
Get Real: no drug or vaccine will avoid a very big coronavirus epidemic - daddylonglegs
https://blogs.sciencemag.org/pipeline/archives/2020/03/04/get-real
======
RcouF1uZ4gsC
I know Derek Lowe is an expert. However, sometimes, experts think that because
things have always been a certain way throughout their career, they will
always be like that. Drug development has been very conservative especially in
the US for the past several decades. The FDA is all about making sure they
never have a thalidomide incident and would rather lose a lot of good drugs
than approve a bad drug. This is the steady state.

However, a global pandemic is more akin to wartime footing. During WWII design
and production ramped up to an unprecedented degree. There is a possibility
that Covid19 will spark such a global response.

~~~
blobbers
`...would rather lose a lot of good drugs than approve a bad drug.`

Thanks for saying this, and rightfully so! Approving a bad drug in the world
where distribution channels are very well set up could have disastrous
effects.

We can point to things like the opioid crisis in the USA right now - a drug
that is so addictive it should have never been put into use the way it was.

~~~
mhb
I don't understand the "rightfully so!" There is a real cost to not approving
good drugs in order to avoid approving bad ones.

~~~
rjkennedy98
> There is a real cost to not approving good drugs in order to avoid approving
> bad ones.

Do you have any evidence for this? Seems to me like a classic shibboleth of
the pharma guild.

~~~
mhb
Not sure what sort of evidence you're looking for. There are certainly
approved life-saving and other valuable drugs. If they had been approved
sooner they would have had a greater benefit. There is an institutional bias
towards avoiding costs due to approving a bad drug versus delaying approval
and incurring unseen costs.

------
howmayiannoyyou
Lowe was a proponent of intravenous vitamin C under a specific set of
circumstances for immune response during oncology
([https://blogs.sciencemag.org/pipeline/archives/2020/03/02/vi...](https://blogs.sciencemag.org/pipeline/archives/2020/03/02/vitamin-
c-and-immuno-oncology)), and in China and Korea claims are being made that
similar intravenous (not oral therapy) has positive results:
([https://www.youtube.com/watch?v=6-elCYFhqJs&feature=emb_logo](https://www.youtube.com/watch?v=6-elCYFhqJs&feature=emb_logo))
and
([https://clinicaltrials.gov/ct2/show/NCT04264533](https://clinicaltrials.gov/ct2/show/NCT04264533))

It would be ironic if the most overhyped supplement of all time had efficacy
here.

------
anu7df
Yes. It is worse than a regular flu. But, if you look at statistics from S.
Korea, the only country with a substantial infection and trust worthy numbers
(as in they test heavily), the death rate is around 0.6% overall. So not the
end of the world, but nothing to be complacent about either. If the White
house will get out of the way and let the system work, we may still have time
to mitigate the worst here in the USA. But of course, we don't even want to
cancel SXSW. What more needs to be said? <insert Darwin thumbs up gif >

Addition: No, I "trust" the reported numbers from Italy. I think they are
missing a lot of mild cases that are not being reported or tested. When I
checked a few days ago, it looked like of the tests that South Korea ran, only
5% or so were positive. So, their infected numbers are probably more accurate.
The death rate may still be higher, because we don't know how many in the
infected population as of today will recover. One could for example calculate
the death rate as [Number_of_deaths.today]/[Number_infected.x_days_ago] I
don't really know the "x" to use in this circumstance, but just using 7 days
(since a lot of deaths occurred in 7-9 days from positive detection), the
death rate may be about a factor of 2 higher. So about 1% overall. I have been
looking at so many different sources in the last few days, I can't seem to
find the sites where I got the numbers for the above calculations from. So I
might be off by a bit.

~~~
dgacmu
You're making a somewhat dangerous mistake in your analysis. South Korea's
death rate is not well established yet: 7% of their cases were new just in the
last day, and they've had very few people with confirmed recovery yet. There
are likely to be more deaths to come.

~~~
asdfman123
To correctly analyze the morality rates you have to take a _lot_ of things
into account: hardly anyone is being honest (South Korea is better, but not
perfect), testing is rate limited, death rates are a lagging indicator, etc.
etc. etc.

Lots of experts have made guesses with these assumptions factored in, but at
this point, there is so much uncertainty it's hard for anyone to tell.

------
haunter
So some comments here say 60-70% global infection [0] and 3-4% death rate [1].
Is this really possible? That would be like ~150 million deaths.

