Here’s a pair of arti­cles about recent COVID research that high­light the ongo­ing chal­lenges in under­stand­ing both how the human immune sys­tem deals with the SARS-CoV­‑2 virus, ques­tions of how wide­spread the out­break actu­al­ly is, and how those two ques­tions inter­re­late:

First, there was anoth­er study that found a sub­stan­tial num­ber of peo­ple who were infect­ed by the virus but only had mild or no symp­toms did­n’t have anti­bod­ies after recov­er­ing. But many of them did have T‑cells that were tar­get­ing the virus. It’s the kind of find­ing that’s both good news in the sense that it means peo­ple with­out anti­bod­ies might still have some degree of remain­ing immu­ni­ty but also bad news in the sense that it’s much hard­er to mea­sure the pres­ence of these T‑cells, which might be hid­ing in lymph nodes or oth­er hard-to-mea­sure tis­sues, com­pared to anti­bod­ies that are going to be cir­cu­lat­ing in the blood­stream and can there­fore be more eas­i­ly mea­sured.

Recall the pre­vi­ous small study out of Chi­na that found that a lack of anti­bod­ies in around a third of the recov­ered patients they exam­ine, with younger and health­i­er patients being more like­ly to lack the anti­bod­ies. This raised the ques­tion of whether or not the anti­body lev­els dis­si­pate quick­ly but also led the researchers to spec­u­late that T‑cells might be fight­ing off the virus instead of anti­bod­ies for these indi­vid­u­als. So it sounds like their spec­u­la­tion panned out and T‑cells were play­ing a role in these anti­body-free patients suf­fer­ing mild or no symp­toms, although it remains unclear if the peo­ple who are lack­ing anti­bod­ies in the study nev­er devel­oped them at all or the anti­bod­ies devel­oped and fad­ed before they were mea­sured in these stud­ied.

It also opti­misti­cal­ly sug­gests that the lev­els of expo­sure of the virus are actu­al­ly much high­er than cur­rent anti­body-based sur­veys sug­gest. Recall the study from back in April con­duct­ed in New York City that con­clud­ed that 20 per­cent of the city’s pop­u­la­tion might have already been exposed to the virus because around 20 per­cent of the peo­ple in a sam­ple of 1300 New York­ers had anti­bod­ies. If around a third of exposed peo­ple don’t have anti­bod­ies but do have T‑cells that sug­gest around 27% of New York­ers may have already had some degree of immu­ni­ty to the virus back in April. In gen­er­al the find­ing on anti­bod­ies and T‑cells sug­gests that assess­ing the lev­el of col­lec­tive immu­ni­ty in a pop­u­la­tion is going to be more chal­leng­ing than we hoped.

It’s also worth recall­ing the study that found that SARS-CoV­‑2 might actu­al­ly infect and kill T‑cells, via a dif­fer­ent mode of entry into the cell that does­n’t involve the ACE2 recep­tor. The virus thank­ful­ly could­n’t repli­cate in the T‑cell (which could have made it more like HIV) but it can still kill the cells. It rais­es all sorts of the ques­tion of how re-expo­sure to the virus might affect those pro­tec­tive T‑cell lev­els.

Addi­tion­al­ly, there was anoth­er recent study that found that T cells devel­oped from expo­sure to oth­er coro­n­avirus­es, like coro­n­avirus­es that cause the com­mon cold, might help fight the SARS-CoV­‑2 virus. A study out of the La Jol­la Insti­tute found that T cells from blood sam­ples col­lect­ed by 2015 and 2018 were react­ing to the SARS-CoV­‑2 virus. So sim­ply hav­ing had a lot of pre­vi­ous immuno­log­i­cal expo­sure could give one an addi­tion­al edge against this virus. On the oth­er hand, if you already avoid expo­sure to virus­es due to a weak immune sys­tem you’re might be extra vul­ner­a­ble to SARS-CoV­‑2. It’s anoth­er exam­ple of this being a eugenic virus.

The sec­ond arti­cle we’re going to look at also cov­ers stud­ies that point to sig­nif­i­cant com­pli­ca­tions in how to treat the virus. In part because it sounds like SARS-CoV­‑2 impacts the immune sys­tem in ways no oth­er stud­ied virus does and this might explain the mech­a­nisms through which the virus trig­gers the cas­cade of immune over-response that ends up killing patients: Most virus­es try to accom­plish two key tasks in order to suc­cess­ful­ly repro­duce with­out the immune sys­tem squash­ing the infec­tion. First, typ­i­cal virus­es try to sup­press the cells genes that trig­ger the cel­l’s “call to arms” sig­nal­ing mech­a­nisms that pro­duce inter­fer­ons. Inter­fer­ons cause sur­round­ing cells to turn on a num­ber of genes that com­pli­cate the virus’s abil­i­ty to repli­cate itself, slow­ing down the infec­tion. The sec­ond set of genes typ­i­cal virus­es tar­get are the genes that pro­duce chemokines which are like the “call for rein­force­ments” sig­nal­ing mol­e­cules that recruit B‑cells and T‑cells from far away to the site of the infec­tion.

So the first “call to arms” genes buy time while the sec­ond “call for rein­force­ments” genes recruit the spe­cial­ized immune cells that can come in an fin­ish off the infec­tion. Tar­get­ing those two areas is how virus­es nor­mal­ly. But what researchers out of Mount Sinai dis­cov­ered back in May is that SARS-CoV­‑2 ONLY blocks the “call to arms” genes, mean­ing that the virus is allowed to repli­cate uncon­trol­lably while the spe­cial­ized immune cells like B and T‑cells are still get­ting recruit­ed to the site of infec­tion. It’s this dynam­ic that appears to lead to the kind of over­whelm­ing immune response that ends up killing patients and SARS-CoV­‑2 is the only known virus to induce this.

An addi­tion, anoth­er study out of Japan found pub­lished back in May iden­ti­fied the SARS-CoV­‑2 pro­tein (known as a tran­scrip­tion fac­tor) that blocks the cel­l’s inter­fer­on sig­nalling and found that the SARS-CoV­‑2 tran­scrip­tion fac­tor is stronger than the orig­i­nal 2003 SARS vari­ant of the pro­tein as well as influen­za­’s ver­sion. So SARS-CoV­‑2 appears to be excep­tion­al at block­ing the “call to arms” sig­nal­ing at the same time it’s the only known virus that does­n’t even try to block the “call for rein­force­ments” sig­nal­ing.

All in all, it’s more dis­turb­ing SARS-CoV­‑2 news, but there was one bit of good news from the dis­cov­ery of this anom­alous “call to arms” vs “call for rein­force­ments” behav­ior of the virus: pro­vid­ing patients with inter­fer­ons can poten­tial­ly pre­emp­tive­ly pre­vent a full blown infec­tion. That’s what Uni­ver­si­ty of Texas Med­ical Branch researchers dis­cov­ered when they exposed human cells in cell cul­tures to inter­fer­on and then tried to infect them with the virus. Inter­fer­on expo­sure real­ly did seem to sup­press the virus’s abil­i­ty to repli­cate. So that opens a third avenue for treat­ing the pan­dem­ic: pre­ven­ta­tive drugs. But, of course, drugs have side-effects includ­ing inter­fer­on so this is far from an ide­al solu­tion. But at least it’s anoth­er tool in the tool­box.

Ok, first, here’s a recent arti­cle about how a large por­tion of patients who had mild or no symp­toms and recov­ered appear to only pos­sess T‑cell fol­low­ing recov­er­ing and how it rais­es the ques­tion of whether or not these patients are fight­ing off the virus with T‑cells alone of if they devel­oped anti­bod­ies but they already fad­ed away, leav­ing just the T‑cells behind for longer-term immu­ni­ty:

Reuters

Sci­en­tists focus on how immune sys­tem T cells fight coro­n­avirus in absence of anti­bod­ies

Deena Beasley
July 10, 2020 / 6:09 AM

(Reuters) — As sci­en­tists ques­tion whether the pres­ence, or absence, of anti­bod­ies to the nov­el coro­n­avirus can reli­ably deter­mine immu­ni­ty, some are look­ing to a dif­fer­ent com­po­nent of the immune sys­tem, known as T cells, for their role in pro­tect­ing peo­ple in the pan­dem­ic.

Recent stud­ies show that some recov­ered patients who test­ed neg­a­tive for coro­n­avirus anti­bod­ies did devel­op T cells in response to their COVID-19 infec­tion. While the stud­ies are small and have yet to be reviewed by out­side experts, some sci­en­tists now say that peo­ple who expe­ri­ence a mild ill­ness, or no symp­toms at all, from the new coro­n­avirus, may be elim­i­nat­ing the infec­tion through this T cell response.

The find­ings add to the evi­dence that an effec­tive COVID-19 vac­cine will need to prompt T cells to work in addi­tion to pro­duc­ing anti­bod­ies, and may have impli­ca­tions for sev­er­al treat­ments in devel­op­ment. They may also shed light on how immu­ni­ty to new expo­sure to infec­tion could work.

There is mount­ing evi­dence that peo­ple exposed to the virus have a tran­sient (short-lived) anti­body response, or have a T cell response in spite of a minor or absent anti­body response Dr Alessan­dro Sette, pro­fes­sor and mem­ber of the La Jol­la Institute’s Infec­tious Dis­ease and Vac­cine Cen­ter in Cal­i­for­nia, told Reuters.

When a virus gets past the body’s ini­tial defens­es — which include infec­tion-fight­ing white blood cells — a more spe­cif­ic “adap­tive” response kicks in, trig­ger­ing pro­duc­tion of cells that tar­get the invad­er. These include anti­bod­ies that can rec­og­nize a virus and lock onto it, pre­vent­ing its entry into a person’s cells, as well as T cells that can kill both invaders and the cells they have infect­ed.

Six months into a glob­al COVID-19 pan­dem­ic that has infect­ed more than 12 mil­lion peo­ple, ques­tions remain about whether the anti­body response to this virus is robust and lasts over time. That could mean T cells have a more impor­tant role in offer­ing pro­tec­tion against the ill­ness.

...

A recent small French study here not yet reviewed by experts, found that six out of eight fam­i­ly mem­bers in close con­tact with rel­a­tives who had COVID-19 devel­oped a T cell response, but did not test pos­i­tive for anti­bod­ies.

A Swedish study here of 200 peo­ple found a strong T cell response in most indi­vid­u­als who had mild ill­ness or no symp­toms fol­low­ing coro­n­avirus infec­tion, regard­less of whether they showed an anti­body response. The find­ing sug­gests that coro­n­avirus infec­tion rates may be high­er than what has been stud­ied using anti­body tests alone, the researchers said.

MEMORIES OF CORONAVIRUS

The focus on T cell respons­es could also shed light on the prospect for longer-term immu­ni­ty.

There is some evi­dence that T cells devel­oped after expo­sure to oth­er coro­n­avirus­es that cause the com­mon cold could help fight off the new virus, known as SARS-CoV­‑2.

A study led by the La Jol­la Insti­tute detect­ed T cells that react­ed to SARS-CoV­‑2 in about half of stored blood sam­ples col­lect­ed between 2015 and 2018, sug­gest­ing that the immune sys­tem cells devel­oped after pre­vi­ous infec­tion with cir­cu­lat­ing com­mon cold coro­n­avirus­es, and that they might help pro­tect against the new virus.

“It is a poten­tial­ly encour­ag­ing piece of evi­dence,” Wher­ry said.

Vac­cine can­di­dates against COVID-19 cur­rent­ly in the works aim to gen­er­ate anti­body and T cell respons­es, and the recent find­ings high­light the impor­tance of gaug­ing the T cell response seen in human clin­i­cal tri­als.

“We believe that the opti­mal vac­cine design would be one that induces both an anti­body and T cell response,” Sette said.

After an infec­tion or vac­ci­na­tion, the immune sys­tem retains a num­ber of “mem­o­ry” cells that are already primed to quick­ly attack the same virus in case of a future infec­tion.

Many coun­tries are using blood tests that look for anti­bod­ies to esti­mate how many peo­ple have been infect­ed with the new virus even if they nev­er showed symp­toms. But sci­en­tists still do not know how anti­body lev­els cor­re­late to expo­sure to the virus or how long they may last. There are also ques­tions about exact­ly which com­bi­na­tion of immune-sys­tem cells will result in sig­nif­i­cant pro­tec­tion.

Mea­sur­ing the lev­el of mem­o­ry T cells is much more com­pli­cat­ed, espe­cial­ly if the cells are in lymph nodes or oth­er hard-to-access areas of the body. In addi­tion, T‑cell respons­es are high­ly vari­able.

“It is a lot eas­i­er to col­lect anti­body data,” said Dr Daniela Weiskopf, an assis­tant pro­fes­sor at the La Jol­la Insti­tute.

———–

“Sci­en­tists focus on how immune sys­tem T cells fight coro­n­avirus in absence of anti­bod­ies” by Deena Beasley; Reuters; 07/10/2020

“Recent stud­ies show that some recov­ered patients who test­ed neg­a­tive for coro­n­avirus anti­bod­ies did devel­op T cells in response to their COVID-19 infec­tion. While the stud­ies are small and have yet to be reviewed by out­side experts, some sci­en­tists now say that peo­ple who expe­ri­ence a mild ill­ness, or no symp­toms at all, from the new coro­n­avirus, may be elim­i­nat­ing the infec­tion through this T cell response.”

The evi­dence keeps com­ing in: this virus is fought off dif­fer­ent­ly by dif­fer­ent peo­ple, and if you’re young and healthy you’re less like­ly to even need anti­bod­ies at all. Your T‑cells can do the job on their own. And if those T‑cells are stick­ing around after the infec­tion that rep­re­sents a form of immu­ni­ty that we aren’t going to detect in anti­body sur­veys. It also sug­gests there’s a lot more peo­ple with immu­ni­ty already than anti­body sur­veys sug­gest:

...
There is mount­ing evi­dence that peo­ple exposed to the virus have a tran­sient (short-lived) anti­body response, or have a T cell response in spite of a minor or absent anti­body response Dr Alessan­dro Sette, pro­fes­sor and mem­ber of the La Jol­la Institute’s Infec­tious Dis­ease and Vac­cine Cen­ter in Cal­i­for­nia, told Reuters.

...

A Swedish study here of 200 peo­ple found a strong T cell response in most indi­vid­u­als who had mild ill­ness or no symp­toms fol­low­ing coro­n­avirus infec­tion, regard­less of whether they showed an anti­body response. The find­ing sug­gests that coro­n­avirus infec­tion rates may be high­er than what has been stud­ied using anti­body tests alone, the researchers said.

...

Mea­sur­ing the lev­el of mem­o­ry T cells is much more com­pli­cat­ed, espe­cial­ly if the cells are in lymph nodes or oth­er hard-to-access areas of the body. In addi­tion, T‑cell respons­es are high­ly vari­able.

“It is a lot eas­i­er to col­lect anti­body data,” said Dr Daniela Weiskopf, an assis­tant pro­fes­sor at the La Jol­la Insti­tute.
...

And then there’s the intrigu­ing find­ing that T cells from pre­vi­ous expo­sure to dif­fer­ent coro­n­avirus­es can help fight off SARS-CoV­‑2. So if you’ve been healthy enough to allow your­self to get exposed to lots of virus­es before this pan­dem­ic you’re more like­ly to sur­vive it:

...
MEMORIES OF CORONAVIRUS

The focus on T cell respons­es could also shed light on the prospect for longer-term immu­ni­ty.

There is some evi­dence that T cells devel­oped after expo­sure to oth­er coro­n­avirus­es that cause the com­mon cold could help fight off the new virus, known as SARS-CoV­‑2.

A study led by the La Jol­la Insti­tute detect­ed T cells that react­ed to SARS-CoV­‑2 in about half of stored blood sam­ples col­lect­ed between 2015 and 2018, sug­gest­ing that the immune sys­tem cells devel­oped after pre­vi­ous infec­tion with cir­cu­lat­ing com­mon cold coro­n­avirus­es, and that they might help pro­tect against the new virus.
...

You have to won­der if a SARS-CoV-2-like cold virus designed to induce a mild cold but gen­er­ate T‑cells that attack SARS-CoV­‑2 is some­thing that can be devel­oped.

It’s also worth recall­ing the phe­nom­e­na of anti­body-depen­dent enhance­ment (ADE) — the phe­nom­e­na of the infec­tion being more seri­ous if you’re pre­vi­ous­ly been exposed to the virus and have low but inad­e­quate remain­ing anti­body lev­els, trig­ger­ing an over­ag­gres­sive immune response — that was observed with the orig­i­nal SARS virus and might be present with SARS-CoV­‑2. And while we don’t know yet if ADE is going to be an issue with SARS-CoV­‑2, if your body can fight off the virus with­out hav­ing to gen­er­ate anti­bod­ies that would pre­sum­ably help avoid future ADE events.

Ok, now here’s the arti­cle from back in May about a pair of stud­ies exam­in­ing how the virus actu­al­ly car­ries out its infec­tion. One study out of Mount Sinai found that the virus does try to block the “call-to-arms” ini­tial immune response that warns sur­round­ing cells to pre­pare to thwart the virus’s repli­ca­tion but it does­n’t block the “call-for-rein­force­ments” sig­nal­ing that brings in spe­cial­ized B and T‑cells to actu­al­ly clear up the infec­tion, a com­bi­na­tion nev­er before observed in a virus that might also explain why it induces a lethal immune response in some patients. And then there’s a study out of Japan that found that SARS-CoV­‑2 blocks that “call-to-arms” sig­nal­ing even more effec­tive­ly than SARS or influen­za. So SARS-CoV­‑2 appears to unique­ly excep­tion­al at induc­ing a lethal immune response:

STAT News

‘It’s some­thing I have nev­er seen’: How the Covid-19 virus hijacks cells

By Sharon Beg­ley
May 21, 2020

A deep dive into how the new coro­n­avirus infects cells has found that it orches­trates a hos­tile takeover of their genes unlike any oth­er known virus­es do, pro­duc­ing what one lead­ing sci­en­tist calls “unique” and “aber­rant” changes.

Recent stud­ies show that in seiz­ing con­trol of genes in the human cells it invades, the virus changes how seg­ments of DNA are read, doing so in a way that might explain why the elder­ly are more like­ly to die of Covid-19 and why antivi­ral drugs might not only save sick patients’ lives but also pre­vent severe dis­ease if tak­en before infec­tion.

“It’s some­thing I have nev­er seen in my 20 years of” study­ing virus­es, said virol­o­gist Ben­jamin tenO­ev­er of the Icahn School of Med­i­cine at Mount Sinai, refer­ring to how SARS-CoV­‑2, the virus that caus­es Covid-19, hijacks cells’ genomes.

The “some­thing” he and his col­leagues saw is how SARS-CoV­‑2 blocks one virus-fight­ing set of genes but allows anoth­er set to launch, a pat­tern nev­er seen with oth­er virus­es. Influen­za and the orig­i­nal SARS virus (in the ear­ly 2000s), for instance, inter­fere with both arms of the body’s immune response — what tenO­ev­er dubs “call to arms” genes and “call for rein­force­ment” genes.

The first group of genes pro­duces inter­fer­ons. These pro­teins, which infect­ed cells release, are bio­log­i­cal sem­a­phores, sig­nal­ing to neigh­bor­ing cells to acti­vate some 500 of their own genes that will slow down the virus’ abil­i­ty to make mil­lions of copies of itself if it invades them. This lasts sev­en to 10 days, tenO­ev­er said, con­trol­ling virus repli­ca­tion and there­by buy­ing time for the sec­ond group of genes to act.

This sec­ond set of genes pro­duce their own secret­ed pro­teins, called chemokines, that emit a bio­chem­i­cal “come here!” alarm. When far-flung anti­body-mak­ing B cells and virus-killing T cells sense the alarm, they race to its source. If all goes well, the first set of genes holds the virus at bay long enough for the lethal pro­fes­sion­al killers to arrive and start erad­i­cat­ing virus­es.

“Most oth­er virus­es inter­fere with some aspect of both the call to arms and the call for rein­force­ments,” tenO­ev­er said. “If they didn’t, no one would ever get a viral ill­ness”: The one-two punch would pum­mel any incip­i­ent infec­tion into sub­mis­sion.

SARS-CoV­‑2, how­ev­er, unique­ly blocks one cel­lu­lar defense but acti­vates the oth­er, he and his col­leagues report­ed in a study pub­lished last week in Cell. They stud­ied healthy human lung cells grow­ing in lab dish­es, fer­rets (which the virus infects eas­i­ly), and lung cells from Covid-19 patients. In all three, they found that with­in three days of infec­tion, the virus induces cells’ call-for-rein­force­ment genes to pro­duce cytokines. But it blocks their call-to-arms genes — the inter­fer­ons that damp­en the virus’ repli­ca­tion.

The result is essen­tial­ly no brakes on the virus’s repli­ca­tion, but a storm of inflam­ma­to­ry mol­e­cules in the lungs, which is what tenO­ev­er calls an “unique” and “aber­rant” con­se­quence of how SARS-CoV­‑2 manip­u­lates the genome of its tar­get.

In anoth­er new study, sci­en­tists in Japan last week iden­ti­fied how SARS-CoV­‑2 accom­plish­es that genet­ic manip­u­la­tion. Its ORF3b gene pro­duces a pro­tein called a tran­scrip­tion fac­tor that has “strong anti-inter­fer­on activ­i­ty,” Kei Sato of the Uni­ver­si­ty of Tokyo and col­leagues found — stronger than the orig­i­nal SARS virus or influen­za virus­es. The pro­tein basi­cal­ly blocks the cell from rec­og­niz­ing that a virus is present, in a way that pre­vents inter­fer­on genes from being expressed.

In fact, the Icahn School team found no inter­fer­ons in the lung cells of Covid-19 patients. With­out inter­fer­ons, tenO­ev­er said, “there is noth­ing to stop the virus from repli­cat­ing and fes­ter­ing in the lungs for­ev­er.”

That caus­es lung cells to emit even more “call-for-rein­force­ment” genes, sum­mon­ing more and more immune cells. Now the lungs have macrophages and neu­trophils and oth­er immune cells “every­where,” tenO­ev­er said, caus­ing such run­away inflam­ma­tion “that you start hav­ing inflam­ma­tion that induces more inflam­ma­tion.”

At the same time, unchecked viral repli­ca­tion kills lung cells involved in oxy­gen exchange. “And sud­den­ly you’re in the hos­pi­tal in severe res­pi­ra­to­ry dis­tress,” he said.

In elder­ly peo­ple, as well as those with dia­betes, heart dis­ease, and oth­er under­ly­ing con­di­tions, the call-to-arms part of the immune sys­tem is weak­er than in younger, health­i­er peo­ple, even before the coro­n­avirus arrives. That reduces even fur­ther the cells’ abil­i­ty to knock down virus repli­ca­tion with inter­fer­ons, and imbal­ances the immune sys­tem toward the dan­ger­ous inflam­ma­to­ry response.

The dis­cov­ery that SARS-CoV­‑2 strong­ly sup­press­es infect­ed cells’ pro­duc­tion of inter­fer­ons has raised an intrigu­ing pos­si­bil­i­ty: that tak­ing inter­fer­ons might pre­vent severe Covid-19 or even pre­vent it in the first place, said Vineet Men­ach­ery of the Uni­ver­si­ty of Texas Med­ical Branch.

In a study of human cells grow­ing in lab dish­es, described in a preprint (not peer-reviewed or pub­lished in a jour­nal yet), he and his col­leagues also found that SARS-CoV­‑2 “pre­vents the vast amount” of inter­fer­on genes from turn­ing on. But when cells grow­ing in lab dish­es received the inter­fer­on IFN‑1 before expo­sure to the coro­n­avirus, “the virus has a dif­fi­cult time repli­cat­ing.”

After a few days, the amount of virus in infect­ed but inter­fer­on-treat­ed cells was 1,000- to 10,000-fold low­er than in infect­ed cells not pre-treat­ed with inter­fer­on. (The orig­i­nal SARS virus, in con­trast, is insen­si­tive to inter­fer­on.)

End­ing the pan­dem­ic and pre­vent­ing its return is assumed to require an effec­tive vac­cine to pre­vent infec­tion and antivi­ral drugs such as remde­sivir to treat the very sick, but the genet­ic stud­ies sug­gest a third strat­e­gy: pre­ven­tive drugs.

It’s pos­si­ble that treat­ment with so-called type‑1 inter­fer­on “could stop the virus before it could get estab­lished,” Men­ach­ery said.

Giv­ing drugs to healthy peo­ple is always a dicey propo­si­tion, since all drugs have side effects — some­thing con­sid­ered less accept­able than when a drug is used to treat an ill­ness. “Inter­fer­on treat­ment is rife with com­pli­ca­tions,” Men­ach­ery warned. The var­i­ous inter­fer­ons, which are pre­scribed for hepati­tis, can­cers, and many oth­er dis­eases, can cause flu-like symp­toms.

But the risk-ben­e­fit equa­tion might shift, both for indi­vid­u­als and for soci­ety, if inter­fer­ons or antivi­rals or oth­er med­ica­tions are shown to reduce the risk of devel­op­ing seri­ous Covid-19 or even make any infec­tion near­ly asymp­to­matic.

...

————–

“‘It’s some­thing I have nev­er seen’: How the Covid-19 virus hijacks cells” by Sharon Beg­ley; STAT News; 05/21/2020

“The “some­thing” he and his col­leagues saw is how SARS-CoV­‑2 blocks one virus-fight­ing set of genes but allows anoth­er set to launch, a pat­tern nev­er seen with oth­er virus­es. Influen­za and the orig­i­nal SARS virus (in the ear­ly 2000s), for instance, inter­fere with both arms of the body’s immune response — what tenO­ev­er dubs “call to arms” genes and “call for rein­force­ment” genes.”

A pat­tern nev­er seen with oth­er virus­es. It’s unfor­tu­nate­ly becom­ing a meta-pat­tern with this virus: find­ing things nev­er seen before:

...
The first group of genes pro­duces inter­fer­ons. These pro­teins, which infect­ed cells release, are bio­log­i­cal sem­a­phores, sig­nal­ing to neigh­bor­ing cells to acti­vate some 500 of their own genes that will slow down the virus’ abil­i­ty to make mil­lions of copies of itself if it invades them. This lasts sev­en to 10 days, tenO­ev­er said, con­trol­ling virus repli­ca­tion and there­by buy­ing time for the sec­ond group of genes to act.

This sec­ond set of genes pro­duce their own secret­ed pro­teins, called chemokines, that emit a bio­chem­i­cal “come here!” alarm. When far-flung anti­body-mak­ing B cells and virus-killing T cells sense the alarm, they race to its source. If all goes well, the first set of genes holds the virus at bay long enough for the lethal pro­fes­sion­al killers to arrive and start erad­i­cat­ing virus­es.

...

SARS-CoV­‑2, how­ev­er, unique­ly blocks one cel­lu­lar defense but acti­vates the oth­er, he and his col­leagues report­ed in a study pub­lished last week in Cell. They stud­ied healthy human lung cells grow­ing in lab dish­es, fer­rets (which the virus infects eas­i­ly), and lung cells from Covid-19 patients. In all three, they found that with­in three days of infec­tion, the virus induces cells’ call-for-rein­force­ment genes to pro­duce cytokines. But it blocks their call-to-arms genes — the inter­fer­ons that damp­en the virus’ repli­ca­tion.

The result is essen­tial­ly no brakes on the virus’s repli­ca­tion, but a storm of inflam­ma­to­ry mol­e­cules in the lungs, which is what tenO­ev­er calls an “unique” and “aber­rant” con­se­quence of how SARS-CoV­‑2 manip­u­lates the genome of its tar­get.
...

And the virus isn’t just unique in how it only blocks the “call-to-arms” expres­sion of inter­fer­on that would tell sur­round­ing cells to pre­pare to stop the virus from repli­cat­ing. It blocks inter­fer­on excep­tion­al­ly well. So well that the Mount Sinai team found NO inter­fer­on at all in the infect­ed lung cells they stud­ied. At the same time, the unin­hib­it­ed viral repli­ca­tion ends up killing cells involved in oxy­gen exchange and trig­ger­ing an even stronger “call-for-rein­force­ments” response, thus set­ting up a per­fect storm of over-inflam­ma­tion:

...
In anoth­er new study, sci­en­tists in Japan last week iden­ti­fied how SARS-CoV­‑2 accom­plish­es that genet­ic manip­u­la­tion. Its ORF3b gene pro­duces a pro­tein called a tran­scrip­tion fac­tor that has “strong anti-inter­fer­on activ­i­ty,” Kei Sato of the Uni­ver­si­ty of Tokyo and col­leagues found — stronger than the orig­i­nal SARS virus or influen­za virus­es. The pro­tein basi­cal­ly blocks the cell from rec­og­niz­ing that a virus is present, in a way that pre­vents inter­fer­on genes from being expressed.

In fact, the Icahn School team found no inter­fer­ons in the lung cells of Covid-19 patients. With­out inter­fer­ons, tenO­ev­er said, “there is noth­ing to stop the virus from repli­cat­ing and fes­ter­ing in the lungs for­ev­er.”

That caus­es lung cells to emit even more “call-for-rein­force­ment” genes, sum­mon­ing more and more immune cells. Now the lungs have macrophages and neu­trophils and oth­er immune cells “every­where,” tenO­ev­er said, caus­ing such run­away inflam­ma­tion “that you start hav­ing inflam­ma­tion that induces more inflam­ma­tion.”

At the same time, unchecked viral repli­ca­tion kills lung cells involved in oxy­gen exchange. “And sud­den­ly you’re in the hos­pi­tal in severe res­pi­ra­to­ry dis­tress,” he said.

...

So that’s all rather omi­nous, except it might lead to a pre­ven­ta­tive drug treat­ment by treat­ing pre­emp­tive­ly treat­ing peo­ple with inter­fer­on. It’s not an ide­al solu­tion giv­en the side-effects of inter­fer­on but we may not be able to rely on a vac­cine if a large por­tion of the pop­u­lace does­n’t devel­op anti­bod­ies so the more tools the bet­ter. All in all, the more we learn about this virus the more we’re learn­ing how unusu­al it is. It’s an awful pat­tern that hope­ful­ly remains unique to this virus.

Here’s a pair of arti­cles that high­light some­thing that could be done right now that would help con­trol the cur­rent coro­n­avirus pan­dem­ic while simul­ta­ne­ous­ly help­ing to pre­pare for future pan­demics and ret­ro­spec­tive exam­ine where and when the cur­rent out­break start­ed. It’s some­thing that could be par­tic­u­lar­ly use­ful for the US right now where mas­sive delays in coro­n­avirus test­ing has made test­ing effec­tive­ly use­less as an imme­di­ate con­trol strat­e­gy:

First, here’s a STAT News piece that calls for the US to do some­thing many coun­tries are already doing to take advan­tage of the fact that SARS-CoV­‑2 can be detect­ed in the feces of infect­ed peo­ple to detect emerg­ing new COVID out­breaks in par­tic­u­lar towns are regions: test sewage for the virus. It’s that sim­ple. Just rou­tine­ly sam­ple and test sewage across the US. It’s a rel­a­tive­ly cheap solu­tion that does­n’t rely on indi­vid­u­als going in to get test­ed which is cru­cial giv­en the grow­ing evi­dence of the role asymp­to­matic spread­ing is play­ing. In addi­tion, this approach can poten­tial­ly be car­ried out in a high­ly local­ized man­ner, like just test­ing the sewage of a retire­ment home so it can be used to cre­ate ear­ly warn­ing sys­tems for the most vul­ner­a­ble com­mu­ni­ties.

Also note that there remain major open ques­tions like how wide­spread the infec­tions real­ly com­pared to the offi­cial case num­bers. The CDC recent­ly reit­er­at­ing that the num­ber of infect­ed peo­ple is prob­a­bly 2 to 24 times high­er than the offi­cial num­bers in the US. Waste­water sam­pling, how­ev­er, can be used for quan­ti­ta­tive esti­mates too so it could invalu­able for esti­mat­ing the true scope of the num­ber of cas­es.

And once this kind of test­ing infra­struc­ture is set up it can be applied for future pan­demics too, at least for virus­es that show up in fecal mat­ter. Or, if sam­ples are pre­served, to ret­ro­spec­tive­ly look back after a pan­dem­ic has start­ed to try to find where and when the virus first start­ed appear­ing. And that’s part of what’s going to be inter­est­ing to watch as viral waste­water sur­vey­ing becomes more com­mon­place: giv­en the accu­mu­la­tion of evi­dence that this pan­dem­ic did­n’t start in Wuhan in Decem­ber and may have been cir­cu­lat­ing on mil­i­tary bases around the world for long before that, any sort of mean­ing­ful ret­ro­spec­tive analy­sis could be extreme­ly polit­i­cal­ly unwel­come for a num­ber of nations but espe­cial­ly the US gov­ern­ment that has made direct­ing anger at Chi­na one of the core ele­ments of its pan­dem­ic response. And as we’ll see in the sec­ond arti­cle below, researchers in Barcelona have already con­duct­ed this kind of ret­ro­spec­tive analy­sis using frozen waste­water sam­ples and detect­ed the SARS-CoV­‑2 virus in a sin­gle sam­ple back in March of 2019. If those results could be repro­duced else­where it would fun­da­men­tal­ly alter the pre­vail­ing “Chi­na did it!” nar­ra­tive that gov­ern­ments around the world are rely­ing on to deflect cul­pa­bil­i­ty. So it’s going to be inter­est­ing to see if there’s any real attempt to set up a nation­al waste­water viral sur­veil­lance net­work and even more inter­est­ing to see if any sort of ret­ro­spec­tive analy­sis will be allowed to hap­pen if such a net­work is indeed set up:

STAT News

It’s time to begin a nation­al waste­water test­ing pro­gram for Covid-19

By Anna Mehro­tra, David A. Larsen, and Ashish K. Jha
July 9, 2020

As the Covid-19 pan­dem­ic march­es across Amer­i­ca, caus­ing record-break­ing num­bers of cas­es, almost every solu­tion for con­trol­ling the dis­ease includes more test­ing, espe­cial­ly as cities and states try to reopen. But with states hit­ting their lim­its on test­ing, we need new tools for under­stand­ing Covid-19 trans­mis­sion. A nation­al waste­water sur­veil­lance pro­gram offers a cost-effec­tive approach to track Covid-19 across the major­i­ty of the U.S. pop­u­la­tion and pro­vide ear­ly warn­ings of resur­gence.

Sim­ply test­ing indi­vid­u­als with symp­toms won’t be enough to track how many peo­ple are infect­ed. Giv­en the high degree of asymp­to­matic spread — even in the absence of super­spread­ing events — we need a nation­al strat­e­gy that relies heav­i­ly on sur­veil­lance. Experts increas­ing­ly argue that we should be test­ing nurs­ing home res­i­dents every week. Some uni­ver­si­ties are plan­ning to test every stu­dent mul­ti­ple times per week. And the fed­er­al gov­ern­ment is talk­ing about pooled test­ing as a strat­e­gy for test­ing large groups of indi­vid­u­als at once. The hope is that such test­ing, when cou­pled with robust con­tact trac­ing, can iden­ti­fy infec­tions before they spread.

Since the start of the pan­dem­ic in Feb­ru­ary, approx­i­mate­ly 30 mil­lion indi­vid­ual Covid-19 tests have been per­formed in the U.S. Nobel lau­re­ate Paul Romer and oth­ers argue that we need the capac­i­ty to per­form this num­ber of tests every day — about 80 times our cur­rent capac­i­ty. Even if we could afford the $3 bil­lion dai­ly expense, it would be logis­ti­cal­ly near­ly impos­si­ble to achieve, at least with­out sub­stan­tial fed­er­al engage­ment and lead­er­ship, which does not appear to be immi­nent.

Test­ing indi­vid­u­als is the only way to find out who is infect­ed, iso­late them, and trace their con­tacts. But we should not rely on indi­vid­ual test­ing to under­stand trans­mis­sion trends in com­mu­ni­ties. An alter­na­tive approach that com­ple­ments the cur­rent need for test­ing more indi­vid­u­als is test­ing entire com­mu­ni­ties by track­ing the coro­n­avirus in waste­water. This is logis­ti­cal­ly eas­i­er, would serve as an ear­ly warn­ing sig­nal of the pres­ence of SARS-CoV­‑2 in a com­mu­ni­ty, and result in near­ly con­tin­u­ous track­ing of Covid-19 in three-quar­ters of the U.S. pop­u­la­tion at a cost of $40 mil­lion to $80 mil­lion per week.

Peo­ple infect­ed with SARS-CoV­‑2 shed the virus in their stool even before they show symp­toms of Covid-19. Ana­lyz­ing sewage for the virus, using meth­ods like the ones used for test­ing indi­vid­u­als, can pre­dict the com­mu­ni­ty lev­el of infec­tion one week to two weeks in advance of clin­i­cal diag­noses, and show increas­ing and decreas­ing lev­els of coro­n­avirus infec­tion and trans­mis­sion. Test­ing the waste­water of a nurs­ing home, prison, or dor­mi­to­ry could poten­tial­ly give an ear­ly sig­nal that one or more res­i­dents are infect­ed and there­fore prompt test­ing of each res­i­dent.

Nation­al waste­water sur­veil­lance would require at least week­ly test­ing at waste­water treat­ment plants and in sew­ers. Although some states, such as Col­orado, Ohio, and New York, have tak­en steps toward imple­ment­ing waste­water sur­veil­lance efforts, the U.S. lacks a nation­al Covid-19 pro­gram for it.

Oth­er coun­tries have nation­al pro­grams in place. Aus­tralia is work­ing with state and ter­ri­to­ry author­i­ties and 16 of the largest util­i­ties in the coun­try to imple­ment week­ly waste­water mon­i­tor­ing as part of the Col­lab­o­ra­tion on Sewage Sur­veil­lance of SARS-COV‑2 project. In Fin­land, the Finnish Insti­tute for Health and Wel­fare is over­see­ing sam­pling at 28 waste­water treat­ment plants in a mon­i­tor­ing pro­gram that cov­ers 60% of the Finnish pop­u­la­tion. The Nether­lands has imple­ment­ed week­ly test­ing at 29 plants that cov­er about 25% of the Dutch pop­u­la­tion. Pak­istan has insti­tut­ed a pro­gram that lever­ages the exist­ing polio envi­ron­men­tal sur­veil­lance net­work to mon­i­tor SARS-CoV­‑2 at 78 waste­water treat­ment plants across the coun­try.

Although we can learn from the nation­al waste­water sur­veil­lance expe­ri­ence of oth­er coun­tries, any pro­gram designed for the U.S. will nec­es­sar­i­ly be larg­er and more com­plex. At last count in 2012, there were 14,748 waste­water treat­ment plants pro­vid­ing sewage col­lec­tion and treat­ment to 80% of peo­ple liv­ing in the U.S. The oth­er 20% are served by sep­tic sys­tems. While reg­u­lar sam­pling for all waste­water treat­ment plants is cer­tain­ly fea­si­ble, even focus­ing on just the 542 largest ones — those with treat­ment capac­i­ties exceed­ing 10 mil­lion gal­lons of sewage per day — would cov­er half the U.S. pop­u­la­tion.

To be effec­tive, waste­water sur­veil­lance needs to use a sen­si­tive and spe­cif­ic test­ing method that gives reli­able and repeat­able results that are avail­able with­in a day. The results need to be quan­ti­ta­tive, such as genome copies per liter of waste­water, which can then be trans­lat­ed into an esti­mate of peo­ple infect­ed. Such ana­lyt­i­cal capa­bil­i­ties already exist in com­mer­cial envi­ron­men­tal test­ing lab­o­ra­to­ries. And efforts are under­way to adapt elec­tro­chem­i­cal biosen­sors pre­vi­ous­ly devel­oped for virus detec­tion, includ­ing microflu­idic paper-based devices, for near real-time SARS-CoV­‑2 quan­tifi­ca­tion in waste­water.

There are still impor­tant ques­tions to be answered about nation­al waste­water sur­veil­lance for SARS-CoV­‑2: How should sam­ples be col­lect­ed? (We rec­om­mend com­bin­ing sam­ples tak­en from one loca­tion over the course of a day, although a sam­ple from one point in time could also suf­fice.) How often should test­ing be done? (We rec­om­mend two to three times per week.) Where should test­ing be done? (We rec­om­mend test­ing at waste­water treat­ment plants and in select loca­tions in the sew­er sys­tem feed­ing the plants). Col­lect­ing sam­ples in the sew­er sys­tem could be accom­plished by deploy­ing autosam­plers at man­holes, ide­al­ly select­ing those down­stream of nurs­ing homes and oth­er vul­ner­a­ble facil­i­ties.

We will also need a nation­al sur­veil­lance data­base that allows seam­less input of ana­lyt­i­cal results, visu­al­iza­tion of trends, and ulti­mate­ly pre­dic­tions of where the next out­break will be.

The U.S. needs to get start­ed with waste­water sur­veil­lance now. The sci­ence clear­ly sup­ports this strat­e­gy. Doing so will pro­vide a cost-effec­tive method of under­stand­ing the pan­dem­ic and an ear­ly warn­ing sys­tem for increased and decreased trans­mis­sion as the pan­dem­ic wax­es and wanes.

...

Anna Mehro­tra is a senior waste­water engi­neer with CDM Smith Inc., in Boston. David A. Larsen is an envi­ron­men­tal epi­demi­ol­o­gist and asso­ciate pro­fes­sor of pub­lic health at Syra­cuse Uni­ver­si­ty in New York. Ashish Jha is the direc­tor of the Har­vard Glob­al Health Insti­tute and pro­fes­sor of glob­al health at the Har­vard T.H. Chan School of Pub­lic Health.

————

“It’s time to begin a nation­al waste­water test­ing pro­gram for Covid-19” by Anna Mehro­tra, David A. Larsen, and Ashish K. Jha; STAT News; 07/09/2020

“Since the start of the pan­dem­ic in Feb­ru­ary, approx­i­mate­ly 30 mil­lion indi­vid­ual Covid-19 tests have been per­formed in the U.S. Nobel lau­re­ate Paul Romer and oth­ers argue that we need the capac­i­ty to per­form this num­ber of tests every day — about 80 times our cur­rent capac­i­ty. Even if we could afford the $3 bil­lion dai­ly expense, it would be logis­ti­cal­ly near­ly impos­si­ble to achieve, at least with­out sub­stan­tial fed­er­al engage­ment and lead­er­ship, which does not appear to be immi­nent.”

There’s sim­ply no way the US is going to have the nec­es­sar­i­ly indi­vid­ual-lev­el test­ing capac­i­ty required in time to deal with a grow­ing pan­dem­ic. That’s the pic­ture that’s emerged over the sum­mer: the explo­sion in cas­es has­n’t been met with an explo­sion of test­ing capac­i­ty and there’s no sign this is going to change any time soon. It’s the kind of sit­u­a­tion that points towards an even greater test­ing capac­i­ty deficit in future months. And that’s why solu­tions that can track the spread of the virus that don’t rely on indi­vid­ual tests are going to be increas­ing­ly tempt­ing going for­ward too. Espe­cial­ly since these solu­tions are much cheap­er than indi­vid­ual-lev­el test­ing too and this kind of test­ing can be extreme­ly local­ized down to just indi­vid­ual nurs­ing homes or pris­ons:

...
Test­ing indi­vid­u­als is the only way to find out who is infect­ed, iso­late them, and trace their con­tacts. But we should not rely on indi­vid­ual test­ing to under­stand trans­mis­sion trends in com­mu­ni­ties. An alter­na­tive approach that com­ple­ments the cur­rent need for test­ing more indi­vid­u­als is test­ing entire com­mu­ni­ties by track­ing the coro­n­avirus in waste­water. This is logis­ti­cal­ly eas­i­er, would serve as an ear­ly warn­ing sig­nal of the pres­ence of SARS-CoV­‑2 in a com­mu­ni­ty, and result in near­ly con­tin­u­ous track­ing of Covid-19 in three-quar­ters of the U.S. pop­u­la­tion at a cost of $40 mil­lion to $80 mil­lion per week.

Peo­ple infect­ed with SARS-CoV­‑2 shed the virus in their stool even before they show symp­toms of Covid-19. Ana­lyz­ing sewage for the virus, using meth­ods like the ones used for test­ing indi­vid­u­als, can pre­dict the com­mu­ni­ty lev­el of infec­tion one week to two weeks in advance of clin­i­cal diag­noses, and show increas­ing and decreas­ing lev­els of coro­n­avirus infec­tion and trans­mis­sion. Test­ing the waste­water of a nurs­ing home, prison, or dor­mi­to­ry could poten­tial­ly give an ear­ly sig­nal that one or more res­i­dents are infect­ed and there­fore prompt test­ing of each res­i­dent.
...

A nation­al waste­water test­ing net­work that rou­tine­ly checks waste­water and feeds the infor­ma­tion back to the net­work. The sh*ternet. Is such a sys­tem fea­si­ble? Of course it is because nations like Pak­istan have already been doing it for virus­es like polio and states like New York, Col­orado and Ohio have already tak­en steps to set up their own sys­tems:

...
Nation­al waste­water sur­veil­lance would require at least week­ly test­ing at waste­water treat­ment plants and in sew­ers. Although some states, such as Col­orado, Ohio, and New York, have tak­en steps toward imple­ment­ing waste­water sur­veil­lance efforts, the U.S. lacks a nation­al Covid-19 pro­gram for it.

Oth­er coun­tries have nation­al pro­grams in place. Aus­tralia is work­ing with state and ter­ri­to­ry author­i­ties and 16 of the largest util­i­ties in the coun­try to imple­ment week­ly waste­water mon­i­tor­ing as part of the Col­lab­o­ra­tion on Sewage Sur­veil­lance of SARS-COV‑2 project. In Fin­land, the Finnish Insti­tute for Health and Wel­fare is over­see­ing sam­pling at 28 waste­water treat­ment plants in a mon­i­tor­ing pro­gram that cov­ers 60% of the Finnish pop­u­la­tion. The Nether­lands has imple­ment­ed week­ly test­ing at 29 plants that cov­er about 25% of the Dutch pop­u­la­tion. Pak­istan has insti­tut­ed a pro­gram that lever­ages the exist­ing polio envi­ron­men­tal sur­veil­lance net­work to mon­i­tor SARS-CoV­‑2 at 78 waste­water treat­ment plants across the coun­try.
...

So we’ll hope­ful­ly be get­ting a much bet­ter sense of how fea­si­ble these kinds of sys­tems are and what types of chal­lenges they’ll face as states like New York and Ohio begin exper­i­ment­ing with set­ting up these kinds of sys­tems. But as the fol­low­ing arti­cle makes clear, one thing they should be sure to include is frozen sam­ples for future analy­sis so researchers can ask ques­tions months or years from now that they know to ask or need to ask. For exam­ple, if there’s a new nov­el coro­n­avirus out­break in 2022, it would be real­ly use­ful to have frozen sewage sam­ples sit­ting there from 2021 to ret­ro­spec­tive­ly go back and ask whether COVID-22 was already float­ing around in 2021. It’s the kind of data that could be absolute­ly invalu­able dur­ing an emerg­ing pan­dem­ic. Which rais­es the obvi­ous ques­tion: so are there any frozen sewage sam­ples from 2019 or 2018 that can be sam­pled to look for signs of SARS-CoV­‑2? And it turns out, yes, at least in some cities, there are rou­tine­ly frozen sewage sam­ples and researchers have been look­ing at them and find­ing signs of SARS-CoV­‑2 in 2019, includ­ing researchers in Barcelona who got a pos­i­tive hit from a sin­gle sam­ple from March of 2019.

Oth­er researchers not involved with the study are skep­ti­cal of the find­ing and sug­gest the pos­i­tive result was some sort of tech­ni­cal arti­fact and note that it did­n’t show up in sam­ples before or after that they test­ed. Just March of 2019. So was the virus in Barcelona in March of 2019? Unfor­tu­nate­ly because there was only a sin­gle frozen sam­ple and it was all used up for the ini­tial analy­sis we can’t go back and val­i­date their find­ings but the Barcelona researchers insist that they know how to car­ry­ing out these analy­ses cor­rect­ly with min­i­mal chance of a tech­ni­cal screw up caus­ing the pos­i­tive hit. So hope­ful­ly any future nation­al waste­water sur­veil­lance regimes will include keep­ing mul­ti­ple frozen sam­ples from each site for exact­ly this kind of sit­u­a­tion:

The New York Times

Study Sug­gests Coro­n­avirus Emerged Much Ear­li­er Than Thought. Some Are Skep­ti­cal.

