🦠 COVID-19 | Preparing for the next ones | 🤕 2,712,626 | Deaths 190,206
I am a scientist by education, banker at JPMorgan for a few years, then mature PhD student in Chemical Biology at Oxford under the supervision of Christofer Schofield (FRS) and Peter Ratcliffe (Nobel laureate in medicine in 2019). Founder and tech investor focusing on media and education. I care about science, learning and Democracy which are good bedfellows.
📊 Daily Data Brief:
2,712,626 (+81,845) cumulative cases
Active cases: 1,777,937 (+47,666) (this is the number of currently infected patients)
Total Deaths: 190,206 (+6,434)
Serious/Critical Cases: 58,675 (+1,997)
Recovered: 744,483 (+27,745)
Source: Worldometers
Death curves (updated daily as ECDC releases). Major update with per country graphs now available (Link)
Is the “next ones” the second peak or the second pandemic or both. The Corona Daily starts off with an interesting exit plan being modelled by non-epidemiologists and supported by a former Nobel laureate in economics. Gates has written a long blog about “The first modern pandemic” summarised here.
The World Economic Forum has produced a nice visualisation of reduced NO2 emissions in areas in lockdown but warns about an upswing when and if countries attempt to rapidly make up for the months of de-growth. A tweet by a doctor corrects a mis-headlined report on the percentage of people who die once they are intubated. Like governments, the general media interaction with science remains problematic. When a pre-print triggers scrutiny and learning in the scientist, the journalist looks for the headline. It will need to improve as clear and objective communication is key in the current fight and as we reported yesterday misinformation kills.
Three articles on treatments and vaccine, with one promising advance in monoclonal antibodies and a setback for remdesivir. Vietnam has been very successful in its containment and it is seldom being reported. More troubling is the fact that this pandemic might lead to a ‘hunger pandemic’ killing one million people.
We need to prepare for the next ones.
🧮 Article of the day: "Exit strategy: from self-confinement to green zones” (Report Link and intro article Link).
A group of mathematicians and economists used to model complex problems got together to test an exit strategy. It would consist of first identifying ‘green zones’ and then joining them together:
“First, identifying green zones, meaning areas where the sanitary system is operational, the growth rate of infections is low and the future risks appear manageable. And second, progressively joining these green zones together once it is safe to do so.”
This is what it looks like visually: (Image: The Conversation)
It echoes the clustering modelling which Stefan Flasche (Associate Professor, London School of Hygiene and Tropical Medicine) is working on and which the Corona Daily reported on two days ago. Flasche et al. want to assess the risk of allowing young children to meet again by organising small exclusive clusters between families with young children. The article about “green zoning” focuses more on economic activity but is based on the same principles.
One of the downside of such nuanced zoning is its enforcement (if population cannot be trusted) as it would require “a step up in state-enforced control in many countries.” Some of the zoning (within a large city like Paris or London) would not be as easily enforceable as locking the borders of smaller cities.
This solution is effectively pre-organising/constraining the network of allowed contacts so as to allow a quicker return to economic and societal activity. It should also result in a reduction of the testing capacity needed to monitor the epidemic. It would undeniably require a variant and combination of mobile apps with their resulting privacy and civil liberties issues.
Great read.
🦠Long read of the day: “The first modern pandemic” by Bill Gates (Link)
The title sets the scene. This is pandemic I. The same way the public is being slowly prepared for peak II of COVID19, Gates prepares us to pandemic II in the title of his post. This should have consequences on public and private investment in public health, research and innovation going forward.
This is a long post covering the following issues: “exponential growth and decline, have we overreacted?, difference among countries, what we need to learn, The Gates Foundation’s role, Innovation to beat the enemy, Treatments, Vaccines, Testing, Contact tracing, Opening up and conclusion.”
