed that neutralizing antibody responses against SARS-CoV-2 were detected in 91 percent of participants after a single dose of the vaccine, and in all participants after a booster dose.
AstraZeneca has already committed to supply more than two billion doses of their vaccine to the UK, the US, and several European and other national vaccine alliances including GAVI. In late August, the European Commission also offered AstraZeneca $396 million as a down payment to provide at least 300 million doses of its potential COVID-19 vaccine to its European country members.
Johnson & Johnson’s COVID-19 Vaccine
For their part, Johnson & Johnson published findings at the end of July in which they reported a single dose of their vector-based vaccine induced robust neutralizing antibody responses in rhesus macaques. These responses provided complete or near-complete protection in bronchoalveolar lavage and nasal swabs following SARS-CoV-2 challenge, suggesting that a single shot of the J&J candidate vaccine protected at least nonhuman primates against SARS-CoV-2 infection.
Ottawa has also reached out to Johnson & Johnson to secure up to 38 million doses of their candidate vaccine, if approved.
Merck’s COVID-19 Vaccine
Merck is a bit of a dark horse in the COVID-19 race, announcing it will begin its human trials of a candidate vaccine only in mid-August. However, Merck has expended some effort on the development of two potential vaccines in collaboration with the International AIDS Vaccine Initiative and has announced it plans to acquire Themis Bioscience, a company that is focused on vaccines and immune-modulatory therapies.
The company is also in collaboration with Ridgeback Biotherapeutics to develop a novel oral antiviral treatment for COVID-19. So, while not a front-runner, don’t count Merck out of any vaccine contest, as the company has a long history of coming up with vaccine “firsts” including vaccines for measles, mumps, rubella and chickenpox, all in widespread use today.
Pfizer and BioNTech’s COVID-19 Vaccine
Pfizer is actually working with Germany’s BioNTech on mRNA vaccines against the coronavirus, using strands of mRNA to generate protective antibodies. It, too, is now in Phase III human trials, with an earlier trial showing that after seven days of receiving a second dose of their vaccine, the BNT162b2 candidate vaccine induced neutralizing antibodies in adults up to the age of 55 years that were almost four times higher than levels seen in blood taken from previously infected patients.
In older adults, the same vaccine elicited neutralizing antibodies 1.6 times higher than those from previously infected patients. The partners are now on track to study their candidate vaccine in up to 30,000 participants in countries where viral infection rates are sky-high.
If successful, Pfizer and BioNTech anticipate achieving regulatory review as early as October of this year and promise to supply up to 100 million doses worldwide by the end of the year. Ottawa has also entered into an agreement with Pfizer to secure a quantity of its potential vaccine, with Pfizer promising to supply a minimum of 20 million doses to the federal government, should its vaccine be approved.
Novavax’ COVID-19 Vaccine
Novavax has also tested its recombinant SARS-CoV-2 nanoparticle adjuvanted vaccine in a Phase I/II trial. It was recently reported that the addition of an adjuvant to their vaccine led to enhanced immune responses that exceeded responses in convalescent serum from symptomatic COVID-19 patients.
China’s COVID-19 Vaccine: Sinovac Biotech and CanSino Biologics
It is also worth pointing out that there are two companies in China — Sinovac Biotech in Beijing and CanSino Biologics in Tianjin — who are also key contenders in the COVID-19 vaccine race. Sinovac Biotech is already in Phase III clinical trials testing its CoronaVac vaccine which it plans to evaluate in approximately 11,000 volunteers. Unlike other candidate vaccines, CoronaVac is an inactivated whole virus vaccine developed through the same process as has long been used to make influenza vaccines, among many others.
CanSino Biologics is developing a vaccine that involves snipping a bit of the virus’ genetic code off and coupling it with a harmless virus to provoke a SARS-CoV-2 immune response. The company is currently in Phase II trials, having published interim data showing a consistent antibody response, although that response seemed to fade in older participants.
An agreement had previously been reached between Ottawa and CanSino Biologics to launch a joint testing program in Canada. However, that agreement recently fell through because shipment of supplies to Canada had seemingly been sidelined by Chinese bureaucrats.
Russia’s COVID-19 Vaccine
Lastly, amid world-wide criticism, Russia’s “Sputnik-V” COVID-19 vaccine has actually now been tested in Phase I/II trials where investigators reported the vaccine induced strong humoral and cellular immune responses in all 76 participants.
Russia had already approved the Sputnik-V well ahead of having any substantial evidence supporting its safety and efficacy, which was the reason for the widespread criticism. In fact, even before investigators had published early Phase I/II trial results, Russia had received international requests for one billion doses of its vaccine. Russia has just announced it intends to test the vaccine in 40,000 participants in a late-stage trial.
Importantly, and even somewhat miraculously, no serious adverse events have been reported for any of the candidate vaccines tested thus far, a highly laudable finding.
New COVID-19 Treatments
As for new treatments, the FDA just authorized the use of convalescent plasma for the treatment of COVID-19. Convalescent plasma is antibody-rich plasma taken from patients who have survived COVID-19 with the intension of giving it to those who are currently infected in the hopes it might speed up their recovery. FDA commissioner Stephen Hahn himself made a statement echoing Trump that 35 more people out of 100 would survive the coronavirus if treated with the plasma.
However, Hahn later retracted that statement, as that claim seriously overstated preliminary findings released by the Mayo Clinic about the benefit of convalescent plasma. WHO chief scientist, Soumya Swaminathan also expressed extreme skepticism of the new treatment’s benefits, stating that so far, there is little evidence to support the use of convalescent plasma for the treatment of COVID-19 infected patients.
The National Institutes of Health in the US recently announced it was putting several million dollars toward a convalescent plasma trial.
Update: July 27, 2020
As of the morning of July 27, 2020, the Johns Hopkins Coronavirus Resource Center posted the following statistics:
- The number of confirmed cases around the world now exceeds 16 million with close to 650,000 deaths
- The US continues to lead the world in the number of confirmed cases at over four million while the number of deaths is now approaching 150,000. In fact, the infection rate across the US has doubled in less than one month. Unhappily, there are a rising number of people in their 20s, 30s and 40s who are testing positive. The Centers for Disease Control and Prevention (CDC) still says that the number of people infected with the virus is anywhere from two to 13 times higher than reported rates depending on the region
- Brazil still ranks second to the US with over 2,419,000 confirmed cases and about 87,000 deaths
- India is now third with over 1.4 million confirmed cases and over 32,000 deaths
- Russia’s confirmed cases count now exceeds 811,000 with over 13,000 deaths
- South Africa now has over 445,000 confirmed cases but only about 6,700 deaths
- Mexico is next at over 390,000 confirmed cases and about 43,000 deaths
- The United Kingdom is reporting over 301,000 confirmed cases and over 45,000 deaths. However, the rate of infections in the UK has remained stable over the past week and the so-called “reproduction” number (R0) remains below one, meaning that technically, the disease is on its way out.
- Spain, Italy, France and Germany are all reporting only slight increases over rates reported several weeks ago and their death rates continue to remain relatively stable. That said, the average number of new daily cases in Spain has tripled in the month since the country ended its lockdown, so what happens next is anyone’s guess
- Canada now has over 115,000 confirmed cases and almost 9,000 deaths.
ECONOMIC IMPACT: The US
If retail sales were the sole indicator that the US economy is recovering, the country would have something to cheer about.
According to the Commerce Department, retail sales rose 7.5 percent in June after posting a major surge in sales May, probably because people still had federal stimulus checks in hand to spend in newly reopened outlets.
However, that happy picture is clouded by an epic rise in the number of COVID-19 cases in many states including California, Florida and Georgia and many businesses are being reshuttered in an attempt to rein the virus in.
In fact, over a dozen states have either delayed plans to reopen or have introduced new restrictions as the number of cases hit record highs in mid-July. The number of people filing for unemployment benefits, while down since its peak in late March, still numbers over one million – the 17th week in a row that this many people have been without work. In fact, the US labor Department reported that almost 32 million Americans were still collecting unemployment at the beginning of the month although more recent reports suggest that the number of unemployed has now dropped by about half that number.
And people are returning to work. A survey conducted by The New York Times found that about 40 percent of people who had been out of work had returned to work in July. On the other hand, only about one-quarter of Americans who are still out of work felt they might get back to work reasonably soon and fewer than half expected they would ever go back.
Many retailers across the US have also now stopped giving their workers what they called “hero pay” in acknowledgment that the work they were doing during the pandemic was essential and, yes, possibly even dangerous.
The situation can only be expected to get worse as the federal government has now lifted a moratorium that protected millions of people who rent or live in homes with federally backed mortgages – estimated to be about 30 percent of all renters nationwide – from being evicted if they couldn’t pay their rent.
If jobs continue to disappear in the wake of swelling numbers of COVID-19 cases, the number of evictions can only go up. Furthermore, the $600 weekly jobless benefit offered to unemployed Americans is set to expire at the end of the month. All this cannot begin to explain the weird reality that the stock markets in the US (and elsewhere) are doing just fine. For example, the S&P 500 is just 100 points below its pre-pandemic peak while NASDAQ had fully recovered its losses by early June and is now reporting record highs.
In fact, financial markets have almost regained most of the losses caused by COVID-19.
Very hard to square with what the average American is still experiencing as a result of the pandemic.
ECONOMIC IMPACT: Europe and the United Kingdom
The most important news out of Europe was the €750 billion ($1.16 trillion) agreement reached in late July between leaders of the 27 countries in the European Union, a truly historic stimulus package designed to rescue flailing economies from COVID-19. Under the agreement, the very Canadian-like plan will allow the European Commission to transfer wealth from “have” countries to the “have nots” – a distribution of joint debt that, until now, wealthier countries like Germany and the Netherlands had refused to consider.
The package is made up of a €390 billion fund in grants and a €360 billion in low interest loans. Italy is one of the key countries expected to really benefit from the stimulus package. As Europe’s third largest economy, Italy represented the biggest risk to the European Union and if the Italian economy was left to drown, it threatened to pull the entire EU and the euro down with it.
In the meantime, Spain was hoping to welcome tourists back to its beaches but alas, is experiencing a new wave of infections, which threatens to hit summer fun hard. More than one in eight jobs in Spain are related to tourism so the country needs to keep its doors open if the economy is ever to regain momentum.
Elsewhere in southern Europe, tourism is also slow. In Italy, bookings are down about 80 percent and apparently ferries to the Greek islands are carrying half the number of passengers they used to carry. Vacationers are traveling, just not outside of their own countries so tourist spots are apparently getting only a trickle of guests compared to last summer.
Here again, the stock markets are functioning in a parallel universe. The Euro Stoxx 50 Index, for example, has outperformed its peers around the world. Germany’s DAX index has also regained most of the losses incurred in March and overall, confidence is returning to the EU, at least in part because of unprecedented stimulus packages that solidify the future of the union.
Over the Channel, Britain is making its tentative way back towards a “V-shaped” recovery, although that recovery might not last. Retail sales in the UK have bounced back to relatively high levels, even though initially, sales were extremely anemic, with only a 0.9 percent growth in the service sector in May.
Online sales seem to be responsible for much of the spending with average sales hitting a record of £2.5 billion in June.
ECONOMIC IMPACT: Canada
Here in Canada, the stock market is behaving just like most of the others in other parts of the world: The S&P/TSX Composite Index, for example, has gone up 45 percent since it bottomed out at the end of March – offsetting 75 percent of the market’s losses from the first COVID-19 hit. And stimulus packages continue. For the second time in a row, Ottawa is extending its wage subsidy program to companies who are struggling to get back from the wasteland caused by COVID-19.
The program covers 75 percent of employees’ wages provided they continue to work, but spending from the program has actually been below projections as only about $18 billion had been paid out by the first week in July. Meanwhile, multiple lobby groups and businesses across the country are warning the government that the restaurant and food-service industry is about to sink unless the government extends some sort of relief package to them as well.
Employment in the food-service and accommodation sector had dropped by a third compared to pre-COVID-19 levels. Rent is the biggest bane of restaurant owners’ lives, but the Canada Emergency Commercial Rent Assistance program hasn’t helped much because it is up to landlords to apply for assistance and many of them who should have, have not.
Furthermore, small businesses whose premises are in government-owned buildings are not eligible for either federal or provincial rent relief programs so they, too, are crying the blues. As is true for the Bank of America among others, Canada’s “Big Six” banks are anticipating mounting losses to the tune of about $11 billion as stimulus packages wind down and people start to default on their loans.
At the same time, four of Canada’s largest banks are collecting very big bucks from the US government as they dole out US funds to small American businesses eligible for federal loans. Banks that extend loans through the federal government’s Paycheck Protection Program get generous fees of up to five percent for administering the program, and Canada’s banks are pocketing very heavy change for the service.
Back home, data from Workers Compensation Boards indicate that about 17,000 employees across the country have filed claims for lost wages because of COVID-19, and approximately 13,000 of those who have filed being health care workers. In Alberta, most of the COVID-19-related claims are from people who currently work, or have worked, in the meat processing industry.
Despite this, the housing market continues to rebound unabated, with sales up over 15 percent compared with a year ago, according to the Canadian Real Estate Association.
Drugs and Vaccines
The most promising news about any drug thus far in the pandemic just came out of the UK where Southampton researchers together with Synairgen showed that an inhaled form of interferon-β helped protect COVID-19 patients against developing severe disease.
The study involved 101 patients recruited from hospitals in the UK who were treated with the anti-viral drug, SNG001, an inhaled form of interferon-β. Patients who received SNG001 were at least twice as likely to recover, to the point where their day-to-day activities were not limited by COVID-19. Treatment also significantly reduced breathlessness, one of the main debilitating symptoms of severe COVID-19 infection.
It is thought that COVID-19 suppresses interferon-β production and that treatment with this new drug may boost the lung’s antiviral defenses against the virus.
Meanwhile, a study published in the British medical journal The Lancet is raising hope that there may be a vaccine against COVID-19 in the not-too-distant future.
The candidate vaccine is from the Chinese company, CanSino. According to the report, the company’s recombinant adenovirus type-5 (Ad5) vectored COVID-19 vaccine was tolerable and immunogenic at 28 days post-vaccination and deserves further investigation. The CanSino vaccine is a now scheduled to be testing for further efficacy in a larger trial in Brazil.
The Trump administration continues to pump money into vaccine research, this time shelling out $1.95 billion to buy 100 million doses of a COVID-19 vaccine being developed by Pfizer and the German biotech company BioNTech, provided their vaccine proves to be safe and effective.
The deal is part of “Operation Warp Speed” whose aim is to shorten the time it takes to develop and test any vaccine. The US has put in a lot of additional money into at least half a dozen other efforts to develop a COVID-19 vaccine at “warp speed.”
Lest you think all this research effort is altruistic, keep in mind that companies such as Novavax are getting billions of taxpayers’ dollars to develop a COVID-19 vaccine, only to hand over tens of millions of dollars in stock options to their top executives – even if their vaccine never makes it to the market!
Elsewhere, The University of Oxford recently announced that results from the first phase of their clinical program showed that their vaccine is safe and induces strong immune responses. If all goes well for Oxford, they predict that their candidate vaccine could be ready for widespread use by the end of 2020. That’s if Russia doesn’t get its hands on it first.
Last week, Britain, Canada and the US all accused Russia of trying to steal information from researchers working on the development of a COVID-19 vaccine. The hacking group, known as “Cozy Bear,’ is thought to be part of the Russian intelligence service and is taking aim at research institutions in order gain some sort of edge on COVID-19 development.
COVID-19: Future and Predictions
With all the to-and-fro-ing about whether wearing a mask protects the wearer or at least those around them from COVID-19, the CDC now appears to have come out squarely in favor of masks. In a case described in their publication, Morbidity and Mortality Weekly Report, the CDC describe a situation where 139 clients had been exposed to two hair stylists, both confirmed positive for COVID-19, but who wore masks while styling their clients’ hair (as did the clients).
Having contacted each and every client after the fact, the CDC found no symptomatic cases. Among 67 clients tested for SARS-CoV-2, all tests were negative. And in an unpublished analysis of 194 countries, in countries where masks were not recommended, mortality from COVID-19 increased by over 50 percent every week after the first case was documented in the region.
In contrast, where masked were mandated, the weekly increase in COVID-19 deaths was only eight percent.
So against any future speculation, wearing a mask in cramped public spaces seems like a good strategy. And in fact, many countries have already mandated the wearing of masks in public areas including France, Germany, Italy, Spain and even, most recently, the United Kingdom, where those who refuse to do so, face a fine of £100. Strangely, people who work in shops and supermarkets in the UK are only encouraged to wear a mask, but they are not mandatory for employees even in places where shoppers must don one.
Germany is not taking any chances either – citizens returning from high-risk countries not only have to wear a mask, they have to be tested for COVID-19 before they are even allowed out of the airport. In the US, it’s still a patchwork productions approach to mask-wearing but slowly – too slowly, given the surge of new coronavirus cases in recent weeks – more and more US states are implementing mandatory mask requirements.
Some American businesses aren’t waiting for the government to mandate masks. For example, Walmart now requires shoppers to wear a mask in its stores while Target, CVS, Winn-Dixie and Whole Foods have the same policy as do Lowe’s and Home Depot, Apple, Best Buy and Starbucks. Most US airlines have also made it known that passengers who aren’t wearing a mask on their flights won’t be going anywhere soon.
American and Southwest have announced they won’t let passengers even board if they refuse to wear a mask, while Delta Airlines has announced that anyone who refuses to wear a mask will need to be screened before being allowed to board. Canadian airlines have done the same and cities like Toronto and Montreal have made masks mandatory on public transit and in indoor public spaces.
On the other hand, there are some staunch holdouts against protecting citizens. Georgia’s Governor, Brian Kemp, has suspended all local mask mandates even, or perhaps in spite of, cities like Atlanta who had made masks mandatory. Ditto the Governor of Oklahoma, despite the fact that he himself has actually tested positive for COVID-19.
As stressed by the CDC’s director Dr. Robert Redfield, “Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting. All Americans have a responsibility to protect themselves, their families and their communities.”
Amen.
Update: July 13, 2020
Global Footprint
As of the morning of July 13, 2020, the Johns Hopkins Coronavirus Resource Center posted the following statistics:
- The number of confirmed cases around the world is approaching 13 million, with over 569,000 deaths
- The US continues to lead the world in the number of confirmed cases at over 3.3 million with over 135,000 deaths. It’s been widely reported that Black and Latino people have been disproportionately affected by COVID-19 and the numbers per 10,000 people now suggest this with 23 per 10,000 infections among whites, 62 per 10,000 among Blacks and 73 per 10,000 people among Latinos
- US officials have also estimated that approximately 20 million Americans have actually been infected with COVID-19, which would translate to about to about six percent of the population overall.
- Brazil has the second worst outbreak in the world, as it is now reporting over 1.8 million confirmed cases with over 72,000 deaths. President Jair Bolsonara recently admitted that he, too has tested positive for COVID-19 and he, like Trump, believes in the medicinal power of hydroxychloroquine, despite good evidence to the contrary
- India has now surpassed Russia with the third-highest number of confirmed cases at over 878,000 and over 23,000 deaths
- Russia now has over 726,000 confirmed cases with 11,000 deaths. The number of new infections is actually falling in Russia but the decline has mostly been confined to Moscow and not outside the capital
- Peru is next as the most infected country with over 326,000 confirmed cases and 11,800 deaths
- Mexico is now counting almost 300,000 confirmed cases and over 35,000 deaths.
- The UK has over 291,000 cases and over 44,000 deaths
- South Africa is counting over 276,000 cases but only about 4,000 deaths
- The numbers in Spain (~254,000), Italy (~243,000), France (~208,000) and Germany (~200,000) have climbed slightly over the past three weeks and the death rates have actually remained relatively stable
- Canada now has over 109,000 confirmed cases but the death rate at about 8,800 remains low. That said, the percentage of all COVID-19 deaths that occurred in nursing homes, standing at 81 percent, is the highest in the world followed by Spain at 66 percent. Interestingly, the median age at which people in Canada are being infected by the virus has been dropping since the beginning of April, according to the Public Health Agency of Canada
Economic Impact: Global
Newly lifted lockdown restrictions brought with them tangled consequences, key among them the ability to travel—or not. By mid-June, most European countries had selectively reopened their doors to continental travellers (although not to visitors from the US or Russia) but it’s not clear how many tourists are going to embrace the risk to visit others. Denmark, for example, will welcome some Scandinavian visitors but not those from Sweden, who did not lockdown its economy.
The Czech Republic said it would accept Swedish tourists but only if they have proof that they are negative for COVID-19 on arrival and agree to self-quarantine. Britain, too, has issued a warning that all international visitors must self-quarantine for two weeks although visitors coming from countries in Europe including France, Italy and Spain will be spared the self-quarantine rule. Visitors wanting to breach the shores of Italy will have to agree to the same mandatory quarantine if they are coming in from any country outside of Europe.
Meanwhile, passengers on any flight in the European Union will have to wear masks on planes and in airports. Down Under, Australia and New Zealand resumed flights between the two countries back in early June while Estonia, Latvia and Lithuania dropped travel restrictions between each other back in mid-May. Travel restrictions have also been lifted in Atlantic Canada where residents will be allowed to travel between the four Atlantic provinces, though not visitors outside of the eastern “bubble.”
Despite these fledgling steps, global aviation continues to flounder. In Late June, Airbus, an aerospace giant, announced it was cutting 15,000 jobs, blaming a 40 percent slump in its commercial aircraft business activity for the massive job cuts. The company also predicted that global air travel won’t reach pre-pandemic levels before 2023 at the earliest.
Among the many countries who have bailed out their airlines, the Dutch announced that they would be supporting the Dutch wing of the Air France-KLM group with $5.2 billion in rescue funds, a move that comes on the heels of the French government announcing a $10.7 billion rescue package for Air France in April. The German government has also acquired a 20 percent stake in its national airline, Lufthansa. And Chile’s LATAM Airlines Group has now filed for bankruptcy protection, announcing it had accumulated $7.6 billion in debt even though the airline still plans to fly while it sorts out its financial woes.
