Where Do We Stand: Transparency, COVID19, Flu

Last night I did a post that summarized a theory advanced by a doctor who comments at Steve Sailer's blog: Does COVID19 Piggyback On The Flu? If you haven't read it yet, I urge you to do so, because it will be the background to what follows. Here's a summary of the basic idea that the doctor is advancing:

What the doctor does is examine vaccination rates around the world--concentrating on the flu, for obvious reasons--including looking at which age groups get vaccinated and whether the countries in question tend  to have bad flu seasons. The idea is that people who contract COVID19 are, in effect, getting hit with a double whammy. COVID19 is preying on people whose immune system is compromised to one degree or another, and in particular--no surprise--with regard to respiratory diseases. To me, this seems like an idea worth examining, because the demographics of this pandemic seem to vary so widely around the world.

We've already discussed how different the demographics are for Italy and Germany--and the social networking is undoubtedly a factor as well. Unfortunately, Germany is the one country for which data is missing re vaccination. The US also seems not to be tracking too closely with Italy's demographic mortality rates or even infection rates among different age groups  (recall the Milwaukee demographics that I linked this morning--apparently those are fairly typical for the US). There's gotta be an explanation for these discrepancies, and this makes some sense to me.

Let me be clear: I'm not suggesting that COVID19 is just the seasonal flu. It's NOT just the seasonal flu. Nevertheless, the data we have so far suggests that it would be worthwhile examining whether COVID19 is a "fellow traveler" with the flu. What I mean is that what we seem to be seeing is that COVID19 appears to hit hardest those groups that have the lowest rate of flu vaccination in countries that typically have bad flu seasons.

This morning I recalled that a common meme among COVID19 minimizers has been: If COVID19 is so deadly, why did only 17% of the passengers on the Diamond Princess cruise ship contract the virus, in an environment that noted epidemiologist Michael Osterholm deemed ideal for spreading it? Putting that together with the theory advanced by Sailer's doctor-commenter, I did a quick search regarding what vaccincations are either required for passengers on cruise ships. I can't tell you how strictly the policies are enforced, but I can tell you that cruise companies want their passengers to be very healthy and to be pretty much fully vaccinated. Measles leads the list of vaccines, but influenza is right up there, too. This would at least appear to support the doctor's theory: Healthy populations that are fully vaccinated for the flu will typically have a low infection rate.

Obviously my views on medical matters should carry no weight. I'm simply saying this seems a worthwhile line of inquiry. Transparency in these matters would be very helpful for the general public to protect itself. Public health officials have relevant demographic-medical information already in their possession. They should be making it available but are not doing so. That's a problem that no one is addressing.
With that in mind, there are two very informative articles out today that provide an overview of two important topics: What do we know and what do still need to know about COVID19? and what were public health officials doing to prepare for this pandemic? The answers are quite relevant to the current situation, as we will see.

First up is What we’ve learned about the coronavirus — and what we still need to know, by Helen Branswell. Here are the highlights. Branswell begins by noting that we actually do have a lot of information at our disposable. Some of that information dates from the 2003 SARS outbreak. As a result, identification of COVID19 as a new form of SARS was relatively rapid--compared to 2003. But then she shifts to an important bit of information that, she says, "we’re learning the hard way right now."

It’s not just older populations. 

If you look at who is dying from this disease, known as Covid-19, you are looking largely at older adults. ... 

But the focus on fatalities among older populations — a focus fueled by the media — may have obscured the full picture of who is getting sick, sometimes severely so. The virus, SARS-CoV2, is not ageist. 

In South Korea, ... 44% of the country’s 9,137 cases so far are in people under the age of 40. People in their 20s make up 27% of the cases. 

In China, an analysis of the country’s first 45,000 showed 27% of cases were people under the age of 40. In Spain, 32% of cases to March 20 were people aged 20 to 44. 

And a recent update from the Centers for Disease Control and Prevention showed that one-fifth of cases in the United States were among people between the ages of 20 to 44. 

This non-ageist feature of COVID19 is an aspect that the doctor-commenter focused on--but from the standpoint of vaccination. His examination of the data suggests that any age group that's not vaccinated may be at higher risk, and he massages that data based on the different vaccination rates among countries hit by COVID19. Branswell next looks at transmission of COVID19, comparing it to SARS:

Whereas its older cousin, SARS, was mainly transmissible when people were really sick — and almost always hospitalized — Covid-19 transmits very early in infection, even before people start to become unwell.

