Sunday School Extra Credit 5/3/20

In our Sunday School post this week, we heard from five governors In this Extra Credit post, we'll give the medical folks their turn.

First up? Dr. Deborah Birx, who talked with Chris Wallace on Fox News Sunday. Now Birx has been a regular on the shows, replacing Dr. Fauci as the face of Trump's medical and household disinfectant task force, so we'll move here stuff pretty quickly. (As an aside, I miss Dr. Fauci.)

• She thinks the gating criteria and the phased reopening guidelines are a "pretty firm policy" even though no state has met them and many are reopening anyway. And she said that states have been asked to make all of their data public, including where they are with the gating criteria. She pointed to Florida, a state that has had issues around reporting COVID-19 data, as a example of a state doing that right.
• Protesting without masks is "devastatingly worrisome" to her personally, and people need to protect each other while voicing discontent. We'll have to see if that happens; it seems unlikely based on what we've seen so far.
• On paper, at least, it's possible there'll be a vaccine by January of 2021, by moving forward with multiple candidates and compressing the phases without sacrificing safety. But, "it's whether we can execute, and execute around the globe."  

Next up we have Dr. Tom Inglesby talking with Chuck Todd on MTP. Inglesby's from the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health. He expressed some concern about states moving forward, while recognizing that they're not all the same from a COVID-19 standpoint. He focused on areas being able to "rapidly isolate and trace contacts" and diagnose everyone who has symptoms of the virus as being the 'least risky" places to begin reopening. He said it's going to be two or three weeks before we'll know the impact of the reopening, due to the incubation period of the virus.

He said that "it's like a patchwork across the country" in terms of access to and "the operations around" testing, in contrast to what the White House has maintained. He noted in some places the percentage of people testing positive is very low, while in others it's very high, and said "that's worrisome." And more diagnostic testing is important because we're not capturing the mildly or moderately sick folks now, so we "can't break their chains of transmission."

Finally, on whether he's worried about a "bad fall outcome" if we don't see advancements on treatment or a vaccine, Inglesby is worried even before we get to fall. 

Nothing has changed in the underlying dynamics of this virus. If we stop social distancing all together tomorrow, we would recreate the conditions that existed in the country in February and March. So what we need to do is continue, to our best possible effort, all the individual efforts we're making around social distancing...the extent to which we're able to do that over the next couple of months will dictate how we do as states and as a country.

Because, as he reminded us, in the fall we'll still have COVID and we'll have the flu, at the same time, and together they'll impact hospitalizations, and

...I don't think people should think that there will be a lull. That just because the summer's coming we're going to have a lull before the fall. It'd be wonderful if that happens. But I don't think we should at all assume that at this point given the nature of this virus. 

Dr. Ingelsby was not the only expert sitting down with Chuck; he also talked with Dr. Scott Harris from the Alabama Department of Public Health and Dr. Joneigh Khaldun, who's with the Michigan Department of Health and Human Services.

Harris said that they reopened in Alabama in a very gradual way, not a full 'phase 1' thing like was in the WH guidelines, given how things were going there. He also said that testing is "really unevenly distributed" with folks in rural areas facing more barriers, such as transportation or access to a health care provider.

In Michigan, Dr. Khaldun said, they have seen burdens on hospitals, capacity not being where it needs to be and testing also falling a little short. He's "cautiously optimistic" but they "need to be very careful." They're looking at regional data on a daily basis, tracking outbreaks, and also paying attention to hospital capacity and what not - basically, every region of the state is different.

Chuck asked them if they were feeling pressure to move things along and speed things up. While Khaldun said no, Harris said the pressure is "significant," noting that lots of folks in his state don't have an option to make a living now, and they need to try and "balance the health of the economy with the health of average Alabamians." He agreed that, with Georgia being more aggressive with reopening, they have to be careful and he plans to watch what happens there closely. And, he said,

...we certainly will consider dialing things back if we see an increase in cases... I think that's the approach - that probably all states would want to take.

And finally, Chuck had Sir John Bell, from Oxford University to talk about a vaccine that's being tested there that shows some promise - and is ahead of some of the other vaccine projects. Referring to a colleague saying there was an 80% chance their vaccine would be "at least somewhat successful, in the next year," Bell was a little bit more circumspect. He said that was high, but the likelihood of success goes up every day.

They're looking to start some human trials, so they need to be able to test where there are outbreaks. Bell said there's no shortage of disease in the UK, and they've already given the vaccine to around 1,000 people, but they want to ramp up quickly.

We've consolidated a phase one and two programs because we are pretty confident that the vector itself is safe because it's been used in about 5,000 people already up to now. So that's allowed us to really accelerate the phase one program, and we hope that there would be enough disease that we would get evidence that the vaccine has efficacy by the beginning of June.

Chuck wondered if there was any chance their drug could be used as a therapeutic if it doesn't work as a vaccine, or how helpful the therapeutics like remdesivir are in terms of developing a vaccine.
Bell said remdesivir works completely differently than what they're doing, so there's probably no connection between them, but "both could be helpful steps" to get the virus under control.

On whether everyone's going too fast, and if safety protocols could be overlooked and what's being done to prevent that, Bell said that the efficacy of the vaccine, to generate "strong antibody responses" is good, but "the real question is whether the safety profile's going to be fine." And that's what the clinical studies focus on. They did all the preclinical work, he said, including "mouse, ferret, primate" tests which it sounds like some others might not have done.

And now, we're being very careful in the clinic to try and monitor exactly what's happening. But, you know, that doesn't mean there won't be safety signals, because there may well be. And we'll be on the alert to see if we can see them.

He said that there'll be data on the primate tests this week, referring to it as "an important milestone." After that, they'll look to see whether the vaccine worked to "largely eliminate" the disease in test group compared to a placebo group. 

...we'll probably get a signal based on current levels of the disease. We'll probably get a signal in early June. We're ready to move trials overseas if the disease peters out in the U.K. So we've got sites already in play in other bits of the world where it's active. So we're pretty sure we'll get a signal by June about whether this works or not.

And whether this will be like the annual flu vaccine, or just used to protect against this particular coronavirus, Bell said

... I suspect we may need to have relatively regular vaccinations against coronaviruses going into the future. That... of course remains to be seen, but that's my bet at the moment, is that this is likely to be a seasonal coronavirus vaccine.

 So, there you have it, from a host of experts:

• reopening is going to happen (hopefully carefully and with respect the relevant regional data), whether we're ready for it or not;
• we're not going to see a national policy on who can do what when, all we have are the guidelines we've already been given;
• there's a chance we'll see a vaccine sooner than later, although we don't know what kind it is; and
• we must continue to practice social distancing for the foreseeable future. 

You know the drill - wash your hands, cover your face, keep your distance - and I'll see you around the virtual campus.