Globally, the United Nations Conference on Trade and Development predicted that at best, with lockdown measures in place for only four months, revenue from global tourism will drop by $1.17 trillion which could balloon up to $3.3 trillion if the lockdown lasts a full 12 months.
In the US, ten US airlines have now signed letters of intent to accept government loans through the $2 trillion relief Cares Act package in addition to billions of dollars already received in government grants as they struggle to stay aloft.
Economic Impact: US
Predictably, as the rush to reopen the US economy in many States took off, the number of coronavirus cases went through the roof. In early July, the US was counting over 50,000 new cases a day, with Florida, Texas, Arizona and California emerging as the new epicenters of the pandemic. The new wave of infections prompted at least some of those states to order bars and restaurants to close back down again.
In fact, by early July, there was an increase in the number of cases in over 30 states and more than half of the US has either paused or reversed plans to reopen for business.
At about the same time, the relief program for small businesses, the Paycheck Protection Program, announced it was closing down—with over $130 billion still left in its coffers that could have gone to help preserve workers’ jobs. The relief program did hand out $520 billion in loans since its inception but as new outbreaks peak across the country, many more job losses are predicted and the so-called “left over” money could have helped mitigate the pain.
Prior to the new recent surge in viral cases across the States, job gains had been made but as businesses were ordered to close down again, further layoffs are predicted. Unemployment claims, also down from record levels of over 6.8 million in March, were still more than double the levels they reached in the 2007-2009 recession, with 31.5 million people still collecting unemployment in mid-June. Unbelievably, the federal government reportedly doled out payments worth $1.4 billion to dead people by the end of June as well.
Payments went to people who filed their income tax returns in 2018 and 2019 even though they had since died. Meanwhile, the Congressional Budget office predicted that the US economy would expand at an annual rate of 12.4 percent in the second half of the year, down from 15.8 percent it predicted in May but still unusually rapid growth.
Be that as it may, experts predict that the wave of “mega bankruptcies” by companies with $1 billion or more in debt will continue. For example, Tailored Brands, the parent of Men’s Wearhouse and K & G, have declared they may have to file for bankruptcy protection, joining almost 7,000 other companies that filed for Chapter 11 bankruptcy protection last year.
Brooks Brothers, a venerable men’s clothing store that has been in business for 200 years, has also filed for bankruptcy protection, as have department store chains Neiman Marcus, J.C. Penny and J. Crew. By the end of June, the stock market’s rebound that actually started last March scuttled back by almost five percent at least in part because of concerns over the surging numbers of new COVID-19 infections across the southern US.
The economic fallout is also predicted to be long-lasting. One group of authors argues that the COVID-19 pandemic will make people and business owners more wary of resuming pre-pandemic spending and investment patterns, while others argue that young people who survive a pandemic such as COVID-19 cannot be expected to trust government and public institutions for many years, making it more difficult for governments to manage any further pandemics that could occur in the future.
The one bright spot in the economy: Liquor sales, which were up, way up, by the end of June!
Economic Impact: Europe and the UK
The biggest economic news to be coming out of the UK is that the pubs are finally open again. This reopening met with mixed reviews, as photos showed that many who’d imbibed a tad too much weren’t all that good at social distancing. Meanwhile the Chancellor of the Exchequer in Britain announced a $37.7 billion plan for tax cuts, employment coaching and a 50 percent discount for people who patronize restaurants and pubs.
Employers will also receive 1,000 pounds for each employee they recall to work through to January next year. In France, the world’s most-visited museum, the Louvre, finally opened again after being closed for four months, though the number of visitors was only a fraction of their usual head count because of international flight restraints.
Over in Italy, the economic picture is still grim for many of its citizens. Because Italian banks are already overwhelmed with debt, loans are hard to come by. So Italians are resorting to a time-honored practice of taking whatever they have of value to pawnshops—referred to as the collateral loan sector—to try and secure whatever they can to tide them through.
Overall though, European stocks seem to be in relatively good shape, the pan-European STOXX 600 having outperformed world stocks by about 1.5 percent in the past few months. The health of the European economy has a lot to do with the Union’s proposed $841.5 billion recovery fund that will help countries hardest hit by the virus to get back on their feet.
Nevertheless, the European Commission expected the GDP in the EU to shrink by over eight percent this year, with the biggest contractions happening in Italy, Spain and France and the smallest in Germany.
Economic Impact: Canada
In Canada, financial experts were predicting that the GDP would contract by ten percent in the second quarter. In April alone, food and accommodation services had dropped by a good 42 percent, manufacturing followed with a 22.5 percent decline, while construction and retail were down by 23 percent—all on the heels of deep loses already posted in March. According to Statscan, no industry remained unscathed.
However, loses were especially apparent in the airline industry. Air Canada alone closed down 30 domestic routes and terminated operations at eight airports across the country. Air Canada has also laid off about 20,000 employees while other Canadian airlines including Westjet, Air Transat, Porter and Sunwing have all halted operations as the federal government continues to impose travel restrictions especially between Canada and the US.
That has not stopped the federal government from trying to prop up provincial and territorial tourism by splashing some $30 million in advertising to prod Canadians into discovering their own backyard. The tourism industry employs about one in every 11 Canadians so its collapse is a very big deal.
Overall, the federal deficit is predicted to exceed $300 billion this year as the government continues to pay its way out of the pandemic for individuals and companies alike.
Still, all is not doom and gloom. In the month of June alone, Canada set a record by adding over 950,000 jobs to the labor market, which, combined with job gains made in May, represented a 40 percent recovery of some three million jobs lost to COVID-19 earlier in the year.
COVID-19 Treatments and Vaccines
A study published in the Mayo Clinic Proceedings supports the use of convalescent plasma as a way to alter the clinical course of COVID-19 and possibly reduce related mortality. In a collaborative effort involving some 20,000 hospitalized COVID-19 patients, researchers found that in patients who received transfused plasma, the incidence of serious adverse events (AEs) was under one percent, including rates of transfusion reactions and thromboembolic or thrombotic events. Mortality at seven days was 8.6 percent although it was slightly higher among more critically ill patients as well as those who needed ICU care and ventilation.
These data provide solid evidence that transfusion of convalescent plasma is at least safe in patients hospitalized for COVID-19. The Korean Centers for Disease Control and Prevention also announced it has conducted antibody tests on 1000s of blood samples in an effort to determine herd immunity within the South Korean population.
However, Korean experts are not holding out much hope that the population has developed heard immunity against COVID-19. This sentiment has been echoed by European researchers who have found relatively low antibody levels in residents even in regions heavily infected by the virus.
Meanwhile, Gilead Sciences, who is behind remdesivir, has declared that it will charge $3,120 to treat a single patient, at least those with private insurance in the US. Treatment will cost slightly less for patients in other countries.
Vaccines
At the end of June, Inovio Pharmaceuticals said results from a small trial of their candidate COVID-19 vaccine were positive but failed to disclose how many patients produced neutralizing antibodies against the virus, meaning the vaccine might be beneficial and it might not be. That hasn’t stopped Inovio’s stock prices from skyrocketing despite the paucity of data, which so far have only made it into a press release.
Similarly, Moderna issued a press release describing their candidate vaccine minus any real data. Early-stage human trials of another candidate vaccine developed by German biotech firm BioNTech SE and Pfizer at least found the vaccine to be well tolerated and most volunteers who received two doses of the vaccine developed levels of COVID-19 antibodies typically seen in people infected with the virus. As a result, BioNTech shares again shot up over the past few months as did Pfizer’s stock.
Elsewhere, the WHO and its key partners have announced they plan to purchase two billion doses of a COVID-19 vaccine when one does become available for those at the highest risk of infection. WHO estimated that it will cost over $18 billion to deliver its plan to those at highest risk including health care workers and older adults. The organization has already signed a memorandum of understanding with AstraZeneca, who is partnering with Oxford University on a joint vaccine that is already in a Phase III clinical trial.
In early July, Novavax announced that it, too, has joined the COVID-19 vaccine team supported by the US initiative, “Operation Warp Speed”, having been awarded $1.6 billion to support any late-stage clinical trials that it needs to launch. Results from their Phase I trial suggest that mice and primates vaccinated with their candidate vaccine exhibited an eight-fold rise in neutralizing antibodies, which are thought to be protective against infection. For its part, Novavax has promised the US government it will provide 100 million doses of a future vaccine which would cover about 50 million people across the country.
The US government is already assessing 14 candidate vaccines, with plans to cut that number in half as research proceeds.
COVID-19: Predictions and Future Directions
Almost 135,000 Americans have now died from COVID-19 which is more than the total number of US military who died during World War I.
Now, a comparison of fatalities in the US with those in other countries including South Korea, Australia, Germany and Singapore—countries that took decisive, early measures against COVID-19—showed that between 70 and 99 percent of Americans who have died from COVID-19 might not have if the US had taken similar measures. To work this out, a team at the University of Oxford developed a “stringency index” based on 13 policy responses enacted by different countries to protect the population against the pandemic.
This index showed that two weeks from the 15th confirmed outbreak in each of the comparator countries, the US stringency score was much, much lower than each of the four countries’ scores, resulting in over 117,000 deaths in the four months following the first 15 confirmed cases in the US. During that same period, Germany had only about 8,900 casualties which, when worked out on a population-based scale, meant that 70 percent of deaths from COVID-19 in the US might have been prevented if the US had behaved like Germany in response to the pandemic.
Compared to South Korea, Australia and Singapore, the same stringency index showed that almost 99 percent of deaths that occurred in the US from COVID-19 might have been prevented if the US had behaved as decisively as these other countries did.
Update: June 22, 2020
Global Footprint
As of the morning of June 22, 2020, the Johns Hopkins Coronavirus Resource Center and the ncov2019.live web site posted the following statistics:
- The number of confirmed cases around the world now exceeds 8.9 million, up from 5.4 million barely one month ago. Globally, there have been over 468,000 deaths caused by COVID-19
- The US continues to lead the world in the number of confirmed cases at almost 2.3 million, from which 120,000 patients have died. This number is on track to exceed the death toll from the 1918 flu pandemic during which 675,000 Americans died. Furthermore, between March 1 and May 9, there were an estimated 26,000 more deaths than the number that would have been expected for that time of year. These “excess” deaths were not necessarily due to the virus but people may not have sought medical attention out of fear of contracting the virus and died of other causes.
- New York is now counting over 411,000 cases, up only slightly from the 359,000 cases it reported a month ago. The number of deaths from COVID-19 in New York has also climbed only slightly to approximately 31,000, up from about 29,000 a month ago
- Brazil is now reporting a blistering excess of over 1 million confirmed cases and over 50,000 deaths, making it the world’s second worst-hit country next to the US. Experts say that the actual number of people who have been infected with COVID-19 in Brazil is five to ten times higher than the official viral count
- Russia is reporting an excess of 591,000 confirmed cases but only about 8,200 deaths to date
- India is not far behind Russia with over 425,000 confirmed cases but has far more deaths at over 13,000
- The UK is unfortunately still leading Europe in both the number of reported cases at over 305,000 and over 42,000 deaths
- Peru now has over one-quarter of a million confirmed cases with approximately 7,900 deaths while Chile is not far behind with over 242,000 confirmed cases and approximately 4,500 deaths
- Spain has moved only slightly upward with about 246,000 confirmed cases compared with 235,000 about one month ago, while the number of deaths has remained the same as last month at just over 28,000
- The same is also true for Italy who is reporting slightly over 238,000 confirmed cases, up from 229,000 a month ago while the death toll has also stayed about the same at 34,000 compared with 32,000 a month ago
- France now has over 197,000 confirmed cases with over 29,000 deaths while Germany has almost the same number of confirmed cases at approximately 191,000 but far fewer deaths at only almost 9,000
- Canada is now reporting over 103,000 confirmed cases but a relatively low death count at approximately 8,500. Recently, people in their 20s have been driving the COVID-19 numbers up, especially in Toronto and Hamilton while the number of people in their 70s have made a relatively small contribution to the official viral count
- Overall, the death toll from COVID-19 is starkly higher in Western Europe and North America than it is in Asia. For example, the death rate per 100,000 people is highest in Belgium at 81.7 while in Spain, Britain, Italy and France, that rate runs between 42 to 58 per 100,000. In the US, it is approximately 30 per 100,000 and in Canada, it is about 18 per 100,000. Yet in Japan, South Korea, China and India, the death rate from COVID-19 is between 0.3 to 0.7 per 100,000 people, a remarkable geographic difference that nobody can explain.
Economic Impact
Economic Impact: The US
For the past month, the main story behind the headlines has been the reopening of the economy in the US and elsewhere.
And with the reopening, there have been plenty of ups—and downs—in these COVID-cursed times. National sales, for example, did see a rebound in May as stores and restaurants reopened after months of being locked down.
However, these rebounds came on the heels of record losses in March and April, and many stores and restaurants that were allowed to reopen in May reopened with far fewer employees, a fact reflected by predictions that the unemployment rate will still hover around 9.3 percent at the end of the year, down from its current level of 13.3 percent, but still far higher than pre-pandemic levels. Consumer demand for goods and services has also remained weak, indicating that just because a business has reopened doesn’t mean that it is doing good business.
Many have predicted a second wave of layoffs as businesses deal with weak consumer demand. Moreover, by the second week in June, some 21 states were reporting notable upticks in the number of positive cases or hospitalizations for COVID-19—this in essence only a few weeks after restrictions had been lifted on most businesses and large gatherings.
Meanwhile, after enjoying an inexplicable rebound since late March, stock markets in the US shed an average of 6.9 percent in mid-June, as investors apparently got real about the awful effect that the virus has had on the economy. Experts predict the markets will continue to be mixed, driven in turns by optimism and pessimism about hopes that a vaccine will soon be available to defeat the pandemic
May was also the month when almost half of commercial retail rents were not paid, even by companies like Starbucks who claims the shutdown has left them unable to fully pay their property bills on time. Starbucks has also announced it will close hundreds of coffee shops in Canada over the next few years in response to changes in consumer behavior necessitated by the pandemic.
Retailers in malls and of course movie theatres and gyms were unable to pay their rent at all in May and data indicate that fewer than 60 percent of retail rents were paid in May. One would think that the fed’s multi-billion dollar aid package for small businesses would have helped keep them afloat.
But the aid hasn’t, not because the money wasn’t there but because billions went into the pockets of public companies while small businesses lost out. This included wealth management firms, some of whom are responsible for managing billions of dollars a year on behalf of affluent clients.
And don’t forget about the Pentagon. The Pentagon had a plan to spend $4.4 billion for coronavirus-related medical care. By the beginning of June, only 15 percent of the funding allotted to the behemoth had been contracted out to suppliers.
Moreover, the Pentagon received $10.5 billion in Care Act funding to address the COVID-19 crisis but so far, they have spent only about $2.65 billion, with 100s of millions of dollars apparently being spent on stuff like space launch facilities and golf course staffing instead of the pandemic!
Economic Impact: Canada
Here in Canada, retail sales dropped by 26.4 percent in April, a predicted low point in the economy before the country gradually reopened in May. Continuing trends suggest the worst may be over provided the outbreak is contained over the next few months. For example, spending on cars and houses did pick up in May; some 290,000 new job postings were listed across the country and manufacturing plants started to climb back to life after being clobbered in April when sales plummeted.
In fact, almost 40 percent of small businesses are now fully open, up from 21 percent in late April and consumer spending is bouncing back, which should improve as more businesses continue to open throughout the summer. That said, Export Development Canada predicted that exports overall will fall a good 20 percent this year compared to last year.
The real estate industry is also posting major declines in home sales compared with a year earlier, despite a 56 percent increase in home sales in the month of May alone. On the plus side of the ledger, the pandemic has put downward pressure on urban rental properties, with rents actually dropping for the first time in decades as Airbnb owners in particular can no longer count on temporary visitors to fill their condos. Happily, too, the Canada Emergency Response Benefit (CERB) that has gotten many of the jobless through these past months has been extended to cover nearly six months of payments instead of four.
On the other hand, the cost of the program has now reached over $42 billion as some 8.4 million people applied for benefits. An estimated 2.4 percent of applicants have apparently been defrauding the program by “double-dipping”, a no-no that the federal government is threatening to punish.
Economic Impact: Europe
Europe is putting a lot of eggs into its tourism basket to kick-start their moribund economies. For example, tourism contributes to 13 percent of Italy’s gross domestic product and 40 percent of that comes from beach tourism. Starting in mid-May, different regions in Italy are allowing their beach clubs to open despite government warnings that any sharp rise in new infections would trigger another lockdown.
Greece is trying hard to entice British bathers to its sunny shores while the Spanish are working hard on Germany to send tourists to its beaches. In fact, most European countries have now reopened travel to continental residents although people arriving from outside of Europe will likely have to spend the first two weeks of their holiday in mandatory quarantine.
In recognition of the economic collapse caused by COVID-19 across the European Union, the European Commission has proposed it raise $826 billion to finance the continent’s recovery. The plan still needs to be approved by 27 national leaders and their governments but if it is, it will be the first time that the union has raised a large amount of money to be shared as a common debt among union members.
Still, as countries emerge from their own versions of lockdown, a return to business doesn’t mean a return to “normal”. From London to Paris to Milan, luxury shops are suffering big time, largely because well-heeled travelers from China, the Middle East and the US are no longer traveling and no longer spending while local shoppers at home can’t begin to replace wealthy visitors.
Restaurants in Europe and Asia are far from returning to normal either, though you have to applaud their efforts to keep people socially distanced while dining together. Some have placed Plexiglas partitions on the table between two diners, for example. Others have devised plastic bubbles that hang from the ceiling to keep people physically apart.
Still others have placed fashionably-dressed mannequins around the room to strategically distance diners, and large teddy bears have been used for the same purpose. Meanwhile, beleaguered Britain is trying to reopen its economy but with a 14-day quarantine rule in place for all travelers arriving in Britain, it’s far from certain how many people will be visiting Britain any time soon. Britain’s economy shrank by over 20 percent between March and April and it had already shrunk by nearly 6 percent in March alone. Nevertheless, much of the country’s retail sector was set to open by mid-June and people are being encouraged to return to work if they can’t do their job at home.
That said, the British government takes the prize for killjoy of the day. Recently, they announced that it was illegal for people from different households to meet indoors or—good grief—spend the night together! If people are caught sleeping together, they will be fined. As for predicting when there might be a second wave of COVID-19, Finland, Germany and the Netherlands have launched national waste water surveillance programs to detect COVID-19 should it rear its ugly head again.
Several laboratories have already shown that they can detect genetic material from the virus in wastewater. If this approach works, governments hope that wastewater analyses will help them detect the emergence of a second COVID wave before it has time to overwhelm the health care system. In the meantime, researchers are still cautioning against lifting COVID-19 restrictions too hastily, especially in France.
For herd immunity to happen, an estimated 69 percent of the population will need to be infected at some point in time. Right now, that figure is under four percent in France—a long way to go before the population can claim immunity against COVID-19. With all this, the Organization for Economic Cooperation and Development (OECD) still predicts the global economy will contract by six percent this year if a second wave of the virus doesn’t happen.
If it does, world economic output would fall by 7.6 percent before clawing its way back up by 2.8 percent in 2021.
Drugs, Vaccines and Masks
Separate lines of research have come up with some novel—and some not so novel—possible treatments for COVID-19. From the National Institute of Health/National Cancer Institute (NIH/NCI), researchers found that the Bruton tyrosine kinase (BTK) inhibitor, acalabrutinib (Calquence, AstraZeneca), approved for the treatment of certain hematological malignancies, appeared to reduce respiratory distress and the risk of a cytokine storm, which is an over-reactive immune response from which COVID-19 patients can easily die.
The study involved 19 patients hospitalized with COVID-19, 11 of whom had been receiving oxygen for several days and eight of whom had been ventilated. Within one to three days after receiving acalabrutinib, most patients in the oxygen group showed significantly less inflammation and could come off oxygen, although symptomatic improvement was less dramatic in patients on a ventilator. Levels of interleukin-6—a major cytokine that drives the cytokine storm that some patients develop—also improved.
It’s felt that the drug may be effective in severe COVID-19 because it targets the BTK, which is hyperactive in COVID-19 immune cells. Researchers at the University of Oxford also recently reported that a widely used and cheap corticosteroid, dexamethasone, might reduce mortality in severely ill COVID-19 patients. As a potent anti-inflammatory, dexamethasone reduces inflammation produced by the immune system in response to the virus. In one study, treatment reduced deaths from COVID-19 in patients on ventilators by one-third and deaths among patients on oxygen by one-fifth.
If findings can be validated, this would represent a major breakthrough in the potential treatment of COVID-19. Meanwhile, Regeneron announced in early June that they would be launching a clinical trial to test an “antibody cocktail” to prevent and ideally treat COVID-19. They are one of a number of pharmaceutical companies working with antibody cocktails which could provide temporary protection for high-risk health care workers and serve as a bridge to an eventual vaccine. Other companies working on antibody treatments include Eli Lilly and Vir Biotechnology.
Meanwhile, researchers at the University of Toronto are developing synthetic therapeutic antibodies that they say are more potent than naturally occurring antibodies and which can be readily manufactured in large quantities.
Vaccines
Two very old vaccines—the bacillus Calmette-Guerin vaccine that is used to prevent TB, and the oral polio vaccine—are now being tested to see if they might help patients mount an innate immune response to better fight the virus off. The idea is that the vaccines could prime the body’s immune system and provide protection against a second wave of the coronavirus, widely predicted to occur before a COVID-19-specific vaccine becomes available.
Researchers came up with the idea when they reviewed the COVID-19 experience in Pakistan and other countries where the population is widely vaccinated against TB. In Pakistan, for example, there have been relatively few deaths from COVID-19 despite a population of 212 million and high infection rates.
Back in the US, Washington recently handpicked five companies as being the most likely to come up with a vaccine by their much ballyhooed target date early next year.
The companies include Moderna, a Massachusetts-based biotech company expected to enter the final phase of clinical trials for its vaccine by July; Oxford University who has partnered with Astra Zeneca and who has a similar clinical trials schedule, plus three additional large pharma firms—Johnson & Johnson, Merck and Pfizer.
More than 30 countries, including Canada, have pledged $8.8 billion to fund a global vaccination effort over the next five years, with funds being committed to the Global Alliance for Vaccines and Immunization or GAVI, which runs vaccination programs for children in the developing world.
