COVID-19: Is the fear worse than the reality?

By Kent Giles

Overview: There’s a lot of concern over the COVID-19 pandemic. Some of it is justified. Some of it is misleading. This article focuses on medical and scientific facts about COVID-19. Based upon these facts, the article looks at what can be done to address the virus.

FACTS: Below are some key facts about the virus from the CDC and WHO (the charts come from healthaffairs.org, reference link below:

[i] https://www.healthaffairs.org/doi/full/10.1377/hlthaff.W3.219

[1] https://www.vox.com/science-and-health/2020/3/18/21184992/coronavirus-covid-19-flu-comparison-chart

COVID-19 is Hitting the Economy and the People

?The serious devaluation of global markets and isolation protocols will hit individual pocketbooks directly. This will leave a lasting impression on Americans on a variety of fronts. COVID-19 is the first pandemic in modern history in which the fear of the virus has impacted markets to this degree. The shutdown of major service and manufacturing sectors is a result of fear and well-intended leaders quarantining people to save lives.

There's no question, effective hand washing, covering or masking coughs and sneezes, and physical distancing (aka social distancing or isolation) help contain COVID-19 and other pathogens. These are our first line defenses. Testing symptomatic persons allows us to know who needs to be isolated. Testing does not currently mean that people can be provided with a cure. As of this writing, no generally accepted "cure" is available for COVID-19. What can be done is treatment of symptoms (coughing, sneezing, fever, respiratory inflammation, etc.) with over the counter or prescription remedies. If severe pneumonia (serious difficulty breathing and low blood oxygen levels) become a factor, we can also use respiratory therapies to address these issues (oxygen, ventilators, etc.) until the patient regains proper lung function. There are also drugs that can be used to treat opportunistic infections that attack a body weakened by COVID-19.

Closures of businesses and travel restrictions will slow the spread of COVID-19. They could also drive unemployment as high as 40% within two quarters. Some sectors will take a long time to recover, other sectors will represent once in a lifetime buying opportunities. The good news is that the fundamentals of the US economy are sound. Once pandemic fears abate, economic recovery will begin. The time to economic recovery will be directly related to the time we remain in isolation. The longer the “shut down” lasts, the more protracted the recovery. In the end, it comes down to putting lives ahead of economics.

How bad is it? What Doctors tell me privately.

One respected researcher said yesterday, “COVID-19 has a very low mortality rate. For healthy people, 97% will recover. Most will recover at home without needing hospital care.” When asked about the critically ill and those over 80, he said, “The critically ill are in the last stages of life already. When your major organs are shot, you are much more likely to die. It’s a medical reality. Most of these people, unfortunately, will pass away with or without COVID-19. As for older Americans whose immune systems are weak, they are susceptible to a wide number of infections. COVID-19 is just one more risk factor we need to address.”

One well respected internal medicine physician I interviewed this week said, “If COVID-19 had occurred 20 years ago, we’d never have known about it. We would have treated people and 98% of them would have recovered and never known they had it.”

One British physician said, “We should not quarantine young people and people at low risk. The human immune system is well prepared to fight COVID-19 and leave people with immunity afterward. Shutting down commerce and isolating everyone will only prolong virus duration.”

A CDC official said, "Large events and mass gatherings can contribute to the spread of COVID-19 in the United States via travelers who attend these events and introduce the virus to new communities." The CDC recommends cancelling gatherings of over 50 people.

This means we have well qualified physicians and scientists with varying approaches to COVID-19. At this point, our best path is to follow the advice of the CDC, WHO and our leaders. Limiting the spread of COVID-19 will help buy time to prepare for increased cases, find a cure, reduce demand on our healthcare institutions; and help reduce the number of deaths and disabilities.

Cure It or Fear It?