Sci­en­tists not involved in the study seri­ous­ly doubt the find­ings, which chal­lenge the cur­rent con­sen­sus on where and when the virus orig­i­nat­ed.

By Carl Zim­mer and Raphael Min­der
June 26, 2020

In a study not yet pub­lished in a jour­nal, sci­en­tists have report­ed that the new coro­n­avirus was present in waste­water in Barcelona, Spain in March 2019, a find­ing that, if con­firmed, would show that the pathogen had emerged much ear­li­er than pre­vi­ous­ly thought.

But inde­pen­dent experts who reviewed the find­ings said they doubt­ed the claim. The study was flawed, they said, and oth­er lines of evi­dence strong­ly sug­gest the virus emerged in Chi­na late last year.

Up until now, the ear­li­est evi­dence of the virus any­where in the world has been from Decem­ber 2019 in Chi­na and it was only known to have hit main­land Spain in Feb­ru­ary 2020.

“Barcelona is a city that is fre­quent­ed by Chi­nese peo­ple, in tourism and busi­ness, so prob­a­bly this hap­pened also else­where, and prob­a­bly at the same time,” said the lead author, Albert Bosch, a pro­fes­sor in the Depart­ment of Micro­bi­ol­o­gy of the Uni­ver­si­ty of Barcelona who has been study­ing virus­es in waste­water for more than 40 years.

Sev­er­al experts not involved in the research point­ed out prob­lems with the new study, which has not yet been sub­ject­ed to the crit­i­cal review by out­side experts that occurs before pub­li­ca­tion in a sci­en­tif­ic jour­nal. They sug­gest­ed that the tests might very well have pro­duced false pos­i­tives because of con­t­a­m­i­na­tion or improp­er stor­age of the sam­ples.

“I don’t trust the results,” said Irene Xago­rara­ki, an envi­ron­men­tal engi­neer at Michi­gan State Uni­ver­si­ty.

Researchers at the Uni­ver­si­ty of Barcelona post­ed their find­ings online on June 13. Most of their report described research on waste­water treat­ments from ear­ly 2020. The sur­pris­ing find­ing about March 2019 was only men­tioned briefly at the end of the report.

The research gained more atten­tion when the uni­ver­si­ty issued a news release on Fri­day.

...

Researchers have stud­ied the muta­tions that have arisen in coro­n­avirus sam­ples col­lect­ed from across the world since then and have esti­mat­ed on the basis of their find­ings that the sam­ples shared a com­mon ances­tor that dat­ed to late 2019.

More evi­dence for the ori­gin of the nov­el coro­n­avirus has come from oth­er virus­es that sci­en­tists have found in ani­mals. The clos­est rel­a­tives to the coro­n­avirus infect bats in Chi­na.

Because the virus can be shed in feces, researchers have begun exam­in­ing waste­water to detect the pathogen’s genes.

In Europe, Aus­tralia and the Unit­ed States, researchers dis­cov­ered ris­ing lev­els of the virus’s genes in waste­water days before con­firmed cas­es began to arise. These dis­cov­er­ies have led a num­ber of researchers to exam­ine frozen waste­water sam­ples from ear­li­er peri­ods, seek­ing evi­dence of the virus’s pres­ence before any­one knew to look for it.

Last week, Ital­ian researchers report­ed find­ing the virus in Milan and Turin on Decem­ber 18, two months before north­ern Italy was besieged by Covid-19 cas­es.

Sep­a­rate­ly, in Spain, Dr. Bosch and his col­leagues began tak­ing week­ly sam­ples of waste­water from two of Barcelona’s treat­ment plants in April. They found the virus in these sam­ples, prompt­ing them to look back at ear­li­er sam­ples.

The researchers found the virus in a num­ber of sam­ples from ear­ly 2020, in the months before the pan­dem­ic struck Spain.

Dr. Bosch and his col­leagues then went back even fur­ther, exam­in­ing nine sam­ples tak­en every few weeks or months between Jan­u­ary 2018 and Decem­ber 2019. In a sin­gle sam­ple, tak­en March 12, 2019, they got a pos­i­tive result from their tests for the virus.

Dr. Bosch found it plau­si­ble that the virus could appear in March but not show up in more recent sam­ples.

“Res­pi­ra­to­ry virus­es usu­al­ly have peaks around this time of the year,” Dr. Bosch said. “Prob­a­bly the virus then dis­ap­peared.”

But Dr. Xago­rara­ki not­ed that the researchers used tests that search for bits of three dif­fer­ent genes. The only tests that came back pos­i­tive were for a gene called RdRp. One of the oth­er tests, for a gene called N, is known to be more sen­si­tive. “It should have shown a sig­nal as well,” Dr. Xago­rara­ki said.

It was pos­si­ble that the pos­i­tive results were the result of con­t­a­m­i­na­tion from oth­er sam­ples that did have the virus, Dr. Xago­rara­ki said. She also doubt­ed whether the del­i­cate coro­n­avirus could have sur­vived for over a year with­out the sam­ple hav­ing been put in a deep freeze. “If the sam­ples were not stored in ‑80 degrees, you can’t trust the results,” she said.

Gert­jan Mede­ma of the KWR Water Research Insti­tute in the Nether­lands said that the study came from a “knowl­edge­able research team,” and so should be tak­en seri­ous­ly. But, he added, “they need to con­firm this find­ing in mul­ti­ple ways.”

Dr. Bosch said that his team would not be able to repeat the exper­i­ments in the pos­i­tive sam­ple from March 2019 because it was deplet­ed dur­ing the first test. “We proved it from this sam­ple but we can­not repeat it,” he said. But con­t­a­m­i­na­tion was unlike­ly, he said. “The way we work, when there is con­t­a­m­i­na­tion, we notice it.”

Anoth­er way to con­firm the find­ing would be to search through stored sam­ples of blood from patients in Barcelona hos­pi­tals in March 2019. If the virus were cir­cu­lat­ing, even briefly, in Spain, some peo­ple would most like­ly have been hos­pi­tal­ized com­plain­ing of flu­like symp­toms.

————–

“Study Sug­gests Coro­n­avirus Emerged Much Ear­li­er Than Thought. Some Are Skep­ti­cal.” by Carl Zim­mer and Raphael Min­der; The New York Times; 06/26/2020

“Up until now, the ear­li­est evi­dence of the virus any­where in the world has been from Decem­ber 2019 in Chi­na and it was only known to have hit main­land Spain in Feb­ru­ary 2020.”

Was this virus cir­cu­lat­ing in Spain for near­ly a year before it was detect­ed in Feb­ru­ary of this year? That’s what the find­ings from the Uni­ver­si­ty of Barcelona team sug­gests. Recall that Spain was one of the coun­tries with mil­i­tary ath­letes who report­ed feel­ing ill with COVID-like symp­toms dur­ing and after the Mil­i­tary World Games in Wuhan so the virus was like­ly cir­cu­lat­ing in Spain by at least Novem­ber. But could the virus have showed in in March and then dis­ap­peared again? Well, the researchers explain that it’s plau­si­ble that the virus would­n’t have been detect­ed in lat­er months because res­pi­ra­to­ry virus­es tend to peak in March and may have effec­tive­ly dis­ap­peared at that point:

...
Dr. Bosch and his col­leagues then went back even fur­ther, exam­in­ing nine sam­ples tak­en every few weeks or months between Jan­u­ary 2018 and Decem­ber 2019. In a sin­gle sam­ple, tak­en March 12, 2019, they got a pos­i­tive result from their tests for the virus.

Dr. Bosch found it plau­si­ble that the virus could appear in March but not show up in more recent sam­ples.

“Res­pi­ra­to­ry virus­es usu­al­ly have peaks around this time of the year,” Dr. Bosch said. “Prob­a­bly the virus then dis­ap­peared.”
...

Could this virus have sim­ply have dis­ap­peared with the wan­ing cold and flu sea­son? Giv­en that a high lev­el of infec­tious­ness has been one of the key fea­tures of these virus and it’s been spread­ing through­out the spring and sum­mer of 2020 it seems hard to imag­ine that the virus would have dis­si­pat­ed like that with the sea­sons. But it’s also worth recall­ing how ear­ly phy­lo­ge­net­ic analy­sis that exam­ined which strains of the virus were emerg­ing and spread­ing found that the virus seemed to mutate into a some­what more infec­tious form in Wuhan in Decem­ber of 2019 (the new “L‑type” vs old­er “S‑type” strains). A sin­gle muta­tion to the viral pro­tein sequence may have some­how made the virus even more capa­ble of spread­ing. Then there was a lat­er set of stud­ies that found anoth­er new strain (the new “G‑clade” vs old­er “D‑clade”) that either emerged in Wuhan or Ger­many in Jan­u­ary of 2020 has already com­plete­ly dom­i­nat­ed new cas­es because it’s bet­ter at spread­ing for some rea­son. So if the virus was already cir­cu­lat­ing (per­haps on mil­i­tary bases) ear­li­er in 2019 but it was the ear­li­er less infec­tious strain per­haps it could have fad­ed from Barcelona as the annu­al cold and flu sea­son.

But as one out­side researcher points out, there’s anoth­er rea­son to sus­pect the March 2019 hit: there were three tests used to search for signs of the virus in the sam­ple and the one that got a pos­i­tive hit was not the most sen­si­tive of the three tests. The most sen­si­tive test did­n’t get that pos­i­tive hit and that’s why they sus­pect a con­t­a­m­i­na­tion. But the Barcelona researchers are stand­ing by the qual­i­ty of their assay:

...
But Dr. Xago­rara­ki not­ed that the researchers used tests that search for bits of three dif­fer­ent genes. The only tests that came back pos­i­tive were for a gene called RdRp. One of the oth­er tests, for a gene called N, is known to be more sen­si­tive. “It should have shown a sig­nal as well,” Dr. Xago­rara­ki said.

It was pos­si­ble that the pos­i­tive results were the result of con­t­a­m­i­na­tion from oth­er sam­ples that did have the virus, Dr. Xago­rara­ki said. She also doubt­ed whether the del­i­cate coro­n­avirus could have sur­vived for over a year with­out the sam­ple hav­ing been put in a deep freeze. “If the sam­ples were not stored in ‑80 degrees, you can’t trust the results,” she said.

Gert­jan Mede­ma of the KWR Water Research Insti­tute in the Nether­lands said that the study came from a “knowl­edge­able research team,” and so should be tak­en seri­ous­ly. But, he added, “they need to con­firm this find­ing in mul­ti­ple ways.”

Dr. Bosch said that his team would not be able to repeat the exper­i­ments in the pos­i­tive sam­ple from March 2019 because it was deplet­ed dur­ing the first test. “We proved it from this sam­ple but we can­not repeat it,” he said. But con­t­a­m­i­na­tion was unlike­ly, he said. “The way we work, when there is con­t­a­m­i­na­tion, we notice it.”
...

So val­i­dat­ing that spe­cif­ic March 2019 sam­ple test real­ly is an open ques­tion that can’t be direct­ly answered. It was a one-shot test. But that does­n’t mean there’s no way to answer this ques­tion. Check­ing frozen sam­ples from sur­round­ing cities, if they’re avail­able, would be one way. And then there’s check­ing frozen blood sam­ples:

...
Anoth­er way to con­firm the find­ing would be to search through stored sam­ples of blood from patients in Barcelona hos­pi­tals in March 2019. If the virus were cir­cu­lat­ing, even briefly, in Spain, some peo­ple would most like­ly have been hos­pi­tal­ized com­plain­ing of flu­like symp­toms.
...

Keep in mind, of course, that while a pos­i­tive hit from frozen blood sam­ples tak­en in March would be a strong con­fir­ma­tion of these waste­water find­ings, not find­ing the virus in frozen blood sam­ples would­n’t nec­es­sar­i­ly inval­i­date the find­ing. Frozen blood is tak­en from just one per­son, after all, where­as waste­water is sam­pling the entire pop­u­la­tion. But it under­scores the fact that if we are gen­uine­ly inter­est­ed in find­ing the when and where this out­break may have start­ed we have options. At least as long as there are stored sam­ples kept some­where.

And that’s all part of why it’s going to be very inter­est­ing to see how which coun­tries show an inter­est in set­ting up nation­al waste­water sur­veil­lance net­works. It’s the kind of infra­struc­ture that could answer a whole lot of ques­tions about when and where pan­demics start­ed. And in the age of an explo­sion of biowar­fare research facil­i­ties around the globe and the grow­ing use of ‘gain-of-func­tion’ exper­i­men­tal tech­niques, with all of the risks of oppor­tu­ni­ties that entails, the ques­tion of whether or not gov­ern­ments are nec­es­sar­i­ly going to want robust net­works that allow for mean­ing­ful ret­ro­spec­tive analy­sis of when and where pan­demics start­ed remains a very open ques­tion too.

Here’s a set of arti­cles that raise intrigu­ing ques­tions about why it is that some peo­ple are min­i­mal­ly impact­ed by the SARS-CoV­‑2 virus while oth­ers are immuno­log­i­cal­ly dev­as­tat­ed by the virus that relates to the grow­ing aware­ness of the impor­tance of T‑cells, and not just anti­bod­ies, in pro­vid­ing some sort of immu­ni­ty to the virus along with the obser­va­tion that pri­or expo­sure to mild cold-like coro­n­avirus­es might con­fer some lev­el of resis­tance to SARS-CoV­‑2:

First, as described in the fol­low­ing review arti­cle recent­ly pub­lished in Nature Reviews Immunol­o­gy, there are now mul­ti­ple stud­ies out that exam­ined the response of T‑cells drawn from peo­ple before the cur­rent out­break (so they pre­sum­ably weren’t exposed to SARS-CoV­‑2 when the blood was drawn) and, sure enough, these researchers are find­ing that these old­er T‑Cells can iden­ti­fy SARS-CoV­‑2 as a viral invad­er in a large num­ber of instances. In one study that looked at blood drawn from peo­ple in the US from 2015–2018, around 50% of the blood sam­ples had T‑cells that react­ed to SARS-CoV­‑2. But oth­er stud­ies from Europe and Sin­ga­pore also showed a high lev­el of reac­tiv­i­ty to the SARS-CoV­‑2 virus from old­er pre-pan­dem­ic blood sam­ples. Five pub­lished stud­ies in all so far have demon­strat­ed this and since more than 90% of the pop­u­la­tion is ser­pos­i­tive for at least three of these com­mon-cold coro­n­avirus­es (CCCs) — like HCoV-OC43, HCoV-HKU1, HCoV-NL63 and HCoV-229E — the ques­tion of what role that pri­or expo­sure is play­ing in the cur­rent pan­dem­ic is obvi­ous­ly a cru­cial and poten­tial­ly very help­ful ques­tion to ask. After all, would­n’t it be nice if we could just expose every­one to a bunch of com­mon-cold coro­n­avirus­es to con­fer par­tial immu­ni­ty?

As the review arti­cle also reminds us, while there’s much hope that pri­or expo­sure to mild cold-like coro­n­avirus­es is pro­tec­tive, we can’t ignore the pos­si­bil­i­ty that pri­or expo­sure to these coro­n­avirus­es is actu­al­ly mak­ing the SARS-CoV­‑2 infec­tion worse in some cas­es. Recall how this kind of “anti­body-depen­dent enhance­ment” (ADE) sce­nario was observed by researchers when they were work­ing on a vac­cine for the orig­i­nal SARS vac­cine, lead­ing some researchers to spec­u­late that the high fatal­i­ty rate of SARS in Chi­na was due to pri­or expo­sure to com­mon-cold coro­n­avirus. It’s anoth­er rea­son the rela­tion­ship between past com­mon cold coro­n­avirus expo­sure and cur­rent SARS-CoV­‑2 immu­ni­ty is a cru­cial ques­tion to answer as the cur­rent pan­dem­ic plays out:

Nature Reviews Immunol­o­gy
vol­ume 20, pages457–458(2020)

Pre-exist­ing immu­ni­ty to SARS-CoV­‑2: the knowns and unknowns

Alessan­dro Sette & Shane Crot­ty

Pub­lished: 07 July 2020

T cell reac­tiv­i­ty against SARS-CoV­‑2 was observed in unex­posed peo­ple; how­ev­er, the source and clin­i­cal rel­e­vance of the reac­tiv­i­ty remains unknown. It is spec­u­lat­ed that this reflects T cell mem­o­ry to cir­cu­lat­ing ‘com­mon cold’ coro­n­avirus­es. It will be impor­tant to define speci­fici­ties of these T cells and assess their asso­ci­a­tion with COVID-19 dis­ease sever­i­ty and vac­cine respons­es.

******

As data start to accu­mu­late on the detec­tion and char­ac­ter­i­za­tion of SARS-CoV­‑2 T cell respons­es in humans, a sur­pris­ing find­ing has been report­ed: lym­pho­cytes from 20–50% of unex­posed donors dis­play sig­nif­i­cant reac­tiv­i­ty to SARS-CoV­‑2 anti­gen pep­tide pools1,2,3,4.

In a study by Gri­foni et al.1, reac­tiv­i­ty was detect­ed in 50% of donor blood sam­ples obtained in the USA between 2015 and 2018, before SARS-CoV­‑2 appeared in the human pop­u­la­tion. T cell reac­tiv­i­ty was high­est against pro­teins oth­er than the coro­n­avirus spike pro­tein, but T cell reac­tiv­i­ty was also detect­ed against spike. The SARS-CoV­‑2 T cell reac­tiv­i­ty was most­ly asso­ci­at­ed with CD4+ T cells, with a small­er con­tri­bu­tion by CD8+ T cells1. Sim­i­lar­ly, in a study of blood donors in the Nether­lands, Weiskopf et al.2 detect­ed CD4+ T cell reac­tiv­i­ty against SARS-CoV­‑2 spike pep­tides in 1 of 10 unex­posed sub­jects and against SARS-CoV­‑2 non-spike pep­tides in 2 of 10 unex­posed sub­jects. CD8+ T cell reac­tiv­i­ty was observed in 1 of 10 unex­posed donors. In a third study, from Ger­many, Braun et al.3 report­ed pos­i­tive T cell respons­es against spike pep­tides in 34% of SARS-CoV­‑2 seroneg­a­tive healthy donors (CD4+ and CD8+ T cells were not dis­tin­guished). Final­ly, a study of indi­vid­u­als in Sin­ga­pore, by Le Bert et al.4, report­ed T cell respons­es to nucle­o­cap­sid pro­tein nsp7 or nsp13 in 50% of sub­jects with no his­to­ry of SARS, COVID-19, or con­tact with patients with SARS or COVID-19. A study by Meck­iff using sam­ples from the UK also detect­ed reac­tiv­i­ty in unex­posed sub­jects5. Tak­en togeth­er, five stud­ies report evi­dence of pre-exist­ing T cells that rec­og­nize SARS-CoV­‑2 in a sig­nif­i­cant frac­tion of peo­ple from diverse geo­graph­i­cal loca­tions.

These ear­ly reports demon­strate that sub­stan­tial T cell reac­tiv­i­ty exists in many unex­posed peo­ple; nev­er­the­less, data have not yet demon­strat­ed the source of the T cells or whether they are mem­o­ry T cells. It has been spec­u­lat­ed that the SARS-CoV-2-spe­cif­ic T cells in unex­posed indi­vid­u­als might orig­i­nate from mem­o­ry T cells derived from expo­sure to ‘com­mon cold’ coro­n­avirus­es (CCCs), such as HCoV-OC43, HCoV-HKU1, HCoV-NL63 and HCoV-229E, which wide­ly cir­cu­late in the human pop­u­la­tion and are respon­si­ble for mild self-lim­it­ing res­pi­ra­to­ry symp­toms. More than 90% of the human pop­u­la­tion is seropos­i­tive for at least three of the CCCs6. Thiel and col­leagues3 report­ed that the T cell reac­tiv­i­ty was high­est against a pool of SARS-CoV­‑2 spike pep­tides that had high­er homol­o­gy to CCCs, but the dif­fer­ence was not sig­nif­i­cant.

What are the impli­ca­tions of these obser­va­tions? The poten­tial for pre-exist­ing cross­re­ac­tiv­i­ty against COVID-19 in a frac­tion of the human pop­u­la­tion has led to exten­sive spec­u­la­tion. Pre-exist­ing T cell immu­ni­ty to SARS-CoV­‑2 could be rel­e­vant because it could influ­ence COVID-19 dis­ease sever­i­ty. It is plau­si­ble that peo­ple with a high lev­el of pre-exist­ing mem­o­ry CD4+ T cells that rec­og­nize SARS-CoV­‑2 could mount a faster and stronger immune response upon expo­sure to SARS-CoV­‑2 and there­by lim­it dis­ease sever­i­ty. Mem­o­ry T fol­lic­u­lar helper (TFH) CD4+ T cells could poten­tial­ly facil­i­tate an increased and more rapid neu­tral­iz­ing anti­body response against SARS-CoV­‑2. Mem­o­ry CD4+ and CD8+ T cells might also facil­i­tate direct antivi­ral immu­ni­ty in the lungs and nasophar­ynx ear­ly after expo­sure, in keep­ing with our under­stand­ing of antivi­ral CD4+ T cells in lungs against the relat­ed SARS-CoV7 and our gen­er­al under­stand­ing of the val­ue of mem­o­ry CD8+ T cells in pro­tec­tion from viral infec­tions. Large stud­ies in which pre-exist­ing immu­ni­ty is mea­sured and cor­re­lat­ed with prospec­tive infec­tion and dis­ease sever­i­ty could address the pos­si­ble role of pre-exist­ing T cell mem­o­ry against SARS-CoV­‑2.

If the pre-exist­ing T cell immu­ni­ty is relat­ed to CCC expo­sure, it will become impor­tant to bet­ter under­stand the pat­terns of CCC expo­sure in space and time. It is well estab­lished that the four main CCCs are cycli­cal in their preva­lence, fol­low­ing mul­ti­year cycles, which can dif­fer across geo­graph­i­cal loca­tions8. This leads to the spec­u­la­tive hypoth­e­sis that dif­fer­ences in CCC geo-dis­tri­b­u­tion might cor­re­late with bur­den of COVID-19 dis­ease sever­i­ty. Fur­ther­more, high­ly spec­u­la­tive hypothe­ses relat­ed to pre-exist­ing mem­o­ry T cells can be pro­posed regard­ing COVID-19 and age. Chil­dren are less sus­cep­ti­ble to COVID-19 clin­i­cal symp­toms. Old­er peo­ple are much more sus­cep­ti­ble to fatal COVID-19. The rea­sons for both are unclear. The age dis­tri­b­u­tion of CCC infec­tions is not well estab­lished and CCC immu­ni­ty should be exam­ined in greater detail. These con­sid­er­a­tions under­line how mul­ti­ple vari­ables may be involved in poten­tial pre-exist­ing par­tial immu­ni­ty to COVID-19 and mul­ti­ple hypothe­ses are wor­thy of fur­ther explo­ration, but cau­tion should be exer­cised to avoid over­gen­er­al­iza­tions or con­clu­sions in the absence of data.

Pre-exist­ing CD4+ T cell mem­o­ry could also influ­ence vac­ci­na­tion out­comes, lead­ing to a faster or bet­ter immune response, par­tic­u­lar­ly the devel­op­ment of neu­tral­iz­ing anti­bod­ies, which gen­er­al­ly depend on T cell help. At the same time, pre-exist­ing T cell mem­o­ry could also act as a con­found­ing fac­tor, espe­cial­ly in rel­a­tive­ly small phase I vac­cine tri­als. For exam­ple, if sub­jects with pre-exist­ing reac­tiv­i­ty were assort­ed uneven­ly in dif­fer­ent vac­cine dose groups, this might lead to erro­neous con­clu­sions. Obvi­ous­ly, this could be avoid­ed by con­sid­er­ing pre-exist­ing immu­ni­ty as a vari­able to be con­sid­ered in tri­al design. Thus, we rec­om­mend mea­sur­ing pre-exist­ing immu­ni­ty in all COVID-19 vac­cine phase I clin­i­cal tri­als. Of note, such exper­i­ments would also offer an excit­ing oppor­tu­ni­ty to ascer­tain the poten­tial bio­log­i­cal sig­nif­i­cance of pre-exist­ing SARS-CoV-2-reac­tive T cells.

It is fre­quent­ly assumed that pre-exist­ing T cell mem­o­ry against SARS-CoV­‑2 might be either ben­e­fi­cial or irrel­e­vant. How­ev­er, there is also the pos­si­bil­i­ty that pre-exist­ing immu­ni­ty might actu­al­ly be detri­men­tal, through mech­a­nisms such as ‘orig­i­nal anti­genic sin’ (the propen­si­ty to elic­it poten­tial­ly infe­ri­or immune respons­es owing to pre-exist­ing immune mem­o­ry to a relat­ed pathogen), or through anti­body-medi­at­ed dis­ease enhance­ment. While there is no direct evi­dence to sup­port these out­comes, they must be con­sid­ered. A detri­men­tal effect linked to pre-exist­ing immu­ni­ty is emi­nent­ly testable and would be revealed by the same COVID-19 cohort and vac­cine stud­ies pro­posed above.

There is sub­stan­tial data from the influen­za lit­er­a­ture indi­cat­ing that pre-exist­ing cross-reac­tive T cell immu­ni­ty can be ben­e­fi­cial. In the case of the H1N1 influen­za pan­dem­ic of 2009, it was not­ed that an unusu­al ‘V’-shaped age dis­tri­b­u­tion curve exist­ed for dis­ease sever­i­ty, with old­er peo­ple far­ing bet­ter than younger adults. This cor­re­lat­ed with the cir­cu­la­tion of a dif­fer­ent H1N1 strain in the human pop­u­la­tion decades ear­li­er, which pre­sum­ably gen­er­at­ed pre-exist­ing immu­ni­ty in peo­ple old enough to have been exposed to it. This was ver­i­fied by show­ing that pre-exist­ing immu­ni­ty against H1N1 exist­ed in the gen­er­al human pop­u­la­tion9,10. It should be not­ed that if some degree of pre-exist­ing immu­ni­ty against SARS-CoV­‑2 exists in the gen­er­al pop­u­la­tion, this could also influ­ence epi­demi­o­log­i­cal mod­el­ling, and sug­gests that a slid­ing scale mod­el of COVID-19 sus­cep­ti­bil­i­ty may be con­sid­ered.

....

————

“Pre-exist­ing immu­ni­ty to SARS-CoV­‑2: the knowns and unknowns” by Alessan­dro Sette & Shane Crot­ty; Nature Reviews Immunol­o­gy, vol­ume 20, pages457–458(2020); 07/07/2020

“These ear­ly reports demon­strate that sub­stan­tial T cell reac­tiv­i­ty exists in many unex­posed peo­ple; nev­er­the­less, data have not yet demon­strat­ed the source of the T cells or whether they are mem­o­ry T cells. It has been spec­u­lat­ed that the SARS-CoV-2-spe­cif­ic T cells in unex­posed indi­vid­u­als might orig­i­nate from mem­o­ry T cells derived from expo­sure to ‘com­mon cold’ coro­n­avirus­es (CCCs), such as HCoV-OC43, HCoV-HKU1, HCoV-NL63 and HCoV-229E, which wide­ly cir­cu­late in the human pop­u­la­tion and are respon­si­ble for mild self-lim­it­ing res­pi­ra­to­ry symp­toms. More than 90% of the human pop­u­la­tion is seropos­i­tive for at least three of the CCCs6. Thiel and col­leagues3 report­ed that the T cell reac­tiv­i­ty was high­est against a pool of SARS-CoV­‑2 spike pep­tides that had high­er homol­o­gy to CCCs, but the dif­fer­ence was not sig­nif­i­cant.”

We know a large per­cent of the pop­u­lace has some sort of immu­ni­ty to SARS-CoV­‑2, but we don’t know where exact­ly it came from and we don’t know if they hap­pen to the long-liv­ing “mem­o­ry” T‑cells that can con­fer long-term immu­ni­ty. But anoth­er major rea­son for clos­er study of which spe­cif­ic com­mon-cold coro­n­avirus­es might be con­tribut­ing to SARS-CoV­‑2 immu­ni­ty is that the four main com­mon-cold coro­n­avirus­es fol­low mul­ti-year geo­graph­ic cycles, sug­gest­ing it’s pos­si­ble that the dif­fer­ent observed fatal­i­ty rates of the virus in dif­fer­ent regions might be cor­re­lat­ed with the glob­al dis­tri­b­u­tion of these com­mon-cold coro­n­avirus­es in recent years. In oth­er words, did New York City, Wuhan, and Milan all hap­pen to have sim­i­lar com­mon-cold coro­n­avirus expo­sure in recent year that dif­fers from much of the rest of the world? If so, that might explain why those cities got hit so incred­i­bly hard com­pared to oth­er cities.
On the oth­er hand, if some sort of anti­body-depen­dent enhance­ment sce­nario is impact­ing the mor­tal­i­ty rates of this virus it could be New York City, Wuhan, and Milan all got exposed (per­haps inten­tion­al­ly) to some sort of com­mon-cold coro­n­avirus (or per­haps a still uniden­ti­fied coro­n­avirus) in recent years that haven’t had time to spread around to the rest of the world:

...
If the pre-exist­ing T cell immu­ni­ty is relat­ed to CCC expo­sure, it will become impor­tant to bet­ter under­stand the pat­terns of CCC expo­sure in space and time. It is well estab­lished that the four main CCCs are cycli­cal in their preva­lence, fol­low­ing mul­ti­year cycles, which can dif­fer across geo­graph­i­cal loca­tions8. This leads to the spec­u­la­tive hypoth­e­sis that dif­fer­ences in CCC geo-dis­tri­b­u­tion might cor­re­late with bur­den of COVID-19 dis­ease sever­i­ty. Fur­ther­more, high­ly spec­u­la­tive hypothe­ses relat­ed to pre-exist­ing mem­o­ry T cells can be pro­posed regard­ing COVID-19 and age. Chil­dren are less sus­cep­ti­ble to COVID-19 clin­i­cal symp­toms. Old­er peo­ple are much more sus­cep­ti­ble to fatal COVID-19. The rea­sons for both are unclear. The age dis­tri­b­u­tion of CCC infec­tions is not well estab­lished and CCC immu­ni­ty should be exam­ined in greater detail. These con­sid­er­a­tions under­line how mul­ti­ple vari­ables may be involved in poten­tial pre-exist­ing par­tial immu­ni­ty to COVID-19 and mul­ti­ple hypothe­ses are wor­thy of fur­ther explo­ration, but cau­tion should be exer­cised to avoid over­gen­er­al­iza­tions or con­clu­sions in the absence of data.

...

It is fre­quent­ly assumed that pre-exist­ing T cell mem­o­ry against SARS-CoV­‑2 might be either ben­e­fi­cial or irrel­e­vant. How­ev­er, there is also the pos­si­bil­i­ty that pre-exist­ing immu­ni­ty might actu­al­ly be detri­men­tal, through mech­a­nisms such as ‘orig­i­nal anti­genic sin’ (the propen­si­ty to elic­it poten­tial­ly infe­ri­or immune respons­es owing to pre-exist­ing immune mem­o­ry to a relat­ed pathogen), or through anti­body-medi­at­ed dis­ease enhance­ment. While there is no direct evi­dence to sup­port these out­comes, they must be con­sid­ered. A detri­men­tal effect linked to pre-exist­ing immu­ni­ty is emi­nent­ly testable and would be revealed by the same COVID-19 cohort and vac­cine stud­ies pro­posed above.
...

And then there’s the impor­tance of under­stand the role pre-exist­ing T‑cells might be play­ing when assess­ing the effec­tive­ness of vac­cines. If these T‑cells are play­ing a role in gen­er­at­ing an immune response from the vac­cine and a large per­cent of the pop­u­lace pos­sess­es these T‑cells that’s going to be quite a con­founder when try­ing to assess the effi­ca­cy of the vac­cine on peo­ple with­out those pre-exist­ing T‑cells and it’s that pop­u­la­tion that’s most like­ly to actu­al­ly need the vac­cine:

...
Pre-exist­ing CD4+ T cell mem­o­ry could also influ­ence vac­ci­na­tion out­comes, lead­ing to a faster or bet­ter immune response, par­tic­u­lar­ly the devel­op­ment of neu­tral­iz­ing anti­bod­ies, which gen­er­al­ly depend on T cell help. At the same time, pre-exist­ing T cell mem­o­ry could also act as a con­found­ing fac­tor, espe­cial­ly in rel­a­tive­ly small phase I vac­cine tri­als. For exam­ple, if sub­jects with pre-exist­ing reac­tiv­i­ty were assort­ed uneven­ly in dif­fer­ent vac­cine dose groups, this might lead to erro­neous con­clu­sions. Obvi­ous­ly, this could be avoid­ed by con­sid­er­ing pre-exist­ing immu­ni­ty as a vari­able to be con­sid­ered in tri­al design. Thus, we rec­om­mend mea­sur­ing pre-exist­ing immu­ni­ty in all COVID-19 vac­cine phase I clin­i­cal tri­als. Of note, such exper­i­ments would also offer an excit­ing oppor­tu­ni­ty to ascer­tain the poten­tial bio­log­i­cal sig­nif­i­cance of pre-exist­ing SARS-CoV-2-reac­tive T cells.
...

And as the fol­low­ing Bloomberg arti­cle makes clear, there’s anoth­er major rea­son vac­cine researchers need to keep in mind the pos­si­bil­i­ty that pre-exist­ing T‑cells are what make the vac­cine effec­tive: the recent announce­ments from SARS-CoV­‑2 vac­cine researchers are all falling back on the pres­ence of T‑cells that can rec­og­nize the SARS-CoV­‑2 virus as signs that their vac­cines might be work­ing despite a short-lived of non-exis­tent anti­body response in many of the peo­ple they are test­ing the vac­cines on. So if the vac­cines are indeed trig­ger­ing the devel­op­ing of new T‑cells that’s won­der­ful news. But if the vac­cines are instead just trig­ger­ing pre-exist­ing T‑cells that devel­oped pri­or to the SARS-CoV­‑2 pan­dem­ic that’s hor­ri­ble news that sug­gests the vac­cines aren’t real­ly gen­er­at­ing anti­bod­ies or new T‑cells and there­fore can’t help those with­out those pre-exist­ing T‑cells. So all of this seem­ing­ly good news about vac­cines that are acti­vat­ing T‑cells might actu­al­ly be bad news for the peo­ple who need it most:

Bloomberg

Unsung Immune Cells Take Over When Covid Anti­bod­ies Wane

* Stud­ies show T cells’ cru­cial role in coro­n­avirus pro­tec­tion
* Vac­cine mak­ers hail their pres­ence in tri­als of inoc­u­la­tions

By Marthe Four­cade and Jason Gale
July 22, 2020, 6:40 PM CDT Updat­ed on July 23, 2020, 7:49 AM CDT

Anti­bod­ies have become a famil­iar word in the pan­dem­ic era, per­haps sug­gest­ing they’re the best hope for keep­ing the dead­ly coro­n­avirus at bay. But when cru­cial vac­cine data was released this week, the spot­light panned to an unsung immune play­er: T cells.

AstraZeneca Plc, Pfiz­er Inc. and part­ner BioN­Tech SE, as well as China’s CanSi­no Bio­log­ics Inc. all hailed the pres­ence of these white blood cells in vac­cine recip­i­ents as a sign their exper­i­men­tal shots show promise.

Thrust into focus by recent stud­ies, T cells are a reminder that the body’s defens­es rely on more than one weapon, and that much of the immune response to Covid-19 is still a mys­tery — espe­cial­ly after researchers revealed that the more laud­ed anti­bod­ies lack stay­ing pow­er.

“Anti­bod­ies are only a very small part of the pic­ture,” said Paul Grif­fin, an asso­ciate pro­fes­sor of med­i­cine at the Uni­ver­si­ty of Queens­land in Bris­bane, who is lead­ing clin­i­cal stud­ies in Aus­tralia of two poten­tial Covid-19 vac­cines. But “we’re real­ly not there yet in terms of ful­ly under­stand­ing” people’s immu­ni­ty to the new coro­n­avirus.

As the pan­dem­ic took the world by storm, sci­en­tists first focused on anti­bod­ies — pro­teins that stick to and dis­able for­eign invaders — because elic­it­ing them is the basis for most suc­cess­ful vac­cines. The immune pro­teins are also eas­i­er to mea­sure than T cells and can be used to gauge pri­or infec­tion.

The study show­ing they wane quick­ly in patients with mild dis­ease dealt a blow to hopes that anti­bod­ies will pro­vide some last­ing form of immu­ni­ty.

Unsung War­riors

T cells, by con­trast, are able to kill virus-infect­ed cells, remem­ber past dis­eases for decades, and rouse fresh anti­body sol­diers long after the first have left the bat­tle­field. Peo­ple infect­ed with anoth­er coro­n­avirus that was respon­si­ble for the SARS epi­dem­ic in 2003, for exam­ple, still have a T‑cell response to the dis­ease 17 years lat­er.

That sug­gests T cells may still, at least hypo­thet­i­cal­ly, be ready to pro­tect SARS sur­vivors against the infec­tion almost two decades lat­er, and might bol­ster their defense against Covid-19.

“Anti­bod­ies wane after a cer­tain peri­od of time,” said Thomas Schi­neck­er, who heads the diag­nos­tics unit of Swiss drug­mak­er Roche Hold­ing AG. “This doesn’t mean that there is no immu­ni­ty, it just means that poten­tial­ly the mem­o­ry cells, T cells and oth­ers, will then be trig­gered to respond much bet­ter the sec­ond time so that you don’t have any severe response.”

One study found that some patients with no symp­toms of Covid-19 had T‑cells that rec­og­nized the virus — even when they had no detectable anti­bod­ies. Anoth­er point­ed to a lev­el of immu­ni­ty in peo­ple who nev­er encoun­tered the pathogen, pos­si­bly because of expo­sure to one or more of the coro­n­avirus­es that cause the com­mon cold.

Bal­anc­ing Act

More research is need­ed to deter­mine whether pre-exist­ing T cells that cross-react with the SARS-CoV­‑2 virus may explain why some Covid patients are bare­ly affect­ed while oth­ers get very sick and even die. What’s clear is that a bal­ance of both anti­bod­ies and T cells is nec­es­sary for opti­mal defense, accord­ing to Grif­fin.

Corey Smith, head of trans­la­tion­al and human immunol­o­gy at the QIMR Berghofer Med­ical Research Insti­tute in Bris­bane, says the find­ings about anti­bod­ies’ short dura­tion don’t mean immu­ni­ty wanes com­plete­ly, pre­cise­ly because of T cells.

So-called helper T cells, as well as mem­o­ry T and B cells are able to prime anti­bod­ies to respond to a sub­se­quent infec­tion before it caus­es severe symp­toms, said Smith, who is study­ing the immune response to the SARS-CoV­‑2 virus.

...

If could be that T cells are what ulti­mate­ly sub­due and blunt the pan­dem­ic virus that’s killed more than 600,000 peo­ple in less than sev­en months.

“If we can’t erad­i­cate it, does it end up as a kind of a cir­cu­lat­ing virus, anoth­er cold virus?” Smith said. “I’m not sure, but it’s inter­est­ing.”

————

“Unsung Immune Cells Take Over When Covid Anti­bod­ies Wane” by Marthe Four­cade and Jason Gale; Bloomberg; 07/22/2020

“If could be that T cells are what ulti­mate­ly sub­due and blunt the pan­dem­ic virus that’s killed more than 600,000 peo­ple in less than sev­en months.”

Are T‑cells going to be the heroes of the pan­dem­ic? It’s increas­ing­ly look­ing like that’s going to be the case based on the rel­a­tive suc­cess by the vac­cine researchers at detect­ing T‑cells that can inter­act with the SARS-CoV­‑2 virus in the vac­ci­nat­ed sub­jects. And yet it’s unclear if these vac­cine researchers were check­ing for the pres­ence of these T‑cells before the vac­ci­na­tion and if those T‑cells were already there their pres­ence post-vac­ci­na­tion does­n’t actu­al­ly tell us whether or not the vac­cine in work­ing. And the ques­tion of whether or not these peo­ple already had those T‑cells from past infec­tions remains a very open when mem­o­ry T‑cells from dif­fer­ent coro­n­avirus­es can last decades — with peo­ple infect­ed with SARS still show­ing a T‑cell response 17 years lat­er — and can cross-react with SARS-CoV­‑2:

...
AstraZeneca Plc, Pfiz­er Inc. and part­ner BioN­Tech SE, as well as China’s CanSi­no Bio­log­ics Inc. all hailed the pres­ence of these white blood cells in vac­cine recip­i­ents as a sign their exper­i­men­tal shots show promise.

...

T cells, by con­trast, are able to kill virus-infect­ed cells, remem­ber past dis­eases for decades, and rouse fresh anti­body sol­diers long after the first have left the bat­tle­field. Peo­ple infect­ed with anoth­er coro­n­avirus that was respon­si­ble for the SARS epi­dem­ic in 2003, for exam­ple, still have a T‑cell response to the dis­ease 17 years lat­er.

That sug­gests T cells may still, at least hypo­thet­i­cal­ly, be ready to pro­tect SARS sur­vivors against the infec­tion almost two decades lat­er, and might bol­ster their defense against Covid-19.

...

More research is need­ed to deter­mine whether pre-exist­ing T cells that cross-react with the SARS-CoV­‑2 virus may explain why some Covid patients are bare­ly affect­ed while oth­ers get very sick and even die. What’s clear is that a bal­ance of both anti­bod­ies and T cells is nec­es­sary for opti­mal defense, accord­ing to Grif­fin.
...

Also keep in the pos­si­bil­i­ty that a num­ber of peo­ple might have already devel­oped T‑cells tar­get­ing SARS-CoV­‑2 from an ear­li­er unrec­og­nized out­break of SARS-CoV­‑2.

And then there’s the pos­si­bil­i­ty that the virus is nev­er van­quished via a vac­cine and just keeps cir­cu­lat­ing for­ev­er. Will it just turn into anoth­er com­mon cold coro­n­avirus after we all even­tu­al­ly get exposed? Keep in mind that if this nev­er goes away most peo­ple are going to be exposed when they’re very young, so if this virus does con­tin­ue cir­cu­lat­ing indef­i­nite­ly at some point vir­tu­al­ly every­one alive (who isn’t killed by the virus) is going to have been exposed to it and will hope­ful­ly have this kind of pre-exist­ing T‑cell immu­ni­ty built up:

...
“If we can’t erad­i­cate it, does it end up as a kind of a cir­cu­lat­ing virus, anoth­er cold virus?” Smith said. “I’m not sure, but it’s inter­est­ing.”
...

Might we just have this virus cir­cu­lat­ing for­ev­er as some sort of com­mon cold? Well, as the fol­low­ing Nature arti­cle from ear­ly May (and there­fore two-and-a-half months behind the cur­rent SARS-CoV­‑2 research) sug­gest­ed, yes, that’s exact­ly what could hap­pen. And it could hap­pen despite the fact that coro­n­avirus­es are noto­ri­ous­ly slow at mutat­ing com­pared to oth­er viral fam­i­lies which makes it less like­ly the virus will mutate into a less vir­u­lent form, espe­cial­ly giv­en its wild suc­cess at spread­ing already that would blunt the evo­lu­tion­ary forces that might dri­ve the emer­gence of a less vir­u­lent form of the virus that’s more sim­i­lar to the com­mon cold. Instead, that rel­a­tive sta­bil­i­ty of the virus along with repeat­ed glob­al expo­sure could effec­tive­ly turn SARS-CoV­‑2 into a com­mon cold. It’s a sce­nario some researchers see as plau­si­ble in part because it’s thought that one of today’s exist­ing com­mon cold coro­n­avirus­es, OC43, under­went that same shift from a killer virus to a com­mon cold with­out actu­al­ly mutat­ing. As researchers found, the OC43 virus appears to have jumped from cows to humans around 1890 and may have been respon­si­ble for a pan­dem­ic that killed more than a mil­lion peo­ple glob­al­ly from 1889–1890. That same virus cir­cu­lates wide­ly today, but we’re all exposed to it repeat­ed­ly and now it’s just a com­mon cold:

Nature 581, 22–26 (2020)

Pro­file of a killer: the com­plex biol­o­gy pow­er­ing the coro­n­avirus pan­dem­ic
Sci­en­tists are piec­ing togeth­er how SARS-CoV­‑2 oper­ates, where it came from and what it might do next — but press­ing ques­tions remain about the source of COVID-19.

David Cyra­nos­ki
04 May 2020
Nature 581, 22–26 (2020)

In 1912, Ger­man vet­eri­nar­i­ans puz­zled over the case of a fever­ish cat with an enor­mous­ly swollen bel­ly. That is now thought to be the first report­ed exam­ple of the debil­i­tat­ing pow­er of a coro­n­avirus. Vet­eri­nar­i­ans didn’t know it at the time, but coro­n­avirus­es were also giv­ing chick­ens bron­chi­tis, and pigs an intesti­nal dis­ease that killed almost every piglet under two weeks old.

The link between these pathogens remained hid­den until the 1960s, when researchers in the Unit­ed King­dom and the Unit­ed States iso­lat­ed two virus­es with crown-like struc­tures caus­ing com­mon colds in humans. Sci­en­tists soon noticed that the virus­es iden­ti­fied in sick ani­mals had the same bristly struc­ture, stud­ded with spiky pro­tein pro­tru­sions. Under elec­tron micro­scopes, these virus­es resem­bled the solar coro­na, which led researchers in 1968 to coin the term coro­n­avirus­es for the entire group.

It was a fam­i­ly of dynam­ic killers: dog coro­n­avirus­es could harm cats, the cat coro­n­avirus could rav­age pig intestines. Researchers thought that coro­n­avirus­es caused only mild symp­toms in humans, until the out­break of severe acute res­pi­ra­to­ry syn­drome (SARS) in 2003 revealed how eas­i­ly these ver­sa­tile virus­es could kill peo­ple.

Now, as the death toll from the COVID-19 pan­dem­ic surges, researchers are scram­bling to uncov­er as much as pos­si­ble about the biol­o­gy of the lat­est coro­n­avirus, named SARS-CoV­‑2. A pro­file of the killer is already emerg­ing. Sci­en­tists are learn­ing that the virus has evolved an array of adap­ta­tions that make it much more lethal than the oth­er coro­n­avirus­es human­i­ty has met so far. Unlike close rel­a­tives, SARS-CoV­‑2 can read­i­ly attack human cells at mul­ti­ple points, with the lungs and the throat being the main tar­gets. Once inside the body, the virus makes use of a diverse arse­nal of dan­ger­ous mol­e­cules. And genet­ic evi­dence sug­gests that it has been hid­ing out in nature pos­si­bly for decades.

But there are many cru­cial unknowns about this virus, includ­ing how exact­ly it kills, whether it will evolve into some­thing more — or less — lethal and what it can reveal about the next out­break from the coro­n­avirus fam­i­ly.

“There will be more, either out there already or in the mak­ing,” says Andrew Ram­baut, who stud­ies viral evo­lu­tion at the Uni­ver­si­ty of Edin­burgh, UK.

Bad fam­i­ly

Of the virus­es that attack humans, coro­n­avirus­es are big. At 125 nanome­tres in diam­e­ter, they are also rel­a­tive­ly large for the virus­es that use RNA to repli­cate, the group that accounts for most new­ly emerg­ing dis­eases. But coro­n­avirus­es real­ly stand out for their genomes. With 30,000 genet­ic bases, coro­n­avirus­es have the largest genomes of all RNA virus­es. Their genomes are more than three times as big as those of HIV and hepati­tis C, and more than twice influenza’s.

Coro­n­avirus­es are also one of the few RNA virus­es with a genom­ic proof­read­ing mech­a­nism — which keeps the virus from accu­mu­lat­ing muta­tions that could weak­en it. That abil­i­ty might be why com­mon antivi­rals such as rib­avirin, which can thwart virus­es such as hepati­tis C, have failed to sub­due SARS-CoV­‑2. The drugs weak­en virus­es by induc­ing muta­tions. But in the coro­n­avirus­es, the proof­read­er can weed out those changes.

Muta­tions can have their advan­tages for virus­es. Influen­za mutates up to three times more often than coro­n­avirus­es do, a pace that enables it to evolve quick­ly and side­step vac­cines. But coro­n­avirus­es have a spe­cial trick that gives them a dead­ly dynamism: they fre­quent­ly recom­bine, swap­ping chunks of their RNA with oth­er coro­n­avirus­es. Typ­i­cal­ly, this is a mean­ing­less trad­ing of like parts between like virus­es. But when two dis­tant coro­n­avirus rel­a­tives end up in the same cell, recom­bi­na­tion can lead to for­mi­da­ble ver­sions that infect new cell types and jump to oth­er species, says Ram­baut.