Mask Wars
At a time when the pandemic was still confined to China (remember that?), Yale hospital administrators bought about 1,200 reusable silicone masks and started distributing them to local doctors, nurses and respiratory therapists.
These masks, known as “elastometric respirators”, were designed to be cleaned and reused for years and had previously been shown to protect the wearer against infectious particles at least as well as N95 masks. Yet today, only a handful of US hospitals are using elastometric respirators and the federal government has made no effort to increase their production or help with their distribution, according to a New York Times investigation.
Meanwhile, N95 masks are in such short supply that regulators have told healthcare workers they can be used multiple times with little evidence that disinfecting them works. The main reason the elastomeric respirators are being so little used? Nothing so practical as how best to fit and clean them.
Rather, the main objection to their use has been concern about the appearance of the worker wearing the mask (which the masks admittedly do make the wearer look pretty weird). Still—healthcare workers should at least be given a choice, don’t you think? New research is also suggesting that widespread use of a homemade mask could help control transmission of the virus.
Published in the Proceedings of the Royal Society, researchers found that wearing a face mask in public at all times would be twice as effective at slowing the spread of the virus than wearing a face mask only after symptoms appear. Together with social distancing, the team predicted that widespread mask use could prevent a second wave of infection before the world finally welcomes a COVID-19 vaccine.
Yet despite recommendations to wear face masks at all times in pubic from multiple organizations, some businesses in the US are not allowing people into their stores or restaurants if they are wearing a face mask.
Here in conservative Canada, people in Toronto will be required to wear a face mask when riding public transit starting July 2nd.
COVID-19: Predictions and Future Directions
Shutting the economy down in order to contain the spread of COVID-19 prevented roughly 60 million new coronavirus infections in the US and 285 million in China, according to a study published in the journal Nature.
In a separate study, also published in Nature, researchers estimated that shutdowns saved 3.1 million lives in 11 European countries, dropping infection rates by over 80 percent. Having complied data on over 1,700 local, regional and national interventions deployed in China, South Korea, Italy, Iran, France and the US, the multi-center research team evaluated the effect that these anti-contagion policies had on rates of infectious growth.
In the absence of policy actions, the team estimated that early infections with COVID-19 would have grown by roughly 38 percent a day. Across these six countries alone, anti-contagion interventions prevented or delayed some 62 million COVID-19 infections. Thus, both studies suggest that despite massive economic disruptions and job losses, the unprecedented shutdowns effectively halted the spread of COVID-19.
The corollary to these analyses is that the risk of a second wave of COVID-19 is very real if these same interventions are abandoned.
Update: June 8, 2020
As part of ongoing coverage of the COVID-19 pandemic, Xtalks continues to bring the latest stories and host informative webinars on the coronavirus situation.
Below are some of the latest articles of interest:
Eli Lilly and AbCellera Begin Phase I Trials for a COVID-19 Antibody Treatment
CDC Stresses Social Distancing in Updated Guidelines for Restaurants and Bars
Also register for some of these free webinars on continuing business and innovation in the biotechnology, pharmaceutical and food sectors during the current pandemic and beyond:
Data & Analytics in the Time of COVID-19: Evaluating Business
Navigating the “New Normal” During COVID-19: A Regulatory and Clinical Perspective
And below are some upcoming webinars that you can register for:
Back to Laboratory Productivity in the New Normal: Optimizing Operations through Asset Management
Navigating the “New Normal” During COVID-19: A Regulatory and Clinical Perspective
Update: June 1, 2020
Xtalks will now be providing monthly COVID-19 Pandemic Coverage updates (as opposed to weekly).
Nevertheless, Xtalks remains committed to covering the latest stories and information on the coronavirus pandemic, ranging from the latest scientific developments, to the impact it is having on the food sector.
Below are some recent articles that may be of interest:
Low T Cell Counts Observed in COVID-19 Patients
FDA Eases Food Rules for Fifth Time During Pandemic
Xtalks has hosted some excellent webinars on navigating development and operations during the current pandemic, presented by leading experts in the pharmaceutical, biotechnology and food industries. Below are some free webinars you can register for that have delved into the topic:
Continuing Clinical Research Innovations After COVID-19
The Impact of COVID-19 on Early Clinical Development – What the New Landscape Will Look Like
Addressing the Rapidly Evolving Vaccine Development Landscape
The following are links to some upcoming webinars that you can also register for:
COVID19: Ensuring Scientific Integrity of Clinical Trials During the Pandemic
Data & Analytics in the Time of COVID-19: Evaluating Business
Stay safe and connected!
Update: May 25, 2020
Global Footprint
As of the morning of May 25, 2020, the Johns Hopkins Coronavirus Resource Center and the ncov2019.live web site posted the following statistics:
- The number of confirmed COVID-19 cases around the world now exceeds 5.4 million with over 345,000 deaths
- The US continues to lead the world in the number of confirmed cases at over 1.6 million with the number of deaths now coming in at over 97,000. The Kaiser Family Foundation estimates that homes and other assisted-living facilities account for 41 percent of all COVID-19 deaths in the US but in some states, the may be as high as 70 to 80 percent. More than one in four nursing homes in the US has reported cases of coronavirus infection. Experts are also now reporting that COVID-19 may still be spreading at epidemic rates in almost half of all states in the US
- New York is in a league of its own with over 359,000 confirmed cases and over 29,000 deaths, up from the death rate of about 28,000 last week. However, the number of new patients in the city and the daily death toll have dropped sharply over the past week
- Age still appears to be the biggest risk factor for death from COVID-19. For example, a Lancet study reported that most elderly (median age 62 years!) COVID-19 patients who required ventilator treatment did not survive. In 257 critically ill adults treated at two New York Hospitals between March 2nd and April 1st, 39 percent had died by April 28th and 37 percent remained hospitalized. In contrast, no critically ill patient under the age of 30 died at either of the two hospitals during the same study interval
- Brazil has now overtaken Russia in the number of confirmed cases counted at over 363,000 with over 22,000 deaths. Fears that the coronavirus would hit poorer countries particularly hard have accelerated across Latin America and Mexico. Both Brazil and Mexico reported record counts of new cases and deaths almost every day last week and by all accounts, the official numbers are much lower than the actual head counts across Latin American because people aren’t being tested
- Russia claimed to have over 353,000 confirmed cases but is only reporting around 3,500 deaths from COVID-19 so far, an implausibly low number as it means the fatality rate from COVID-19 is under one percent in Russia. In the US, the fatality rate from COVID-19 is 6 percent while in Canada, it is 7.5 percent
- The UK is still leading Europe in the number of confirmed cases at over 260,000 and over 36,000 deaths, the highest death toll in Europe
- Spain is now counting over 235,000 confirmed cases with over 28,000 deaths. Still, that is only about 1,000 more deaths compared with last week so the death toll from COVID-19 in Spain is at least flattening
- Italy is not far behind Spain at over 229,000 confirmed cases but the death toll in Italy from COVID-19 is similar to that in Spain in that at approximately 32,000, it is similar to fatality rates reported last week. Half of the deaths that have occurred in Italy from COVID-19 have occurred in one region, Lombardy, whose main city is Milan. Southern Italy, including the area around Rome, has seen far fewer cases
- France now has over 182,000 confirmed cases and approximately 28,000 deaths – about the same fatality rate as was reported last week
- Germany is reporting over 180,000 confirmed cases but still has a remarkably low death rate at about 8,200
- Canada is now reporting over 86,000 confirmed cases and approximately 6,500 deaths. However, data from Toronto Public Health is showing that neighborhoods in the city with the lowest incomes, the highest rates of unemployment and the highest numbers of immigrants had twice the number of COVID-19 cases than more affluent neighborhoods and more than twice the rate of hospital admissions. The same pattern is also being seen in other large Canadian cities
- Furthermore, and in contrast to other countries, women have made up over half of all COVID-19 related deaths in Canada, a reflection of the fact that long-term care homes have been the epicenter of the COVID-19 pandemic in Canada where far more females than males are housed and far more females than males take care of them
- Meanwhile, continue to stay outdoors as much as possible. Experts report that life is safer outside because even a light wind will quickly dissipate the virus, exposing people to smaller quantities of it if they are exposed than if they had been exposed to the virus indoors. Also to get sick from COVID-19, a person needs a few hundred to a few thousand of SARS-CoV-2 viral particles to overwhelm the immune response so viral load matters to infectious transmission. And coronaviruses are unstable in water and, if that water is chlorinated, are highly sensitive to chlorine. So you can go swimming but stay away from people swimming along beside you
Economic Impact: The US
At least some of the much ballyhooed economic packages touted as saviors of the American economy have offered far less than their initial hype would have it. In a new report last week, the Treasury Department had apparently spent very little from the $500 billion fund created by the Cares Act in March to help businesses and local governments, even though many of them did ask for help right away. Fund managers also set aside $46 billion out of that fund largely for the airline industry to help them over the coronavirus hump.
As of last week, none of that $46 billion had been distributed. In the meantime, many businesses across the US have shuttered their doors and are not expected to reopen if and when the pandemic fades to black. Consumers, on the other hand, are starting to pop up again as states have begun to reopen.
And they are spending: total credit and debit card balances, having bottomed out in early April, slowly starting climbing back in May. That still doesn’t mean US citizens are going back to work.
Last week alone, another 2.4 million Americans applied for unemployment benefits, bringing the total number of residents who have filed for unemployment in the past nine weeks to some 38.6 million.
The seasonally adjusted unemployment rate in the US reached 17.2 percent for the week ending in May 9th, up from 14.7 percent a few short weeks ago. In March, Congress passed a law that gave people applying for unemployment benefits an additional $600 each week until July but the Trump administration is campaigning against these so-called enhanced benefits, expressing doubt about how much money is really needed to get the economy going again.
Record unemployment perhaps predictably led to the biggest, one-month increase in mortgage delinquencies on record, bringing the number of people who stopped paying their mortgages to 1.6 million last month.
Meanwhile, giants such as Google, Facebook, Microsoft, Amazon and Twitter, have sent out a signal that they are likely going to be the last of the big employers to welcome staff back to headquarters. Google and Facebook have made it clear that any employee who can work remotely should plan to do so until 2021; Amazon said that employees who work at its headquarters should plan on working remotely until at least October; Microsoft had the same message for most of its employees, and Twitter has told most of its employees that they can work from home permanently.
Predictably, the new “work-at-home rules” mindset will leave a major footprint on cities’ real estate markets, with many forecasting there will be far less need for office space in the not-very-distant future. On the plus side of the economic ledger, many 1000s of auto workers have gone back to their plants across the US.
Motor vehicle production is often the lynch-pin in any healthy economy (think Germany) and a mass return to car and truck production in the US can only bode well, even though production levels are still way below levels from last year.
Economic Impact: Europe
Last week, German Chancellor Angela Merkel and President Emmanuel Macron of France proposed borrowing €500 billion euros ($545 billion US) for a common recovery fund to help countries like Italy and Spain recover from the crisis. Importantly, the financial responsibility to repay those funds will be shouldered by the entire European Union, a move that wealthier northern countries have long resisted. After nearly ten weeks of a strict lockdown, Italy’s restaurants and bars along with almost all other shops—hair salons included—opened last week.
These businesses join previously reopened factories and parks while churches are now allowed to welcome their congregations as well. This week, sports centers and swimming pools will also reopen in Italy and travel between regions will soon be allowed as well.
In most of Spain, restaurants were also allowed to cater to clients as of last week. Denmark has also reported decreasing numbers of new COVID-19 cases so is proceeding with plans to reopen much of what was previously shut down. However, things are less rosy in the United Kingdom.
The number of people applying for unemployment benefits hit its highest level last month in almost a quarter of a century, with an estimated loss of 450,000 jobs in April alone. Economists predict unemployment could affect ten percent of its citizens between April and June, with the pub industry being particularly badly affected. News has it that of the 47,000 some pubs in Britain now closed for two months as part of the country’s lockdown, as many as half of them won’t ever reopen.
If they do, it’s hard to imagine how the typical British pub will make any money when some of them are so small that they’ll only be able to serve a handful of customers compared to pre-pandemic days. UK officials have also had to launch a new “Pick for Britain” campaign to try and entice people who have been laid off to come and help farmers harvest their crops this summer. Almost all of fruit and vegetable picking in Britain had been done by seasonal workers from Eastern Europe until this season. Now that Britain has shut its borders to labourers, farmers are being left high and dry with no one to do the work.
So far, there have been few takers from Britain itself, with just over 100 people actually saying yes to the job offer, most of them having turned it down after learning how hard it is to be a seasonal worker.
Economic Impact: Canada
Real estate is officially in big trouble now in Canada, with Canada Mortgage and Housing Corporation predicting that home prices could drop by up to 18 percent over the next 12 months and that as many as 20 percent of mortgage holders could default on their mortgage payments by September of this year. Meanwhile, corporate profits in the country shrank by an estimated 17 percent in the first quarter compared to last year and the second quarter contraction is expected to be as high as 40 percent.
Despite this, Bank of Canada Governor Stephen Poloz remains optimistic about the country’s economic recovery from the crisis, maintaining that income supports from the federal government will help cushion its citizens from spiraling out of control financially.
Economic Impact: China
China’s economic woes were widely reported last week, a bit surprising given that much of their economy has already been reopened. Officially, China’s unemployment rates look relatively good, but people and businesses are clearly struggling as the government in Beijing announced last week that they have set aside almost $400 billion for local governments to give people the means to achieve a basic living standard.
Furthermore, in the first quarter alone, China reported that their GDP shrank by 6.8 percent while government revenues fell by 14.5 percent in the first four months of 2020. Economic woes did not stop President Xi Jinping of China from announcing that Beijing would donate $2 billion toward fighting the good fight against the coronavirus.
China has also announced plans to send doctors and medical supplies to Africa among other countries in the developing world to help them through the pandemic. China’s donation is over twice what the US has been giving WHO before Trump shut down funds completely to the organization last month.
Despite their best efforts, China continues to experience small eruptions of the coronavirus and has recently closed down three cities which a combined population of 13 million in another attempt to contain the spread of COVID-19.
Drugs and Vaccines
If ever there were a death knell for a drug, one came this week for the anti-malaria drug, hydroxychloroquine as well as a closely-related drug, chloroquine, for the treatment of COVID-19.
Out of 96,000 patients hospitalized for COVID-19, almost 15,000 of them had been treated with either hydroxychloroquine or chloroquine alone, or in combination with azithromycin or clarithromycin, both macrolide antibiotics. For those given hydroxychloroquine, there was a 34 percent increased risk of mortality and a 137 percent increased risk of patients developing a serious heart arrhythmia compared to those who were not treated with hydroxychoroquine. For those treated with chloroquine, there was a 37 percent increased risk of death and a 256 percent increased risk of patients developing a serious heart arrhythmia compared to patients who were not given chloroquine.
For patients given hydroxychloroquine plus a macrolide, there was a 45 percent increased risk of death and a 411 percent increased risk of patients developing a serious heart arrhythmia, while for those taking chloroquine plus an antibiotic, there was a 37 percent increased risk of death and a 301 percent increased risk of patients developing a serious heart arrhythmia, again compared to patients treated with neither drug.
Unbelievably, Trump announced last week that he is taking hydroxychloroquine daily and feels just fine.
Tentative Steps
Tentative steps are being made towards the development of an effective vaccine to counter the coronavirus. Last week, Moderna, a US biotechnology company, released results from a small trial where different doses of their vaccine were given to eight healthy volunteers. Although the results have not yet been published, findings so far suggest that the vaccine is at least safe and that medium and larger doses of the vaccine triggered the production of antibodies at levels similar or greater to levels in COVID-19 patients who have recovered from the infection.
Another vaccine endeavor is being led by the University of Oxford in the UK who, together with AstraZeneca, have now enrolled over 1,000 patients in a clinical trial with their own vaccine. The trial was expected to have begun in April. Meanwhile, Sinovac Biotech in China reported that their recombinant adenovirus type-5 vectored COVID-19 vaccine was both tolerable and immunogenic 28 days post-vaccination in a study of 108 participants.
No serious adverse events were noted within the 28 day post-vaccination interval and neutralizing antibodies to the vaccine increased significantly by day 13, as did specific T cell responses. The US government has pledged to commit up to $1.2 billion to AstraZeneca for its efforts to perfect a COVID-19 vaccine.
And Sanofi, Pfizer and GlaoxoSmithKline are all working in various partnerships with other companies to achieve the same end goal.
COVID-19: Prediction and Future Directions
Columbia University epidemiologists have worked out how many cases of COVID-19 and deaths from it would have been prevented had states declared an emergency lockdown a single week earlier.
Nationwide, 61.6 percent of reported infections and 55 percent of reported deaths as of May 3, 2020 could have been avoided if the same control measures implemented one week later had been implemented just one week earlier. The team examined the spread of the virus from March 15, 2020 when the nation started staying home until May 3rd and tracked viral spread across the country over the next seven weeks.
That translates into approximately 36,000 deaths that could have been prevented through early May—some 40 percent of deaths reported to date.
Meanwhile, PolicyLab at the Children’s Hospital of Philadelphia has predicted that provided residents maintain social distancing as businesses open up, most communities in the US should be able to avoid a second wave of COVID-19.
Update: May 18, 2020
Global Footprint
As of the morning of May 18, 2020, the Johns Hopkins Coronavirus Resource Center and the ncov2019.live web site posted the following statistics:
- The number of confirmed COVID-19 cases around the world now exceeds 4.7 million with over 315,000 deaths caused by the infection
- The US continues to lead the world in the number of confirmed cases at almost 1.5 million with the number of deaths now coming in at over 89,000. More than 26,000 of those deaths have occurred in nursing homes and long-term care facilities, according to the Associated Press
- New York alone has reached over 359,000 confirmed cases and over 28,000 deaths, up from the death rate of about 26,000 last week but still an encouraging trend. Mayor Bill de Blasio nevertheless said that widespread closure of nonessential businesses was not likely to end before June.
- Russia has now shot past many other counties with the number of confirmed cases now in excess of 290,000. Implausibly, the country is reporting only about 2,700 deaths at this point in time. Russia has reported that over 180 healthcare workers have already died of COVID-19, with more bad news likely to come
- The UK has taken the lead in Europe, now counting almost one-quarter of a million confirmed cases and over 34,000 deaths, the highest death toll in Europe
- Brazil has moved up rapidly in the coronavirus head counts, now reporting over 241,000 confirmed cases and over 16,000 deaths
- Spain is now counting over 230,000 confirmed cases with over 27,000 deaths. Still, that is only about 1,000 more deaths compared with last week so the death toll from COVID-19 in Spain is at least flattening
- Italy is not far behind Spain at over 225,000 confirmed cases but again, has only reported about 1,000 more deaths from COVID-19 compared with last week. The death toll in Italy from COVID-19 is now approaching 32,000
- France now has over 179,000 confirmed cases and approximately 28,000 deaths
- Germany is reporting over 176,000 confirmed cases but still has a remarkably low death rate at about 8,000. However, last week, hundreds of workers in at least three meat-processing plants have tested positive for COVID-19, in keeping with the heavy toll of COVID-19 among workers at meat packing plants in Canada and in the US. For example, Cargill Ltd, a meat-packing plant near Montreal, suspended its operations last week after more than ten percent of its work force tested positive for COVID-19
- Canada is now reporting over 78,000 confirmed cases and approximately 5,900 deaths. The lion’s share of those deaths has taken place in long-term care facilities
- Meanwhile, fears that the coronavirus would hit poorer countries particularly hard have unfortunately come true for much of Latin America. Just as the viral devastation is easing in New York and in Europe, cities in Latin America are now reporting a COVID-19 wave that rivals some of the worst outbreaks in the world, with death rates now comparable to those reported in Europe
- The happiest note last week was in Slovenia, where it has now joined New Zealand in declaring an end to its coronavirus epidemic. Citizens of countries from the EU are now allowed to cross freely into the country but they will still have to self-quarantine for two weeks before they can enjoy the country
- Meanwhile, stay outdoors. A study from China indicated that only one transmission involving two cases of COVID-19 occurred outdoors in an analysis of over 7,300 cases that occurred in China. Breathe deep and stay healthy
Economic Impact
The big numbers coming out of the US last week were frankly confusing. First, the House Democrats passed a $3 trillion relief package, roughly $1 trillion of which was slated for state and local governments. Another large chunk would go to taxpayers, about $200 billion would serve as hazard pay for essential workers and another $75 billion would help with testing for the virus and contract tracing.
However, Trump is promising to veto the legislation so it has little chance of becoming law over Republican opposition. Was this an exercise in futility?
Meanwhile, the US economy continues to tank. Retail sales dropped by 16.4 percent in April, nearly double the predicted decline in retail sales proposed only a month ago. Any drop in consumer spending has very serious repercussions.
Consumer spending is responsible for about 70 percent of the economy and with a 14.7 percent unemployment rate in the US, things are not looking good even for the biggest retailers. Major chains closed over 260,000 stores in March alone and while some are now beginning to reopen, others will never see the light of day. For example, retail giants including J. Crew and Neiman Marcus have already filed for bankruptcy protection.
JCPenny, in business for 118 years, also filed for bankruptcy last week. Stage Stores, which operates hundreds of stores in almost all states, is planning to liquidate hundreds of its locations and is looking for someone to buy them out.
Almost 17 percent of small business owners have either no cash now or can cover only about one week’s work of expenses; roughly half of small businesses in the US report will be out of cash within a month.
The only bright spots in the economy are grocery stores, where sales have risen by 13 percent compared with a year ago, and online sales which have climbed by 21 percent compared to last year as well.
As of last week, some 36 million workers in the US had applied for jobless benefits over the past seven weeks, including 3.2 million of them last week alone. In fact, 20.5 million people were eliminated from the nation’s payrolls in April, roughly 25 times the worst monthly decline in jobs since the last recession in 2007 to 2009.
The most severely affected are low-wage earners. Almost 40 percent of Americans with a household income under $40,000 lost a job in March. This compared to only 13 percent of US workers with a household income in excess of $100,000 during the same month.
