The role of testing while waiting for a cure and a vaccine

Testing for COVID-19: A way to lift confinement restrictions

HORIZONTE COVID-19: CLAVES PARA LA REINCORPORACIÓN AL TRABAJO

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

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
Epilogue

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. 

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.

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 

Back to work

NATIONAL COVID-19 TESTING ACTION PLAN

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.

How coronavirus affects the body

From FT The medical mysteries of coronavirus

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

The current COVID-19 test mess

Guidelines on COVID-19 in vitro diagnostic tests and their performance

If you receive a document with the title Guidelines on COVID-19 in vitro diagnostic tests and their performance you may expect to read about Guidelines and Performance. Unfortunately, you'll not find them in such document. After 2 months and a half, and an absolute market and regulatory chaos, the European Union releases a document that says that in the future they will provide some analysis of the situation. Meanwhile the regulation is the one enacted in 1998, that it was updated in 2017, but it will not be applied until 2022!!!
It could seem a joke if we were not talking about issues of life and death. The health and the economy is affected by his situation and unless we are able to asses the current extent of pandemics and immunity, we will not succeed from the current lockdown. Live and livelihood deserve better european policy makers.

Carlos Díaz

The viruses to come

Crisis in the Red Zone. THE STORY OF THE DEADLIEST EBOLA OUTBREAK IN HISTORY, AND OF THE VIRUSES TO COME

If you want to read a story of ebola outbreak and its implications beyond it, this is the book you have to read. It may be translated into a screenplay of a film.

At the end it says:

A family of viruses called the morbilliviruses is regarded by some experts as a leading candidate for the emergence of a previously unknown Level 4 monster that travels in the air. If there was no vaccine or drug for it, and if it was highly infectious, and if it floated out of peoples mouths, the virus could go around the world in a few weeks, traveling inside people who are flying on airplanes and walking through airport terminals, breathing. 

Glups!

A pandemic is not a war

Deadliest Enemy. Our War Against Killer Germs

Key messages from the book:

To review, our greatest threats are:
1. Pathogens of pandemic potential, which essentially means influenza and the downstream effects of antimicrobial resistance.
2. Pathogens of critical regional importance, which include Ebola, coronaviruses like SARS and MERS, other viruses such as Lassa and Nipah, and Aedes-transmitted diseases such as dengue, yellow fever, and Zika.
3. Bioterrorism and dual-use research of concern (DURC), and gain-of-function research of concern (GOFRC).
4. Endemic diseases that continue to have a major impact on the world’s health, particularly among emerging nations, including malaria, tuberculosis, AIDS, viral hepatitis, childhood diarrheal diseases, and bacterial pneumonia.

Priority 1: Create a Manhattan Project–like program to secure a game-changing influenza vaccine and vaccinate the world.
Priority 2: Establish an international organization to urgently address all aspects of antimicrobial resistance.
Priority 3: Support and substantially expand the mission and scope of the Coalition for Epidemic Preparedness and Innovations (CEPI) to fast-track comprehensive public-private vaccine research, development, manufacturing, and distribution for diseases of current or potential critical regional importance.
Priority 4: Launch the Global Alliance for Control of Aedes-Transmitted Diseases (GAAD) and coordinate with the Bill & Melinda Gates Foundation’s malaria strategy, “Accelerate to Zero.
Priority 5: Fully implement the recommendations of the bipartisan report of the Blue Ribbon Study Panel on Biodefense.
Priority 6: Establish an international organization similar to the National Scientific Advisory Board for Biosecurity (NSABB) to minimize the use of DURC and GOFRC to transmit pathogens of pandemic potential
Priority 7: Recognize that TB, HIV/AIDS, malaria, and other life-threatening infectious diseases remain major global health problems
Priority 8: Anticipate climate-change effects
Priority 9: Adopt a One Health approach to human and animal diseases throughout the world.