Gates overwhelmingly backs the lockdown measures in slowing the spread. He does make the point that regardless of what policies had been put in place, individuals would have changed their behaviour on their own with the ensuing negative effect on economic growth. Even without shelter-in-place orders, 2020 would have never been like 2019 once COVID19 was spreading. Gates also believes that the back to normal will take time, and that a new normal would only happen once people feel that a treatment reduces death by more than 95%. In his opinion, until we reach that number economies will not be at full potential.
The one other part I want to focus on, is Gates’ assessment of the vaccine given his long standing involvement in vaccines with the Gates Foundation. Gates starts by outlining the normal timeline:
“Unfortunately, the typical development time for a vaccine against a new disease is over five years. This is broken down into: a) making the candidate vaccine; b) testing it in animals; c) safety testing in small numbers of people (this is known as phase 1); d) safety and efficacy testing in medium numbers (phase 2); e) safety and efficacy testing in large numbers (phase 3); and f) final regulatory approval and building manufacturing while registering the vaccine in every country.”
Gates walks us through the different types of vaccines being in development including the new RNA vaccines pursued by three companies and the “5 other leading efforts”. We are someone removed from the number of 70+ vaccines candidates which are being frequently reported, given how expensive it is to carry a candidate through approval. There are 8 serious efforts.
Gates predicts that it will not take five years in the case of the COVID19 vaccine:
“Like American’s top public health officials, I say that it is likely to be 18 months, even though it could be as short as nine months or closer to two years. A key piece will be the length of the phase 3 trial, which is where the full safety and efficacy are determined.”
Production of 7 billion (1 dose) to 14 billion (2 doses per vaccination) will undoubtedly lead to a successful vaccine not being equally available. Gates wishes that a Global Agreement will be reached but doubt that it will happen.
Gates conclude by the realisation that Pandemic I will be as defining to this generation as the World War was to his parents. He worries about COVID19 affecting the poor more severely, but is also impressed on how the population have come together to fight this enemy with a special mention for healthcare workers.
A long read.
💨 Animation of the day: The World Economic Forum (WEF) has produced this animated visualisation of reduced pollution of places which went into lockdown. The WEF warns that as we had seen in China after the Beijing Olympics, authorities wanting to make up for lost time might relax regulation and clean air standards for the economy to make up lost production during the pandemic. (Link)
Tweet of the day: There was a headline running yesterday which said that 88% of patients which were intubated die. Dr John Scott puts the record right below after looking at the numbers. This is an under-reported information problem during COVID19 stemming from general media and scientists being presented with the same evidence at the same time. A scientist will look at it with a critical eye where the journalist will look at it looking for a headline
💉 Robert Bazell (adjunct professor of molecular, cellular, and developmental biology at Yale) writes “Straight Talk About a COVID-19 Vaccine” for Nautilus. It is a narrated interview of Wayne Koff (president and CEO of the Human Vaccines Project). A world renowned vaccine expert who never produced a successful vaccine. He spent most of his career looking for a HIV vaccine. Koff starts off with general cost and probability for vaccines:
“The probability of success, depending on whose metric is used in vaccines, is somewhere between 6 and 10 percent of candidate vaccines that make it from the animal model through licensure. That process costs $1 billion or more. So you can do the math.”
The article and Koff walks us through all the challenges and uncertainties, including how production of such a vaccine which might not require 1 but potentially multiple doses will be produced for 4 billion plus individuals. Koff ends nonetheless on a positive note drawing from his experience (and failure) on a HIV vaccine:
“The reason COVID-19 vaccines should be a lot easier is because most of the platforms, the novel approaches, and the clinical infrastructure for the testing of vaccines, came out of HIV.”
(Link)
💊 Xiangyu Chen et al. “Human monoclonal antibodies block the binding of SARS-CoV-2 spike protein angiotensin converting enzyme 2 receptor” in Nature. It might be helpful to watch this short explainer video on monoclonal antibodies (mAbs) before reading the article. The video looks at the usage of mAbs in cancer but the principles are the same. The paper looks at using monoclonal antibodies to disrupt the binding of SARS-CoV-2 to a key cell receptor to then takeover the cell machinery to replicate itself.