This is a reflection of the fact that people who can work from home are better educated than those who cannot. For example, 63 percent of people with a college degree reported they could work from home fully in March compared with only 20 percent of people with a high school degree or less. And don’t hold your breath that the reopening of businesses in a number of states is going to resuscitate the economy any time soon.
Among others, the nation’s top infectious diseases expert, Anthony Fauci, MD, warned that additional economic damage will rain down on states that ignore federal guidelines about businesses staying closed until there is a dramatic decline in the number of COVID-19 cases. And Fauci really isn’t kidding.
In a study published in the journal Health Affairs, researchers looked at what might happen in states that do not follow any social distancing policies.
For those who do not, rates of COVID-19 infection could be 35 times higher than those who follow the strictest of distancing measures. Then, there is the not-so-small issue of businesses facing legal responsibilities if returning workers get infected with COVID-19. In a bid to make sure this doesn’t happen, there are calls from Republicans to shield employers from any liability should their employees fall ill from the virus, although the Democrats are opposed to such a move.
Economies Elsewhere
Elsewhere, Germany’s gross domestic product (GDP) shrank by over two percent compared to the previous quarter while consumer spending also fell sharply. This essentially put Europe’s strongest economy into a recession, where it unhappily joins Italy and France whose GDPs have declined by almost five and six percent, respectively.
Last week, people in Britain were finally allowed to leave their homes for outdoor activities such as golf but the economy still shrank by two percent in the second quarter of the year, which ended on March 31 and which therefore included only a few weeks during which Britain was put on lockdown.
About two million people in Britain are estimated to be unemployed but another 7.5 million people have become “economically inactive” since the lockdown. The British government pays up to 80 percent of salaries for workers retained under the Coronavirus Job Retention Scheme—meaning that people can be covered for up to $4300 a month, a scheme that will stay in place until October.
In Canada, the federal government is also still providing financial assistance. Last week, they announced a one-time, tax-free payment of $300 for any senior eligible for the Old Age Security pension and another $200 for seniors eligible for the Guaranteed Income Supplement. This is in addition to the $1.3 billion that the federal government earmarked for a one-time payment through the goods and services tax credit last month, which apparently benefited 4 million seniors.
The Canadian government also offered a financing package for small and medium-sized businesses last week, offering them partially forgivable loans of up to $40,000 if the business meets repayment terms. The new $962 million program referred to as the Regional Relief and Recovery Fund is aimed at businesses that can’t access other relief programs like the Canada Emergency Business Account loan program. Small and medium-sized businesses contribute to more than half of Canada’s economic output so relief is needed.
Last week, the federal government announced another new loan program, the Large Employer Emergency Financing Facilities, which will offer bridge financing to some of the largest employers in the country if they can’t secure loans from private lenders. The bridge financing program will be open for large, for-profit businesses, excluding those in the financial sector, as well as some not-for-profit businesses like airports. At the same time, the government is also expanding its Business Credit Availability Program which will make loans of up to $60 million available for mid-sized companies with big financial needs. Meanwhile, as is true for the US, the less a Canadian worker makes, the more likely they are to have lost their job due to the pandemic.
From February to April, roughly half of employees who earned under $16 an hour had lost their job or most of their work hours while young Canadians have been disproportionately affected by unemployment as well.
Drugs, Vaccines and Tests
Trump’s unsupported enthusiasm for the use of the anti-malarial drug, hydroxychloroquine for the treatment of COVID-19, has turned even more sinister with new reports on the drug’s link to serious cardiac problems. Researchers have reported that the combination of hydroxychloroquine and azithromycin, an antibiotic used to treat infections, could cause cardiac arrhythmias, thereby increasing the risk of death in COVID-19-infected patients.
The Food and Drug Administration (FDA) has now warned against the use of hydroxychloroquine, just weeks after it approved the drug for emergency treatment of COVID-19. Unfortunately, the former director of the Biomedical Advanced Research and Development Authority, Rick Bright, told Congress that he was likely removed from his post last month because he did not support the President’s enthusiasm for hydroxychloroquine, citing lack of evidence supporting any benefit in COVID-19.
Without a real vaccine in sight, the politics governing the procurement of one, when and if developed, are already a bit ridiculous. Last week, Trump announced a plan, entitled “Operation Warp Speed,” in which his administration is aiming to have 300 million doses of a vaccine on standby for the nation by the beginning of next year.
That may work for the US, but the announcement made other countries, especially France, very testy. It seems that Sanofi, a large pharmaceutical company based in France, feels that if the US helped pay for them to develop a vaccine—which they did– they should get first dibs on it. Well, not so fast, says the French government.
In fact, the French president, along with German Chancellor Angela Merkel and the World Health Organization (WHO), orchestrated an $8 billion plus vaccine fundraising drive to fund research, testing kits and mass-produced drugs that could help treat the virus. Needless to say, the US did not participate in the fundraising effort. The US did, however, contribute half a billion bucks to Johnson & Johnson, who are among the hundreds of companies trying to bring a COVID-19 vaccine to market, along with many millions of dollars to both Sanofi and Moderna, the latter a US-based biotech company who is leading the corporate pack in the collective search for a vaccine.
If a vaccine does become available, Trump only has to use the “Defense Production Act” to force companies to manufacture vaccines for use at home, even if they don’t agree with the order. That will only work if the vaccine is produced in the US. Still, enough world leaders and dignitaries are concerned about Trump’s “America First” attitude, that 140 of them signed an open letter to all governments demanding that any vaccine against COVID-19 be shared equitably by countries around the world.
Meanwhile, Canada has hooked up with a Chinese company to co-develop the Ad5-nCoV vaccine, among the most rapidly developed of vaccine candidates anywhere in the world. The National Research Council (NRC) has pledged to use its genetic technology while the Tianjin-based CanSino Biologics Inc, together with the Institute of Biotechnology of the Academy of Military Medical Sciences, will try to develop the vaccine.
The federal government lent the NRC some $44 million to upgrade its facilities so it will be able to produce large amounts of vaccine outside of clinical trials, which are expected to begin soon.
More Faulty Tests
And reports continue to accumulate about how defective tests and other medical supplies keep coming to the fore in the on-going battle against COVID-19. For example, in the US, the rapid COVID-19 test from Abbott used by Trump and others in the White House failed to detect a third of positive tests found by a rival company, Cepheid, in a head to head comparison. Both tests use nasopharyngeal swabs but the Abbott test missed almost half of the positive tests when dry nasal swabs were run on their platform compared to when the swabs were run on the Cepheid platform.
Abbott denied there are flaws in their rapid test suggesting instead that that the samples may not have been tested correctly. The US FDA also decided last week that a widespread COVID-19 testing program in the Seattle area funded by Bill Gates now needs their approval to continue and has ordered the team to stop work until they can review all relevant protocols. Lastly, when China does things, they do it big.
According to Chinese media reports, officials are planning to test all 11 million residents in the city of Wuhan where the coronavirus first took hold—this over a period of exactly ten days!
Of the 4,633 deaths from COVID-19 reported in China, 4,512 were in the province of Hubei and 3,869 of them were in Wuhan, the provincial capital.
COVID-19: Prediction and Future Directions
As if there weren’t already far too many deaths from COVID-19 worldwide, the New York Times is reporting that far more people have died from other causes because patients with other serious illnesses could not be properly treated in hospitals overwhelmed by COVID-19. Here is what they found:
- In the UK, there were 67 percent more deaths than normal between March 14 and May 1, 2020
- In Italy, there were 49 percent more deaths than normal in March
- In Ecuador, there were 84 percent more deaths than normal between March and April
- In Spain, there were 60 percent more deaths than normal between March 16 and May 3, 2002
- In France there were 44 percent more deaths than normal between March 16 and April 26, 2020
- In New York City, there were 277 percent more deaths than normal between March 11 and May 9, 2020
- In the Netherlands, there were 50 percent more deaths than normal between March 16 and April 26, 2020
- And in five cities in Brazil, there were 39 percent more deaths than normal between March 30 and April 26, 2020
Update: May 11, 2020
Global Footprint
As of the morning of May 11, 2020, the Johns Hopkins Coronavirus Resource Center and the ncov2019.live web site posted the following statistics:
- The number of confirmed cases around the world now exceeds 4.1 million with over 282,000 deaths
- The US continues to lead the world in the number of confirmed cases at over 1.3 million with the number of deaths now coming in at over 79,000. Blacks continue to be disproportionately affected by COVID-19, as some 22 percent of predominantly black US counties account for more than half of all cases and nearly 60 percent of all deaths
- New York is in a league of its own with over 345,000 confirmed cases and over 26,000 deaths
- Spain is reporting over 224,000 confirmed cases and now has over 26,000 deaths
- Italy is not far behind Spain at over 219,000 confirmed cases but still has more deaths than Spain at over 30,000
- The UK has now surpassed Italy in the number of confirmed cases at over 220,000 but with over 32,000 deaths, the UK now has the highest death toll from COVID-19 in Europe
- Russia continues to experience huge bursts in viral counts with over 221,000 confirmed cases but so far is reporting only about 2,000 deaths. Nearly half of all of Russia’s new cases in the recent past were in Moscow
- France now has over 177,000 confirmed cases and approximately 26,000 deaths
- Germany is reporting over 171,000 confirmed cases but still has a remarkably low death rate at only slightly over 7,500
- Canada is now reporting over 70,000 confirmed cases and approximately 5,000 deaths. At least 80 percent of all COVID-19-related deaths in the country were in long-term care facilities and seniors homes
- India is experiencing a major leap forward in new infectious peaks with approximately 63,000 confirmed cases but only 2,100 deaths
Economic Impact
Last week in the US, it was all about jobs, or more accurately, job losses. By the middle of last week, over 33 million Americans had lost their job because of the pandemic but job losses did not affect all groups equally. For example, Hispanics were nearly twice as likely as white people to have lost their jobs, according to a Washington Post-Ipsos poll.
The same poll showed that 20 percent of Hispanics and 16 percent of blacks had been laid off or furloughed since the outbreak began compared to 11 percent of whites. Officially, the unemployment rate in the US is now at 14.7 percent.
This is roughly double what the country experienced during the financial meltdown between 2007 and 2009. That, however, doesn’t tell the whole story, as millions of people have been forced to take part-time work or have given up even looking for job, presumably because there aren’t that many going around. If these people are factored into the unemployment numbers, 26.4 percent of workers in the US are now employed below their capacity.
Moreover, since women represented a large proportion of the workforce where jobs have been lost (think hospitality industry, day-care workers, service industry, receptionists), the unemployment rate among women, now at 16.2 percent, is 3 percentage points higher than the rate for men. Apparently, the majority of people believe that they will get their jobs back when the worst is over.
But economists are not so sure, predicting that it could take years before the economy gets back to its record low rate at 3.5 percent seen only a few months ago. Still, US consumers appear to be programmed to consume. Just one week after Georgia allowed certain businesses to reopen, some 62,000 visitors drove from out of state daily to get a whiff of whatever “normal” now looks like.
Meanwhile, in Europe, Germans flocked to newly opened hair salons and barber shops to rid themselves of the shaggy-dog corona look while small shops in Greece and Portugal also reopened.
In Italy, over 4 million people are expected to return to work, although non-essential services are still closed. Italy went into quarantine on March 9, 2020 so it had among the longest lockdowns of any European country. Spain also allowed its citizens to venture outside for the first time in almost two months. Given its soaring death rate, the UK has not yet relaxed its restrictions but is apparently making plans for its citizens to get back to work, while underscoring the need to work from home whenever possible.
Boris Johnson has also dropped the “stay home” mantra and is telling its people to “stay alert, control the virus and save lives” – whatever that means. The British government is also set to publish a 50-page document outlining its plans to restart the economy which it will present to fellow members of parliament this week. Whatever fledgling economic activity there may be in Europe, the continent is still facing its worst recession ever.
Overall, Europe’s economy is expected to shrink by 7.4 percent this year, making this year the worst performance the continent has seen since World War II. Spain, Greece and Italy – all dependent on tourism – will each see their economies shrink by over 9 percent this year while Italy is projecting its debt to rise to 158.9 percent of its gross domestic product, one of the highest rates in the world. Projections also suggest that France’s economy will shrink by 8.2 percent, Germany remaining slightly better off, with a projected drop of only 6.5 percent.
Here in Canada, the unemployment rate hit 13 percent, up from 7.8 percent in March, according to Statistics Canada. In the past two months alone, 5.5 million Canadians have lost their jobs or seen the number of hours they work shrink. In a recent poll by Modus Research, one in five Canadian companies surveyed indicated they can’t survive past three months under current restrictions, while another 25 percent said they couldn’t survive past six months under the same conditions.
Worse, almost half of the Canadian companies surveyed had either closed down already or indicated they wouldn’t make it past six months if the economy doesn’t open up again. Previously “hot” real estate markets like Vancouver reported a 40 percent drop in home sales last month compared to last year while Toronto home sales were down 67 percent compared with the previous year. Condos in Toronto dropped even more at over 70 percent compared with the previous year.
Last week, Prime Minister Justin Trudeau announced that the Canadian Emergency Wage Subsidy that covers 75 percent of wage costs up to a maximum benefit of $847 a week for each employee will be extended. The program is currently available for up to 12 weeks. At the same time, the Prime Minister did not extend the Canada Emergency Response Benefit (CERB) which provides $500 a week for 16 weeks for those who have lost most of their income because of the virus. The CERB program is set to expire in October of this year.
Markets Defy Logic
Meanwhile, the stock markets continue to defy logic. The Down Jones Industrial Average gained over 450 points last Friday, and stocks have continued to rally since early April. In Europe, stock exchanges in France and Germany made gains as well, though modest at about one percent and markets also finished up in Asia. Analysts speculate that stocks continue to climb in spite of horrific job losses in part because of the unprecedented stimulus packages unleashed by the feds to shore up workers and companies. Plus the fact that the economy is so dismal right now, the thinking is that it can’t get any worse! Some of those stimulus packages are not going well though.
For example, Congress gave the Economic Injury Disaster loan program over $50 billion in new funding to help businesses survive the pandemic. But the Small Business Administration has been so overwhelmed by demands for funds that it is now allowing only agricultural groups to apply as it tries to wrestle a backlog of applications into some sort of order.
The disaster loans, which are separate from the Paycheck Protection Program run by private banks, were intended to serve as a lifeline to help small business survive the crisis.
Drugs, Tests and PPE
Confusion still surrounds Gilead Sciences broad-spectrum, anti-viral drug, remdesivir, but this time it’s over how it is being distributed by the US government.
Shown to modestly shorten the time to recovery in COVID-19-infected patients, hospitals have no idea why a few have been chosen to receive remdesivir while most have not. Even those centers who have been told they will get the drug don’t know how or why they were selected.
Meanwhile, a newly developed at-home saliva collection test has been fast-tracked for approval by the Food and Drug Administration (FDA) with the intention of limiting the test to individuals who have symptoms of COVID-19. The kit was developed by Rutgers University in partnership with Spectrum Solutions and Accurate Diagnostic Labs. The test has to be prescribed by a physician.
However, once the test is received at home, people can simply spit into the tube provided in the test kit, replace the cap and ship the kit back to the lab. Rutgers apparently already has 75,000 kits ready to ship across the country and will be able to process 20,000 tests a day. The FDA has recently come under criticism for allowing dozens of companies to market antibody tests, only to find that many of those tests are far from accurate.
The organization has now demanded that companies making those antibody tests submit data to prove their accuracy; otherwise, the product could be removed from the market. The FDA has also just announced emergency authorization for an antigen test developed by Quidel Corporation of San Diego. The test has to rely on nasal swabs taken from inside the nasal cavity as do other currently available COVID-19 tests.
However, the Quidel test can provide an automated result in 15 minutes, greatly accelerating first responders’ ability to diagnose and potentially treat an infected patient. Abbott Laboratories also makes a genetic test that takes about 15 minutes to produce an accurate result. It is currently used by the White House where, as of last week, three members of the White House Coronavirus Task Force placed themselves in self-quarantine after coming in contact with an individual who tested positive for COVID-19.
These three members include Anthony Fauci, MD, director, National Institute of Allergy and Infectious Disease; Robert Redfield, MD, director of the Centers for Disease Control and Prevention and Stephen Hahn, commissioner of the FDA.
And Canada has again been handed a defective shipment of PPE, this time in the form of N95 respirators from a Montreal-based supplier, after some eight million of the respirators failed to meet standard requirements. Trudeau promised the public that the government will not be paying full price for masks they are unable to use, although the masks may be released for non-medical use. Canada continues to be short of personal protective equipment (PPE) despite having contracts with suppliers for 135.5 million masks.
Happily, however, the country has recently received 23 planeloads of PPE and other medical supplies, including over 33 million surgical masks.
Last week, Spartan Biosciences Inc. announced that concerns regarding the propriety swab used in their rapid test for COVID-19 has prompted them to recall some 5,500 tests already shipped across the country. The company plans to carry out additional studies to improve the sampling method and its proprietary swab.
COVID-19: Predictions and Future Directions
Projections of how COVID-19 might behave can be misleading but the latest modeling projections from the University of Washington’s Institute for Health Metrics and Evaluation are sobering. Based on the latest available data, here is what the institute projects for the US among other countries as of May 4, 2020:
- A projected 134,475 cumulative COVID-19 deaths could occur in the US through to August. These projections are considerably higher than previous estimates – as of April 29, 2020, the same institute was earlier projecting the US would have only 72,433 COVID-19-related deaths
- The death toll in New York is projected to reach 32,132 through to August, again higher than the April 29th projection which settled in at 24,314
- For the UK, the cumulative number of deaths from COVID-19 could reach 40,555 again through to August of this year
- Other European countries saw their COVID-19 death projections go up slightly though not strikingly so. For example, in Italy, predicted cumulative deaths through to August could reach 31,458, up from 27,777 from April 29
- Similarly, France could see 28,859 cumulative deaths through to August, up from 25,096 while Spain could see 27,727 cumulative deaths, up from 25,231 predicted on April 29
- Interestingly, Sweden and the Netherlands were among the few European countries where there may be fewer projected cumulative deaths through to August than predicted earlier. In Sweden, the predicted cumulative death toll from COVID-19 through to August is set at 10,196, down from the 17,337 predicted on April 29. And in the Netherlands, the projected cumulative number of deaths through to August is 6,572 is down from the 9,101 predicted on April 29.
Update: May 4, 2020
Global Footprint
As of the morning of May 4, 2020, the Johns Hopkins Coronavirus Resource Center and the ncov2019.live web site posted the following statistics:
- The number of confirmed cases around the world now exceeds 3.5 million, with approximately one-quarter of a million deaths
- The US is leading the world in the number of cases at over 1.1 million and over 68,000 deaths.
- New York itself has over 288,000 cases and is approaching 19,000 deaths
- Spain is reporting over 217,000 confirmed cases with over 25,000 deaths
- Italy has fewer confirmed cases than Spain at approximately 210,000 but more deaths at over 28,000
- The UK now has over 187,000 confirmed cases and almost the same number of deaths as Italy at over 28,000
- France is reporting over 168,000 confirmed cases with over 24,000 deaths
- Germany now counts approximately 165,000 cases but has had only about 6,800 deaths
- Russia has taken a massive leap upward in the number of confirmed cases at over 145,000 with over 18,000 deaths so far
- Canada now has over 60,000 confirmed cases and is reporting roughly 3,600 deaths
- Meanwhile, New Zealand announced last week that they have “eliminated” the coronavirus in their country with new reported cases being in the single digits for a number of days
Economic Impact
With more than a dozen states warily opening their economies last week, a poll somewhat unexpectantly showed that twice as many Americans are concerned about the country opening up too quickly rather than too slowly despite having been terribly hurt by shuttered businesses.
According to the Kaiser Family Foundation poll, 35 percent of the nation’s workforce had either lost their job, had their hours reduced, taken a pay cut or had been furloughed as a result of COVID-19 (note that these numbers were based on the country’s workforce in February; it is likely much worse now). Forty two percent of all adults said that they or their partner had lost their job or taken a cut in pay due to the coronavirus and for almost 60 percent of those earning under $40,000 a year, loss of income was a major problem. Staggeringly, up to 13 million healthcare workers and other emergency responders – including some nurses – are not eligible for two weeks of emergency sick pay because Congress specifically excluded healthcare companies with more than 500 employees from having to give employees the paid sick leave in a Families First Coronavirus Response Act passed in March.
Meanwhile, another 3.8 million Americans applied for unemployment benefits last week, suggesting that the pandemic still has a heavy hand on the US economy. With millions of the nation’s people out of work, consumer spending – the most important economic engine a nation can have – is nose-diving and if China is any example to the world, opening the economy up is not going to incentivize consumers to start spending again. China was among the first economies to open up as the virus ebbed and it was safe to send people back to work.
But as of last week, the Chinese, even those who liked to throw their money around before they lost their jobs, had not resumed their spendthrift ways but rather reportedly planned to save money in case they find themselves sidelined by yet another economic disaster. Unlike massive stimulus packages offered by Western governments, China has been reluctant to dole out direct payments to in-need consumers, fearing the accumulation of more debt, of which they already have a mountain. This idea of consumer malaise appears to have finally penetrated stock markets around the world.
After a blistering recovery of stocks in the US and Europe over the past month, markets were in a free fall last week with the S& P 500 falling close to one percent on Thursday alone, the biggest loss for the US stock market in over a week. Asian markets also plunged after receiving bad news about the economy. Of course, it didn’t help that the price of West Texas Intermediate, the type of oil used to determine oil prices in the US, is still only about $12 a barrel, the result of both the pandemic and a price war between Saudi Arabia and Russia. Economists are predicting that the US GDP will contract by 30 percent this year if figures from the second quarter more fully capture the virus’ effect on the overall economy.
European Economies
A number of countries in Europe including Italy, Spain and Germany continue with their cautious re-opening of certain sectors of the economy. In Germany, playgrounds, cultural institutions like museums and zoos and even churches are being allowed to reopen again. In fact, most countries with the exception of France are planning to let their major soccer leagues back on the field, if only to play to empty stadiums. Spain has a plan to return to a “new normalcy” by late June.