0,
[https://news.ycombinator.com/item?id=22485485](https://news.ycombinator.com/item?id=22485485)

1,
[https://news.ycombinator.com/item?id=22485692](https://news.ycombinator.com/item?id=22485692)

~~~
bcrosby95
Outcome of critical cases is heavily reliant upon whether the medical system
can handle the number of infected. If someone requires a ventilator and you're
out of ventilators they're kinda fucked. There's also evidence that lots of
people show little to no symptoms. There's probably a large number of people
that simply don't know they had it. Which is both good and bad.

If we manage to keep it from spreading too far too fast, from the variety of
studies I've seen then anywhere from .5% to 1% is probably more realistic. But
if we don't, expect something higher. This is why waiting for "enough" people
to die as evidence of severity, then responding is a poor response.

FWIW the Spanish Flu infected 27% of the world's population. 60-70% seems
really high.

~~~
harambaebae69
Commercial aviation had barely begun when the Spanish Flu occurred, and the
world was nowhere near as connected.

------
tonmoy
I have personal reasons to hate the current administration. However, even an
incompetent government is better than no government during times like these. I
hope we can stay united in our plight against the common enemy.

------
daddylonglegs
I've edited the sub-title (that I added) from "no COVID-19 drug or vaccine in
the short term" to "no drug or vaccine will avoid a very big coronavirus
epidemic." The author or magazine nailed their colours to the mast with the
title "Get Real," so I think that should stay in the title. Lowe doesn't use
"COVID-19" or "SARS-CoV-2" or "nCov" in the article so I've used "coronavirus
epidemic."

I did not expect the title detract from the discussion to the extent that it
has, sorry.

------
bhanhfo
Scientific agreement seems to be that ~60-70% of the population will get
infected. It is just not sure if within months or (hopefully!) years.

And no drugs within at least one year.

Edit: Source => Original in German here:
[https://www.sueddeutsche.de/gesundheit/krankheiten-
experte-e...](https://www.sueddeutsche.de/gesundheit/krankheiten-experte-
erwartet-60-bis-70-prozent-infizierte-in-deutschland-dpa.urn-newsml-dpa-
com-20090101-200228-99-108884)

Express UK translated it here:
[https://www.express.co.uk/news/science/1249963/Coronavirus-n...](https://www.express.co.uk/news/science/1249963/Coronavirus-
news-COVID19-worse-than-Spanish-Flu-latest-coronavirus-update)

The guy interview is Prof. Drosten. He is the co-discoverer of the SARS virus,
and is one of the top 10 guys in this field.

PS: Sorry for not adding the source right away.

~~~
cactus2093
Sources? It seems far too early and there isn't enough reliable observational
data, much less scientific trial data, available for broad "scientific
agreement".

Although obviously the accuracy of China's data is in question, it's promising
that they were able to get the reproduction rate below 1 pretty quickly. And
within Wuhan itself the spreading seems to have slowed with something like
0.6% of the population of 11 million infected.

Not to mention in China outside of Wuhan/Hubei, which have conditions much
more similar to most of the rest of the world in having some advanced warning
of the virus, the spread seems also to have slowed down at a much much lower
infection rate.

Based on this information it's not clear to me where the "40-70% of the world
getting infected" idea is coming from, though I've seen a few headlines
reporting that too.

~~~
dwild
Wuhan is your reference? China too? Aren't they putting pretty severe
quarantine in Wuhan? Aren't their quarantine outside of Wuhan still quite
strong?

The Diamond Princess had a quarantine, and yet the infection reached 706
peoples, in a boat with 3711 peoples. Sure that's "only" 20%, but that seems
to me like 40% isn't that far out if we are considering that it's hard to
quarantine a whole country.

The timeframe is important too, as long as we don't have developed any
vaccine, the only way to develop immunity is by being infected... thus if the
virus spread that easily, it's only a question of when will we reach 40-70%,
not if.

~~~
physicles
Yeah I’m in Beijing now and there’s no way most of the world could implement
this kind of quarantine. I can’t leave or come back home without presenting a
special card at the gate of my apartment complex.

But it’s working, and at this point I’d rather be here than in many other
countries.

------
aazaa
For those suggesting that a COVID-19 vaccine can somehow be fast tracked,
consider what happens if something goes wrong during deployment to the
population.

The US has an active, very vocal anti-vax community. They've been growing and
gaining ground for decades.

The first sign of trouble of any kind with a new COVID-19 vaccine would result
in a backlash of biblical proportions. It could be so strong as to derail any
attempt at a follower.

For this reason, I expect to see two things:

1\. withering pressure from the current administration to cut corners on
testing any new vaccine

2\. a good chance for disastrous consequences resulting from (1)