Ending the economic free-fall comes down to either a cure or a rational understanding of COVID-19. The reality is that COVID-19 is a corona virus that is not as lethal as many other pathogens. However, it is a disease for which we currently don't have a cure. Worst case estimates for the US seem to coalesce around 1.5 million people dying from COVID-19 or complications of the disease. Like other viruses, COVID-19 will have the highest mortality in the least healthy in our society. While mortality has been higher in older adults and the critically ill, it is affecting people of all ages. It comes down to your overall health. One epidemiologist told me that, "smokers, people with poor lung function, obese and overweight persons, people with heart disease, and diabetics are also at higher risk. It comes down to your overall health. Anything that weakens your body, increases your risk."

The good news is that we will cure COVID-19 and prevent it going forward, just like we have done with a host of other diseases. Remember that we cured polo decades ago at a time when science was much less capable. We also survived the 1918 Spanish Influenza pandemic before we had anti-virals, electron microscopes or a global pharmaceutical industry. There's no doubt that we will win! The question is how long it will take?

The Solution to COVID-19

Economic recovery will start once COVID-19 is considered "under control". That means a positive shift in the curve (new cases and recoveries). Shifting the curve comes down to two vectors: self-recovery and science.

Self-Recovery: The human immune system is designed to fight pathogens. We already know about 97% of people who are otherwise healthy and get COVID-19 will develop antibodies that fight the virus and protect them from recurrence. Most, we are told, will only have a mild set of cold symptoms. Some will have moderate symptoms. Less than one in five will need hospitalization. The US rate of hospitalization will likely be lower due to our reservation of hospital beds for tertiary patients and the legacy of "managed care." Most of the elderly (82% to 92% will also recover). For the critically ill, the mortality rate will be about 50%. The good news is that most infected people will survive and will recover within a few weeks of symptoms arising.

Science: We have a more advanced and efficient life sciences industry than ever before. This is a worldwide capability. As it relates to COVID-19, there’s a lot of good news. 

Below are some examples of therapies under evaluation:

Two days ago Sanofi/Regeneron said they were starting phase II/III trials with their own anti-IL-6 MAb, Kevzara. The side-effects of Kevzara and Acetmra carry black box warnings about the risk of serious infections in patients with pulmonary disease. This means, these high-risk patients will need to be closely monitored.   

Another emergency measure saw China add favipiravir to its Covid-19 treatment program. The flu drug is sold in Japan by Taisho and Fujifilm as Avigan. It has been discontinued virtually everywhere else. Its toxicity profile will likely limit its use in Covid-19.

As far as antivirals, the greatest current hope in the west comes from Gilead’s remdesvir, now in two pivotal studies that could finish by May. One study enrolls moderately ill subjects with COVID-19. The other enrolls patients with severe COVID-19.

Several other intriguing studies have recently been posted on the Clinicaltrials.gov registry. Neurorx plans to test aviptadil, a mostly discontinued antihypertensive, in Covid-19-related respiratory distress. Academic medical centers are studying chloroquine as a prevention strategy for Covid-19, see Cozaar and Soliris.

Biocryst is evaluating galidesvir. Evercore ISI’s Josh Shimmer has highlighted the potential of lopinavir/rotinavir.    He sees this category of antivirals as a first line of attack against the new coronavirus.

These are just a few examples of the global activity to cure or prevent COVID-19. With the private sector seeing huge profit potential and academic sectors finding significant grant writing opportunities, research efforts will be at unprecedented levels. This will help shorten the time to cure. Fast tracking therapies by removing “unnecessary government "red tape” will also take place. These factors will combine to bring solutions rapidly from bench to bedside. There are also several existing drugs that may offer efficacy in treating COVID-19. These drugs are already being produced and represent the shortest path to cure. 

Summary

The great news is that we have never been in a better position to cure COVID-19. Worst case, the virus spreads rapidly and about 97% of our people recover and gain an immunity. The sad fact is that we could lose over a million Americans in the process. The high level of attention the pandemic is getting in the US will provide an environment for rapidly bringing solutions to market. Once Americans start seeing recoveries from COVID-19 and restrictions lifted, the economy will begin recovery. The speed to recovery will be determined by the length of the “shut down.”

This is a time to address fear with accurate information and keep COVID-19 in context. COVID-19 will be cured. COVID-19 is not the apocalypse. We will all get through this together. Let's come together and beat this disease.