Recom­bi­na­tion hap­pens often in bats, which car­ry 61 virus­es known to infect humans; some species har­bour as many as 121. In most cas­es, the virus­es don’t harm the bats, and there are sev­er­al the­o­ries about why bats’ immune sys­tems can cope with these invaders. A paper pub­lished in Feb­ru­ary argues that bat cells infect­ed by virus­es rapid­ly release a sig­nal that makes them able to host the virus with­out killing it2.

Esti­mates for the birth of the first coro­n­avirus vary wide­ly, from 10,000 years ago to 300 mil­lion years ago. Sci­en­tists are now aware of dozens of strains3, sev­en of which infect humans. Among the four that cause com­mon colds, two (OC43 and HKU1) came from rodents, and the oth­er two (229E and NL63) from bats. The three that cause severe dis­ease — SARS-CoV (the cause of SARS), Mid­dle East res­pi­ra­to­ry syn­drome MERS-CoV and SARS-CoV­‑2 — all came from bats. But sci­en­tists think there is usu­al­ly an inter­me­di­ary — an ani­mal infect­ed by the bats that car­ries the virus into humans. With SARS, the inter­me­di­ary is thought to be civet cats, which are sold in live-ani­mal mar­kets in Chi­na.

...

Two open doors

Although the known human coro­n­avirus­es can infect many cell types, they all main­ly cause res­pi­ra­to­ry infec­tions. The dif­fer­ence is that the four that cause com­mon colds eas­i­ly attack the upper res­pi­ra­to­ry tract, where­as MERS-CoV and SARS-CoV have more dif­fi­cul­ty gain­ing a hold there, but are more suc­cess­ful at infect­ing cells in the lungs.

SARS-CoV­‑2, unfor­tu­nate­ly, can do both very effi­cient­ly. That gives it two places to get a foothold, says Shu-Yuan Xiao, a pathol­o­gist at the Uni­ver­si­ty of Chica­go, Illi­nois. A neighbour’s cough that sends ten viral par­ti­cles your way might be enough to start an infec­tion in your throat, but the hair-like cil­ia found there are like­ly to do their job and clear the invaders. If the neigh­bour is clos­er and coughs 100 par­ti­cles towards you, the virus might be able get all the way down to the lungs, says Xiao.

These vary­ing capac­i­ties might explain why peo­ple with COVID-19 have such dif­fer­ent expe­ri­ences. The virus can start in the throat or nose, pro­duc­ing a cough and dis­rupt­ing taste and smell, and then end there. Or it might work its way down to the lungs and debil­i­tate that organ. How it gets down there, whether it moves cell by cell or some­how gets washed down, is not known, says Stan­ley Perl­man, an immu­nol­o­gist at the Uni­ver­si­ty of Iowa in Iowa City who stud­ies coro­n­avirus­es.

Clemens-Mar­tin Wendt­ner, an infec­tious-dis­ease physi­cian at the Munich Clin­ic Schwabing in Ger­many, says it could be a prob­lem with the immune sys­tem that lets the virus sneak down into the lungs. Most infect­ed peo­ple cre­ate neu­tral­iz­ing anti­bod­ies that are tai­lored by the immune sys­tem to bind with the virus and block it from enter­ing a cell. But some peo­ple seem unable to make them, says Wendt­ner. That might be why some recov­er after a week of mild symp­toms, where­as oth­ers get hit with late-onset lung dis­ease. But the virus can also bypass the throat cells and go straight down into the lungs. Then patients might get pneu­mo­nia with­out the usu­al mild symp­toms such as a cough or low-grade fever that would oth­er­wise come first, says Wendt­ner. Hav­ing these two infec­tion points means that SARS-CoV­‑2 can mix the trans­mis­si­bil­i­ty of the com­mon cold coro­n­avirus­es with the lethal­i­ty of MERS-CoV and SARS-CoV. “It is an unfor­tu­nate and dan­ger­ous com­bi­na­tion of this coro­n­avirus strain,” he says.

The virus’s abil­i­ty to infect and active­ly repro­duce in the upper res­pi­ra­to­ry tract was some­thing of a sur­prise, giv­en that its close genet­ic rel­a­tive, SARS-CoV, lacks that abil­i­ty. Last month, Wendt­ner pub­lished results8 of exper­i­ments in which his team was able to cul­ture virus from the throats of nine peo­ple with COVID-19, show­ing that the virus is active­ly repro­duc­ing and infec­tious there. That explains a cru­cial dif­fer­ence between the close rel­a­tives. SARS-CoV­‑2 can shed viral par­ti­cles from the throat into sali­va even before symp­toms start, and these can then pass eas­i­ly from per­son to per­son. SARS-CoV was much less effec­tive at mak­ing that jump, pass­ing only when symp­toms were full-blown, mak­ing it eas­i­er to con­tain.

These dif­fer­ences have led to some con­fu­sion about the lethal­i­ty of SARS-CoV­‑2. Some experts and media reports describe it as less dead­ly than SARS-CoV because it kills about 1% of the peo­ple it infects, where­as SARS-CoV killed at rough­ly ten times that rate. But Perl­man says that’s the wrong way to look at it. SARS-CoV­‑2 is much bet­ter at infect­ing peo­ple, but many of the infec­tions don’t progress to the lungs. “Once it gets down in the lungs, it’s prob­a­bly just as dead­ly,” he says.

What it does when it gets down to the lungs is sim­i­lar in some respects to what res­pi­ra­to­ry virus­es do, although much remains unknown. Like SARS-CoV and influen­za, it infects and destroys the alve­oli, the tiny sacs in the lungs that shut­tle oxy­gen into the blood­stream. As the cel­lu­lar bar­ri­er divid­ing these sacs from blood ves­sels break down, liq­uid from the ves­sels leaks in, block­ing oxy­gen from get­ting to the blood. Oth­er cells, includ­ing white blood cells, plug up the air­way fur­ther. A robust immune response will clear all this out in some patients, but over­re­ac­tion of the immune sys­tem can make the tis­sue dam­age worse. If the inflam­ma­tion and tis­sue dam­age are too severe, the lungs nev­er recov­er and the per­son dies or is left with scarred lungs, says Xiao. “From a patho­log­i­cal point of view, we don’t see a lot of unique­ness here.”

And as with SARS-CoV, MERS-CoV and ani­mal coro­n­avirus­es, the dam­age doesn’t stop with the lungs. A SARS-CoV­‑2 infec­tion can trig­ger an exces­sive immune response known as a cytokine storm, which can lead to mul­ti­ple organ fail­ure and death. The virus can also infect the intestines, the heart, the blood, sperm (as can MERS-CoV), the eye and pos­si­bly the brain. Dam­age to the kid­ney, liv­er and spleen observed in peo­ple with COVID-19 sug­gests that the virus can be car­ried in the blood and infect var­i­ous organs or tis­sues, says Guan Wei-jie, a pul­mo­nolo­gist at the Guangzhou Insti­tute of Res­pi­ra­to­ry Health at Guangzhou Med­ical Uni­ver­si­ty, Chi­na, an insti­tu­tion laud­ed for its role in com­bat­ing SARS and COVID-19. The virus might be able to infect var­i­ous organs or tis­sues wher­ev­er the blood sup­ply reach­es, says Guan.

But although genet­ic mate­r­i­al from the virus is show­ing up in these var­i­ous tis­sues, it is not yet clear whether the dam­age there is being done by the virus or by a cytokine storm, says Wendt­ner. “Autop­sies are under way in our cen­tre. More data will come soon,” he says.

...

Pow­er spikes

SARS-CoV­‑2 is unique­ly equipped for forc­ing entry into cells. Both SARS-CoV and SARS-CoV­‑2 bind with ACE2, but the recep­tor-bind­ing domain of SARS-CoV­‑2 is a par­tic­u­lar­ly snug fit. It is 10–20 times more like­ly to bind ACE2 than is SARS-CoV9. Wendt­ner says that SARS-CoV­‑2 is so good at infect­ing the upper res­pi­ra­to­ry tract that there might even be a sec­ond recep­tor that the virus could use to launch its attack.

Even more trou­bling is the fact that SARS-COV‑2 seems to make use of the enzyme furin from the host to cleave the viral spike pro­tein. This is wor­ry­ing, researchers say, because furin is abun­dant in the res­pi­ra­to­ry tract and found through­out the body. It is used by oth­er for­mi­da­ble virus­es, includ­ing HIV, influen­za, dengue and Ebo­la to enter cells. By con­trast, the cleav­age mol­e­cules used by SARS-CoV are much less com­mon and not as effec­tive.

Sci­en­tists think that the involve­ment of furin could explain why SARS-CoV­‑2 is so good at jump­ing from cell to cell, per­son to per­son and pos­si­bly ani­mal to human. Robert Gar­ry, a virol­o­gist at Tulane Uni­ver­si­ty in New Orleans, Louisiana, esti­mates that it gives SARS-CoV­‑2 a 100–1,000 times greater chance than SARS-CoV of get­ting deep into the lungs. “When I saw SARS-CoV­‑2 had that cleav­age site, I did not sleep very well that night,” he says.

The mys­tery is where the genet­ic instruc­tions for this par­tic­u­lar cleav­age site came from. Although the virus prob­a­bly gained them through recom­bi­na­tion, this par­tic­u­lar set-up has nev­er been found in any oth­er coro­n­avirus in any species. Pin­ning down its ori­gin might be the last piece in the puz­zle that will deter­mine which ani­mal was the step­ping stone that allowed the virus to reach humans.

End game

Some researchers hope that the virus will weak­en over time through a series of muta­tions that adapt it to per­sist in humans. By this log­ic, it would become less dead­ly and have more chances to spread. But researchers have not yet found any sign of such weak­en­ing, prob­a­bly because of the virus’s effi­cient genet­ic repair mech­a­nism. “The genome of COVID-19 virus is very sta­ble, and I don’t see any change of path­o­genic­i­ty that is caused by virus muta­tion,” says Guo Deyin, who research­es coro­n­avirus­es at Sun Yat-sen Uni­ver­si­ty in Guangzhou.

Ram­baut, too, doubts that the virus will become milder over time and spare its host. “It doesn’t work that way,” he says. As long as it can suc­cess­ful­ly infect new cells, repro­duce and trans­mit to new ones, it doesn’t mat­ter whether it harms the host, he says.

But oth­ers think there is a chance for a bet­ter out­come. It might give peo­ple anti­bod­ies that will offer at least par­tial pro­tec­tion, says Klaus Stöhr, who head­ed the World Health Organization’s SARS research and epi­demi­ol­o­gy divi­sion. Stöhr says that immu­ni­ty will not be per­fect — peo­ple who are rein­fect­ed will still devel­op minor symp­toms, the way they do now from the com­mon cold, and there will be rare exam­ples of severe dis­ease. But the virus’s proof­read­ing mech­a­nism means it will not mutate quick­ly, and peo­ple who were infect­ed will retain robust pro­tec­tion, he says.

“By far the most like­ly sce­nario is that the virus will con­tin­ue to spread and infect most of the world pop­u­la­tion in a rel­a­tive­ly short peri­od of time,” says Stöhr, mean­ing one to two years. “After­wards, the virus will con­tin­ue to spread in the human pop­u­la­tion, like­ly for­ev­er.” Like the four gen­er­al­ly mild human coro­n­avirus­es, SARS-CoV­‑2 would then cir­cu­late con­stant­ly and cause main­ly mild upper res­pi­ra­to­ry tract infec­tions, says Stöhr. For that rea­son, he adds, vac­cines won’t be nec­es­sary.

Some pre­vi­ous stud­ies sup­port this argu­ment. One10 showed that when peo­ple were inoc­u­lat­ed with the com­mon-cold coro­n­avirus 229E, their anti­body lev­els peaked two weeks lat­er and were only slight­ly raised after a year. That did not pre­vent infec­tions a year lat­er, but sub­se­quent infec­tions led to few, if any, symp­toms and a short­er peri­od of viral shed­ding.

The OC43 coro­n­avirus offers a mod­el for where this pan­dem­ic might go. That virus also gives humans com­mon colds, but genet­ic research from the Uni­ver­si­ty of Leu­ven in Bel­gium sug­gests that OC43 might have been a killer in the past11. That study indi­cates that OC43 spilled over to humans in around 1890 from cows, which got it from mice. The sci­en­tists sug­gest that OC43 was respon­si­ble for a pan­dem­ic that killed more than one mil­lion peo­ple world­wide in 1889–90 — an out­break pre­vi­ous­ly blamed on influen­za. Today, OC43 con­tin­ues to cir­cu­late wide­ly and it might be that con­tin­u­al expo­sure to the virus keeps the great major­i­ty of peo­ple immune to it.

But even if that process made OC43 less dead­ly, it is not yet clear whether some­thing sim­i­lar would hap­pen with SARS-CoV­‑2. A study in mon­keys showed that they retained anti­bod­ies to SARS-CoV­‑2, but the researchers only report­ed on the first 28 days after infec­tion, so it is unclear how long the immu­ni­ty last­ed12. Con­cen­tra­tions of anti­bod­ies against SARS-CoV also dropped sig­nif­i­cant­ly over a two- to three-year peri­od13. Whether those low­ered lev­els would be enough to pre­vent infec­tion or reduce sever­i­ty has not been test­ed. Cats, cows, dogs and chick­ens do not seem to become immune to the some­times dead­ly coro­n­avirus­es that infect them, leav­ing vet­eri­nar­i­ans over the years to scram­ble for vac­cines. Despite all the ques­tions about whether peo­ple retain any immu­ni­ty to SARS-CoV­‑2, some coun­tries are pro­mot­ing the idea of giv­ing sur­vivors ‘immu­ni­ty pass­ports’ to allow them to ven­ture out with­out fear of being infect­ed or infect­ing oth­ers.

Many sci­en­tists are reserv­ing judge­ment on whether the tamer coro­n­avirus­es were once as vir­u­lent as SARS-CoV­‑2. Peo­ple like to think that “the oth­er coro­n­avirus­es were ter­ri­ble and became mild”, says Perl­man. “That’s an opti­mistic way to think about what’s going on now, but we don’t have evi­dence.”

———–

“Pro­file of a killer: the com­plex biol­o­gy pow­er­ing the coro­n­avirus pan­dem­ic” by David Cyra­nos­ki; Nature; 05/04/2020

““By far the most like­ly sce­nario is that the virus will con­tin­ue to spread and infect most of the world pop­u­la­tion in a rel­a­tive­ly short peri­od of time,” says Stöhr, mean­ing one to two years. “After­wards, the virus will con­tin­ue to spread in the human pop­u­la­tion, like­ly for­ev­er.” Like the four gen­er­al­ly mild human coro­n­avirus­es, SARS-CoV­‑2 would then cir­cu­late con­stant­ly and cause main­ly mild upper res­pi­ra­to­ry tract infec­tions, says Stöhr. For that rea­son, he adds, vac­cines won’t be nec­es­sary.”

No vac­cines will be nec­es­sary because this is just going to become a slow­ly evolv­ing com­mon cold after we’re all exposed to it. That was the view of Klaus Stöhr, the for­mer head of the World Health Organization’s SARS research and epi­demi­ol­o­gy divi­sion. And it’s human­i­ty’s expe­ri­ence with OC43 that gives Stöhr this kind of opti­mism:

...
Ram­baut, too, doubts that the virus will become milder over time and spare its host. “It doesn’t work that way,” he says. As long as it can suc­cess­ful­ly infect new cells, repro­duce and trans­mit to new ones, it doesn’t mat­ter whether it harms the host, he says.

But oth­ers think there is a chance for a bet­ter out­come. It might give peo­ple anti­bod­ies that will offer at least par­tial pro­tec­tion, says Klaus Stöhr, who head­ed the World Health Organization’s SARS research and epi­demi­ol­o­gy divi­sion. Stöhr says that immu­ni­ty will not be per­fect — peo­ple who are rein­fect­ed will still devel­op minor symp­toms, the way they do now from the com­mon cold, and there will be rare exam­ples of severe dis­ease. But the virus’s proof­read­ing mech­a­nism means it will not mutate quick­ly, and peo­ple who were infect­ed will retain robust pro­tec­tion, he says.

...

Some pre­vi­ous stud­ies sup­port this argu­ment. One10 showed that when peo­ple were inoc­u­lat­ed with the com­mon-cold coro­n­avirus 229E, their anti­body lev­els peaked two weeks lat­er and were only slight­ly raised after a year. That did not pre­vent infec­tions a year lat­er, but sub­se­quent infec­tions led to few, if any, symp­toms and a short­er peri­od of viral shed­ding.

The OC43 coro­n­avirus offers a mod­el for where this pan­dem­ic might go. That virus also gives humans com­mon colds, but genet­ic research from the Uni­ver­si­ty of Leu­ven in Bel­gium sug­gests that OC43 might have been a killer in the past11. That study indi­cates that OC43 spilled over to humans in around 1890 from cows, which got it from mice. The sci­en­tists sug­gest that OC43 was respon­si­ble for a pan­dem­ic that killed more than one mil­lion peo­ple world­wide in 1889–90 — an out­break pre­vi­ous­ly blamed on influen­za. Today, OC43 con­tin­ues to cir­cu­late wide­ly and it might be that con­tin­u­al expo­sure to the virus keeps the great major­i­ty of peo­ple immune to it.
...

Is Stöhr going to be cor­rect? Let’s hope so because hav­ing the virus just fade into com­mon-cold sta­tus would be a real­ly nice back­up ‘plan’ should the vac­cines fail. It also rais­es the ques­tion of whether or not we should be just expos­ing peo­ple to these com­mon cold coro­n­avirus­es as a kind of vac­cine, along with the dis­turb­ing pos­si­bil­i­ty that social dis­tanc­ing mea­sures might be lim­it­ing the ben­e­fits of com­mon cold coro­n­avirus expo­sure right now. One of the inter­est­ing ques­tions raised by this the­o­ry is why the elder­ly, who would have had the most com­mon cold coro­n­avirus expo­sure over the course of their lives, are the most vul­nen­able to the dis­ease. Are they los­ing their mem­o­ry T‑cells from past com­mon cold coro­n­avirus expo­sures? Would new expo­sures bring those T‑cells back at lev­els high enough to pro­tect against SARS-CoV­‑2? These are the kinds of ques­tions we’re going to have to ask if the vac­cines don’t pan out as hoped.

But as Klaus Stöhr makes clear in anoth­er recent Bloomberg arti­cle, there’s anoth­er we might have to rely on T‑cell immu­ni­ty and hope that this virus even­tu­al­ly does just become anoth­er com­mon cold coro­n­avirus: most of the devel­op­ing world is unlike­ly to get access to a vac­cine even if one is devel­oped, at least for a long time. And in the mean time, the virus is going to keep spread­ing. In oth­er words, it’s pos­si­ble that the vac­cine is the solu­tion for wealth­i­er coun­tries but for most of the rest of the world they’re going to have lit­tle choice but to even­tu­al­ly just let the virus run through the pop­u­lace until they acquire ‘herd immu­ni­ty’ so we had bet­ter hope the tran­si­tion-to-com­mon-cold sce­nario real­ly does play out:

Bloomberg

Most of the World May Face Covid With­out a Vac­cine

“There will be anoth­er wave, and it will be very seri­ous.”

By James Paton
July 18, 2020, 1:00 AM CDT

Klaus Stohr has urged gov­ern­ments for many years to pre­pare for the grim pos­si­bil­i­ty of a pan­dem­ic.

In 2003, he played a key role in a World Health Orga­ni­za­tion inves­ti­ga­tion that swift­ly iden­ti­fied a coro­n­avirus as the cause of SARS. Stohr also sound­ed the alarm on the pan­dem­ic poten­tial of avian flu, bring­ing coun­tries and com­pa­nies to the table to increase pro­duc­tion of vac­cines in case it began spread­ing wide­ly in peo­ple.

...

Bloomberg: How do you see the pan­dem­ic advanc­ing before a vac­cine poten­tial­ly is avail­able?

Stohr: The epi­demi­o­log­i­cal behav­ior of this virus will not be that much dif­fer­ent from oth­er res­pi­ra­to­ry dis­eases. Dur­ing win­ter, they come back.

There will be anoth­er wave, and it will be very seri­ous. More than 90% of the pop­u­la­tion is sus­cep­ti­ble. If we do not tight­en again to a seri­ous lock­down or sim­i­lar mea­sures, the virus is going to cause a sig­nif­i­cant out­break. Win­ter is com­ing before the vac­cine. There will be an increase in cas­es, and there will be prob­lems con­tain­ing it because peo­ple seem not very amenable to more con­straints in their move­ment and free­dom.

Bloomberg: When do you pre­dict vac­cines may arrive?

Stohr: Coun­tries like Ger­many may have a sig­nif­i­cant amount of vac­cine by the begin­ning of next year and a roll­out that may take four, five, six months for the elder­ly. The strat­e­gy may be dif­fer­ent for a coun­try like Brazil, Argenti­na or Chile, which may nev­er get a sin­gle dose of a vac­cine and still has to cope.

The world will be divid­ed into two groups, those with vac­cines and those with no vac­cines.

Bloomberg: How do you see world­wide immu­ni­ty ramp­ing up as vac­cines are intro­duced and the dis­ease spreads?

Stohr: I would assume that by the mid­dle of next year a sig­nif­i­cant por­tion of the world will have anti­bod­ies. That will increase grad­u­al­ly over time. Then there will be a third wave, and when that is over, I would think that 80% of the world may have anti­bod­ies if lock­downs are not insti­tut­ed, which I doubt.

Bloomberg: What does that mean for vac­cines under devel­op­ment?

Stohr: We’re in a big, big quandary. We have to throw all the resources we can afford toward the devel­op­ment of a vac­cine. On the oth­er hand, I believe com­mon sense tells us vac­cines will not be avail­able for the major­i­ty of the world.

There may be, by the end of this year or begin­ning of next year, a half a bil­lion dos­es avail­able. The world pop­u­la­tion is 7.5 bil­lion. Par­tic­u­lar­ly in those coun­tries which have insuf­fi­cient infra­struc­ture and strug­gle with their health-care sys­tems and have huge pop­u­la­tions, what vac­cine are they going to have?

Bloomberg: A num­ber of groups, includ­ing the WHO, are focus­ing on equi­table access. Won’t that help tack­le those con­cerns?

Stohr: It would be irre­spon­si­ble not to do any­thing. Nev­er­the­less, the major­i­ty of the world pop­u­la­tion will not receive a vac­cine. The virus will con­tin­ue to spread, and it could take two to three years before the virus has affect­ed a large major­i­ty of the pop­u­la­tion.

It’s not the vac­cine that’s going to end the pan­dem­ic. The virus will end this pan­dem­ic by burn­ing every piece of dry wood it will find. The fire will not go out before the last sus­cep­ti­ble per­son has been affect­ed.

Then the ques­tion is what role will any vac­cine play after­ward.

Bloomberg: You seem opti­mistic researchers will suc­ceed in com­ing up with vac­cines. How do you assess the prospects and poten­tial risks?

Stohr: The coro­n­avirus is not a par­tic­u­lar­ly dif­fi­cult virus to han­dle. Even the con­ven­tion­al vac­cines could make a dif­fer­ence, and we have dif­fer­ent approach­es, vec­tor vac­cines, mRNA. That is very promis­ing.

In the past, when a vac­cine is intro­duced, you have a grad­ual increase in its use, in the num­ber of peo­ple immu­nized, and if any­thing comes up, even very rare events, they will be noticed pret­ty ear­ly. But here, a vac­cine will be used in large amounts, pos­si­bly hun­dreds of mil­lions of dos­es, in a rel­a­tive­ly short peri­od of time, six months to a year. So the ques­tion is if there is any­thing pos­si­bly lin­ger­ing in the vac­cine that can­not be detect­ed in the large-scale safe­ty test­ing dur­ing the approval process.

It could hit many, many peo­ple. If you immu­nize 500 mil­lion, and it’s only 1 in a mil­lion who is affect­ed, you still have a sig­nif­i­cant num­ber of peo­ple who may have safe­ty prob­lems, so that is some­thing that has to be addressed. But one has to bal­ance the con­cern about the impact of the dis­ease against the con­cern of the pos­si­ble impact of the use of the vac­cine.

Bloomberg: You’ve said coun­tries need to adjust their strate­gies. What is the best approach gov­ern­ments can take?

Stohr: We have to find a way to open our com­mu­ni­ty in a way that sup­ports our long-term med­ical goal, which is the least num­ber of casu­al­ties over time, know­ing that you can­not avoid the spread of infec­tion. There is no oth­er tool avail­able. If you’ve got a med­ical prob­lem, you go ski­ing, you break your leg, your knee lig­a­ment is torn, no prob­lem, go to the doc­tor and get it fixed. We have no fix here.

We have to live with this virus and we have to find a prop­er way to ensure that when we are through with this we look back and say we did the best to pre­vent death and dis­ease. But we can­not do the ostrich pol­i­cy here and hope that some mir­a­cle will hap­pen and the virus will dis­ap­pear. The per­fect strat­e­gy isn’t avail­able.

Bloomberg: You’ve tack­led oth­er virus­es from SARS to bird flu, are there any lessons from the past that are rel­e­vant today?

Stohr: Since 2003 we’ve been talk­ing about pan­dem­ic plan­ning. Some coun­tries devel­oped these plans and used them. I believe those who had a decent pan­dem­ic plan were a cou­ple of steps ahead. But there are still coun­tries with no plans. The learn­ing is get your pan­dem­ic plan ready.

It may be clear that only those who will have vac­cine pro­duc­tion on their soil will have access to vac­cines dur­ing the pan­dem­ic. I hope it’s not going to turn out this way, but I fear it will. That hope­ful­ly will result in more invest­ment into pan­dem­ic pre­pared­ness and vac­cine pre­pared­ness in the com­ing years, so that the next pan­dem­ic will be addressed bet­ter than this one.

————

“Most of the World May Face Covid With­out a Vac­cine” by James Paton; Bloomberg; 07/18/2020

“It’s not the vac­cine that’s going to end the pan­dem­ic. The virus will end this pan­dem­ic by burn­ing every piece of dry wood it will find. The fire will not go out before the last sus­cep­ti­ble per­son has been affect­ed.”

That was the very recent pre­dic­tion by for­mer WHO head of SARS vac­cine devel­op­ment: there’s no way a vac­cine is stop­ping this. The only thing that’s stop­ping it is basi­cal­ly ‘herd immu­ni­ty’. And he appears to pre­dict that this herd immu­ni­ty — around 80% of the world hav­ing anti­bod­ies — will be achieved fol­low­ing a “third wave” that may take two to three years to achieve. And there’s noth­ing to pre­vent that sce­nario because even if a vac­cine is devel­oped it’s high­ly unlike­ly the entire world is going to get access to it in time before the virus has already hit that ‘herd immu­ni­ty’ lev­el. Only renewed lock­downs could avoid the sce­nario he’s describ­ing and he doubts new lock­downs are going to hap­pen:

...
Bloomberg: How do you see world­wide immu­ni­ty ramp­ing up as vac­cines are intro­duced and the dis­ease spreads?

Stohr: I would assume that by the mid­dle of next year a sig­nif­i­cant por­tion of the world will have anti­bod­ies. That will increase grad­u­al­ly over time. Then there will be a third wave, and when that is over, I would think that 80% of the world may have anti­bod­ies if lock­downs are not insti­tut­ed, which I doubt.

...

There may be, by the end of this year or begin­ning of next year, a half a bil­lion dos­es avail­able. The world pop­u­la­tion is 7.5 bil­lion. Par­tic­u­lar­ly in those coun­tries which have insuf­fi­cient infra­struc­ture and strug­gle with their health-care sys­tems and have huge pop­u­la­tions, what vac­cine are they going to have?

...

Stohr: It would be irre­spon­si­ble not to do any­thing. Nev­er­the­less, the major­i­ty of the world pop­u­la­tion will not receive a vac­cine. The virus will con­tin­ue to spread, and it could take two to three years before the virus has affect­ed a large major­i­ty of the pop­u­la­tion.

...

Stohr: We have to find a way to open our com­mu­ni­ty in a way that sup­ports our long-term med­ical goal, which is the least num­ber of casu­al­ties over time, know­ing that you can­not avoid the spread of infec­tion. There is no oth­er tool avail­able. If you’ve got a med­ical prob­lem, you go ski­ing, you break your leg, your knee lig­a­ment is torn, no prob­lem, go to the doc­tor and get it fixed. We have no fix here.

We have to live with this virus and we have to find a prop­er way to ensure that when we are through with this we look back and say we did the best to pre­vent death and dis­ease. But we can­not do the ostrich pol­i­cy here and hope that some mir­a­cle will hap­pen and the virus will dis­ap­pear. The per­fect strat­e­gy isn’t avail­able.
...

So unless the strat­e­gy of glob­al lock­downs intend­ed to min­i­mize the spread of the virus is kept in place glob­al­ly for the next two to three years (if we’re lucky enough for a safe vac­cine to be devel­oped by then), it’s almost inevitable that the devel­op­ing world is just going to see this virus blow through the pop­u­lace until ‘herd immu­ni­ty’ is achieved. And that immu­ni­ty will, hope­ful­ly, be main­tained over time as the virus just con­tin­ues to cir­cu­late the world for­ev­er and is effec­tive­ly turned into a com­mon cold coro­n­avirus. Stöhr seems pret­ty adamant that this is how this pan­dem­ic will play out.

It’s also worth recall­ing that very dis­turb­ing study that found the SARS-CoV­‑2 virus was capa­ble of infect­ing T‑cells and killing them in the process. And the virus’s entry into the cell was medi­at­ed through a means oth­er than the ACE2 recep­tor rais­ing the pos­si­bil­i­ty that the virus can infect all sorts of oth­er cell types than cur­rent­ly sus­pect­ed. Part of what makes that find­ing so dis­turb­ing in the con­text of T‑cell-based immu­ni­ty and pos­si­bil­i­ty that SARS-CoV­‑2 could just cir­cu­late the globe for years as a com­mon cold coro­n­avirus is a sce­nario where it con­tin­ues to cir­cu­late the globe each year and ends up killing those pre­cious mem­o­ry T cells in the process. So instead of the rou­tine cir­cu­la­tion of SARS-CoV­‑2 help­ing us all build up our immu­ni­ty to the virus (and relat­ed coro­n­avirus­es) and turn­ing it into a com­mon cold virus it could become like an uncom­mon cold that’s mild but still steadi­ly kills off your earned immu­ni­ty from past infec­tions. We don’t know that’s what’s going to hap­pen but it would cer­tain­ly be the­mat­i­cal­ly con­sis­tent with the gen­er­al night­mare sit­u­a­tion.

All in all, it’s quite a bit to chew on. Klaus Stöhr, some­one very famil­iar with coro­n­avirus vac­cine devel­op­ment, does­n’t see min­i­miz­ing expo­sure or vac­cines as fea­si­ble glob­al strate­gies for con­tain­ing the virus. It also rais­es a chal­lenge asso­ci­at­ed with the upcom­ing cold and flu sea­son: if social dis­tanc­ing lim­its the spread of com­mon cold coro­n­avirus­es we could end up mak­ing a bad sit­u­a­tion worse. ‘Tis the sea­son of “com­mon cold coro­n­avirus par­ties”?

Here’s an inter­est­ing arti­cle from 2004 about a con­tro­ver­sial exper­i­ment that’s sim­i­lar to “gain-of-func­tion” exper­i­ments: reas­sort­ment stud­ies. That’s when you inten­tion­al­ly try to cre­ate hybrids of two exist­ing virus­es by infect­ing cells or an organ­ism with both virus­es at once and wait­ing to see if a new hybrid virus emerges.

It turns out this sto­ry relates to the whole SARS-CoV­‑2 coro­n­avirus sit­u­a­tion in a num­ber of ways. First, recall how the pre­vail­ing the­o­ry of the ori­gins of the SARS-CoV­‑2 virus — that it emerged nat­u­ral­ly — has increas­ing­ly relied on the assump­tion that the virus arose from a recom­bi­na­tion event. This is because, while parts of the SARS-CoV­‑2 genome has a high sim­i­lar­i­ty to a strain of bat coro­n­avirus that was iden­ti­fied by researchers in 2013 in a cave in Yun­nan Chi­na, the part of the spike pro­tein that actu­al­ly binds to the ACE2 recep­tor — the Recep­tor Bind­ing Domain (RBD) — was more close­ly relat­ed to a known Pan­golin coro­n­avirus, although the SARS-CoV­‑2 canon­i­cal furin cleav­age site was­n’t found in either of the two Pan­golin or Bat coro­n­avirus­es. Also recall a lat­er study that com­pared the abil­i­ty of SARS-CoV­‑2 to bind to the ACE2 recep­tor to oth­er coro­n­avirus­es and found that SARS-CoV­‑2 binds bet­ter than them all, includ­ing the Pan­golin coro­n­avirus, lead­ing the researchers to sug­gest that a Pan­golin was­n’t actu­al­ly the like­ly inter­me­di­ary species that the virus evolved in before jump­ing to humans and there must be some oth­er undis­cov­ered inter­me­di­ary species.

These are the kinds of obser­va­tions that made a recom­bi­na­tion event a stan­dard assump­tion now for how the virus could have emerged nat­u­ral­ly. So if recom­bi­na­tion events were being arti­fi­cial­ly gen­er­at­ed in the lab in these reas­sort­ment stud­ies that would obvi­ous­ly be some­thing we would want to keep in mind when inves­ti­gat­ing the ori­gins of the virus. Now, keep in mind that with gain-of-func­tion exper­i­ments those recom­bi­na­tion events can be basi­cal­ly built into the exper­i­ment as the first step because the exper­i­ments can involve direct­ly cre­at­ing new chimeric virus­es by comb­ing dif­fer­ent parts of dif­fer­ent virus­es using recom­bi­nant genom­ic meth­ods. That was the case with the now-noto­ri­ous 2015 exper­i­ment when Ralph Bar­ic’s lab cre­at­ed a chimera out of a Horse­shoe bat coro­n­avirus with the back­bone of the 2003 SARS virus.

So reas­sort­ment stud­ies are like sim­pler “gain-of-func­tion” exper­i­ments, focused on ask­ing the ques­tion of whether two exist­ing virus­es can recom­bine at all. As the arti­cle notes, the CDC actu­al­ly start­ed such stud­ies with H5N1 in 2000 in response to the 1997 bird flu out­break. They man­aged to cre­ate hybrid strains but had­n’t had a chance to study them yet as of 2004 because the SARS out­break swamped the researchers so the hybrid virus­es were still sit­ting in freez­ers. It’s the kind of anec­dote that rais­es the ques­tion of how many hybrid strains, stud­ied and not-yet-stud­ied, are sit­ting in freez­ers some­where.

Also of inter­est in the fol­low­ing 2004 sto­ry about the debate over reas­sort­ment stud­ies is the fact that the per­son who appeared to be the biggest advo­cate of them at the time was Klaus Stöhr, the for­mer head of the World Health Orga­ni­za­tion’s SARS research and epi­demi­ol­o­gy pro­gram at the time who recent­ly came out and declared that a vac­cine was unlike­ly to end the pan­dem­ic the only way it was going to end was by infect­ing the world and run­ning out of new peo­ple to infect. He’s described as the WHO’s prin­ci­ple flu expert at the time so Stöhr was a very influ­en­tial fig­ure in shap­ing the con­tem­po­rary glob­al approach to prepar­ing for pan­demics.

As we’ll see, back in 2004 when the world was in the mid­dle of a giant H5N1 bird flu scare, Stöhr was open­ly call­ing for coun­tries to rapid­ly begin reas­sort­ment stud­ies specif­i­cal­ly with H5N1. The rea­son­ing was quite sim­ple: giv­en the repeat­ed out­breaks of avian flu that could infect humans but could­n’t yet car­ry out human-to-human trans­mis­sion, human­i­ty was one awful recom­bi­na­tion event away from the emer­gence of a hybrid ver­sion of bird flu that could jump from human-to-human and cre­ate the much feared super pan­dem­ic that could kill hun­dreds of mil­lions or bil­lions. Reas­sort­ment stud­ies would act as an ear­ly warn­ing sys­tem for the pos­si­bil­i­ty of such a recom­bi­na­tion event tak­ing place nat­u­ral­ly.

Now here’s a part of this sto­ry that relates to the inter­est­ing his­to­ry of for­mer Gilead Chair­man Don­ald Rums­feld becom­ing Sec­re­tary of Defense dur­ing the peri­od of the post‑9/11 explo­sion in biode­fense spend­ing and the mas­sive prof­its Gilead made dur­ing this time from the gov­ern­ment stock­pil­ing of Tam­i­flu, the pri­ma­ry drug used to fight the bird flu at the time: When Klaus Stöhr was advo­cat­ing for reas­sort­ment stud­ies as a new pan­dem­ic warn­ing sys­tem tool, he was clear that the pur­pose of these stud­ies was­n’t to devel­op new drugs to treat the hybrid virus­es because exist­ing drugs were ade­quate. No, the pur­pose of the reas­sort­ment stud­ies was to let gov­ern­ments know whether or not they should stock­pile even more of these exist­ing drugs. Keep in mind that Stöhr was mak­ing these state­ments at a time when Tam­i­flu was the drug get­ting stock­piled by gov­ern­ments around the world.

Now, on the one hand, hav­ing large stock­piles of an effec­tive drug is indeed quite help­ful if you’re fac­ing a glob­al pan­dem­ic of a high­ly dead­ly virus like H5N1. But on the oth­er hand, it’s kind of odd to just assume that the new hybrid virus is going to work with exist­ing ther­a­pies as the cur­rent pan­dem­ic should make abun­dant­ly clear which is why this push for reas­sort­ment stud­ies almost seem like being part of the Gilead Tam­i­flu bonan­za going on at that moment. Of course, once you cre­ate the hybrid virus you could test exist­ing ther­a­peu­tics against it, so it’s not like there could­n’t be any new drug devel­op­ment that emerges from such exper­i­ments. But Stöhr felt the need to point out that the pur­pose was­n’t about devel­op­ing new drugs but instead about assess­ing whether or not gov­ern­ments need­ed to stock­pile more exist­ing drugs, which is why the call for more reas­sort­ment stud­ies is almost like a gim­mick to encour­age even more stock­pil­ing of Tam­i­flu.

So that gives us a sense of the World Health Orga­ni­za­tion’s stance on these reas­sort­ment stud­ies back in 2004 that were sort of like ear­ly “gain-of-func­tion” stud­ies: it was an enthu­si­as­tic backer of the stud­ies because they would leave the world bet­ter pre­pared for future pan­demics by scar­ing gov­ern­ments into stock­pil­ing more drugs like Tam­i­flu:

Sci­ence

Tip­toe­ing Around Pan­do­ra’s Box

Researchers say cross­ing avian and human flu virus­es is cru­cial to under­stand­ing the threat of a new influen­za pan­dem­ic, but they admit that they might cre­ate a mon­ster

Mar­tin Enserink
July 30, 2004, Vol. 305, No. 5684, pp. 594–595

Once again, the world is cross­ing its fin­gers. The avian influen­za out­break in Asia, already one of the worst ani­mal-health dis­as­ters in his­to­ry, has flared up in four coun­tries; tens of thou­sands of birds are being killed in des­per­ate attempts to halt the virus’s spread. And again, the unnerv­ing ques­tion aris­es: Could the out­break of the H5N1 strain spi­ral into a human flu pan­dem­ic, a glob­al cat­a­clysm that could kill mil­lions in a mat­ter of months and shake soci­eties to their core?

There is a way to find out, flu sci­en­tists say—but it’s con­tro­ver­sial.

Leav­ing nature to take its course, a pan­dem­ic could be ignit­ed if avian and human influen­za strains recombine—say, in the lungs of an Asian farmer infect­ed with both—producing a brand-new hybrid no human is immune to. By mix­ing H5N1 and human flu virus­es in the lab, sci­en­tists can find out how like­ly this is, and how dan­ger­ous a hybrid it would be.

Such exper­i­ments can give the world a bet­ter han­dle on the risks, but they could also cre­ate dan­ger­ous new virus­es that would have to be destroyed or locked up for­ev­er in a sci­en­tif­ic high-secu­ri­ty prison. An acci­den­tal release—not so far-fetched a sce­nario giv­en that the severe acute res­pi­ra­to­ry syn­drome (SARS) virus man­aged to escape from three Asian labs in the past year—could lead to glob­al dis­as­ter. Giv­en their sci­en­tif­ic mer­it, the World Health Orga­ni­za­tion (WHO) is enthu­si­as­ti­cal­ly pro­mot­ing the exper­i­ments. But wor­ried crit­ics point out that there is no glob­al mech­a­nism to ensure that they are done safe­ly.

Despite the con­cerns, such stud­ies have already begun. In 2000, the U.S. Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) in Atlanta, Geor­gia, start­ed exper­i­ments to cre­ate crossovers between the H5N1 strain iso­lat­ed dur­ing a 1997 out­break in Hong Kong and a human flu virus adapt­ed for the lab. The study was sus­pend­ed when CDC’s flu researchers became over­whelmed by SARS and the new H5N1 out­break, both in 2003, says CDC flu expert Nan­cy Cox, who led the work. But the agency plans to resume the work short­ly with the H5N1 strain now rag­ing in Asia.

Oth­ers are explor­ing the options as well. Virol­o­gist Albert Oster­haus of Eras­mus Uni­ver­si­ty in Rot­ter­dam, the Nether­lands, is eager to try not just H5N1 but also oth­er bird flu strains, such as H7N7. The Nether­lands won’t have the required high-lev­el biosafe­ty lab until late 2005, so Oster­haus is talk­ing to researchers in France who do. In the Unit­ed King­dom, researchers at the Health Pro­tec­tion Agency, the Nation­al Insti­tute for Bio­log­i­cal Stan­dards and Con­trol, and uni­ver­si­ties are also dis­cussing the idea. There are no con­crete plans yet—in part because of a lack of funds—but there’s a con­sen­sus that the stud­ies are impor­tant and that Britain is well suit­ed to do them, says influen­za researcher Maria Zam­bon of the Health Pro­tec­tion Agency.

The aim of reas­sort­ment stud­ies, as they’re called, would not be to devel­op new coun­ter­mea­sures, says WHO’s prin­ci­pal flu sci­en­tist, Klaus Stöhr, because researchers believe cur­rent drugs and an H5N1 vac­cine in devel­op­ment would work against a pan­dem­ic strain as well. But the exper­i­ments would pro­vide a bad­ly need­ed way to assess the risk of a pan­dem­ic. If they indi­cate that a pan­dem­ic virus is just around the cor­ner, health offi­cials would fur­ther inten­si­fy their fight in Asia and go full-throt­tle in stash­ing vac­cines and drugs; if not, they could breathe a lit­tle eas­i­er. “It’s an extreme­ly impor­tant ques­tion, and we have a respon­si­bil­i­ty to answer it,” insists Stöhr.

The safe­ty wor­ries are legit­i­mate, Stöhr con­cedes, and the work should be done only by labs with ample flu exper­tise and excel­lent safe­ty systems—not the ones that let SARS out. “We don’t want peo­ple just fid­dling around,” he says. He also down­plays con­cerns that the results, when pub­lished, might help those who would unleash a pan­dem­ic on pur­pose. Any­one with the sci­en­tif­ic smarts to do so can already find plen­ty of ideas in the lit­er­a­ture, Stöhr asserts. More­over, the stud­ies are unlike­ly to pro­duce any­thing that could not arise nat­u­ral­ly, says Oster­haus: “You could cre­ate a mon­ster. But it’s a mon­ster that nature could pro­duce as well.”

But crit­ics beg to dif­fer. “We’ve been debat­ing whether to destroy the small­pox virus for years—and now we’re plan­ning to cre­ate some­thing that’s almost as dan­ger­ous?” asks Mark Wheel­is, an arms-con­trol researcher at the Uni­ver­si­ty of Cal­i­for­nia, Davis. Wheel­is also points out that there’s no way to keep coun­tries with poor safe­ty records from get­ting in on the game. At the very least, there should be some glob­al con­sen­sus on how to pro­ceed, adds Elisa Har­ris, a researcher at the Cen­ter for Inter­na­tion­al and Secu­ri­ty Stud­ies at the Uni­ver­si­ty of Mary­land, Col­lege Park—although no for­mal mech­a­nism for reach­ing it exists.

Mix and match

The H5N1 strain has been vicious to its human vic­tims, killing 23 of 34 patients in Viet­nam and Thai­land this year. So far, how­ev­er, every known patient had been in con­tact with infect­ed birds; there’s no evi­dence that the virus can jump from one per­son to the next—for now. But the virus could evolve inside one of its human hosts, acquir­ing muta­tions that make it pos­si­ble to infect humans direct­ly, Stöhr says. Anoth­er scenario—one researchers believe sparked sev­er­al pre­vi­ous influen­za pandemics—is reas­sort­ment with a human flu virus in a per­son infect­ed with both.

...

To cre­ate a world­wide out­break, a new­com­er must cause dis­ease in humans and be trans­mis­si­ble between them, and its coat must look so new that no human immune sys­tem rec­og­nizes it. This is deter­mined pri­mar­i­ly by the two gly­co­pro­teins on the viral sur­face, hemag­glu­tinin and neuraminidase—the “H” and “N” in names like H5N1. (Hemag­glu­tinin comes in at least 16 dif­fer­ent types, N in nine.) The cur­rent fear is that the Asian flu will keep its H5—which humans have nev­er seen before—but swap enough of the remain­ing sev­en gene seg­ments with those of a human strain to become more adept at repli­ca­tion in its new host.

Dur­ing H5N1’s first major out­break in Hong Kong poul­try in 1997, 18 peo­ple got sick and six died. But the out­break was stamped out effi­cient­ly, and lit­tle was heard of H5N1 for 6 years—until it came roar­ing back last year. Giv­en the mag­ni­tude of the cur­rent out­break, the rid­dle is why reas­sort­ment has not yet tak­en place, says Stöhr. Reas­sort­ment stud­ies could help explain whether the world has sim­ply been lucky, or whether there’s some bar­ri­er to reas­sort­ment of H5N1.

The exper­i­ments are straight­for­ward. Researchers take a cell line such as MDCK or Vero cells, often used for virus iso­la­tion, and add both H5N1 and a cur­rent­ly cir­cu­lat­ing human strain, such as H3N2 or H1N1. Or they can use a slight­ly less nat­ur­al tech­nique called reverse genet­ics, with which vir­tu­al­ly any com­bi­na­tion of genes can be put into a flu virus. Any viable hybrid strains would be inoc­u­lat­ed into mice; those that cause dis­ease would move on to fer­rets, a species very sim­i­lar to humans in its sus­cep­ti­bil­i­ty to influen­za. Any strain that is path­o­gen­ic in fer­rets and also jumps, say, from a sick ani­mal to a healthy one in an adja­cent cage could be humankind’s next night­mare.

Dur­ing its first round of exper­i­ments with the H5N1 strain, CDC man­aged to cre­ate sev­er­al reas­sor­tants, Cox says, but it did­n’t get around to char­ac­ter­iz­ing them; they’re still sit­ting in a locked freez­er in Atlanta.

Glob­al risks, glob­al review?

Most agree that such exper­i­ments are in a league of their own. Con­tro­ver­sial flu stud­ies were con­duct­ed in the past; for instance, researchers sequenced parts of the genome of the “Span­ish flu” strain from 1918 (Sci­ence, 21 March 1997, p. 1793) and insert­ed its genes into oth­er strains to find out why it was so dead­ly. But that did­n’t amount to a whole­sale fish­ing expe­di­tion for pan­dem­ic strains. And because the 1918 strain was an H1 virus, just like one of the cur­rent­ly active ones, you’d expect at least some immu­ni­ty to it in the human pop­u­la­tion, says Yoshi­hi­ro Kawao­ka of the Uni­ver­si­ty of Tokyo and the Uni­ver­si­ty of Wis­con­sin, Madi­son, who stud­ies the 1918 strain. With an H5 virus, in con­trast, every­one would be vul­ner­a­ble.

