š¦ Covid-19 - Expand "Compassionate use" | š¤ 434,511 | Deaths 19,601
šĀ Daily Data Brief:Ā
434,511Ā Ā cumulative cases (+41,547)
Active cases:Ā 303,290 (+30,904) (this is the number of currently infected patients)
Total Deaths:Ā Ā 19,601 (+2,447)Ā
Serious/Critical Cases:Ā Ā 13,130Ā (+943)Ā
Source: https://www.worldometers.info/coronavirus/
Death curves (updated daily as ECDC releases). Major update with per country graphs now availableāļø(Link)
There is a wonderfully termed drug regulation model: ācompassionate useā.
The European Medicines Agency defines it as follows:
āCompassionate useĀ is a treatment option that allows the use of an unauthorised medicine. Under strict conditions, products in development can be made available to groups of patients who have a disease with no satisfactory authorised therapies and who cannot enterĀ clinical trials.ā
The FDA (the American drug regulator) calls it āExpanded accessā:
āSometimes called ācompassionate useā, expanded access is a potential pathway for a patient with anĀ immediately life-threatening condition or serious disease or conditionĀ to gain access to anĀ investigational medical productĀ (drug, biologic, or medical device) for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available.āĀ
As we run under our health capacity in certain areas of the world (for ICU beds and/or ventilator), you could see how such potential pathway could become critical in saving lives whilst accelerating therapeutic discovery against COVID19.
There is one treatment which received Investigational New DrugĀ approval yesterday from the FDA: convalescent plasma. It is early days but the symbolism behind the science is key for us as societies and communities to defeat COVID19. Convalescent plasma is basically, using the antibodies from an immune patient and donating them to another patient. It is transferring the immunity developed by one patient to another.
This is happening under the ācompassionate useā model. Regardless of whether it scales or succeeds, it highlights one trait and human quality which we all need to express as we go thought this pandemic: compassion.
What happens to the virus is more than ever up to. In medicine and beyond, let us expand ācompassionate useā.
Podcast of the day:Ā I have featured novelist Max Brooks with his dad (comedic filmmaker and actor Mel Brooks) on his informative and funny video for the younger generation not to spread the virus and physical distance in particularly from the elderly (here).
Max is also a lecturer at the U.S. Naval War College and a nonresident fellow at the Modern War Institute at West Point. He's also a nonresident senior fellow at the Atlantic Council's Brent Scowcroft Center for Strategy and Security.
In NPRās Fresh Air podcast with Terry Gross he talks about: āHow The Government Can Mobilize In A Pandemicā and also why it has not done it yet. Echoing my opening in yesterdayās newsletter (āItās gonna get badā) Brooks says:
āWhat could have happened when this virus exploded, even when Wuhan was locked down, is we could have put the word out, the government could have put the word out to ramp up emergency supplies, to get them ready and then have an information strategy in place so if, God forbid, the virus came here, we could have had a press conference, the president could have had a press conference and said, listen - this is not a hoax, but it's also not the end of the world. While you were all going about your daily life, we in the government were working to stockpile all the material that we need to keep this thing at bay. We have done it. We are ready. Here's what you need to do to help us.ā
It goes into details on how the U.S. Defense Production Act works and how it āallows the federal government to step in and aggressively force the private sector to produce what we needā. The podcast is here as well as the transcript. Well worth a read or a listen! (Link)
š I have written several times before about the importance of serological testing. Adam Rogers writes āBlood From Covid-19 Survivors May Point the Way to a Cureā for Wired. Rogers does a good primer on serological testing as well as the use of convalescent plasma as therapeutic. Yesterday, the FDA came through with an Investigational New DrugĀ approval, the first step in beginning trials for compassionate plasma and making it available to certain patients under the compassionate use model. The article also talks about developing and producing monoclonal antibodies in the future to fight COVID19. If you read one article today, read this one. (Link)
šŗšø The biggest fiscal stimulus package in modern American history has now been approved by the Senate. There was some last minute haggle to increase worker protection from the Democrats but the $2 trillion package was approved and will be enacted in the next few days to support the American economy and its workers. (Link)
š¦ Marie Van Beusekom writes āItalian doctors note high COVID-19 death rate, urge actionā for the CIDRAP (Center for Infectious Disease Research and Policy). Van Beusekom reports on a commentary published in a medical journal yesterday and looking at the 7.2% rate of death in Italy versus the 2.3% in China. It highlights in part the higher proportion of older people and Italy and also a different strategy.
