These days, headlines heralding some hopeful — or horrifying — new finding about the coronavirus are multiplying nearly as fast as the bug itself. As medical researchers the world over give COVID-19 their undivided attention, each week brings a new smorgasbord of working papers that leave lay observers jubilantly preparing for the reopening of America’s mud-wrestling rings or despondently preparing for another 18 months of awkward Zoom happy hours, depending on which items they happen to sample.
To help you get a better handle on the latest things we’ve learned about the novel coronavirus, and our prospects for vanquishing it, Intelligencer is assembling periodic rundowns of all the good and bad news that’s come our way. (You can check out last month’s list here.)
Critically, the findings described here are preliminary. Humanity has only had a few months’ experience with the virus formally known as SARS-CoV-2. Our understanding of it is partial and subject to change. So take the following with a grain of salt (but not, under any circumstances, an unprescribed dose of hydroxychloroquine).
The good news:
1) A coronavirus vaccine could conceivably secure approval before winter.
Every government on the planet has been treating the emergence of a coronavirus vaccine as a question of when, not if. The notion that a virus with a significant fatality rate — and exceptional capacity for asymptomatic spread — might become a perennial fact of life has proven too loathsome a hypothetical for most policymakers to entertain. But there was never much basis for dismissing that possibility. Plenty of viruses have outmatched humanity’s top biotechnologists.
So, the fact that 27 separate vaccines have now demonstrated sufficient efficacy in animals to qualify for human trials is an immensely encouraging development. And this week, a vaccine jointly developed by the biotech firm Moderna and the National Institute of Allergy and Infectious Diseases became the first to enter a phase 3 clinical trial in the United States. In other words, the Moderna vaccine has already displayed safety and efficacy in a trial featuring hundreds of humans and will now be given to tens of thousands of volunteers. If the vaccine replicates its earlier performance at scale, it will be eligible for FDA approval and then mass dissemination. This means that, in the characteristically careful wording of Anthony Fauci, it is now “conceivable” that an FDA-approved vaccine will be on the market as soon as October.
Even in that best-case scenario, it is not certain that the vaccine will confer long-term immunity, nor that the U.S. government will be prepared to rapidly manufacture and distribute the vaccine at the scale necessary for producing herd immunity. And there’s some reason to fear a critical mass of Americans will refuse to inoculate themselves against the virus (more on this in a moment). But it now looks very likely that a vaccine that confers (at least) short-term immunity against the novel coronavirus will be ready in the near future — something that was never a given, our leaders’ optimistic presumptions notwithstanding.
2) A variety of potential COVID-19 therapeutics have shown early promise, and could slash the disease’s fatality rate in the near future.
Donald Trump’s decision to appoint himself hydroxychloroquine hype-man-in-chief was wildly irresponsible. But his eagerness to find an effective treatment for COVID-19 was quite understandable.
Generally speaking, therapeutics take less time to secure regulatory approval than vaccines do. And this is especially true if the treatment in question is an already existing drug that simply needs the FDA’s green light for a novel application. From both a public-health and economic standpoint, a highly effective treatment is nearly as good as vaccine: If widely available, medicines can avert the most severe manifestations of COVID-19, then the coronavirus will produce far fewer long-term hospitalizations and deaths, and it will therefore be much less risky to restore some approximation of pre-pandemic normality.
At this point, though, no such medicines exist. The antiviral remdesivir has reduced recovery time among COVID-19 patients in clinical trials, and the steroid dexamethasone has prolonged survival among the severely ill in one British study. But neither of these remedies appear to be game-changing.
A drug known as LAM-002A (apilimod), however, has shown some efficacy at blocking the cellular entry and spread of SARS-CoV-2 in early trials. This suggests LAM-002A has the potential to halt the progression of disease in those infected with coronavirus, thereby reducing the number of cases that result in hospitalization. It is also possible that the drug could avert the development of illness in people who’ve been exposed to coronavirus but have yet to develop symptoms. The Yale Center for Clinical Investigation is currently enrolling patients in a phase two trial of the drug. Two separate, recently published studies have found LAM-002A to be effective in combating the spread of SARS-CoV-2 in lung cells.
Meanwhile, the National Institutes of Health is launching a “flurry” of large-scale clinical trials of various potential coronavirus therapeutics, including ones based on clones of antibodies found in patients who’ve recovered from COVID-19.
3) Rapid, low-cost saliva tests are on the way.