Chen and his colleagues identified two mAbs which can block the interaction between SARS-CoV-2 and human angiotensin converting enzyme 2 (hACE2). It is early days in assessing the viability of these as effective treatments for COVID19. These mAbs nonetheless hold “great promise” the day we have negative news on a previously encouraging drug candidate (see below). (Link)
💊 “New data on Gilead’s remdesivir, released by accident, show no benefit for coronavirus patients. Company still sees reason for hope” in STAT news. It was STAT which reported encouraging data from a severe trial of remdesivir last week. A new trial in China shows no significant benefit for coronavirus patients:
“According to the summary of the China study, remdesivir was “not associated with a difference in time to clinical improvement” compared to a standard of care control. After one month, it appeared 13.9% of the remdesivir patients had died compared to 12.8% of patients in the control arm. The difference was not statistically significant.”
(Link)
🇻🇳 James Pearson and Phuong Nguyen write “Vietnam to ease nationwide coronavirus lockdown” for Reuters. Vietnam is an underreported success in fighting COVID19. It has less than 300 cases and no death so far for a population of nearly 95 million. It took strong measures early on including barring flights from Wuhan, one day after the first 2 cases were reported in Hanoi. Like all successful countries it has practiced aggressive contact-tracing and testing.
However, a bigger revelation in my view is:
“Hanoi may have also gleaned crucial early information from China.
On Wednesday, U.S. cybersecurity firm FireEye said Vietnamese state-backed hackers had attempted to break into organisations at the centre of Beijing's efforts to contain the outbreak, days before the first international COVID-19 cases were reported.”
It raises the question whether the US and/or Western intelligence have done the same. We are unlikely to ever find out. (Link)
🌍 David M. Beasley (executive director of the U.N. World Food Program (WFP)) writes “Covid-19 could detonate a ‘hunger pandemic.’ With millions at risk, the world must act.” in the Washington Post. This is very concerning:
When you consider that already, despite our best efforts, 21,000 people die of hunger every single day, the scale of the potential death toll is heart-rending. We could be looking at famine in about three dozen countries. In 10 countries, we have more than a million people who are on the verge of starvation as we speak.
This is a call to action for donor nations to fund the WFP and strengthen its food supply to the most vulnerable population. (Link)
Contact tracing corner:
🚔 Privacy International publishes “There’s an app for that: Coronavirus App”. It aims to answer the question: “Should we trust governments and industry with their app solutions at this moment of global crisis?”.
The key finding is that these apps will “all require trust, and that has yet to be built after years of abuses and exploitation.” The article is comprehensive in identifying the issues. It also outlines how to mitigate the concerns which these apps might trigger amongst citizens. The public appears quite well disposed nonetheless:
“For the contact-tracing apps to be successful, they must be wildly popular. Early surveys have shown that, in the UK for instance, nearly two thirds of people support the use of some sort of contact-tracing app. For quarantining, however, the support drops dramatically to less than half.”