And Italy, still reeling from the virus and its fatal fallout, is taking baby steps by allowing manufacturers, construction companies and wholesalers to go back to work this week. Parks will be open again and people will be allowed out to exercise. Even restaurants will be allowed to reopen this week – but only for take-out. By mid-May, retail stores in Italy will apparently be able to reopen, as will museums and libraries.
At the beginning of June, Italian restaurants, cafes, hairdressers and other small shops will be open for business as well. Still, other sectors of the economy, notably the travel industry and airlines in particular, have faded to black in these viral times. The result is that many airlines have cancelled orders for new planes because with most flights grounded, the last thing the airlines need are more planes. As a result, Airbus, a global leader in airplane production with headquarters in France, announced last week they could go out of business.
In contrast, the UK is maintaining its strict orders for a total shutdown, with Prime Minister Boris Johnson warning that lifting restrictions too early could lead to increasing numbers of infections and deaths, both of which are rising at an alarming rate in the UK.
US Economic News
Back in the US, much of the economic news seemed to be centered around meat, or at least meat packing plants. According to multiple news reports, outbreaks of the coronavirus have plagued meat facilities across the US leading to closures of some of the nation’s largest meat processors. Many of their workers have been infected by the virus that the nation’s supply of beef, pork and poultry was reportedly in real jeopardy, until Trump put his foot down and decreed meat processing plants to be an essential service.
Any shuttered meat packing plants in the US will now be forced to reopen.
Canada’s meat processing plants have similarly become coronavirus hotbeds, with thousands of workers having tested positive for the virus. As is likely the case in the US, many of the slaughterhouses in Canada are staffed by immigrants and temporary foreign workers who have to live and work in close quarters. Unlike the US, however, many of the meat processing operations in Canada voluntarily shut down either temporarily in response to sickened workers or in some cases, closed altogether, as the number of infected employees mounted.
As for the rest of the economy, at least half of Canadian companies are reporting a drop of at least 20 percent in profits since the lockdown became a reality.
Experts are also predicting the federal deficient could reach over $252 billion by the end of the pandemic which represents 12.7 percent of the country’s GDP.
Drugs and Medical Supplies
You might be forgiven if you’re confused over results released last week by Gilead Sciences about what their clinical trial evaluating remdesivir really means for the treatment of COVID-19.
Referred to formally as the Adaptive COVID-19 Treatment Trial or ACTT, preliminary findings indicated that patients who received remdesivir had a 31 percent faster recovery time than placebo controls. While the difference between the 2 groups was statistically significant (p<0.001), the median time to recovery was 11 days for patients who received active treatment compared with 15 days for placebo controls, according to a report from the National Institute of Allergy and Infectious Diseases (NIAID) who carried out the study.
Depending on what you read, this was either a major triumph or a modest step forward. NIAID director, Dr. Anthony Fauci, said that the study was “a very important proof of concept” but not a “knockout.” Still, the US Food and Drug Administration (FDA) issued an emergency approval for remdesivir, a highly unusual thing for the FDA to do. Gilead Sciences itself issued notice that it was their goal to have millions of doses of the drug ready for use by the end of the year, a clear sign that the company feels they have a winner on their hands.
On the other hand, a study published in the Lancet last week found no significant difference in the time to clinical improvement in patients hospitalized with severe COVID-19 treated with remdesivir compared to placebo, although patients who received the drug had a numerically faster time to clinical improvement. Currently, there are over 1,000 ongoing clinical trials and some 250 drugs in development that companies hope will help them hit the COVID-19 jackpot.
So far, early results from these trials have all been disappointing. And while most think of a drug as being orally taken or injectable, a Canadian company, SaNOtize Research and Development Corp. of Vancouver is about to initiate a clinical trial of a nasal spray it hopes will make the sprayees’ airways too hostile for the virus to gain access. The killer ingredient in the spray is nitric oxide, a chemical shown to deter viruses from gaining entry into cells.
Ideally, the nasal spray could serve as a preventive treatment for those who are at high risk for COVID-19, notably front-line healthcare workers. Think of it as a hand sanitizer for the nose.
On-Going Equipment Issues
Faced with an on-going shortage of personal protective equipment (PPE) and medical supplies for patients, healthcare professionals and inventors of all sorts are getting creative or perhaps more accurately desperate. Out of Stanford University in California, a bioengineer fashioned a potentially reusable mask, the Pneumask, from an off-the shelf, full-face scuba mask fitted with a medical-grade filter. The FDA has already allowed the group to label their mask as a face shield or surgical mask (it’s not a respirator) so that they can ship the masks directly to healthcare workers.
The Stanford team is now in the process of shipping 1500 free masks to several states and they are planning to produce many thousands more in the coming weeks. The team will inform healthcare workers how to use their mask as well as how to sterilize it between uses via Google. The mask costs all of about $40 to make.
On the not-so-positive side of the ledger, Chinese ventilators ordered by the British were so badly built that doctors declared that patients could die if they used them. Technical staff spent days trying to get the ventilators to work but all the ventilators failed. The ventilators were apparently made by Beijing Aeonmed in China and they were designed for use in ambulances, not hospitals, according to the news report.
The ventilators were bought in an attempt to boost the National Health Services’ (NHS) supply of ventilators to a target goal of 30,000. In the meantime, a British survey showed that almost half of Britain’s doctors are buying their own PPE or relying on donations to secure it. However, some good Samaritans remain.
Taiwan, for example, is donating half a million, surgical-grade masks to Canada. Taiwan was probably the most effective country overall at containing COVID-19, counting all of 429 infections and 6 deaths from COVID-19 as of last week. This has left the country in good shape to help out other countries who do not have enough PPE.
And despite the small issue of Canada holding the head of Huawei hostage for the US, the Chinese telecommunications behemoth quietly ordered a million masks, 30,000 goggles and 50,000 pairs of gloves to be delivered to Canada as a gesture of good will.
COVID-19 Predictions and Future Directions
The Center for Infectious Disease Research and Policy (CIDRAP) issued a scary report last week in which they predicted that the pandemic could last for another 18 to 24 months until such time when about two-thirds of the population has been infected with the virus.
This is the length of time researchers envision for the virus to infect up to 70 percent of the population, at which point they expect that herd immunity will help protect people against the spread of COVID-19.
In the report, researchers envisioned three different scenarios.
Scenario 1: The current wave of COVID-19 we are now experiencing will be followed by a series of smaller waves that will occur throughout the summer and then consistently over the next 18 to 24 months, when the waves will gradually peter out in the year 2021.
Scenario 2: The current wave of COVID-19 will be followed by an even bigger wave this fall or winter, followed by one or more smaller waves in 2021.This pattern is actually similar to what was seen during the 1918 to 1919 influenza pandemic.
Scenario 3: A “slow burn” of on-going transmission.
Researchers recommended that states plan for scenario 2, which is the worst-case scenario. The team also acknowledged that a vaccine could help determine the course of the pandemic but that one will likely not be available until at least sometime in 2021.
Update: April 27, 2020
Global Footprint
As of the morning of April 27, 2020, the Johns Hopkins Coronavirus Resource Center posted the following statistics:
- Globally, there have been over 3 million confirmed cases of COVID-19 with over 200,000 deaths
- The US continues to have the highest number of cases in the world with over 965,000 confirmed cases and over 54,000 deaths
- However, contrary to Trump’s claim that the US has one of the lowest COVID-19 mortality rates in the world, well, yes and no. The US does have a lower mortality rate at 5.4 percent of confirmed cases than the hardest hit European countries such as Italy and the UK where the mortality rate is 13.4 percent for both countries
- However, New York alone is reporting close to 290,000 cases in the city and over 17,000 deaths
- In a JAMA paper, last week, researchers determined that among patients hospitalized with COVID-19 in New York, 14.2 percent of some 5,700 patients required ICU care, 12.2 percent of them required mechanical ventilation and over one-quarter of them died. Mortality for those requiring mechanical ventilation was over 88 percent
- The COVID-19 percent mortality rate for some countries around the world are as follows: France 13.1; Sweden 11; Netherlands 11; Spain 10.4; Canada 4.8; Germany 3.4; South Korea: 2.2
- In fact, according to the Johns Hopkins University Coronavirus Center, over 100 countries have a lower death rate from COVID-19 than that of the US
- Spain continues to report the greatest number of confirmed cases in Europe at approximately one-quarter of a million and over 23,000 deaths. Last week, children under the age of 14 were finally allowed to leave their homes for all of one hour each day but they were forbidden to go further than a kilometer away from their home
- Italy now has approximately 200,000 confirmed cases and over 26,000 deaths. Italian epidemiologists are now suggesting that Italian households are a leading source of contagion, along with long-term care facilities, for the country’s citizens, an unintended consequence of the pandemic’s mantra to stay home
- France is closing in on Spain and Italy with over 22,000 deaths out of over 161,000 confirmed cases. However, the number of ICU patients in France has been steadily declining for at least the last 11 days in a row
- Germany has over 157,000 confirmed cases and approximately 6,000 deaths. Shops under 8,600 square feet in Germany began to open last week, under strict admonitions for continued vigilance
- The United Kingdom now has over 154,000 confirmed cases and over 20,000 deaths. However, last week, the Office for National Statistics (ONS) said it had recorded over 13,000 deaths as of April 10th in England and Wales where the vast majority of the population lives. This compared to over 9,200 deaths according to the government’s daily toll. The ONS figures include deaths from COVID-19 that occur in care homes and hospitals, whereas the government’s figures only include those who died in hospital
- Turkey is experiencing a major surge in coronavirus cases at over 110,000 and 2,800 deaths, exceeding coronavirus counts in Iran where over 90,000 cases have been confirmed along with 5,700 deaths
- Canada is reporting over 47,000 confirmed cases and over 2,500 deaths. More than one-third of patients admitted to hospital for COVID-19 in Canada are under the age of 60, and some 36 percent of those needing ICU care are under 60 as well. These figures suggest that it is not only the elderly that are vulnerable to the deadly virus
- According to Dr. Eric Hoskins, former health minister for Ontario, by the end of April, Canada should be through the worst of the pandemic, at that point counting between 50,000 to 75,000 confirmed cases with approximately 3,000 deaths. The numbers indicate that deaths from COVID-19 in Canada will be lower than predicted at the start of the pandemic
Economic Impact
Amid considerable consternation on the part of public health officials, a number of States in the US are preparing to, or have already opened some of their doors in an effort to stem the economic floodgates brought about by the COVID-19 lockdowns.
In Georgia, Governor Brian Kemp allowed barbershops, nail salons, gyms, bowling alleys and tattoo parlors to reopen late last week while restaurants and movie theatres will be opened this week for the full restaurant experience.
South Carolina allowed “nonessential” retail stories to reopen as well and residents are now back onto the State’s beaches if they are so inclined. Minutes after Florida lifted its ban on public beaches, hundreds of Floridians flocked to its sandy shores for a welcome stroll. Other states including Tennessee, Ohio, Mississippi and Colorado have indicated they are likely to lift stay-at-home orders in the coming weeks as well. Governors are still exhorting people to maintain the 6-foot social distancing rule.
Despite these orders, the number of coronavirus cases continues to increase in many of the states who have already relaxed their restrictions. In response, economists are predicting any early recovery seen in the economy will nosedive as a result of reopening the country too early, leading to a second wave of COVID-19 infections and deaths.
It has not helped that during the pandemic, oil prices have dropped to unheard of lows as the world is awash with oil nobody needs. At its current price of $20 a barrel, 533 US oil exploration and production companies will file for bankruptcy by the end of 2021, predicts Rystad Energy.
More Stimulus Announced
Meanwhile, the federal government passed another $484 billion spending package last week aimed at kick-starting small businesses and helping health-care providers better cope. The new program was rushed into place when the former program, Paycheck Protection Program, was overwhelmed by business demands for loans, including some very big businesses who many feel took advantage of what was to be a bailout for those most in need.
All told, over 70 publically-traded companies reported receiving money from the program. Congress has now offered almost $3 trillion in emergency funding to help control the economic fallout from COVID-19. That money still hasn’t helped many states stay afloat and at least 6 of them have sounded the alarm that they will soon run out of funds.
Certain sectors appear to be particularly badly affected by COVID-19. For example, another major pork production plant, Tyson Foods in Iowa, had to shut down because so many of their plant workers have been infected by the virus. Tyson represents about 4 percent of the US pork processing capacity.
This closure follows on the heels of other meat processing plant closures such as Smithfield Foods and JBS USA. In the US, much of the meat supply comes from only a few massive facilities so the shuttering of a single plant could have significant repercussions for consumers as well as hundreds of farmers, truckers, distributors and grocers themselves.
That said, some 26.5 million Americans have filed for unemployment since mid-March, a sign that this pandemic really is affecting the whole nation.
Business As Usual?
Interestingly, the stock markets are behaving as if it were business as usual – or almost. Late last week, S&P 500 surged ahead, the second straight week of stock market gains, bringing it to just short of about 16 percent of its record highs. In fact, the S&P 500 is up almost 30 percent from its low one month ago, stocks in technology, healthcare and consumer staples apparently holding it all together. Even the European STOXX 600 index finished the week on a slightly upward trend, after tumbling earlier in the week in response to the unprecedented collapse in oil prices.
Since its benchmark lows in March, the STOXX 600 has also bounced back by over 20 percent, powered by an aggressive trillion-dollar pan-European plan announced a few weeks ago to stimulate the economy. Other European stock exchanges also finished up on a higher note, including Italy’s main index, possibly in response to the slight easing of the country’s lockdown scheduled for early May.
But the market’s behavior may simply reflect confidence in global central banks who have pledged to purchase up to $5.5 trillion in assets over the next year. Meanwhile, six European countries have announced they are going to lift certain restrictions, even Italy and Spain, the two countries most severely affected by COVID-19. France, for example, has laid out a gradual reopening plan even though that plan calls for the maintenance of strict social distancing and the likely mandatory use of masks on public transportation.
Sweden, on the other hand, remains an outlier in that it chose to leave most schools and restaurants open despite having at least as many COVID-19 cases as their neighbors. Public health officials urged its citizens to practice social distancing and work from home but they gambled that the virus would spread through the population and allow some herd immunity to build up against it. Officials claim that the strategy has worked because at no point during the outbreak have the country’s ICUs not been able to take care of COVID-19 patients.
In Canada, the biggest announcement last week was a rent relief program for small businesses that will cover half of small businesses’ rents for April, May and June, although landlords will have to absorb one-quarter of the cost. Tenants who have seen revenues drop by at least 70 percent since the pandemic began will be eligible to apply for the Canada Emergency Commercial Rent Assistance program. Ottawa said loans will be forgiven if landlords reduce their tenants’ rent by 75 percent.
The federal government also announced a $9 billion aid package for the country’s students to tide them over a summer that looks like it will have few jobs for them to help pay for tuition and living expenses. For students who can’t find a job, the plan will pay them a $1250 a month. The nation’s biggest cities are pleading for emergency funding from the federal government as well, as they, just like many states in the US, are running out of money to keep essential services going.
On the positive side of the ledger, the journal Carbon Brief, reported that the world has seen the largest annual fall in CO2 emissions ever, coming in 5.5 percent below CO2 emission levels recorded in 2019.
This happy effect can be directly linked to coronavirus-driven declines in just about everything including air, sea and land travel as well as declines in industry, retail and personal energy use.
Drugs, Vaccines, and Tests
Serious concerns are being raised on both sides of the border that drugs needed to sedate intubated patients or help them breathe are in short supply.
The drugs in jeopardy include injectable fentanyl, propofol, salbutamol and midazolam, all of which are in great demand to care for seriously ill COVID-19 patients. Propofol, a widely used anesthetic, has no alternative. Between half to 80 percent of the drugs used in Canada come from India and China, where production has been shut down for months. In the US, where the scenario is likely the same, hospitals are reporting they are only getting the medications needed to treat ventilated COVID-19 patients about half of the time.
This alarming trend suggests that health care providers may not be able to put patients on ventilators as there won’t be enough drugs to help mange pain and comfort levels while the patient is on mechanical ventilation.
VACCINES
So confident are researchers at the University of Oxford in England that their vaccine against COVID-19 will work that they have already recruited seven manufacturers in a number of different countries to produce one million doses by the fall of this year and a million more by the end of the year.
Trials with the Oxford candidate vaccine will be underway this week starting with about 500 volunteers who will receive the vaccine. The virus used in the vaccine has been genetically altered to render it harmless to patients and engineered to produce the same spike-like proteins the coronavirus uses to infect cells.
The same technology was actually used to make vaccines against other coronavirus diseases including the Middle East Respiratory Syndrome (MERS).
TESTS
The first new coronarvirus test that will allow people to collect samples at home has been approved by the Food and Drug Administration (FDA) in the US. The test, developed by LabCorp, is the first to allow for at-home sample collection. The test will initially be made available to first-line responders and results are expected to be available within a day or two of a lab receiving a sample.
Meanwhile, antibody tests, widely touted as a key strategy by which to safely restart the economy, are proving to be no panacea.
The FDA in the US has allowed some 90 companies – many based in China – to sell antibody tests but the tests have not been evaluated by the government and many tests are apparently flawed. Rapid tests, for example, which deliver results in minutes, perform badly according to countries that have bought them. Britain, for one, bought millions of rapid tests that were not sensitive enough to detect antibodies except in all but the most severely ill COVID-19 patients.
Spain reported that an initial batch of tests they received had an accuracy rate of 30 percent. All of this, however, may be completely irrelevant in light of a recent WHO warning that even if people have developed antibodies from a previous COVID-19 infection, that does not mean they can’t get reinfected.
“Some governments have suggested that the detection of antibodies to the SARS-CoV-2 [virus that causes COVID-19] could serve as a basis for an ‘immunity passport’ or ‘risk-free certificate’ that would enable individuals to travel or to return to work assuming that they are protected against re-infection,” the WHO said in a statement.
“There is currently no evidence that people who have recovered from COVID-19 and have antibodies [to the virus] are protected from a second infection,” they added.
Take that, Chile, the first country to issue such ‘immunity cards’ that would have allowed people to return to work, may now be problematic.
COVID-19: Predictions and Future Directions
Global competition for personal protective equipment (PPE) is fierce as nobody can predict how long the pandemic will last or how many people will be infected by the end of the first wave of COVID-19.
More PPE is clearly better but getting it is a whole other story. Competing demands from state and provincial governments for gowns, masks and gloves are making for some bad bedfellows and it’s come down to every man for himself. In China, demand for PPE is so frantic that Shanghai’s Pudong International Airport, where much of the PPE is dispatched, has become a scene of chaos. On April 17th alone, 329 cargo flights stormed the airport.
Trucks delivering supplies from factories across China have had to line up for days before they could stack their wares in warehouses, while airport wait times for security scans have grown so long that shipments have missed flights. Moreover, the Chinese have now cracked down on global complaints about defective PPE, making wait times to get equipment even longer.
There are also tight restrictions on how long a plane can stay at the airport before they have to leave. Two flights ordered by the Canadian government for a massive PPE run for example, recently had to return home empty because they ran out of time. Defective equipment also abounds.
Ottawa just discovered that about a million face masks it had bought from China were defective and couldn’t be used (it should be said that China has promised to make up for those defective masks and will resend them). Toronto purchased multiple boxes of masks only to have to return them as they, too, were defective. Meanwhile, governments have appealed to manufacturers far and wide to repurpose any equipment they might have in their factories and make PPE instead.
Still, it may all be overkill according to some. For example, look at what has happened in the US, where the US Army Corps of Engineers set out to covert dozens of conference centers, dorms and hotels into makeshift hospitals to the tune of $1.7 billion. Their intention was to build at least 32 facilities, 18 of which have already been completed including the Jacob K. Javits Convention Center in New York.
Because social distancing is actually helping control viral spread, many are now questioning whether efforts to add another 33,000 hospital beds to the nation’s stock will ever be used or if used, widely underused. Thousands of beds in the converted convention center in New York as well as a hospital ship nearby still have not been needed.
Then again, there is always the second wave of COVID-19 that everyone expects to see once states start unlocking restrictions more broadly so the efforts may not be so futile.
Update April 20, 2020
Global Footprint
As of the morning of April 20, 2020, the Johns Hopkins Coronavirus Resource Center posted the following statistics:
- Globally, there have been over 2,417,000 confirmed cases of COVID-19 with over 166,000 deaths
- The US continues to have the most number of confirmed cases in the world at over 759,000 and over 39,000 deaths
- Last week, the Centers for Disease Control (CDC) and Prevention reported that over 9,200 healthcare workers in the US have tested positive for COVID-19 although at the time of the report’s release, only 27 had died
- New York is reporting over 247,000 cases in the city and over 18,000 deaths
- New York is now leasing hotel rooms to keep the homeless safe and in cases where the homeless test positive for the virus, to keep them in isolation. San Francisco, San Diego and Los Angeles have also started leasing 1000s of hotel rooms to house the homeless during the pandemic
- Spain continues to report the greatest number of confirmed cases in Europe at over 200,000 and over 20,000 deaths
- Italy now has over 179,000 confirmed cases and over 23,000 deaths, more deaths this week than Spain, interestingly enough, as the reverse was true last week
- France is closing in on Spain and Italy with over 154,000 confirmed cases and over 19,000 deaths. More than 1,000 sailors from the French aircraft carrier group Charles de Gaulle have tested positive for the virus but it’s not clear if these cases are included in the country’s total
- Germany has over 145,000 confirmed cases and over 4,600 deaths
- The United Kingdom is reporting over 121,000 confirmed cases and over 16,000 deaths
- China and Iran are both reporting over 83,000 confirmed cases in each country. In Hubei China, there have been over 4,600 deaths.
- According to the New York Times, the death toll from the virus in Wuhan, China was increased by 50 percent last week after a thorough re-calibration of presumed viral deaths in and out of hospital
- Canada is reporting over 36,000 confirmed cases and over 1,600 deaths
Economic Fallout
Last week, the International Monetary Fund (IMF) warned governments that the global economy is facing its worse economic downturn since the Great Depression.
Compared to earlier projections where the IMF anticipated global economies would grow by 3.3 percent, it now predicts that the world’s economies will contract by 3 percent in 2020. These losses would be far worse than those documented in the 2008 financial crisis; if the pandemic extends into the second half of this year, it could reduce the global GDP by $9 trillion over the next 2 years.
