October 20, 2020

Challenge

I think one reason we hear clamoring for herd immunity and returning to “normal” is a misunderstanding of the risks from Covid-19. The messages have been muddled and people will make choices based on their biases and who they get their news from, especially if they don’t know anyone personally who has been ill. Make no mistake, people are suffering job loss, loneliness, money worries, more depression and anxiety, along with more alcohol and drug use. These are extraordinarily tough times.

Interestingly, mask use is going up as the virus is now hitting more rural communities that were spared earlier. This has stabilized some of the projections from the IHME regarding deaths, although the projections are starting to creep back up. I am worried about the deaths continuing to rise, but I am also worried about the survivors whose lives changed after contracting the virus. Every infection seems different and we are still unable to predict with certainty who will get critically ill, who gets mild symptoms, who will have symptoms lasting months or longer, and who will not show any symptoms. We have clues mostly based on age and risky health conditions, but many of the sickest patients don’t fall in those categories. Still most people survive, especially younger people. People want to know how long their symptoms will last and that is hard to answer. Some people just a week or two, some people may still be coughing after 3 weeks, and others are still ill after 6 months.

Which is why I am not sure what to think about the report today out of the UK regarding testing the effectiveness of a SARS-CoV-2 vaccine by inoculating volunteers with the virus. What they propose initially is to spray a small controlled amount of SARS-CoV-2 that has been standardized into a volunteers nose. In the first phase, the subject has not been vaccinated but this step is to find out how little virus is needed to cause an infection. Later they plan to inoculate previously vaccinated subjects with the standardized form of SARS-CoV-2 to check for effectiveness of the vaccine.

This approach was used decades ago in testing treatment and vaccines for other infectious diseases. But for years, this approach has been avoided because it runs along the ethical border. Informed consent will be done and people are volunteering, but the outcomes will be hard to measure. I hope the volunteers are counseled thoroughly on their risks of “long covid”.

The truth is, this challenge method will prove that a vaccine is effective much faster than more conventional research, which can take years to prove efficacy. That would be a huge breakthrough. Mostly, I am worried about the volunteers who may develop long COVID or get sicker than expected, especially in the initial phase when there is no protection from a vaccine and they are looking for the dosing needed to cause an infection. For these reasons the US’s FDA is not planning to participate in studies such as these.

Time will help us decide the next best course action. In the meantime, wash your hands, cover your nose, keep safe six, and stay sensible.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.cnbc.com/2020/10/20/uk-strikes-deal-with-open-orphan-for-coronavirus-challenge-study.html

https://www.nytimes.com/2020/10/19/opinion/coronavirus-herd-immunity.html

https://covid19.healthdata.org/united-states-of-america?view=total-deaths&tab=trend

https://www.mdlinx.com/news/every-covid-19-case-seems-different-these-scientists-want-to-know-why/5mU9MuUMK2nBfdib6Glq9F

https://www.seattletimes.com/seattle-news/health/how-long-can-i-expect-a-covid-19-illness-to-last/

https://www.theguardian.com/world/2020/oct/15/long-covid-what-we-know-so-far

https://www.washingtonpost.com/world/europe/covid-challenge-trials-uk/2020/10/20/00a31136-026c-11eb-b92e-029676f9ebec_story.html