Commentary: Good news on the Covid scene, but 'we're still on the highway--don't take your seat belts off'

Bill Walczak

The news that it only took one week for the US to add one million new cases of COVID was reported alongside the news that Moderna, the Cambridge-based pharmaceutical company, posted preliminary data indicating that their vaccine reduced transmission of symptomatic cases of Covid by 94.5 percent. The juxtaposition of these two things led me to an oft-quoted proverb: “It is always darkest just before the dawn” – perhaps better known to the younger generation from its use in the song “Shake it Out” by Florence + the Machine.

The darkness is our own doing. The astonishing case and death rates did not have to be what they are, and you’d have to have been in hibernation since March to not know how to curtail these numbers. But let’s focus on the dawn.

As predicted, our medical system has continued to learn much about how to treat the coronavirus, and we now have the ability to lessen its impact through the use of anti-viral medications like the steroid dexamethasone, blood thinners, convalescent plasma, and drugs like remdesivir. There are many more treatments in development, though the most exciting recent development is the unpronounceable one – bamlanivimab – the Eli Lilly product that has been nicknamed “Bam” or “Bambam” by many in the medical world.

“Bam” is an antibody therapy, similar to the regeneron that President Trump received after his Covid diagnosis. It has been given an “emergency use authorization” (EUA) by the federal government and approved for payment by Medicare and Medicaid, which means that private insurance will likely also approve it.

It is for use by patients in early stages of Covid following a positive diagnosis, who are at 10 percent or higher risk of winding up in a hospital, e.g., 65+, those immuno-compromised, with a BMI of over 35, etc. It is administered intravenously, mostly in outpatient settings. It works against the virus by preventing its replication in human cells. Though it is still undergoing testing for efficacy, it has shown enough promise to allow for emergency use.

Dr. Fauci has called these treatments a “bridge to a vaccine.” We received good news from two companies developing a vaccine this past week. Pfizer and Moderna have been making vaccines based on what is called “messenger RNA” (mRNA), which is genetic material that can activate immune cells that scientists have been redesigning to recognize and fight Covid.

We have preliminary results for the vaccines based on a limited number of participants. Covid expert Dr. Daniel Griffin in Episode 681 of This Week in Virology (TWIV) discussed the Pfizer study, in which 43,538 participants resulted in 94 evaluable cases, split between those who received the two-dose vaccine, and those who received placebos. Those who had taken the vaccine were 90 percent less likely to be sick. Moderna’s early analysis was based on 90 placebo patients having symptoms (11 severe), and only 5 vaccine participants getting symptoms (none severe).

Though this is a reason for optimism for both of these vaccines, they and other vaccine developers are limited by the low numbers of people in these trials. Experts need more information on how these vaccines affect outcomes for different populations and subgroups (age, race, gender, etc.), and we don’t know enough about how the vaccines affect asymptomatic patients, or how they affect transmission of the virus.

So, while we wait for the dawn, which TWIV experts think will begin later in the winter, we currently have a gigantic surge in cases, increasing infection rates, and an average of 42 Americans dying of Covid per hour.

What should we be doing now? Practice bubble fidelity; meet those outside your bubble outdoors; and stay away from risky indoor activities. Take Vitamin D, and think of masks like you think about washing your hands – it’s good hygiene. If you’re planning to spend Thanksgiving with peoples outside your bubble, start your quarantining now, and get a test four days before the holiday and four days after it.

As Dr. Griffin says, “We’re still on the highway; don’t take your seat belts off.” It should only be a few months before we see light on the horizon.

Stay healthy.