May 28, 2020

How advances in biological science are transforming economies and societies

McKinsey Global Institute is well known by their excellent papers and analysis. Forget consultancy for a while, if you are interested in the disruptive knowledge, go to MGI. Now they have released an excellent report on the Bio Revolution. This is a timely contribution for an issue that those that read this blog already know: we are within a huge change on how life has been considered. CRISPR technology, among others, are changing quickly the landscape.
The potential scope and scale of the (direct and indirect) impact of biological innovations appear very substantial. As much as 60 percent of the physical inputs to the global economy could be produced biologically. Around one-third of these inputs are biological materials (such as wood). The remaining two-thirds are not biological materials, but could, in principle, be produced using innovative biological processes (for instance, bioplastics).
A pipeline of about 400 use cases, almost all scientifically feasible today, is already visible. These applications alone could have direct economic impact of up to $4 trillion a year over the next ten to 20 years. More than half of this direct impact could be outside human health in domains such as agriculture and food, consumer products and services, and materials and energy production. Taking into account potential knock-on effects, new applications yet to emerge, and additional scientific breakthroughs, the full potential could be far larger.
A must read.

May 27, 2020

The role of global governance in a pandemic

COVID-19: Public Health Is a Question of National Security

Three critical points in a document of the Council of Foreign Relations:
Transparency and Knowledge Sharing
The primary flaw in the COVID-19 response has been the opacity in knowledge sharing. China is the first country to claim to have successfully flattened the curve. Research suggests that China’s nonpharmaceutical interventions, such as travel bans, social distancing, isolation, and contact tracing, wereeffective in containing the outbreak.
Strengthening Global Mechanisms
During health crises, the world looks to the primary global health agency, the World Health Organization (WHO), for guidance. Surprisingly, the WHO’s response to COVID-19 was lacking. Although the body had once warned that caution and vigilance were necessary against any future Sudden Acute Respiratory Syndrome (SARS)-like disease, it ignored this advice in late 2019 when managing the mysterious pneumonia in Wuhan, China. For months, it failed to recommend travel restrictions or bans.  
Capacity Building
COVID-19 has rendered some of the better health systems in the world inoperable. A country’s first line of defense is the capability of its health system to detect and control contagious diseases. Underinvestment in preparedness and reliance on treatment rather than a preemptive response has proven costly in terms of lives and dollarspportunity to tackle the pandemic was missed, raising questions about the WHO’s credibility. 

Juan Correa

May 26, 2020

How epidemic-macroeconomic models of pandemic create uncertainty

Dealing with Covid-19: understanding the policy choices

A model is as good as its assumptions!. This is obvious and the application requires good data. Both issues, assumptions and data are the reasons why many models doesn't fit in this pandemic. Bad assumptions and bad data give bad conclusions. Have a look at this paper and in p.5 you'll find the different health and economic impact of models under different assumptions. So different that require a clever explanation if somebody wants to use them to take a decision.
VSL-based and SIR-macro models have helped to inform policy decisions in the early stages of the Covid-19 pandemic. However, the existing models are subject to a number of caveats, particularly relating to the uncertainty of their underlying epidemiological projections and stylised economic foundations.

 Juan Genovés

May 25, 2020

Can capitalism be reimagined? (3)

The future of capitalism

Martin Wolf said that this book was one of his main references. And I agree, it contains many well structured messages. Specially, it links economics with politics, quite a difficult issue:
 Our political systems are democratic, but the details of their architecture have increasingly inclined them to polarization. Most of our voting systems favour the two largest parties. So, the menu of choice facing voters depends upon what these two parties offer. The key dangerous step has been that, in the name of greater democracy, in many countries the major political parties have empowered their members to elect their leaders. This has replaced a system in which the leader of a party was drawn from among its most experienced people, and often chosen by its elected representatives.
Leaders can promote new narratives, but the decline of trust in political leaders has inverted authority; people pay more attention to those at the hub of their social networks than to the talking heads on the television. The networks, however, have become self-contained echo-chambers and so we even lack the common space in which to communicate. This is enormously damaging because participation in a common network constitutes the common knowledge that we all hear the same narratives.
 Reduced to a sentence, shared identity becomes the foundation for far-sighted reciprocity. Societies that succeed in building such belief systems work better than those based on either individualism or any of the revivalist ideologies. Individualist societies forfeit the vast potential of public goods. The revivalist ideologies are each based on hatred of some other part of society and are culs-de-sac to conflict. In a healthy society, those who become successful have been reared into acceptance of that web of reciprocal obligations.
 In contrast to the Utilitarian vision of autonomous individuals, each generating utility from their own consumption, and counting equally in the great moral arithmetic of total utility, the atoms of a real society are relationships. In contrast to the psychopathic selfishness of economic man restrained by the Platonic guardians of social paternalism, normal people recognize that relationships bring obligations, and that meeting them is central to our sense of purpose in life. The toxic combination of Platonic Guardians and economic man that has dominated public policy has inexorably stripped people of moral responsibility, shifting obligations to the paternalist state. In a bizarre parody of medieval religion, ordinary people are cast as sinners who need to be ruled by exceptional people – the moral meritocracy.
He is in favour of inclusive politics. Me too. Definitely, capitalism can be reimagined.