The IMF also predicts that the US economy will shrink by 5.9 percent while in Europe, the economy will shrink by 7.5 percent, driven largely by unprecedented losses in Italy and Spain. The French Central Bank estimated that the country’s economy has already contracted by 6 percent in the first quarter of this year.
The German economy is also expected to plunge by approximately 10 percent from April through to June although the German unemployment rate at 3.2 percent in March was the lowest in Europe.
Importantly, job losses in France and Germany have not been draconian as they have been in North America as workers there are largely protected by governments who have stepped in with subsidies to top up “short-time” work programs.
In Germany for example, the government pays workers up to two-thirds of their usual salary until the employer can take over – essentially, there are no layoffs. The French government also covers a good 80 percent of a worker’s salary, a magnanimous gesture which will nevertheless cost the government an estimated $21 billion over the next 3 months.
Experts in Britain are predicting that the economy will shrink by a whopping 35 percent in the second quarter if the lockdown lasts until June. Britain has also promised to subsidize up to 80 percent of workers’ salaries provided they are not laid off. The estimated cost of this program could be $50 billion over the next 3 months. Meanwhile, Italy has banned companies from making any layoffs for 3 months.
China, in turn, reported that its economy had contracted by 6.8 percent compared with the same quarter in 2019, while retail sales had also dropped by 19 percent, a reflection of economic stagnation in many parts of the world who no longer need as many Chinese goods. Experts in China also predicted that exports for 2020 may be down by as much as 20 percent.
Turning to the US, retail purchases online and in stores as well as money spent in bars and restaurants fell 8.7 percent last month, the biggest decline in nearly 3 decades.
Sales at clothing stores were down by over 50 percent, at furniture stores by over 26 percent and at sporting goods, hobby and book stores by over 23 percent. Bars and restaurants lost over 26 percent in sales in March alone.
The National Restaurant Association in the US says that the industry has lost 3 million jobs and $25 billion in sales since March 1st.
Even some of the country’s largest meat processing plants have had to reduce production by up to 25 percent as workers fell sick from COVID-19, forcing slowdowns and closures. And small business owners who applied for loans under the Paycheck Protection Program starting in mid-March are still waiting for their money.
At the same time, an emergency loan program, the Economic Injury Disaster Loan program, run by the Small Business Administration, and which is separate from the Paycheck Protection Program, has been overwhelmed by demands for loans, leaving many small business without funds either. All of this has meant that by the end of last week, an estimated 25 million Americans will have filed for unemployment benefits.
At the same point in time, 5.4 million Canadians were getting payments through the emergency response benefit program. This number includes approximately 2 million people who had been approved for unemployment benefits but who switched over to the new, $2000-month Emergency Response Benefit program once it had been opened for application. Late last week, the federal government also announced it will make $500 million available to Canada’s cultural and sporting sectors to help artists and athletes get through months of cancelled or postponed events.
The federal government also allocated $50 million for farmers, fish harvesters and those involved in food production and processing who need to impose a 2-week isolation period for temporary foreign workers to self-quarantine.
Meanwhile, Canadian hotels are reporting over 200,000 job losses, with occupancy rates in luxury hotels hovering at about 2.5 percent across Canada in early April.
By the end of last week, the Canadian government had delivered $16 billion in income support to workers, paying out $7.9 billion in unemployment benefits alone since mid-March. Another $8.4 billion had been sent to Canadians who are not eligible for unemployment insurance but who do quality for the $2,000-a- month Canada Emergency Response Benefit program.
Canada’s biggest banks announced they had approved more than $5 billion in no-interest loans to small businesses within the first five days of an emergency program being launched. In total, the federal government plans on spending $255 billion on economic disease relief – nearly three-quarters of last year’s entire federal budget, according to the Globe and Mail.
Not surprisingly, the Canadian economy also shrunk by 9 percent in March alone. The IMF is also forecasting that Canada’s economy will contract by 6.2 percent this year although if the pandemic fades in the second half of 2020, the organization predicted the country’s economy could rebound by over 4 percent in 2021.
Drugs, Vaccines and Tests
Chalk one up for Gilead Sciences and the anti-viral remdesivir? Maybe.
In a study involving 53 evaluable patients with an oxygen saturation of 94 percent or less, two-thirds had an improvement in oxygen-support class, including over half who had been receiving mechanical ventilation, following a ten-day course of remdesivir, 200 mg, IV, on day one, followed by 100 mg IV for the remaining 9 days.
Caveats abound here: There was no control arm in the study and 13 percent of patients died, with higher mortality rates at 18 percent among patients who were receiving ventilation on treatment initiation. That still didn’t stop happy investor reaction when an unnamed Chicago researcher released comments that in another study of 113 severely ill patients, only 2 patients died and most got better quickly following treatment with remdesivir.
Meanwhile, don’t chalk one up for Sanofi, who makes the branded formulation (Plaquenil) of hydroxychloroquine (HCQ). In a study of 84 severely ill COVID-19 patients receiving HCQ and 97 who did not, 20.2 percent of patients who received HCQ were transferred to the ICU or died within 7 days of admission compared with 22.1 percent in the no-HCG group. Moreover, 9.5 percent of patients receiving HCQ had ECG abnormalities necessitating discontinuation of treatment. So much for US President Donald Trump’s endorsement of HCG as a miracle drug for COVID-19.
As an aside, patients who do benefit from the drug, among them people with autoimmune disorders, have been having great difficulty getting the drug for themselves, the result of greedy hoarding of HCQ by people who don’t need it but who smell a profit to be made (it should also be noted that the US government has itself stockpiled 29 million HCQ pills).
And for the record, HCQ is not without side effects including vision loss caused by retinal detachment, which can lead to permanent vision loss. Ask any HCQ patient how often they see an ophthalmologist.
Vaccines
As for vaccines, international pharmaceutical giants are forming previously unthinkable alliances with each other in an effort to be first in line for a COVID-19 vaccine. The incentive is high: the $50 billion global vaccine industry is clearly spurring them on. One such historic partnership is a recent alliance between Sanofi in France and GlaxoSmithKline (GSK) in Britain – two of the world’s largest vaccine manufacturers. The partnership will meld together Sanofi’s expertise in antigen research and GSK’s experience in adjuvant technologies.
US Drug giant Pfizer Inc has also entered into an agreement with German drug maker BioNTech. The partners have already announced they plan to initiate vaccine trials very shortly.
Researchers in several different countries including the US are also expressing an interest in testing the bacille Calmette-Guérin (BCG) vaccine, normally used to prevent tuberculosis, to boost the immune system in frontline health workers. Although the WHO has cautioned that there is no evidence that the BCG vaccine will protect people against COVID-19, researchers from the Massachusetts General Hospital in Boston are still planning to enroll thousands of high-risk health care workers to see if the vaccine can make a difference in their health outcomes.
According to the Milken Institute, at least 79 vaccines are in various stages of early testing, although only three of them have so far been tested in humans: one from Moderna, one from Inovio and the third from China’s Cansino Biologics.
New Rapid Test
Meanwhile, Health Canada has given approval to Spartan Biosciences to start shipping its new rapid test for COVID-19 to federal and provincial governments immediately.
Unlike COVID-19 tests that need to be processed through PCR machines, the new rapid test is processed through a handheld DNA analyzer. This means that hospitals can receive results in under an hour without having to send samples to provincial labs. The company also produces the swabs needed to collect samples from patients – swabs that until now have been in desperately short supply, at least in the US.
Companies and governments alike are begging Spartan Biosciences to supply them with tests, hoping they can screen employees for the virus and allow those who test negative to return to work.
In Germany, the country is planning to sample the nation’s blood and test it for antibodies against COVID-19 in a mammoth effort to determine how widely the virus has penetrated its citizens, how deadly the virus actually is and whether citizens who recover from COVID-19 develop immunity to it.
COVID-19: Predictions and Future Directions
With an eye on the fall elections in the US, President Trump needs to get the economy going again, the threat of COVID-19 notwithstanding.
So far, all he has promised is a “safe, gradual and phased opening” but public health officials are cautioning that the country’s capacity for testing must be greatly expanded before efforts are made to ease restrictions. Officially, the US is running about 120,000 tests per day, not enough to accurately gauge how widely the virus has really spread, experts say.
And without more widespread testing, officials will not be able to identify – and isolate – people who are infected even if they aren’t showing any symptoms, guaranteeing the continued spread of the virus throughout the community. The WHO has warned about lifting restrictions too early, warily eyeing continents like Africa where the virus is spreading at an alarming rate.
There is also a cautionary tale coming out of Singapore. By testing widely and isolating all those who were potentially contagious right at the beginning of the pandemic, Singapore was able to remain relatively open and continue functioning pretty much as usual until very recently. But people, being people, started to relax social distancing rules and in the space of one month, the number of confirmed cases in the country exploded from under 300 in mid-March to over 6,600 as of this weekend.
However, there is some reason to think that the US will soon be able to ramp up testing that might permit careful relaxation of the lockdown. As reported by Stat News, a simple shortage of swabs used to collect nasal samples has been holding up more widespread testing. Late last week, the Food and Drug Administration (FDA) said US Cotton, one of the largest cotton swab manufacturers in the country, can now make polyester-based swabs, which will be cheap, easy to make in large quantities and may even be used by individuals themselves to collect samples.
People might even be able to put the swab in a saline bath rather than have it transported in a special solution that is also in short supply.
On the European front, some construction and manufacturing business were allowed to reopen in Spain although strict social distancing will still be enforced. Spanish police have also started to hand out masks by the millions so that people who are allowed back to work will be better protected.
Italy has reopened some bookshops and clothing stores as well while in Austria, hardware and home improvements stores have been allowed to reopen – provided everyone in and out of the store wears a mask. Schoolteachers in Denmark are also getting classrooms ready so that young children can return to school while in the Czech Republic, some shops and sports centers have once again opened their doors.
The cautious restarting of European economics should serve as a litmus test for the US to see whether it can reopen its own economy, however gingerly.
Update April 13, 2020
Global Footprint
As of the morning of April 13, 2020, the ncov2019.live web site posted the following statistics:
- Globally there have been over 1,868,000 confirmed cases of COVID-19 with over 115,000 deaths
- The US continues to have the most number of cases in the world at over 560,000 cases with over 22,000 deaths, which is more deaths than any other country in the world has seen thus far.
- New York remains the epicenter of the coronavirus crisis in the US, reporting over 189,000 cases and over 9,500 deaths. It is noteworthy that people who die at home or on the street in New York are not included in the fatality toll.
- Believe it or not, over the weekend, the Governor of New York said that the state’s death toll appears to be stabilizing, even though it was stabilizing at a “horrific rate”
- Spain continues to be the hardest hit country in Europe, reporting over 169,000 cases and over 17,000 deaths. The number of deaths per 100,000 people in Spain is also higher than in any other country in Europe at 32.6 deaths/100,000
- Italy is reporting over 156,000 cases and approximately 20,000 deaths. The number of deaths per 100,000 people in Italy is nevertheless lower than it is in Spain at 30.2/100,000. Late last week, Italy reported that the coronavirus is just now showing signs of faltering after 5 weeks of mass isolation.
- France is closing in at over 132,000 cases and over 14,000 deaths. Again, the death rate per 100,000 people in France is about half that of Italy’s at 16.3 deaths/100,000
- Germany now has over 127,000 cases but at only about 3,000 deaths, it has a remarkably low death rate per 100,000 people at only 2.8/100,000. Experts attribute Germany’s remarkably low death rate to widespread testing and confinement of those testing positive
- The United Kingdom is reporting over 84,000 confirmed cases with over 10,000 deaths and a death rate per 100,000 people of 10.7/100,000. Boris Johnson is likely quite pleased he is not among those numbers as Johnson has now been discharged from hospital and is resting at his country home. Still, a senior scientific advisor in the UK has warned that the country is likely going to be among those European countries most adversely affected by the coronavirus
- Iran continues its upward trajectory of confirmed coronavirus cases at over 73,000 but is reporting fewer than 5,000 deaths
- Canada is happily lagging way behind in the coronavirus counts compared to Europe and elsewhere at over 24,000 cases and about 700 deaths so far. However, modeling estimates released last week indicate that Canada will likely see between 11,000 and 22,000 deaths from COVID-19 – a seemingly grim picture but much lower that the projected death toll of up to 300,000 had the provinces not imposed strict business closures and even stricter rules on social distancing
Economic Fallout
Stocks actually rose last week in response to the Federal Reserve’s announcement to create a new $2.3 trillion program to help shore up companies, state and local governments during this global viral meltdown.
In fact, the S & P 500 has gained over 23 percent since the third week of March as the central bank’s efforts to keep everyone afloat have possibly helped soothe investors’ jitters about huge financial losses. The Federal Reserve said it would work through banks to offer loans to companies of up to 10,000 employees and lend money directly to state governments to help them get through the crisis.
Nevertheless, the Democrats still want to see another $250 billion package pumped into the system to help small businesses with additional funding – a demand that was rejected by the Republicans over the weekend.
Meanwhile, hospitals across the US have had to defer or cancel non-urgent surgeries to free up beds and equipment for COVID-19 patients. As a consequence, Bon Secours Mercy Health, which runs 51 hospitals, along with Ballard Health, which runs 21 hospitals, have had to lay off thousands of employees because it was those very procedures which brought in the cash. For example, Bon Secours reportedly is losing about $100 million a month.
A consulting firm, the Advisory Board, has also calculated that a hospital with 1,000 beds with the capacity to do outpatient surgeries would likely lose $140 million – half of its operating revenue – over a 3-month period as a result of the COVID-19 pandemic.
Europe, including the UK, continues to enforce lockdowns on virtually all businesses and Easter – normally a big deal in many European countries – came and went with even the Vatican sending its digital blessings out to an empty St. Peter’s square.
However, finance ministers in the European Union finally did reach a deal worth over half a trillion Euros although the ministers refused to assume a joint debt with countries like Italy and Spain where the virus has caused economic devastation. The new plan calls for €100 billion in loans for unemployment benefits; €200 billion in loans for smaller businesses, and access to another €240 billion in loans for eurozone countries to draw on from the eurozone bailout fund. The money however, will have to be repaid.
The Stoxx Europe 600, which represents stocks in 17 European countries, also moved up by 3.7 percent last week adding to significant gains over the past few weeks. Japan finally got with the program last week too, announcing a $1 trillion stimulus package to keep the economy afloat. The governor of Tokyo also requested the closure of businesses including bars, gyms, movie theaters and night clubs. Actually, the governor really only asked – and once assumes she asked very politely—that restaurants and bars close by 8 pm and to stop serving alcohol by 7 pm – a far cry from the shutdown of bars and restaurants pretty much everywhere else.
Even these seemingly lenient restrictions fly in the face of Prime Minister Shinao Abe’s call to wait a few more weeks before asking businesses to close out of concern that earlier closure will flatten the country’s economy even more than it already has been. Even Britain’s historic pubs have been closed, the first time in the country’s history that every single pub has been closed.
On a happier note, the city of Wuhan ended its 76-day lockdown on April 8, 2020, opening up airways and passenger trains and allowing people to leave the city, which the coronavirus had sealed off for 2.5 months, leaving its citizens in isolation.
Job Losses Mount
Currently, unemployment in the US sits at 13 percent – the highest levels of unemployment since the Great Depression. Over 17 million Americans filed for unemployment in the past month and economists predict that by the end of this month, over 20 million people will have lost their jobs, leaving the country with an unemployment rate of about 15 percent compared to 3.5 percent way back in February, 2020.
JP Morgan Chase is also predicting that the unemployment rate will soar to 20 percent – and the economy will shrink by 40 percent – by the end of June. In addition, the Chair of the Federal Reserve warned that the US economy is deteriorating with “alarming speed”, hitting new 50-year lows in unemployment rates.
Here in Canada, the unemployment rate is hovering at around 7.8 percent compared to 5.6 percent in February. Statscan also anticipates that the number of Canadians already affected by job losses or reduced working hours is now over 3 million. Predictably, the accommodation and food industry has suffered the most job losses, reporting a decline of 24 percent.
The information, culture and recreation industry also lost 13.3 percent of their business during the same interval.
Drugs and Vaccines
The biggest news about drugs to treat COVID-19 actually came from Canada last week.
As reported by the Globe & Mail, the Convalescent Plasma for COVID-19 Research or CONCOR study will test an experimental treatment that takes antibody-rich plasma from patients who have recovered from COVID-19 and then injects it into patients who are still sick.
The theory behind the treatment is that if a recovered patient produced enough antibodies to clear their own infection, then those who are acutely ill with COVID-19 might be able benefit from the antibodies of others, as lead investigator Donald Arnold, MD, at McMaster University in Hamilton explained to a McMaster publication.
The treatment, known as convalescent plasma therapy, has shown some promise in the past. In China, researchers described how COVID-19 antibodies were used to treat patients in the ICU and patients did recover – but there were only five of them. The same approach was used during both SARS and MERS and apparently did improve patient outcomes but evidence is weak as it comes from non-randomized studies.
CONCOR is aiming to enrol about 1,000 patients and there will be a small control group who do not receive treatment. How well convalescent plasma therapy will work will clearly depend on how many recovered COVID-19 patients are willing to donate plasma. The plan is that donation centers across the country will collect plasma, make sure it contains enough antibodies to be potentially therapeutic and then ship the frozen plasma to participating hospitals where it will be infused into critically ill patients to try and speed their recovery.
The study is a collaboration between the Canadian Transfusion Research Network, the McMaster Centre for Transfusion Research, Canadian Blood Services and Hema-Quebec and will be conducted in about 40 hospitals across the country. Realistically, researchers don’t expect to get results for at least 6 to 10 months but are hopeful they may have some data in as little as 3 months.
In the meantime, Regeneron is developing what they are calling an antibody cocktail that may help prevent COVID-19 in high-risk healthcare workers and possibly help treat those who are sick.
Eli Lilly is also working with a small Canadian biotech company, AbCellera, to discover other potent antibodies to treat COVID-19, having already identified over 500 such antibodies from the blood of recovered COVID-19 patients.
Amgen has also announced they are partnering with Adaptive Biotechnologies to try and better understand patients’ immune response to COVID-19. Again, the partners are planning to analyze blood samples from patients who have survived COVID-19.
Takeda, too, is looking to recovered COVID-19 patients in an attempt to isolate a hyperimmune globulin in plasma with the intention of transferring the plasma to infected patients to give their immune system a boost.
Emergent BIoSolutions is also planning to use plasma from recovered COVID-19 patients and is preparing to launch human testing by the end of the summer.
COVID-19: Predictions and Future Directions
A panel put together by the National Academies of Sciences reported that the COVID-19 pandemic is unlikely to fade with the arrival of summer, although they cautioned that evidence supporting this hypothesis is still slim.
An argument had been previously raised that transmission of the virus may be weaker in the face of warmer and more humid conditions. For example, MIT researchers found that 90 percent of COVID-19 transmission has occurred within a temperature range of 37 to 63 degrees. The virus still spreads in temperatures warmer than 63 degrees but much more slowly.
Transmission is reduced in increasingly humid air as well. Rates of infection in March across the US were also higher in states such as New York and Washington where it was colder, and lower in warmer, more humid states such as Georgia and Florida.
Importantly, however, the coronavirus that caused SARs as well as the one that caused MERS did not have any evidence of seasonal transmission once the epidemics took off.
Update: April 6, 2020
Global Footprint
As of the morning of April 6, 2020, the ncov2019.live web site indicated that almost every country in the world has been affected by COVID-19.
- Globally, there have been close to 1.4 million confirmed cases of COVID-19 and over 70,000 deaths
- The US continues to have the most number of cases in the world at over 336,000, with the total number of deaths now approaching 10,000
- Spain has overtaken Italy as having the most cases in Europe at over 135,000 and the number of deaths now stands at over 13,000. Still, Spanish officials say that the number of deaths fell for several days in a row last week, suggesting that the country may be close to passing the peak of infections
- Italy is still reporting over 129,000 cases and close to 16,000 deaths. However, the country-wide lockdown may be paying off as Italian officials announced last week that the numbers of new infections has plateaued. Sadly, by April 3, 2020, 74 physicians had died of the coronavirus, the highest number of deaths among physicians reported by any country during the outbreak. At the same time, approximately 10,000 Italian hospital workers of every description had tested positive for COVID-19
- New York is unhappily reporting over 123,000 cases and over 4100 deaths. The city has erected a makeshift hospital scheduled to open in the city’s Central Park while an indoor tennis center – the site of the US Open tennis tournament – is being turned into a hospital as well. Additionally, a 1000-bed emergency hospital has been set up at the huge Javits Convention Center while a US Navy hospital ship with 1000 beds was beginning to accept patients last week as well
- Germany is inching up to over 101,000 cases but the country still has a very low death rate at approximately 1600
- France is approaching 93,000 cases, with over 8000 deaths
- The United Kingdom has over 47,000 cases and the death rate is now approaching 5000
- Canada has over 15,000 cases but fewer than 300 deaths so far
- Iran continues as the COVID-19 “hotspot” in the Middle East, now reporting over 105,000 cases and over 4500 deaths
- The Centers for Disease Control and Prevention (CDC) issued a report on March 18, 2020 in which they analyzed COVID-19 cases in the US by age group. As of March 16, 2020, 31 percent of reported cases at that time, 45 percent of hospitalizations, 53 percent of ICU admissions and 80 percent of deaths attributed to COVID-19 were among adults 65 years of age and older and the highest percentage of severe outcomes were seen among people 85 years of age and older
- Nevertheless, among patients whose ages were known at that time, COVID-19 occurred in 17 percent of patients between 55 to 64 years of age, 18 percent between 45 and 54 years of age and 20 percent of patients were between 20 and 44 years of age
- Contrary to the general perception that younger patients experience only minor symptoms, the CDC also points out that while no patient 19 years of age and younger has yet needed admission to the ICU because of COVID-19, 36 percent of adults between 45 and 64 years of age and 12 percent of patients between 20 and 44 years of age did need intensive care as a result of the infection
- 20 percent of adults between 20 and 64 years of age in the US have also died of COVID-19, according to the same CDC report
- The WHO also issued a warning on April 3, 2020 that more young people are becoming critically ill and dying of COVID-19; in Italy, for example, 10 to 15 percent of all COIVD-19 patients in the ICU are under the age of 50
Economic Fallout
The S&P 500 fell 2.1 percent during the week ending on April 3, 2020, following a rally that sent it 18 percent higher to almost bull market levels in response to a possible truce between Saudi Arabia and Russia over the price of oil.
