THE OPTIMISM THAT COMES FROM [Bulletin of April 17, 2020] By Guido Silvestri, MD. Emory University Atlanta GA

Translated by G.M. Trovato, MD, EMA

1. THE MOST IMPORTANT NUMBER

Slowly the "numbers" in Italy are better. This time, however, I would like to think about the number that I am convincing myself to be the most important of all. I refer to the number of ICU patients. Why it is important? Because of all it is the most reliable number - in fact, the confirmed cases depend very much on the number of swabs that are made and even the number of deaths has given rise to doubts and controversy. On the other hand, there is little to discuss the number of ICU admissions, because they are just enough. In this sense, it should be noted that in the last five days the number of people hospitalized in intensive care has constantly decreased, in these terms: 3,442 - 3,260 - 3,186 - 3,069 - 2,936. It is a slow descent, there is no doubt, and we know that many of these patients unfortunately will not survive: but it is a constant descent, which indicates in an increasingly convincing way that we are coming out of the worst part of the epidemic.

2. UPDATE ON VACCINES

Have a look at the summary on the current situation, with the help of our friend Wayne Koff, president of the Human Vaccine Project. To date, there are as many as 78 vaccine candidates for COVID-19 in the pre-clinical development phase, and five in phase I clinical trials (safety and immunogenicity). The latter are:

an RNA vaccine that encodes the S (spike) protein produced by Moderna;

an Adeno-5 vector vaccine expressing the S protein produced by CanSino Biologicals;

a DNA plasmid encoding the S protein produced by Inovio Pharmaceuticals;

and two methods in which antigen presenting cells are transduced with lentiviral vectors expressing SARS-CoV-2 (produced by Shenzhen Geno-Immune).

Remember, please, that SARS-CoV-2 is an RNA virus capable of mutation, but does not have the areas of hypervariability typical of HIV, hepatitis C and flu (all viruses for which we do not have vaccines or we have them of limited efficacy). Moreover, indeed vaccines against SARS and MERS have been shown effective in animals. For timing, the most optimistic scenario sees a vaccine with proven clinical efficacy ready for mass use between 15-18 months.

3. SOME LIKE IT COLD

Canada and Australia are two distant but very similar countries. They both have the same population (around 30 million inhabitants) spread over a huge territory, have similar systems of government, a strong tradition of democracy and freedom, and a public and universal health service. Faced with the COVID-19 pandemic, Canada and Australia have implemented similar "social isolation" measures and with very similar timing. The first deaths from COVID occurred in both countries on March 9, and on March 10 there were 98 active cases in Canada and 107 in Australia. We send the film forward yesterday, April 16, and we find that Canada has 28,379 cases and 1,010 confirmed deaths, while Australia has 6462 cases and 63 deaths. Do I have to tell you what is very different between Canada and Australia? [suggestion: I am not referring to proximity to the USA or to trade with China]. I honestly don't know what to do, this poor guy from viruses, to convince us that he, unlike Marilyn Monroe, likes it cold.

4. GERMAN CONTACTS

In the link you see my friend Hendrik Streeck, a Berlin doctor and scientist who spent 10 years at Harvard and returned to Germany to head the Institute of Virology at the University of Bonn. Hendrik is a leader in research on COVID-19 in Germany, and has examined how the virus is transmitted in a thousand infected people in Heinsberg, which is an epicenter of the German epidemic. The very interesting result is that every single case can be traced back to close contacts (family, cohabitation, hospitals, rest homes) while NO CASE comes from restaurants, hairdressers, supermarkets and various shops. In addition, Hendrik and his team repeatedly searched for the virus in handles, doors, telephones and public toilets, without ever finding it. This is in accordance with Wuhan's data, where almost all cases were related to family clusters. As the great friend Lopalco, the Italian Epidemiologist, says, this virus infects a lot not because it is diabolically infectious, but because it finds many susceptible beings (in other words: there is little immunity among the population).

5. HARVARD STUDY ON PHASE-2

In these days, we have talked a lot about "reopening", phase-2, and pandemic-endemic transition. Two days ago, Roberto Burioni and I released a proposal to which numerous medical associations and scientific societies have joined. Yesterday the prestigious Science magazine published an article by Lipsitch, at Harvard, which describes the same thing ... that is, the need to monitor both active infections (with swabs) and immunity (with serological tests) in the population. All to acquire data that will guide a flexible response to the possible return of the virus in late 2020.

Thanks again for following this page and good day to all!