May 24, 2020

Stop Covid with CRISPR Diagnostics (2)

CRISPR–Cas12-based detection of SARS-CoV-2

Mammoth Biosciences (a firm founded by Jennifer Doudna) has partenered with GSK to commercialise a CRISPR Covid test. Therefore, there are right now two firms in the race: Sherlock and Mammoth.
The paper in Nature explains the details:
Here we report the development and initial validation of a CRISPR–Cas12-based assay9 for detection of SARS-CoV-2 from extracted patient sample RNA, called SARS-CoV-2 DNA Endonuclease-Targeted CRISPR Trans Reporter (DETECTR). This assay performs simultaneous reverse transcription and isothermal amplification using loop-mediated amplification (RT–LAMP)14 for RNA extracted from nasopharyngeal or oropharyngeal swabs in universal transport medium (UTM), followed by Cas12 detection of predefined coronavirus sequences, after which cleavage of a reporter molecule confirms detection of the virus. We first designed primers targeting the E (envelope) and N (nucleoprotein) genes of SARS-CoV-2 (Fig. 1a). The primers amplify regions that overlap the World Health Organization (WHO) assay (E gene region) and US CDC assay (N2 region in the N gene)6,15, but are modified to meet design requirements for LAMP. We did not target the N1 and N3 regions used by the US CDC assay, as these regions lacked suitable protospacer adjacent motif sites for the Cas12 guide RNAs (gRNAs). Next, we designed Cas12 gRNAs to detect three SARS-like coronaviruses (SARS-CoV-2 (accession NC_045512), bat SARS-like coronavirus (bat-SL-CoVZC45, accession MG772933) and SARS-CoV (accession NC_004718)) in the E gene and specifically detect only SARS-CoV-2 in the N gene (Supplementary Fig. 1). This design is similar to those used by the WHO and US CDC assays, which use multiple amplicons with probes that are either specific to SARS-CoV-2 or are capable of identifying related SARS-like coronaviruses.

Edward Hopper 

May 23, 2020

After all these years, a new pandemic and the same behavioral biases

Using social and behavioural science to support COVID-19 pandemic response

This is the best paper as far as I know on behavioral biases in the current pandemic. The conclusion says:
Over 100 years ago, Science magazine published a paper on lessons from the Spanish Flu pandemic. The paper argued that three main factors stand in the way of prevention: (i) people do not appreciate the risks they run, (ii) it goes against human nature for people to shut themselves up in rigid isolation as a means of protecting others, and (iii) people often unconsciously act as a continuing danger to themselves and others. Our paper provides some insights from the past century of work on related issues in the social and behavioural sciences that may help public health officials mitigate the impact of the current pandemic. Specifically, we discussed research on threat perception, social context, science communication, aligning individual and collective interests, leadership, and stress and coping. 
A century ago paper:  Soper, G. A. The lessons of the pandemic. Science 49, 501–506 (1919).
First, public indifference. People do not appreciate the risks they run. The great complexity and range in severity of the respiratory infections confuse and hide the danger. The infections vary from the common cold to pneumonia. They are not all separate entities by any means. An attack which begins as a coryza or rhinitis may develop into a pharyngitis, tonsilitis, laryngitis, bronchitis or pneumonia. The gravity increases with the progress toward the lungs. The infection sometimes seems to begin in the chest, sometimes in the throat, sometimes in the head. It may stop where it started or pass through several phases. This is the story of the common cold. It is generally more discomforting than dangerous. Most people get well without skillful treatment, or indeed any great interference with business. No specific virus is known to produce it.

May 22, 2020

Searching for a vaccine and a drug in the surreal and accelerated world of Covid-19 research

What Is the World Doing to Create a COVID-19 Vaccine?

Building the critical path for COVID-19 therapeutics

How to Discover Antiviral Drugs Quickly

The world needs Covid-19 vaccines. It may also be overestimating their power

From CFR:
Public officials worldwide have stressed that the pandemic likely will not end until there is an effective vaccine. Even after a vaccine is approved, however, there remains the tremendous challenge of producing enough of it for the world’s population. An estimated one billion doses would need to be manufactured just to vaccinate workers in health care and other essential industries globally, and that is if only a single dose is required for each person.
This task has both motivated countries to prepare for large-scale production, as well as pitted them against one another amid fears of a potentially limited vaccine supply. While Brazil, China, and India all have large vaccine industries, they also have among the largest populations, and they could reserve their vaccine supplies for their own citizens before opening them up to others. Some countries are seeking to strike monopoly agreements with vaccine manufacturers to avoid domestic shortages. Experts including CFR’s Bollyky have warned that bidding wars over a vaccine will lead to inequitable distribution and, ultimately, fail to eliminate the risk of new outbreaks.
Moreover, amid these extraordinary efforts to secure a vaccine, scientists are still investigating how this new coronavirus behaves and trying to answer the many questions people have about the risk it poses and how protected they will be. This includes how effective a vaccine will be against a mutating coronavirus, though researchers point out that mutations do not necessarily mean different strains of the virus or changes in its infectiousness or lethality. Uncovering such details about the virus, they say, will only help in the development of a successful vaccine.
From NEJM:
 So, what is happening now? The laborious, decade-long, classic pathway for the discovery and approval of new drugs could hardly be less well suited to the present pandemic. Repurposing existing drugs offers a potentially rapid mechanism to deployment, since the safety profiles are known. Therefore, a preliminary report of a supercomputer-driven ensemble docking study of a repurposing compound database to the viral S protein was published on a preprint server in mid-February, with 8000 compounds ranked according to the calculated binding affinity to the receptor-binding domain of the S protein.3 Top-ranked compounds from the original S-protein virtual screen are being tested for activity against the live virus. The results will inform future calculations in a speedy, iterative process.