Note that well. COVID19 is SARS2. The doctor-commenter suggests that it is being heavily transmitted to people who may already be sick to some degree, or who contract both diseases--flu and COVID19--simultaneously. COVID19 seems more readily transmitted than SARS, but does it still preferentially infect those whose immune systems are in less than tip-top condition?

Likewise, a big portion of cases, perhaps as many as 40%, have very mild symptoms. Some people who had no idea they were infected have tested positive. Italian authorities say 6% of people there who have tested positive had no symptoms and another 12% were paucisymptomatic — barely symptomatic. It’s still unclear, though, how often these people spread the virus to others.

The question is: Who are these people? What do we know about them? Why do some only get a mild illness? Does it relate to their general health and health habits--including vaccination?

Another lesson that was neglected early on but which we're learning--or maybe relearning, because the evidence from the Spanish flu pandemic was pretty clear:

A respiratory virus can be stopped or at least slowed. 

It’s long been thought that transmission of viruses that cause influenza-like illnesses can’t really be stopped. Even with a vaccine — a modestly effective vaccine, admittedly — flu wreaks havoc every winter, for example. And there is no vaccine for Covid-19 at present. 

That dogma may have contributed to the sense of skepticism among some experts when, in early February, Ryan, the WHO’s health emergencies chief, insisted that Covid-19 could still be contained. ...

... 

And yet: China’s aggressive actions have beat down transmission. For more than a week, most of China’s cases have been people infected abroad and detected on their return home. 

...

With so much SARS-CoV2 virus spreading globally, none of these places is out of the woods. But they have shown it’s possible to do what was once considered impossible.

Death rates will differ by location. 

This was true with the infamous Spanish flu pandemic of 1918 and it will be true when the history of Covid-19 is written. With so little testing still and good evidence that mild cases are being missed, it’s impossible to come up with a reliable infection fatality rate. 

But different countries battling outbreaks are calculating crude death rates based on confirmed cases. They range from .5% in Germany to 1.38% in South Korea (its number has been climbing) to 4% in China to 9% in Italy. Using the same formula, the rate in the United States would currently be about 1.4%. 

Another factor to consider is who is getting sick in these countries. In South Korea, a large chunk of the 9,100 cases recorded so far were young people, as we mentioned above. None of them has died. By comparison, Italy has one of the oldest populations in the world; this virus is cruel in the elderly. 

Germany’s low death rate is both a puzzle and a beacon of hope. But it remains to be seen if it will remain an outlier.

Another lesson: we were warned. As we'll see in the next article (below), most experts were caught preparing for the next global flu pandemic--and with good reason. Avian flu is known to jump relatively readily from birds to humans and to then transmit from human to human. There were strains of avian flu circulating that had made the jump from birds to humans in isolated cases, but had not yet made the jump to human to human transmission. When humans catch that flu, mortality rates are 40-60%. No wonder experts were focusing on avian flu.

The world has been warned about this over and over again. In the mid-2000s, when it looked like a very dangerous bird flu virus, H5N1, might trigger a pandemic, experts including Michael Osterholm, of the University of Minnesota’s Center for Infectious Diseases Research and Policy, warned of the possibility of disaster when it comes to the supply of protective equipment for health workers, essential drugs, and other goods.

And that's where we stand, with regard to preparedness.

In some of the Asian countries where SARS-CoV2 is under control, most people wear at least a surgical mask when out in public. But hospitals in other parts of the world, including the United States, are rationing even surgical masks, reusing for as long as a week or two masks that are typically discarded after seeing a single patient.

Supplies will only get tighter unless and until extraordinary actions are taken to ramp up production.

Branswell concludes with the critical questions we need to answer:

Why do some people have such severe disease and others barely get sick? 

... 

“This is my big question. It’s really a mystery. I just don’t get it. It’s so variable,” said Susan Weiss, co-director of the University of Pennsylvania’s new research center for coronavirus and other emerging pathogens. 

How many people have been infected? 

... 

Knowing who is still vulnerable to the virus is important. For starters: When vaccine becomes available, supplies will be limited initially. In that scenario, it might make sense to delay vaccine delivery for people who have antibodies from a prior infection. 

Problem: Will any vaccine--when and if one is developed--be equally effective for all demographic groups concerned? Remember, this is not the flu.

“I don’t think we know,” said Weiss when asked about the immunity question. “I think they’re going to be immune for a while.” 