Yet although most coun­tries have sys­tems to review the safe­ty and eth­i­cal aspects of run-of-the-mill sci­en­tif­ic stud­ies, none have for­mal pan­els to weigh stud­ies that could, say, put the entire world at risk or be of poten­tial help to bioter­ror­ists. [The U.S. gov­ern­ment has announced plans for a nation­al biose­cu­ri­ty pan­el and a review sys­tem to fill that gap (Sci­ence, 12 March, p. 1595), but they have yet to be imple­ment­ed.] So although CDC’s first round of stud­ies cleared all the usu­al review hur­dles at the agency, Cox says, noth­ing beyond that was con­sid­ered nec­es­sary.

Since then, “the times have changed,” Cox says. The H5N1 strain now plagu­ing Asia, with which CDC wants to work this time, appears to be more vir­u­lent than the 1997 ver­sion, and the specter of nefar­i­ous use of pathogens looms much larg­er. More­over, the mishaps with SARS have made peo­ple jit­tery about labs’ abil­i­ties to keep bugs on the inside. That’s why Cox says she has con­sult­ed more exten­sive­ly with col­leagues inside and out­side CDC, includ­ing experts such as Nobel lau­re­ate Joshua Leder­berg and WHO. She also plans to seek approval from col­leagues at the U.S. Nation­al Insti­tutes of Health and the U.S. Food and Drug Admin­is­tra­tion.

But flu researcher Karl Nichol­son of the Uni­ver­si­ty of Leices­ter, U.K., says there should be a more for­mal, glob­al con­sen­sus on the neces­si­ty of the stud­ies, who should con­duct them, and how. For any coun­try to under­take them on its own, he says, “is like a deci­sion to start test­ing nuclear weapons uni­lat­er­al­ly.” WHO would be the best orga­ni­za­tion to start such a process, says Har­ris: The destruc­tion of the small­pox virus has been debat­ed at WHO, and an inter­na­tion­al pan­el there is over­see­ing exper­i­ments with it at CDC and in Rus­sia.

But Stöhr believes exist­ing safe­guards suf­fice. The stud­ies have been dis­cussed wide­ly with sci­en­tists in WHO’s glob­al flu lab net­work and at a recent flu meet­ing in Lis­bon, he says, and have met with noth­ing but “over­whelm­ing agree­ment.” “If there are oth­er voic­es, we will take them seri­ous­ly,” Stöhr adds—but for now, it’s up to the labs to have their plans rig­or­ous­ly vet­ted by nation­al author­i­ties and get start­ed.

Even­tu­al­ly, any strain with pan­dem­ic poten­tial should be destroyed, he says. But there’s no way to enforce this, and skep­tics point out that the small­pox virus was slat­ed for destruc­tion, too—until the threat of bioter­ror­ism cre­at­ed a move­ment to keep it alive, per­haps indef­i­nite­ly, for defen­sive stud­ies. In a way this dis­cus­sion is moot, says Richard Web­by of St. Jude Chil­dren’s Research Hos­pi­tal in Mem­phis, Ten­nessee. With flu strains read­i­ly avail­able, any­one with a good knowl­edge of mol­e­c­u­lar biol­o­gy could recre­ate a pan­dem­ic virus once it’s dis­cov­ered, he says. “You can destroy this virus,” Web­by says, “but it will nev­er real­ly be gone.”

———-

“Tip­toe­ing Around Pan­do­ra’s Box” by Mar­tin Enserink; Sci­ence; 07/30/2004

“The exper­i­ments are straight­for­ward. Researchers take a cell line such as MDCK or Vero cells, often used for virus iso­la­tion, and add both H5N1 and a cur­rent­ly cir­cu­lat­ing human strain, such as H3N2 or H1N1. Or they can use a slight­ly less nat­ur­al tech­nique called reverse genet­ics, with which vir­tu­al­ly any com­bi­na­tion of genes can be put into a flu virus. Any viable hybrid strains would be inoc­u­lat­ed into mice; those that cause dis­ease would move on to fer­rets, a species very sim­i­lar to humans in its sus­cep­ti­bil­i­ty to influen­za. Any strain that is path­o­gen­ic in fer­rets and also jumps, say, from a sick ani­mal to a healthy one in an adja­cent cage could be humankind’s next night­mare.”

A “humankind’s next night­mare” machine. Build the night­mare in a lab as a way of test­ing whether or not the night­mare might emerge nat­u­ral­ly. It’s a sim­ple con­cept. A sim­ple scary con­cept that was enthu­si­as­ti­cal­ly cham­pi­oned by the WHO at the time. But it was­n’t like the WHO need­ed to give its bless­ings to the reas­sort­ment exper­i­ments for coun­tries to car­ry them out, as evi­denced by the fact that the CDC start­ed these exper­i­ments in 2000 before putting them lit­er­al­ly on ice fol­low­ing the 2003 SARS out­break. But hybrids were cre­at­ed:

...
Such exper­i­ments can give the world a bet­ter han­dle on the risks, but they could also cre­ate dan­ger­ous new virus­es that would have to be destroyed or locked up for­ev­er in a sci­en­tif­ic high-secu­ri­ty prison. An acci­den­tal release—not so far-fetched a sce­nario giv­en that the severe acute res­pi­ra­to­ry syn­drome (SARS) virus man­aged to escape from three Asian labs in the past year—could lead to glob­al dis­as­ter. Giv­en their sci­en­tif­ic mer­it, the World Health Orga­ni­za­tion (WHO) is enthu­si­as­ti­cal­ly pro­mot­ing the exper­i­ments. But wor­ried crit­ics point out that there is no glob­al mech­a­nism to ensure that they are done safe­ly.

Despite the con­cerns, such stud­ies have already begun. In 2000, the U.S. Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) in Atlanta, Geor­gia, start­ed exper­i­ments to cre­ate crossovers between the H5N1 strain iso­lat­ed dur­ing a 1997 out­break in Hong Kong and a human flu virus adapt­ed for the lab. The study was sus­pend­ed when CDC’s flu researchers became over­whelmed by SARS and the new H5N1 out­break, both in 2003, says CDC flu expert Nan­cy Cox, who led the work. But the agency plans to resume the work short­ly with the H5N1 strain now rag­ing in Asia.

...

Dur­ing its first round of exper­i­ments with the H5N1 strain, CDC man­aged to cre­ate sev­er­al reas­sor­tants, Cox says, but it did­n’t get around to char­ac­ter­iz­ing them; they’re still sit­ting in a locked freez­er in Atlanta.
...

But despite the con­cerns about these hybrid virus­es acci­den­tal­ly leak­ing out of a lab, Klaus Stöhr, speak­ing on behalf of the WHO, down­played such con­cerns by point­ing out that any­one with mali­cious intent and the skills to do so would have plen­ty of hor­ri­ble night­mare ideas already avail­able to deploy based on exist­ing sci­en­tif­ic lit­er­a­ture. So, yes, safe­ty con­cerns are valid but dwarfed by the exist­ing safe­ty risks. That was how Stöhr down­played these con­cerns:

...
The safe­ty wor­ries are legit­i­mate, Stöhr con­cedes, and the work should be done only by labs with ample flu exper­tise and excel­lent safe­ty systems—not the ones that let SARS out. “We don’t want peo­ple just fid­dling around,” he says. He also down­plays con­cerns that the results, when pub­lished, might help those who would unleash a pan­dem­ic on pur­pose. Any­one with the sci­en­tif­ic smarts to do so can already find plen­ty of ideas in the lit­er­a­ture, Stöhr asserts. More­over, the stud­ies are unlike­ly to pro­duce any­thing that could not arise nat­u­ral­ly, says Oster­haus: “You could cre­ate a mon­ster. But it’s a mon­ster that nature could pro­duce as well.”

But crit­ics beg to dif­fer. “We’ve been debat­ing whether to destroy the small­pox virus for years—and now we’re plan­ning to cre­ate some­thing that’s almost as dan­ger­ous?” asks Mark Wheel­is, an arms-con­trol researcher at the Uni­ver­si­ty of Cal­i­for­nia, Davis. Wheel­is also points out that there’s no way to keep coun­tries with poor safe­ty records from get­ting in on the game. At the very least, there should be some glob­al con­sen­sus on how to pro­ceed, adds Elisa Har­ris, a researcher at the Cen­ter for Inter­na­tion­al and Secu­ri­ty Stud­ies at the Uni­ver­si­ty of Mary­land, Col­lege Park—although no for­mal mech­a­nism for reach­ing it exists.

...

But Stöhr believes exist­ing safe­guards suf­fice. The stud­ies have been dis­cussed wide­ly with sci­en­tists in WHO’s glob­al flu lab net­work and at a recent flu meet­ing in Lis­bon, he says, and have met with noth­ing but “over­whelm­ing agree­ment.” “If there are oth­er voic­es, we will take them seri­ous­ly,” Stöhr adds—but for now, it’s up to the labs to have their plans rig­or­ous­ly vet­ted by nation­al author­i­ties and get start­ed.

Even­tu­al­ly, any strain with pan­dem­ic poten­tial should be destroyed, he says. But there’s no way to enforce this, and skep­tics point out that the small­pox virus was slat­ed for destruc­tion, too—until the threat of bioter­ror­ism cre­at­ed a move­ment to keep it alive, per­haps indef­i­nite­ly, for defen­sive stud­ies. In a way this dis­cus­sion is moot, says Richard Web­by of St. Jude Chil­dren’s Research Hos­pi­tal in Mem­phis, Ten­nessee. With flu strains read­i­ly avail­able, any­one with a good knowl­edge of mol­e­c­u­lar biol­o­gy could recre­ate a pan­dem­ic virus once it’s dis­cov­ered, he says. “You can destroy this virus,” Web­by says, “but it will nev­er real­ly be gone.”
...

But the pur­pose of these reas­sort­ment stud­ies isn’t to devel­op new coun­ter­mea­sures for the iden­ti­fied viable hybrid virus­es. The pur­pose is to let gov­ern­ments know whether or not they should stock­pile more exist­ing drugs. At least that was the case in 2004, when Gilead­’s Tam­i­flu was the drug gov­ern­ments was stock­pil­ing:

...
The aim of reas­sort­ment stud­ies, as they’re called, would not be to devel­op new coun­ter­mea­sures, says WHO’s prin­ci­pal flu sci­en­tist, Klaus Stöhr, because researchers believe cur­rent drugs and an H5N1 vac­cine in devel­op­ment would work against a pan­dem­ic strain as well. But the exper­i­ments would pro­vide a bad­ly need­ed way to assess the risk of a pan­dem­ic. If they indi­cate that a pan­dem­ic virus is just around the cor­ner, health offi­cials would fur­ther inten­si­fy their fight in Asia and go full-throt­tle in stash­ing vac­cines and drugs; if not, they could breathe a lit­tle eas­i­er. “It’s an extreme­ly impor­tant ques­tion, and we have a respon­si­bil­i­ty to answer it,” insists Stöhr.
...

So that’s part of the his­to­ry of “gain-of-func­tion” exper­i­ments and the role the WHO played in pro­mot­ing these kinds of exper­i­ments. It’s a his­to­ry that rais­es an obvi­ous ques­tion giv­en that we’re told that SARS-CoV­‑2 like­ly arose nat­u­ral­ly from a recom­bi­na­tion event: so have there been any reas­sort­ment stud­ies involv­ing Hor­shoe bat and Pan­golin coro­n­avirus­es late­ly? Maybe around 2018 or 2019?

The New York Times has a new piece out exam­in­ing a grow­ing pat­tern of behav­ior with­in the exec­u­tive boards of the grow­ing num­ber of biotech com­pa­nies that are involved in the race for a coro­n­avirus vac­cine. It’s a pat­tern of behav­ior that is com­plete­ly pre­dictable, in part because much of it is legal even if its unseem­ly:

As the race to find a coro­n­avirus vac­cine con­tin­ues it turns out the insid­ers at the biotech com­pa­nies involved in that race are mak­ing tons of mon­ey from the soar­ing share prices of their com­pa­nies. And while it’s not exact­ly a rev­e­la­tion that com­pa­ny insid­ers are sell­ing their shares after mak­ing pos­i­tive announce­ments that cause their stock prices to pop, it does become a more mean­ing­ful sto­ry if it turns out com­pa­nies are basi­cal­ly prey­ing on the pub­lic’s des­per­a­tion for a vac­cine to first issue a bunch of stock options to them­selves, then make a vague­ly pos­i­tive announce­ment about the vac­cine and watch the stock price dou­ble over night only to exe­cute those options and make an imme­di­ate mas­sive wind­fall. And it’s even worse if the com­pa­nies are issu­ing spe­cial stock options to their exec­u­tives that can be exec­u­tive in the short-term instead of only being exe­cutable after a num­ber of years like most stock options. And that’s exact­ly what’s hap­pen­ing across the indus­try as this vac­cine hunt plays in accord­ing to this inves­ti­ga­tion. In many cas­es exec­u­tives are oppor­tunis­ti­cal­ly exe­cut­ing exist­ing stock options to take advan­tage of this sud­den surge in biotech shares, but we’re also see­ing spe­cial unusu­al stock options get­ting issued that can be exe­cut­ed in the short-term which is noth­ing oth­er than insid­ers try­ing to cash in on this spec­u­la­tive boom. All in all, insid­ers from 11 vac­cine com­pa­nies, most of them small­er com­pa­nies, have sold well over $1 bil­lion in shares imme­di­ate­ly fol­low­ing pos­i­tive announce­ments about their vac­cine devel­op­ment efforts since March:

The New York Times

Cor­po­rate Insid­ers Pock­et $1 Bil­lion in Rush for Coro­n­avirus Vac­cine

Well-timed stock bets have gen­er­at­ed big prof­its for senior exec­u­tives and board mem­bers at com­pa­nies devel­op­ing vac­cines and treat­ments.

By David Gelles and Jesse Druck­er

July 25, 2020
Updat­ed 9:28 a.m. ET

On June 26, a small South San Fran­cis­co com­pa­ny called Vaxart made a sur­prise announce­ment: A coro­n­avirus vac­cine it was work­ing on had been select­ed by the U.S. gov­ern­ment to be part of Oper­a­tion Warp Speed, the flag­ship fed­er­al ini­tia­tive to quick­ly devel­op drugs to com­bat Covid-19.

Vaxart’s shares soared. Com­pa­ny insid­ers, who weeks ear­li­er had received stock options worth a few mil­lion dol­lars, saw the val­ue of those awards increase six­fold. And a hedge fund that part­ly con­trolled the com­pa­ny walked away with more than $200 mil­lion in instant prof­its.

The race is on to devel­op a coro­n­avirus vac­cine, and some com­pa­nies and investors are bet­ting that the win­ners stand to earn vast prof­its from sell­ing hun­dreds of mil­lions — or even bil­lions — of dos­es to a des­per­ate pub­lic.

Across the phar­ma­ceu­ti­cal and med­ical indus­tries, senior exec­u­tives and board mem­bers are cap­i­tal­iz­ing on that dynam­ic.

They are mak­ing mil­lions of dol­lars after announc­ing pos­i­tive devel­op­ments, includ­ing sup­port from the gov­ern­ment, in their efforts to fight Covid-19. After such announce­ments, insid­ers from at least 11 com­pa­nies — most of them small­er firms whose for­tunes often hinge on the suc­cess or fail­ure of a sin­gle drug — have sold shares worth well over $1 bil­lion since March, accord­ing to fig­ures com­piled for The New York Times by Equi­lar, a data provider.

In some cas­es, com­pa­ny insid­ers are prof­it­ing from reg­u­lar­ly sched­uled com­pen­sa­tion or auto­mat­ic stock trades. But in oth­er sit­u­a­tions, senior offi­cials appear to be pounc­ing on oppor­tu­ni­ties to cash out while their stock prices are sky high. And some com­pa­nies have award­ed stock options to exec­u­tives short­ly before mar­ket-mov­ing announce­ments about their vac­cine progress.

The sud­den wind­falls high­light the pow­er­ful finan­cial incen­tives for com­pa­ny offi­cials to gen­er­ate pos­i­tive head­lines in the race for coro­n­avirus vac­cines and treat­ments, even if the drugs might nev­er pan out.

Some com­pa­nies are attract­ing gov­ern­ment scruti­ny for poten­tial­ly using their asso­ci­a­tions with Oper­a­tion Warp Speed as mar­ket­ing ploys.

For exam­ple, the head­line on Vaxart’s news release declared: “Vaxart’s Covid-19 Vac­cine Select­ed for the U.S. Government’s Oper­a­tion Warp Speed.” But the real­i­ty is more com­plex.

Vaxart’s vac­cine can­di­date was includ­ed in a tri­al on pri­mates that a fed­er­al agency was orga­niz­ing in con­junc­tion with Oper­a­tion Warp Speed. But Vaxart is not among the com­pa­nies select­ed to receive sig­nif­i­cant finan­cial sup­port from Warp Speed to pro­duce hun­dreds of mil­lions of vac­cine dos­es.

“The U.S. Depart­ment of Health and Human Ser­vices has entered into fund­ing agree­ments with cer­tain vac­cine man­u­fac­tur­ers, and we are nego­ti­at­ing with oth­ers. Nei­ther is the case with Vaxart,” said Michael R. Caputo, the department’s assis­tant sec­re­tary for pub­lic affairs. “Vaxart’s vac­cine can­di­date was select­ed to par­tic­i­pate in pre­lim­i­nary U.S. gov­ern­ment stud­ies to deter­mine poten­tial areas for pos­si­ble Oper­a­tion Warp Speed part­ner­ship and sup­port. At this time, those stud­ies are ongo­ing, and no deter­mi­na­tions have been made.”

Some offi­cials at the Depart­ment of Health and Human Ser­vices have grown con­cerned about whether com­pa­nies includ­ing Vaxart are try­ing to inflate their stock prices by exag­ger­at­ing their roles in Warp Speed, a senior Trump admin­is­tra­tion offi­cial said. The depart­ment has relayed those con­cerns to the Secu­ri­ties and Exchange Com­mis­sion, said the offi­cial, who spoke on the con­di­tion of anonymi­ty.

It isn’t clear if the com­mis­sion is look­ing into the mat­ter. An S.E.C. spokes­woman declined to com­ment.

“Vaxart abides by good cor­po­rate gov­er­nance guide­lines and poli­cies and makes deci­sions in accor­dance with the best inter­ests of the com­pa­ny and its share­hold­ers,” Vaxart’s chief exec­u­tive, Andrei Floroiu, said in a state­ment on Fri­day. Refer­ring to Oper­a­tion Warp Speed, he added, “We believe that Vaxart’s Covid-19 vac­cine is the most excit­ing one in O.W.S. because it is the only oral vac­cine (a pill) in O.W.S.”

Well-timed stock trans­ac­tions are gen­er­al­ly legal. But investors and cor­po­rate gov­er­nance experts say they can cre­ate the appear­ance that exec­u­tives are prof­it­ing from inside infor­ma­tion, and could erode pub­lic con­fi­dence in the phar­ma­ceu­ti­cal indus­try when the world is look­ing to these com­pa­nies to cure Covid-19.

“It is inap­pro­pri­ate for drug com­pa­ny exec­u­tives to cash in on a cri­sis,” said Ben Wakana, exec­u­tive direc­tor of Patients for Afford­able Drugs, a non­prof­it advo­ca­cy group. “Every day, Amer­i­cans wake up and make sac­ri­fices dur­ing this pan­dem­ic. Drug com­pa­nies see this as a pay­day.”

Exec­u­tives at a long list of com­pa­nies have reaped sev­en- or eight-fig­ure prof­its thanks to their work on coro­n­avirus vac­cines and treat­ments.

Shares of Regen­eron, a biotech com­pa­ny in Tar­ry­town, N.Y., have climbed near­ly 80 per­cent since ear­ly Feb­ru­ary, when it announced a col­lab­o­ra­tion with the Depart­ment of Health and Human Ser­vices to devel­op a Covid-19 treat­ment. Since then, the company’s top exec­u­tives and board mem­bers have sold near­ly $700 mil­lion in stock. The chief exec­u­tive, Leonard Schleifer, sold $178 mil­lion of shares on a sin­gle day in May.

Alexan­dra Bowie, a spokes­woman for Regen­eron, said most of those sales had been sched­uled in advance through pro­grams that auto­mat­i­cal­ly sell exec­u­tives’ shares if the stock hits a cer­tain price.

Mod­er­na, a 10-year-old vac­cine devel­op­er based in Cam­bridge, Mass., that has nev­er brought a prod­uct to mar­ket, announced in late Jan­u­ary that it was work­ing on a coro­n­avirus vac­cine. It has issued a stream of news releas­es hail­ing its vac­cine progress, and its stock has more than tripled, giv­ing the com­pa­ny a mar­ket val­ue of almost $30 bil­lion.

Mod­er­na insid­ers have sold about $248 mil­lion of shares since that Jan­u­ary announce­ment, most of it after the com­pa­ny was select­ed in April to receive fed­er­al fund­ing to sup­port its vac­cine efforts.

While some of those sales were sched­uled in advance, oth­ers were more spur of the moment. Flag­ship Ven­tures, an invest­ment fund run by the company’s founder and chair­man, Noubar Afeyan, sold more than $68 mil­lion worth of Mod­er­na shares on May 21. Those trans­ac­tions were not sched­uled in advance, accord­ing to secu­ri­ties fil­ings.

Exec­u­tives and board mem­bers at Luminex, Quidel and Emer­gent BioSo­lu­tions have sold shares worth a com­bined $85 mil­lion after announc­ing they were work­ing on vac­cines, treat­ments or test­ing solu­tions.

At oth­er com­pa­nies, exec­u­tives and board mem­bers received large grants of stock options short­ly before the com­pa­nies announced good news that lift­ed the val­ue of those options.

Novavax, a drug­mak­er in Gaithers­burg, Md., began work­ing on a vac­cine ear­ly this year. This spring, the com­pa­ny report­ed promis­ing pre­lim­i­nary test results and a $1.6 bil­lion deal with the Trump admin­is­tra­tion.

In April, with its shares below $24, Novavax issued a batch of new stock awards to all its employ­ees “in acknowl­edg­ment of the extra­or­di­nary work of our employ­ees to imple­ment a new vac­cine pro­gram.” Four senior exec­u­tives, includ­ing the chief exec­u­tive, Stan­ley Erck, received stock options that were worth less than $20 mil­lion at the time.

Since then, Novavax’s stock has rock­et­ed to more than $130 a share. At least on paper, the four exec­u­tives’ stock options are worth more than $100 mil­lion.

So long as the com­pa­ny hits a mile­stone with its vac­cine test­ing, which it is expect­ed to achieve soon, the exec­u­tives will be able to use the options to buy dis­count­ed Novavax shares as ear­ly as next year, regard­less of whether the com­pa­ny devel­ops a suc­cess­ful vac­cine.

Sil­via Tay­lor, a Novavax spokes­woman, said the stock awards were designed “to incen­tivize and retain our employ­ees dur­ing this crit­i­cal time.” She added that “there is no guar­an­tee they will retain their val­ue.”

Two oth­er drug­mak­ers, Trans­late Bio and Inovio, award­ed large batch­es of stock options to exec­u­tives and board mem­bers short­ly before they announced progress on their coro­n­avirus vac­cines, send­ing shares high­er. Rep­re­sen­ta­tives of the com­pa­nies said the options were reg­u­lar­ly sched­uled annu­al grants.

Vaxart, though, is where the most mon­ey was made the fastest.

At the start of the year, its shares were around 35 cents. Then in late Jan­u­ary, Vaxart began work­ing on an oral­ly admin­is­tered coro­n­avirus vac­cine, and its shares start­ed ris­ing.

Vaxart’s largest share­hold­er was a New York hedge fund, Armistice Cap­i­tal, which last year acquired near­ly two-thirds of the company’s shares. Two Armistice exec­u­tives, includ­ing the hedge fund’s founder, Steven Boyd, joined Vaxart’s board of direc­tors. The hedge fund also pur­chased rights, known as war­rants, to buy 21 mil­lion more Vaxart shares at some point in the future for as lit­tle as 30 cents each.

Vaxart has nev­er brought a vac­cine to mar­ket. It has just 15 employ­ees. But through­out the spring, Vaxart announced pos­i­tive pre­lim­i­nary data for its vac­cine, along with a part­ner­ship with a com­pa­ny that could man­u­fac­ture it. By late April, with investors sens­ing the poten­tial for big prof­its, the company’s shares had reached $3.66 — a ten­fold increase from Jan­u­ary.

On June 8, Vaxart changed the terms of its war­rants agree­ment with Armistice, mak­ing it eas­i­er for the hedge fund to rapid­ly acquire the 21 mil­lion shares, rather than hav­ing to buy and sell in small­er batch­es.

One week lat­er, Vaxart announced that its chief exec­u­tive was step­ping down, though he would remain chair­man. The new C.E.O., Mr. Floroiu, had pre­vi­ous­ly worked with Mr. Boyd, Armistice’s founder, at the hedge fund and the con­sult­ing firm McK­in­sey.

On June 25, Vaxart announced that it had signed a let­ter of intent with anoth­er com­pa­ny that might help it mass-pro­duce a coro­n­avirus vac­cine. Vaxart’s shares near­ly dou­bled that day.

The next day, Vaxart issued its news release say­ing it had been select­ed for Oper­a­tion Warp Speed. Its shares instant­ly dou­bled again, at one point­ing hit­ting $14, their high­est lev­el in years.

“We are very pleased to be one of the few com­pa­nies select­ed by Oper­a­tion Warp Speed, and that ours is the only oral vac­cine being eval­u­at­ed,” Mr. Floroiu said.

Armistice took advan­tage of the stock’s expo­nen­tial increase — at that point up more than 3,600 per­cent since Jan­u­ary. On June 26, a Fri­day, and the next Mon­day, the hedge fund exer­cised its war­rants to buy near­ly 21 mil­lion Vaxart shares for either 30 cents or $1.10 a share — pur­chas­es it would not have been able to make as quick­ly had its agree­ment with Vaxart not been mod­i­fied weeks ear­li­er.

Armistice then imme­di­ate­ly sold the shares at prices from $6.58 to $12.89 a share, accord­ing to secu­ri­ties fil­ings. The hedge fund’s prof­its were immense: more than $197 mil­lion.

“It looks like the war­rants may have been recon­fig­ured at a time when they knew good news was com­ing,” said Robert Daines, a pro­fes­sor at Stan­ford Law School who is an expert on cor­po­rate gov­er­nance. “That’s a valu­able change, made right as the company’s stock price was about to rise.”

At the same time, the hedge fund also unloaded some of the Vaxart shares it had pre­vi­ous­ly bought, notch­ing tens of mil­lions of dol­lars in addi­tion­al prof­its.

By the end of that Mon­day, June 29, Armistice had sold almost all of its Vaxart shares.

...

Mr. Floroiu said the change to the Armistice agree­ment “was in the best inter­ests of Vaxart and its stock­hold­ers” and helped it raise mon­ey to work on the Covid-19 vac­cine.

He and oth­er Vaxart board mem­bers also were posi­tioned for big per­son­al prof­its. When he became chief exec­u­tive in mid-June, Mr. Floroiu received stock options that were worth about $4.3 mil­lion. A month lat­er, those options were worth more than $28 mil­lion.

Nor­mal­ly when com­pa­nies issue stock options to exec­u­tives, the options can’t be exer­cised for months or years. Because of the unusu­al terms and the run-up in Vaxart’s stock price, most of Mr. Floroiu’s can be cashed in now.

Vaxart’s board mem­bers also received large grants of stock options, giv­ing them the right to buy shares in the com­pa­ny at prices well below where the stock is now trad­ing. The high­er the shares fly, the big­ger the prof­its.

“Vaxart is dis­rupt­ing the vac­cine world,” Mr. Floroiu boast­ed dur­ing a vir­tu­al investor con­fer­ence on Thurs­day. He added that his impres­sion was that “it’s OK to make a prof­it from Covid vac­cines, as long as you’re not prof­i­teer­ing.”

————

“Cor­po­rate Insid­ers Pock­et $1 Bil­lion in Rush for Coro­n­avirus Vac­cine” by David Gelles and Jesse Druck­er; The New York Times; 07/25/2020

“They are mak­ing mil­lions of dol­lars after announc­ing pos­i­tive devel­op­ments, includ­ing sup­port from the gov­ern­ment, in their efforts to fight Covid-19. After such announce­ments, insid­ers from at least 11 com­pa­nies — most of them small­er firms whose for­tunes often hinge on the suc­cess or fail­ure of a sin­gle drug — have sold shares worth well over $1 bil­lion since March, accord­ing to fig­ures com­piled for The New York Times by Equi­lar, a data provider.”

It’s a great time to be an exec­u­tive at a vac­cine devel­op­ment com­pa­ny. That’s not a sur­prise giv­en the sit­u­a­tion. The prob­lem is that it’s turn­ing out to be a great time to be an exec­u­tive at a vac­cine devel­op­ment com­pa­ny whether or not the com­pa­ny has any hope of actu­al­ly cre­at­ing a viable vac­cine and bring­ing it to mar­ket. Some sort of vague­ly pos­i­tive announce­ment, that can be as sim­ple as an announce­ment of a part­ner­ship with the US fed­er­al gov­ern­ment, can trig­ger a stock price pop fol­lowed by a flur­ry of insid­er sales. It real­ly is the per­fect envi­ron­ment for a sec­tor-wide ‘pump and dump’ dynam­ic.

Even worse is that this is kind of legal and kind of not legal. Exec­u­tives can oppor­tunis­ti­cal­ly sell shares and exec­u­tive avail­able stock options when stock prices are high. But when com­pa­nies are award­ing stock options to exec­u­tives short­ly before mar­ket-mov­ing announce­ments about their vac­cine devel­op­ment it’s the kind of sit­u­a­tion that just looks like a giant pump and dump scheme. Because that’s prob­a­bly what it is in many cas­es:

...
In some cas­es, com­pa­ny insid­ers are prof­it­ing from reg­u­lar­ly sched­uled com­pen­sa­tion or auto­mat­ic stock trades. But in oth­er sit­u­a­tions, senior offi­cials appear to be pounc­ing on oppor­tu­ni­ties to cash out while their stock prices are sky high. And some com­pa­nies have award­ed stock options to exec­u­tives short­ly before mar­ket-mov­ing announce­ments about their vac­cine progress.

The sud­den wind­falls high­light the pow­er­ful finan­cial incen­tives for com­pa­ny offi­cials to gen­er­ate pos­i­tive head­lines in the race for coro­n­avirus vac­cines and treat­ments, even if the drugs might nev­er pan out.

...

Well-timed stock trans­ac­tions are gen­er­al­ly legal. But investors and cor­po­rate gov­er­nance experts say they can cre­ate the appear­ance that exec­u­tives are prof­it­ing from inside infor­ma­tion, and could erode pub­lic con­fi­dence in the phar­ma­ceu­ti­cal indus­try when the world is look­ing to these com­pa­nies to cure Covid-19.

“It is inap­pro­pri­ate for drug com­pa­ny exec­u­tives to cash in on a cri­sis,” said Ben Wakana, exec­u­tive direc­tor of Patients for Afford­able Drugs, a non­prof­it advo­ca­cy group. “Every day, Amer­i­cans wake up and make sac­ri­fices dur­ing this pan­dem­ic. Drug com­pa­nies see this as a pay­day.”

Exec­u­tives at a long list of com­pa­nies have reaped sev­en- or eight-fig­ure prof­its thanks to their work on coro­n­avirus vac­cines and treat­ments.
...

And note how, in the case of Vaxart, the com­pa­ny trig­gered a stock surge when it announced that it was select­ed to be part of “Oper­a­tion Warp Speed”. And while it was tech­ni­cal­ly cho­sen to par­tic­i­pate in a non-human pri­mate study that was being orga­nized by Oper­a­tion Warp Speed, the com­pa­ny had­n’t actu­al­ly been select­ed to received large gov­ern­ment grants like oth­er com­pa­nies that have received awards exceed­ing a bil­lion dol­lars from Oper­a­tion Warp Speed. So the Vaxart announce­ment about being select­ed by Oper­a­tion Warp Speed real­ly was a decep­tion. A decep­tion that worked, which is part of why some gov­ern­ment offi­cials have report­ed­ly raised con­cerns with the Secu­ri­ties and Exchange Com­mis­sion (SEC) but there’s no sign this is actu­al­ly being inves­ti­gat­ed:

...
Some com­pa­nies are attract­ing gov­ern­ment scruti­ny for poten­tial­ly using their asso­ci­a­tions with Oper­a­tion Warp Speed as mar­ket­ing ploys.

For exam­ple, the head­line on Vaxart’s news release declared: “Vaxart’s Covid-19 Vac­cine Select­ed for the U.S. Government’s Oper­a­tion Warp Speed.” But the real­i­ty is more com­plex.

Vaxart’s vac­cine can­di­date was includ­ed in a tri­al on pri­mates that a fed­er­al agency was orga­niz­ing in con­junc­tion with Oper­a­tion Warp Speed. But Vaxart is not among the com­pa­nies select­ed to receive sig­nif­i­cant finan­cial sup­port from Warp Speed to pro­duce hun­dreds of mil­lions of vac­cine dos­es.

“The U.S. Depart­ment of Health and Human Ser­vices has entered into fund­ing agree­ments with cer­tain vac­cine man­u­fac­tur­ers, and we are nego­ti­at­ing with oth­ers. Nei­ther is the case with Vaxart,” said Michael R. Caputo, the department’s assis­tant sec­re­tary for pub­lic affairs. “Vaxart’s vac­cine can­di­date was select­ed to par­tic­i­pate in pre­lim­i­nary U.S. gov­ern­ment stud­ies to deter­mine poten­tial areas for pos­si­ble Oper­a­tion Warp Speed part­ner­ship and sup­port. At this time, those stud­ies are ongo­ing, and no deter­mi­na­tions have been made.”

Some offi­cials at the Depart­ment of Health and Human Ser­vices have grown con­cerned about whether com­pa­nies includ­ing Vaxart are try­ing to inflate their stock prices by exag­ger­at­ing their roles in Warp Speed, a senior Trump admin­is­tra­tion offi­cial said. The depart­ment has relayed those con­cerns to the Secu­ri­ties and Exchange Com­mis­sion, said the offi­cial, who spoke on the con­di­tion of anonymi­ty.

It isn’t clear if the com­mis­sion is look­ing into the mat­ter. An S.E.C. spokes­woman declined to com­ment.
...

It’s also worth not­ing that Fort Det­rick announced back in May that it was going to be car­ry­ing out ani­mal stud­ies stud­ies as part of Oper­a­tion Warp Speed so there’s a good chance the pri­mate study Vaxart is par­tic­i­pat­ing in is being car­ried out at Fort Det­rick. Hope­ful­ly they got all those safe­ty issues worked out at the facil­i­ty where non-human pri­mate stud­ies were being con­duct­ed, although at least if any­thing escapes from those stud­ies it will be a virus that’s already out there.

So it’s going to be very inter­est­ing to see if the SEC actu­al­ly looks into these con­cerns about com­pa­nies mak­ing exag­ger­at­ed claims to inflate their stock prices. Those exag­ger­at­ed claims are polit­i­cal­ly con­ve­nient claims, after all, that help but­tress the broad­er finan­cial mar­kets with a gen­er­al opti­mism that a vac­cine real­ly might be right around the cor­ner. That’s part of what makes this such an inter­est­ing sto­ry: yes, there appears to be wide­spread hyp­ing of the progress made on COVID ther­a­peu­tics — from vac­cines to drug devel­op­ment — but that hyp­ing real­ly is like­ly help­ing to keep the broad­er stock mar­ket ele­vat­ed. Do Trump admin­is­tra­tion offi­cials nec­es­sar­i­ly want to burst that opti­mism bub­ble? They haven’t so far and it’s hard to see what’s going to change that sit­u­a­tion. Plus, this is the Trump admin­is­tra­tion. Decep­tive­ly exploit­ing hype is one of the few things it does well.

Here’s a quick pair of updates on remde­sivir: First, here’s an update on the assess­ments of remde­sivir’s effec­tive­ness against COVID-19. A pan­el of inter­na­tion­al experts con­vened by the British Med­ical Jour­nal reviewed the avail­able evi­dence on remde­sivir and con­clud­ed that it’s worth pre­scrib­ing to patients with sev­er COVID-19 despite its effec­tive­ness remain­ing incon­clu­sive due to the fact that most of the tri­als were small and have had lim­i­ta­tions. Recall how the study design of the remde­sivir clin­i­cal tri­als run by Gilead itself has been a tar­get of fre­quent crit­i­cism. So this expert pan­el appears to have large­ly con­curred with those crit­i­cisms and are rec­om­mend­ing remde­sivir large­ly because it’s prob­a­bly bet­ter than noth­ing even though we don’t know if it’s actu­al­ly bet­ter than noth­ing.

The pan­el also address­es remde­sivir’s rather high price tag of $3,120 a course for most US patients, warn­ing that the use of such cost­ly drugs notes, using cost­ly drugs like remde­sivir may divert funds, time, atten­tion and work­force away from oth­er poten­tial­ly worth­while treat­ments. So the pan­el is tepid­ly endors­ing the use of the drug despite lim­it­ed evi­dence that it actu­al­ly helps patients — because there’s no oth­er options — at the same time it notes that the use of cost­ly drugs like remde­sivir may be lim­it­ing the search from oth­er treat­ments:

Bloomberg

Remde­sivir Gets Luke­warm Endorse­ment From Experts in Covid Fight

By Jade Wil­son
July 30, 2020, 6:01 PM CDT

* Tri­als of remde­sivir have had lim­i­ta­tions, jour­nal says
* Pan­el calls for more study of Gilead drug in Covid patients

Gilead Sci­ences Inc.’s remde­sivir is worth pre­scrib­ing for patients with severe Covid-19 though evi­dence of its ben­e­fits remains incon­clu­sive, accord­ing to a pan­el of inter­na­tion­al experts con­vened by the British Med­ical Jour­nal.

The effec­tive­ness of most inter­ven­tions with remde­sivir is uncer­tain because most of the tri­als so far have been small and have lim­i­ta­tions, the authors said in a review for the jour­nal.

...

Remde­sivir may be effec­tive in reduc­ing recov­ery time in patients with severe Covid-19, though more tri­als are need­ed to con­firm this, the experts said. The drug prob­a­bly has no impor­tant effect on the need for mechan­i­cal ven­ti­la­tion and may have lit­tle or no effect on the length of hos­pi­tal stay.

Gilead said in June that it will charge U.S. hos­pi­tals rough­ly $3,120 for a course of treat­ment of remde­sivir for most patients. The drug received an emer­gency use autho­riza­tion from U.S. reg­u­la­tors in May, after a big tri­al found it sped recov­ery by about four days in hos­pi­tal­ized patients.

The authors said use of a cost­ly drug like remde­sivir may divert funds, time, atten­tion and work­force away from oth­er poten­tial­ly worth­while treat­ments. They sug­gest­ed future research should focus on areas such as opti­mal dose of the drug, dura­tion of ther­a­py, and whether there are spe­cif­ic groups of patients most like­ly to ben­e­fit.

————-

“Remde­sivir Gets Luke­warm Endorse­ment From Experts in Covid Fight” by Jade Wil­son; Bloomberg; 07/30/2020

“The authors said use of a cost­ly drug like remde­sivir may divert funds, time, atten­tion and work­force away from oth­er poten­tial­ly worth­while treat­ments. They sug­gest­ed future research should focus on areas such as opti­mal dose of the drug, dura­tion of ther­a­py, and whether there are spe­cif­ic groups of patients most like­ly to ben­e­fit.”

An expen­sive diver­sion that’s hope­ful­ly bet­ter than noth­ing but we can’t be sure because the effi­ca­cy stud­ies were so inad­e­quate. That was the gen­er­al take of this expert pan­el. It’s less an endorse­ment than a capit­u­la­tion to cir­cum­stance.

And now here’s an arti­cle about the update Gilead just gave on its 2020 sales out­look. Despite a near­ly 9.6% drop in base­line sales of Gilead­’s exist­ing drugs — which appears to be large­ly dri­ven by the pan­dem­ic lead­ing to a fall in demand for Gilead­’s HIV drugs — the com­pa­ny is rais­ing its pre­vi­ous sales guid­ance of $21.8 -$22.2 bil­lion made back in Feb­ru­ary to $23-$25 bil­lion due entire­ly to sales of remde­sivir:

Fierce Phar­ma

Gilead banks on block­buster remde­sivir with sun­nier 2020 out­look

by Angus Liu | Jul 31, 2020 11:51am

Gilead is part of a long list of drug­mak­ers that have suf­fered from busi­ness slow­downs caused by COVID-19. But unlike its peers, the Big Biotech has an unex­pect­ed block­buster source of rev­enue that led it to ele­vate its full-year out­look: COVID-19 ther­a­py remde­sivir.

The com­pa­ny on Thurs­day increased its 2020 sales guid­ance to the range of $23 bil­lion to $25 bil­lion, from a pre­vi­ous $21.8 bil­lion to $22.2 bil­lion, even after it was hit with a big­ger-than-expect­ed year-over-year top-line decline of 9.6% in the sec­ond quar­ter.

The rea­son? It now expects to sell 1 mil­lion to 1.5 mil­lion treat­ment cours­es of remde­sivir in COVID-19, Chief Finan­cial Offi­cer Andrew Dick­in­son told investors dur­ing a con­fer­ence call on Thurs­day. By RBC Cap­i­tal Mar­kets ana­lyst Bri­an Abra­hams’ cal­cu­la­tion, that rough­ly equates to $3.5 bil­lion in addi­tion­al sec­ond-half 2020 sales of the antivi­ral.

Gilead­’s pre­vi­ous guid­ance, mean­while didn’t include any con­tri­bu­tions from remde­sivir. It was only in late April—on the eve of Gilead’s first-quar­ter earn­ings report—that the Nation­al Insti­tutes of Health unveiled the first data from a place­bo-con­trolled clin­i­cal tri­al, show­ing the drug cut recov­ery time by 31% for hos­pi­tal­ized COVID-19 patients. And it wasn’t until two months lat­er that the com­pa­ny unveiled its com­mer­cial plan, set­ting the list price at $3,120 for a stan­dard five-day treat­ment course for pri­vate insur­ance plans and $2,340 per course for gov­ern­ment pur­chas­es from devel­oped coun­tries.

In a con­tro­ver­sial move, the U.S. Depart­ment of Health and Human Ser­vices has secured over 500,000 treat­ment cours­es of remde­sivir for U.S. use through Sep­tem­ber. That rep­re­sents near­ly all of Gilead’s pro­ject­ed yield dur­ing the peri­od. As it works to ramp up man­u­fac­tur­ing, the com­pa­ny now expects to have enough sup­plies to “meet real-time glob­al demand” from Octo­ber, Gilead CEO Daniel O’Day said dur­ing the call.

Gilead exec­u­tives acknowl­edged that there remain many uncer­tain­ties around how the pan­dem­ic will evolve in the sec­ond half of the year, which explains why the com­pa­ny is leav­ing a wide $2 bil­lion dif­fer­ence between the two ends of its full-year sales expec­ta­tions. But in a Fri­day note to clients, SVB Leerink ana­lyst Geof­frey Porges said he expects there will be “sig­nif­i­cant demand” for remde­sivir giv­en the disease’s unre­lent­ing grip on the world, and that gov­ern­ment nego­ti­a­tions on stock­pil­ing will start in the fourth quar­ter.

...

————-

“Gilead banks on block­buster remde­sivir with sun­nier 2020 out­look” by Angus Liu; Fierce Phar­ma; 07/31/2020

“The com­pa­ny on Thurs­day increased its 2020 sales guid­ance to the range of $23 bil­lion to $25 bil­lion, from a pre­vi­ous $21.8 bil­lion to $22.2 bil­lion, even after it was hit with a big­ger-than-expect­ed year-over-year top-line decline of 9.6% in the sec­ond quar­ter.”

A big­ger-than-expect­ed drop off in the base­line sales of its drugs is going to be more than off­set by a pro­ject­ed $3.5 bil­lion in remde­sivir sales. That’s the new guid­ance for Gilead now that it has a much bet­ter sense of how much of the drug it’s going to sell this year and how much it can charge for it.

So while we still have no idea whether or not remde­sivir actu­al­ly helps COVID-19 patients we are get­ting much greater clar­i­ty on the impact of remde­sivir or Gilead­’s bot­tom line. As for­mer Gilead chair­man Don­ald Rums­feld once said, “You go to war with the army you have, not the army you might want or wish to have at a lat­er time.” The same is true of pan­demics and pri­or­i­ties.

Very clever use of the NYT stand­by “right wing pop­ulist”. They let the counter-pro­tes­tors call the marchers “Nazis”, but their own writer calls them “Right wing pop­ulists”. Oh, Times, nev­er change..

https://www.nytimes.com/aponline/2020/08/01/world/europe/ap-virus-outbreak-germany.html

Thou­sands protest­ed Ger­many’s coro­n­avirus restric­tions Sat­ur­day in a Berlin demon­stra­tion mark­ing what orga­niz­ers called “the end of the pan­dem­ic” — a dec­la­ra­tion that comes just as author­i­ties are voic­ing increas­ing con­cerns about an uptick in new infec­tions.

...Police esti­mat­ed about 17,000 peo­ple turned out. The demon­stra­tors were kept apart from coun­ter­pro­test­ers, some of whom chant­ed “Nazis out!”

Pro­test­ers con­tin­ued to a sub­se­quent ral­ly on a boule­vard run­ning through the city’s Tier­garten park, which police esti­mat­ed drew 20,000 peo­ple. Police declared that event over as orga­niz­ers again failed to get demon­stra­tors to wear masks or keep their dis­tance.

Protests against anti-virus restric­tions in Ger­many have drawn a vari­ety of atten­dees, includ­ing con­spir­a­cy the­o­rists and right-wing pop­ulists.

Here’s a pair of arti­cles relat­ed to the COVID vac­cine race and con­cerns about the Trump admin­is­tra­tion skew­ing the vac­cine-approval process so he can have an vac­cine “Octo­ber Sur­prise” in time for the Novem­ber 2020 elec­tion:

First, the New York Times has a new piece filled with anony­mous sources describ­ing grow­ing con­cerns about Trump admin­is­tra­tion med­dling with­in the gov­ern­ment agen­cies like the FDA that will be tasked with ulti­mate­ly approv­ing any vac­cines. It sounds like the expec­ta­tions for some sort of med­dling are wide­spread. The deci­sion to approve a vac­cine for emer­gency use is a pow­er held by the FDA’s senior reg­u­la­tor, although an inde­pen­dent advi­so­ry pan­el of out­side experts is involved in the FDA’s deci­sion-mak­ing. But it’s the fact that FDA’s top lead­er­ship and/or the sec­re­tary of Health and Human Ser­vices (HHS) have the pow­er to over­ride those deci­sion that has peo­ple con­cerned. In oth­er words, the ulti­mate deci­sion won’t be make be pro­fes­sion­al gov­ern­ment sci­en­tists. It will be made by polit­i­cal appointees like HHS sec­re­tary Alex Azar. And with Jared Kush­n­er report­ed­ly deeply involved this process all indi­ca­tions are that this is going to be a hyper-politi­cized deci­sion.

But as the NY Times arti­cle notes, there’s still a recog­ni­tion with­in the Trump team that a vac­cine “Octo­ber Sur­prise” may not have the impact the Trump team is hop­ing for because it’s not like Joe Biden would can­cel the vac­cine if he won the elec­tion. Any vac­cine that gets approved pre-elec­tion does­n’t just leave with Trump.

It under­scores one of the more inter­est­ing dynam­ics involved with this vac­cine race in the mid­dle of an elec­tion: if Trump is going to use the vac­cine as a reelec­tion sales pitch he’s going to have to some­how por­tray it as some­thing that only Trump could accom­plish. And it’s very unclear what sort of scheme Trump could come up with where he can sell the idea that only he can pro­vide some sort of mir­a­cle COVID cure. But there is one such sce­nario and it hinges on irre­spon­si­bly get­ting a vac­cine pre­ma­ture­ly approved with­out ade­quate safe­ty test­ing: The sce­nario where the Trump admin­is­tra­tion pre­ma­ture­ly approves a vac­cine that many experts are say­ing needs more test­ing and should be recalled. Under that sce­nario, assum­ing Joe Biden fol­lows the advice of the experts call­ing for a recall, Trump real­ly could tell the elec­torate some­thing like, “if you vote for Joe Biden you’re vot­ing against hav­ing this awe­some vac­cine avail­able right now!” or some­thing like that. It’s not exact­ly a com­pelling sales pitch for Trump but it would be at least one exam­ple of a sce­nar­ios where Trump can claim some sort of spe­cial vac­cine-out­come only if he gets reelect­ed and at this point we should prob­a­bly assume that Trump is active­ly look­ing for sce­nar­ios like that.