Saudi Arabia also called for a cut in oil production to stem the plunge of oil prices. Still, that rally followed a 30 percent drop in the S&P 500 index as the coronavirus morphed into a global wrecking ball, flattening finances everywhere. European stocks also ended lower at the week’s end, as countries extended national lockdowns and businesses remained shuttered.
Economists are now predicting that the euro area GDP will contract by up to 43 percent in the second quarter alone. The European Commission also indicated it expects the EU to go into a deep recession this year as economic activity grinds to a halt across its 27 member states.
At the same time, the Commission has proposed an aid plan to prevent European firms from laying off workers, even though there’s a scarcity of work, where employees will work shorter hours but jobs will not be lost. Governments will then be obliged to top up the shortfall in workers’ salaries. The Commission has also proposed cash advances for farmers and fisherman but these measures still need approval by both the European Parliament and EU member states before workers see any benefits.
Jobless Claims
Meanwhile, in the US, 6.6 million people filed new jobless claims last week, bringing the total number of claims in March to over 10 million. Canada’s numbers are sky high too, with over 2 million Canadians already registering for emergency financial help since the lockdown began last month. According to a survey from Restaurants Canada, the food service industry alone has lost approximately 800,000 of the 1.2 million jobs it had before the pandemic took hold.
Air Canada has temporarily laid off half of its workforce, effective April 3, 2020, noting that it intends to cut capacity by up to 90%. The same degree of devastation has also been seen in the US, where as of April 3, 2020, 459,000 jobs in leisure and hospitality were vanquished in the month of March alone. Companies that prepare meals, snacks and beverages for customers on or off the premise lost over 400,000 jobs in the same month.
US-based airlines are also slated for a $50 billion bailout from the Trump administration as part of the $2 trillion plus rescue package signed into law last week. Credit raters predict that the volume of the relief programs rolled out by both the US and Canadian governments will result in federal deficits as high as 13 percent for both countries this year.
Several of Canada’s big banks have already lowered credit-card interest rates for some customers to slightly under 11 percent, while the big six banks in Canada say they have deferred more than ten percent of mortgages. The Canadian government has also extended its wage subsidy of 75 percent for any business – large or small – along with charities and non-profits that have experienced a 30 percent drop in revenue because of the coronavirus.
Drugs and Vaccines
Clinical trials for possible candidate drugs that could be effective against the novel coronavirus are continuing and results are eagerly awaited by the global medical community.
In the meantime, several new developments surfaced last week which deserve singling out. The first is that the Food and Drug Administration (FDA) in the US approved a new test that can pick up evidence of past infection through the detection of coronavirus antibodies. Done through a standard finger prick approach, the test, made by Cellex, can tell if a patient has ever been exposed to the virus and who thus may be immune to it or at least be partially protected from repeat infection. Results are available in about 15 minutes, so the test is much faster than currently available tests which detect viral genes.
Although it might take several days after being infected for a person to develop antibodies, the new test could provide important information, as once people with immunity against the virus know it, they may be able to safely return to work. Healthcare workers on the frontline would also benefit from knowing if they have some protection against the virus. And policy makers would have a better handle on how many asymptomatic cases are likely to have occurred in the general public so as to be better able to estimate the case fatality rate from COVID-19.
Experts feel that as many as one-quarter of all people who are infected with COVID-19 never develop symptoms. China, Singapore and a few other countries already use antibody tests and public health officials in England have apparently bought millions of them and plan to make them available for home use.
Chinese scientists also announced last week that they have isolated several antibodies that block the ability of COVID-19 from entering cells and replicating, thus potentially preventing the infection from occurring. Meanwhile, researchers at the University of Pittsburgh School of Medicine in Pennsylvania along with other collaborators have an article in press detailing quite stunning results of a strategy by which they developed recombinant coronavirus vaccines delivered via a microneedle array (MNA).
In their paper, the team first identified a key structural component of the viral envelope, the coronavirus spike (S) protein, which represents a key target for vaccines. For the MERS coronavirus, they generated MERS-S1 subunit vaccines and using that as a template, added immune stimulants to engineer the SARS-CoV-2 vaccine. They evaluated the immunogenicity of the vaccines in mice delivered either through traditional needle injection or intracutaneously by MNAs. Immunogenicity results were excellent.
The same approach was used to rapidly develop MNA SARS-CoV-2 (the virus that causes COVID-19) subunit vaccines. The team again found that MNA-delivered MERS-S1 subunit vaccines elicited strong and long-lasting antigen-specific antibody responses. Moreover, they were able to produce these MNA SARS-CoV-2 subunit vaccines within 4 weeks of having identified the SARA-CoV-2 S1 sequence. On testing, the vaccines were also able to elicit antigen-specific antibody responses within 2 weeks of the mice having been immunized.
Investigators concluded that their results support the clinical development of MNA-delivered recombinant protein subunit vaccines against SARS, MERS, COVID-19 and potentially other emerging coronaviruses.
As soon as the FDA gives the team the go-ahead, the vaccines will be ready to be tested in humans.
COVID-19: Predictions and Future Directions
If there was one story that dominated the news last week, it was what was happening to masks and other personal protective equipment (PPE) for healthcare workers, as well as ventilators for critically ill patients.
Accurate predictions about shortages – real and politically imagined – are anyone’s guess but countries significantly affected by COVID-19 are either desperately seeking to ramp up production of equipment, buy it from others, beg for it and in one instance, even steal it for questionable motives. Last Friday, Trump used an arcane law to order mask manufacturer 3M to redirect production of surgical masks and other types of protective equipment made overseas to the US.
At the same time, the administration ordered the company to stop exporting US-made masks to other countries – a move that could backfire if other countries retaliate and stop the flow of protective equipment to the US. The new executive order also allows federal emergency officials to set aside other types of protective gear for domestic use only. These moves do not bode well for Canada who was counting on a massive delivery, some of which had to be from the US, to help shore up its protective equipment supplies.
According to a recent survey done by the Canadian Medical Association, shortages of protective equipment in the country are real. Here are three key findings from the survey:
- Over one-third of Canadian physicians in community care indicated they will run out of respirators (N95 masks), eye/face shields and goggles/glasses within two or fewer days, or had already run out
- More than two-thirds of Canadian physicians in community care said they had tried to order supplies in the past month while fewer than 15 percent said they had received confirmation that supplies were en route or had been received
- Physicians in hospitals said they have no idea how long their current supply of protective gear would last but many said they are being asked to ration supplies
Auto part makers in Canada and the US are teaming up with medical firms to try and fill the demand for protective equipment and ventilators. The Canadian government has also pledged to spend $2 billion on additional medical supplies including diagnostic testing kits. And the world’s largest glove maker, Top Glove, which is based in Malaysia, is anticipating a product shortage as world demand for gloves escalates along with cases of COVID-19.
This despite the fact that the company can produce 200 million natural and synthetic rubber gloves a day. Meanwhile, the Governor of Massachusetts called on the state’s football team, the New England Patriots, to use the club’s private plane and help bring in 1.2 million masks from China.
New York Governor, Andrew Cuomo, in turn thanked the Chinese government for donating 1000 ventilators, which are due to arrive in New York shortly.
The FBI recently intercepted a truckload of medical supplies consisting of nearly 200,000 surgical masks coming into the US from Canada with the intention of being sold at steep markups as desperation over the pandemic deepens. The culprit is now out on a $50,000 bond and the masks have been redirected to healthcare professionals in the US.
Public Health Mantra
On April 3, 2020, the CDC reversed their public health mantra advising against healthy people wearing masks to protect themselves from infection. Now, the CDC is recommending that everyone wear non-medical face coverings in public settings like grocery stores and pharmacies where social distancing may be hard to practice.
At the same time, everyone agrees that any available supply of medical masks should be reserved for hospital and emergency workers. Since commercially available masks are very difficult to find and as a result, people have been hoarding them along with toilet paper, the public will likely have to resort to a scarf, bandana or a home-made mask to cover their nose and mouth.
Cautions against healthy people wearing any type of face mask include the fact that there is no proof that cloth masks deflect potentially infectious droplets that everyone fears others will pass on to them. Wearing a mask also makes it more likely that people will touch their faces frequently to adjust the mask, again a big ‘no-no’ if people want to protect themselves against COVID-19. There is also a risk of the mask becoming contaminated from viral droplets while on the face and once contaminated, the virus may get into the eyes, nose or mouth when the mask is removed.
That said, a recent paper from the University of Hong Kong has suggested that surgical face masks can protect people from viral transmission including transmission of the coronavirus.
Update: March 30, 2020
Global Footprint
As of the morning of March 30, 2020, the ncov2019.live web site has reported that 192 out of 195 countries around the world have been affected by COVID-19.
- Globally, there have been over 742,000 confirmed cases of COVID-19 and over 35,000 deaths.
- The US has taken the top spot for the highest number of confirmed cases at over 143,000 with over 2500 reported deaths.
- The State of New York now has over 60,000 confirmed cases and is reporting over 1000 deaths, most being in New York City. Approximately 13% of those in New York City who have tested positive for COVID-19 have required hospitalization as of last week with almost one-quarter of them having needed intensive care.
- The actual number of infections in the US is bound to be much higher than is currently being reported as only about 1% of citizens in the country have been tested for COVID-19.
- Top US infectious disease expert, Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases, told CNN that between 100,000 and 200,000 Americans could die as a result of the virus.
- Italy continues to be the epicenter of the virus in Europe where over 97,000 confirmed cases have been reported and over 10,000 deaths. Between 10 to 15% of doctors and nurses working in the epicenter of the pandemic in Italy are out of commission because they have been infected by COVID-19.
- China, which appears to be containing the virus, still had over 81,000 confirmed cases by the end of last week but reported only about 3300 deaths. Over 75,000 people in China have recovered from COVID-19 infection as well.
- Spain has also been severely affected by the virus where over 85,000 confirmed cases have been reported along with over 7300 deaths. Nearly 14% of the confirmed cases in Spain are medical professionals, according to the New York Times.
- Germany is rapidly inching upwards with now over 63,000 confirmed cases but an exceptionally low death rate at only about 550.
- France is third in Europe in terms of confined cases at over 40,000 and over 2600 deaths.
- The United Kingdom (UK) is approaching 20,000 confirmed cases. Cases include Prime Minister Boris Johnson and his health secretary, Matt Hancock. Heir-to-the-throne, Prince Charles, has also tested positive for COVID-19. Meanwhile, the death toll in the UK mounts daily, now standing at over 1200.
- Iran continues to stand out as the coronavirus hotspot in the Middle East with over 41,000 confirmed cases and over 2700 deaths.
- South Korea, once second only to China in terms of their coronavirus body count, is looking like a real winner in the virus sweepstakes with only about 9600 confirmed cases and around 50 deaths. Over 5,000 people in South Korea have recovered from the infection.
- Canada has been relatively spared so far, reporting only about 6300 confirmed cases and 65 deaths. The country is still bracing for many more.
- The ncov2019.live web site reports that globally, 23% of previously infected citizens have recovered; as have 15% in Europe versus only 3% in the US. By way of comparison, 93% of previously infected citizens in China have now recovered.
Economic Fallout
On Friday, March 27, 2020, Trump signed the biggest economic stimulus package ever into law, a $2.2 trillion package that will bailout businesses and states and direct payments into jobless benefits for Americans.
The same law will direct $377 billion in guaranteed loans to small business; establish a $500 billion lending program for decimated companies and, for the first time, extend payments to freelancers and gig workers.
As of the week ending on March 21, 3.3 million Americans had filed for unemployment but the number of unemployed Americans is likely much higher. Small business owners can get loans or payroll relief from this fund, but not both.
Stocks markets, having posted their biggest gains in the early part of the week, crashed back down, with the S&P 500 falling by over 3% on Friday. Currently, the stock market is more than 20% below February’s highs and has lost almost all of the gains investors made under Trump’s presidency. At the same point in time, European stock markets fell even further than the S& P 500.
Earlier in the week, Trump was threatening to quarantine New York, parts of New Jersey and Connecticut to try and stem the spread of the virus but later changed his mind. Instead, a “strong travel advisory” was issued to these three states, as directed by the Centers for Disease Control and Prevention (CDC) over the weekend.
Outside of America
Elsewhere, India, a country of 1.3 billion people, is in the world’s largest COVID-19 lockdown as residents have been ordered to stay inside for three weeks in an effort to curb the spread of the coronavirus. A day earlier, all domestic flights in India had been grounded.
South Africa has also mobilized its military to enforce a strict, 21-day lockdown across the country, where people won’t be allowed to leave their homes except for food, medicine and other essential supplies.
In Europe, Italy and Spain have asked for more help from the rest of Europe to fight the still-escalating number of infections in their countries. This could come in the form of common bonds – Eurobonds – which, if backed by the Euro Zone, would be highly secure.
However, wealthier countries such as Germany and the Netherlands are against sharing common debt with indebted countries like Italy. Germany itself has just passed a $1.2 trillion bailout package that will directly subsidize those who are self-employed and guarantee loans for businesses.
The British Government also announced payments worth 80% of lost income up to a monthly maximum of $4285 for self-employed workers affected by COVID-19. Britain also remains in near total lockdown since the beginning of last week with all non-essential shops now closed. People have also been ordered to work from home unless absolutely impossible to do so.
The Canadian federal government also pledged to increase wage subsidies late last week by up to 75% to help small and median-sized business keep workers on payroll. Canadian businesses will also be allowed to defer GST/HST remittances and a new loan program for businesses, the Canada Emergency Business Account, will provide $25 billion in interest-free loans for small businesses and not-for-profits who qualify. The Bank of Canada also lowered its key interest rate to 0.25%, an all-time low.
Meanwhile, by mid-week last week, nearly one million Canadians had applied for unemployment benefits amidst sweeping shutdowns of all non-essential businesses across the country.
And the Summer Olympics in Tokyo will be postponed until 2021 because of the pandemic.
Drugs in Development
There is an exceptionally long list of drugs in the earliest and not-quite-so-early stages of development that companies hope will help them hit the jackpot in the treatment of COVID-19.
Gilead Science’s with its drug, remdesivir, was up first for clinical trials but a few other drugs have actually been approved for the treatment of COVID-19, while others are also heading into clinical trials.
Based on a long list compiled by the digital website, Clinical Trial Arena, here is a short version of the list of drugs that are furthest along in development and trial – in other words, where there is at least some evidence of efficacy – although many more are in much earlier stages of development.
| Company | Drug | Purported Mechanism of Action | Evidence to Date | Developmental Status |
|---|---|---|---|---|
| Fujifilm | Favipiravir (Avigan) | Inhibits RNA-dependent RNA polymerase. Mainly used for treating influenza in Japan and China | Compared with placebo, SARS-Cov-2 (the virus that causes COVID-19) infected patients tested negative for the virus after a median of 4 days vs a median of 11 days for those not treated with the drug. Some 91% of patients treated with favipiravir showed signs of improvement on X-ray vs 62% of those not treated with the drug. | First ever drug to be approved by the National Medical Products Administration of China for the treatment of the virus |
| Airway Therapeutics | AT-100 | Human Recombinant Protein | Has shown efficacy in pre-clinical studies in reducing inflammation in the lungs. | Company has filed with the National Institutes of Health (NIH) to evaluate the drug against COVID-19. |
| Apeiron Biologics/UBC | AOBO1 | Research has revealed that the ACE2 protein is the main receptor for the SARS virus so the hope is that the drug will reduce the viral load in COVID-19-infected patients. | Was originally developed by the University of British Columbia (UBC) for the treatment of SARS. Now it is in a phase I pilot trial in China as a potential treatment for COVID-19. | Results from the phase I trial are awaited and based on trial results, additional trials may be warranted. |
| Genentech | Tocilizumab (Actemra) | An interleukin-6 (IL-6) inhibitor already approved for rheumatoid arthritis among other indications. In COVID-19, the hope is tocilizumab could disrupt the so-called cytokine release syndrome, a serious inflammatory response that can occur as a complication of some infections. | The trial – COVACTA – is a randomized, placebo-controlled trial that will recruit about 330 COVID-19 patients worldwide and is expected to start in early April. Patients will be followed for 60 days with an interim analysis. Key study endpoints will be clinical status, mortality, mechanical ventilation and intensive care unit variables. | The FDA recently approved the drug for evaluation in a randomized, placebo-controlled phase III trial for the treatment of the coronavirus. China has also approved the drug for the treatment of COVID-19. |
| Regeneron/Sanofi | Sarilumab (Kevzara) | Similar to tociluzumab, sarilumab is also an IL-6 inhibitor approved for the treatment of rheumatoid arthritis. The aim with this drug is to also block IL-6 to prevent an overactive inflammatory response in the lungs of COVID-19-infected patients. | A phase II/III randomized, placebo-controlled trial will evaluate the safety and efficacy of sarilumab in patients hospitalized with serious complications from COVID-19. The optimal dose of the drug will first be evaluated but the main endpoint will be a reduction in fever, while a secondary endpoint will be a decreased need for supplemental oxygen. | The trial has been initiated and will first involve medical centers in New York. Target enrollment is up to 400 patients. If phase II goes well, the larger part of the trial will evaluate improvement in longer-term outcomes, including a reduced need for mechanical ventilation and mortality. |
COVID-19: Predictions and Future Directions
Under considerable pressure from cities and states that have been pleading for help to deal with deathly ill coronavirus patients, Trump finally announced the feds would buy 1000s of ventilators from a variety of makers late last week.
Among the companies that will produce the ventilators will be General Motors (GM) who the feds have commandeered to transform their factories and supply chains in order to produce life-saving equipment that is now in desperately short supply across the US. Trump promised that GM and other companies would produce 100,000 ventilators in the next 3 months.
Meanwhile, a good 15 years ago, the Centers for Disease Control (CDC) estimated that the US would need over 740,000 ventilators if the country were hit with a pandemic as severe as the world saw with the influenza crisis in 1918, otherwise known as the ‘Spanish Flu’.
New York Governor Andrew Cuomo has also called for 30,000 ventilators for the city’s sick, a far cry from the 400 ventilators that New York City has received so far.
Elsewhere, the United States Conference of Mayors announced that 200 municipalities were reporting critical shortage of face masks and other personal protective equipment as of last week.
Ideally, health care workers should be outfitted with a tightly sealed respirator like the N95, which fit more tightly around the mouth and nose and block out much smaller particles than standard surgical masks. The CDC has given up on these directives, stating of late that as a “last resort”, health care workers can use homemade masks like a bandanna or a scarf, even though there is no evidence that homemade masks will protect workers.
Trump has also mandated the production of 60,000 coronavirus test kits, according to a CNN report, along with 500 million masks. Meanwhile, Spain has ordered $670 million of goods from China to boost their supply of ventilators, face masks and quick test kits.
Update: March 23, 2020
Global Footprint
- Early in the morning of March 23, 2020, the Johns Hopkins University of Medicine Coronavirus Resource Center reported that there are now 349,211 confirmed cases of COVID-19 around the world with 15,307 deaths and 100,165 patients who had recovered from the virus
- Italy is now the epicenter of the pandemic where close to 60,000 cases have been confirmed. The death toll in Italy is approaching 5,500 and now exceeds the death toll in China. Approximately 2600 members of the country’s medical staff are reportedly infected with COVID-19 as well
- The USA now has over 35,000 cases, making it the third highest country after China and Italy in the COVID-19 infection count
- Next to Italy, Spain, with approximately 33,000 cases and 2200 deaths is the second hardest-hit country in Europe. Over the weekend, it was reported that 3500 doctors and other healthcare workers had tested positive for the virus in Spain
- Germany closely follows Spain with approximately 26,000 cases, but has far fewer deaths at slightly over 100
- Iran has become one of the most affected countries in the world and has the highest number of documented cases in the Middle East. As of March 23, 2020, there was in excess of 23,000 COVID-19 infections in the country and an official death count of 1812
- China reported no new local coronavirus infections as of late last week. The only new cases being reported involved people who had traveled to China from elsewhere, according to government reports
- In addition, South Korea appears to have tamed the virus as have several other Asian countries, namely Taiwan and Singapore, all of whom reacted swiftly with sweeping public health measures from the onset of the outbreak. Their preparations and early preventative measures can be attributed to lessons they learned from the SARS and H1N1 epidemics, which had hit the countries hard
Economic Fallout
With everyday life being virtually suspended in many parts of the world, the economic fallout from the novel coronavirus has been harsh and somewhat predictable.
In the US alone, a report in the Washington Times outlines that economists are warning that millions of jobs could disappear this year. The same report noted that nearly all of the advances the stock market has made under President Trump have been wiped out. The Wall Street Journal pointed out that in just a few weeks, US stocks have lost roughly a third of their value.
And there appears to be no end in sight. Business Insider points out that all major US indices are now in a “bear market”, with some Federal Reserve critics predicting that the stock market will return to the same lows seen in 2009.
The same critics are also blaming the artificially low monetary policy adopted by central banks a decade ago during the financial crisis, which made cheap money widely available, fueling unprecedented amounts of corporate debt today. According to the Organisation for Economic Co-operation and Development, corporate debt hit a record $13.9 trillion by the end of 2019.
Now that companies are completely disarmed in the wake of COVID-19, prospects for many look nothing short of grim. This is in spite of aggressive measures being taken by the Federal Reserve which has signalled that it will buy a significant amount of short-term loads that businesses need to pay their expenses. The White House itself is seeking over one trillion dollars to blunt the economic impact caused by the coronavirus and promises cash payouts to many Americans.
Meanwhile, global market plunged on Wednesday following a brave rally earlier in the week. In response, The European Union has promised 100s of billions of dollars to support member states while Germany pledged $600 billion to help businesses and its own people. Similarly, France, Spain and Italy have all promised to spend whatever it takes to weather the crisis.