America’s efforts to contain the coronavirus through mass testing have been worse than lackluster. Our country’s lack of state capacity and virulent individualism have prevented the development of a national testing and contact tracing program. But America’s technological prowess remains robust, even as its social fabric has grown threadbare. And on the challenge of coronavirus containment, the former may soon mitigate the harms of the latter. A variety of laboratories, including one at University of Colorado Boulder, are in the late stages of developing rapid, saliva-based COVID-19 tests that Americans could take at home, potentially on a daily basis. In small-scale experiments, the CU Boulder test yielded highly accurate results within 45 minutes. Assuming adequate manufacturing and distributional infrastructure can be secured, researchers estimate that these tests would make it possible for Americans to confirm their coronavirus-lessness on a daily basis, at a cost of between $1 and $5 per person, per day. This would enable asymptomatic coronavirus carriers to self-isolate shortly after infection.
4) The outbreaks in Arizona, Texas, and Florida appear to be slowing.
In the United States, the explosion of infection across the Sun Belt is now the dominant coronavirus story. But the past week of data makes the worst-case scenarios for that resurgent outbreak appear less likely. First, there is evidence that belated social distancing and shutdown measures are slowing the pace of infection. Last week, Texas recorded 19 percent fewer coronavirus cases than it had the week before. In Arizona, that week-over-week decline was 13 percent; in Florida, it was 8 percent. The significance of the Sunshine State’s decline is uncertain, as daily testing in Florida also declined last week. But Arizona’s progress looks genuine, as evidenced by its declining number of hospitalizations.
Second, although coronavirus deaths are rising in the region, the death rate from the Sun Belt outbreak remains lower than it was at the apex of New York’s crisis in the spring. This is likely attributable to a combination of under-testing earlier in the year (an inadequate testing regime is more likely to miss benign cases than fatal ones), the concentration of new cases among younger Americans, and modest advances in treatment of COVID-19.
To be sure, even if one stipulates the most optimistic reading of the present data, America remains mired in a devastating crisis. Absent a pharmaceutical breakthrough, there is a very good chance that coronavirus cases will plateau at a high level through the autumn and then rise substantially at the onset of winter, when cold weather forces Americans to retreat en masse to indoor spaces where the coronavirus spreads more readily.
But for the moment, it is now possible to say of the U.S. outbreak, “things could be worse,” since, one week ago, they were.
The bad news:
1) The world’s second-largest country now has the fastest growing outbreak in the world.
India is home to 1.3 billion people, myriad areas of extreme poverty, an informal economic sector that employs the bulk of its nonagricultural labor force — and the fastest growing COVID-19 epidemic in the world. According to Bloomberg’s Coronavirus Tracker, confirmed cases of the virus rose by 20 percent in India last week, bringing the nation’s total to 1.4 million. The actual number of cases is likely an order of magnitude higher, as India has one of the lowest testing rates in the world, having completed about 11.8 tests per 1,000 people; in the U.S., that figure is 152.98, according to the University of Oxford’s Our World In Data project.
Coronavirus has wrought mass death and economic devastation in wealthy countries with strong public-health systems and significant fiscal capacity. The implications of a prolonged outbreak in a developing nation like India — which lacks the means necessary for replacing the incomes of workers sidelined by shutdowns, and has fewer hospital beds per capita than any developed country — are harrowing. As is, India has already recorded more than 33,000 COVID-19 deaths.
2) People who develop symptom-free coronavirus infections may be as contagious as those with manifest illness.
From an epidemiological perspective, the most distinct and devastating feature of the novel coronavirus is its capacity to spread through asymptomatic (and/or presymptomatic) transmission. But precisely how common it is for a person to carry significant concentrations of the virus within their bodies — without manifesting any symptoms — isn’t entirely clear.
Unfortunately, a new preprint study from researchers at the Broad Institute suggests it is quite common indeed. Analyzing the results of SARS-CoV-2 tests taken from more than 32,000 Massachusetts nursing-home residents and staff, researchers found that 71 percent of all residents who tested positive for the virus — and 92 percent of all employees who tested positive — presented no symptoms at the time their samples were taken. More critically, the viral loads detected in the samples of these non-symptomatic infectees were roughly as large as those taken from individuals who were manifestly ill.
These findings suggest that the novel coronavirus is not only capable of spreading through people who appear healthy, but that it is as capable of spreading through such individuals as it is through sniffling, shuddering wretches. If true, this would mean that the challenge of containing this virus once it gains a foothold is even more daunting than previously thought.
3) The U.S. is running short on testing supplies, again.
Perhaps, in a few months, you’ll be able to walk into your local drugstore and purchase rapid salivary tests you can take at home. But for now, in much of the U.S., the best you can hope for is an uncomfortable nasal test that will tell you whether you’re carrying a highly contagious disease a little over a week after you’ve taken it. As the New York Times reports:
Labs across the country are facing backlogs in coronavirus testing thanks in part to a shortage of tiny pieces of tapered plastic.
Researchers need these little disposables, called pipette tips, to quickly and precisely move liquid between vials as they process the tests.