But as we’ll see in the sec­ond arti­cle below, there’s a real ques­tion of whether or not an “Octo­ber Sur­prise” vac­cine announce­ment would help Trump at all because a large por­tion of both Democ­rats and Repub­li­cans already don’t trust the safe­ty of the vac­cines being devel­oped. That’s accord­ing to a new­ly released Yahoo News/YouGov poll on US atti­tudes towards the idea of tak­ing a COVID vac­cine which found that near­ly iden­ti­cal num­bers of Democ­rats, Repub­li­cans, and inde­pen­dents, 70 per­cent, are “very” or “some­what” con­cerned about the safe­ty of the upcom­ing vac­cines. The sources of the con­cerns tend to dif­fer, with Repub­li­cans hav­ing a more gen­er­al dis­trust of vac­cines and Democ­rats not trust the Trump admin­is­tra­tion to safe­ly eval­u­ate the vac­cine.

Over­all, only 42 per­cent of respon­dees indi­cat­ed they were plan­ning on tak­ing a COVID vac­cine once is avail­able and that lev­el of sup­port dropped sig­nif­i­cant­ly when respon­dees were asked about vac­cines that might have com­mon side effects like headaches or fevers. So if this vac­cine gets rushed and there are ear­ly indi­ca­tions of even expect­ed side-effects its unclear Trump will actu­al­ly be polit­i­cal­ly helped by a vac­cine “Octo­ber Sur­prise”. Will this kind of dynam­ic give the Trump team pause of make them even more des­per­ate and more inclined to take big­ger risks? Per­haps, but it also might make the Trump team more intent on cov­er­ing up con­cern­ing safe­ty-tri­al results. So the more con­cerned the pub­lic is about the Trump team rush­ing the safe­ty tri­als the more incen­tivized the Trump team is to hide safe­ty con­cerns which should only make the pub­lic even more con­cerned about the integri­ty safe­ty assess­ments. It’s like a doom loop of decep­tion and despair. A doom loop that could have been avoid­ed if this admin­is­tra­tion could­n’t be trust­ed to lie all the time:

The New York Times

Sci­en­tists Wor­ry About Polit­i­cal Influ­ence Over Coro­n­avirus Vac­cine Project

Oper­a­tion Warp Speed has moved along at a rapid clip. But some peo­ple involved in the process fear pres­sure to deliv­er an Octo­ber sur­prise for Pres­i­dent Trump.

By Sharon LaFraniere, Katie Thomas, Noah Wei­land, Peter Bak­er and Annie Karni

Aug. 2, 2020

In April, with hos­pi­tals over­whelmed and much of the Unit­ed States in lock­down, the Depart­ment of Health and Human Ser­vices pro­duced a pre­sen­ta­tion for the White House argu­ing that rapid devel­op­ment of a coro­n­avirus vac­cine was the best hope to con­trol the pan­dem­ic.

“DEADLINE: Enable broad access to the pub­lic by Octo­ber 2020,” the first slide read, with the date in bold.

Giv­en that it typ­i­cal­ly takes years to devel­op a vac­cine, the timetable for the ini­tia­tive, called Oper­a­tion Warp Speed, was incred­i­bly ambi­tious. With tens of thou­sands dying and tens of mil­lions out of work, the cri­sis demand­ed an all-out pub­lic-pri­vate response, with the gov­ern­ment sup­ply­ing bil­lions of dol­lars to phar­ma­ceu­ti­cal and biotech­nol­o­gy com­pa­nies, pro­vid­ing logis­ti­cal sup­port and cut­ting through red tape.

It escaped no one that the pro­posed dead­line also inter­sect­ed nice­ly with Pres­i­dent Trump’s need to curb the virus before the elec­tion in Novem­ber.

The ensu­ing race for a vac­cine — in the mid­dle of a cam­paign in which the president’s han­dling of the pan­dem­ic is the key issue after he has spent his time in office under­min­ing sci­ence and the exper­tise of the fed­er­al bureau­cra­cy — is now test­ing the sys­tem set up to ensure safe and effec­tive drugs to a degree nev­er before seen.

Under con­stant pres­sure from a White House anx­ious for good news and a pub­lic des­per­ate for a sil­ver bul­let to end the cri­sis, the government’s researchers are fear­ful of polit­i­cal inter­ven­tion in the com­ing months and are strug­gling to ensure that the gov­ern­ment main­tains the right bal­ance between speed and rig­or­ous reg­u­la­tion, accord­ing to inter­views with admin­is­tra­tion offi­cials, fed­er­al sci­en­tists and out­side experts.

Even in a less polit­i­cal­ly charged envi­ron­ment, there would be a fraught debate about how much to accel­er­ate the process of tri­als and approval. The longer that vac­cines are test­ed before being released, the like­li­er they are to be safe and effec­tive.

But with 1,000 peo­ple dying each day in the Unit­ed States, schools find­ing it dif­fi­cult to reopen and the deep reces­sion inflict­ing eco­nom­ic pain across the coun­try, the desire to find a way to return to nor­mal life is pow­er­ful and tran­scends par­ti­san pol­i­tics and bor­ders. On Sun­day, Rus­sia announced that it planned to start a nation­wide inoc­u­la­tion cam­paign in Octo­ber with a vac­cine that had yet to com­plete clin­i­cal tri­als, the lat­est evi­dence of the glob­al poten­tial for cut­ting cor­ners.

Despite con­cert­ed efforts by the Trump admin­is­tra­tion and a bevy of phar­ma­ceu­ti­cal com­pa­nies it is work­ing with, the orig­i­nal Octo­ber tar­get has slipped, with the admin­is­tra­tion now push­ing to have hun­dreds of mil­lions of dos­es avail­able by the end of the year or ear­ly 2021.

But experts inside and out­side the gov­ern­ment still say they fear the White House will push the Food and Drug Admin­is­tra­tion to over­look insuf­fi­cient data and give at least lim­it­ed emer­gency approval to a vac­cine, per­haps for use by spe­cif­ic groups like front-line health care work­ers, before the vote on Nov. 3.

“There are a lot of peo­ple on the inside of this process who are very ner­vous about whether the admin­is­tra­tion is going to reach their hand into the Warp Speed buck­et, pull out one or two or three vac­cines, and say, ‘We’ve test­ed it on a few thou­sand peo­ple, it looks safe, and now we are going to roll it out,’” said Dr. Paul A. Offit of the Uni­ver­si­ty of Penn­syl­va­nia, who is a mem­ber of the Food and Drug Administration’s vac­cine advi­so­ry com­mit­tee.

“They are real­ly wor­ried about that,” he added. “And they should be.”

Mr. Trump relent­less­ly touts progress toward a vac­cine, rais­ing hopes of quick approval. Tour­ing a North Car­oli­na biotech­nol­o­gy lab last week, he vowed to “deliv­er a vac­cine in record time.” In a tweet last month, he explic­it­ly tied vac­cines to his re-elec­tion hopes.

On a cam­paign call with sup­port­ers in Penn­syl­va­nia on Sun­day evening, Mr. Trump said the “F.D.A. has been great, at my instruc­tion,” and he again raised hopes of rapid progress.

“We expect to have a vac­cine avail­able very, very ear­ly before the end of the year, far ahead of sched­ule,” he said. “We’re very close to hav­ing that final­ized.”

The president’s son-in-law and senior advis­er, Jared Kush­n­er, who is help­ing to steer the re-elec­tion cam­paign from the White House, is a reg­u­lar par­tic­i­pant in meet­ings of a board formed to over­see the vac­cine effort.

While White House offi­cials do not specif­i­cal­ly men­tion the elec­tion dur­ing the board’s dis­cus­sions, peo­ple famil­iar with the con­ver­sa­tions say they ask reg­u­lar­ly about Octo­ber, a date that hangs over the effort. Trump cam­paign advis­ers pri­vate­ly call a pre-elec­tion vac­cine “the holy grail.”

The Food and Drug Administration’s approval of a new vac­cine is typ­i­cal­ly an exhaus­tive process, where agency employ­ees metic­u­lous­ly go through data from clin­i­cal tri­als to review whether the vac­cine is both safe and effec­tive. The thresh­old for approv­ing vac­cines is typ­i­cal­ly high­er than it is for ther­a­peu­tic drugs because they will be used in mil­lions of oth­er­wise healthy peo­ple, mean­ing that even rare side effects could affect many more peo­ple than a drug that treats a spe­cif­ic ill­ness.

An inde­pen­dent advi­so­ry pan­el of out­side experts also weighs in, and while the agency has the pow­er to make its own deci­sion, it typ­i­cal­ly fol­lows the advice of its out­side pan­els. The Food and Drug Administration’s senior reg­u­la­tor has the pow­er to approve or deny vac­cines for emer­gency use, but that deci­sion could be over­rid­den by the agency’s top lead­ers, or by the sec­re­tary of health and human ser­vices.

White House offi­cials said that Mr. Trump would not dis­tort the vac­cine review process to help his cam­paign. “The rapid research, devel­op­ment, tri­als and even­tu­al dis­tri­b­u­tion of a Covid-19 vac­cine is emblem­at­ic of Pres­i­dent Trump’s high­est pri­or­i­ty: the health and safe­ty of the Amer­i­can peo­ple,” said Judd Deere, a White House spokesman. “It has noth­ing to do with pol­i­tics.”

Dr. Antho­ny S. Fau­ci, the direc­tor of the Nation­al Insti­tute of Aller­gy and Infec­tious Dis­eases, told law­mak­ers on Fri­day that he remained “cau­tious­ly opti­mistic that we will have a vac­cine by the end of this year and as we go into 2021.”

Dr. Stephen Hahn, the com­mis­sion­er of the Food and Drug Admin­is­tra­tion, has not ruled out emer­gency approval of a vac­cine.

“We would con­sid­er using an emer­gency use autho­riza­tion if we felt that the risks asso­ci­at­ed with the vac­cine were much low­er than the risks of not hav­ing a vac­cine,” he told The Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion in an online inter­view.

He also said reg­u­la­tors would cer­ti­fy that any vac­cine would meet the agency’s rig­or­ous stan­dards, adding, “My job as com­mis­sion­er is to make sure to the fullest extent pos­si­ble that any pres­sure that comes to the agency is not reflect­ed down­ward” onto reg­u­la­tors and sci­en­tists study­ing the vac­cines.

At the same time, a senior admin­is­tra­tion offi­cial refused to promise that any emer­gency approval of a vac­cine would be vet­ted through the Food and Drug Administration’s out­side advi­so­ry pan­el of experts, sched­uled to meet on Oct. 22.

Oper­a­tion Warp Speed got its start in April, the brain­child of Dr. Peter Marks, a pen­cil-thin, bespec­ta­cled physi­cian who leads the reg­u­la­to­ry unit at the Food and Drug Admin­is­tra­tion that approves vac­cines and ther­a­pies.

A “Star Trek” fan, Dr. Marks named the ini­tia­tive Warp Speed and pitched it in an April 10 phone call to Alex M. Azar II, the sec­re­tary of health and human ser­vices, who quick­ly embraced it. In a fol­low-up phone call a few days lat­er, accord­ing to a per­son famil­iar with the dis­cus­sions, sev­er­al health offi­cials said the Octo­ber dead­line was unre­al­is­tic; over the next few months, offi­cials began pub­licly cit­ing the end of the year or ear­ly 2021 as a tar­get.

With his job on the line, Mr. Azar, the tar­get of Mr. Trump’s wrath over the virus, was espe­cial­ly eager to prove his worth to the White House. He teamed up with Defense Sec­re­tary Mark T. Esper, whose depart­ment has long expe­ri­ence with vac­cine devel­op­ment and dis­tri­b­u­tion to pro­tect troops. An expert in com­plex logis­tics, Gen. Gus­tave F. Per­na, became the operation’s chief oper­at­ing offi­cer.

Mr. Kush­n­er, Dr. Deb­o­rah L. Birx, the White House coro­n­avirus coor­di­na­tor, and oth­ers inter­viewed Dr. Mon­cef Slaoui, a phar­ma­ceu­ti­cal indus­try vet­er­an, and orches­trat­ed his appoint­ment as chief sci­en­tif­ic advis­er despite con­cerns with­in the Food and Drug Admin­is­tra­tion about con­flicts of inter­est because of his finan­cial ties to two com­pa­nies that are devel­op­ing a vac­cine. Rather than being both­ered by the con­flict, Mr. Kush­n­er and oth­ers rea­soned that it took some­one with such indus­try expe­ri­ence to over­see the effort.

Dr. Slaoui resigned from the board of Mod­er­na, which has received near­ly $1 bil­lion in fed­er­al sup­port to devel­op a vac­cine. But as of May he still had near­ly $10 mil­lion of stock in Glax­o­SmithK­line, a part­ner with the French drug­mak­er Sanofi, which last week signed a $2.1 bil­lion agree­ment to pro­duce 100 mil­lion dos­es. Dr. Slaoui, who is work­ing on a $1 con­tract, cleared an ethics review by the Depart­ment of Health and Human Ser­vices and has said he is deter­mined to avoid any con­flict.

Short­ly after Dr. Slaoui’s appoint­ment, Dr. Marks resigned from the project he con­ceived and returned full-time to his post as a senior reg­u­la­tor at the Food and Drug Admin­is­tra­tion, where he will be the key deci­sion mak­er on whether a vac­cine mer­its approval.

The admin­is­tra­tion has con­duct­ed the vac­cine hunt with a focus lack­ing in much of the rest of its pan­dem­ic response. Con­tracts have been exe­cut­ed at a brisk pace. Mobile trail­ers have been speed­i­ly deliv­ered for exper­i­men­tal dos­es to be admin­is­tered. When a com­pa­ny was short on nee­dles, the Pen­ta­gon dis­patched planes to deliv­er sup­plies with­in 48 hours.

The phar­ma­ceu­ti­cal com­pa­nies are report­ing the results of their tri­als at reg­u­lar inter­vals, accel­er­at­ing the review process. With the gov­ern­ment pay­ing much of the cost, the com­pa­nies are begin­ning the process of man­u­fac­tur­ing mil­lions of dos­es of vac­cine essen­tial­ly on spec so that they can be dis­trib­uted quick­ly if they secure approval.

The process has moved at a remark­able clip. Two vac­cine can­di­dates, one devel­oped by Mod­er­na in con­junc­tion with Dr. Fauci’s insti­tute and anoth­er by Pfiz­er, last week began Phase 3 tri­als, the final stage of clin­i­cal exper­i­men­ta­tion. Oth­ers are expect­ed soon.

In Mr. Azar’s con­fer­ence room at the Depart­ment of Health and Human Ser­vices head­quar­ters, Mr. Kush­n­er and Dr. Birx join meet­ings with Mr. Azar, Mr. Esper and oth­ers. Mr. Kush­n­er repeat­ed­ly push­es the group to move faster and has dep­u­tized two close asso­ciates, Brad Smith and Adam Boehler, to press the case.

The team has sought to ensure that a vari­ety of dif­fer­ent types of poten­tial vac­cines are being pur­sued to increase the chances that at least one will work. Dr. Birx has been inter­est­ed in what is known as a sub­unit pro­tein vac­cine, and at one point called exec­u­tives at the biotech­nol­o­gy com­pa­ny Genen­tech and asked what they could do. (Warp Speed is now work­ing with two com­pa­nies pur­su­ing that type of vac­cine.)

Mark Mead­ows, the White House chief of staff, also talks with phar­ma­ceu­ti­cal exec­u­tives. Peo­ple briefed on the dis­cus­sions say the White House has also pushed for progress by the fall on ther­a­peu­tics — drugs to treat peo­ple who fall ill to the dis­ease — includ­ing the pos­si­bil­i­ty of an emer­gency use autho­riza­tion for one or more of those drugs. Late last month, Mr. Trump called the chief exec­u­tive of Regen­eron Phar­ma­ceu­ti­cals to check on the progress of a poten­tial anti­body treat­ment.

Career offi­cials have assured Dr. Hahn that they would stand behind him to head off any vac­cine deci­sion not based on sci­ence. But Dr. Hahn already lost a mea­sure of cred­i­bil­i­ty with the sci­en­tif­ic com­mu­ni­ty for approv­ing the emer­gency use of hydrox­y­chloro­quine and chloro­quine, two anti-malar­ia drugs pro­mot­ed by the pres­i­dent as treat­ments for the coro­n­avirus over the objec­tions of his pub­lic health advis­ers. The Food and Drug Admin­is­tra­tion lat­er revoked the autho­riza­tion, con­clud­ing the risks out­weighed the ben­e­fits.

Sci­en­tists have argued that it would be unwise to cut cor­ners on a vac­cine that is to be inject­ed into some 300 mil­lion Amer­i­cans, adding that a failed effort would fuel pub­lic dis­trust of vac­cines gen­er­al­ly.

But a senior White House offi­cial, who dis­cussed the mat­ter on the con­di­tion of anonymi­ty, said that it would also be uneth­i­cal to with­hold an effec­tive vac­cine for an extra three or four months while more peo­ple died just to check the box­es of a more rou­tine tri­al process.

Michael R. Caputo, a spokesman for Mr. Azar, said Octo­ber was not the goal.

“Every­body at H.H.S. hopes Oper­a­tion Warp Speed will achieve 300 mil­lion dos­es of a safe and effec­tive Covid vac­cine for Amer­i­cans by Jan­u­ary 2021,” he said. “We know that’s opti­mistic. I have nev­er heard men­tion of any oth­er time­line, and cer­tain­ly not from the sec­re­tary.”

“Care­less talk about career F.D.A. reg­u­la­tors some­how approv­ing an unsafe and inef­fec­tive vac­cine just for pol­i­tics only under­mines con­fi­dence in the pub­lic health sys­tem,” he added.

It is not clear that a vac­cine approval short­ly before the elec­tion would be an “Octo­ber sur­prise” suf­fi­cient to alter the out­come of the vote. An announce­ment could give Amer­i­cans hope that the end is in sight. But some Repub­li­can strate­gists said that it might not help Mr. Trump because his oppo­nent, for­mer Vice Pres­i­dent Joseph R. Biden Jr., the pre­sump­tive Demo­c­ra­t­ic nom­i­nee, would sure­ly con­tin­ue the vac­cine process if elect­ed.

“Does it turn every­thing around for him polit­i­cal­ly? I don’t know,” said Sarah Long­well, a con­ser­v­a­tive strate­gist and promi­nent Repub­li­can oppo­nent of Mr. Trump who reg­u­lar­ly con­ducts focus groups and has found that pub­lic atten­tion is more focused on gov­ern­ment relief checks and school reopen­ings.

“If the vac­cine is an Octo­ber sur­prise, there’s a lot of oth­er things that are cut­ting against” it as a game-chang­er, she said.

The drug com­pa­nies find them­selves caught in the mid­dle. While eager to bring prod­ucts to mar­ket as quick­ly as pos­si­ble, they face risks in mov­ing too quick­ly in order to fit an elec­tion cal­en­dar, ana­lysts said.

“They are acute­ly aware of the polit­i­cal dynam­ic here,” said Rob Smith, the direc­tor of Cap­i­tal Alpha Part­ners, a research firm. A vac­cine that flopped would jeop­ar­dize their broad­er busi­ness, he said, and it would not make sense “to take a huge rep­u­ta­tion­al risk not just for your vac­cine but for all the prod­ucts across your port­fo­lio to ben­e­fit the pres­i­dent polit­i­cal­ly.”

...

————

“Sci­en­tists Wor­ry About Polit­i­cal Influ­ence Over Coro­n­avirus Vac­cine Project” by Sharon LaFraniere, Katie Thomas, Noah Wei­land, Peter Bak­er and Annie Karni; The New York Times; 08/02/2020

“An inde­pen­dent advi­so­ry pan­el of out­side experts also weighs in, and while the agency has the pow­er to make its own deci­sion, it typ­i­cal­ly fol­lows the advice of its out­side pan­els. The Food and Drug Administration’s senior reg­u­la­tor has the pow­er to approve or deny vac­cines for emer­gency use, but that deci­sion could be over­rid­den by the agency’s top lead­ers, or by the sec­re­tary of health and human ser­vices.”

As we can see, the con­cerns are very jus­ti­fied because there’s noth­ing stop­ping the Trump admin­is­tra­tion’s senior offi­cials from over­rid­ing the inde­pen­dent pan­els that are sup­posed to be mak­ing these calls. And the admin­is­tra­tion refus­es to rule out the pos­si­bil­i­ty that any deci­sions to make an emer­gency use dec­la­ra­tion will be vet­ted by the inde­pen­dence pan­els. So the deci­sion over which vac­cines are safe to use real­ly is a deci­sion the Trump admin­is­tra­tion can mak­ing inde­pen­dent of the inde­pen­dent pan­els of experts. Even worse, senior Trump offi­cials are now telling basi­cal­ly reporters that it would be uneth­i­cal if they don’t rush the vac­cine. So all signs are point­ing to a rushed vac­cine pushed direct­ly by senior Trump offi­cials (prob­a­bly Jared Kush­n­er):

...
Dr. Stephen Hahn, the com­mis­sion­er of the Food and Drug Admin­is­tra­tion, has not ruled out emer­gency approval of a vac­cine.

“We would con­sid­er using an emer­gency use autho­riza­tion if we felt that the risks asso­ci­at­ed with the vac­cine were much low­er than the risks of not hav­ing a vac­cine,” he told The Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion in an online inter­view.

He also said reg­u­la­tors would cer­ti­fy that any vac­cine would meet the agency’s rig­or­ous stan­dards, adding, “My job as com­mis­sion­er is to make sure to the fullest extent pos­si­ble that any pres­sure that comes to the agency is not reflect­ed down­ward” onto reg­u­la­tors and sci­en­tists study­ing the vac­cines.

At the same time, a senior admin­is­tra­tion offi­cial refused to promise that any emer­gency approval of a vac­cine would be vet­ted through the Food and Drug Administration’s out­side advi­so­ry pan­el of experts, sched­uled to meet on Oct. 22.

...

Career offi­cials have assured Dr. Hahn that they would stand behind him to head off any vac­cine deci­sion not based on sci­ence. But Dr. Hahn already lost a mea­sure of cred­i­bil­i­ty with the sci­en­tif­ic com­mu­ni­ty for approv­ing the emer­gency use of hydrox­y­chloro­quine and chloro­quine, two anti-malar­ia drugs pro­mot­ed by the pres­i­dent as treat­ments for the coro­n­avirus over the objec­tions of his pub­lic health advis­ers. The Food and Drug Admin­is­tra­tion lat­er revoked the autho­riza­tion, con­clud­ing the risks out­weighed the ben­e­fits.

Sci­en­tists have argued that it would be unwise to cut cor­ners on a vac­cine that is to be inject­ed into some 300 mil­lion Amer­i­cans, adding that a failed effort would fuel pub­lic dis­trust of vac­cines gen­er­al­ly.

But a senior White House offi­cial, who dis­cussed the mat­ter on the con­di­tion of anonymi­ty, said that it would also be uneth­i­cal to with­hold an effec­tive vac­cine for an extra three or four months while more peo­ple died just to check the box­es of a more rou­tine tri­al process.
...

And while some observers note that vac­cine man­u­fac­tur­ers are going to be dis­in­cen­tivized to roll out inef­fec­tive vac­cines giv­en the rep­u­ta­tion­al dam­age that would hap­pen to the com­pa­ny, keep in mind that any vac­cine that gets rolled out for emer­gency use will prob­a­bly have bil­lions of dol­lars in guar­an­teed sales to the US gov­ern­ment and pos­si­ble oth­er gov­ern­ments. Also recall that com­pa­nies will be shield­ed from the lia­bil­i­ties of neg­a­tive side-effects thanks to the Pub­lic Readi­ness and Emer­gency Pre­pared­ness Act of 2005, so com­pa­nies like Mod­er­na that are rolling out new tech­nolo­gies that haven’t been approved for use in peo­ple before are going to have an extra incen­tive to roll out a vac­cine right now specif­i­cal­ly because of pos­si­ble safe­ty-con­cerns over their new tech­nol­o­gy. So, yes, com­pa­nies have incen­tives not to roll out flawed vac­cines, but at least some com­pa­nies right now have very big incen­tives in the oppo­site direc­tion:

...
The drug com­pa­nies find them­selves caught in the mid­dle. While eager to bring prod­ucts to mar­ket as quick­ly as pos­si­ble, they face risks in mov­ing too quick­ly in order to fit an elec­tion cal­en­dar, ana­lysts said.

“They are acute­ly aware of the polit­i­cal dynam­ic here,” said Rob Smith, the direc­tor of Cap­i­tal Alpha Part­ners, a research firm. A vac­cine that flopped would jeop­ar­dize their broad­er busi­ness, he said, and it would not make sense “to take a huge rep­u­ta­tion­al risk not just for your vac­cine but for all the prod­ucts across your port­fo­lio to ben­e­fit the pres­i­dent polit­i­cal­ly.”
...

But then there’s the real ques­tion of whether or not a late Octo­ber vac­cine announce­ment would real­ly even help Trump at all. After all, It’s not like Joe Biden would sud­den­ly stop vac­cine devel­op­ment if elect­ed:

...
It is not clear that a vac­cine approval short­ly before the elec­tion would be an “Octo­ber sur­prise” suf­fi­cient to alter the out­come of the vote. An announce­ment could give Amer­i­cans hope that the end is in sight. But some Repub­li­can strate­gists said that it might not help Mr. Trump because his oppo­nent, for­mer Vice Pres­i­dent Joseph R. Biden Jr., the pre­sump­tive Demo­c­ra­t­ic nom­i­nee, would sure­ly con­tin­ue the vac­cine process if elect­ed.

“Does it turn every­thing around for him polit­i­cal­ly? I don’t know,” said Sarah Long­well, a con­ser­v­a­tive strate­gist and promi­nent Repub­li­can oppo­nent of Mr. Trump who reg­u­lar­ly con­ducts focus groups and has found that pub­lic atten­tion is more focused on gov­ern­ment relief checks and school reopen­ings.

“If the vac­cine is an Octo­ber sur­prise, there’s a lot of oth­er things that are cut­ting against” it as a game-chang­er, she said.
...

And that’s why we’re going to have to be ready for some sort of gim­mick that involves Trump declar­ing that he, and only he, is will­ing to pro­vide the imme­di­ate­ly vac­cine relief that Joe Biden won’t allow due to blown up safe­ty con­cerns or some­thing like that. A gim­mick that lit­er­al­ly revolves around brag­ging about a will­ing­ness to flout­ing expert advice. Con­sid­er­ing that Trump’s entire response thus far has revolved around open­ly flout­ing expert advice and por­tray­ing the experts as ‘deep state’ ene­mies it does­n’t seem hard to imag­ine he’ll do it again.

But then there’s the ques­tion of whether or not a vac­cine ‘Octo­ber Sur­prise’ is some­thing the elec­torate is even inter­est­ed in at this point. And based on the fol­low­ing recent Yahoo/YouGov poll, the num­ber of Amer­i­cans are def­i­nite­ly plan on being vac­ci­nat­ed has dropped to 42% and just keeps drop­ping, with wide­spread skep­ti­cism among Democ­rats, Repub­li­cans, and Inde­pen­dents. Although the rea­sons for the skep­ti­cism varies, with Repub­li­cans wary of the med­ical estab­lish­ment in gen­er­al and Democ­rats specif­i­cal­ly wor­ried about the Trump admin­is­tra­tion unsafe­ly rush­ing the vac­cine:

Yahoo News

Yahoo News/YouGov coro­n­avirus poll: Num­ber of Amer­i­cans who plan to get vac­ci­nat­ed falls to 42% — a new low

Andrew Romano
West Coast Cor­re­spon­dent
August 4, 2020, 11:20 AM

So far, most of the con­ver­sa­tion about COVID-19 vac­cines has focused on the ques­tion of whether researchers can devel­op an effec­tive vac­cine in record time.

But maybe we should start ask­ing anoth­er ques­tion as well: Will enough Amer­i­cans actu­al­ly get the vac­cine for it to be effec­tive?

“It’s not a vac­cine that will save us,” says Har­vard Glob­al Health Insti­tute direc­tor Ashish Jha. “It’s vac­ci­na­tion.”

For a COVID-19 vac­cine to actu­al­ly stop the pan­dem­ic, sci­en­tists esti­mate that at least 60 per­cent of the pop­u­la­tion — and prob­a­bly more like 75 or 80 per­cent — would need to be vac­ci­nat­ed, a num­ber that depends on many fac­tors, includ­ing the effi­ca­cy of the vac­cine itself and how wide­ly the virus has already spread.

With that in mind, Yahoo News and YouGov have been polling the Amer­i­can peo­ple for the past few months: “If and when a coro­n­avirus vac­cine becomes avail­able, will you get vac­ci­nat­ed?”

The trend lines have been dis­cour­ag­ing.

At first, respons­es were most­ly favor­able. In ear­ly May, 55 per­cent of Amer­i­cans said yes, they would get vac­ci­nat­ed. But that num­ber shrank in each sub­se­quent sur­vey, slip­ping to 50 per­cent in late May and 46 per­cent in ear­ly July.

Now the lat­est Yahoo News/YouGov poll, con­duct­ed July 28 to 30, shows that just 42 per­cent of Amer­i­cans plan to get vac­ci­nat­ed for COVID-19 — the small­est share to date.

The out­look for uni­ver­sal vac­ci­na­tion is cloud­ed by polit­i­cal con­sid­er­a­tions from both sides: skep­ti­cism about med­ical author­i­ty and exper­tise on one side (more com­mon among Trump sup­port­ers), and sus­pi­cions on the oth­er (most­ly on the part of Democ­rats) that the admin­is­tra­tion is cut­ting cor­ners on safe­ty to rush a vac­cine into pro­duc­tion before the elec­tion.

Togeth­er, these forces threat­en to under­mine COVID-19 vac­ci­na­tion in the U.S.

Vac­cines against dif­fer­ent dis­eases vary in their effec­tive­ness. The effi­ca­cy of the measles vac­cine is 95 per­cent to 98 per­cent, which means that If 100 peo­ple who haven’t been exposed to the measles were giv­en that vac­cine, 95 to 98 of them wouldn’t get infect­ed (on aver­age). The effi­ca­cy of the flu vac­cine gen­er­al­ly ranges from 40 per­cent to 60 per­cent. The more effec­tive a vac­cine is, the few­er vac­ci­nat­ed peo­ple it takes to stop a pan­dem­ic. The reverse is also true — as effi­ca­cy falls, cov­er­age must rise.

Last month, the U.S. Food and Drug Admin­is­tra­tion (FDA) said it would be will­ing to approve a COVID-19 can­di­date vac­cine with an effi­ca­cy of 50 per­cent. Such a vac­cine would help slow the virus’s spread, but it prob­a­bly wouldn’t extin­guish the U.S. epi­dem­ic — even if all Amer­i­cans got vac­ci­nat­ed.

If, say, only 42 per­cent of Amer­i­cans got such a vac­cine, then many lives would still be saved. As with the flu vac­cine, some COVID-19 vac­cines may not pre­vent infec­tion entire­ly, but they may still pre­pare a person’s immune sys­tem and lessen symp­toms, pos­si­bly elim­i­nat­ing them entire­ly. Trans­mis­sion would be tamped down.

Even so, the pan­dem­ic would con­tin­ue.

Experts are opti­mistic that the effi­ca­cy of what­ev­er COVID-19 vac­cines emerge will be high­er than 50 per­cent. They’re also hope­ful that uptake — i.e., the per­cent­age of the pop­u­la­tion that agrees to get vac­ci­nat­ed in the near term — will exceed the 42 per­cent who already say they’re on board.

There’s good rea­son for hope. In the Yahoo New/YouGov polls, the num­ber of Amer­i­cans who say they won’t get vac­ci­nat­ed (between 19 and 25 per­cent) is low­er than the num­ber who say they’re not sure (between 26 and 33 per­cent). Togeth­er, the yeses and the not-sures account for about three-quar­ters of the pop­u­la­tion.

Giv­en the unprece­dent­ed speed of the cur­rent devel­op­ment process — it’s pos­si­ble that a COVID-19 vac­cine could arrive three years faster than any pre­vi­ous vac­cine — the public’s anx­i­ety about cut­ting cor­ners is under­stand­able. Over­all, 34 per­cent of Amer­i­cans say they are “very con­cerned” about the safe­ty of “fast-tracked” COVID-19 vac­cines, accord­ing to the lat­est Yahoo News/YouGov sur­vey. Anoth­er 35 per­cent say they are some­what con­cerned.

“Why should we expect Amer­i­cans to agree to a vac­cine before one is even avail­able?” coro­n­avirus expert Natal­ie Dean, an assis­tant pro­fes­sor of bio­sta­tis­tics at the Uni­ver­si­ty of Flori­da, recent­ly wrote in the New York Times. “I’m a vac­cine researcher, and even I would place myself in the ‘not sure’ buck­et. What we have right now is a col­lec­tion of ani­mal data, immune response data and safe­ty data based on ear­ly tri­als and from sim­i­lar vac­cines for oth­er dis­eases. The evi­dence that would con­vince me to get a COVID-19 vac­cine, or to rec­om­mend that my loved ones get vac­ci­nat­ed, does not yet exist.”

Once the large “phase III” or “effi­ca­cy” tri­als that are just get­ting under­way deliv­er such evi­dence, the think­ing goes, then a lot of not-sures will trans­form into yeses. And once a vac­cine that reg­u­la­tors deem safe and effec­tive is actu­al­ly wide­ly avail­able — and once peo­ple see oth­er peo­ple get­ting vac­ci­nat­ed with­out inci­dent — then uptake will snow­ball. A new CBS News poll, for instance, shows that 50 per­cent of Amer­i­cans say they will “wait and see” what hap­pens to oth­ers before get­ting vac­ci­nat­ed them­selves.

“It seems like­ly to me that many activ­i­ties will require a vac­cine, includ­ing many schools and some employ­ers,” data jour­nal­ist Nate Sil­ver recent­ly pre­dict­ed. “If peo­ple see a vac­cine as a tick­et back to nor­mal life, not just for soci­ety but also in a more lit­er­al way for them­selves per­son­al­ly, that could encour­age more vac­ci­na­tion.”

Yet there’s also rea­son to think peo­ple could be swayed in the oppo­site direc­tion — that is, against get­ting vac­ci­nat­ed.

Just look what hap­pened in the lat­est Yahoo News/YouGov poll when Amer­i­cans were asked the same ques­tion — “Will you get vac­ci­nat­ed?” — but this time under var­i­ous (real­is­tic, even like­ly) con­di­tions.

Would you take a vac­cine if it caused side effects such as fever and headaches in one-third of recip­i­ents?

The yeses fell from 42 per­cent to 35 per­cent. The nos soared from 27 per­cent to 40 per­cent. And the not-sures fell from 32 per­cent to 25 per­cent.

Think about that for a sec­ond. Rough­ly 7 per­cent of those who said yes and anoth­er 7 per­cent of those who said they were not sure switched to no after find­ing out they might have a 1 in 3 chance of expe­ri­enc­ing a fever or headache after get­ting inoc­u­lat­ed against a virus that has killed more than 155,000 Amer­i­cans since Feb­ru­ary.

Com­mon side effects, in oth­er words, were enough to trans­form COVID-19 vac­ci­na­tion from some­thing that Amer­i­cans favored by 15 points to some­thing they opposed by 5.

Would you take a vac­cine if it was only 60 per­cent effec­tive at pre­vent­ing COVID-19 infec­tion?

Even more peo­ple said no in this sce­nario: 43 per­cent. Just 34 per­cent said yes and 23 per­cent said they were unsure.

Would you take a vac­cine if it required mul­ti­ple dos­es over a cou­ple of weeks?

This was the most accept­able sce­nario, with the yeses (39 per­cent) and the nos (38 per­cent) even­ly divid­ed. Still, those num­bers rep­re­sent­ed a 3‑point decline for the yeses and an 11-point increase for the nos.

Would you take a vac­cine if it required wait­ing in line for hours at a time or sched­ul­ing an appoint­ment weeks in advance?

Nope — at least not accord­ing to 42 per­cent of Amer­i­cans. Again, just 39 per­cent said yes.

Across the board, infor­ma­tion about the poten­tial down­sides of vac­ci­na­tion — dis­com­fort, incon­ve­nience, less-than-total pro­tec­tion against the virus — reduced the num­ber of peo­ple who said they would get vac­ci­nat­ed by sev­er­al per­cent­age points (3 to 7) while slash­ing the num­ber who said they were unsure by more (7 to 13).

In all cas­es, the nos gained ground.

This sug­gests that Amer­i­cans are just as ready to reject a poten­tial COVID-19 as embrace it — espe­cial­ly because every one of these con­di­tions is more like­ly than not to apply. In fact, all of them might apply at once.

Around one-third of the young, healthy peo­ple dosed with the COVID-19 vac­cine under devel­op­ment by Oxford Uni­ver­si­ty and the drug giant AstraZeneca “expe­ri­enced mod­er­ate or severe chills, fatigue, headache, malaise, and/or fever­ish­ness.”

One of the oth­er most promis­ing vac­cines, from Mod­er­na, seems to require two dos­es.

Again, the FDA’s effi­ca­cy thresh­old is 50 per­cent, which is low­er than 60 per­cent.

And it’s hard to imag­ine how a coun­try that has tak­en six months to admin­is­ter 52 mil­lion COVID-19 tests will be able to quick­ly admin­is­ter 300 mil­lion dos­es of a vac­cine — or 600 mil­lion, if a boost­er is required.

As a recent Wash­ing­ton Post report put it, “Deploy­ing the vac­cine to peo­ple in the Unit­ed States and around the world will test and strain dis­tri­b­u­tion net­works, the sup­ply chain, pub­lic trust and glob­al coop­er­a­tion. It will take months or, more like­ly, years to reach enough peo­ple to make the world safe.”

Giv­en how frag­ile Amer­i­cans’ cur­rent sup­port for COVID-19 vac­ci­na­tion appears to be — a prod­uct, in part, of the tena­cious anti-vac­ci­na­tion move­ment that has tak­en hold in the U.S. dur­ing the past decade or so — trust and coop­er­a­tion may ulti­mate­ly make the dif­fer­ence between a suc­cess­ful vac­cine and an unsuc­cess­ful one.

It’s easy to imag­ine any num­ber of ways that trust could be squan­dered and coop­er­a­tion sab­o­taged — pol­i­tics and polar­iza­tion chief among them.

When asked about safe­ty, near­ly iden­ti­cal num­bers of Repub­li­cans, Democ­rats and inde­pen­dents told Yahoo News and YouGov that they were “very” or “some­what” con­cerned: about 70 per­cent. And even though Democ­rats tend to be about 20 points more like­ly than Repub­li­cans to say they will get vac­ci­nat­ed, Demo­c­ra­t­ic intent to get the vac­cine (down 15 points) has actu­al­ly fall­en more since ear­ly May than Repub­li­can intent (down 10 points).

Why? Prob­a­bly because Democ­rats don’t trust Pres­i­dent Trump to keep pol­i­tics out of the process, con­sid­er­ing that he has tied his reelec­tion hopes to the vac­cine, and the admin­is­tra­tion once announced an Octo­ber (i.e., pre­elec­tion) dead­line for “broad access to the pub­lic.”

Mean­while, only 26 per­cent of those who intend to vote for Trump say they trust experts such as “the Cen­ters for Dis­ease Con­trol and Pre­ven­tion and pub­lic health author­i­ties” to “judge the risks of vac­cines.” Among Joe Biden vot­ers, that num­ber is 68 per­cent.

...

————

“Yahoo News/YouGov coro­n­avirus poll: Num­ber of Amer­i­cans who plan to get vac­ci­nat­ed falls to 42% — a new low” by Andrew Romano; Yahoo News; 08/04/2020

“The out­look for uni­ver­sal vac­ci­na­tion is cloud­ed by polit­i­cal con­sid­er­a­tions from both sides: skep­ti­cism about med­ical author­i­ty and exper­tise on one side (more com­mon among Trump sup­port­ers), and sus­pi­cions on the oth­er (most­ly on the part of Democ­rats) that the admin­is­tra­tion is cut­ting cor­ners on safe­ty to rush a vac­cine into pro­duc­tion before the elec­tion.”

The pub­lic is get­ting sus­pi­cious. Repub­li­cans are sus­pi­cious of the med­ical estab­lish­ment in gen­er­al and Democ­rats are becom­ing rea­son­ably sus­pi­cious that the Trump admin­is­tra­tion is cut­ting cor­ners. Even a pro­fes­sor in bio­sta­tis­tics, Natal­ie Dean, who works in vac­cine research is her­self on the fence as to whether or not she feels safe tak­ing the vac­cine. As a result, around 50 per­cent of Amer­i­cans are tak­ing a “wait and see” approach. But that lev­el of sup­port falls when peo­ple are asked about even typ­i­cal mild vac­cine side effects like fever or a headache. So if Trump announce an “Octo­ber Sur­prise” vac­cine announce­ment there might be some ini­tial cel­e­bra­tions but half of the elec­torate is going to be more skep­ti­cal­ly watch­ing and wait­ing to assess the side-effects that peo­ple tart report­ing:

...
Giv­en the unprece­dent­ed speed of the cur­rent devel­op­ment process — it’s pos­si­ble that a COVID-19 vac­cine could arrive three years faster than any pre­vi­ous vac­cine — the public’s anx­i­ety about cut­ting cor­ners is under­stand­able. Over­all, 34 per­cent of Amer­i­cans say they are “very con­cerned” about the safe­ty of “fast-tracked” COVID-19 vac­cines, accord­ing to the lat­est Yahoo News/YouGov sur­vey. Anoth­er 35 per­cent say they are some­what con­cerned.

“Why should we expect Amer­i­cans to agree to a vac­cine before one is even avail­able?” coro­n­avirus expert Natal­ie Dean, an assis­tant pro­fes­sor of bio­sta­tis­tics at the Uni­ver­si­ty of Flori­da, recent­ly wrote in the New York Times. “I’m a vac­cine researcher, and even I would place myself in the ‘not sure’ buck­et. What we have right now is a col­lec­tion of ani­mal data, immune response data and safe­ty data based on ear­ly tri­als and from sim­i­lar vac­cines for oth­er dis­eases. The evi­dence that would con­vince me to get a COVID-19 vac­cine, or to rec­om­mend that my loved ones get vac­ci­nat­ed, does not yet exist.”

Once the large “phase III” or “effi­ca­cy” tri­als that are just get­ting under­way deliv­er such evi­dence, the think­ing goes, then a lot of not-sures will trans­form into yeses. And once a vac­cine that reg­u­la­tors deem safe and effec­tive is actu­al­ly wide­ly avail­able — and once peo­ple see oth­er peo­ple get­ting vac­ci­nat­ed with­out inci­dent — then uptake will snow­ball. A new CBS News poll, for instance, shows that 50 per­cent of Amer­i­cans say they will “wait and see” what hap­pens to oth­ers before get­ting vac­ci­nat­ed them­selves.

“It seems like­ly to me that many activ­i­ties will require a vac­cine, includ­ing many schools and some employ­ers,” data jour­nal­ist Nate Sil­ver recent­ly pre­dict­ed. “If peo­ple see a vac­cine as a tick­et back to nor­mal life, not just for soci­ety but also in a more lit­er­al way for them­selves per­son­al­ly, that could encour­age more vac­ci­na­tion.”

...

Across the board, infor­ma­tion about the poten­tial down­sides of vac­ci­na­tion — dis­com­fort, incon­ve­nience, less-than-total pro­tec­tion against the virus — reduced the num­ber of peo­ple who said they would get vac­ci­nat­ed by sev­er­al per­cent­age points (3 to 7) while slash­ing the num­ber who said they were unsure by more (7 to 13).

In all cas­es, the nos gained ground.
...

So that’s all got to be fac­tor­ing into the Trump teams vac­cine scheme polit­i­cal cal­cu­lus: Democ­rats don’t trust the Trump’s admin­is­tra­tion’s vac­cine rec­om­men­da­tions and Repub­li­cans does­n’t trust vac­cines or med­ical advice in gen­er­al. That’s how jad­ed Amer­i­ca has become: the thing that unites Amer­i­ca’s hyper-polar­ized elec­torate is a gen­er­al skep­ti­cism and a sense that they’re being mis­led. And as we’re see­ing, a politi­cian needs at least some degree of cred­i­bil­i­ty with the elec­torate they’re try­ing to win over if an Octo­ber Sur­prise stunt of this nature is going to work. In oth­er words, Trump may have already ‘Jumped the Shark’ and be too wide­ly dis­trust­ed out­side of his hard­core base to fea­si­bly pull off ‘Octo­ber Sur­pris­es’ at this point. We’ll find out. Some­time in the next two to three months. Right on ‘sur­prise’ sched­ule.

Here’s a good news/bad news pair of arti­cles with updates on our under­stand­ing of the nature of the SARS-CoV­‑2 virus:

First, the good news. The Wash­ing­ton Post has a recent piece that gives a nice overview of the var­i­ous areas of inquiry relat­ed to the ongo­ing mys­tery of why so many peo­ple infect­ed with the virus are asymp­to­matic — esti­mat­ed to be around 40 per­cent of cas­es — despite the mea­sured preva­lence of peo­ple with anti­bod­ies for SARS-CoV­‑2 being clos­er to sin­gle-dig­its. The focus of much of the cur­rent research explor­ing this obser­va­tion has been on T‑cells and the pos­si­bil­i­ty that many peo­ple who lack anti­bod­ies still have T‑cells. As we’ve seen, in some cas­es these are peo­ple with T‑cell based immu­ni­ty are peo­ple who were infect­ed with SARS-CoV­‑2 but recov­ered and either nev­er devel­oped anti­bod­ies in the first place or had their anti­body lev­els decline with­in a few months of recov­ery. But in oth­er cas­es they are peo­ple who haven’t been exposed to the SARS-CoV­‑2 virus at all and yet still have T‑cells that respond to the virus. It’s thought that expo­sure oth­er com­mon-cold coro­n­avirus­es may be the source of that par­tial immu­ni­ty. Over­all, the find­ings raise the prospect that over­all pub­lic immu­ni­ty towards the virus is actu­al­ly far high­er than the cur­rent anti­body-based esti­mates can mea­sure.

And as the fol­low­ing arti­cle notes, there’s anoth­er new area being inves­ti­gat­ed regard­ing a phe­nom­e­na that also might con­fer at least par­tial immu­ni­ty towards SARS-CoV­‑2: pre­vi­ous vac­ci­na­tions. In one study, researchers found that vac­ci­na­tions with­in the past five years of sev­en vac­cines dif­fer­ent vac­cines appear to low­er the rates of COVID-19 infec­tions. Two vac­cines in par­tic­u­lar had large asso­ci­at­ed with low­er infec­tion rates: Peo­ple who got a pneu­mo­nia vac­cine had a 28 per­cent low­er infec­tion risk and those who got polio vac­cines had a 43 per­cent reduc­tion in risk. It’s the kind of find­ing that rais­es the tan­ta­liz­ing prospect that exist­ing vac­cines, com­bined with exist­ing immu­ni­ty from T‑cells, could push soci­eties to a lev­el of ‘herd immu­ni­ty’ with­out the need for new exper­i­men­tal vac­cines.

Now here’s the bad news: Researchers are also find­ing that obe­si­ty — a known com­pli­ca­tion with the effi­ca­cy of oth­er vac­cines, like the influen­za vac­cine — is also a com­pli­ca­tion with SARS-CoV­‑2. Vac­cines just don’t seem to oper­ate as well in obese peo­ple and it appears to be asso­ci­at­ed with a gen­er­al dys­reg­u­la­tion of the immune sys­tem asso­ci­at­ed with obe­si­ty. And it’s that dys­reg­u­la­tion of the immune sys­tem that also makes the obese more vul­ner­a­ble to the lethal effects of COVID-19 which are induced by the immune sys­tem going hay­wire. In oth­er words, the obese are less like­ly to be pro­tect­ed by a vac­cine at the same time they are more vul­ner­a­ble to get­ting severe­ly ill from the dis­ease.