~~~
owlninja
I hear more people talking about anti-vaxxers than I do from any actual anti-
vaxxers. I don't think they are all that powerful.

~~~
mellavora
Huh. Wonder where you heard this?

Perhaps you missed the recent American Academy of Family Physicians survey on
the topic?

Here is the NBC recap: [https://www.nbcnews.com/health/cold-and-
flu/millennials-leas...](https://www.nbcnews.com/health/cold-and-
flu/millennials-least-likely-get-flu-shot-anti-vax-beliefs-may-n1116601)

~~~
koheripbal
This survey did not find that anti-vax had a meaningful impact on vaccination
rates. The NBC article is poorly written and misleading.

------
ouid
This post has 164 points and 204 comments in 3 hours, and is on the second
page?

Do I fundamentally misunderstand how this works?

~~~
tonmoy
Yes, HN heavily penalizes posts with votes lower than number of comments

~~~
ouid
alright, thanks.

------
cryoshon
a vaccine might be 18 months away, if we're lucky and divert resources to the
effort. if we're unlucky, it could be four to five years or even longer.
remember, there's no guarantee that we can even make a vaccine for any
arbitrary viral disease. we can't do nothing while we wait for a vaccine.

placeholder antiviral therapies are also a non-starter. we can't manufacture
the drugs at the scale we need them unless we massively expand our production
capabilities, and that takes time as well as money.

\---

as things stand currently, there has been no substantive response by the US
federal government to the coronavirus which will lead to the lessening of
infections or mortality.

china and south korea both explicitly stated that they were transitioning to
wartime footing to combat the virus. we need to follow in their footsteps. we
need billions of dollars in spending, suspension of normal daily life, and
requisitioning of the necessary resources from private entities if needed. and
we need to do this today. now. this afternoon. preferably before 5 PM. this
isn't a problem to be left until tomorrow.

yet we're still here, conducting life as normal as the infection reaches the
exponential part of its spread. people are still going to work, going to
church, and riding the subway. hospitals and prisons don't have any special
measures in place.

we aren't even testing people after weeks of knowing that we are at risk for
local transmissison. we have no extra resources queued up. as of today, our
congress can't even agree to pass a funding bill to combat the disease. we
have no leadership, and it's going to kill quite a few people.

if you think i'm being "alarmist", please revisit my here comment in six
months, when we'll have a clearer idea of the death toll. i don't know if this
virus will kill a million americans, or only a few hundred. either way, if we
act with more vigor over the last few weeks, i can say with confidence that
more people will live.

~~~
theseadroid
I totally agree with you.

>china and south korea both explicitly stated that they were transitioning to
wartime footing to combat the virus. we need to follow in their footsteps. we
need billions of dollars in spending, suspension of normal daily life, and
requisitioning of the necessary resources from private entities if needed. and
we need to do this today. now. this afternoon. preferably before 5 PM. this
isn't a problem to be left until tomorrow.

This won't happen in North America. As a Chinese who reads Chinese and English
news sources everyday, it appears while China is very heavy handed in
censorship for anything coronavirus related, in NA there is too much
misinformation floating around, to the point that people cannot agree on
anything. Specifically western media have been producing outrage porn for
clicks around Covid 19 for a while, resulting in much misinformation on how
China's measurements in combatting the virus are inhumane and in violation of
human rights, that even talking about those options will bring so much
negativity into the discussion. Apparently inaction and incapability of the
government and every one only takes care of themselves are not human right
violation.

Even we don't have a cure, slowing down the spread is a huge win in for the
healthcare system as a whole.[1]

1\. [https://www.vox.com/2020/3/2/21161067/coronavirus-
covid19-ch...](https://www.vox.com/2020/3/2/21161067/coronavirus-
covid19-china)

------
swsieber
Most comments seemed to be responding to the title, which misses the point.
The title is quite editorialized.

The real point of the article is that there's no drug or vaccine in the works
that will be able to prevent the impending U.S. epidemic, so don't pin your
hopes on them.

I'd go so far as to suggest a new title of "Get Real - Drugs and Vaccines
won't Prevent a U.S. Epidemic".

~~~
rolph
its too late to prevent an epidemic in most places

there is no star trek solution that will suddenly prevent epidemic anywhere
that is apparently free of virus for the time being.

the virus is not so lethal as to justify suspension of safety and efficacy
trials. the potential to kill far more people with a mistake than the virus
would kill, is very real.

