(BANGKOK) — Authorities in the Chinese city where the coronavirus pandemic began were moving forward Wednesday with efforts to test all 11 million residents for the virus within 10 days after a handful of fresh infections were found there.
The U.S. government’s top infectious disease expert, meanwhile, issued a blunt warning that cities and states could see more COVID-19 deaths and economic damage if they lift stay-at-home orders too quickly — a sharp contrast to President Donald Trump, who is pushing to right a free-falling economy.
“There is a real risk that you will trigger an outbreak that you may not be able to control,” Dr. Anthony Fauci warned a Senate committee and the nation Tuesday as more than two dozen states have begun to lift their lockdowns.
The tension in balancing people’s safety from the virus against the severe economic fallout is playing out in many other countries, too. Italy partially lifted lockdown restrictions last week only to see a big jump in confirmed coronavirus cases in its hardest-hit region. Pakistan reported 2,000 new infections in a single day for the first time after the easing of its lockdown saw crowds of people crammed into markets throughout the country.
China, the first nation to put a large number of its citizens under lockdown and the first to ease those restrictions, has been strictly guarding against any resurgence.
District health commissions and neighborhood committees in the city of Wuhan have been told to develop a plan to test all residents in their jurisdictions, local media reports said. The directive also said the testing should focus on the elderly, densely populated areas and places with mobile populations.
A person who answered the mayor’s hotline in Wuhan on Wednesday said local districts had been given 10 days to carry out the tests. The official declined to give his name because she was not authorized to speak to reporters.
The first cases of the new coronavirus were found in Wuhan in December, and by the end of January the government had placed the entire city and the surrounding region, home to more than 50 million people, under a strict lockdown.
A cluster of six new cases was recently found in one part of the city, the first local infections the government has reported in Wuhan since before the lockdown was eased in early April.
It wasn’t clear how many people would actually still need to be tested, as one expert at Wuhan University told the Global Times newspaper that up to 5 million residents of Wuhan have already been tested since the outbreak began.
Worldwide, the virus has infected more than 4.2 million people and killed over 291,000 — with more than 82,000 deaths in the U.S. alone, the world’s highest toll. Experts say the actual numbers are likely far higher.
Progress was being made in many places, including New Zealand, which reported no new cases on Wednesday. It was the second day in a row without any and the fourth such day since early last week.
Director-General of Health Ashley Bloomfield said it was encouraging news as New Zealand prepares to ease many of its lockdown restrictions on Thursday. Most businesses, including malls, retail stores and sit-down restaurants, will be able to reopen. Social distancing rules will remain in place and gatherings will be limited to 10 people.
“The sense of anticipation is both palpable and understandable,” Bloomfield said.
Authorities in South Korea said Wednesday that they had no immediate plans to revive strict social distancing rules despite a spike in cases linked to nightclubs in Seoul.
In his Senate testimony, Dr. Fauci said more infections and deaths are inevitable as people again start gathering, but how prepared communities are to stamp out those sparks will determine how bad the rebound is.
“There is no doubt, even under the best of circumstances, when you pull back on mitigation you will see some cases appear,” Fauci said.
Move too quickly and “the consequences could be really serious,” he added. It not only would cause “some suffering and death that could be avoided, but could even set you back on the road to try to get economic recovery.”
With more than 30 million people unemployed in the U.S., Trump has been pressuring states to reopen.
A recent Associated Press review determined that 17 states did not meet a key White House benchmark for loosening restrictions — a 14-day downward trajectory in new cases or positive test rates. Yet many of those states have begun to reopen or are about to do so, including Alabama, Kentucky, Maine, Mississippi, Missouri, Nebraska, Ohio, Oklahoma, Tennessee and Utah.
Of the 33 states that have had a 14-day downward trajectory, 25 are partially opened or moving to reopen within days, the AP analysis found. Other states that have not seen a 14-day decline remain closed despite meeting some benchmarks.
Fauci expressed optimism that eventually vaccines will arrive, along with treatments in addition to the one drug that so far has shown a modest effect in fighting COVID–19. But it would be “a bridge too far” to expect them in time for fall, when schools hope to reopen, he said.
Although Trump declared this week that “we have met the moment, and we have prevailed” in increasing and improving virus testing, Republican senators on the panel were noticeably less sanguine.
A lack of testing has dogged the U.S. response from the beginning, when a test developed by the Centers for Disease Control and Prevention ran into numerous problems. Sen. Mitt Romney said the U.S. may finally have outpaced testing leader South Korea but that country has far fewer deaths because it started testing early.
“I find our testing record nothing to celebrate whatsoever,” said Romney, a Republican from Utah.
Trump administration “testing czar” Adm. Brett Giroir said the U.S. could be performing at least 40 million to 50 million tests per month by September. That would work out to between 1.3 million and 1.7 million tests per day. Harvard researchers have said the U.S. must be doing 900,000 by this Friday in order to safely reopen.