May 21, 2020

Counterfeit medicines: the time to act is now

Trade in Counterfeit Pharmaceutical Products
Coronavirus (COVID-19) and the global trade in fake pharmaceuticals

OECD has released an iluminating report about counterfeit medicines around the world. And my surprise was:
Commenting specifically on manufacturing, Table 4.5 indicates that China arrested the largest number of individuals engaged in the manufacture of counterfeit medicines. It was followed by Spain, the United States, India, Pakistan and Indonesia. Note that almost all of these countries (except the United States and Spain) were identified as potential producers of counterfeit pharmaceuticals in the methodology developed by OECD/EUIPO and described in the previous section .
The second method for determining the main producing economies of fake pharmaceuticals and the key transit points involves using PSI data. Through liaison   contacts, member reports and open source reports, PSI has documented the arrest of 2253 people involved in counterfeiting, diversion or theft of pharmaceutical drugs worldwide during 2018. 
Table 4.5. Top ten countries for the number of arrests of individuals engaged in manufacturing counterfeit medicines, 2018

Number of arrests

United States


Source: PSI data.

As you can see, Spain is the second country in the world. Nothing to add.

May 20, 2020

Can capitalism be reimagined? (2)

Capitalism at Risk: Rethinking the Role of Business

Ten years after its first release, a new and updated edition of this book is available. Let me say that the book by Rebecca Henderson is better than this one. Anyway, this is an additional reference to take into account.

WHAT, THEN, should be done about the challenges facing market capitalism? And what, specifically, is the role of business in this effort? In our conversations, we heard answers reflecting a spectrum of views. Although executives in our forums did not use our terminology, their positions clustered into four broad categories that we term business as bystander, business as activist, business as innovator, and business as usual.
Ten years after, the same views...(?)

May 19, 2020

Assessing the government job on COVID-19

The citizens voice has said that several governments are doing a poor job in front of covid-19. Japan, Spain and France are the worst.  In the case of Spain there are clear reasons behind such opinion (please see below).

A picture is worth a thousand words

May 18, 2020

Germline editing: fasten seat belts

We conclude that so long as heritable genome editing interventions are consistent with the welfare of the future person and with social justice and solidarity, they do not contravene any categorical moral prohibition.
Nuffield Council on Bioethics (2018)
This statement changed the existing bioethics view on genome editing. From then, the door is open and nobody knows exactly what does it mean.

In this article, the authors open the possibilities without knowing exactly its implications:
 Two technologies under consideration to tackle this challenge are preimplantation genetic diagnosis (PGD) and remedial germline editing (RGE). Preimplantation genetic diagnosis is an established diagnostic technique, widely deployed today to identify a genetic defect in embryos created through in vitro fertilization, with the goal of transferring only embryos lacking the defect to the mother’s uterus. Remedial germline editing is a novel therapeutic paradigm that has has yet to be applied in the clinic to correct a heritable deleterious mutation in a fertilized egg. We predict that, in time, safe and efficacious RGE will eclipse PGD, the relative shortcomings of which are becoming increasingly apparent.
The final reports of the International Commission on the Clinical Use of Human Germline Genome Editing and the World Health Organization’s Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing are due later this year.
Meanwhile, take care!

May 17, 2020

The next future

Choices for the “New Normal”

A short article writen by Don Berwick sheds light on the main topics for the next future:

  • The Speed of Learning
  • The Value of Standards
  • Protecting the Workforce
  • Virtual Care
  • Preparedness for Threats
  • Inequity
Fate will not create the new normal; choices will. Will humankind meet its needs—not just pandemic needs—at the tempo the COVID-19–related morbidity and mortality demand? Will science and fact gain the high ground in guiding resources and behaviors? Will solidarity endure? Will compassion and respect be restored for the people—all the people—who make life agreeable and civilization feasible, including a guarantee of decent livelihoods and security for everyone? Will the frenzied world of commerce take a breath and let technology help simplify work without so much harm to the planet and without so much stress on everyone? And will society take a break from its obsessive focus on near-term gratification to prepare for threats ahead?
Ps. Video in JAMA Network

May 16, 2020

May 15, 2020

Can capitalism be reimagined?

A new book says that reimagining is possible. Rebecca Henderson is a well known reference for her studies on pharmaceutical innovation for decades. Beyond pharma, she is recognised by her works on innovation in general. Now, she has released a book on Reimagining Capitalism and this may sound a huge goal. Rebecca provides clear hints about what can be done, and says:
I spend a good chunk of my time now working with business people who are thinking of doing things differently. They can see the need for change. They can even see a way forward. But they hesitate. They are busy. They don’t feel like doing it today. It sometimes seems as if I’m still at the bottom of that ladder, looking up, waiting for others to take the risk of acting in new and sometimes uncomfortable ways. But I am hopeful. I know three things.
First, I know that this is what change feels like. Challenging the status quo is difficult—and often cold and lonely. We shouldn’t be surprised that the interests that pushed climate denialism for many years are now pushing the idea that there’s nothing we can do. That’s how powerful incumbents always react to the prospect of change.
Second, I am sure it can be done. We have the technology and the resources to fix the problems we face. Humans are infinitely resourceful. If we decide to rebuild our institutions, build a completely circular economy, and halt the damage we are causing to the natural world, we can. In the course of World War II, the Russians moved their entire economy more than a thousand miles to the east—in less than a year. A hundred years ago, the idea that women or people with black or brown skin were just as valuable as white men would have seemed absurd. We’re still fighting that battle, but you can see that we’re going to win.
Last, I am convinced that we have a secret weapon. I spent twenty years of my life working with firms that were trying to transform themselves. I learned that having the right strategy was important, and that redesigning the organization was also critical. But mostly I learned that these were necessary but not sufficient conditions. The firms that mastered change were those that had a reason to do so: the ones that had a purpose greater than simply maximizing profits. People who believe that their work has a meaning beyond themselves can accomplish amazing things, and we have the opportunity to mobilize shared purpose at a global scale.
 The titles of the chapters speak by themselves. You'll get the flavour of a great book, and a personal message (in chapter 8). And don't miss chapter 4 on Aetna CEO and the purpose of the firm.