------
the_af
I see a lot of panicky comments, both in real life and in this very thread.

I know COVID19 is different from a regular flu, but is it more serious?
"Regular" flu is very contagious and kills lots of people every year. It's ok
to study coronavirus and to try to find ways to effectively manage it, combat
it or prevent the disease -- but why are we panicking? Nobody panics about the
flu and it's proven to be fatal for a lot of people every year. Why the panic
with coronavirus, why are people in this very thread worrying about "the death
toll"? Is there _any_ projection that the death toll is going to be higher
than usual for a flu?

For what it's worth, my doctor told me "it's like a flu, don't worry". A
doctor friend of mine told me the same.

~~~
sachdevap
The death rate of COVID-19 is at about 3.4% on average. In comparison, the
death rate of seasonal flu is about 0.1% in the US. No, it is not "like" the
flu.

[https://www.cnbc.com/2020/03/03/who-says-coronavirus-
death-r...](https://www.cnbc.com/2020/03/03/who-says-coronavirus-death-rate-
is-3point4percent-globally-higher-than-previously-thought.html)

~~~
capkutay
3.4% of reported cases have died. That doesn’t mean the actual IFR is 3.4%.

Data modeling suggests it’s closer to 0.98%. It’s also important to note that
age plays a significant factor. The IFR is about 0.2% for young healthy
people, while it is quite dangerous for people over 60 with existing
conditions.

[https://institutefordiseasemodeling.github.io/nCoV-
public/an...](https://institutefordiseasemodeling.github.io/nCoV-
public/analyses/first_adjusted_mortality_estimates_and_risk_assessment/2019-nCoV-
preliminary_age_and_time_adjusted_mortality_rates_and_pandemic_risk_assessment.html)

~~~
edmundsauto
Just curious, what is the mortality rate of the regular flu for young healthy
people?

~~~
WaltPurvis
For US adults ages 18-49, it varies (depending on the severity of flu strains)
between .01% and .02%.

[https://www.cdc.gov/flu/about/burden/2016-2017.html](https://www.cdc.gov/flu/about/burden/2016-2017.html)

------
mellavora
Looking at this thread as an interesting datapoint. Typically HN is
thoughtful, well reasoned, and well informed. This thread is not holding that
same level.

Wonder what this says about the level of concern over this bug.

~~~
iamatworknow
This has been true of every HN thread in the past week or two relating to
COVID-19. The typical objectivity you see among the usual audience has
disappeared.

~~~
mellavora
ok, so I'm not the only person seeing this.

Concerning.

Thanks for sharing.

------
shrubble
Is it the case that SARS (of many years ago) had a vaccine developed for it,
but it had too many side effects or was not effective enough to get past
trials?

And that while this virus is different it is similar in many respects...
leading me to think that a vaccine may also be difficult to produce.

~~~
daxorid
Yes, the SARS vaccine virtually guaranteed severe lung scarring if you were
re-exposed to full-strength SARS:

[https://journals.plos.org/plosone/article?id=10.1371/journal...](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035421)

~~~
UncleOxidant
Would this also the case if someone who had SARS and recovered was re-exposed
to SARS?

------
elihu
To be fair, it's possible that we discover that an existing, already-approved
drug or treatment is more effective at reducing the death rate of people
experiencing the worst symptoms than what we're doing now.

A vaccine is probably very far away, though.

------
partingshots
Given that this is so similar to the previous SARS epidemic, how did that
whole thing eventually end? Was a vaccine created? Did it just naturally
fizzle out?

~~~
Dirlewanger
Summer hit the Northern Hemisphere.