Ok, first, here’s the Wash­ing­ton Post piece describ­ing the grow­ing num­ber of stud­ies indi­cat­ing T‑cells are play­ing a key role in asymp­to­matic cas­es and gen­er­al­ly con­fer­ring a large­ly unrec­og­nized lev­el of pop­u­la­tion-lev­el par­tial immu­ni­ty. And in addi­tion to com­mon-cold coro­n­avirus­es being a source for those T‑cells it’s also pos­si­ble exist­ing vac­cines for dif­fer­ent virus­es may be sur­pris­ing­ly effec­tive at gen­er­at­ing that T‑cell response which could be a com­plete game-chang­er in how we address this:

The Wash­ing­ton Post

Forty per­cent of peo­ple with coro­n­avirus infec­tions have no symp­toms. Might they be the key to end­ing the pan­dem­ic?
New research sug­gests that some of us may be par­tial­ly pro­tect­ed due to past encoun­ters with com­mon cold coro­n­avirus­es

By Ari­ana Eun­jung Cha
August 8, 2020 at 12:31 p.m. CDT

When researcher Mon­i­ca Gand­hi began dig­ging deep­er into out­breaks of the nov­el coro­n­avirus, she was struck by the extra­or­di­nar­i­ly high num­ber of infect­ed peo­ple who had no symp­toms.

A Boston home­less shel­ter had 147 infect­ed res­i­dents, but 88 per­cent had no symp­toms even though they shared their liv­ing space. A Tyson Foods poul­try plant in Spring­dale, Ark., had 481 infec­tions, and 95 per­cent were asymp­to­matic. Pris­ons in Arkansas, North Car­oli­na, Ohio and Vir­ginia count­ed 3,277 infect­ed peo­ple, but 96 per­cent were asymp­to­matic.

Dur­ing its sev­en-month glob­al ram­page, the coro­n­avirus has claimed more than 700,000 lives. But Gand­hi began to think the big­ger mys­tery might be why it has left so many more prac­ti­cal­ly unscathed.

What was it about these asymp­to­matic peo­ple, who lived or worked so close­ly to oth­ers who fell severe­ly ill, she won­dered, that pro­tect­ed them? Did the “dose” of their viral expo­sure make a dif­fer­ence? Was it genet­ics? Or might some peo­ple already have par­tial resis­tance to the virus, con­trary to our ini­tial under­stand­ing?

Efforts to under­stand the diver­si­ty in the ill­ness are final­ly begin­ning to yield results, rais­ing hope the knowl­edge will help accel­er­ate devel­op­ment of vac­cines and ther­a­pies — or pos­si­bly even cre­ate new path­ways toward herd immu­ni­ty in which enough of the pop­u­la­tion devel­ops a mild ver­sion of the virus that they block fur­ther spread and the pan­dem­ic ends.

“A high rate of asymp­to­matic infec­tion is a good thing,” said Gand­hi, an infec­tious-dis­ease spe­cial­ist at the Uni­ver­si­ty of Cal­i­for­nia at San Fran­cis­co. “It’s a good thing for the indi­vid­ual and a good thing for soci­ety.”

The coro­n­avirus has left numer­ous clues — the uneven trans­mis­sion in dif­fer­ent parts of the world, the most­ly mild impact on chil­dren. Per­haps most tan­ta­liz­ing is the unusu­al­ly large pro­por­tion of infect­ed peo­ple with no symp­toms. The Cen­ters for Dis­ease Con­trol and Pre­ven­tion last month esti­mat­ed that rate at about 40 per­cent.

Those clues have sent sci­en­tists off in dif­fer­ent direc­tions: Some are look­ing into the role of the recep­tor cells, which the virus uses to infil­trate the body, to bet­ter under­stand the role that age and genet­ics might play. Oth­ers are delv­ing into face masks and whether they may fil­ter just enough of the virus so that those wear­ing them had mild cas­es or no symp­toms at all.

The the­o­ry that has gen­er­at­ed the most excite­ment in recent weeks is that some peo­ple walk­ing among us might already have par­tial immu­ni­ty.

When SARS-CoV­‑2 was first iden­ti­fied on Dec. 31, 2019, pub­lic health offi­cials deemed it a “nov­el” virus because it was the first time it had been seen in humans who pre­sum­ably had no immu­ni­ty from it what­so­ev­er. There’s now some very ear­ly, ten­ta­tive evi­dence sug­gest­ing that assump­tion might have been wrong.

One mind-blow­ing hypoth­e­sis — bol­stered by a flur­ry of recent stud­ies — is that a seg­ment of the world’s pop­u­la­tion may have par­tial pro­tec­tion thanks to “mem­o­ry” T cells, the part of our immune sys­tem trained to rec­og­nize spe­cif­ic invaders. This could orig­i­nate from cross pro­tec­tion derived from stan­dard child­hood vac­ci­na­tions. Or, as a paper pub­lished Tues­day in Sci­ence sug­gest­ed, it could trace back to pre­vi­ous encoun­ters with oth­er coro­n­avirus­es, such as those that cause the com­mon cold.

“This might poten­tial­ly explain why some peo­ple seem to fend off the virus and may be less sus­cep­ti­ble to becom­ing severe­ly ill,” Nation­al Insti­tutes of Health Direc­tor Fran­cis Collins remarked in a blog post this past week.

On a pop­u­la­tion lev­el, such find­ings, if val­i­dat­ed, could be far-reach­ing.

Hans-Gustaf Ljung­gren, a researcher at Sweden’s Karolin­s­ka Insti­tute, and oth­ers have sug­gest­ed that pub­lic immu­ni­ty to the coro­n­avirus could be sig­nif­i­cant­ly high­er than what has been sug­gest­ed by serol­o­gy stud­ies. In com­mu­ni­ties in Boston, Barcelona, Wuhan and oth­er major cities, the pro­por­tion of peo­ple esti­mat­ed to have anti­bod­ies and there­fore pre­sum­ably be immune has most­ly been in the sin­gle dig­its. But if oth­ers had par­tial pro­tec­tion from T cells, that would raise a community’s immu­ni­ty lev­el much high­er.

This, Ljung­gren said, would be “very good news from a pub­lic health per­spec­tive.”

Some experts have gone so far as to spec­u­late whether some sur­pris­ing recent trends in the epi­demi­ol­o­gy of the coro­n­avirus — the drop in infec­tion rates in Swe­den where there have been no wide­spread lock­downs or mask require­ments, or the high rates of infec­tion in Mumbai’s poor areas but lit­tle seri­ous dis­ease — might be due to pre­ex­ist­ing immu­ni­ty.

Oth­ers say it’s far too ear­ly to draw such con­clu­sions. Antho­ny S. Fau­ci, the Unit­ed States’ top infec­tious-dis­ease expert, said in an inter­view that while these ideas are being intense­ly stud­ied, such the­o­ries are pre­ma­ture. He agreed that at least some par­tial pre­ex­ist­ing immu­ni­ty in some indi­vid­u­als seems a pos­si­bil­i­ty.

And he said the amount of virus some­one is exposed to — called the inocu­lum — “is almost cer­tain­ly an impor­tant and like­ly fac­tor” based on what we know about oth­er virus­es.

But Fau­ci cau­tioned there are mul­ti­ple like­ly rea­sons — includ­ing youth and gen­er­al health — that deter­mine whether a par­tic­u­lar indi­vid­ual shrugs off the dis­ease or dies of it. He also empha­sized that even those with mild ill­ness may have lin­ger­ing med­ical issues.

That rein­forces the need, in his view, for con­tin­ued vig­i­lance in social dis­tanc­ing, mask­ing and oth­er pre­cau­tions.

...

Immune mem­o­ry machine

News head­lines have tout­ed the idea based on blood tests that 20 per­cent of some New York com­mu­ni­ties might be immune, 7.3 per­cent in Stock­holm, 7.1 per­cent in Barcelona. Those num­bers come from look­ing at anti­bod­ies in people’s blood that typ­i­cal­ly devel­op after they are exposed to a virus. But sci­en­tists believe anoth­er part of our immune sys­tem — T cells, a type of white blood cell that orches­trates the entire immune sys­tem — could be even more impor­tant in fight­ing against the coro­n­avirus.

Recent stud­ies have sug­gest­ed that anti­bod­ies from the coro­n­avirus seem to stick around for only two to three months in some peo­ple. While work on T cells and the coro­n­avirus is only get­ting start­ed — test­ing T cells is much more labo­ri­ous than anti­body test­ing — pre­vi­ous research has shown that, in gen­er­al, T cells tend to last years longer.

One of the first peer-reviewed stud­ies on the coro­n­avirus and T cells was pub­lished in mid-May in the jour­nal Cell by Alessan­dro Sette, Shane Crot­ty and oth­ers at the La Jol­la Insti­tute for Immunol­o­gy near San Diego.

The group was research­ing blood from peo­ple who were recov­er­ing from coro­n­avirus infec­tions and want­ed to com­pare that to sam­ples from unin­fect­ed con­trols who were donors to a blood bank from 2015 to 2018. The researchers were floored to find that in 40 to 60 per­cent of the old sam­ples, the T cells seemed to rec­og­nize SARS-CoV­‑2.

“The virus didn’t even exist back then, so to have this immune response was remark­able,” Sette said.

Research teams from five oth­er loca­tions report­ed sim­i­lar find­ings. In a study from the Nether­lands, T cells react­ed to the virus in 20 per­cent of the sam­ples. In Ger­many, 34 per­cent. In Sin­ga­pore, 50 per­cent.

The dif­fer­ent teams hypoth­e­sized this could be due to pre­vi­ous expo­sure to sim­i­lar pathogens. Per­haps for­tu­itous­ly, SARS-CoV­‑2 is part of a large fam­i­ly of virus­es. Two of them — SARS and MERS — are dead­ly and led to rel­a­tive­ly brief and con­tained out­breaks. Four oth­er coro­n­avirus vari­ants, which cause the com­mon cold, cir­cu­late wide­ly each year but typ­i­cal­ly result in only mild symp­toms. Sette calls them the “less-evil cousins of SARS-CoV­‑2.”

This week, Sette and oth­ers from the team report­ed new research in Sci­ence pro­vid­ing evi­dence the T cell respons­es may derive in part from mem­o­ry of “com­mon cold” coro­n­avirus­es.

...

Inter­est­ing­ly, the researchers not­ed in their paper, the strongest reac­tion they saw was against the spike pro­teins that the virus uses to gain access to cells — sug­gest­ing that few­er viral copies get past these defens­es.

“The cur­rent mod­el assumes you are either pro­tect­ed or you are not — that it’s a yes or no thing,” Sette added. “But if some peo­ple have some lev­el of pre­ex­ist­ing immu­ni­ty, that may sug­gest it’s not a switch but more con­tin­u­ous.”

Child­hood vac­cines

Near­ly 2,000 miles away, at the Mayo Clin­ic in Rochester, Minn., Andrew Badley was zero­ing in the pos­si­ble pro­tec­tive effects of vac­cines.

Team­ing up with data experts from nfer­ence, a com­pa­ny that man­ages their clin­i­cal data, he and oth­er sci­en­tists looked at records from 137,037 patients treat­ed at the health sys­tem to look for rela­tion­ships between vac­ci­na­tions and coro­n­avirus infec­tion.

They knew that the vac­cine for small­pox, for exam­ple, had been shown to pro­tect against measles and whoop­ing cough. Today, a num­ber of exist­ing vac­cines are being stud­ied to see if any might offer cross-pro­tec­tion against SARS-CoV­‑2.

The results were intrigu­ing: Sev­en types of vac­cines giv­en one, two or five years in the past were asso­ci­at­ed with hav­ing a low­er rate of infec­tion with the new coro­n­avirus. Two vac­cines in par­tic­u­lar seemed to show stronger links: Peo­ple who got a pneu­mo­nia vac­cine in the recent past appeared to have a 28 per­cent reduc­tion in coro­n­avirus risk. Those who got polio vac­cines had a 43 per­cent reduc­tion in risk.

Venky Soundarara­jan, chief sci­en­tif­ic offi­cer of nfer­ence, remem­bers when he first saw how large the reduc­tion appeared to be, he imme­di­ate­ly picked up his phone and called Badley: “I said, ‘Is this even pos­si­ble?’”

The team looked at dozens of oth­er pos­si­ble expla­na­tions for the dif­fer­ence. They adjust­ed for geo­graph­ic inci­dence of the coro­n­avirus, demo­graph­ics, comor­bidi­ties, even whether peo­ple had had mam­mo­grams or colono­scopies under the assump­tion that peo­ple who got pre­ven­tive care might be more apt to social dis­tance. But the risk reduc­tion still remained large.

“This sur­prised us com­plete­ly,” Soundarara­jan recalled. “Going in we didn’t expect any­thing or maybe one or two vac­cines show­ing mod­est lev­els of pro­tec­tion.”

The study is only obser­va­tion­al and can­not show a causal link by design, but Mayo researchers are look­ing at a way to quan­ti­fy the activ­i­ty of these vac­cines on the coro­n­avirus to serve as a bench­mark to the new vac­cines being cre­at­ed by com­pa­nies such as Mod­er­na. If exist­ing vac­cines appear as pro­tec­tive as new ones under devel­op­ment, he said, they could change the world’s whole vac­cine strat­e­gy.

Genet­ics and biol­o­gy

At NIH head­quar­ters in Bethes­da, Md., mean­while, Alkis Togias has been laser-focused on one group of the mild­ly impact­ed: chil­dren. He won­dered if it might have some­thing to do with the recep­tor known as ACE2, through which the virus hitch­hikes into the body.

In healthy peo­ple, the ACE2 recep­tors per­form the impor­tant func­tion of keep­ing blood pres­sure sta­ble. The nov­el coro­n­avirus latch­es itself to ACE2, where it repli­cates. Phar­ma­ceu­ti­cal com­pa­nies are try­ing to fig­ure out how to min­i­mize the recep­tors or to trick the virus into attach­ing itself to a drug so it doesn’t repli­cate and trav­el through­out the body.

Was it pos­si­ble, Togias asked, that chil­dren nat­u­ral­ly expressed the recep­tor in a way that makes them less vul­ner­a­ble to infec­tion?

He said recent papers have pro­duced coun­ter­in­tu­itive find­ings about one sub­group of chil­dren — those with a lot of aller­gies and asth­ma. The ACE2 recep­tors in those chil­dren were dimin­ished, and when they were exposed to an aller­gen such as cat hair, the recep­tors were fur­ther reduced. Those find­ings, com­bined with data from hos­pi­tals show­ing that asth­ma did not seem to be a risk fac­tor for the res­pi­ra­to­ry virus, as expect­ed, have intrigued researchers.

“We are think­ing aller­gic reac­tions may pro­tect you by down-reg­u­lat­ing the recep­tor,” he said. “It’s only a the­o­ry of course.”

Togias, who is in charge of air­way biol­o­gy for the Nation­al Insti­tute of Aller­gy and Infec­tious Dis­eases, is look­ing at how those recep­tors seem to be expressed dif­fer­ent­ly as peo­ple age, as part of a study of 2,000 U.S. fam­i­lies. By com­par­ing those dif­fer­ences and immune respons­es with­in fam­i­lies, they hope to be able to bet­ter under­stand the recep­tors’ role.

Sep­a­rate­ly, a num­ber of genet­ic stud­ies show vari­a­tions in genes asso­ci­at­ed with ACE2 with peo­ple from cer­tain geo­graph­ic areas, such as Italy and parts of Asia, hav­ing dis­tinct muta­tions. No one knows what sig­nif­i­cance, if any, these dif­fer­ences have on infec­tion, but it’s an active area of dis­cus­sion in the sci­en­tif­ic com­mu­ni­ty.

Masks

Before the pan­dem­ic, Gand­hi, the Uni­ver­si­ty of Cal­i­for­nia researcher, spe­cial­ized in HIV. But like oth­er infec­tious-dis­ease experts these days, she has spent many of her wak­ing hours think­ing about the coro­n­avirus. And in scru­ti­niz­ing the data on out­breaks one day, she noticed what might be a pat­tern: Peo­ple were wear­ing masks in the set­tings with the high­est per­cent­age of asymp­to­matic cas­es.

The num­bers on two cruise ships were espe­cial­ly strik­ing. In the Dia­mond Princess, where masks weren’t used and the virus was like­ly to have roamed free, 47 per­cent of those test­ed were asymp­to­matic. But in the Antarc­tic-bound Argen­tine cruise ship, where an out­break hit in mid-March and sur­gi­cal masks were giv­en to all pas­sen­gers and N95 masks to the crew, 81 per­cent were asymp­to­matic.

Sim­i­lar­ly high rates of asymp­to­matic infec­tion were doc­u­ment­ed at a pedi­atric dial­y­sis unit in Indi­ana, a seafood plant in Ore­gon and a hair salon in Mis­souri, all of which used masks. Gand­hi was also intrigued by coun­tries such as Sin­ga­pore, Viet­nam and the Czech Repub­lic that had pop­u­la­tion-lev­el mask­ing.

“They got cas­es,” she not­ed, “but few­er deaths.”

The sci­en­tif­ic lit­er­a­ture on viral dose goes back to around 1938 when sci­en­tists began to find evi­dence that being exposed to one copy of a virus is more eas­i­ly over­come than being exposed to a bil­lion copies. Researchers refer to the infec­tious dose as ID50 — or the dose at which 50 per­cent of the pop­u­la­tion would become infect­ed.

While we don’t know what that lev­el might be for the coro­n­avirus (it would be uneth­i­cal to expose humans in this way), pre­vi­ous work on oth­er non­lethal virus­es showed that peo­ple tend to get less sick with low­er dos­es and more sick with high­er dos­es. A study pub­lished in late May involv­ing ham­sters, masks and SARS-CoV­‑2 found those giv­en cov­er­ings had milder cas­es than those who did not get them.

In an arti­cle pub­lished this month in the Jour­nal of Gen­er­al Inter­nal Med­i­cine, Gand­hi not­ed that in some out­breaks ear­ly in the pan­dem­ic in which most peo­ple did not wear masks, 15 per­cent of the infect­ed were asymp­to­matic. But lat­er on, when peo­ple began wear­ing masks, the rate of asymp­to­matic peo­ple was 40 to 45 per­cent.

She said the evi­dence points to masks not just pro­tect­ing oth­ers — as U.S. health offi­cials empha­size — but pro­tect­ing the wear­er as well. Gand­hi makes the con­tro­ver­sial argu­ment that while we’ve most­ly talked about asymp­to­matic infec­tions as ter­ri­fy­ing due to how peo­ple can spread the virus unwit­ting­ly, it could end up being a good thing.

“It is an intrigu­ing hypoth­e­sis that asymp­to­matic infec­tion trig­ger­ing immu­ni­ty may lead us to get more pop­u­la­tion-lev­el immu­ni­ty,” Gand­hi said. “That itself will lim­it spread.”

———–

“Forty per­cent of peo­ple with coro­n­avirus infec­tions have no symp­toms. Might they be the key to end­ing the pan­dem­ic?” by Ari­ana Eun­jung Cha; The Wash­ing­ton Post; 08/08/2020

“Efforts to under­stand the diver­si­ty in the ill­ness are final­ly begin­ning to yield results, rais­ing hope the knowl­edge will help accel­er­ate devel­op­ment of vac­cines and ther­a­pies — or pos­si­bly even cre­ate new path­ways toward herd immu­ni­ty in which enough of the pop­u­la­tion devel­ops a mild ver­sion of the virus that they block fur­ther spread and the pan­dem­ic ends.”

New path­ways to herd immu­ni­ty sure would be a wel­come devel­op­ment, espe­cial­ly giv­en the low prob­a­bil­i­ty that a new effec­tive SARS-CoV­‑2 vac­cine is going to be wide­ly avail­able any time soon. And under­stand­ing why it is that around 40 per­cent of infect­ed peo­ple don’t show symp­toms is turn­ing out to be key for devel­op­ing those new herd immu­ni­ty strate­gies:

...
The coro­n­avirus has left numer­ous clues — the uneven trans­mis­sion in dif­fer­ent parts of the world, the most­ly mild impact on chil­dren. Per­haps most tan­ta­liz­ing is the unusu­al­ly large pro­por­tion of infect­ed peo­ple with no symp­toms. The Cen­ters for Dis­ease Con­trol and Pre­ven­tion last month esti­mat­ed that rate at about 40 per­cent.

...

One mind-blow­ing hypoth­e­sis — bol­stered by a flur­ry of recent stud­ies — is that a seg­ment of the world’s pop­u­la­tion may have par­tial pro­tec­tion thanks to “mem­o­ry” T cells, the part of our immune sys­tem trained to rec­og­nize spe­cif­ic invaders. This could orig­i­nate from cross pro­tec­tion derived from stan­dard child­hood vac­ci­na­tions. Or, as a paper pub­lished Tues­day in Sci­ence sug­gest­ed, it could trace back to pre­vi­ous encoun­ters with oth­er coro­n­avirus­es, such as those that cause the com­mon cold.

...

Hans-Gustaf Ljung­gren, a researcher at Sweden’s Karolin­s­ka Insti­tute, and oth­ers have sug­gest­ed that pub­lic immu­ni­ty to the coro­n­avirus could be sig­nif­i­cant­ly high­er than what has been sug­gest­ed by serol­o­gy stud­ies. In com­mu­ni­ties in Boston, Barcelona, Wuhan and oth­er major cities, the pro­por­tion of peo­ple esti­mat­ed to have anti­bod­ies and there­fore pre­sum­ably be immune has most­ly been in the sin­gle dig­its. But if oth­ers had par­tial pro­tec­tion from T cells, that would raise a community’s immu­ni­ty lev­el much high­er.

...

Immune mem­o­ry machine

News head­lines have tout­ed the idea based on blood tests that 20 per­cent of some New York com­mu­ni­ties might be immune, 7.3 per­cent in Stock­holm, 7.1 per­cent in Barcelona. Those num­bers come from look­ing at anti­bod­ies in people’s blood that typ­i­cal­ly devel­op after they are exposed to a virus. But sci­en­tists believe anoth­er part of our immune sys­tem — T cells, a type of white blood cell that orches­trates the entire immune sys­tem — could be even more impor­tant in fight­ing against the coro­n­avirus.

Recent stud­ies have sug­gest­ed that anti­bod­ies from the coro­n­avirus seem to stick around for only two to three months in some peo­ple. While work on T cells and the coro­n­avirus is only get­ting start­ed — test­ing T cells is much more labo­ri­ous than anti­body test­ing — pre­vi­ous research has shown that, in gen­er­al, T cells tend to last years longer.

...

Research teams from five oth­er loca­tions report­ed sim­i­lar find­ings. In a study from the Nether­lands, T cells react­ed to the virus in 20 per­cent of the sam­ples. In Ger­many, 34 per­cent. In Sin­ga­pore, 50 per­cent.
...

But it’s the prospect of exist­ing vac­cines — vac­cines that have already been thor­ough­ly test­ed for safe­ty with risk pro­files that are large­ly well under­stood — that is per­haps the most excit­ing. If a new round of polio or pneu­mo­nia vac­cines can gen­er­ate immune respons­es in peo­ple who don’t already have T‑cells that would allow us to start vac­ci­nat­ing vul­ner­a­ble pop­u­la­tions right now:

...
Child­hood vac­cines

Near­ly 2,000 miles away, at the Mayo Clin­ic in Rochester, Minn., Andrew Badley was zero­ing in the pos­si­ble pro­tec­tive effects of vac­cines.

Team­ing up with data experts from nfer­ence, a com­pa­ny that man­ages their clin­i­cal data, he and oth­er sci­en­tists looked at records from 137,037 patients treat­ed at the health sys­tem to look for rela­tion­ships between vac­ci­na­tions and coro­n­avirus infec­tion.

They knew that the vac­cine for small­pox, for exam­ple, had been shown to pro­tect against measles and whoop­ing cough. Today, a num­ber of exist­ing vac­cines are being stud­ied to see if any might offer cross-pro­tec­tion against SARS-CoV­‑2.

The results were intrigu­ing: Sev­en types of vac­cines giv­en one, two or five years in the past were asso­ci­at­ed with hav­ing a low­er rate of infec­tion with the new coro­n­avirus. Two vac­cines in par­tic­u­lar seemed to show stronger links: Peo­ple who got a pneu­mo­nia vac­cine in the recent past appeared to have a 28 per­cent reduc­tion in coro­n­avirus risk. Those who got polio vac­cines had a 43 per­cent reduc­tion in risk.

...

The study is only obser­va­tion­al and can­not show a causal link by design, but Mayo researchers are look­ing at a way to quan­ti­fy the activ­i­ty of these vac­cines on the coro­n­avirus to serve as a bench­mark to the new vac­cines being cre­at­ed by com­pa­nies such as Mod­er­na. If exist­ing vac­cines appear as pro­tec­tive as new ones under devel­op­ment, he said, they could change the world’s whole vac­cine strat­e­gy.
...

The more we learn, the more it looks like this virus is much more wide­spread than pre­vi­ous­ly rec­og­nized but so is immu­ni­ty for the virus, even if it’s just par­tial immu­ni­ty. All in all it’s very good news.

Now here’s the bad news. And it’s the kind of bad news that could be blunt the good news for one par­tic­u­lar demo­graph­ic. And it’s a demo­graph­ic that com­pris­es a large per­cent of the US pop­u­la­tion: those who are over­weight or obese. As past vac­cine research as demon­strat­ed, vac­cines sim­ply don’t seem to work as well in the obese. The rea­sons aren’t entire­ly under­stood but it appears the pro-inflam­ma­to­ry sig­nal­ing mol­e­cules secret­ed by fat cells end up dys­reg­u­lat­ing the immune response in obese peo­ple. And that dys­reg­u­la­tion ends up make the obese less like­ly to devel­op an effec­tive immune response and more vul­ner­a­ble to viral infec­tions in gen­er­al:

CNN

US obe­si­ty epi­dem­ic could under­mine effec­tive­ness of a Covid-19 vac­cine

By Sarah Var­ney, Kaiser Health News
Updat­ed 4:01 AM ET, Wed August 5, 2020

(Kaiser Health News)For a world crip­pled by the coro­n­avirus, sal­va­tion hinges on a vac­cine.

But in the Unit­ed States, where at least 4.6 mil­lion peo­ple have been infect­ed and near­ly 155,000 have died, the promise of that vac­cine is ham­pered by a vex­ing epi­dem­ic that long pre­ced­ed Covid-19: obe­si­ty.

Sci­en­tists know that vac­cines engi­neered to pro­tect the pub­lic from influen­za, hepati­tis B, tetanus and rabies can be less effec­tive in obese adults than in the gen­er­al pop­u­la­tion, leav­ing them more vul­ner­a­ble to infec­tion and ill­ness. There is lit­tle rea­son to believe, obe­si­ty researchers say, that Covid-19 vac­cines will be any dif­fer­ent.

“Will we have a Covid vac­cine next year tai­lored to the obese? No way,” said Raz Shaikh, an asso­ciate pro­fes­sor of nutri­tion at the Uni­ver­si­ty of North Car­oli­na-Chapel Hill.

“Will it still work in the obese? Our pre­dic­tion is no.”

More than 107 mil­lion Amer­i­can adults are obese, and their abil­i­ty to return safe­ly to work, care for their fam­i­lies and resume dai­ly life could be cur­tailed if the coro­n­avirus vac­cine deliv­ers weak immu­ni­ty for them.

In March, still ear­ly in the glob­al pan­dem­ic, a lit­tle-noticed study from Chi­na found that heav­ier Chi­nese patients afflict­ed with Covid-19 were more like­ly to die than lean­er ones, sug­gest­ing a per­ilous future await­ed the US, whose pop­u­la­tion is among the heav­i­est in the world.

And then that future arrived.

As inten­sive care units in New York, New Jer­sey and else­where filled with patients, the fed­er­al Cen­ters for Dis­ease Con­trol and Pre­ven­tion warned that obese peo­ple with a body mass index of 40 or more — known as mor­bid obe­si­ty or about 100 pounds over­weight — were among the groups at high­est risk of becom­ing severe­ly ill with Covid-19. About 9% of Amer­i­can adults are in that cat­e­go­ry.

As weeks passed and a clear­er pic­ture of who was being hos­pi­tal­ized came into focus, fed­er­al health offi­cials expand­ed their warn­ing to include peo­ple with a body mass index of 30 or more. That vast­ly expand­ed the ranks of those con­sid­ered vul­ner­a­ble to the most severe cas­es of infec­tion, to 42.4% of Amer­i­can adults.

Obe­si­ty interef­eres with immune response

Obe­si­ty has long been known to be a sig­nif­i­cant risk fac­tor for death from car­dio­vas­cu­lar dis­ease and can­cer. But sci­en­tists in the emerg­ing field of immunome­tab­o­lism are find­ing obe­si­ty also inter­feres with the body’s immune response, putting obese peo­ple at greater risk of infec­tion from pathogens such as influen­za and the nov­el coro­n­avirus.

In the case of influen­za, obe­si­ty has emerged as a fac­tor mak­ing it more dif­fi­cult to vac­ci­nate adults against infec­tion. The ques­tion is whether that will hold true for Covid-19.

A healthy immune sys­tem turns inflam­ma­tion on and off as need­ed, call­ing on white blood cells and send­ing out pro­teins to fight infec­tion. Vac­cines har­ness that inflam­ma­to­ry response. But blood tests show that obese peo­ple and peo­ple with relat­ed meta­bol­ic risk fac­tors such as high blood pres­sure and ele­vat­ed blood sug­ar lev­els expe­ri­ence a state of chron­ic mild inflam­ma­tion; the inflam­ma­tion turns on and stays on.

Adi­pose tis­sue — or fat — in the bel­ly, the liv­er and oth­er organs is not inert; it con­tains spe­cial­ized cells that send out mol­e­cules, like the hor­mone lep­tin, that sci­en­tists sus­pect induces this chron­ic state of inflam­ma­tion. While the exact bio­log­i­cal mech­a­nisms are still being inves­ti­gat­ed, chron­ic inflam­ma­tion seems to inter­fere with the immune response to vac­cines, pos­si­bly sub­ject­ing obese peo­ple to pre­ventable ill­ness­es even after vac­ci­na­tion.

...

Evi­dence that obese peo­ple have a blunt­ed response to com­mon vac­cines was first observed in 1985 when obese hos­pi­tal employ­ees who received the hepati­tis B vac­cine showed a sig­nif­i­cant decline in pro­tec­tion 11 months lat­er that was not observed in non-obese employ­ees. The find­ing was repli­cat­ed in a fol­low-up study that used longer nee­dles to ensure the vac­cine was inject­ed into mus­cle and not fat.

Researchers found sim­i­lar prob­lems with the hepati­tis A vac­cine, and oth­er stud­ies have found sig­nif­i­cant declines in the anti­body pro­tec­tion induced by tetanus and rabies vac­cines in obese peo­ple.

“Obe­si­ty is a seri­ous glob­al prob­lem, and the sub­op­ti­mal vac­cine-induced immune respons­es observed in the obese pop­u­la­tion can­not be ignored,” plead­ed researchers from the Mayo Clin­ic’s Vac­cine Research Group in a 2015 study pub­lished in the jour­nal Vac­cine.

Vac­cines also are known to be less effec­tive in old­er adults, which is why those 65 and old­er receive a super­charged annu­al influen­za vac­cine that con­tains far more flu virus anti­gens to help juice up their immune response.

By con­trast, the dimin­ished pro­tec­tion of the obese pop­u­la­tion — both adults and chil­dren — has been large­ly ignored.

“I’m not entire­ly sure why vac­cine effi­ca­cy in this pop­u­la­tion has­n’t been more well report­ed,” said Cather­ine Ander­sen, an assis­tant pro­fes­sor of biol­o­gy at Fair­field Uni­ver­si­ty who stud­ies obe­si­ty and meta­bol­ic dis­eases. “It’s a missed oppor­tu­ni­ty for greater pub­lic health inter­ven­tion.”

In 2017, sci­en­tists at the Uni­ver­si­ty of North Car­oli­na — Chapel Hill pro­vid­ed a crit­i­cal clue about the lim­i­ta­tions of the influen­za vac­cine. In a paper pub­lished in the Inter­na­tion­al Jour­nal of Obe­si­ty, researchers showed for the first time that vac­ci­nat­ed obese adults were twice as like­ly to devel­op influen­za or flu-like ill­ness com­pared with adults of a healthy weight.

Curi­ous­ly, the study found that adults with obe­si­ty did pro­duce a pro­tec­tive lev­el of anti­bod­ies to the influen­za vac­cine, but these adults still respond­ed poor­ly.

“That was the mys­tery,” said Chad Petit, an influen­za virol­o­gist at the Uni­ver­si­ty of Alaba­ma.

One hypoth­e­sis, Petit said, is that obe­si­ty may trig­ger a meta­bol­ic dys­reg­u­la­tion of T cells, white blood cells crit­i­cal to the immune response. “It’s not insur­mount­able,” said Petit, who is research­ing Covid-19 in obese patients. “We can design bet­ter vac­cines that might over­come this dis­crep­an­cy.”

His­tor­i­cal­ly, peo­ple with high BMIs often have been exclud­ed from drug tri­als because they fre­quent­ly have relat­ed chron­ic con­di­tions that might mask the results. The clin­i­cal tri­als under­way to test the safe­ty and effi­ca­cy of a coro­n­avirus vac­cine do not have a BMI exclu­sion and will include peo­ple with obe­si­ty, said Dr. Lar­ry Corey, of the Fred Hutchin­son Can­cer Research Cen­ter, who is over­see­ing the phase III tri­als spon­sored by the Nation­al Insti­tutes of Health.

Although tri­al coor­di­na­tors are not specif­i­cal­ly focused on obe­si­ty as a poten­tial com­pli­ca­tion, Corey said, par­tic­i­pants’ BMI will be doc­u­ment­ed and results eval­u­at­ed.

Dr. Tim­o­thy Gar­vey, an endocri­nol­o­gist and direc­tor of dia­betes research at the Uni­ver­si­ty of Alaba­ma, was among those who stressed that, despite the lin­ger­ing ques­tions, it’s still safer for obese peo­ple to get vac­ci­nat­ed than not.

“The influen­za vac­cine still works in patients with obe­si­ty, but just not as well,” Gar­vey said. “We still want them to get vac­ci­nat­ed.”

————

“US obe­si­ty epi­dem­ic could under­mine effec­tive­ness of a Covid-19 vac­cine” by Sarah Var­ney; Kaiser Health News; 08/05/2020

“Sci­en­tists know that vac­cines engi­neered to pro­tect the pub­lic from influen­za, hepati­tis B, tetanus and rabies can be less effec­tive in obese adults than in the gen­er­al pop­u­la­tion, leav­ing them more vul­ner­a­ble to infec­tion and ill­ness. There is lit­tle rea­son to believe, obe­si­ty researchers say, that Covid-19 vac­cines will be any dif­fer­ent.”

There is lit­tle rea­son to believe, obe­si­ty researchers say, that Covid-19 vac­cines will be any dif­fer­ent. Unfor­tu­nate­ly. As a result, there’s no rea­son to assume we’re going to be able to assume there’s going to be a high­ly effec­tive COVID-19 vac­cine avail­able for obese indi­vid­u­als even are a vac­cine is final­ly devel­oped and made wide­ly avail­able. Yes, the vac­cine might be par­tial­ly effec­tive which is cer­tain­ly a lot bet­ter than noth­ing. But the high­ly effi­ca­cious vac­cine that many are hop­ing for sim­ply might not be an option for the obese, which is a very large por­tion of the US pop­u­la­tion:

...
“Will we have a Covid vac­cine next year tai­lored to the obese? No way,” said Raz Shaikh, an asso­ciate pro­fes­sor of nutri­tion at the Uni­ver­si­ty of North Car­oli­na-Chapel Hill.

“Will it still work in the obese? Our pre­dic­tion is no.”

...

In March, still ear­ly in the glob­al pan­dem­ic, a lit­tle-noticed study from Chi­na found that heav­ier Chi­nese patients afflict­ed with Covid-19 were more like­ly to die than lean­er ones, sug­gest­ing a per­ilous future await­ed the US, whose pop­u­la­tion is among the heav­i­est in the world.

...

In 2017, sci­en­tists at the Uni­ver­si­ty of North Car­oli­na — Chapel Hill pro­vid­ed a crit­i­cal clue about the lim­i­ta­tions of the influen­za vac­cine. In a paper pub­lished in the Inter­na­tion­al Jour­nal of Obe­si­ty, researchers showed for the first time that vac­ci­nat­ed obese adults were twice as like­ly to devel­op influen­za or flu-like ill­ness com­pared with adults of a healthy weight.

Curi­ous­ly, the study found that adults with obe­si­ty did pro­duce a pro­tec­tive lev­el of anti­bod­ies to the influen­za vac­cine, but these adults still respond­ed poor­ly.

“That was the mys­tery,” said Chad Petit, an influen­za virol­o­gist at the Uni­ver­si­ty of Alaba­ma.

One hypoth­e­sis, Petit said, is that obe­si­ty may trig­ger a meta­bol­ic dys­reg­u­la­tion of T cells, white blood cells crit­i­cal to the immune response. “It’s not insur­mount­able,” said Petit, who is research­ing Covid-19 in obese patients. “We can design bet­ter vac­cines that might over­come this dis­crep­an­cy.”
...

But there’s still one bit of good news that could come from this find­ing: maybe the issues of obe­si­ty and vac­ci­na­tion will final­ly be ade­quate­ly stud­ied:

...
Vac­cines also are known to be less effec­tive in old­er adults, which is why those 65 and old­er receive a super­charged annu­al influen­za vac­cine that con­tains far more flu virus anti­gens to help juice up their immune response.

By con­trast, the dimin­ished pro­tec­tion of the obese pop­u­la­tion — both adults and chil­dren — has been large­ly ignored.

“I’m not entire­ly sure why vac­cine effi­ca­cy in this pop­u­la­tion has­n’t been more well report­ed,” said Cather­ine Ander­sen, an assis­tant pro­fes­sor of biol­o­gy at Fair­field Uni­ver­si­ty who stud­ies obe­si­ty and meta­bol­ic dis­eases. “It’s a missed oppor­tu­ni­ty for greater pub­lic health inter­ven­tion.”
...

And that’s all why alter­na­tive path­ways to herd immu­ni­ty may not just be wel­come at this point but nec­es­sary. It’s extreme­ly pos­si­ble a vac­cine alone sim­ply can’t do the job for a large por­tion of the pop­u­lace. It’s also pos­si­ble that, like with the elder­ly, the obese will need to take much high­er dos­es of the vac­cine to get an effec­tive response, which is also going to make the safe­ty issues of a rushed vac­cine even more of an issue for this demo­graph­ic.

So that’s our good news/bad news coro­n­avirus research update. The good news is that our immune sys­tems are even more resource­ful than pre­vi­ous­ly rec­og­nized, with pri­or expo­sure to virus­es or vac­cines that don’t even appear to be par­tic­u­lar­ly close­ly relat­ed to SARS-CoV­‑2 con­fer­ing at least some degree par­tial immu­ni­ty. The bad news is that when our immune sys­tems are in a state where they can’t gen­er­ate par­tial immu­ni­ty for past viral expo­sure those immune sys­tems are prob­a­bly not able to react to a vac­cine prop­er­ly either. It’s anoth­er exam­ple of how this real­ly is a remark­ably eugenic virus: the good news just keeps get­ting bet­ter for the young and healthy. Quite the oppo­site for every­one else.

There’s anoth­er emerg­ing sto­ry of gross cor­rup­tion involv­ing the Trump admin­is­tra­tion’s coro­n­avirus response and wild stock swings. Of course. This one involves a $765 mil­lion fed­er­al gov­ern­ment loan to Kodak for a project involv­ing cre­at­ing the ingre­di­ents for a coro­n­avirus-relat­ed drug. The fact that Kodak is involved , not exact­ly a like­ly sus­pect for coro­n­avirus cor­po­rate malfea­sance. But as we’ll see, the fact that Kodak got a sub­stan­tial gov­ern­ment loan for a coro­n­avirus-relat­ed project at all despite hav­ing no appar­ent exper­tise in this area is one of the cor­rup­tion-relat­ed ques­tions swirling around this sto­ry. It turns out Jared Kush­n­er’s for­mer room­mate may be the fig­ure behind the loan:

So on July 28 the $765 loan was announced under the Defense Pro­duc­tion Act. But it was an unprece­dent­ed loan. It turns out Kodak got the first ever loan from the US Inter­na­tion­al Devel­op­ment Finance Cor­po­ra­tion, a gov­ern­ment agency that’s set up to pro­vide for­eign aid. The agency is head­ed by Adam Boehler, the for­mer room­mate of Jared Kush­n­er. Kush­n­er select­ed Boehler to his shad­ow coro­n­avirus task force back in March. So that right there makes this a very unusu­al loan.

But Boehler’s role in approv­ing this loan is just of the many shady aspects of this deal that is now under inves­ti­ga­tion by both the House and the Secu­ri­ty and Exchange Com­mis­sion (SEC). Much of the scruti­ny has to do with the wild ride Kodak’s stock took around when the loan was announced and asso­ci­at­ed insid­er buy­ing that took place right before the announce­ment includ­ing a large num­ber of stock options issued to Kodak’s CEO Jim Con­ti­nen­za. A wild ride that start­ed one day before the pub­lic announce­ment of the loan, which is what ini­tial­ly led to reg­u­la­tor scruti­ny. Kodak’s stock jumped 25% on July 27th under heavy trad­ing. As news of the deal broke the next day, the stock jumped from under $2 to near­ly $60 with­in two days.

It also turns out that Kodak informed some local news out­lets on July 27th of the upcom­ing loan but then asked the out­lets to delete their announce­ment of the deal after the new was pub­lished that day. So Kodak did improp­er­ly dis­close the deal ahead of time against reg­u­la­tions which is why much of the inquiry at this point appears to be focused on whether or not that pre­ma­ture dis­clo­sure was an inno­cent mis­take or part of some sort of attempt to manip­u­late the stock price.

As of now the White House is try­ing to brush the entire thing off as an exam­ple of Kodak’s exec­u­tives just mak­ing a real­ly dumb mis­take and that’s all there is to the sto­ry. But that ignores all of the ques­tions sur­round­ing Adam Boehler and the fact that Kodak is the only domes­tic com­pa­ny to have ever received a loan from a fed­er­al agency that’s nor­mal­ly asso­ci­at­ed with for­eign aid. Ques­tions that tie into anoth­er very strange aspect of this sto­ry: George Kar­funkel, a major investor in Kodak, hap­pened to make a rather odd dona­tion on July 29th, the day the stock price hit $60. Kar­funkel also hap­pens to be and major Repub­li­can donor and his daugh­ter, Anne Neu­berg­er, was named the head of the NSA’s new cyber­se­cu­ri­ty direc­torate in July of 2019, so he’s some­one who we should expect to have ready access to to Trump admin­is­tra­tion offi­cials.

So on July 29th, a day after the for­mal loan announce­ment, Kar­funkel donat­ed 3 mil­lion shares of Kodak to an obscure reli­gious char­i­ty called Con­gre­ga­tion Chem­das Yis­roel. If the the dona­tion was exe­cut­ed at the end of the day it would have been worth $99.6 mil­lion. If it was exe­cut­ed at the $60/share peak ear­li­er that day it would have been worth $180 mil­lion. What­ev­er the val­ue was, it turns out to be the largest sin­gle char­i­ta­ble dona­tion to a reli­gious enti­ty in US his­to­ry. And since Chem­das Yis­roel is a tax-exempt reli­gious orga­ni­za­tion what­ev­er the val­ue was when that dona­tion was exe­cut­ed would be val­ue that Kar­funkel could claim as a tax deduc­tion. Adding to the mys­tery is that Chem­das Yis­roel does­n’t appear to actu­al­ly do any­thing. It was reg­is­tered as a Delaware cor­po­ra­tion in Decem­ber 2018 and was reg­is­tered with the New York Depart­ment of State as a Brook­lyn-based enti­ty two weeks lat­er. That’s basi­cal­ly all any­one knows about the group. And that’s the group that received the largest char­i­ta­ble dona­tion to a reli­gious group in US his­to­ry using the pro­ceeds earned from the stock explo­sion trig­gered by this bizarre spe­cial loan issue to Kodak from a fed­er­al agency run by Jared Kush­n­er’s for­mer room­mate.

Ok, first, here’s an arti­cle from last week about Kodak’s shares plung­ing 42% fol­low­ing the announce­ment that the gov­ern­ment loan was being put on hold fol­low­ing an SEC inves­ti­ga­tion. It’s the kind of extreme mar­ket move that under­scores how almost all of the val­ue of Kodak at that point was pred­i­cat­ed on Kodak receiv­ing that loan:

CNBC

Kodak shares tank as much as 42% as gov­ern­ment loan is put on pause while alle­ga­tions inves­ti­gat­ed

* Shares of East­man Kodak plunged 27.89% on Mon­day after a fed­er­al agency said it was review­ing a pre­vi­ous­ly announced $765 mil­lion loan for the one­time pho­tog­ra­phy pio­neer to pro­duce drug ingre­di­ents.
* “Recent alle­ga­tions of wrong­do­ing raise seri­ous con­cerns. We will not pro­ceed any fur­ther unless these alle­ga­tions are cleared,” the U.S. Inter­na­tion­al Devel­op­ment Finance Cor­po­ra­tion said in a tweet Fri­day.
* The review of fund­ing comes as the Secu­ri­ties and Exchange Com­mis­sion is report­ed­ly inves­ti­gat­ing how the com­pa­ny dis­closed the deal with the gov­ern­ment.
* The deal kicked off a fren­zy of trad­ing activ­i­ty, which saw the stock jump 600% in the span of just two days.

Pip­pa Stevens
Pub­lished Mon, Aug 10 2020 7:22 AM EDT Updat­ed

Shares of East­man Kodak plunged more than 42% at the low on Mon­day after a fed­er­al agency said it was review­ing a pre­vi­ous­ly announced $765 mil­lion loan for the one­time pho­tog­ra­phy pio­neer to pro­duce drug ingre­di­ents.

“Recent alle­ga­tions of wrong­do­ing raise seri­ous con­cerns. We will not pro­ceed any fur­ther unless these alle­ga­tions are cleared,” the U.S. Inter­na­tion­al Devel­op­ment Finance Cor­po­ra­tion said in a tweet Fri­day.

On July 28, we signed a Let­ter of Inter­est with East­man Kodak. Recent alle­ga­tions of wrong­do­ing raise seri­ous con­cerns. We will not pro­ceed any fur­ther unless these alle­ga­tions are cleared.— DFC­gov (@DFCgov) August 7, 2020

The review of fund­ing comes as the Secu­ri­ties and Exchange Com­mis­sion is report­ed­ly inves­ti­gat­ing how the com­pa­ny dis­closed the deal with the gov­ern­ment, accord­ing to a report from The Wall Street Jour­nal. The probe is also report­ed­ly expect­ed to review stock options that were grant­ed to exec­u­tive chair­man James Con­ti­nen­za ahead of the announce­ment.

After the ini­tial drop in ear­ly trad­ing, shares recov­ered some­what to end the day 27.89% low­er. At one point in the morn­ing, the stock was halt­ed for volatil­i­ty.

The stock has been on a wild ride since the fund­ing was announced on Tues­day, July 28. But trad­ing activ­i­ty picked up the day before the offi­cial announce­ment, which raised some eye­brows on the Street.

The day before the deal was announced the stock jumped 25%, and saw 1,645,719 shares exchange hands, far sur­pass­ing the aver­age dai­ly trad­ing vol­ume of 236,479 for the year pri­or, accord­ing to data from Fact­Set.

As news of the deal broke Kodak, which had been trad­ing under $2, sky­rock­et­ed. With­in two days, the stock was trad­ing at $60, with 284 mil­lion shares chang­ing hands. In the span of just 24 hours, more than 100,000 investors added the stock to their account on Robin­hood, an app pop­u­lar with mil­len­ni­al investors, accord­ing to data from Robin­track. The stock was so volatile the day after the announce­ment — at one point it was up more than 600% — that it was halt­ed 20 times dur­ing the ses­sion.

But the momen­tum didn’t hold and on Fri­day the stock closed at $14.88, or 75% below its recent high. How­ev­er, the cur­rent price is still more than 400% above where the stock trad­ed ahead of the loan announce­ment.

The loan, which was the first of its kind under the Defense Pro­duc­tion Act, was meant to aid the com­pa­ny in its piv­ot to drug pro­duc­tion. With the fund­ing, Kodak said it would expand exist­ing facil­i­ties in Rochester, New York and St. Paul, Min­neso­ta under a new Kodak Phar­ma­ceu­ti­cals arm, which would pro­duce drugs to treat a wide vari­ety of ill­ness­es.

“Our 33rd use of the Defense Pro­duc­tion Act will mobi­lize Kodak to make gener­ic, active phar­ma­ceu­ti­cal ingre­di­ents,” pres­i­dent Don­ald Trump said when announc­ing the deal. “We will bring back our jobs and we will make Amer­i­ca the world’s pre­mier med­ical man­u­fac­tur­er and sup­pli­er.”

