COVID19 update, April 30, 2020: Remdesivir clinical trial; South Korea stats redux; miscellaneous updates

(1) Yesterday, the NIAID announced the results of the first large-scale Remdesivir clinical trial. It is not a “magic bullet”, but this is a milestone in that for the first time, any drug has been shown to have an unambiguous therapeutic advantage: it significantly accelerates recovery in severe COVID19 cases. (I would be very interested to know if administering it before the patient’s symptoms escalate would forestall the latter. That would be an even bigger game-changer.[*]) Gilead Scientific’s CEO was restrained but upbeat in an open letter.— clearly they are looking at licensing the drug for manufacturing by third parties, as they clearly do not have the in-house manufacturing base for the massive amounts that would have to be synthesized.

Recapping how remdesivir works: it effectively impersonates a letter of the genetic code, except without an attachment point for the next letter. So when RdRp (RNA-dependent RNA polymerase) starts copying the genome, copying breaks off if the “imposter” letter is inserted. This trick in principle can mess up the replication of any RNA virus (not just SARS-nCoV-2), and in the test tube it did so for Ebola, SARS original edition ;), and MERS — but when given to actual Ebola patients its performance was underwhelming. (Such is the difference between a model and a patient.) Fortunately, it seems to be rather more successful against SARS-nCoV-2.

(2) In an earlier post, I looked at (meticulous and generally reliable) statistics for South Korea. At the time their case fatality rate (CFR) was only about 1%: according to a more recent Korean CDC report, it is 2.26%. Now their report gives a detailed distribution by age cohort. Apparently, their infections are not homogenously spread across the age pyramid: if we were to apply their mortality rates per age cohort to the published population pyramid of South Korea, we would get a CFR of 2.01%. If we substituted the much “younger” published population pyramid of Israel, that would lead to a CFR of 1.58%. This is still higher than the 1.35% I mentioned yesterday, but clearly indicates that the discrepancy between South Korean and Israeli CFRs is at least in part explicable by different age distributions.

(3) Miscellaneous updates:

“I think it is the worst pandemic since 1918,” said Cecile Viboud, an epidemiologist at the National Institutes of Health’s Fogarty International Center, alluding to the “Great Influenza” pandemic that claimed an estimated 675,000 lives in the United States.

The new serological data, which is provisional, suggests that coronavirus infections greatly outnumber confirmed covid-19 cases, potentially by a factor of 10 or more. Many people experience mild symptoms or none at all, and never get the standard diagnostic test with a swab up the nose, so they’re missed in the official covid-19 case counts.

[…]A commonly cited statistic about seasonal flu is that it has a fatality rate of 0.1 percent, That, however, is a case fatality rate. The infection fatality rate for flu is perhaps only half that, Viboud said. Shaman estimated that it’s about one-quarter the case fatality rate.

  • an article in Die Welt (in German) looks at the male-female mortality difference, which is most pronounced in the younger cohorts (the article speaks of 3:1 for people in they 50s) but dwindles to 1.5:1 in old age. Estrogen production in women is of course decreased in old age…
  • Via Instapundit: confirming earlier Chinese hints, a preprint from New York Presbyterian Hospital reports a relatively small, but significant difference in COVID-19 suspectbility between Rhesus-positive blood groups. (The difference for Rhesus-negative ones is not statistically significant.) O is least suspectible, A most so. (Unlucky me ;))
  • And via Sarah Hoyt, disinfectant poisonings in children are on the rises since the epidemic. Reportedly, call volume rose by 20%. What does that mean in absolute numbers? According to https://www.poison.org/poison-statistics-national in 2018 hotlines of the 55 U.S. poison control centers assisted 2.1 million callers with actual or suspected poison exposure. 44.2% of these calls concerned children younger than 6. So 20% of 44.2% of 2.1 million works out to… 15,470 calls per month. I suspect a large fraction of these calls concern toddlers who cannot stop themselves from taste-testing any possible and impossible household object — but in a population of 330 million people, by the law of large numbers you will find some derpseals who will actually think drinking household cleaners is a good idea. [**]

Speaking of which, whatever marketing “geniuses” thought THIS was an appropriate packaging for household cleaning fluid — it looks almost exactly like a grape-flavored soft drink that is wildly popular with toddlers here — need to have their head examined. Or maybe THEY’ve been drinking too many cleaning fluids.

[*] allow me to belabor this point: If we could reliably stop this disease from developing the severe presentation, we could afford changing gears entirely and allowing herd immunity to develop.

[**] I would caution against the automatic assumption that anybody who is mind-blowingly stupid in one thing is an idiot overall. I know many brilliant scientists and artists who couldn’t manage a grocery store, or a vegetables stand in a farmer’s market, to save their lives. One of the surprising things I learned from Jan Swofford’s excellent biography of Ludwig van Beethoven was that he would multiply numbers by repeated addition — he never learned how to multiply  properly.  (Beethoven had been groomed as a child prodigy keyboardist — his father, a washed-up court musician, harbored hopes of turning Beethoven into the next Mozart — so young Ludwig’s general education was perfunctory at best. Nevertheless, he  became an avid reader and was very familiar with the literature of his day, which inspired a number of his greatest compositions. Mozart’s general education was similarly defective. J. S. Bach actually graduated from a Latin high school — with indifferent grades, but three years younger than his class average — and later collected numerous scholarly works on theology, in Latin and in German, when he could afford to do so.)

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