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COVID-19 Danger Close

One of the first things to recognize about the current outbreak is that it is very unlikely that anyone can predict how serious this will become. Part of the problem is that, so far as anyone knows, humanity has no natural immunity to SARS-CoV-2 (the virus causing COVID-19). This issue suggests that it will sweep through populations.

microscopic example of a coronavirus

People being different, we can add to this problem that many people who have been infected might be asymptomatic, or not unwell enough to seek medical treatment. If that is the case, the current number of reported cases very likely grossly underestimates the number of people infected. Add to this the unclear effect, if any, that control measures, such as travel bans and quarantining people, are having on the timing and severity of a future potential peak.

In other words, we simply don’t know much about this virus. We should stop pretending that we do. About the only thing we know for sure is that if everyone gets this thing at once, we are unlikely to have capacity enough in our medical systems (globally) to treat everyone who needs aggressive treatment, which means more people than might have died with a slower progression will, unfortunately, die.

So, we must face the fact that whatever control measures we think we have put in place, there will be escapees. You can think about it in similar terms to how bacteria evolves with hopeful monsters to overwhelm the increasing levels of antibiotics in the environment. Watch this video to observe over two weeks how the bacterium Escherichia coli adapted to increasingly higher doses of antibiotics. The idea that containment strategies (short of a global shelter in place order) will work is pure folly.

If we look at the problems we have with SARS-CoV-2/COVID-19 we can take an educated guess that the outbreak in the United States and other countries is more widespread than tracked because many people with mild symptoms don’t know they have been infected. Knowing this, we can also infer that it is highly likely that the coronavirus will become ubiquitous like H1N1. That leads us to the rather inescapable position that [trigger warning for the anti-vaxers] it will be crucial to develop a vaccine.

After the 2009 outbreak (H1N1pdm09), experts developed an H1N1 vaccine that was included in flu shots people received in subsequent years. This helped protect especially vulnerable populations following waves of infection. Epidemiologists seem to think H1N1 is a particularly good parallel to SARS-CoV-2/COVID-19 because, while H1N1 had a lower fatality rate than SARS or MERS, it was deadlier because of how infectious and widespread it became.

Fortunately, our ability to quickly sequence the SARS-CoV-2 genome and the subsequent distribution of the data early on in the COVID-19 outbreak, allowed for the development of a variety of assays to diagnose patients based on snippets of the virus’s genetic code. Yet, as the number of potential cases increases, and concerns rise about the possibility of a global pandemic, the pressure is on to enable even faster, more-accessible testing. As a benefit, this has also allowed pharmaceutical companies to jump on creating vaccine candidates.

One company, Inovio Pharmaceuticals expedited its timeline for the development of a Covid-19 vaccine candidate, INO-4800, with human clinical trials currently scheduled for April this year. The company already had a vaccine candidate in Phase II development for similar coronavirus that leads to the development of Middle East Respiratory Syndrome (MERS). It seems Inovio was able to leverage its DNA medicines platform to design INO-4800 within three hours of the publication of the novel coronavirus’ genetic sequence.

At some point we simply have to recognize that nature is out to kill us and we are able to respond (to most things). SARS-CoV-2/COVID-19 is not the black swan pandemic we need to excessively worry about. It’s the one that looks like nothing we have previously imagined. My guess is that it will look a lot like (A) ebola or some other hemmorhagic fever; coupled (B) with a long pre-symptomatic incubation period (14-21 days) during which (C)the host also happens to be highly infectious.

High mortality + high infectiousness + long pre-symptomatic latency == Global Suck (for humans)

On that note, I think I’ll head to the supermarket to grab up some toilet paper … (Just Kidding)

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