Perlman said some other coronaviruses — the four that cause colds and flu-like illnesses — can be caught more than once. He wonders if people who had asymptomatic infection would not develop enough antibodies to be able to fend off the virus on a later exposure but might have a mild infection on a second go-round. 

“I don’t know the answer to that,” he said. “It’s really going to be time that’s going to tell us.”

The next of the two articles focuses on preparedness, especially with regard to medicines and vaccines, during the period from the first SARS outbreak in 2003 to the present:

The road not traveled: How Big Science skipped clinical trials after past coronavirus outbreaks

'There was no economic incentive for pharmaceutical companies ... and governmental attention' drifted elsewhere, former HHS boss laments.

This is a lengthy article, but not at all arcane. I will provide some excerpts that pertain to two hot topics: 1) What was the scientific community doing from 2003 to the present? and 2) What was known about Chloroquine?

The answers can be briefly anticipated. For good reasons scientists were focused on the threat of a new flu pandemic--which we referred to above. It seems clear that such a pandemic would be far deadlier than the COVID19 pandemic, so it's hard to fault the scientific community in that regard. With regard to Chloroquine, the answer is equally unequivocal: It was well known among researchers that Chloroquine showed great promise as an antiviral medication. To find out what happened--why there was such inaction among pharmaceutical companies and government agencies--follow the link. Before you do, I'll repeat what Michael Osterholm has said on that topic. He is not inclined to blame the pharmaceutical companies, noting that on several occasions in the past they've been left holding the research funding bag to the tune of many millions of dollars, because government agencies lost interest once a crisis passed.

With that, the excerpts:

Since the COVID-19 pandemic burst upon the world, scientists have been scrambling to conduct clinical tests on possible treatments, both old and new, like HIV cocktails, remdesivir, and anti-malaria drugs. Their answers are weeks or months away, even as the disease spreads and claims more lives now. 

But it didn't have to be this way, experts say. Government and private scientists could have taken the lessons and promising indicators gathered from prior coronavirus outbreaks dating to 2002 and turned them into clinical trials for the medicines that showed the most hope. 

But instead the scientific world bet that the next big pandemic would emanate from a more traditional flu and not a coronavirus like Sudden Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS).

"We knew a pandemic was coming at some point," said Dr. Sarah Fortune, Professor of Immunology and Infectious Diseases and chair of the Department of Immunology and Infectious Diseases at Harvard T.H. Chan School of Public Health. "Given our experiences with SARS1, MERS versus the various modern flu epidemics, I do not think it was unreasonable to put our bets on flu. And in many ways, the investments that we made — and those we failed to make — in flu preparedness are bearing fruit now." 

Hal King, the chief executive officer for the nonprofit Public Health Innovations and an infectious diseases scientist formerly at the Center for Disease Control and at Emory University School of Medicine, agreed. 

"I believe the COVID-19 pandemic was more difficult to prepare for because the majority of the global preparation before this was centered on pandemic flu," King told Just the News. "Pandemic Flu was expected to spread much faster and become more lethal because of the natural spread by birds across continents and via significant human travel by air (of which the models predicted it to kill millions quickly). COVID-19 does not spread across continents by natural spread via birds but only via human to human contact, which we would expect to be more easily containable."   

"However," he continued, "because air travel has so significantly increased in the last 10 years, we need to rethink preparedness (including drugs, diagnostics, and vaccines) for all human to human infectious diseases that could be pandemic."  

This tale of inaction and inertia dates to a period after the 2002-03 eruption in China of SARS, a coronavirus sister to today's pathogen. After the SARS virus peaked, the Chinese Ministry of Health invited scientists, researchers, and doctors to participate in reflective discussions about what was learned and what could be done to thwart future pandemics. 

... 

Equally alarming was the lack of followup after early drug studies found some promising treatments that worked anecdotally during the SARS outbreak in 2003, two smaller coronavirus outbreaks in 2004-05, and MERS in 2012. The anti-malarial drug known as chloroquine was one of a handful flagged as a potential treatment. 

One such study in 2005 found “chloroquine has strong antiviral effects on SARS-Cove infection of primate cells. These inhibitory effects are observed when the cells are treated with the drug either before or after exposure to the virus, suggesting both prophylactic and therapeutic advantage.” 

... 

Much like chloroquine, an experimental drug known as remdesivir began to show promise during the MERS outbreak years ago, but it too never got to clinical trial stage.