Italian doctors also recently wrote a letter in the Lancet:
āWe urge all countries to acknowledge the Italian lesson and to immediately adopt very restrictive measures to limit viral diffusion, ensure appropriate health-system response, and reduce mortality, which appears to be higher than previously estimated, with a crude case-fatality rate of almost 4%"Ā
The stark news coming from Italy support the strong physical distancing urged around the world particularly given the uncertainty still surrounding COVID19 fatality rate. (Link)
š¦ There was a lot of noise yesterday about the āOxford Studyā in part due to a misguided and catchy title from the Financial Times heading its article reporting it as: āCoronavirus may have infected half of UK population ā Oxford studyā. The author of the article also tried to pit the lead researcher of the study against the Neil Ferguson modelling which is the one which allegedly made the UK government change its policy.
This type of reporting is unfortunate and show predominantly three things:
The public wanting to hear good news
Epidemiologistsā lack of experience in engaging with the democratic debate and the press, partly because the importance of their work has been undervalued and consequently underfunded. The FT Economic Editor wrote a really good and previously reported article on this. Some of the best (and nicest) scientists are part of the London School of Hygiene and Tropical Medicine. The name of the institution reveals how much we thought it was a threat for Western society. Maybe they should rename themselves the āLondon School of Pandemicsāā¦
The disarray of the media in courting controversy and maximising circulation and somewhat linked to 1.
I would just say that the Oxford group announced its study on paper highlighting an important task in our fight against the pandemic and which will make their modelling relevant when we have the serological testing at scale:
It is really important that both journalists and scientists learn from the above, in order to give its right place to science in the democratic debate as is urgently needed for COVID19 and other challenges we face. Equally, it demands responsibility and maturity from both scientists and journalists to maintain a high level of trust from the public. Here is a good Twitter thread on the subject starting with Chris Gilesā article (Link)
One of the things we have learned from the COVID19 pandemic and which I addressed in my newsletter yesterday, it is how our single and narrow focus on financial gains has created some of the fragility exposed in this fight (starting with our appeasement of China and over outsourcing of drugs, masks, and manufacturing capabilities in general). It has also resulted in the erosion of both trust and resilience within our society. It is important that science and the media do not fall or sink into the same fragility trap.
Here is the draft of the āOxford Studyā (Link)
š Chloroquine/HydroxyChloroquine (CQ/HCQ) keep being in the headlines having been publicly promoted by Trump as a promising potential treatment for COVID19. There is a very good critical blog āThoughts on the Gautret et al. paper about Hydroxychloroquine and Azithromycin treatment of COVID-19Ā infectionsā on the Science Integrity Digest site. It is a pseudo peer review of a French paper soon CQ/HCQ and is very informative. There is also a pre-print published by a Chinese group reported by Michelle Fay Cortez and Claire Che for Bloomberg: āMalaria Drug Chloroquine No Better Than Regular Coronavirus Care, Study Findsā. In the article, the authors write:
āThe study involved just 30 patients. Of the 15 patients given the malaria drug, 13 tested negative for the coronavirus after a week of treatment. Of the 15 patients who didnāt get hydroxychloroquine, 14 tested negative for the virus.ā
The bottom line of both is: let science and the regulatory process runs its course. (Link)
š Matthew Herper for STAT writes: āWhen might experimental drugs to treat Covid-19 be ready? A forecastā. It is a difficult and well-meaning exercise. Apart from CQ/HCQ Herper lists the most prominent candidates and when to expect them. The article covers existing anti-virals, Remsdesivir, arthritis drug, convalescent plasma, monoclonal antibodies, new antivirals and vaccines.