Shareholder Value as Yesterday’s Idea
Welcome to the World’s Most Important Conversation
Reducing Risk, Increasing Demand, Cutting Costs
Revolutionizing the Purpose of the Firm
Learning to Love the Long Term
 Learning to Cooperate
 Markets, Politics, and the Future of the Capitalist System
 Finding Your Own Path Toward Changing the World

May 14, 2020


The Incidental economist blog provides information regarding QALY in the current pandemic. Forget the cost per QALY (so difficult to estimate in my opinion) and take only the 6,4 QALYs per death avoided.

It updates previous estimates and says:

The table below summarizes the previous calculations and current updates. Our revisited analysis shows that, as the shutdown continues, the cost per QALY gained increases exponentially due to the exponential growth in the total cost of both forgone productivity and business failure.

We previously emphasized that a key challenge in making calculations of this type is the uncertainty around the data inputs. Six weeks later, this still holds true, particularly for the range of QALY losses without a shutdown, i.e. the predicted corona-related deaths in the absence of intervention.
One interesting aspect of this analysis is that as time goes on, the cost per QALY gained will become higher and higher. This is because the net gains will diminish — the lives saved remains constant, but the offsetting life years lost due to other factors increase — while the costs increase exponentially. The key number that remains unknown is the relationship between the length of the lockdown and the number of lives lost.
In our first post, we concluded that the shutdown would meet conventional standards of cost effectiveness only if the deaths avoided was on the high end of the possible range and the costs on the low end — an outcome that seemed unlikely. Revisiting the issue, it is now clear that the cost per QALY gained from the shutdown will be outside the conventional range of acceptability even at the high end of deaths avoided. How far outside the range the shutdown policy will ultimately prove to be is unknown.

May 13, 2020

Searching for a healthy ageing

The Biology of Inequalities in Health

The Lifepath research consortium aimed to investigate the effects of socioeconomic inequalities on the biology of healthy aging. The main research questions included the impact of inequalities on health, the role of behavioral and other risk factors, the underlying biological mechanisms, the efficacy of selected policies, and the general implications of our findings for theories and policies. 
 The impact of socioeconomic condition on premature aging is mediated by known behavioral and clinical factors and intermediate molecular pathways that Lifepath studies have revealed, including epigenetic clocks (age acceleration), inflammation, allostatic load, and metabolic pathways—highlighting the biological imprint (embodiment) of social variables and strengthening causal attribution.
 There is still a wide gap between social and natural sciences, both on methodological and conceptual grounds. Natural sciences focus in particular on biological mechanisms and outcomes, i.e., they address “zoe” (biological life), while social sciences address “bios” (biographical life), if we refer to the terminology used by Ronald Dworkin. In fact, epidemiologists aim to connect zoe and bios in meaningful ways, though this attempt has rarely become explicit. An exception is the work of Nancy Krieger who proposed the concept of “embodiment.” Biology and biography (124) meet in the health status of an individual, depending on social position at a given age. These concepts start to be incorporated into epidemiological research, via the integration of social contexts and biomarkers in a life-course approach. The results from analyses carried out within Lifepath suggest that the socioeconomic environment, from early life and across the life-course, is an important risk factor for health and exerts its effects via intermediate biological mechanisms.
Great research!

PS. Austin Frakt in NYT Putting a Dollar Value on Life? Governments Already Do

Edward Hopper

May 12, 2020

What is going on here?

 Radical Uncertainty
Decision-Making Beyond the Numbers
The question ‘What is going on here?’ sounds banal, but it is not. In our careers we have seen repeatedly how people immersed in technicalities, engaged in day-to-day preoccupations, have failed to stand back and ask, ‘What is going on here?’ We have often made that mistake ourselves.
This is precisely the question that Mervyn King and John Kay pose in their new book Radical Uncertainty. Terrific reading for lockdown days. Below, I've selected some statements:
 The difference between risk and uncertainty was the subject of lively debate in the inter-war period. Two great economists – Frank Knight in Chicago and John Maynard Keynes in Cambridge, England – argued forcefully for the continued importance of the distinction. Knight observed that ‘a measurable uncertainty, or “risk” proper, as we shall use the term, is so far different from an unmeasurable one that it is not in effect an uncertainty at all’
The title of this book, and its central concept, is radical uncertainty . Uncertainty is the result of our incomplete knowledge of the world, or about the connection between our present actions and their future outcomes. Depending on the nature of the uncertainty, such incomplete knowledge may be distressing or pleasurable. I am fearful of the sentence the judge will impose, but look forward to new experiences on my forthcoming holiday. We might sometimes wish we had perfect foresight, so that nothing the future might hold could surprise us, but a little reflection will tell us that such a world would be a dull place.
We have chosen to replace the distinction between risk and uncertainty deployed by Knight and Keynes with a distinction between resolvable and radical uncertainty. Resolvable uncertainty is uncertainty which can be removed by looking something up (I am uncertain which city is the capital of Pennsylvania) or which can be represented by a known probability distribution of outcomes (the spin of a roulette wheel). With radical uncertainty, however, there is no similar means of resolving the uncertainty – we simply do not know. Radical uncertainty has many dimensions: obscurity; ignorance; vagueness; ambiguity; ill-defined problems; and a lack of information that in some cases but not all we might hope to rectify at a future date. These aspects of uncertainty are the stuff of everyday experience.
Radical uncertainty cannot be described in the probabilistic terms applicable to a game of chance. It is not just that we do not know what will happen. We often do not even know the kinds of things that might happen.
Our ability as humans to deal with radical uncertainty is the product of our much greater capacity for social learning and greater ability to communicate relative to other species. We are social animals; we manage radical uncertainty in a context determined by the knowledge we have acquired through education and experience, and we make important decisions in conjunction with others – friends, family, colleagues and advisers.
Reference to the ‘wisdom of crowds’ makes an important point while missing another. The crowd always knows more than any individual, but what is valuable is the aggregate of its knowledge, not the average of its knowledge.

