COVID DIARIES, WEEK OF 13 NOVEMBER 2020

Amid a Pandemic, Signs of Hope

The virus is out of control, and getting worse. But this week brought at least two positive signs

This week’s coronavirus news is so awful at every level that I’m instead going to focus mostly on two positive developments. As usual there are complete weekly stats at the end of this post.

First, a caveat. Neither of new these developments will help us right now. The whole country is a coronavirus hot spot, and things will likely worsen for at least the next 2–3 months.

Almost every state in the nation is now a coronavirus hot spot. The number of new cases per day has doubled in the past three weeks, and both new cases and hospitalizations are at all-time highs.

This chart, compiled from state data by computational biologist Mike Bass, shows new cases in Ventura County are deep in the state’s most infectious purple tier, and continue to rise sharply. Mike observed today that the virus not only appears to be winning but also picking up speed.

It’s vital that everyone do what we can — wearing masks, limiting indoor gatherings, washing hands, exercising outdoors, keeping physical distance but not social distance — to check the spread of the virus.

All key US coronavirus metrics rose this week. Deaths increased at a substantially slower rate than new cases or hospitalizations — but they are a trailing indicator. Two previous surges suggest an increase in the death rate is likely in the next few weeks.

About the only encouraging things to say about the California situation are that case growth isn’t _quite_ as high as the national total, and that deaths declined this week. But deaths are a trailing indicator, and may soon increase following 19% and 12% weekly increases, respectively, in the state’s hospital and ICU patient counts.

In absolute terms, Illinois was the most infectious state this week. But 12 other states, including California, were also in the top tier of infection levels.

Adjusted for population, the Dakotas remain the most infectious place in the nation. But many other Great Plains and Midwestern states also saw skyrocketing numbers of new cases. The number of new cases per day is now double the level of three weeks ago.

The most promising news this week is Pfizer’s announcement that the vaccine candidate it produced with partner BioNTech far exceeded expectations. Trial subjects who received two doses three weeks apart experienced 90% fewer infections than those on a placebo. Better still, the cohort of around 90 subjects receiving the vaccine included elderly patients.

The physicians and biotech scientists I’ve asked about the news this week are all cautiously optimistic. If the news holds up — we should have more data in 1–2 more weeks, when Pfizer and BioNTech are expected to apply to the FDA for an emergency use permit — the 90% success rate would mean fewer people would need to be vaccinated. Fewer vaccinations is helpful logistically and in overcoming resistance from those skeptical about this vaccine, or any vaccine.

The vaccine represents another kind of landmark: It uses messenger RNA (mRNA) instead of the virus itself to inoculate patients. mRNA-based vaccines are relatively new; they turn the body into a factory for manufacturing needed antibodies, and could be important for vaccination and treatment of many diseases, according to former CDC director Dr. Tom Frieden.

Credit is due to Katalin Karikó, a biochemist who despite 30 years of rejections didn’t give up on mRNA. For decades the knock on the substance was that the body would sense it as an intruder and try to kill it. But about 10 years ago Karikó and longtime research partner Drew Weissman discovered that a slight tweak to mRNA worked without triggering the body’s defenses.

Moderna also is working on an mRNA-based coronavirus vaccine, and is expected to announce Phase 3 trial results soon. Partners AstraZeneca and Oxford University also plan to announce results of a virus-based vaccine by the end of December.

There are still caveats around the Pfizer announcement, which is after all just a press release at this point. First and most important, the vaccine won’t be in widespread circulation for at least several more months. We need to keep up our guard in the meantime.

Second, despite a very promising start the FDA will need a careful review of additional data Pfizer and BioNTech will provide soon. The vaccine may be a home run, or not; it’s far too early to say.

Third, mRNA-based vaccines are tricky to store and administer, according to Laurie Garrett, a Pulitzer Prize-winning science reporter.

mRNA is highly unstable outside of cells, and requires storage at about -100F to -110F degrees. Most healthcare facilities, especially in rural and impoverished areas, currently lack adequate cold storage, though efforts are under way to build and distribute coolers.

Also, the Pfizer vaccine will require two injections three weeks apart. Population tracking has always been a challenge in public health, and that will be especially true here.

The other encouraging news this week is a study that found people carrying antibodies don’t become infected, even amidst superspreader events.

The study, cited in the CDC’s Morbidity and Mortality Weekly Report (MMWR), focused on an outbreak at a summer camp in Wisconsin. There, one camper who’d tested negative the day before infecting more than 100 others at the camp.

The encouraging part is that the 24 campers had antibodies before camp, and none of these became infected. This suggests most people with antibodies are protected, at least for some time.

We still don’t know why kids get less seriously ill than adults, or how long antibody protection lasts, or why there’s so much variation in severity of illness even among patients the same age with the same risk factors. But there is some evidence that cross-reacting antibodies to other coronaviruses may protect from COVID-19.

Encouraging developments, to be sure. But let’s keep our eye on the ball: The situation is out of control throughout the US and we don’t yet have a vaccine. This doesn’t necessarily mean more lockdowns or stay-at-home orders, especially since neither term is particularly accurate.

It does mean we’re all going to have to get more serious about safety measures. There are specific things we can do to mitigate risk. It’s on us — all of us — to do them.

Here are this week’s coronavirus stats, all sourced from covidtracking.com.

US stats for the week ending Friday, November 13 (with % change from previous week):

New cases: 955,084 (+41%)
Total tests (positive, negative, pending): 9,977,515 (+7%)
Cumulative US cases: 10,588,169
Confirmed COVID-19 hospitalizations: 68,516 (+25%)
Confirmed COVID-19 ICU: 13,132 (+18%)
Deaths: 7,488 (+10%)
Cumulative US deaths: 235,629

CA stats for the week ending Friday, November 13 (with % change from previous week):

New cases: 47,408 (+39%)
Total tests (positive, negative, pending): 1,082,151 (+14%)
Cumulative CA cases: 998,502
Confirmed COVID-19 hospitalizations: 4,138 (+19%)
Confirmed COVID-19 ICU: 1,031 (+12%)
Deaths: 271 (-8%)
Cumulative CA deaths: 18,137