Update: April 6, 2020
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
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.
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
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.
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
- 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
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
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
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.
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
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.
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.
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.