May 11, 2020

CRISPR Technology explained by Dr. Martínez Mojica

El impacto de la tecnología CRISPR en biomedicina.

Sesión científica celebrada en la sede de la Reial Acadèmia de Medicina de les Illes Balears el 9 de julio de 2019 a cargo del profesor Francisco Juan Martínez Mojica, microbiólogo, investigador y profesor español titular del Departamento de Fisiología, Genética y Microbiología de la Universidad de Alicante.

May 10, 2020

The narrative of pandemics

Pandemics, Publics, and Narrative

This is a book that explains the lived experience of general publics affected by the 2009 swine flu pandemic, establishes an interesting narrative approach to health communications and public health. Good read for nowadays.

In what follows we draw out three key lessons for public engagement with pandemic threats: persuasion narrative and its implications; how individuals addressed themselves to biopolitical citizenship in light of the 2009 pandemic, and; biopolitical metaphors— contagion and immunity— and their association with embodied individualism. We also consider a more general question of what our research suggests for the turn to narrative in public health with reference to the global nature of pandemics.
Just like now.

May 9, 2020

The transformative power of a pandemic

Humanitarian Economics
War, Disaster and the Global Aid Market

From the chapter of Disaster Economics

Referring to the notion of creative destruction developed by the Austrian economist Joseph Schumpeter in the mid-twentieth century,several scholars argue that disasters stimulate economic growth in the long run. Disaster precipitates the destruction of the old and thus makes way for the new faster than would otherwise be the case (see Chapter 7 on the transformative power of disasters). Based on a Schumpeterian model of endogenous growth, Aghion and Howitt find that disaster accelerates capital replacement
associated with technological change, which increases productivity and generates a positive economic impact. Under endogenous growth theory, the destruction brought about by disasters can be seen as a form of accelerated capital depreciation that leads to the rapid adoption of new technology and infrastructure upgrading, which increases productivity. This is part of the theoretical foundations behind building back better (BBB).
We still don't know if this will be the case with our pandemic.
These are the remaining chapters.
1.Reason, Emotion and Compassion
2.The Humanitarian Market
3.War Economics
4.Terrorism Economics
5.Disaster Economics
6.Survival Economics
7.The Transformative Power of Humanitarian Crises 

May 8, 2020

Stop covid with CRISPR Diagnostics

With Crispr, a Possible Quick Test for the Coronavirus

Sherlock's quick, CRISPR-based coronavirus test gets emergency nod


Point-of-care testing for COVID-19 using SHERLOCK diagnostics

The FDA granted its first emergency authorization for a CRISPR-based test for COVID-19, developed by Sherlock Biosciences, designed to turn results around in about an hour compared to the four to six hours needed for other molecular diagnostics.
The test is based on the company’s namesake technology, SHERLOCK, short for Specific High-sensitivity Enzymatic Reporter unLOCKing, a Cas13a-based CRISPR system that targets RNA rather than DNA. It looks for an RNA sequence specific to SARS-CoV-2, the virus that causes COVID-19, in patient samples taken from the upper airways with a swab or from airways in the lungs known as bronchoalveolar washing.
“If it’s there, it attaches to the Cas13 enzyme and activates it, which leads to the chewing up and cleaving of RNA probes,” Sherlock CEO Rahul Dhanda told FierceMedTech. When cleaved, those RNA molecules release a fluorescent signal to show the virus is present.

May 7, 2020

Gates on the pandemic

Responding to Covid-19 — A Once-in-a-Century Pandemic?

Bill Gates says in NEJM:
The long-term challenge — improving our ability to respond to outbreaks — isn’t new. global health experts have been saying for years that another pandemic whose speed and severity rivaled those of the 1918 influenza epidemic was a matter not of if but of when. The Bill and Melinda Gates Foundation has committed substantial resources in recent years to helping the world prepare for such a scenario.
Finally, governments and industry will need to come to an agreement: during a pandemic, vaccines and antivirals can’t simply be sold to the highest bidder. They should be available and affordable for people who are at the heart of the outbreak and in greatest need. Not only is such distribution the right thing to do, it’s also the right strategy for short-circuiting transmission and preventing future pandemics. These are the actions that leaders should be taking now. There is no time to waste.

Edward Hopper 

May 6, 2020

Paying providers and adjusting for quality and performance

Payment Methods and Benefit Designs: How They Work and How They Work Together to Improve Health Care

Value-Based Provider Payment Initiatives Combining Global Payments With Explicit Quality Incentives: A Systematic Review

Figure 1. Core components and associated design features of a VBP model combining global base payments with explicit quality incentives.

In the coming years, VBP models stimulating value in a broad sense will likely continue to gain ground, as the quest toward VBHC proceeds. This article demonstrates that VBP models consisting of global base payments combined with explicit quality incentives are operationalized in practice in various ways. In addition, our results show that this particular VBP model has the potential to improve value and contribute to VBHC. Going forward, this article may serve as inspirational material for those interested in developing new or improving on existing VBP models.