Design, democratic debate and proper communication might further increase trust and adoption to make these a success. Governments around the world considering them have yet to do significant and visible preparatory work. The earlier they start the better. (Link)
🎬 “Public health surveillance, AI bias, and risks to privacy in the fight against COVID-19” from the Brookings Institution. Duration: 1 hour (Video Link)
📊 A picture is worth a thousand words: Global (🌎) and local (with relevant flag) visualisation and forecasting tool
🇺🇸 The John Hopkins University resource center was the first one I used back in January they have now made available in their latest iteration a county by county dashboard in the US including information about health capacity, insurance coverage, ethnicity and age breakdown of the population (New York example below) (Link)
💊 The "Map of Hope" provides a geographical overview of planned, ongoing and completed clinical trials. It is put together with data from WHO Clinical Trials Search Portal by the Heidelberg Institute for Geoinformation technology. (Link)
🌍 MRC Centre for Global Infectious Disease Analysis started to publish weekly death estimates for countries (Link)
🇺🇸 The US Center for Disease Control and Surveillance (CDC) publishes “A Weekly Surveillance Summary of U.S. COVID-19 Activity” (Link)
Google has published a new website to “See how your community is moving around differently due to COVID-19”. They have a lot of data to do so… (Link)
🌎The Financial Times has a data tracking page which is in front of the paywall, looking at cases and fatality curves for selective countries and metropolitan areas/region. It is not as extensive as the Madlag link below, where you can see static as well as animated images for a greater number of individual countries. (Link)🇺🇸Another valuable resource by Unacast ( a data company providing human mobility insights). Their “Social distancing scoreboard looks and compares (State by State and County by County), the change in mobility to prior to COVID19 (Link)
🌎 Country by Country Curves: This is a GitHub made by my friend Francois Lagunas. He has written a script to scrape deaths and number of cases in order to visualise the rate of growth on a logarithmic scale. Great resource (Link)
CityMapper has started to produce City Mobility Index to show how much a City is moving. This is a very good indicator of how well lockdowns are respected around the world: Barcelona (4% of city moving) at one end and St Petersburg at the other end (68% of city moving) for yesterday (Link)
🌎A great resource put together by Ben Kuhn and Yuri Vishnevsky. At a time when we need solidarity and cooperation, I prefer their subtitle “We need stronger measures, much faster” than their title. It’s a simulator on what case growth looks like depending on your community’s measures. Fantastic resource to stir communities and governments to action (Link)
🇩🇪 The COVID19 dashboard for Germany is one of the best around. (Link)
🌎A helpful guide by VOX of the “9 coronavirus pandemic charts everyone should see” (Link)
🌎Data and chart regularly updated by the Centre for the Mathematical Modelling of Infectious Diseases at the London School of Hygiene & Tropical Medicine. It maps the effective reproduction number (also known as R0) of COVID19. You want to get it below 1 as fast as possible to contain an epidemic. (Link to see charts and more data about your country)
🌎This is a great COVID19 Dashboard prepared by Andrzej Leszkiewicz. Andrzej has also written an introductory and explanatory blog for it (“Coronavirus disease (COVID-19) fatality rate: WHO and media vs logic and mathematics”). I particularly like the country comparison tab, which allows you to track and benchmark the curve of the epidemic (number of cases and deaths) in your country with that of another. Very well done and informative. (Link)
“Going Critical” by Kevin Simler is a detailed interacting essay talking about complex systems, the importance of understanding networks, modelling and how this applies to: memes, infectious diseases, herd immunity, wildfire, neutrons and culture. Must read (Link)
🏛 Notable tracking projects
💊“COVID-19 treatment and vaccine tracker”. This tracker contains an aggregation of publicly-available information from validated sourcesby the Milken Institute (Link)🏛Tariq Krim has started a COVID19 website tracking data about each government policy response to the pandemic (Link)
🏛Oxford COVID-19 Government Response Tracker (OxCGRT) was launched yesterday. Data is collected from public sources by a team of dozens of Oxford University students and staff from every part of the world. It also looks at stringency of the measures and plots stringency with case curves. A great initiative and resource (Link)
👩💻Mike Butcher (Editor at Large Techcrunch and founder of TechforUK), had refocused TechforUK on the fight against COVID19. It is a very effective hands-on team of volunteer. Do reach out to them. He has also teamed up with We are now working closely with the volunteers behind the “Coronavirus Tech Handbook”. (They are ‘cousins’ of ours who originally created the Electiontechhandbook). Volunteer collaboration at its best! (Link)
📰 Cronycle resource:
Cronycle has made available a number of open-access feeds on its website which I extensively use for the Corona Daily. The four first feeds are:
1. COVID-19 General (Link)
2. COVID-19 x Resilience (Link)
3. COVID-19 x HCQ/CQ (Link) (HydroxyChloroquine and Chloroquine)
4. Gig Economy x COVID-19 (Link) 5. Supply Chain x COVID-19 (Link)
5. Supply Chain x COVID-19 (Link)
Human Rights x COVID-19 (Link)