Britain has also announced a major fiscal stimulus package to help save British businesses and blunt job losses. According to the New York Times, the British government is promising $422 billion and will include government-backed loans and tax breaks for companies. Homeowners will also get a break in mortgage repayments for the next 3 months.
Meanwhile, the Canadian government has pledged billions in tax referrals ($55 billion), emergency aid ($27 billion), emergency care benefits ($10 billion), increase to GST credit ($5.5 billion), emergency support benefits ($5 billion) and wage subsidies for small business ($3.8 billion). The Canadian government also has promised new emergency measures for workers who must stay home because of the virus and who don’t get paid sick leave, providing as much as $900 every 2 weeks for up to 15 weeks for those who do not quality for employment insurance (EI). By Saturday March 21, 2020, a half a million Canadian workers had reportedly filed for EI benefits.
Also on Wednesday of last week, Belgium joined Italy, Spain and France in a total lockdown that saw a shutdown of all businesses with the exception of grocery stores and other food outlets. Restrictions in Belgium are not quite as severe as they are in France and Italy, where, for example, the French are require to carry a permission form even if they are only walking their dog to explain why they are not in their homes. In fact, the French are now only allowed to walk their dog once a day – this in a nation that mandated that dogs had to be walked 3 times a day not so long ago.
Meanwhile, Italy remains a basket case. Not economically stable well before COVID-19 hit the country hard, the economy is essentially shuttered with only grocery stores, pharmacies, post offices, banking services and some public transportation services remaining open. Italy now has a debt-to-GDP ratio of about 135% – twice the level of Germany’s – and an unemployment rate among its youth of 29%.
How Italy will spend whatever it takes to get through the crisis is utterly unclear. Automakers abroad and at home are also closing down. For example, the French multinational automobile manufacturer PSA announced it was closing European factories this week, while Germany’s flagship carmaker, Volkswagen, may be forced to limit production because of disruptions in its supply chains from Italy and Spain.
Similarly, the ‘Big Three’ North American automakers announced suspension in production across North America last week.
This while Canadian airlines including Air Canada, WestJet, Porter and Transat, as well as US airlines including American Airlines, Delta and United have virtually eliminated international travel in an attempt to limit the global spread of COVID-19.
Britain, lagging considerably behind the rest of Europe, finally announced that all restaurants, cafes and pubs and other public spaces like gyms, theatres and museums must close. Late last week, the United States and Canada mutually agreed to close the border to non-essential travel while true to form, any migrant who tries to cross the border into the US illegally from Mexico will be immediately sent back.
And even laid-back Australians have nowhere to go either, as Australia is also shutting down non-essential services as of this week. The total financial package now on offer from the Australian government will amount to $109 billion.
Drugs and Vaccines
There is a seemingly endless list of candidate drugs and vaccines that companies around the world are racing to test against the novel coronavirus.
Yet a far less costly approach would be to find a drug that could be repurposed to treat COVID-19 rather than having to start from scratch. In fact, several drugs that have been around for a long time for different indications are being tested against the coronavirus. As reported by Reuters, researchers from the University of Minnesota have now launched a trial to see whether hydroxychloroquine, a low-cost generic treatment for malaria, might be useful against COVID-19.
Not only does hydroxychloroquine have a direct antiviral effect, it has also been shown to suppress the production and release of proteins involved in inflammatory complications in a number of viral diseases, and may thus prove to be effective in this new infection as well. Reportedly, a research team in France found that only 25% of COVID-19 infected patients treated with hydroxychloroquine carried the virus after 6 days compared with 90% of patients treated with placebo.
Also this week, the University of Minnesota launched two trials testing losartan, an antihypertensive agent long since genericized, to see if the drug might reduce the risk of organ failure for COVID-19 patients who require hospitalization or limit its need. Researchers hope that losartan might be able to block an enzyme used by COVID-19 to bind to human cells.
Elsewhere, Abbvie’s HIV protease inhibitor, lopinavir/ritonavir, which is repurposed and approved for the treatment of HIV infection under the trade name Kaletra, may again be repurposed to help treat COVID-19.
According to a separate news report, a combination of lopinavir/ritonavir and ribavirin reportedly reduced the fatality rate in patients who had contracted SARS during the 2003 SARS outbreak. The same report also signaled that Cipla is planning to repurpose its HIV drug, Lopimune (again, lopinavir/ritonavir) for the treatment of COVID-19. On March 18, 2020, a report in the New England Journal of Medicine appeared to quash hopes that this HIV combination would be effective against COVID-19 infections, as researchers reported no observable benefit when infected patients were treated with the lopinavir/ritonavir combination compared with standard care.
Nevertheless, investigators suggested that the lopinavir/ritonavir combination might be paired with other antivirals to achieve greater clinical benefit against COVID-19.
Meanwhile, Janssen Pharmaceutical Companies has donated Prezcobix (darunavir/cobicistat) for use in research aimed at finding a treatment for COVID-19. The hope is that this particular combination may have potential antiviral activity against COVID-19 as well.
COVID-19: Predictions and Future Directions
A research team from the Imperial College in London, UK warned that uncontrolled spread of the novel coronavirus infection could cause as many as half a million deaths in Britain alone.
As reported by the New York Times, the team projected there could be up to 2.2 million deaths in the United States if the virus is allowed to spread uncontrollably there as well. Meanwhile, the Washington Post reported that the spread of the coronavirus in Wuhan, China was fueled by people whose symptoms were so mild that they likely didn’t know they were infected.
Through the use of an advanced computer model, an international team of investigators uncovered data that suggested that undocumented COVID-19 cases were responsible for more than 80% of the infections that occurred in that region.“These stealth transmissions will continue to present a major challenge to the containment of this outbreak going forward,” said Jeffrey Shaman, Professor of Environmental Health Sciences at the Columbia University Mailman School, who co-wrote the study.
Therefore seemingly healthy people can transmit the virus – a scary thought that strongly supports the need for social distancing as is urgently being advised across the world.
Update: March 16, 2020
Global Footprint
According to reports from multiple news sources:
- The World Health Organization (WHO) declared COVID-19 to be a pandemic on March 12, 2020
- As of March 16, 2020, the combined global caseload stands at 169,446 with the death toll passing 6,500, according to figures compiled by Johns Hopkins University
- The Washington Post reported that 3,500 coronavirus cases had been documented in the United States as of March 15, 2020, although experts believe the true number is much higher
- The European Center for Disease Prevention and Control reports that 51,771 cases of COVID-19 have been reported in the European Union and the United Kingdom along with 2316 deaths as of March 16, 2020
- Italy is the hardest-hit European country where there have been approximately 24,000 cases as of March 16, 2020 and at least 1000 deaths
- Infections have now spread from northern Italy, initially the epicenter of COVID-19, down to Rome and beyond, leading to a virtual lockdown of the entire country
- Iran now has almost 15,000 cases of COVID-19 and 853 deaths
- The influenza infection has a mortality rate of 0.1%. COVID-19 has a mortality rate 10 times that, according to Anthony Fauci, MD, a member of the US President’s coronavirus task force
Economic Fallout
On March 13, 2020, US President Donald Trump announced that the coronavrius was a national emergency, a move that will allow state and local governments access to federal disaster-relief funding, according to the Washington Post.
Trump’s travel ban started on the same day, where he has barred all passengers from Europe entering the country for 30 days. The United Kingdom was initially exempted, but the ban has been expanded to include the United Kingdom and Ireland as of now.
With that announcement, stock prices in European airlines took a nose dive.
Reports from the Statista Infographics Bulletin indicated that stocks in Lufthansa, Air France-KLM and International Airlines Group dropped by between 6.7% and 9% on March 12, 2020, compounding market woes that had already been triggered by the spread of the coronavirus.
Even before these latest losses, stock prices for European long-haul carriers had lost between 40 and 50% of their market value between mid-February and early March.
This is not to say that Canadian and US airlines have fared any better: WestJet, for example, is set to cut its international seat capacity by 60% according to the Globe and Mail, while in the US, the American Airlines group and Delta Air Lines have both announced major suspensions of international flights and even domestic routes in response to US travel bans both in and out of the country.
Market Shock
On March 12, 2020, Wall Street traders posted their worst losses in 3 decades while the next day, the Asian markets took another pummeling. In response, the US Federal Reserve announced that it will make $1.5 trillion available to shore up the financial system.
Then, on March 15, 2020, the United States central bank announced a series of measures including a full percentage point reduction in its benchmark interest rate (now essentially set at zero percent), and said it would buy hundreds of billions of dollars in US government debt. This move follows similar announcements in Canada where banks have promised to boost loans to Canadian businesses by $10 billion to soften the virus’ economic blow.
Meanwhile, the markets have imploded and exploded in response to fiscal stimulus announcements, swinging from a week of trading that included the worst day since Black Monday in 1987 back to significant gains, followed again by significant losses.
For example, The New York Times reported that stocks around the world dropped dramatically on March 16, 2020 despite the US Federal Reserve’s attempts to curb the economic impact of the virus. European makers also opened 4% lower on the same day then fell by more than 8% by later on that same day. Markets in other parts of the world posted losses of a similar magnitude.
Experts are now predicting that many countries, including Canada, are heading into a recession as a result of the COVID-19’s devastating impact on businesses and consumer spending. And no business has been left unscarred by the spread of COVID-19. Virtually all major league professional sporting events – basketball, baseball, hockey and soccer – have all been cancelled, at least temporarily.
Conferences and trade shows, indeed any event that might bring as many as 50 people or more together in a single venue, have been postponed. In New York, Broadway is dark and bars and restaurants have been ordered to shut down in a number of major cities including New York City itself. Even Disney Parks are closing their doors, the first time they have done so since September 11, 2001.
Schools across the country have just now been closed, leaving some 32 million students in limbo.
Fallout in Europe: The New Epicenter of the COVID-19 Outbreak
Meanwhile, in Europe, the New York Times just reported that residents in Spain will only be allowed to leave their homes for essential activities for at least the next 2 weeks, while France has announced it is closing all non-essential businesses including restaurants, bars and movie theatres until further notice.
Italy remains in total lockdown and even the Vatican will be livestreaming traditional Easter services this year rather than hold them in public. Doug Saunders of the Globe and Mail also reports that Italy has about 12 hospital beds with ventilators for every 100,000 people meaning that doctors there are now essentially having to decide which patients are most likely to live, and which are not, and triage the ventilators they have, accordingly.
In response to the COVID-19 crisis in Italy, China is reportedly sending 1000 ventilators to Italy along with thousands of swab test kits and protective suits and millions of face masks.
In the US, there are 35 beds with ventilators for every 100,000 people, a good ratio compared to most other countries including Canada which has only 10 to 12 ventilators for every 100,000 people.
Drugs and Vaccines
Gilead Sciences might have made the first move on possible new treatments for COVID-19, while Moderna Therapeutics was the first to have its COVID-19 vaccine ready for human testing but that doesn’t mean other pharmaceutical companies aren’t vying to get into the same race and finish in the black.
According to Business Insider, Sanofi joined the fray in mid-February to develop a vaccine against the novel coronavirus in conjunction with the US Biomedical Advanced Research and Development Authority. The company actually had a fairly good head start already because they could build off prior research done when trying to develop a vaccine against the 2002 – 2003 outbreak of Severe Acute Respiratory Syndrome, or SARS.
Sanofi expects to have a candidate vaccine ready for in vitro testing within the next six months, although it will take considerably longer before the vaccine can be tested in the clinic.
Johnson & Johnson is also aiming to start vaccine trials by the end of this year. Currently, they are already testing several candidate vaccines in animals and hope a vaccine will be ready for human testing by November 2020.
On the other hand, Regeneron is exploring a large number of antibodies in its search for a treatment for the COVID-19 infection, as well as to protect individuals not yet infected. Once they have identified the most promising candidate, Regeneron predicts that they may be able to begin testing the drug in humans by late summer of this year.
Pfizer already has a number of antiviral medications under development which they hope will be ready for testing against COVID-19 by the end of the year.
Alnylam Pharmaceuticals has similarly teamed up with another biotechnology company in order to use the company’s RNA interference (RNAi) platform against the virus. A company spokesperson predicted that an RNAi therapeutic might be particularly helpful in patients at high risk of infection such as healthcare workers.
Takeda is looking to recover blood plasma containing hyperimmune globulin from people who have recovered from COVID-19. When transferred to a new patient, the company believes their donor blood could boost an immune response since it already contains antibodies against the virus.
COVID-19: Predictions and Future Directions
According to the BBC, US Vice-President Mike Pence has announced that free coronavirus testing would be made available for every American.
Indeed, Trump himself has had himself tested, announcing results that came back negative. The Washington Post reported that the White House now plans to work with the private sector to set up “drive-through” testing centers to cater to residents fearful that they have contracted the virus.
The New York Times reported that the US government will dedicate over a million dollars to two companies – DiaSorin Molecular and Qiagen – to speed up the development of COVID-19 tests. However, an editorial in the Journal of Thoracic Oncology points out that the number of people infected with the SARS-CoV-2 virus in different parts of the world is greatly influenced by the number of tests performed.
This had led to a false sense of security that some parts of the world have not yet largely succumbed to COVID-19 because if only a few people have been tested, then even fewer will have tested positive for the virus. In the US for example, the COVID-19 Tracking Project estimated that only about 16,500 people in the US had been tested for COVID-19 as of the end of last week.
This stands in stark contrast to South Korea where the National Public Radio estimates that approximately 250,000 people, or about 3600 tests per million people, have been done since the outbreak began in the country in late January 2020. In the US, about 5 tests per million people have been done so far. The Centers for Disease Control (CDC) and Prevention in the US is partly to blame for the poor test performance up to now in the US.
In early February of this year, the CDC sent out test kits to laboratories across the US but labs soon found that some of the chemicals used in the tests were faulty and the CDC was forced to replace the early tests with newer, more accurate kits. The CDC has now done this but, according to some news reports, there are still not enough tests to go around for people who want to be tested. On March 13, 2020, the New York Times reported that measures have been put into place to speed up both the distribution of the tests and process the ones that have been recently deployed.
At least now, the testing situation in the US can be expected to improve.
Update: March 9, 2020
According to reports from sources:
- As of March 9, 2020, the number of COVID-19 infections globally has risen to 108,000, with over 3800 deaths linked to the infection
- The COVID-19 infection is caused by SARS-CoV-2, the official name for the coronavirus that causes COVID-19
- The novel coronavirus emerged in the Chinese city of Wuhan in early December and has since spread around the world
- Some countries still haven’t reported any signs of the infection but at least 112 countries and territories around the world have reported at least one case
- The number of cases outside of China is now larger than the number of cases in China, where the spread of infection is slowing
- Until very recently, the country that has been most adversely affected by COVID-19 outside of China was South Korea, where the national infection total reached 7382 as of March 9, 2020, with at least 51 deaths
- Italy now rivals South Korea as the country most adversely affected by COVI-19 as the number of reported cases in Italy reached a total of 7375, resulting in 366 fatalities (as of March 9, 2020)
- At the same point in time, almost 500 cases of COVID19 have been confirmed in the United States, along with 19 deaths; in Canada, 67 cases have been reported
- As of March 6, 2020, Iran reported 4747 COVID-19 infections and 124 deaths. However, there is controversy over the number of deaths in the country. For example, BBC reports that it may be as high as 210 — the highest number of coronavirus-related deaths outside of China
Economic Fallout
The last week in February marked the worse week the stock markets have seen since the height of the financial crisis more than a decade ago.
That fallout continued during the first week of March, as reported by the Washington Post and the New York Times.
On March 6, 2020, the Dow Jones industrial average fell roughly 3% while Standard & Poor’s (S&P) 500 fell slightly more at 3.5%. The 10-year Treasury yield is also at new lows, with bonds now paying less than 1% interest, a sign that investors are very worried about future growth in the economy, according to the Washington Post.
On March 9, 2020, London and Frankfurt stock markets were down 8% with other European exchanges close behind. The Nikkei index in Japan also dropped by over 5% on the same day while US futures pointed to heavy losses on Wall Street upon opening the week of March 9, 2020.
Meanwhile, in the aftermath of Saudi Arabia announcing plans to raise crude oil production and cutting its price for all crude grades, oil futures suffered their biggest loss since 1991, as reported by multiple news outlets including the Washington Post
In response to the epidemic, President Trump signed an $8.3 billion emergency spending package on March 3, 2020 to help stimulate the US economy.
Last week, the Bank of Canada also cut back on its benchmark interest rate by half a percentage point to 1.25% while the International Monetary Fund has now committed $50 billion to low–income and emerging-market countries to help fend off the coronavirus epidemic should it reach their shores.
Financial Impact
The financial shock caused by COVID-19 is affecting both the supply and the demand side of the global economy. For example, on February 28, 2020, the Food and Drug Administration (FDA) in the US announced the first manufacturing shortage of a drug due to the COVID-19 outbreak. While they did not identify the drug, the FDA stated in a notice issued on February 27, 2020 that “the shortage is due to an issue with manufacturing of an active pharmaceutical ingredient used in the drug.”
The FDA has also identified approximately 20 other drugs, which either source their active pharmaceutical ingredients from China, or finish making the drug product there. In fact, in a report by Eric Reguly on March 4, 2020 in the Globe and Mail, Rosemary Gibson, co-author of China Rx: Exposing the Risks of American’s Dependence on China for Medicines, observed that 80% of the core components that go into generic drugs sold in the US are made in China. If that supply chain dries up, Gibson predicts that the pharmacy shelves in the US would be empty within months and that hospitals across the US would cease to function.
With respect to medical devices, the FDA is aware of some 63 manufacturers representing 72 facilities in China where essential medical devices are produced — all of which they have contacted. Currently, there are no reported shortages of these specific medical devices within the US market.
However, both the FDA and the WHO are reporting that there is an increased demand for, and shortages of personal protective equipment such as surgical gowns, gloves, masks, respiratory protective devices or other medical equipment that are designed to protect the wearer from the spread of infection or illness. These shortages are leaving doctors, nurses and other frontline workers “dangerously ill-equipped to care for COVID-19 patients” according to a WHO press release.
On March 9, 2020, Reguly also reported that 14 regions in Northern Italy went into lockdown, putting 16 million people into isolation. And with travel advisories from the Centers for Disease Control (CDC) cautioning all would-be visitors against all non-essential travel to South Korea, China, Italy and Iran, the New York Times predicted that the fallout from the coronavirus could cost the airline industry between $63 and $113 billion in worldwide revenues in 2020.
This ominous trend is not being helped by the fact that conferences and meetings are being cancelled right, left and center, including medical conferences in Europe such as the International Conference on Thrombosis and Hemostasis Issues in Cancer in April, which was to be held at the University of Bergamo in Italy, and the European Society of Radiology, which has been postponed until mid-July of this year.
Drugs and Vaccines
Two new phase III clinical trials will be initiated shortly to evaluate the safety and efficacy of remdesivir, a nucleotide analog with broad-spectrum antiviral activity, in adults diagnosed with COVID-19.
The FDA in the US granted Gilead Sciences, Inc. the right to investigate remdesivir for the treatment of COVID-19 in record time.
These 2 new randomized trials will enroll approximately 1000 patients, mostly from Asian countries, beginning in March of this year. They are both designed to assess 2 different dosing durations of remdesivir, which is given intravenously. One study will assign about 400 patients with severe symptoms of COVID-19 to receive 5 or 10 days of the drug, while the other study will randomize about 600 patients with more mild symptoms to receive either 5 or 10 days of the drug or standard-of-care alone.
The primary endpoint of the study involving more severely affected patients is the degree of normalization of fever following treatment together with oxygen saturation, sustained for at least 24 hours and up to day 14. The primary endpoint of the study involving less severely affected patients will be to evaluate the effect of remdesivir on the proportion of participants discharged by day 14.
The 2 new trials will add to research already being done with remdesivir, which includes 2 trials led by the China-Japan Friendship Hospital in China’s Hubei province as well as the recently initiated trial led by the National Institute of Allergy and Infectious Diseases in the US. Results from these 2 trials are expected in April 2020.
“This complementary array of studies helps to give us a more expansive breadth of data globally on the drug’s profile in a short amount of time,” Merdad Parsey, MD, PhD, chief medical officer at Gilead Sciences said in a press release.
“The speed with which remdesivir has moved into clinical development for this coronavirus reflects the pressing need for treatment options,” he added.
Meanwhile, the race is on to come up with a vaccine to prevent infection from the novel coronavirus with more than 20 vaccines in development already.
According to TIME magazine (February 25, 2020), Moderna Therapeutics has already shipped vials of its COVID-19 vaccine to the National Institute of Allergy and Infectious Disease, part of the National Institutes of Health (NIH) in Bethesda, Maryland. The vaccine could be ready for human testing as early as April.
The vaccine was created in record time following the genetic sequencing of the COVID-19 virus by Chinese researchers in mid-January. This particular vaccine is loaded with mRNA that makes the virus’ Spike (S) protein, exposure to which will mimic viral infection and lead to an immune response. This will allow the company to scale up the production of the vaccine quickly, a virtue that matters with COVID-19 threatening to become a pandemic.
That said, experts estimate that the development of a COVID-19 vaccine could take between a year and 18 months, if not longer, before it is granted approval for public inoculation. Four companies in China have also entered into a contract with Generex Biotechnology for the development of a Ii-Key peptide-based COVID-19 vaccine, according to a report from Pharmaceutical Technology (February 8, 2020).
The vaccine could be available for human clinical trials within the next 3 months.
COVID-19: Predictions and Future Directions
Experts are predicting there could be as many as 96 million cases of COVID-19 in the US and 480,000 deaths by the time the coronavirus outbreak is over, according to a webinar held by the American Hospital Association.
As reported by Business Insider, these estimates were presented by James Lawler, MD of the University of Nebraska Medical Center in a recent webinar titled “What healthcare leaders need to know: Preparing for the COVID-19”, which took place on February 26, 2020 with representatives from the National Ebola Training and Education Center.
Dr. Lawler suggested that hospitals should prepare for an impact to the system that is 10 times greater than that seen in a severe flu session. He estimated that as many as 4.8 million hospitalizations could result from COVID-19 infections.
The American Hospital Association said the webinar reflected the views of the experts who spoke during it and do not necessarily reflect their own views.
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