May 5, 2020

Behavioral contagion

So much has been written on behavioral economics and nudging, and I always think about the implications. Robert Frank in his new book provides new insights to understand the behavioral contagion among all of us. He says:
The argument I will defend in this book, implicit in several of the examples already discussed, is summarized in the following seven premises:
1. Context shapes our choices to a far greater extent than many people consciously realize.
2. The influence of context is sometimes positive (as when people become more likely to exercise regularly and eat sensibly if they live in communities where most of their neighbors do likewise).
3. Other times, the influence of context is negative (as when people who live amidst smokers become more likely to smoke, or when neighboring business owners erect ugly signs).
4. The contexts that shape our choices are themselves the collective result of the individual choices we make.
5. But because each individual choice has only a negligible effect on those contexts, rational, self-interested individuals typically ignore the feedback loops described in premise 4.
6. We could often achieve better outcomes by taking collective steps to encourage choices that promote beneficial contexts and discourage harmful ones.
7. To promote better environments, taxation is often more effective and less intrusive than regulation.
Among behavioral scientists, the first five of these premises are completely uncontroversial. It is only 6 and 7 that provoke disagreement. Regarding 6, even when everyone acknowledges that behavioral contagion causes harm, as in the smoking example, it is often hard to reach consensus on collective actions that would modify the contexts that shape our actions. In part, the difficulty is that individual incentives and collective incentives often diverge so sharply. But objections to premise 6 are also rooted in the long American tradition of hostility toward regulations generally. Nor can there be any presumption that regulation always improves matters. Markets sometimes fail to deliver optimal results, but government interventions are also imperfect. Premise 7 is controversial simply because many people dislike being taxed. Yet a moment’s reflection reveals that the only interesting questions in this domain concern not whether we should tax but rather which things we should tax and at what rates. Whether you’re a small-government conservative or an expansive progressive, tax revenue is necessary to pay for valued public services.
A must read. The book has clear messages for professionalism in Medicine and for pandemics.

May 4, 2020

How testing market fails during a pandemic

The evidence of market failure during this pandemic is everywhere. Shortages, excessive prices, unavailable capacity...It is a clear example of mismatch between demand and supply. The question is, Can we do it otherwise?. In this article there are some hints for resource allocation for testing activities.

Globally, the development of diagnostics has long been left to markets, many of which are highly specialized. But while there are diagnostics markets for major infectious and non-infectious diseases, and even neglected tropical diseases, there is none for pandemic diseases.
Governments can of course counteract market deficiencies, but the commonly used mechanisms still require a trace level of demand, which does not exist for pandemic-disease diagnostics until the brink of an outbreak. And national governments, subject as they are to political and ideological constraints, cannot be relied upon always to create markets with the same swiftness demonstrated by South Korea. Reactive market creation is therefore not the way forward.
Instead, national governments should support the creation of a global coordinating platform for pandemic preparedness. Such a platform can take the lead in raising and pooling capital to channel toward rapid development, production, and distribution of diagnostics for pandemic diseases.
The blueprint for such a platform already exists. The Coalition for Epidemic Preparedness Innovations (CEPI) is a coordinating mechanism focused on advancing vaccine development and facilitating clinical validation, mass-scale manufacturing, and stockpiling. By reducing uncertainty and minimizing disruptions, CEPI makes vaccine markets more secure, accessible, and dynamic.
CEPI relies on both traditional financing (large grants from governments and foundations) and innovative financing (the returns from instruments like the International Finance Facility for Immunization, or IFFIm). In the event of an outbreak, CEPI uses instruments like Advanced Market Commitments (AMCs) or volume guarantees – which can be structured through mechanisms like the Global Health Investment Fund and InnovFin, or as conditional pledges to IFFIm and Gavi, the Vaccine Alliance – to enable it to scale up production quickly.
This blueprint can easily be replicated for diagnostics. All that is needed is a specialized entity – an institution or initiative that couples research and development with market access. 

May 3, 2020

Health vs. wealth in a pandemic


A NBER paper says:
A pandemic can impact an economy in many ways: reductions in people’s willingness
to work, dislocations in consumption patterns and lower consumption, added stress on the financial system, and greater uncertainty leading to lower investment. These are
respectively referred to as (labor) supply shocks, demand shocks, financial shocks and
uncertainty shocks. Connected economies and epidemiological communities also move in synch. Even a healthy economy, or an economy that has not mandated a shutdown, may feel the impact of external events. With the exception of the 1918 influenza, recent
pandemics have neither had as large of a global impact, nor has there been as much real
time data available to empirically assess the economic and public health impact of NPIs.
We study outcomes during the Covid-19 pandemic.
We have three main results. First, our analysis shows NPIs may have been effective
in slowing the growth rate of confirmed cases of Covid-19 but not in decreasing the growth rate of cumulative mortality. Second, we find evidence of spillovers. NPIs may have impacts on other jurisdictions. Finally, there is little evidence that NPIs are associated with larger declines in local economic activity than in places without NPIs.

May 2, 2020

Against patents for the current pandemic

Imagine a world in which a global network of medical professionals monitored for emerging strains of a contagious virus, periodically updated an established formula for vaccinating against it, and then made that information available to companies and countries around the world. Moreover, imagine if this work were done without any intellectual-property (IP) considerations, and without pharmaceutical monopolies exploiting a desperate public to maximize their profits.
This may sound like a utopian fantasy, but it is actually a description of how the flu vaccine has been produced for the past 50 years. Through the World Health Organization’s Global Influenza Surveillance and Response System, experts from around the world convene twice a year to analyze and discuss the latest data on emerging flu strains, and to decide which strains should be included in each year’s vaccine.
This is exactly what Nobel prize David Stiglitz says in his op-ed in Project Syndicate. Absolutely agree.

For too long, we have bought into the myth that today’s IP regime is necessary. The proven success of GISRS and other applications of “open science” shows that it is not. With the COVID-19 death toll rising, we should question the wisdom and morality of a system that silently condemns millions of human beings to suffering and death every year.
It’s time for a new approach. Academics and policymakers have already come forward with many promising proposals for generating socially useful – rather than merely profitable – pharmaceutical innovation. There has never been a better time to start putting these ideas into practice.


