Covid Update - 11 October 2020

Overall the US is not in a great place. California and the Northeast continue to perform well. Still, the south and midwest are reopening even among not good tested and poor trend lines. I fear that the next few weeks will be critical because Halloween, the election, and Thanksgiving will be spread events. As a result, the lower we can get the infection level now, the less spread we will see.

This week Prof. Emily Oster published an op-ed in The Atlantic titled "Schools Aren't Super-Spreaders: Fears from the summer appear to have been overblown." Oster has long been one of my favorite economists. She cut her teeth at U Chicago, including some collaborations with Steven Levitt of Freakonomics fame.

Over her career, she has worked on public health-related economics and has a superpower in communicating her ideas. One of her books showed that most of the "rules" we impose on pregnant women aren't based on robust science. In the last few months, she has spearheaded a data collection and analysis effort on Covid spread in schools and youth.

As a result, when Oster speaks up about something, I pay attention. However, the data on schools continues to be mixed.

Israel this week was the first country to impose a countrywide lockdown due to an intense second. The analysis strongly suggests it's related to their reopening of schools. Furthermore, Israel shows that spread in the young will result in spread across all age groups. There is some speculation that Israels' problem is related to the Orthodox resistance to Covid restrictions, similar to what is occurring in Brooklyn.

The CDC released another report this week showing transmission from infants at a nursery. The children then successfully transmitted it to their parents. There is also the open question of testing. Even in SF, which has one of the US's best testing systems, getting children tested is incredibly tricky.

It's frustrating because the best experts are still quibbling over what the risk / right path today is. As impressive as Osters' work is, it's still based on districts and superintendents who opt-in. The CDC / NIH / DOE have the test capability and authority to do these types of studies correctly, but the Trump administration chose not to.

The negative impacts of schools not being open is enormous, and the effects are felt worse on lower-income students. The country is left with a damned if you do/damned if you don't set of choices with no good science or national-level guidance. I can't judge anyone for what they end up doing at this point. No one can say with any confidence what the right choice it.

The FDA issued an update to the rules for issuing the EUA for vaccines. They will now require two months of side effect data after the second shot. As a result, this means that no vaccine will have the data needed to apply for a EUA before the election.

The Trump administration had stated they were going to force the FDA to reject this recommendation to ensure a EUA could be issued before the election. While it's fortunate that science won out in this case, it is a rare victory for public health.
The FDA has also asked the pharma companies not to apply for a EUA until they have enough doses pre-staged to begin a rollout. I think this is a reasonable attitude. I've previously said that scale manufacturing, not the EUA, is the limiting factor. If any of the current top three candidates are viable, I would expect the EUA to come late November / early December.

There are starting to be some scattered reports of side effects after the second dose of some mRNA vaccines. The stories get press because some of the accounts are pretty harrowing. However, the reason we're doing the large Phase III trials is to understand what's occurring. We will know, if true, how common these side effects are.

In this week's therapeutics news, the big attention has been on Regeneron; the monoclonal antibody Trump was given. He was one of the first patients outside of a study group to get the drug. His prognosis aside, Regeneron and another monoclonal antibody by Lilly are both promising. However, nothing is a magic bullet. These drugs must be administered via IV, so almost no one will have access to it outside a hospital.

The other primary concern is availability. Right now, there are 50,000 doses of Regeneron in the world. The US has about 50,000 new cases a day right now. The FDA has prepaid for many doses, and the expectation is that 1,000,000 will be produced before the end of the year. The antibodies can help us make an impact only as part of a broader vaccination and other control measures.

Take care out there. Anyone of the major events right now [Covid, fires, and a contentious election] would be hard. All at once, can seem overwhelming. Bit by bit, we will get through this and take lessons to prevent this in the future.