COVID-19 Roundup

In part because there is so much news, and in part to free my mind up to deal with other things, I'm putting out this roundup of what I regard as the most interesting or useful news about the pandemic that I have encountered recently.

1. At Medium, epidemiologist Amesh Adalja outlines "A Path Forward," leading off in part with:

Plans of prolonged, enforced confinement aimed at preserving life at any cost are premised on a misunderstanding of human life and what makes it worth living. When discussing treatment options with a patient, I often invoke the concept of "quality of life". Patients regularly choose to take on some risk to their longevity in order to preserve or enhance their quality of life. Individual preferences and shared decision-making with physicians guide medical decision making and also should apply to each individual's decision regarding the degree of social distancing that is appropriate for them.

A degraded quality of life, particularly over time, itself generates its own risks of death. If the lockdown is prolonged, we can expect increases in deaths from cancer, cardiovascular disease, stroke, mental illness, and substance abuse. How many cancers will metastasize while colonoscopies or biopsies deemed "elective" will be postponed?

Quality of life consists largely in the ability to engage in the activities that make up our lives, and central to these activities is work... [bold added]

Dr. Adalja also summarizes what got us to this predictable (!) point, and what we can and ought to do going forward, given our current social, political, and economic arrangements.

2. Philosopher-energy advocate Alex Epstein summarizes the contents of his latest Power Hour podcast as follows:

...I discuss four ideas you won't hear anywhere else:

1. The increasingly prevalent COVID-19 policy of indefinite universal isolation is immoral and un-American
2. Climate change fixation blinds us to real threats like COVID-19
3. A Green New Deal would be fatal in the fight against COVID-19
4. The Corona Recession is a mild preview of the Green New Deal

I also discuss a fifth idea that's even more controversial. [bold added]

Each one of the four ideas listed above deserves much wider circulation, and I look forward to hearing Epstein flesh them out. I have embedded the video below.

3. Medicinal chemist Derek Lowe comments on the current state of clinical trials for various COVID-19 therapeutics, including a very promising-sounding re-purposing of two already-existing drugs:

Finally, there are some potentially very interesting results [(PDF)] from France on hydroxychloroquine. That compound (and chloroquine itself) have been the subject of much interest, and these are the first trial data that I've seen. A number of things need to be said up front: first of all, this was a small trial. Second, it was open-label. Third, there were significant patient drop-outs in the treatment group, making the sample even smaller. Under normal circumstances, to be honest, I would be looking askance at this, but (1) these ain't normal circumstances and (2) the effect size seen in this work may be significant.

In summary, 26 patients were enrolled in the treatment group, with 16 controls. Six patients dropped out of the treatment group: 3 went to the ICU, one dropped out due to nausea, one left the hospital (apparently recovered?) and one died. No one left the control group. There were 15 male and 21 female patients. 6 of them were asymptomatic, 22 had upper respiratory symptoms, and 8 had lower respiratory tract symptoms (all of those had confirmed pneumonia by imaging).

The treatment group got 200mg of hydroxychloroquine sulfate three times a day, and six of those patients were also given 500mg azithromycin in addition. The paper says that this was the deal with possible bacterial superinfection, and the lead author also makes mention of possible antiviral effects of the compound. I hadn't heard of these -- azithromycin is, of course, more famous as an antibacterial -- but there seems to be a pretty established literature on this, although the mechanism doesn't seem to be well worked out. [bold added, links in original]

Confirmation of these results would be fantastic news, and in the modern, very positive sense of the term.

4. Finally, it comes as a relief that the Wall Street Journal and a few other prominent voices have called for an end to the massive economic shutdowns we have been using to avert a hospital capacity crisis. Unlike the positive case Dr. Adalja makes for work, and the method of weighing risks (above), the piece focuses on the unseen destruction the shutdowns are wreaking, and I think it is effective in its own way:

Yet the costs of this national shutdown are growing by the hour, and we don't mean federal spending. We mean a tsunami of economic destruction that will cause tens of millions to lose their jobs as commerce and production simply cease. Many large companies can withstand a few weeks without revenue but that isn't true of millions of small and mid-sized firms.

Even cash-rich businesses operate on a thin margin and can bleed through reserves in a month. First they will lay off employees and then out of necessity they will shut down. Another month like this week and the layoffs will be measured in millions of people.

The deadweight loss in production will be profound and take years to rebuild. In a normal recession the U.S. loses about 5% of national output over the course of a year or so. In this case we may lose that much, or twice as much, in a month. [bold added]

The article closes, in part, by noting that "[N]o society can safeguard public health for long at the cost of its overall economic health."

I agree.

-- CAV