May 1, 2020

Austerity is not for nowadays

Austerity When It Works and When It Doesn’t

If somebody want to know what happens with austerity policies, then this is the book to read.

The term “austerity” indicates a policy of sizeable reduction of government
deficits and stabilization of government debt achieved by means
of spending cuts or tax increases, or both. This book examines the costs
of austerity in terms of lost output, what types of austerity policies can
achieve the stated goals at the lowest costs, and the electoral effects for
governments implementing these policies.
Why Austerity?
If governments followed adequate fiscal policies most of the time, we
would almost never need austerity. Economic theory and good practice
suggest that a government should run deficits during recessions—when
tax revenues are low and government spending is high as a result of
the working of fiscal stabilizers such as unemployment subsidies—and
during periods of temporarily high spending needs, say because of a natural
calamity or a war.

April 30, 2020

Surveillance, censorship and manipulation (using covid as excuse)

The Information TradeHow Big Tech Conquers Countries, Challenges Our Rights, and Transforms Our World

What does google know about you?. Right now they have developed a new API with Apple to control citizen location and contacts. This is the perfect tool for the end of privacy with the excuse of a pandemic.

In a recent book, all these strategies are clearly explained, specially how they defeat the democracy.

WE’RE IN A WORLD STILL DOMINATED BY NATION-STATES, BUT INCREASINGLY influenced by the actions of net states. Nation-states continue to own the physical territories within their borders, but net states wield significant power both within and across country space, guiding events that affect us both on an individual and on a global level. Therefore, we need to get smart about what net state power really looks like, and quick.
One country that’s excelling in its efforts to do so is Denmark. In 2017, it opened a door that has the potential to radically alter our existing geopolitical order: it appointed a new ambassador to capital-T Tech itself. Ambassador Casper Klynge is the world’s first-ever tech ambassador. His mandate: to establish diplomatic relations between Copenhagen and Tech. And what exactly that looks like is all fresh territory, yet to be discovered. Fittingly, his office operates as a virtual embassy, with three physical manifestations: one in his home base of Copenhagen and two in the most powerful tech hubs on Earth—Silicon Valley, California, and Beijing, China.

And the film, The creepy line, adds more concern on the same issue.

April 28, 2020

Vaccines for all

How to Develop a COVID-19 Vaccine for All

Messages from Mazzucato and Torreele:
The first, critical step is to adopt a mission-oriented approach that focuses both public and private investments on achieving a clearly defined common goal: developing an effective COVID-19 vaccine(s) that can be produced at global scale rapidly and made universally available for free. Realizing this aim will require firm rules regarding intellectual property (IP), pricing, and manufacturing, designed and enforced in ways that value international collaboration and solidarity, rather than competition between countries.
Second, to maximize the impact on public health, the innovation ecosystem must be steered to use collective intelligence to accelerate advances. Science and medical innovation thrives and progresses when researchers exchange and share knowledge openly, enabling them to build upon one another’s successes and failures in real time.
Third, countries must take the lead in building and buttressing manufacturingcapabilities, particularly in the developing world. While an effective COVID-19 vaccine probably will not be available for another 12-18 months, a concerted effort is needed now to put in place the public and private capacity and infrastructure needed to produce rapidly the billions of doses that will be required.
Because we don’t know yet which vaccine will prove most effective, we may need to invest in a range of assets and technologies. This poses a technological and financial risk that can be overcome only with the help of entrepreneurial states backed by collective, public-interest-driven financing, such as from national and regional development banks, the World Bank, and philanthropic foundations.
Finally, conditions for ensuring global, equitable, and affordable access must be built into any vaccine-development program from the start. This would allow public investments to be structured less like a handout or simple market-fixer, and more like a proactive market-shaper, driven by public objectives.

PS. Masks, tests, treatments, vaccines – why we need a global approach to fighting Covid-19 now
Bill Gates dixit:
 I’m a big believer in capitalism – but some markets simply don’t function properly in a pandemic, and the market for lifesaving supplies is an obvious example. The private sector has an important role to play, but if our strategy for fighting Covid-19 devolves into a bidding war among countries, this disease will kill many more people than it has to.

Edward Hopper. Cape Cod Morning, 1950. Smithsonian American Art Museum

April 25, 2020

What we're up against

Biography of Resistance
The Epic Battle Between People and Pathogens

Great book for nowadays.
Antimicrobial resistance does have a future, one that is going to affect the way we get to live and die. The potential doomsday scenario of tens of millions dead annually is real, but so are the hopeful developments of the last few years. On the technical side, there is promise in vaccines and phage therapies. On the economic front, ideas are being proposed that incentivize pharmaceutical companies to commit themselves to research and development.3 There is a new sense of urgency within the WHO to improve surveillance and empower all countries, rich and poor, large and small. 
 Bacteria will continue to do what they have done since the dawn of life—evolve, adapt, and get ready for the next battle for survival. Our actions are helping them acquire a better arsenal at a faster rate than they probably would have on their own. But despite the challenges and frustrations, in the hundreds of interviews that I conducted for this book, there was a sense of optimism about the future. That optimism stems from a belief in human ingenuity, the vast reserves of natural treasures that are untapped, and the power of coming together. That optimism is also predicated on two things: a commitment to peace, and a desire to care for all people—everywhere.
This is the index:
 Chapter 1: What We’re Up Against
Chapter 2: Fifty Million Dead
Chapter 3: Time and Space
Chapter 4: Friends in Far Places
Chapter 5: Near the Seed Vault
Chapter 6: Keys to Karachi
Chapter 7: War and Peace
Chapter 8: From the Phages of History
Chapter 9: Sulfa and the War
Chapter 10: Mold Juice
Chapter 11: Tablets from Tears
Chapter 12: The New Pandemic
Chapter 13: The Man in the Blue Mustang
Chapter 14: Honeymoon
Chapter 15: Mating Bacteria
Chapter 16: S Is for Soviet
Chapter 17: The Navy Boys
Chapter 18: From Animals to Humans
Chapter 19: The Norwegian Salmon
Chapter 20: Closer to Sydney Than to Perth
Chapter 21: A Classless Problem
Chapter 22: The Stubborn Wounds of War
Chapter 23: Counting the Dead
Chapter 24: Clues in the Sewage
Chapter 25: X Is for Extensive
Chapter 26: Too Much or Too Little?
Chapter 27: Visa Not Required
Chapter 28: The Dry Pipeline
Chapter 29: New Ways to Do Old Business
Chapter 30: A Three-Hundred-Year-Old Idea
Chapter 31: Spoonful of Sugar
Chapter 32: Conflict Inside the Cells
Chapter 33: Security or Service?
Chapter 34: One World, One Health
Chapter 35: Bankers, Doctors, and Diplomats