The pres­i­dent lat­er walked back his com­ments, say­ing he was “not involved” in the loan.

Kodak released the news to local reporters in Rochester, New York, where it is head­quar­tered, on July 27 then asked sev­er­al out­lets that had picked up the sto­ry to delete it, which they did. Accord­ing to a Kodak spokesper­son, the company’s inter­nal com­mu­ni­ca­tions team “did not intend for the news to be pub­lished.”

“We feel very com­fort­able that we’re going to get to the end game,” James Con­ti­nen­za, East­man Kodak exec­u­tive chair­man, told CNBC’s “Squawk Box” after the deal was announced. “We signed a let­ter of inter­est and we’ve been work­ing on this for a few months. We feel very com­fort­able,” he added.

Fil­ings with the Secu­ri­ty and Exchange Com­mis­sion show that on June 23 Con­ti­nen­za pur­chased rough­ly 46,700 addi­tion­al shares. On the same date, board mem­ber Philippe Katz pur­chased 5,000 shares. Addi­tion­al­ly, the day before the deal was announced the com­pa­ny grant­ed Con­ti­nen­za options for 1.75 mil­lion shares, just under 29% of which vest­ed imme­di­ate­ly.

White House eco­nom­ic advi­sor Peter Navar­ro on Fri­day praised the DFC for its move, say­ing he was “very dis­ap­point­ed” over the alle­ga­tions.

VERY dis­ap­point­ed last week’s great deal with Kodak tar­nished by alle­ga­tions. Absolute­ly RIGHT move by DFC! We must redou­ble efforts to bring our phar­ma man­u­fac­tur­ing home!! #BuyAmer­i­can https://t.co/2OfAjJFHKH— Peter Navar­ro (@PeterNavarro45) August 7, 2020

...

———–

“Kodak shares tank as much as 42% as gov­ern­ment loan is put on pause while alle­ga­tions inves­ti­gat­ed” by Pip­pa Stevens; CNBC; 08/10/2020

“The loan, which was the first of its kind under the Defense Pro­duc­tion Act, was meant to aid the com­pa­ny in its piv­ot to drug pro­duc­tion. With the fund­ing, Kodak said it would expand exist­ing facil­i­ties in Rochester, New York and St. Paul, Min­neso­ta under a new Kodak Phar­ma­ceu­ti­cals arm, which would pro­duce drugs to treat a wide vari­ety of ill­ness­es.”

It was the very first loan of its kind under the Defense Pro­duc­tion Act, some­thing the Trump admin­is­tra­tion proud­ly tout­ed. Until the tout­ing stopped. And yet White House eco­nom­ic advi­sor Peter Navar­ro appeared to be very upset about the announced inves­ti­ga­tion and the halt­ing of the loan:

...
“Our 33rd use of the Defense Pro­duc­tion Act will mobi­lize Kodak to make gener­ic, active phar­ma­ceu­ti­cal ingre­di­ents,” pres­i­dent Don­ald Trump said when announc­ing the deal. “We will bring back our jobs and we will make Amer­i­ca the world’s pre­mier med­ical man­u­fac­tur­er and sup­pli­er.”

The pres­i­dent lat­er walked back his com­ments, say­ing he was “not involved” in the loan.

...

White House eco­nom­ic advi­sor Peter Navar­ro on Fri­day praised the DFC for its move, say­ing he was “very dis­ap­point­ed” over the alle­ga­tions.

VERY dis­ap­point­ed last week’s great deal with Kodak tar­nished by alle­ga­tions. Absolute­ly RIGHT move by DFC! We must redou­ble efforts to bring our phar­ma man­u­fac­tur­ing home!! #BuyAmer­i­can https://t.co/2OfAjJFHKH— Peter Navar­ro (@PeterNavarro45) August 7, 2020

...

Flash for­ward a week and Navar­ro is singing a dif­fer­ent tune. Now he’s dis­ap­point­ed at Kodak. Specif­i­cal­ly the exec­u­tives involved with the deci­sion to inform the local media out­lets about the loan one day before it was announced. As Navar­ro put it, “You can’t fix stu­pid”. But as Navar­ro also made clear, his crit­i­cisms are pure­ly lim­it­ed to the deci­sions by Kodak’s exec­u­tives, with the ques­tions of how Kodak got this unprece­dent­ed loan from the Trump admin­is­tra­tion left unac­knowl­edged:

CNBC

‘You can’t fix stu­pid’ — Trump trade advi­sor Peter Navar­ro rips Kodak exec­u­tives as dumb­est ever

Kevin Stankiewicz
Pub­lished Mon, Aug 17 2020 9:35 AM EDT
Updat­ed Mon, Aug 17 2020 12:23 PM EDT

* White House trade advi­sor Peter Navar­ro blast­ed exec­u­tives at East­man Kodak for their han­dling of a gov­ern­ment loan to pro­duce phar­ma­ceu­ti­cal ingre­di­ents in the Unit­ed States.
* “Based on what I’m see­ing, what hap­pened at Kodak was prob­a­bly the dumb­est deci­sions made by exec­u­tives in cor­po­rate his­to­ry,” Navar­ro said.
* “You can’t fix ‘stu­pid,’” he added.

White House trade advi­sor Peter Navar­ro blast­ed exec­u­tives at East­man Kodak on Mon­day for their han­dling of a gov­ern­ment loan to pro­duce phar­ma­ceu­ti­cal ingre­di­ents in the Unit­ed States.

“Based on what I’m see­ing, what hap­pened at Kodak was prob­a­bly the dumb­est deci­sions made by exec­u­tives in cor­po­rate his­to­ry,” Navar­ro said on CNBC’s “Squawk Box.”

“You can’t fix ‘stu­pid,’” Navar­ro added. “You can’t even antic­i­pate that degree of stu­pid­i­ty.”

The $765 mil­lion gov­ern­ment loan to Kodak has been put on pause as the Secu­ri­ties and Exchange Com­mis­sion inves­ti­gates the company’s dis­clo­sure of the deal, which was offi­cial­ly announced on July 28.

Shares of the Kodak, known for pro­duc­ing cam­era film, sky­rock­et­ed on news of the phar­ma­ceu­ti­cal loan. The stock had been lan­guish­ing around $2 per share for months but surged as high as $60 per share the day after the deal.

How­ev­er, trad­ing activ­i­ty of Kodak’s stock picked up sig­nif­i­cant­ly the day before the offi­cial announce­ment. Ques­tions also have been raised about the tim­ing of stock options grant­ed to Kodak’s exec­u­tive chair­man, Jim Con­ti­nen­za.

In Monday’s inter­view, Navar­ro said the inves­ti­ga­tion of poten­tial wrong­do­ing by Kodak should run its course. “We don’t know why that hap­pened or what they did. Let the inves­ti­ga­tion hap­pen. Kodak’s doing an inter­nal one as well, but we’re mov­ing for­ward. We’re not look­ing in the rearview mir­ror.”

“I’ve got 30 projects on my board across the street,” added Navar­ro, who has tout­ed the impor­tance of relo­cat­ing the phar­ma­ceu­ti­cal sup­ply chain in the U.S., espe­cial­ly in a coro­n­avirus world.

...

———–

“‘You can’t fix stu­pid’ — Trump trade advi­sor Peter Navar­ro rips Kodak exec­u­tives as dumb­est ever” by Kevin Stankiewicz; CNBC; 08/17/2020

“In Monday’s inter­view, Navar­ro said the inves­ti­ga­tion of poten­tial wrong­do­ing by Kodak should run its course. “We don’t know why that hap­pened or what they did. Let the inves­ti­ga­tion hap­pen. Kodak’s doing an inter­nal one as well, but we’re mov­ing for­ward. We’re not look­ing in the rearview mir­ror.””

We’re not look­ing in the rearview mir­ror. That’s the Trump admin­is­tra­tion’s response to the ques­tions swirling around the sto­ry now that a for­mal inves­ti­ga­tion has begun. And it’s an under­stand­able response give that any mean­ing­ful look in the rearview mir­ror would have to exam­ine how it was that Kodak got the unprece­dent­ed loan in the first place. And all of the ques­tions around George Kar­funkel’s mys­te­ri­ous mega-dona­tion dona­tion to a reli­gious char­i­ty that does­n’t appear to do any­thing:

Moth­er Jones

The White House–Kodak Con­tro­ver­sy Has a New Angle: A Billionaire’s Huge Stock Gift to a Syn­a­gogue

Why did investor George Kar­funkel donate shares worth up to $180 mil­lion to a lit­tle-known con­gre­ga­tion?

David Corn
Wash­ing­ton, DC, Bureau Chief

August 11, 2020

In late July, a wild chain of events occurred when the Trump admin­is­tra­tion decid­ed to give East­man Kodak, the film giant that went bank­rupt in 2012, an unprece­dent­ed $765 mil­lion gov­ern­ment loan through the Defense Pro­duc­tion Act. Under this deal, which Pres­i­dent Trump tout­ed, the com­pa­ny would man­u­fac­ture ingre­di­ents for an assort­ment of drugs, includ­ing hydrox­y­chloro­quine, the anti­malar­i­al drug Trump has repeat­ed­ly promoted—without sci­en­tif­ic support—as a treat­ment for COVID-19. The agree­ment was offi­cial­ly announced on July 28, but the pre­vi­ous day, the price of Kodak’s stock began to surge, fol­low­ing local media leaks about the loan in Rochester, New York (the home of Kodak). This buy­ing fren­zy con­tin­ued for a cou­ple of days. Dur­ing that time, bil­lion­aire investor George Kar­funkel, a mem­ber of Kodak’s board of direc­tors, made an unusu­al trans­ac­tion: He donat­ed 3 mil­lion Kodak shares—worth up to $180 mil­lion at the time—to a rel­a­tive­ly new Jew­ish con­gre­ga­tion that has almost no pub­lic pro­file.

The out-of-the-ordi­nary loan for Kodak came from a new and lit­tle-known gov­ern­ment agency: the US Inter­na­tion­al Devel­op­ment Finance Cor­po­ra­tion. This out­fit was cre­at­ed to pro­vide for­eign aid—not domes­tic assistance—and it is head­ed by Adam Boehler, a for­mer room­mate of Jared Kush­n­er. In March, Kush­n­er tapped Boehler to be part of his shad­ow coro­n­avirus task force.

The Kodak deal is now under inves­ti­ga­tion by sev­er­al House com­mit­tees, which have raised ques­tions about Kodak’s “lack of phar­ma­ceu­ti­cal expe­ri­ence” and about stock options hand­ed to exec­u­tives and board mem­bers right before the announce­ment. Sen. Eliz­a­beth War­ren (D‑Mass.) has called for a probe of whether “one or more indi­vid­u­als may have engaged in insid­er trad­ing.” In a let­ter to the Secu­ri­ties and Exchange Com­mis­sion, she observed, “This is just the lat­est exam­ple of unusu­al trad­ing activ­i­ty involv­ing a major Trump admin­is­tra­tion deci­sion.” Accord­ing to the Wall Street Jour­nal, “In the wake of the wild trad­ing, the SEC opened an inves­ti­ga­tion look­ing at the company’s dis­clo­sure of the pre­lim­i­nary agree­ment and the tim­ing of options grants to Exec­u­tive Chair­man Jim Con­ti­nen­za.” (The SEC declined to con­firm the exis­tence of an inves­ti­ga­tion.) On Fri­day night, the Inter­na­tion­al Devel­op­ment Finance Cor­po­ra­tion tweet­ed: “Recent alle­ga­tions of wrong­do­ing raise seri­ous con­cerns. We will not pro­ceed any fur­ther unless these alle­ga­tions are cleared.” In response, Kodak stock plunged near­ly 30 per­cent on Mon­day.

Kodak did not reply to a request for com­ment. It has cre­at­ed a spe­cial com­mit­tee to con­duct an inter­nal review.

The tur­bu­lent trad­ing began on July 27, as news of the loan seeped out. Kodak’s stock opened at $2.13 and closed at $2.62, with 1,645,700 shares traded—more than 20 times the vol­ume of pre­vi­ous days. On July 28, with the word now out offi­cial­ly, the stock opened at $9.63, hit a high of $11.80, and then dropped to $7.94, which was an almost four-fold gain from the start of the pre­vi­ous day, with a whop­ping 284,666,800 shares trad­ed. The next day, July 29, was cra­zier. Kodak shares start­ed at $18.43, and at one point reached an eye-pop­ping peak of $60. Its low that day was $17.50, and it closed at $33.20, with 276,020,100 shares in play. But then investors real­ized that Kodak’s agree­ment was not yet a done deal, and over the next few days, the stock declined and sta­bi­lized in the $15 region.

In the mid­dle of this spree, Kar­funkel, a major investor in Kodak, and his wife, Renee, donat­ed those 3 mil­lion shares to an enti­ty called Con­gre­ga­tion Chem­das Yis­roel, accord­ing to an SEC fil­ing. They did so on July 29, the day the stock price hit $60, so those shares could have been worth as much as $180 mil­lion at the time of the gift. If the dona­tion was exe­cut­ed at the end of the trad­ing day, its val­ue would have been $99.6 mil­lion. Giv­en that Con­gre­ga­tion Chem­das Yis­roel is reg­is­tered as a tax-exempt reli­gious orga­ni­za­tion, the Kar­funkels will be able to claim this dona­tion as a tax deduc­tion. That means they could pock­et a deduc­tion between $52.5 mil­lion and $180 mil­lion for a bloc of stocks that two days ear­li­er was worth $6.39 mil­lion. (The dona­tion also low­ered the Kar­funkels’ hold­ings in Kodak to 4.4 percent—which is below the 5 per­cent thresh­old that requires investors in a pub­licly trad­ed com­pa­ny to report their stock trans­ac­tions.)

The gift to Con­gre­ga­tion Chem­das Yis­roel from Kar­funkel, an Ortho­dox Jew who has sup­port­ed var­i­ous Ortho­dox schools and syn­a­gogues in Brook­lyn, was not­ed in pass­ing in media accounts of the Kodak stock fren­zy. But what went unre­port­ed were details regard­ing the recip­i­ent of this immense gift. And it is tough to find any traces of this Con­gre­ga­tion Chem­das Yis­roel. It has no web­site. It is not list­ed on the syn­a­gogue loca­tor of the Ortho­dox Union, a large sup­port net­work for Ortho­dox con­gre­ga­tions. There is no infor­ma­tion on it with­in var­i­ous online data­bas­es, beyond its exis­tence as a cor­po­rate enti­ty.

Chem­das Yis­roel was reg­is­tered as a Delaware cor­po­ra­tion in Decem­ber 2018. Two weeks lat­er, Chem­das Yis­roel was reg­is­tered with the New York Depart­ment of State as a Brook­lyn-based enti­ty. A search of Delaware cor­po­ra­tion records for groups with the word “con­gre­ga­tion” in their names yield­ed only 19 enti­ties of which 10 appeared to be Jew­ish orga­ni­za­tions. The New York State divi­sion of cor­po­ra­tions lists hun­dreds of orga­ni­za­tions that have “con­gre­ga­tion” in their names and that appear to be Jew­ish.

The New York cor­po­rate reg­is­tra­tion for Con­gre­ga­tion Chem­das Yis­roel list­ed its address as that of an account­ing firm in Brook­lyn, Roth & Co., and Abra­ham Roth, the co-man­ag­ing part­ner of the firm, was cit­ed as a point of con­tact. Roth did not respond to mul­ti­ple requests seek­ing com­ment about Chem­das Yis­roel and Karfunkel’s mas­sive dona­tion.

Kar­funkel pre­sides over at least two long-stand­ing foun­da­tions that have sup­port­ed Ortho­dox Jew­ish groups. The Kar­funkel Fam­i­ly Foun­da­tion, of which he is a trustee, had $19 mil­lion in assets in 2018, and it donat­ed $1 mil­lion total to six Ortho­dox Jew­ish orga­ni­za­tions that year, accord­ing to its most recent avail­able tax fil­ings. This includ­ed a $150,000 dona­tion to the Con­gre­ga­tion Chem­das Yis­roel. His Chesed Foun­da­tion of America—Karfunkel is its president—had $196 mil­lion in assets in 2018 and donat­ed $2.4 mil­lion to “schools and syn­a­gogues.” The foundation’s tax fil­ing that year did not list the indi­vid­ual recip­i­ents.

George Kar­funkel and his broth­er Michael were born in Hun­gary and grew up in Brook­lyn, their father a fish­mon­ger and a reli­gious schol­ar, accord­ing to a For­ward arti­cle pub­lished in 2016 when Michael died. (The head­line: “Michael Kar­funkel, the Ortho­dox Bil­lion­aire No One Heard Of, Dies at 72.”) Through a wide col­lec­tion of busi­ness­es, they became one of the wealth­i­est Amer­i­can fam­i­lies. In 1976, George was on an Air France plane hijacked by Pales­tin­ian ter­ror­ists that was flown to Entebbe, Ugan­da, where Israeli com­man­does mount­ed a res­cue.

A 2014 Foun­da­tion for Finan­cial Jour­nal­ism report recount­ed the Kar­funkel broth­ers’ ear­ly days in finance:

The broth­ers were employ­ees at a mutu­al fund boil­er room called Eco­nom­ic Plan­ning Corp.; their bid to diver­si­fy the firm by hav­ing it engage in the cap­i­tal mar­kets end­ed with them at the cen­ter of a wide-rang­ing pump and dump scam that col­lapsed in 1971…[T]he Secu­ri­ties and Exchange Com­mis­sion injunc­tion and sus­pen­sions they received hard­ly set them back.

The broth­ers went on to cre­ate their own finan­cial pow­er­house. In 2008, they sold their Amer­i­can Stock Trans­fer & Trust Co. for close to $1 bil­lion. (In July 2019, Anne Neu­berg­er, George Karfunkel’s daugh­ter, was named head of the Nation­al Secu­ri­ty Agency’s new cyber­se­cu­ri­ty direc­torate.)

Both broth­ers have been high­ly regard­ed with­in the Ortho­dox com­mu­ni­ty of Brook­lyn for their phil­an­thropy. Accord­ing to the Foun­da­tion for Finan­cial Jour­nal­ism report, “Their foun­da­tions give almost exclu­sive­ly to yeshiv­as and syn­a­gogues con­nect­ed to Hare­di Judaism, many of which are affil­i­at­ed with the Belz Hasidic sect.” The report also not­ed that their foun­da­tions “employ risk in a fash­ion rarely seen in oth­er pri­vate foun­da­tions,” and it out­lined finan­cial trans­ac­tions mount­ed by the foun­da­tions involv­ing com­pli­cat­ed stock trades. And the For­ward report­ed, “The char­i­ties the two broth­ers con­trolled are among the largest, and most unusu­al, Jew­ish pri­vate foun­da­tions in the coun­try.”

Even with this long his­to­ry of phil­an­thropy, George Karfunkel’s gift of Kodak stock to Chem­das Yis­roel stands out as much greater—by a fac­tor of 15 to 50—than the grants on the most recent tax fil­ings of the Kar­funkel Fam­i­ly Foun­da­tion and the Chesed Foun­da­tion of Amer­i­ca. When Moth­er Jones called Hen­ry Rein­hold, the accoun­tant list­ed on the tax returns for these two foun­da­tions and an offi­cer of each one, the man who answered the phone would not iden­ti­fy him­self but demand­ed to know the sub­ject of the inquiry. When told it was about the Kar­funkel Fam­i­ly Foun­da­tion, he hung up. A sub­se­quent call went to voice­mail, where there was a record­ed greet­ing from a per­son who referred to him­self as Hen­ry Rein­hold in a voice sim­i­lar to that of the man who moments ear­li­er had refused to pro­vide his name.

What hap­pened to the 3 mil­lion Kodak shares after Kar­funkel and his wife donat­ed them to the con­gre­ga­tion? Were they sold? If so, at what price? How might this organization—with no pub­licly iden­ti­fied officials—use a wind­fall of tens of mil­lions of dol­lars or much more? There are no answers. The pub­lic trail ends with the stock trans­fer.

...

UPDATE: After the above sto­ry was pub­lished, the Wall Street Jour­nal also report­ed on George Karfunkel’s dona­tion of Kodak shares to the Con­gre­ga­tion Chem­das Yis­roel. The news­pa­per not­ed that Gar­funkel is list­ed as the pres­i­dent of the syn­a­gogue in New York State char­i­ty-reg­is­tra­tion records. It report­ed that this dona­tion “would make it the sin­gle largest gift record­ed to a reli­gious group, based on a list main­tained by the Chron­i­cle of Phil­an­thropy.” Accord­ing to the Jour­nal, “The New York paper­work describes the con­gre­ga­tion as an Ortho­dox Jew­ish syn­a­gogue that con­ducts reli­gious ser­vices, class­es, lec­tures and sem­i­nars, and would use any funds raised only for reli­gious, char­i­ta­ble and edu­ca­tion­al pur­pos­es. The con­gre­ga­tion appears to have a small space attached to a three-sto­ry apart­ment build­ing on a qui­et side street in the ultra-Ortho­dox Jew­ish neigh­bor­hood of Brooklyn’s Bor­ough Park. A small name­plate on the building’s exte­ri­or is the only vis­i­ble sign of its loca­tion.” In its char­i­ty reg­is­tra­tion records, the con­gre­ga­tion lists Rein­hold as its sec­re­tary and Roth as its direc­tor. With Kar­funkel, they are the only offi­cers of Chem­das Yis­roel. Kar­funkel is also list­ed as the “Chief Finan­cial Offi­cer or Trea­sur­er.”

———–

“The White House–Kodak Con­tro­ver­sy Has a New Angle: A Billionaire’s Huge Stock Gift to a Syn­a­gogue” by David Corn; Moth­er Jones; 08/11/2020

“The out-of-the-ordi­nary loan for Kodak came from a new and lit­tle-known gov­ern­ment agency: the US Inter­na­tion­al Devel­op­ment Finance Cor­po­ra­tion. This out­fit was cre­at­ed to pro­vide for­eign aid—not domes­tic assistance—and it is head­ed by Adam Boehler, a for­mer room­mate of Jared Kush­n­er. In March, Kush­n­er tapped Boehler to be part of his shad­ow coro­n­avirus task force.”

Yes, in a thor­ough­ly unsur­pris­ing sur­prise, it turns out that Adam Boehler, the head of the fed­er­al agency that issued the unprece­dent­ed loan, was a for­mer room­mate of Jared Kush­n­er. It’s Jared’s world now, we’re just liv­ing in it. But the role that Kush­n­er may have played in the issu­ing of this loan isn’t lim­it­ed to ques­tions about his ties to Adam Boehler. We also have to ask what if any ties Kush­n­er might have to George Kar­funkel. Giv­en the promi­nent role the Kar­funkel fam­i­ly plays in Brook­lyn and the fact that Kush­n­er’s fam­i­ly is a major prop­er­ty devel­op­er there it seems pret­ty plau­si­ble that they would have at least known each oth­er, espe­cial­ly since Kar­funkel’s daugh­ter, Anne Neu­berg­er was appoint­ed to the head of the NSA’s new cyber­se­cu­ri­ty direc­torate last year. And with the mys­te­ri­ous nature of the Con­gre­ga­tion Chem­das Yis­roel that does­n’t seem to actu­al­ly do any­thing we have to won­der if this ‘dona­tion’ was intend­ed to be like a kick-back vehi­cle for Trump-affil­i­at­ed cronies to cash in on this absurd loan:

...
A 2014 Foun­da­tion for Finan­cial Jour­nal­ism report recount­ed the Kar­funkel broth­ers’ ear­ly days in finance:

The broth­ers were employ­ees at a mutu­al fund boil­er room called Eco­nom­ic Plan­ning Corp.; their bid to diver­si­fy the firm by hav­ing it engage in the cap­i­tal mar­kets end­ed with them at the cen­ter of a wide-rang­ing pump and dump scam that col­lapsed in 1971…[T]he Secu­ri­ties and Exchange Com­mis­sion injunc­tion and sus­pen­sions they received hard­ly set them back.

The broth­ers went on to cre­ate their own finan­cial pow­er­house. In 2008, they sold their Amer­i­can Stock Trans­fer & Trust Co. for close to $1 bil­lion. (In July 2019, Anne Neu­berg­er, George Karfunkel’s daugh­ter, was named head of the Nation­al Secu­ri­ty Agency’s new cyber­se­cu­ri­ty direc­torate.)

Both broth­ers have been high­ly regard­ed with­in the Ortho­dox com­mu­ni­ty of Brook­lyn for their phil­an­thropy. Accord­ing to the Foun­da­tion for Finan­cial Jour­nal­ism report, “Their foun­da­tions give almost exclu­sive­ly to yeshiv­as and syn­a­gogues con­nect­ed to Hare­di Judaism, many of which are affil­i­at­ed with the Belz Hasidic sect.” The report also not­ed that their foun­da­tions “employ risk in a fash­ion rarely seen in oth­er pri­vate foun­da­tions,” and it out­lined finan­cial trans­ac­tions mount­ed by the foun­da­tions involv­ing com­pli­cat­ed stock trades. And the For­ward report­ed, “The char­i­ties the two broth­ers con­trolled are among the largest, and most unusu­al, Jew­ish pri­vate foun­da­tions in the coun­try.”
...

Note that Neu­berg­er also led the NSA’s elec­tion secu­ri­ty efforts in 2018 and the cre­ation of the new cyber­se­cu­ri­ty direc­torate in 2019 was seen as a means of con­sol­i­dat­ing the efforts to thwart for­eign cyber inter­fer­ence. So the daugh­ter of the Repub­li­can mega-donor who made this wild­ly sus­pi­cious dona­tion to a wild­ly sus­pi­cious ‘reli­gious char­i­ty’ appears to be the NSA offi­cial who is going to be in charge of pre­vent for­eign elec­tion inter­fer­ence in 2020. It’s anoth­er rea­son the Trump admin­is­tra­tion is prob­a­bly very keen on not ‘look­ing in the rearview mir­ror’ too much on this sto­ry.

Amidst all of the con­cern and out­cry over the appar­ent politi­ciza­tion of COVID treat­ment deci­sions — the reports of CDC order to pre­pare for a pre­ma­ture pre-elec­tion COVID vac­cine announce­ment and the FDA sur­prise announce­ment to approve the use of con­va­les­cent plas­ma based on no evi­dence and seem­ing­ly under pres­sure from Trump — there was anoth­er deci­sion by the FDA on Fri­day that aroused sim­i­lar con­cerns but has­n’t received as much atten­tion: The FDA approved emer­gency autho­riza­tion of Remde­sivir for a much broad­er class of cas­es than before, allow­ing it to be admin­is­tered to less sick patients ear­li­er dur­ing the course of the dis­ease. Gilead wel­comed the news, espe­cial­ly the part about allow­ing less sick patients to get the drug ear­li­er in the course of the dis­ease, a move that should hypo­thet­i­cal­ly explode demand for the drug. But experts are warn­ing that the FDA pro­vid­ed no data jus­ti­fy­ing the move and now the drug is going to be in even short­er sup­ply for the sick­est patients:

USA TODAY

‘With­out evi­dence’: Once again, FDA expands use of COVID-19 treat­ment with­out research to back it up

Karen Wein­traub
Pub­lished 10:11 p.m. ET Aug. 28, 2020 | Updat­ed 3:10 p.m. ET Aug. 29, 2020

The U.S. Food and Drug Admin­is­tra­tion late Fri­day allowed the drug remde­sivir to be used on all patients hos­pi­tal­ized with COVID-19, although no pub­lished research sup­ports such wide­spread use.

The approval allows doc­tors free­dom to pre­scribe the antivi­ral ear­li­er. But it comes less than a week after the agency approved use of con­va­les­cent plas­ma with­out pub­lished sci­en­tif­ic sup­port, fuel­ing con­cerns the agency is yield­ing to polit­i­cal pres­sure.

“It seems to be a pat­tern of approval with­out sci­ence, with­out data, with­out evi­dence,” said Dr. Eric Topol, vice pres­i­dent for research at Scripps Research in La Jol­la, Cal­i­for­nia and a nation­al expert on the use of data in med­ical research.

In May, the FDA allowed remde­sivir to be used for hos­pi­tal­ized adults who need oxy­gen, but not those sick enough to require ven­ti­la­tion. A gov­ern­ment study pub­lished that month in the New Eng­land Jour­nal of Med­i­cine found those patients recov­ered faster than those who had­n’t got­ten the drug, though there was no evi­dence that it saved lives.

Ear­li­er this month, the Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion pub­lished a study of less severe­ly ill hos­pi­tal­ized adults, show­ing that five days of treat­ment with remde­sivir was bet­ter than stan­dard care, though “the dif­fer­ence was of uncer­tain clin­i­cal impor­tance.”

No oth­er stud­ies have been pub­lished sup­port­ing more wide­spread use of remde­sivir. Yet the FDA said the data is now com­pelling enough to expand its use to all hos­pi­tal­ized patients, includ­ing chil­dren.

“The data show that this treat­ment has the poten­tial to help even more hos­pi­tal­ized patients who are suf­fer­ing from the effects of this dev­as­tat­ing virus,” FDA Com­mis­sion­er Dr. Stephen M. Hahn said in a pre­pared state­ment announc­ing the agency had grant­ed an emer­gency use autho­riza­tion for remde­sivir.

The FDA uses that process to approve prod­ucts that, based on sci­en­tif­ic evi­dence, it is “rea­son­able to believe … may be effec­tive.” An emer­gency use autho­riza­tion can be issued only dur­ing an emer­gency, such as the COVID-19 pan­dem­ic, when there are no ade­quate, approved and avail­able alter­na­tives.

Topol said he was appalled by the expand­ed approval of the drug. “There are no data to sup­port wide use of remde­sivir,” he said. “This is extra­or­di­nary.”

The FDA announced the expand­ed use of remde­sivir at 5:20 p.m. ET on Fri­day, cit­ing the stud­ies pub­lished in May and August.

In a state­ment, Dr. Mer­dad Parsey, chief med­ical offi­cer of the Fos­ter City, Cal­i­for­nia-based Gilead Sci­ences Inc., said the com­pa­ny was pleased with the FDA’s deci­sion to expand use of the drug, which he referred to by its trade name.

“As we learn more about COVID-19 and we fur­ther estab­lish the effi­ca­cy and safe­ty pro­file of Vek­lury, we see ben­e­fit to mak­ing the drug avail­able to patients at ear­li­er stages of the dis­ease,” he wrote.

Will expand­ed use of remde­sivir help patients?

Dr. Fran­cis­co Mar­ty, an infec­tious dis­ease doc­tor and researcher at Brigham & Wom­en’s Hos­pi­tal and Har­vard Med­ical School, said the expand­ed emer­gency use will help him get the drug to patients who are less sick but who he thinks are like­ly to ben­e­fit from the antivi­ral.

Mar­ty, who has helped con­duct some of the remde­sivir tri­als, said he treats can­cer and trans­plant patients who are high risk for com­pli­ca­tions, and he’d like to get them on the drug as quick­ly as he can. Before the expan­sion, he had to wait until they got sick­er.

“I fight with Gilead as much as many peo­ple, and try to push them,” he said. “But for me, it’s what’s best for the patient. How can we help the most peo­ple?”

Dr. Nuala Mey­er, a crit­i­cal care physi­cian and sci­en­tist at the Perel­man School of Med­i­cine and the Hos­pi­tal of the Uni­ver­si­ty of Penn­syl­va­nia, said she does­n’t think the FDA’s deci­sion will change treat­ment for most of her patients.

Patients at Pen­n­Med are giv­en remde­sivir only if they have pneu­mo­nia requir­ing sup­ple­men­tal oxy­gen. That would have account­ed for more than half of the patients dur­ing Philadel­phi­a’s surge in April and May, Mey­er said, but few­er today.

Most of her cur­rent patients, she said, are in the hos­pi­tal for about 48 hours, so it would­n’t make sense to put them on remde­sivir, an intra­ve­neous ther­a­py with a five-day course. “I’m not aware of a whole lot of data in hos­pi­tal­ized patients who don’t require oxy­gen,” she said.

Mey­er is con­cerned that the expand­ed use may make it hard­er to get the drug for patients who need it. “We would cer­tain­ly pri­or­i­tize patients in whom it is shown to have a ben­e­fit.”

She said she was sur­prised by the FDA’s approval of remde­sivir for all hos­pi­tal­ized patients. “We always expect the FDA to base deci­sions on data and we do get con­cerned when we see deci­sion-mak­ing that we can’t find the data to sup­port,” she said.

FDA under fire for coro­n­avirus response

Hahn, a radi­a­tion oncol­o­gist and for­mer chief med­ical exec­u­tive of the MD Ander­son Can­cer Cen­ter in Hous­ton, has been FDA com­mis­sion­er only since Decem­ber, but this is the fourth time he has run afoul of the sci­en­tif­ic com­mu­ni­ty for his agen­cy’s actions to com­bat the coro­n­avirus.

In March, the FDA allowed mak­ers of COVID-19 anti­body tests to sell their prod­ucts as long as they reg­is­tered with the FDA. The agency tight­ened those restric­tions about six weeks lat­er, but it has been crit­i­cized for stand­ing in the way of oth­er test­ing that could iden­ti­fy more peo­ple while they are con­ta­gious with COVID-19.

In May, the FDA issued an emer­gency use autho­riza­tion for a drug called hydrox­y­chloro­quine, which was strong­ly pro­mot­ed by Pres­i­dent Don­ald Trump. There was lit­tle data sup­port­ing the approval, and the FDA reversed its deci­sion in June after mount­ing evi­dence sug­gest­ed the drug did more harm than good.

Sun­day, Hahn and the pres­i­dent announced the FDA would issue emer­gency approval for con­va­les­cent plas­ma, in which blood prod­ucts from recov­ered patients are admin­is­tered to those whose immune sys­tems haven’t built up enough anti­bod­ies to fight off the virus.

Trump described it as “a pow­er­ful ther­a­py,” and the autho­riza­tion as “a very his­toric break­through.”

But there is no data sup­port­ing the agen­cy’s posi­tion that plas­ma is effec­tive for treat­ing COVID-19 patients.

Hahn claimed at Sun­day’s news con­fer­ence that con­va­les­cent plas­ma reduced fatal­i­ties by 35%, but the study actu­al­ly­found a ben­e­fit only for patients who received plas­ma ear­ly, were under 80 and were not on ven­ti­la­tors.

He lat­er apol­o­gized on Twit­ter for his claim. Fri­day he appeared to have fired his new spokes­woman in response to the inci­dent.

The sci­en­tif­ic com­mu­ni­ty was hor­ri­fied by the autho­riza­tion of plas­ma and its char­ac­ter­i­za­tion by Hahn and the pres­i­dent.

Between that and Fri­day’s announce­ment for remde­sivir, Topol said the agen­cy’s emer­gency approval process appears “far­ci­cal.”

...

———–

“ ‘With­out evi­dence’: Once again, FDA expands use of COVID-19 treat­ment with­out research to back it up” by Karen Wein­traub; USA TODAY; 08/28/2020

“The approval allows doc­tors free­dom to pre­scribe the antivi­ral ear­li­er. But it comes less than a week after the agency approved use of con­va­les­cent plas­ma with­out pub­lished sci­en­tif­ic sup­port, fuel­ing con­cerns the agency is yield­ing to polit­i­cal pres­sure.”

Less than a week after the con­va­les­cent plas­ma scan­dal we get this. The tim­ing was­n’t great. Then again, the tim­ing is nev­er great for emer­gency autho­riza­tions based on no evi­dence:

...
“It seems to be a pat­tern of approval with­out sci­ence, with­out data, with­out evi­dence,” said Dr. Eric Topol, vice pres­i­dent for research at Scripps Research in La Jol­la, Cal­i­for­nia and a nation­al expert on the use of data in med­ical research.

...

No oth­er stud­ies have been pub­lished sup­port­ing more wide­spread use of remde­sivir. Yet the FDA said the data is now com­pelling enough to expand its use to all hos­pi­tal­ized patients, includ­ing chil­dren.

...

Topol said he was appalled by the expand­ed approval of the drug. “There are no data to sup­port wide use of remde­sivir,” he said. “This is extra­or­di­nary.”

The FDA announced the expand­ed use of remde­sivir at 5:20 p.m. ET on Fri­day, cit­ing the stud­ies pub­lished in May and August.

...

The sci­en­tif­ic com­mu­ni­ty was hor­ri­fied by the autho­riza­tion of plas­ma and its char­ac­ter­i­za­tion by Hahn and the pres­i­dent.

Between that and Fri­day’s announce­ment for remde­sivir, Topol said the agen­cy’s emer­gency approval process appears “far­ci­cal.”
...

And that’s all why the sci­en­tif­ic com­mu­ni­ty is increas­ing­ly view­ing the FDA’s approval process as far­ci­cal. A far­ci­cal approval process that relies on pub­lic con­fi­dence to ulti­mate­ly work because the pub­lic isn’t going to take a drug it does­n’t trust.

And the dam­age to the FDA’s pub­lic done by pre­ma­ture approvals for ther­a­peu­tics isn’t lim­it­ed to ther­a­peu­tics. The dam­age will apply to the pub­lic’s trust in the FDA’s approval for vac­cines too, trust that’s already on shaky ground. It points towards one of the more per­verse ways this dynam­ic is work­ing to the ben­e­fit of Gilead: the more dam­age the FDA does to its cred­i­bil­i­ty with pre­ma­ture remde­sivir approvals the less the pub­lic will be inclined to trust the FDA and the less like­ly the pub­lic will be to ulti­mate­ly take an FDA-approved vac­cine. And the less the pub­lic takes the vac­cine the more the pub­lic is going to get infect­ed with COVID and end up on remde­sivir. End up on remde­sivir whether it actu­al­ly helps the patients or not.

Here’s an inter­est­ing update on the sup­ply issues fac­ing Gilead­’s remde­sivir, which is a ques­tion that arguably is only grow­ing more urgent as we get clos­er to our first cold and flu sea­son since the start of the pan­dem­ic:

First, recall how the FDA issued an emer­gency autho­riza­tion for use of remde­sivir on mod­er­ate­ly ill patients a cou­ple of weeks ago, a move that some crit­ics view as “far­ci­cal” giv­en the sparse evi­dence that the drug ben­e­fits mod­er­ate­ly ill patients.

So how will emer­gency use autho­riza­tion for mod­er­ate­ly ill patients impact hos­pi­tal sup­plies as we enter the cold and flu sea­son? Well, it sounds like US hos­pi­tals are suc­cess­ful­ly stock­pil­ing remde­sivir sup­plies in antic­i­pa­tion of this fall. That’s in part because the US gov­ern­men­t’s dis­trib­uted sup­ply of remde­sivir to hos­pi­tals will be dis­bursed by the end of Sep­tem­ber and there have been no announce­ments of future sup­plies from the fed­er­al gov­ern­ment, so hos­pi­tals are stock­pil­ing with that uncer­tain­ty in mind.

But the oth­er rea­son hos­pi­tals are suc­ces­su­flly stock­pil­ing the drug is that they are reserv­ing its use for severe­ly ill patients. Why? because it does­n’t appear that remde­sivir is actu­al­ly help­ful for mod­er­ate­ly severe hos­pi­tal­ized patients. It sounds like there’s so much skep­ti­cism about the drug that Health and Human Ser­vices con­firmed recent­ly that between July 6 and Sep­tem­ber 8, state and ter­ri­to­ry pub­lic health sys­tems accept­ed only around 72% of the remde­sivir they were offered. And 6 out of 8 sur­veyed large hos­pi­tals indi­cat­ed that they still haven’t start­ed using remde­sivir for mod­er­ate cas­es despite the FDA’s emer­gency autho­riza­tion. So the good news is that hos­pi­tals are build­ing up a remde­sivir stock­pile in the face of a sup­ply uncer­tain­ty. The bad news is that the rea­son they can build up this stock­pile is that it remains uncer­tain if remde­sivir is actu­al­ly help­ing but the sick­est of patients:

Reuters

Exclu­sive: U.S. hos­pi­tals turn down remde­sivir, lim­it use to sick­est COVID-19 patients

By Deena Beasley
Sep­tem­ber 11, 2020 2:55 PM Updat­ed

(Reuters) — U.S. hos­pi­tals have turned down about a third of their allo­cat­ed sup­plies of the COVID-19 drug remde­sivir since July as need for the cost­ly antivi­ral wanes, the Depart­ment of Health and Human Ser­vices (HHS) con­firmed on Fri­day.

Some hos­pi­tals said they are still buy­ing the Gilead Sci­ences GILD.O med­i­cine to build inven­to­ry in case the pan­dem­ic accel­er­ates over the win­ter. But they said cur­rent sup­plies are ade­quate, in part because they are lim­it­ing use to severe­ly ill patients.

The Food and Drug Admin­is­tra­tion has allowed more lib­er­al remde­sivir use, but 6 out of 8 major hos­pi­tal sys­tems con­tact­ed by Reuters said they were not using it for mod­er­ate cas­es.

The slow­down sug­gests that a short­age of the drug is over and threat­ens Gilead’s efforts to expand use of remde­sivir, which it sells under the brand name Vek­lury in some coun­tries.

An HHS spokesper­son con­firmed on Fri­day that between July 6 and Sep­tem­ber 8, state and ter­ri­to­ry pub­lic health sys­tems accept­ed about 72% of the remde­sivir they were offered. Hos­pi­tals in turn pur­chased only about two-thirds of what states and ter­ri­to­ries accept­ed, as pre­vi­ous­ly detailed to Reuters by Michael Ganio, senior direc­tor of phar­ma­cy prac­tice and qual­i­ty at the Amer­i­can Soci­ety of Health-Sys­tem Phar­ma­cists.

...

A sur­plus of remde­sivir — which costs $3,120 for a 6‑vial intra­venous course — marks a turn­around from ear­li­er in the pan­dem­ic, when sup­plies of the drug had fall­en short of demand in some regions.

Gov­ern­ment-led dis­tri­b­u­tion of remde­sivir will expire at the end of Sep­tem­ber. Hos­pi­tals said they have lit­tle infor­ma­tion on avail­abil­i­ty after that.

Remde­sivir was first autho­rized by the FDA in May for emer­gency use in COVID-19 patients hos­pi­tal­ized and on oxy­gen sup­port after data showed it helped short­en hos­pi­tal recov­ery time.

‘NOT TERRIBLY IMPRESSED’

The agency last month expand­ed use to hos­pi­tal­ized patients who do not require oxy­gen sup­port, based on data pub­lished in the JAMA med­ical jour­nal show­ing that the drug pro­vid­ed a mod­est ben­e­fit for those patients.

The new­er data has left many experts uncon­vinced.

“I am not ter­ri­bly impressed with the study,” said Dr. Adarsh Bhim­raj, an infec­tious dis­ease spe­cial­ist at the Cleve­land Clin­ic. He said he remains “skep­ti­cal” about using remde­sivir in patients with mod­er­ate COVID-19, espe­cial­ly giv­en the price.

Dr. Rajesh Gand­hi, an infec­tious dis­ease physi­cian at Mass­a­chu­setts Gen­er­al Hos­pi­tal in Boston, said his cen­ter has stayed focused on using remde­sivir for the nar­row­er pop­u­la­tion of seri­ous­ly ill patients who need sup­ple­men­tal oxy­gen.

“No one wants to be in a posi­tion of mak­ing treat­ment deci­sions based on drug avail­abil­i­ty,” he said.

Hous­ton Methodist Hos­pi­tal is hold­ing off on broad­er use of remde­sivir, and instead is stock­pil­ing it in case the pan­dem­ic flares up in win­ter — typ­i­cal­ly the peak sea­son for res­pi­ra­to­ry ill­ness.

“At this point, we are buy­ing far more than we are using because we are unsure about what will hap­pen at the end of Sep­tem­ber,” said Kather­ine Perez, infec­tious dis­ease phar­ma­cist at Hous­ton Methodist.

There is no evi­dence that COVID-19 patients admit­ted to the hos­pi­tal for a day or two due to an under­ly­ing health issue, like dia­betes or high blood pres­sure, would ben­e­fit from the drug, she added.

Mark Sul­li­van, asso­ciate chief phar­ma­cy offi­cer at Nashville’s Van­der­bilt Uni­ver­si­ty Hos­pi­tals & Clin­ics, said his insti­tu­tion also did not expand remde­sivir use based on the new­er JAMA data.

“We have kept our treat­ment pro­to­col the same,” he said.

———-

“Exclu­sive: U.S. hos­pi­tals turn down remde­sivir, lim­it use to sick­est COVID-19 patients” by Deena Beasley; Reuters; 09/11/2020

“The Food and Drug Admin­is­tra­tion has allowed more lib­er­al remde­sivir use, but 6 out of 8 major hos­pi­tal sys­tems con­tact­ed by Reuters said they were not using it for mod­er­ate cas­es.”

The offer is there. Hos­pi­tals just aren’t tak­ing it. And this rel­a­tive lack of demand has been going on all sum­mer, as HHS con­firmed, due in part to remde­sivir’s unim­pres­sive results:

...
An HHS spokesper­son con­firmed on Fri­day that between July 6 and Sep­tem­ber 8, state and ter­ri­to­ry pub­lic health sys­tems accept­ed about 72% of the remde­sivir they were offered. Hos­pi­tals in turn pur­chased only about two-thirds of what states and ter­ri­to­ries accept­ed, as pre­vi­ous­ly detailed to Reuters by Michael Ganio, senior direc­tor of phar­ma­cy prac­tice and qual­i­ty at the Amer­i­can Soci­ety of Health-Sys­tem Phar­ma­cists.

...

‘NOT TERRIBLY IMPRESSED’

The agency last month expand­ed use to hos­pi­tal­ized patients who do not require oxy­gen sup­port, based on data pub­lished in the JAMA med­ical jour­nal show­ing that the drug pro­vid­ed a mod­est ben­e­fit for those patients.

The new­er data has left many experts uncon­vinced.

“I am not ter­ri­bly impressed with the study,” said Dr. Adarsh Bhim­raj, an infec­tious dis­ease spe­cial­ist at the Cleve­land Clin­ic. He said he remains “skep­ti­cal” about using remde­sivir in patients with mod­er­ate COVID-19, espe­cial­ly giv­en the price.

...

Hous­ton Methodist Hos­pi­tal is hold­ing off on broad­er use of remde­sivir, and instead is stock­pil­ing it in case the pan­dem­ic flares up in win­ter — typ­i­cal­ly the peak sea­son for res­pi­ra­to­ry ill­ness.

“At this point, we are buy­ing far more than we are using because we are unsure about what will hap­pen at the end of Sep­tem­ber,” said Kather­ine Perez, infec­tious dis­ease phar­ma­cist at Hous­ton Methodist.

There is no evi­dence that COVID-19 patients admit­ted to the hos­pi­tal for a day or two due to an under­ly­ing health issue, like dia­betes or high blood pres­sure, would ben­e­fit from the drug, she added.
...

Ok, now here’s an arti­cle from last month that describes anoth­er very inter­est­ing, and poten­tial­ly dis­turb­ing, angle to the sto­ry of remde­sivir’s sup­ply issues. The arti­cle describes a con­tro­ver­sy that erupt­ed between Gilead and out­side researchers over the sum­mer. The dis­pute was over whether or not remde­sivir was the best choice for COVID-19 patients of if, instead, they should be test­ing an ear­li­er com­pound Gilead had devel­oped, GS-441524, that some researchers found was not only more effec­tive than remde­sivir at quelling the virus but also cheap­er and eas­i­er to man­u­fac­ture. Recall the ear­ly sup­ply fears due to the logis­ti­cal com­pli­ca­tions of build­ing a com­plex chem­i­cal com­pound like remde­sivir.

So if there’s a chem­i­cal cousin that’s eas­i­er to man­u­fac­ture and more effec­tive at stop­ping the virus why did­n’t Gilead go with GS-441524 instead? That’s not entire­ly clear, which is part of the source of the con­tro­ver­sy. The drug has yet to be test­ed on humans, prompt­ing some researchers to pub­licly argue that Gilead should be run­ning these human tri­als. Gilead coun­tered in ear­ly August that its own evi­dence in test tubes and ani­mal mod­els indi­cates remde­sivir is bet­ter at block­ing viral repli­ca­tion. Inter­est­ing­ly, Gilead also stat­ed that remde­sivir is more active in lab tests against mul­ti­ple coro­n­avirus­es, sug­gest­ing that Gilead is still focused on the hope of remde­sivir being a ‘broad spec­trum’ coro­n­avirus antivi­ral. But last month the NIH announced that it was going to be con­duct­ing its own tri­als of GS-441524 in treat­ing COVID-19 and short­ly after STAT News pub­lished the fol­low­ing arti­cle Gilead announced it would share its own pre­clin­i­cal tri­al data on GS-441524 with the NIH.