~~~
partingshots
So how likely is it that when summer comes the same will happen with the
current coronavirus epidemic?

~~~
ars
It's summer in Brazil, and other southern countries, so we can just watch them
and see.

------
kiterunner2346
The key may not be a vaccine but simply staying alive. Covid-19 kills with a
"cytokine storm":

cytochine release syndrome(cytokine storm):

[https://en.wikipedia.org/wiki/Cytokine_release_syndrome](https://en.wikipedia.org/wiki/Cytokine_release_syndrome)

Article discussing coronavirus et al and cytochine storm:

"Clinical features of patients infected with 2019 novel coronavirus in Wuhan,
China"

[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(20\)30183-5/fulltext)

From the article:

 _" In view of the high amount of cytokines induced by SARS-CoV,22, 24 MERS-
CoV,25, 26 and 2019-nCoV infections, corticosteroids were used frequently for
treatment of patients with severe illness, for possible benefit by reducing
inflammatory-induced lung injury. However, current evidence in patients with
SARS and MERS suggests that receiving corticosteroids did not have an effect
on mortality, but rather delayed viral clearance.27, 28, 29 Therefore,
corticosteroids should not be routinely given systemically, according to WHO
interim guidance."_

Curcumin has been shown to suppress the cytokine storm.

[https://www.ncbi.nlm.nih.gov/pubmed/25600522/](https://www.ncbi.nlm.nih.gov/pubmed/25600522/)

Curcumin is found in the spice turmeric and is available in most grocery
stores. Today you can buy a pound of turmeric powder for ~$6. You can buy
curcumin tablets in the health & fitness section.

Other anti-inflammatory agents (NSAIDS(aspirin, buprofen,
naproxen),prednisone, etc.) are not as effective.

In India children are often given a daily teaspoon of turmeric (curcumin) in
milk or water. India suffered much lower SARS deaths (there are confounding
factors, e.g. India's high summer heat). I expect the same to happen with
covid-19.

~~~
empath75
I haven’t seen anyone say it kills with a cytokine storm — spanish flu did
that.

~~~
kiterunner2346
Title: "Clinical features of patients infected with 2019 novel coronavirus in
Wuhan, China"

[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(20\)30183-5/fulltext)

from the Lancet article:

 _" In view of the high amount of cytokines induced by SARS-CoV,22, 24 MERS-
CoV,25, 26 and 2019-nCoV infections, corticosteroids were used frequently for
treatment of patients with severe illness, for possible benefit by reducing
inflammatory-induced lung injury. However, current evidence in patients with
SARS and MERS suggests that receiving corticosteroids did not have an effect
on mortality, but rather delayed viral clearance.27, 28, 29 Therefore,
corticosteroids should not be routinely given systemically, according to WHO
interim guidance."_

------
LinuxBender
It is interesting to me that people are so laser focused on test kits and
vaccines. In my less than humble opinion, people should focus on improving
their immune system. You can reduce the load on your immune system by not
eating sugar and reducing carbs as much as you can. We also know from history
and science that every plague that killed people from respiratory virus
infections was due to a lack of vitamin D3 and over production of the ACE2
enzyme. The virus quickly binds to ACE2 and their adaptive immune systems did
not have the time to start producing enough anti-bodies. I do not understand
why the CDC is not suggesting that folks increase their D3 intake, cut out
sugar and most importantly, take a break from smoking which is know to
increase ACE2. There are alternate methods of nicotine sources available.

I mention this because a vaccine is only useful for known viral code. nCoV
will have a family of hundreds of variants in no time. Boosting ones built in
adaptive defenses will protect against all of the mutations.

~~~
herf
Here are three negative results (all randomized controlled trials) for Vitamin
D supplementation during the winter:

[https://www.frontiersin.org/articles/10.3389/fimmu.2019.0006...](https://www.frontiersin.org/articles/10.3389/fimmu.2019.00065/full)

failed to show any effect on wintertime supplementation of D (using pre-
registered criteria)

[http://www.vitaminedelft.org/files/art/ling2009.pdf](http://www.vitaminedelft.org/files/art/ling2009.pdf)
"no benefit"

[https://pubs.rsc.org/en/content/articlelanding/2014/fo/c4fo0...](https://pubs.rsc.org/en/content/articlelanding/2014/fo/c4fo00371c/unauth#!divAbstract)
"did not lower incidence of influenza"

~~~
belltaco
Here's a positive result.

[https://www.bmj.com/content/356/bmj.i6583](https://www.bmj.com/content/356/bmj.i6583)

"Vitamin D supplementation was safe and it protected against acute respiratory
tract infection overall. Patients who were very vitamin D deficient and those
not receiving bolus doses experienced the most benefit."

~~~
herf
Good one (odds ratio=0.88), and it's generally low-risk.

------
anticensor
This is SARS type 2; please stop using COVID-19.

> distinction between a disease caused by a specific virus and the virus that
> causes it

The virus is also called SARS-CoV-2.

~~~
SpicyLemonZest
I dunno, I think that one's on the scientists. Expecting the general public to
maintain a nominal distinction between a disease caused by a specific virus
and the virus that causes it isn't reasonable.

~~~
tomatocracy
The concept is well enough understood by the general public I think in the
context of HIV/AIDS so I'm not sure why it couldn't be here too.

I think it would be a useful concept for the general public to understand the
distinction if there turn out to be significant numbers of asymptomatic but
infectious people.