April 23, 2020

Behavioral response to the virus

Using Behavioural Science to Help Fight the Coronavirus

Main topics of the paper:
(1) Evidence on handwashing shows that education and information are not enough. Placing hand sanitisers and colourful signage in central locations (e.g. directly beyond doors, canteen entrances, the middle of entrance halls and lift lobbies) increases use substantially. All organisations and public buildings could adopt this cheap and effective practice.
(2) By contrast, we lack direct evidence on reducing face touching. Articulating new norms of acceptable behaviour (as for sneezing and coughing) and keeping tissues within arm’s reach could help.
(3) Isolation is likely to cause some distress and mental health problems, requiring additional services. Preparedness, through activating social networks, making concrete isolation plans, and becoming familiar with the process, helps. These supports are
important, as some people may try to avoid necessary isolation.
(4) Public-spirited behaviour is most likely when there is clear and frequent communication, strong group identity, and social disapproval for those who don’t comply. This has implications for language, leadership and day-to-day social interaction.
(5) Authorities often overestimate the risk of panic, but undesirable behaviours to watch out for are panic buying of key supplies. Communicating the social unacceptability of both could be part of a collective strategy.  
(6) Evidence links crisis communication to behaviour change. As well as speed, honesty and credibility, effective communication involves empathy and promoting useful individual actions and decisions. Using multiple platforms and tailoring message to
subgroups are beneficial too.
(7) Risk perceptions are easily biased. Highlighting single cases or using emotive language will increase bias. Risk is probably best communicated through numbers, with ranges to describe uncertainty, emphasizing that numbers in the middle are more likely. Stating a maximum, e.g. “up to X thousand”, will bias public perception. 

April 22, 2020

Pandemic socialism

Pandemic Socialism

Great article
By introducing a uniquely disruptive shock to both supply and demand, the COVID-19 pandemic has upended longstanding ideological debates almost overnight. Suddenly, far-reaching state intervention in the economy has become necessary to save market capitalism, which is unlikely to emerge unchanged.
You may agree or not. But it is a fact.

April 21, 2020

CRISPR Diagnostics (for COVID-19)

CRISPR–Cas12-based detection of SARS-CoV-2

Applied technologies for detection of COVID are basically PCR molecular assays and immunoassays. However, CRISPR developments are entering into diagnostics and you may find the first example in Nature.
We report development of a rapid (<40 accurate="" and="" as12-based="" assay="" br="" crispr="" detection="" easy-to-implement="" extracts.="" flow="" for="" from="" lateral="" min="" of="" respiratory="" rna="" sars-cov-2="" swab="">We validated our method using contrived reference samples and clinical samples from patients in the United States, including 36 patients with COVID-19 infection and 42 patients with other viral respiratory infections. Our CRISPR-based DETECTR assay provides a visual and faster alternative to the US Centers for Disease Control and Prevention SARS-CoV-2 real-time RT–PCR assay, with 95% positive predictive agreement and 100% negative predictive agreement.
The role of CRISPR in diagnostics tests is going to increase.

Daido Moriyama 

April 20, 2020

Back to work


Some papers:
Rockefeller Foundation has issued a document of interest about testing and going back to work.
AEI document here.
Center for American Progress document here.
Duke University here.
Harvard University here.
Johns Hopkins University here.

April 19, 2020

How coronavirus affects the body

From FT The medical mysteries of coronavirus

April 17, 2020

A known unknown

Coronavirus and the Limits of Economics
Why standard economic theories have no answers for this kind of crisis

You'll find an interesting article in FP

Economists have long made the distinction between uncertainty and risk. Uncertainty is typically understood as involving outcomes that cannot straightforwardly be assigned a probability, unlike risk. Economics offers limited resources to understand how to make decisions in the presence of fundamental uncertainty. But a still deeper form of uncertainty is one in which the possible outcomes cannot easily be anticipated at all. Such a wildly unpredictable outcome has come to be popularly known in recent years as a black swan event.
 The coronavirus pandemic might at first appear to have been such a black swan event, but that claim does not withstand scrutiny: The possibility of such a threat was long recognized by experts. This recognition led to scenarios being discussed at the highest levels of governments. The possibility of a pandemic was therefore a “known unknown” rather than an “unknown unknown.”
Consider that an economy cannot be separated from society: It is socially embedded. The notion that the economy can be analyzed independently of the public health, political, or social processes—often promoted by the dominant tradition in economics and reflected in general equilibrium theory—is shown by the pandemic to be not merely fragile but false.
PS D Rumsfeld stated:

Reports that say that something hasn't happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don't know we don't know. And if one looks throughout the history of our country and other free countries, it is the latter category that tend to be the difficult ones.

Galeria Marlborough