But there’s anoth­er pos­si­ble rea­son Gilead might have to want to pur­sue remde­sivir over GS-441524 and it relates to the remde­sivir sup­ply issues: ear­li­er this year it was report­ed that a new black mar­ket for GS-441524 has emerged in Chi­na after cat own­ers have start­ed report­ing that GS-441524 is effec­tive against feline infec­tious peri­toni­tis (FIP), an oth­er­wise fatal dis­ease for cats. The GS-441524 sold in Chi­na isn’t man­u­fac­tured by Gilead because, as we’ll see, Gilead avoid­ed actu­al­ly pur­su­ing GS-441524 for FIP treat­ment despite ear­li­er stud­ies indi­cat­ing a remark­able effi­ca­cy in cats. Why did Gilead not pur­sue this drug? Because the com­pa­ny had already start­ed eying remde­sivir for use in humans against Ebo­la. And since GS-441524 and remde­sivir are so chem­i­cal­ly sim­i­lar the com­pa­ny was con­cerned that any side-effects found in its tri­als on cats could ulti­mate­ly com­pli­cate approval of the drug in humans. At the same time, Chi­nese drug man­u­fac­tur­ers were approach­ing Gilead about pro­duc­ing GS-551524 but nev­er got approval. The Chi­nese drug man­u­fac­tur­ers went ahead and cre­at­ed the drug any­way and that’s how a black mar­ket for GS-441524 devel­oped. It’s the kind of sto­ry that rais­es ques­tions about the pri­or­i­ties of Gilead in mak­ing these deci­sions but also ques­tions about the safe­ty issues of these drugs that Gilead fears researchers might find:

STAT News

Urged on by sci­en­tists, NIH will study Gilead’s remde­sivir-like com­pound against Covid-19

By Ed Sil­ver­man
August 24, 2020

The Nation­al Insti­tutes of Health plans to inde­pen­dent­ly explore whether a Gilead Sci­ences (GILD) com­pound, which some aca­d­e­mics main­tain is high­ly sim­i­lar to remde­sivir, but which the com­pa­ny has deem­pha­sized in its efforts, may be use­ful in com­bat­ing Covid-19.

The com­pound, called GS-441524, works in the same way as remde­sivir to inhib­it virus­es, accord­ing to research that was con­duct­ed part­ly by the com­pa­ny (more here). But the com­pound has not been test­ed in humans and, for the past few months, a pair of researchers at the Uni­ver­si­ty of Texas MD Ander­son Can­cer Cen­ter has argued pub­licly that Gilead ought to run tests.

Now, the NIH’s Nation­al Cen­ter for Advanc­ing Trans­la­tion­al Sci­ences is curi­ous. Sci­en­tists at the insti­tute have “reviewed the lit­er­a­ture and agree that this com­pound mer­its fur­ther explo­ration,” accord­ing to an Aug. 20 let­ter sent to MD Ander­son researchers and the advo­ca­cy group Pub­lic Cit­i­zen, which recent­ly wrote to the NIH and the Food and Drug Admin­is­tra­tion in hopes of pres­sur­ing Gilead to con­duct stud­ies.

...

The com­pound actu­al­ly made head­lines for a dif­fer­ent rea­son ear­li­er this year. GS-441524 has been sold on black mar­kets to repel feline infec­tious peri­toni­tis, a dis­ease in cats caused by a dif­fer­ent coro­n­avirus than the virus that caus­es Covid-19.

Lab tests have sug­gest­ed GS-441524 is active against SARS-CoV­‑2, and it is appar­ent­ly sim­i­lar or supe­ri­or to the effects of remde­sivir at lev­els that do not cause much tox­i­c­i­ty, accord­ing to the Ander­son researchers, who want to run their own tests. They also main­tain the com­pound is more eas­i­ly syn­the­sized than remde­sivir, so it should be eas­i­er to cre­ate oral ver­sions and make high­er dos­es.

Ear­li­er this month, the drug mak­er explained there were sev­er­al rea­sons for pur­su­ing remde­sivir instead. These include evi­dence indi­cat­ing remde­sivir is more effec­tive in test tubes and ani­mal mod­els than GS-441524 in block­ing viral repli­ca­tion, and was also more active in lab tests against mul­ti­ple coro­n­avirus­es, include SARS-CoV­‑2.

The com­pa­ny and the researchers sparred over such issues as tox­i­col­o­gy find­ings in both remde­sivir and GS-441524. So far, though, the drug mak­er has not offered to coop­er­ate in their research. A Gilead spokesman recent­ly not­ed that addi­tion­al pre­clin­i­cal stud­ies to fur­ther com­pare remde­sivir and GS-441524 have begun. [UPDATE: The fol­low­ing day, the spokesman wrote us to say the com­pa­ny has shared avail­able pre­clin­i­cal data with the NIH.]

One of the Ander­son researchers, Vic­to­ria Yan, a grad­u­ate research assis­tant spe­cial­iz­ing in phos­phate chem­istry, wrote us that she is “real­ly excit­ed” by the NCATS deci­sion. But she added the researchers are still seek­ing per­mis­sion from Gilead to use data on the com­pound that is on file with the FDA. She is hope­ful any data gen­er­at­ed by NCATS can sup­port their own inves­ti­ga­tion­al drug appli­ca­tion to the FDA.

———-

“Urged on by sci­en­tists, NIH will study Gilead’s remde­sivir-like com­pound against Covid-19” by Ed Sil­ver­man; STAT News; 08/24/2020

“The com­pound actu­al­ly made head­lines for a dif­fer­ent rea­son ear­li­er this year. GS-441524 has been sold on black mar­kets to repel feline infec­tious peri­toni­tis, a dis­ease in cats caused by a dif­fer­ent coro­n­avirus than the virus that caus­es Covid-19.”

Did Gilead real­ly choose remde­sivir over GS-441524 sole­ly due to the sci­ence? That’s what the com­pa­ny would like us to believe. When it’s hard to ignore that the eas­i­er-to-man­u­fac­ture GS-441524 chem­i­cal cousin of remde­sivir already has a Chi­nese black mar­ket and remde­sivir does­n’t. Might that have some­thing to do with Gilead­’s deci­sion?

...
Lab tests have sug­gest­ed GS-441524 is active against SARS-CoV­‑2, and it is appar­ent­ly sim­i­lar or supe­ri­or to the effects of remde­sivir at lev­els that do not cause much tox­i­c­i­ty, accord­ing to the Ander­son researchers, who want to run their own tests. They also main­tain the com­pound is more eas­i­ly syn­the­sized than remde­sivir, so it should be eas­i­er to cre­ate oral ver­sions and make high­er dos­es.

Ear­li­er this month, the drug mak­er explained there were sev­er­al rea­sons for pur­su­ing remde­sivir instead. These include evi­dence indi­cat­ing remde­sivir is more effec­tive in test tubes and ani­mal mod­els than GS-441524 in block­ing viral repli­ca­tion, and was also more active in lab tests against mul­ti­ple coro­n­avirus­es, include SARS-CoV­‑2.

The com­pa­ny and the researchers sparred over such issues as tox­i­col­o­gy find­ings in both remde­sivir and GS-441524. So far, though, the drug mak­er has not offered to coop­er­ate in their research. A Gilead spokesman recent­ly not­ed that addi­tion­al pre­clin­i­cal stud­ies to fur­ther com­pare remde­sivir and GS-441524 have begun. [UPDATE: The fol­low­ing day, the spokesman wrote us to say the com­pa­ny has shared avail­able pre­clin­i­cal data with the NIH.]
...

Final­ly, here’s an arti­cle from May of this year about the GS-441524 black mar­ket that has now emerged in Chi­na this year, coin­cid­ing with the glob­al focus on remde­sivir. As the arti­cle describes, both GS-441524 and remde­sivir demon­strat­ed remark­able effi­ca­cy in cats against FIP so researchers decid­ed to focus on GS-441524. Why? Because it’s so much eas­i­er to pro­duce, which is also part of the rea­son a black mar­ket was even capa­ble of emerg­ing in Chi­na:

The Atlantic

A Much-Hyped COVID-19 Drug Is Almost Iden­ti­cal to a Black-Mar­ket Cat Cure

Cat own­ers are resort­ing to China’s under­ground mar­ket­place to buy antivi­rals for a feline coro­n­avirus.

Sarah Zhang
May 8, 2020

When Robin Kintz’s two kit­tens, Fiona and Hen­ry, con­tract­ed a fatal cat dis­ease last year, she began hear­ing of a black-mar­ket drug from Chi­na. The use of the drug, known as GS-441524, is based on legit­i­mate research from UC Davis, but the ways to get it seemed much less so. “It was, ‘If you want to save your cat, send me thou­sands of dol­lars, and I’ll DHL you some unmarked vials,’” she says. And she did. Kintz trans­ferred the thou­sands of dol­lars, got the unmarked vials from Chi­na, and then inject­ed the clear liq­uid into her dying cats every day for months.

The first remark­able thing, giv­en the nature of the trans­ac­tion, is that Kintz says the vials actu­al­ly worked. Hen­ry lived for almost anoth­er year, and Fiona made a full recov­ery. She’s still scam­per­ing around today, fluffy and alive—a mir­a­cle con­sid­er­ing that vets had long thought her dis­ease, feline infec­tious peri­toni­tis, to be incur­able and 100 per­cent fatal. Kintz now runs a 22,000-member Face­book group that helps cat own­ers using GS-441524. Thou­sands of cats have report­ed­ly been cured of FIP.

The sec­ond remark­able thing is that GS-441524 is almost iden­ti­cal to a much buzzed-about human drug: remde­sivir, the antivi­ral cur­rent­ly our best hope for treat­ing COVID-19, the dis­ease caused by the nov­el coro­n­avirus. Although ear­ly data sug­gest that the drug short­ens recov­ery time at best, Antho­ny Fau­ci has tout­ed remde­sivir from the White House. The Food and Drug Admin­is­tra­tion has autho­rized it for emer­gency use. And Gilead Sci­ences, the com­pa­ny that makes remde­sivir, is donat­ing 1.5 mil­lion dos­es of the drug of the drug amidst the pan­dem­ic.

Gilead invent­ed and patent­ed GS-441524, too. Its sci­en­tists co-authored the UC Davis stud­ies show­ing effec­tive­ness against FIP. But the com­pa­ny has refused to license GS-441524 for ani­mal use, out of fear that its sim­i­lar­i­ty to remde­sivir could inter­fere with the human drug’s FDA-approval process—originally for Ebo­la. When that failed, and a glob­al pan­dem­ic of a nov­el coro­n­avirus lat­er arose, the com­pa­ny began test­ing it against COVID-19. Remde­sivir has a small but clever mod­i­fi­ca­tion that makes it bet­ter at enter­ing cells, but it and GS-441524 work in exact­ly the same way to inhib­it virus­es.

FIP is also caused by a coronavirus—not the same one that caus­es COVID-19, but one that spe­cial­izes in infect­ing cats. (Although humans may be able to pass COVID-19 to cats in rare cas­es, humans can­not get FIP from cats.) In most cats, this feline coro­n­avirus, or FCoV, caus­es mild diar­rhea or no symp­toms at all. But in a small minor­i­ty of cas­es, the virus infects white blood cells, and the immune sys­tem goes hay­wire into full-blown FIP. The dis­ease comes in two forms, both fatal: wet, in which the cat’s chest or bel­ly swells with flu­id, or dry, in which there is no flu­id but the cat is still fever­ish and sick. Even­tu­al­ly, it dies. For decades, vets have had lit­tle to offer but euthana­sia.

Then GS-441524 came along. Small tri­als at UC Davis pub­lished in 2018 and 2019 sug­gest­ed that cats were not just hav­ing their life pro­longed by days or weeks, but were seem­ing­ly cured. “It real­ly was a game chang­er,” says Drew Weign­er, a vet­eri­nar­i­an and the pres­i­dent of the Winn Feline Foun­da­tion, which fund­ed some of the UC Davis research. “Three years ago, we told patients, ‘Your cat is going to die.’ Now we can tell them some­thing else. It’s quite a sto­ry.”

**********

The sto­ry of a drug first test­ed against Ebo­la (that failed), whose close cousin became a ground­break­ing treat­ment for a cat dis­ease (but only ille­gal­ly), and that has been res­ur­rect­ed in the pan­dem­ic of an entire­ly new virus under­scores the vagaries of drug devel­op­ment. To be clear, while remde­sivir is in clin­i­cal tri­als, GS-441524 has not been test­ed in humans for safe­ty or effi­ca­cy against COVID-19. The black-mar­ket for­mu­la­tions of GS-441524 are also incred­i­bly expen­sive. A 12-week reg­i­men for cats can cost upwards of $10,000, depend­ing on the brand, type of FIP, and weight of the cat. Plus, there is no legal way to buy GS-441524 as medicine—not for cats, not for humans.

The drug prob­a­bly would have nev­er been test­ed in cats, if not for the fact that Niels Ped­er­sen, a long­time FIP researcher at UC Davis, per­son­al­ly knew the for­mer chief sci­en­tif­ic offi­cer of Gilead. The two met 30 years ago, when Gilead was test­ing antivi­ral HIV drugs in mon­keys and Ped­er­sen was work­ing at a pri­mate research cen­ter. But Pedersen’s true love has always been cats. He grew up sur­round­ed by them on a poul­try farm. A col­league of his warned me, lov­ing­ly, that Ped­er­sen was “iras­ci­ble,” and he was dif­fi­cult to get on the phone. But his voice soft­ened when he talked about tam­ing those barn cats and find­ing homes for their kit­tens.

Ped­er­sen became fas­ci­nat­ed with FIP in vet school in the 1960s, when it was still a mys­te­ri­ous dis­ease with a mys­te­ri­ous cause. Over the decades, sci­en­tists would dis­cov­er the feline coro­n­avirus behind FIP and then spend years try­ing but fail­ing to devel­op a work­ing vac­cine. Ped­er­sen end­ed up devot­ing his career to the dis­ease. And when the vac­cines failed, he began think­ing about antivi­rals, and he began think­ing, again, of Gilead. The Cal­i­for­nia-based com­pa­ny spe­cial­izes in devel­op­ing antivi­rals, includ­ing Tam­i­flu, Tru­va­da, and a host of HIV and hepati­tis C drugs.

Around five years ago, Ped­er­sen got in touch with his Gilead con­tact, and the com­pa­ny sent him 25 or 30 mol­e­cules, drawn from the large library of drug can­di­dates that phar­ma­ceu­ti­cal com­pa­nies typ­i­cal­ly main­tain. Two of the mol­e­cules worked mar­velous­ly in cat cells infect­ed with the FIP virus: GS-441524 and GS-5734, the lat­ter of which is now bet­ter known as remde­sivir.

Both GS-441524 and remde­sivir work by block­ing viral repli­ca­tion. They are nucle­o­side ana­logues, mean­ing they mim­ic the nucle­o­side build­ing blocks—A, U, C, or G—that make up the virus’s genet­ic mate­r­i­al. Specif­i­cal­ly, they mim­ic “A,” and when the virus is tricked into incor­po­rat­ing a GS-441524 or remde­sivir mol­e­cule instead of “A”, the repli­ca­tion process gets jammed up. Even­tu­al­ly, no more let­ters can be added, and the virus can­not repli­cate. Where the two drugs dif­fer is that remde­sivir has an extra phos­phate group, a small change that helps it enter a cell and get used in repli­ca­tion. This mod­i­fi­ca­tion is com­mon­ly used to enhance the effec­tive­ness of sim­i­lar antivi­rals. “It’s just one of those real­ly clever things that worked per­fect­ly,” says Kather­ine Seley-Radtke, an antivi­ral researcher at the Uni­ver­si­ty of Mary­land, Bal­ti­more Coun­ty.

For what­ev­er rea­son, though, this mod­i­fi­ca­tion did not make much dif­fer­ence in cat cells infect­ed with the FIP virus. Both mol­e­cules were effec­tive, so Ped­er­sen decid­ed to pur­sue the sim­pler one, GS-441524. He then infect­ed 10 cats with FIP and dosed them with GS-441524. All 10 cats recov­ered.

“We almost fell out of our chairs,” says Weign­er.This is ridicu­lous, he remem­bers think­ing. This can’t work this well. Wait, wait, stop, go back? It did what? The ini­tial study was small and under arti­fi­cial con­di­tions, but in a fol­low-up field tri­al of 31 pets with nat­u­ral­ly acquired FIP, 25 ulti­mate­ly made it—an unheard-of recov­ery rate. Ped­er­sen had pre­vi­ous­ly test­ed anoth­er antivi­ral out of Kansas State Uni­ver­si­ty, but only sev­en out of 20 cats had gone into remis­sion. Those results seemed impres­sive at the time, but GS-441524 appeared to be even bet­ter.

Ped­er­sen is 76 now, and he has devot­ed 50 years of his career to FIP research. Final­ly, it seemed, a cure was at hand. “I felt real­ly good,” he told me, “and I thought this was a good cap­stone for my career.” But the cap­stone nev­er mate­ri­al­ized, at least not in the way that he expect­ed. Despite the suc­cess, Gilead refused to license GS-441524 for use in cats.

**********

While Ped­er­sen was test­ing GS-441524 in cats, a dif­fer­ent virus—a human virus—was rag­ing halfway around the world in West Africa: Ebo­la. The virus that caus­es Ebo­la is not a coro­n­avirus, but remde­sivir is unusu­al­ly broad-act­ing for an antivi­ral, and ear­ly results against Ebo­la were promis­ing. So promis­ing, in fact, that the com­pa­ny was eye­ing FDA approval of remde­sivir in humans.

Accord­ing to Ped­er­sen, Gilead wor­ried that the cat research could impede the approval process for remde­sivir. Because GS-441524 and remde­sivir are so sim­i­lar, any adverse effects uncov­ered in cats might have to be report­ed and inves­ti­gat­ed to guar­an­tee remdesivir’s safe­ty in humans. Gilead’s cau­tion about gen­er­at­ing unnec­es­sary cat data is stan­dard indus­try prac­tice.. “One of the rules in drug devel­op­ment is nev­er per­form a test you don’t have to, if the results could be prob­lem­at­ic,” says Richard Sach­leben, a retired phar­ma-indus­try researcher. (Gilead declined to com­ment for this sto­ry.)

For Ped­er­sen, the expla­na­tion was hard to accept. “It was a blow,” he said. “It hits you very hard, espe­cial­ly when you didn’t see any rea­son for it.” He still pub­lished the stud­ies, as aca­d­e­m­ic researchers do, and results became pub­lic in 2018 and 2019.

Not long after, Ped­er­sen began hear­ing from peo­ple in Chi­na. One com­pa­ny want­ed to license the drug from Gilead, he told me, and it asked Ped­er­sen to be the inter­me­di­ary. The com­pa­ny failed to get a license but start­ed sell­ing an FIP drug any­way, and its exact for­mu­la is unclear. Oth­er com­pa­nies explic­it­ly adver­tise their for­mu­la­tions as GS-441524. Chi­na has a large base of phar­ma­ceu­ti­cal man­u­fac­tur­ing, and raw GS-441524 is not par­tic­u­lar­ly dif­fi­cult to syn­the­size. FIP is also a grow­ing prob­lem in the coun­try as cats—especially pure­bred cats, which are more prone to the dis­ease—become more pop­u­lar in Chi­na. A black mar­ket has sprung up to fill the vac­u­um left by Gilead.

The use of drugs from Chi­na was at first con­tro­ver­sial in the FIP com­mu­ni­ty. “I got a lot of hate mail for it. I lost a lot of sup­port­ers,” says Peter Cohen, an ear­ly sup­port­er of the drugs. Cohen runs Zen­By­Cat, a non­prof­it that rais­es mon­ey for two groups fund­ing FIP research, SOCK FIP and the Winn Feline Foundation’s Bria Fund for FIP Research. Ear­li­er iter­a­tions of Face­book sup­port groups, such as FIP Fight­ers, ini­tial­ly banned any dis­cus­sion of the black-mar­ket drugs too.

Susan Gin­grich, a for­mer admin­is­tra­tor of that Face­book group, has focused on pres­sur­ing Gilead. Gin­grich, whose broth­er is for­mer House Speak­er Newt Gin­grich, is also the founder of the Bria Fund. Her cat Bria died of FIP in 2005, and she estab­lished the fund with dona­tions from her broth­er and her­self and her hus­band that same year. “It would be so much eas­i­er if Gilead would have either mar­ket­ed it or let anoth­er enti­ty mar­ket it,” she says. Gin­grich bought stock in Gilead after ear­ly research into GS-441524 seemed promis­ing. In June 2019, she wrote a let­ter to Gilead, as well as to Pres­i­dent Don­ald Trump and her con­gress­man and sen­a­tors in Ten­nessee, implor­ing the com­pa­ny to allow ani­mal use of the drug. She says she’s received no response.

...

The recent surge of inter­est in remde­sivir could change some of this dynam­ic. After Ebo­la tri­als found lit­tle ben­e­fit, remde­sivir became a drug in search of a (human) dis­ease. Should remde­sivir ever be grant­ed prop­er FDA approval beyond emer­gency use for COVID-19, and if it becomes com­mon enough to pre­scribe through phar­ma­cies, then vets could legal­ly use it extra-label in cats. “It may be five years down the road, and COVID is a dis­tant mem­o­ry, and then it is used for FIP,” Weign­er says. For now, at least, the cat-spe­cif­ic data on remde­sivir is still lack­ing.

Kintz hopes that GS-441524 can, one day, be legal­ly avail­able for cats. Then, she says, “no one would need me any­more, but that’s okay.”

————-

“A Much-Hyped COVID-19 Drug Is Almost Iden­ti­cal to a Black-Mar­ket Cat Cure” by Sarah Zhang; The Atlantic; 05/08/2020

“Around five years ago, Ped­er­sen got in touch with his Gilead con­tact, and the com­pa­ny sent him 25 or 30 mol­e­cules, drawn from the large library of drug can­di­dates that phar­ma­ceu­ti­cal com­pa­nies typ­i­cal­ly main­tain. Two of the mol­e­cules worked mar­velous­ly in cat cells infect­ed with the FIP virus: GS-441524 and GS-5734, the lat­ter of which is now bet­ter known as remde­sivir.”

GS-441524 and GS-5734 (remde­sivir) both worked incred­i­bly well against FIP. But GS-441524 was ulti­mate­ly cho­sen by these researchers to focus on because for what­ev­er rea­son the extra chem­i­cal mod­i­fi­ca­tions that could, in the­o­ry, make remde­sivir more effec­tive, but also hard­er to man­u­fac­ture, made no dif­fer­ence. Both drugs worked just as well in cats, which is the kind of find­ing that rais­es the ques­tion about how the drugs com­pare against COVID-19:

...
Both GS-441524 and remde­sivir work by block­ing viral repli­ca­tion. They are nucle­o­side ana­logues, mean­ing they mim­ic the nucle­o­side build­ing blocks—A, U, C, or G—that make up the virus’s genet­ic mate­r­i­al. Specif­i­cal­ly, they mim­ic “A,” and when the virus is tricked into incor­po­rat­ing a GS-441524 or remde­sivir mol­e­cule instead of “A”, the repli­ca­tion process gets jammed up. Even­tu­al­ly, no more let­ters can be added, and the virus can­not repli­cate. Where the two drugs dif­fer is that remde­sivir has an extra phos­phate group, a small change that helps it enter a cell and get used in repli­ca­tion. This mod­i­fi­ca­tion is com­mon­ly used to enhance the effec­tive­ness of sim­i­lar antivi­rals. “It’s just one of those real­ly clever things that worked per­fect­ly,” says Kather­ine Seley-Radtke, an antivi­ral researcher at the Uni­ver­si­ty of Mary­land, Bal­ti­more Coun­ty.

For what­ev­er rea­son, though, this mod­i­fi­ca­tion did not make much dif­fer­ence in cat cells infect­ed with the FIP virus. Both mol­e­cules were effec­tive, so Ped­er­sen decid­ed to pur­sue the sim­pler one, GS-441524. He then infect­ed 10 cats with FIP and dosed them with GS-441524. All 10 cats recov­ered.
...

And yet Gilead chose to basi­cal­ly end its research on GS-445124 in cats despite these remark­able results, appar­ent­ly over fears that any com­pli­ca­tions it dis­cov­ers in cats could com­pli­cate the approval process for remde­sivir in humans. Giv­en how much peo­ple spend on tak­ing care of their pets it’s kind of amaz­ing deci­sion by Gilead. After all, even if remde­sivir did get approval for use against Ebo­la as Gilead hoped, what’s more like­ly to have steady glob­al demand? Ebo­la patients in the pock­ets of the world that might get Ebo­la dur­ing peri­od­ic out­breaks or the mil­lions of cat own­ers around the world deal­ing with a lethal endem­ic dis­ease?

And even Chi­nese man­u­fac­tur­ers that tried to license the drug with Gilead were turned down. As a con­se­quence, the Chi­nese black mar­ket for GS-441524 is now the glob­al sup­ply source for sick cats. And the best hope for legal access to a drug for these ter­mi­nal­ly ill cats is autho­riza­tion of human use of remde­sivir, which could open up extra-label use in cats. So we have to ask: did Gilead choose remde­sivir over GS-441524 specif­i­cal­ly because remde­sivir is hard­er to man­u­fac­ture and there­fore hard­er for gen­er­ate black mar­ket sup­plies? Because the answers Gilead is giv­ing based on the sci­ence just keep rais­ing more ques­tions:

...
Accord­ing to Ped­er­sen, Gilead wor­ried that the cat research could impede the approval process for remde­sivir. Because GS-441524 and remde­sivir are so sim­i­lar, any adverse effects uncov­ered in cats might have to be report­ed and inves­ti­gat­ed to guar­an­tee remdesivir’s safe­ty in humans. Gilead’s cau­tion about gen­er­at­ing unnec­es­sary cat data is stan­dard indus­try prac­tice.. “One of the rules in drug devel­op­ment is nev­er per­form a test you don’t have to, if the results could be prob­lem­at­ic,” says Richard Sach­leben, a retired phar­ma-indus­try researcher. (Gilead declined to com­ment for this sto­ry.)

For Ped­er­sen, the expla­na­tion was hard to accept. “It was a blow,” he said. “It hits you very hard, espe­cial­ly when you didn’t see any rea­son for it.” He still pub­lished the stud­ies, as aca­d­e­m­ic researchers do, and results became pub­lic in 2018 and 2019.

Not long after, Ped­er­sen began hear­ing from peo­ple in Chi­na. One com­pa­ny want­ed to license the drug from Gilead, he told me, and it asked Ped­er­sen to be the inter­me­di­ary. The com­pa­ny failed to get a license but start­ed sell­ing an FIP drug any­way, and its exact for­mu­la is unclear. Oth­er com­pa­nies explic­it­ly adver­tise their for­mu­la­tions as GS-441524. Chi­na has a large base of phar­ma­ceu­ti­cal man­u­fac­tur­ing, and raw GS-441524 is not par­tic­u­lar­ly dif­fi­cult to syn­the­size. FIP is also a grow­ing prob­lem in the coun­try as cats—especially pure­bred cats, which are more prone to the dis­ease—become more pop­u­lar in Chi­na. A black mar­ket has sprung up to fill the vac­u­um left by Gilead.

...

The recent surge of inter­est in remde­sivir could change some of this dynam­ic. After Ebo­la tri­als found lit­tle ben­e­fit, remde­sivir became a drug in search of a (human) dis­ease. Should remde­sivir ever be grant­ed prop­er FDA approval beyond emer­gency use for COVID-19, and if it becomes com­mon enough to pre­scribe through phar­ma­cies, then vets could legal­ly use it extra-label in cats. “It may be five years down the road, and COVID is a dis­tant mem­o­ry, and then it is used for FIP,” Weign­er says. For now, at least, the cat-spe­cif­ic data on remde­sivir is still lack­ing.

Kintz hopes that GS-441524 can, one day, be legal­ly avail­able for cats. Then, she says, “no one would need me any­more, but that’s okay.”
...

And sure enough the FDA did grant emer­gency autho­riza­tion for remde­sivir use in humans a cou­ple weeks ago. We now have a sit­u­a­tion where the sup­ply of remde­sivir has exceed­ed demand due to rel­a­tive­ly low effi­ca­cy in humans at the same time both remde­sivir and GS-441524 are high­ly effec­tive in cats with FIP but unavail­able. Might any of that extra remde­sivir find its way to the sick kit­ties?

Keep in mind that if remde­sivir worked as hoped in humans and the feared sup­ply issues came to fruition this sto­ry would prob­a­bly be a lot more scan­dalous. It’s only a feel good sto­ry about cats because remde­sivir was kind of a bust. And it still might end up being a lot more scan­dalous if it turns out GS-441524 is just as effec­tive in humans like those out­side researchers sus­pect.

But as least we final­ly got a coro­n­avirus-relat­ed good news med­ical sto­ry. It just hap­pens to be good news for cats.

Here’s a pair of arti­cles that point at what could end up being a major in rely­ing on a COVID-19 vac­cine to end the pan­dem­ic:

First, here’s a TPM piece that asks a rather impor­tant ques­tion about the COVID-19 vac­cine. Does it actu­al­ly pre­vent trans­mis­sion of the dis­ease? Because if it only pre­vents the devel­op­ment of the symp­toms but still leaves peo­ple capa­ble of being infect­ed and con­ta­gious, the per­cent of the pop­u­lace that’s going to be required to achieve “herd immu­ni­ty” is high­er than it oth­er­wise would be.

And here’s the answer to the ques­tion of whether or not the vac­cines being rolled out can pre­vent trans­mis­sion of the virus: we have no idea yet:

Talk­ing Points Memo
News

We Still Need An Answer To A Crit­i­cal Ques­tion: Do COVID Vac­cines Pre­vent Trans­mis­sion?

By Josh Koven­sky
Decem­ber 10, 2020 2:34 p.m.

With two COVID-19 vac­cines on track for approval by the end of the year, the coun­try is prepar­ing to inoc­u­late front­line health-care work­ers and the most vul­ner­a­ble.

But while the vac­cine has been found to con­fer immu­ni­ty on those who take it, it’s still not clear whether the shot stops trans­mis­sion. Researchers are rac­ing for an answer to the ques­tion of whether those who are inoc­u­lat­ed are also inca­pable of spread­ing COVID-19.

Not all vac­cines put a stop to both ill­ness and spread. Some vac­cines for res­pi­ra­to­ry dis­eases stim­u­late the body’s immune response but allow the virus to remain in the res­pi­ra­to­ry sys­tem, facil­i­tat­ing trans­mis­sion.

Specif­i­cal­ly, an anti­body that exists in the mucus and sali­va can fail to be acti­vat­ed even as blood-borne anti­bod­ies effec­tive­ly pre­vent dis­ease.

“With res­pi­ra­to­ry ill­ness in par­tic­u­lar, trans­mis­sion is depen­dent on whats in your nose and nasal phar­ynx,” Dr. Lit­jen Tan, chief strat­e­gy offi­cer at the Immu­niza­tion Action Coali­tion, told TPM. “You can be asymp­to­matic, but you’re spit­ting out virus.”

Because so few peo­ple have got­ten the injec­tions so far, there’s not yet data to mea­sure how effec­tive the Pfiz­er and Mod­er­na vac­cines are at curb­ing spread. More infor­ma­tion could reveal the extent to which the vac­cines pre­vent spread, and fur­ther stud­ies could reveal how soon after receiv­ing the dual shots peo­ple become unable to spread the virus.

It’s “not clear whether or not these vac­cines actu­al­ly do pre­vent trans­mis­sion,” Josh Michaud, an epi­demi­ol­o­gist at Kaiser Fam­i­ly Foun­da­tions, told TPM last week. “We know they’re effec­tive in pre­vent­ing dis­ease. But they haven’t test­ed whether or not a per­son who is vac­ci­nat­ed can still trans­mit.”

Life in the nose

The answer to the ques­tion of whether the vac­cine will pre­vent only seri­ous ill­ness, or curb both ill­ness and trans­mis­sion, could shape how the coun­try expe­ri­ences and responds to the virus in 2021.

A vac­cine that’s effec­tive at curb­ing trans­mis­sion could bring an ear­li­er end to the virus, while a vac­cine that only stops seri­ous ill­ness with­out pre­vent­ing spread could result in a sit­u­a­tion in which case rates con­tin­ue to rise even as death rates go down due to the most vul­ner­a­ble get­ting shots first.

It would be “unusu­al” but not unheard of for a vac­cine to allow fur­ther spread of the virus against which it pro­tects, said Dr. William Schaffn­er, an immu­nol­o­gist and pro­fes­sor of pre­ven­tive med­i­cine at Van­der­bilt Uni­ver­si­ty.

The meningo­coc­cal vac­cine, for exam­ple, has been found to allow peo­ple to con­tin­ue to car­ry and spread that dis­ease even while they are immu­nized.

Mod­er­na said this week that it expect­ed to have results in three weeks regard­ing how effec­tive its shot is at stop­ping trans­mis­sion. Schaffn­er said that data released by the FDA sug­gest­ed that Pfizer’s vac­cine was like­ly to be at least some­what effec­tive at lim­it­ing spread.

Researchers will like­ly look at the pop­u­la­tion effects of ear­ly vac­cine use, to see if there are any changes in trans­mis­sion. Blood tests could also deter­mine, on a small scale, whether peo­ple who received the vac­cine were sub­se­quent­ly infect­ed with the virus.

‘Pre­dictable’

The tim­ing over when the pan­dem­ic begins to taper off large­ly depends on how effec­tive the vac­cines end up being at lim­it­ing trans­mis­sion.

Tan sug­gest­ed that between 65 and 75 per­cent of the pop­u­la­tion would need to be vac­ci­nat­ed or have acquired immu­ni­ty through expo­sure to COVID-19 to head off fur­ther out­breaks, assum­ing that the vac­cines pro­vide both long-last­ing pro­tec­tion to the dis­ease and ful­ly elim­i­nate the poten­tial for spread.

“Oth­er fac­tors shape that — how long will that immu­ni­ty last?” Tan said. “If it’s short term, you’re gonna have to vac­ci­nate more peo­ple.”

...

————-

“We Still Need An Answer To A Crit­i­cal Ques­tion: Do COVID Vac­cines Pre­vent Trans­mis­sion?” by Josh Koven­sky; Talk­ing Points Memo; 12/10/2020

“It’s “not clear whether or not these vac­cines actu­al­ly do pre­vent trans­mis­sion,” Josh Michaud, an epi­demi­ol­o­gist at Kaiser Fam­i­ly Foun­da­tions, told TPM last week. “We know they’re effec­tive in pre­vent­ing dis­ease. But they haven’t test­ed whether or not a per­son who is vac­ci­nat­ed can still trans­mit.””

The vac­cines might be effec­tive at stop­ping trans­mis­sion. We don’t know because that has­n’t been test­ed yet. Although it sounds like some of the data from Pfiz­er’s vac­cine indi­cates at least a par­tial pro­tec­tion from trans­mis­sion. Mod­er­na say it’s going to have answers in a few weeks:

...
A vac­cine that’s effec­tive at curb­ing trans­mis­sion could bring an ear­li­er end to the virus, while a vac­cine that only stops seri­ous ill­ness with­out pre­vent­ing spread could result in a sit­u­a­tion in which case rates con­tin­ue to rise even as death rates go down due to the most vul­ner­a­ble get­ting shots first.

It would be “unusu­al” but not unheard of for a vac­cine to allow fur­ther spread of the virus against which it pro­tects, said Dr. William Schaffn­er, an immu­nol­o­gist and pro­fes­sor of pre­ven­tive med­i­cine at Van­der­bilt Uni­ver­si­ty.

The meningo­coc­cal vac­cine, for exam­ple, has been found to allow peo­ple to con­tin­ue to car­ry and spread that dis­ease even while they are immu­nized.

Mod­er­na said this week that it expect­ed to have results in three weeks regard­ing how effec­tive its shot is at stop­ping trans­mis­sion. Schaffn­er said that data released by the FDA sug­gest­ed that Pfizer’s vac­cine was like­ly to be at least some­what effec­tive at lim­it­ing spread.
...

And if it turns out that the vac­cine does NOT pro­tect against trans­mis­sion, the esti­mat­ed per­cent of the pop­u­la­tion that’s required to get immu­nized in order to reach herd immu­ni­ty will actu­al­ly have to be high­er than the cur­rent 65–75 per­cent esti­mate:

...
Tan sug­gest­ed that between 65 and 75 per­cent of the pop­u­la­tion would need to be vac­ci­nat­ed or have acquired immu­ni­ty through expo­sure to COVID-19 to head off fur­ther out­breaks, assum­ing that the vac­cines pro­vide both long-last­ing pro­tec­tion to the dis­ease and ful­ly elim­i­nate the poten­tial for spread.

“Oth­er fac­tors shape that — how long will that immu­ni­ty last?” Tan said. “If it’s short term, you’re gonna have to vac­ci­nate more peo­ple.”
...

So we need to see 65–75 per­cent of the pop­u­la­tion vac­cine if all goes well and the vac­cines do indeed pro­tect against trans­mis­sion. But if not, what per­cent of the pop­u­lace will have to get vac­ci­nat­ed? 80 per­cent? 90 per­cent? The num­ber will pre­sum­ably depend on a num­ber of oth­er fac­tors, like how long the immu­ni­ty lasts and whether or not there’s still a par­tial pro­tec­tion against trans­mis­sion.

And as the fol­low­ing arti­cle about a recent poll of Amer­i­cans about their will­ing­ness to take the vac­cine makes clear, what­ev­er that required thresh­old of vac­ci­nat­ed Amer­i­cans ends up being, it’s going to be too high since only half of the peo­ple in the US appear want a vac­cine shot right now:

Asso­ci­at­ed Press

AP-NORC poll: Only half in US want shots as vac­cine nears

By LAURAN NEERGAARD and HANNAH FINGERHUT
Wed Dec 9 2020 15:59:41 CST

WASHINGTON (AP) — As states fran­ti­cal­ly pre­pare to begin months of vac­ci­na­tions that could end the pan­dem­ic, a new poll finds only about half of Amer­i­cans are ready to roll up their sleeves when their turn comes.

The sur­vey from The Asso­ci­at­ed Press-NORC Cen­ter for Pub­lic Affairs Research shows about a quar­ter of U.S. adults aren’t sure if they want to get vac­ci­nat­ed against the coro­n­avirus. Rough­ly anoth­er quar­ter say they won’t.

Many on the fence have safe­ty con­cerns and want to watch how the ini­tial roll­out fares — skep­ti­cism that could hin­der the cam­paign against the scourge that has killed near­ly 290,000 Amer­i­cans. Experts esti­mate at least 70% of the U.S. pop­u­la­tion needs to be vac­ci­nat­ed to achieve herd immu­ni­ty, or the point at which enough peo­ple are pro­tect­ed that the virus can be held in check.

“Trep­i­da­tion is a good word. I have a lit­tle bit of trep­i­da­tion towards it,” said Kevin Buck, a 53-year-old for­mer Marine from Eure­ka, Cal­i­for­nia.

Buck said he and his fam­i­ly will prob­a­bly get vac­ci­nat­ed even­tu­al­ly, if ini­tial shots go well.

“It seems like a lit­tle rushed, but I know there was absolute­ly a rea­son to rush it,” he said of the vac­cine, which was devel­oped with remark­able speed, less than a year after the virus was iden­ti­fied. “I think a lot of peo­ple are not sure what to believe, and I’m one of them.”

Amid a fright­en­ing surge in COVID-19 that promis­es a bleak win­ter across the coun­try, the chal­lenge for health author­i­ties is to fig­ure out what it will take to make peo­ple trust the shots that Dr. Antho­ny Fau­ci, the top U.S. infec­tious-dis­ease expert, calls the light at the end of the tun­nel.

“If Dr. Fau­ci says it’s good, I will do it,” said Mary Lang, 71, of Fre­mont, Cal­i­for­nia. She added: “Hope­ful­ly if enough of us get the vac­cine, we can make this virus go away.”

Ear­ly data sug­gests the two U.S. fron­trun­ners — one vac­cine made by Pfiz­er and BioN­Tech and anoth­er by Mod­er­na and the Nation­al Insti­tutes of Health — offer strong pro­tec­tion. The Food and Drug Admin­is­tra­tion is por­ing over study results to be sure the shots are safe before decid­ing in the com­ing days whether to allow mass vac­ci­na­tions, as Britain began doing with Pfizer’s shots on Tues­day.

Despite the hope­ful news, feel­ings haven’t changed much from an AP-NORC poll in May, before it was clear a vac­cine would pan out.

In the sur­vey of 1,117 Amer­i­can adults con­duct­ed Dec. 3–7, about 3 in 10 said they are very or extreme­ly con­fi­dent that the first avail­able vac­cines will have been prop­er­ly test­ed for safe­ty and effec­tive­ness. About an equal num­ber said they are not con­fi­dent. The rest fell some­where in the mid­dle.

Experts have stressed that no cor­ners were cut dur­ing devel­op­ment of the vac­cine, attribut­ing the speedy work to bil­lions in gov­ern­ment fund­ing and more than a decade of behind-the-scenes research.

Among those who don’t want to get vac­ci­nat­ed, about 3 in 10 said they aren’t con­cerned about get­ting seri­ous­ly ill from the coro­n­avirus, and around a quar­ter said the out­break isn’t as seri­ous as some peo­ple say.

About 7 in 10 of those who said they won’t get vac­ci­nat­ed are con­cerned about side effects. Pfiz­er and Mod­er­na say test­ing has uncov­ered no seri­ous ones so far. As with many vac­cines, recip­i­ents may expe­ri­ence fever, fatigue or sore arms from the injec­tion, signs the immune sys­tem is revving up.

But oth­er risks might not crop up until vac­cines are more wide­ly used. British health author­i­ties are exam­in­ing two pos­si­ble aller­gic reac­tions on the first day the coun­try began mass vac­ci­na­tions with the Pfiz­er shot.

Among Amer­i­cans who won’t get vac­ci­nat­ed, the poll found 43% are con­cerned the vac­cine itself could infect them — some­thing that’s sci­en­tif­i­cal­ly impos­si­ble, since the shots don’t con­tain any virus.

Pro­tect­ing their fam­i­ly, their com­mu­ni­ty and their own health are chief dri­vers for peo­ple who want the vac­cine. Rough­ly three-quar­ters said life won’t go back to nor­mal until enough of the coun­try is vac­ci­nat­ed.

...

COVID-19 has killed or hos­pi­tal­ized Black, His­pan­ic and Native Amer­i­cans at far high­er rates than white Amer­i­cans. Yet 53% of white Amer­i­cans said they will get vac­ci­nat­ed, com­pared with 24% of Black Amer­i­cans and 34% of His­pan­ics like Mar­tinez.

Because of insuf­fi­cient sam­ple size, the sur­vey could not ana­lyze results among Native Amer­i­cans or oth­er racial and eth­nic groups that make up a small­er pro­por­tion of the U.S. pop­u­la­tion.

...

Health experts say it is not sur­pris­ing that peo­ple have doubts because it will take time for the vac­cines’ study results to become wide­ly known.

“Some­times you have to ask peo­ple more than once,” said John Graben­stein of the Immu­niza­tion Action Coali­tion, a retired Army colonel who direct­ed the Defense Department’s immu­niza­tion pro­gram. He said many even­tu­al­ly will decide it’s “far, far bet­ter to take this vac­cine than run the risk of coro­n­avirus infec­tion.”

Adding to the chal­lenge are polit­i­cal divi­sions that have ham­strung pub­lic health efforts to cur­tail the out­break. The poll found 6 in 10 Democ­rats said they will get vac­ci­nat­ed com­pared with 4 in 10 Repub­li­cans; about a third of Repub­li­cans said they won’t.

Only about 1 in 5 Amer­i­cans are very or extreme­ly con­fi­dent that vac­cines will be safe­ly and quick­ly dis­trib­uted, or fair­ly dis­trib­uted, though majori­ties are at least some­what con­fi­dent.

...

Health work­ers and nurs­ing home res­i­dents are set to be first in line for the scarce ini­tial dos­es. Plans call for oth­er essen­tial work­ers and peo­ple over 65 or at increased risk because of oth­er health prob­lems to fol­low, before enough vac­cine arrives for every­one, prob­a­bly in the spring.

The poll found majori­ties of Amer­i­cans agree with that pri­or­i­ty list. And 59% think vac­ci­nat­ing teach­ers should be a high pri­or­i­ty, too. Most also agree with high­er pri­or­i­ty for hard-hit com­mu­ni­ties of col­or and peo­ple in crowd­ed liv­ing con­di­tions such as home­less shel­ters and col­lege dorms.

...

———–

“AP-NORC poll: Only half in US want shots as vac­cine nears” by LAURAN NEERGAARD and HANNAH FINGERHUT; Asso­ci­at­ed Press; 12/09/2020

“In the sur­vey of 1,117 Amer­i­can adults con­duct­ed Dec. 3–7, about 3 in 10 said they are very or extreme­ly con­fi­dent that the first avail­able vac­cines will have been prop­er­ly test­ed for safe­ty and effec­tive­ness. About an equal num­ber said they are not con­fi­dent. The rest fell some­where in the mid­dle.”

Yes, just 3 in 10 Amer­i­cans have a high con­fi­dence that the vac­cine will be prop­er­ly test­ed for safe­ty and effec­tive­ness. It’s less than half the 7 out of 10 who will be required to take it, and that’s assum­ing the vac­cine actu­al­ly halts trans­mis­sion. Per­haps a more impor­tant sur­vey result is that only 4 in 10 Repub­li­cans say that will get vac­ci­nat­ed and a third of Repub­li­can vot­ers say that won’t get the vac­cine. That last group sounds like they will be extreme­ly opposed to get­ting the vac­cine under vir­tu­al­ly all cir­cum­stances:

...
Adding to the chal­lenge are polit­i­cal divi­sions that have ham­strung pub­lic health efforts to cur­tail the out­break. The poll found 6 in 10 Democ­rats said they will get vac­ci­nat­ed com­pared with 4 in 10 Repub­li­cans; about a third of Repub­li­cans said they won’t.

Only about 1 in 5 Amer­i­cans are very or extreme­ly con­fi­dent that vac­cines will be safe­ly and quick­ly dis­trib­uted, or fair­ly dis­trib­uted, though majori­ties are at least some­what con­fi­dent.
...

The take home les­son from all this appears to be that the prospects for reach­ing herd immu­ni­ty through a vac­cine alone don’t look good for the US, bar­ring some sort of vac­cine man­date. And if there is a vac­cine man­date we can be sure that’s going to erupt into a mas­sive polit­i­cal issue. The kind of polit­i­cal issue that real­ly could be used to spark some sort of civ­il con­flict giv­en the con­tem­po­rary polit­i­cal dynam­ic in the US.

So if a vac­cine man­date is out of the ques­tion, and herd immu­ni­ty via the vac­cine is out of the ques­tion, what’s left? COVID-20. And COVID-21, and a new COVID every year going for­ward. At least in the US. We’ll see if any oth­er parts of the world man­age to reach some sort of herd immu­ni­ty. But for the US it’s like­ly going to be COVID-For­ev­er. And COVID-Vac­cines-For­ev­er for every­one, per­haps with qua­si-per­ma­nent trav­el bans imposed against coun­tries like the US.

Also note that hav­ing COVID per­ma­nent­ly cir­cu­lat­ing the globe makes the prospects of ‘COVID vac­cine pass­ports’ required for not just trav­el but every­day com­merce a lot more like­ly. And the fur­ther we go down the path of requir­ing vac­cine pass­ports the more politi­cized the issue of vac­ci­na­tions is going to become in the US dur­ing a time when the Amer­i­can right wing is feel­ing extra sedi­tious.

It’s all the more rea­son to hope that the sce­nario where SARS-CoV­‑2 even­tu­al­ly turns into a com­mon cold coro­novirus — as appears to have hap­pened with our cur­rent com­mon cold coro­n­avirus­es that may have start­ed off as dead­ly COVID-like dis­eases when they first jumped to humans — real­ly does play out. Because SARS-CoV­‑2 is look­ing like it’s going to be a pret­ty com­mon virus going for­ward, with or with­out an avail­able vac­cine.