On the vaccine front there is a very useful quote from Rajeev Venkayya, president of Takedaās global vaccines unit, duringĀ a press conference:
āIf you look across the many programs that have been launched, if you look atĀ history, not all of those programs will be successful. And I think that is something that I donāt think weāve effectively communicated to the public. Just because we start a vaccine program doesnāt mean that we will definitely get a vaccine on the other end.ā
I think this possibility of no-vaccine is under-reported. We need to make sure that policy is also planned for the possibility that we will not get a vaccine in the foreseeable future. (Link)
š«š· The French government is making ā¬4billion available to support the French Tech startups and follows on the heels of other European governments. Very early on, President Macron has emphasised the need to help companies maintain their skillset. The tech startup scene is one sector for which it particularly applies. (Link)
Department of privacy
š Karen Hao writes āCoronavirus is forcing a trade-off between privacy and public healthā for the MIT Technology Review. It is a reframing of the Privacy vs Security issue in the age of COVID19 āSurveillance Testingā. (Link)
š Thank you to Benji Rogers (Founder and CEO of NewsHero) for flagging the Podcast of the day. The newsletter can only get better with the community helping!
NEWāļøCronycle resource:
Cronycle has made available a number of open-access feeds on its website which I extensively use for the Corona Daily. The four feeds are:
1. Ā COVID-19 General (Link)
2. Ā COVID-19 x Resilience (Link) Ā
3. Ā COVID-19 x HCQ/CQ (Link) Ā
4. Ā Gig Economy x COVID-19 (Link)Ā
I will write more in the future on how you can leverage Cronycle for keeping up to date in between two editions of this newsletter. (Link)
šĀ A picture is worth a thousand words:Ā Ā GlobalĀ (š)Ā andlocal (with relevant flag) visualisation and forecasting tool
āGoing CriticalāĀ 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)Ā
Offset updateĀ š This is a GitHub made by my friend Francois Lagunas (co-founder and CTO extraordinaire of Stupeflix, a company we backed). He has written a script to scrape deaths and number of cases in order to visualise the rate of growth on a logarithmic scale. He has taken a time offset for countries assuming that South Korea and Italy are 36 days behind Chinaās outbreak, and France and the USA a further 9 days behind. Added a number of countries as well.Ā Ā 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)
šA great resource put together byĀ Ben KuhnĀ andĀ Yuri Vishnevsky.Ā Ā At a time when we need solidarity and cooperation, I prefer their subtitle āWe need stronger measures, much fasterā than their title. Itās a simulator on what case growth looks like depending on your communityās measures. Fantastic resource to stir communities and governments to action (Link)
NEWāļøš©šŖ The COVID19 dashboard for Germany is one of the best around. (Link)šA helpful guide by VOX of the ā9 coronavirus pandemic charts everyone should seeā (Link)
šData and chart regularly updated by theĀ Ā Centre for the Mathematical Modelling of Infectious DiseasesĀ at theĀ 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. (LinkĀ to see charts and more data about your country)
šThis is a great COVID19 Dashboard prepared by Andrzej Leszkiewicz. Andrzej has also written an introductory and explanatoryĀ blogĀ for it (āCoronavirus disease (COVID-19) fatality rate: WHO and media vs logic and mathematicsā). It is a very extensive dashboard with 28 pages. 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)
šøš¬/š Singapore remains the gold standard of dashboard. Here is an article with the Best and Worst of all dashboard in the world, with Pros and Cons prepared by Neel V. Patel for MIT Technology (Article)
š Ā Notable collaborative projectsĀ
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 āCoronavirus Tech Handbookā. (They are ācousinsā of ours who originally created theĀ Electiontechhandbook). Volunteer collaboration at its best! (Link)
Tariq Krim has started a COVID19 website tracking data about each government policy response to the pandemic (Link)
šĀ Exponential growth and epidemics (permanent video)
This is an excellent video explaining āexponential growthā and epidemics. Although we are all familiar with the phrase, its authors rightly says that āyet human intuition has a hard time recognising what it meansā. This is a āļøMUST WATCHāļøto understand fully what is upon us but also how early behavioural changes at scale can have a massive impact on the level of exponential growth of COVID19 (Link)