As the number of known coronavirus cases in the United States passes 4 million, these new shortages of pipette tips and other lab supplies are once again stymieing efforts to track and curb the spread of disease. Some people are waiting days or even weeks for results, and labs are vying for crucial materials.
This long delay in the provision of results all but nullifies the primary public-health purpose of mass testing, which is to alert non-symptomatic carriers of coronavirus to their infection, thereby allowing them to self-isolate. Making matters worse, pipette shortages have led many labs to prioritize “testing for the sickest patients.” This policy makes sense on an individual level, since a severely ill person will be more concerned with ascertaining the nature of their sickness than an ostensibly healthy one will. But from an epidemiological perspective, such rationing is backward: We don’t need tests to tell us that people who are febrile and coughing should be isolated from the broader population during a pandemic, we need tests to tell us, rapidly, which apparently healthy individuals need to temporarily separated from the herd. And for now, we don’t have them.
4) The coronavirus vaccine is likely to have unpleasant side effects.
As mentioned above, the news on the vaccine front is largely positive. But there is one fly in the ointment: Although the leading vaccines look safe in early trials, they didn’t look uniformly painless.
Vaccines (typically) work by triggering an immune response to a non-threatening version of a novel pathogen, thereby training the body to recognize and combat the real thing. Unfortunately, the feelings associated with a triggered immune system are often unpleasant. In clinical trials both the Oxford University–AstraZeneca vaccine and the Moderna one caused transient headache, muscle soreness, chills, and fever in some subjects.
This is not a big problem in and of itself. But in late May, 27 percent of Americans told an ABC News–Washington Post poll that they would either “probably not” or “definitely not” take a coronavirus vaccine if one became available. And that survey made no mention of potential side effects, let alone ones as significant as fever. Given the prevalence of both tinfoil-hat libertarianism and healing-crystal-necklace New Age-ism in the United States, it was always going to be a challenge to get enough Americans to take a vaccine to achieve herd immunity. Reports of a vaccine getting people sick (however mildly) would surely magnify that challenge.
5) Countries that appeared to have the virus licked are now battling new outbreaks.
Mainland China, Hong Kong, and Japan all won plaudits for suppressing early outbreaks — and all have seen a resurgence of COVID-19 cases in recent days. None of these new waves of infection is notably large as of yet, but their emergence drives home the fact that this crisis will not be over unless or until an effective vaccine is widely dispersed. If Hong Kong can’t suppress COVID-19 through sheer vigilance, the United States has no chance.
6) Major League Baseball couldn’t make it through a single weekend without a team developing a coronavirus outbreak.
In early April, roughly 30,000 confirmed coronavirus cases were surfacing in the U.S. each day. This led the MLB to conclude that it had a moral obligation to postpone its season for nearly four months. Yesterday, there were 54,806 new, confirmed coronavirus cases in the U.S. — including several among the players and staff of the Miami Marlins — and the MLB decided that this was no reason to stop playing ball.
The fact that the MLB is going forward with plans to send at least 29 squadrons of men — most of whom are too macho to scrupulously wear masks (or even cancel games after their teammates have tested positive for a pandemic disease) — circulating from one major urban center to another, every few days, for the next several months is bad news for America’s coronavirus outlook, in and of itself. But the fact that an organization with the MLB’s resources was unable to make it through a single weekend without seeing one of its teams overtaken by COVID-19 also bodes poorly for the prospects of underfunded public-school districts safely reconvening classes this fall.
7) In some patients, COVID-19 symptoms can linger for months after infection — in others, the disease may do long-lasting damage to cardiac health.
The fact that COVID-19 has a minuscule mortality rate among young, healthy people is one of this pandemic’s few silver linings. Given our manifest lack of preparation for an emergent disease — and the many virological child-killers that humanity has encountered across the ages — we’re quite fortunate that the present disaster isn’t even more gruesome than it is.
Nevertheless, the impact of COVID-19 on young, healthy infectees looks more malign now than it did initially. One recent study from Germany compared cardiac MRIs of 100 people who had recovered from COVID-19 to heart images from a group of 100 people with a similar demographic composition but no exposure to the coronavirus. The average age of the former group was 49. More than two months after infection, 78 of the 100 COVID-19 survivors displayed structural changes to their hearts, and 76 harbored an apparent biomarker associated with cardiac injury.
Other studies indicate that a significant number of COVID-19 survivors retain some of the illness’s symptoms — most commonly, fatigue and breathing problems — for months after their initial infection.
Taken together, the good and bad news about coronavirus point to the same conclusion: Since COVID-19 is a serious illness that can do lasting harm to people of all ages — and since there’s reason to believe an effective vaccine or treatment may only be a few months away — we should not resign ourselves to a de facto “herd immunity” strategy, but rather do what we can to minimize COVID-19’s spread until the biotechnological cavalry arrives.