Health supplies as strategic asset

China Rx
EXPOSING THE RISKS OF AMERICA'S DEPENDENCE ON CHINA FOR MEDICINE

Key messages from Chapter 14:

China has been one of America's bankers, buying US Treasury bonds, and is now America's drugmaker. The centralization of the global supply of key ingredients for America's medicines in a single country poses enormous risks that must be mitigated.
Free market advocates may contend that the United States is better off outsourcing medicine making to China and allowing Americans to keep more of their money to spend on other goods. But medicines are essential for life. A country needs them to function. Prescription drugs are made by private corporations, but many serve a public purpose. 

Not unlike the manufacture of other consumer products, business decisions about manufacturing essential drugs and their therapeutic ingredients have been left to the invisible hand of the market. Financial and human capital have migrated to countries with the lowest cost of doing business. Corporate executives and their boards have determined that for them, the benefits of dependence on China outweigh the risks.
These decisions are too important to leave to the invisible hand. As China rapidly pursues a determined strategy to become a pharmaceutical power, US dependence on a single country will rise dramatically.

Key prescriptions to consider:

1. CONSIDER MEDICINES A STRATEGIC ASSET, NOT A COMMODITY TO BE BOUGHT AT THE LOWEST PRICE
2. TRACK AND FORECAST VULNERABILITIES IN THE SUPPLY OF AMERICA'S MEDICINES
3. PRIORITIZE A LIST OF MEDICINES FOR WHICH A SUPPLY INTERRUPTION POSES AN IMMEDIATE DANGER TO PUBLIC HEALTH
4. INVESTIGATE CHINESE DRUG CARTELS TO FIND OUT IF THEY CAUSE DRUG SHORTAGES IN THE UNITED STATES
5. PROVIDE INCENTIVES TO BRING DRUG MANUFACTURING HOME
6. ENSURE THE US MILITARY DOES NOT DEPEND ON CHINA FOR ESSENTIAL MEDICINES
7. STRENGTHEN, DON'T WEAKEN GOVERNMENT OVERSIGHT OF DRUG MANUFACTURERS
8. DON'T CEDE US REGULATORY OVERSIGHT OF DRUG MANUFACTURING TO CHINA
9. INCREASE FDA TESTING OF MEDICINES                                                            10. LUCK IS NOT A STRATEGY: IDENTIFY PROBLEM PRODUCTS RAPIDLY

Given the current health crisis, you can change medicines by tests and it fits perfectly. You can apply it to your country.

Stories from spanish flu epidemic

THE SPANISH FLU EPIDEMIC AND ITS INFLUENCE ON HISTORY.  Stories from the 1918–1920 global flu pandemic

From Chapter 11:

Perhaps the most lasting legacy of Spanish flu is that it barely left a legacy at all. While it has continued to be studied and analysed in niche virology circles, the collective memory seemed to stub it out and hurry to move on. Were it not thanks to a handful of dedicated historians such as Geoff Rice and Richard Collier, who collected personal accounts of the tragedy through the 1970s and 1980s, many first-person testimonies may have been lost. There are a few explanations of this mass memory loss and one of them related to honour. Perhaps in order to dull the painful reality of the loss of a treasured father, husband, brother or son, much pomp was  conveyed onto the memory of those who died in battle. Dying from flu, however, did not convey the same sense of honour. In fact, in a world where eugenics had played a strong role so far, it made otherwise brave men appear weak and flawed.

 Time is a healer, though, and there are lots of good reasons to be interested in Spanish flu now, a hundred years on from the pandemic; to honour the dead, to analyse the medical response, to measure the impact of the virus on the health of the population through the relatively new discipline of
epigenetics … but perhaps the most pressing reason for us to remember the outbreaks from a virology, epidemiology, sociology and historical point of view, is because of the high possibility it could happen again.

 The outbreak of Spanish flu at the start of the twentieth century is considered to be one of the deadliest infections in the history of humanity, affecting a minimum of 30 per cent of the global population, and killing around 5 per cent.

In a previous post you may find additional details.