Neergaard reported from Washington. Associated Press journalists around the world contributed to this report.
13.9% of people surveyed in New York tested positive for COVID-19 antibodies—a whopping 10 times higher than the state’s presumed infection rate, but still far from what would be considered herd immunity from the pandemic.
Herd immunity happens when over 60% of the population develops immunity—antibodies—to a disease, a phenomenon that usually occurs when a population is vaccinated against a virus.
In the new study cited by New York Governor Andrew Cuomo on 3,000 people across the state, 13.9% exhibited COVID-19 antibodies (21% in New York City), implying that 2.7 million people across the state had been exposed to COVID-19, according to Bloomberg, 10-times higher than the presumed infection rate.
Dr. Nate Favini, medical lead at preventative health clinic Forward, told Forbes he’s skeptical about the antibody tests, and cautions against opening up the country to reach herd immunity, saying that would require infecting four-times the amount of people who’ve had the virus—all over the country—leading to a much higher number of deaths by possibly overwhelming hospital resources.
It is unclear whether, and for how long, those with COVID-19 antibodies are immune to second-time infection, as the CDC says survivor immunity is “not yet understood.”
Further, the validity of antibody tests have been widely criticized, as many on the market are not approved by the FDA.
Favini also thinks that more information about how the study was conducted is needed to accept and understand these numbers.
“For people who want to argue that we should just open up the county and let everyone get coronavirus so we can get to herd immunity: You’d have to go through all the cases and all the deaths that New York has experienced—you’d have to go through four-times that, all around the country,” said Favini.
It may be that COVID-19 is much more common than we initially thought, though this is contested. On Thursday, a new model out of Northeastern University, as reported by New York Times, shows that cities with major COVID-19 outbreaks could’ve had 28,000 cases on March 1, which is contrary to the popular model that showed only 23 cases by this time in the major cities. As of April 22, it also appears that the first COVID-19 death was in California on February 6, rather than February 29 in Washington.
I’m the Under 30 Editorial Community Lead at Forbes. Previously, I directed marketing at a mobile app startup. I’ve also worked at The New York Times and New York Observer. I attended the University of Pennsylvania where I studied English and creative writing. Follow me on Instagram and Twitter at @iamsternlicht.
The infection rate of the coronavirus in New York is slowing, but the state could soon see the full scope of the virus as it begins antibody testing this week. Gov. Andrew Cuomo says antibody testing will help provide the “first true snapshot” of how much of a hold COVID-19 has on the state. On Sunday, the governor toured a testing lab on Long Island, using it as a launching pad for the state’s newest drive toward understanding and defeating the coronavirus. “We’re going to sample people in this state… to find out if they have the [antibodies] that will help us for the first time, what percentage of the population actually has had the coronavirus, and is now at least short term immune to the virus,” the governor said.
In contrast to governmental paralysis and confusion caused by the pandemic, pharmaceutical and biotech firms around the globe are swarming Covid-19 in an effort to stop it in its tracks.
Last September, Gallup released an opinion poll that surveyed Americans’ views of U.S. businesses, ranking 25 different sectors from very positive to very negative. The pharmaceutical industry came in dead last, lower than at any time since Gallup started the poll in 2001.
“We’re below Congress, below bankers, below tobacco,” lamented Ken Frazier, chief executive of drug giant Merck.
What a difference a global pandemic makes.
Today the world is depending upon the pharmaceutical industry to not only save lives, but economies around the world. At this very moment, pharmaceutical companies and biotech startups from San Francisco and Boston to Tianjin, Tokyo and Galilee, are staging a multi-front battle against the novel coronavirus akin to the sea, land and air assault conducted by the allies against Nazi Germany on D-Day during World War II.
There are no fewer than 267 different COVID-19 remedies in development, according to an analysis by Umer Raffat, a senior managing director of investment bank Evercore ISI, with more experimental treatments being added almost daily. This includes testing drugs already available but designed for other ailments, new experimental therapeutics, and vaccines that are being developed from scratch.
The attack against coronavirus is coming from all sides. There are synthetic peptide-based vaccines consisting of two or more linked amino acids created in a lab to immunize against the virus; there are so called nucleic acid vaccines genetically engineered from DNA or RNA sequences of the pathogen; antiviral medications, similar to Tamiflu, that target the virus itself; there are new remedies using existing arthritis drugs to contain the immune system, which sometimes inadvertently kills patients as it unleashes its force on COVID-19. Underlying the multitude of efforts underway is the reality that most drugs in development are ultimately unsuccessful.
“A lot of companies are doing the rational thing: testing therapies already in their pipeline which have a plausible mechanism of action. We need to get drugs into clinical trials rapidly so we can quickly learn and double down behind promising results and follow the winners,” says Vivek Ramaswamy, CEO of Roivant Sciences, a drug development firm that acquires hidden gems among forgotten drugs in the pharmaceutical pipelines.
“The idea is to find the best horse in each of the categories. Antivirals plus host immune response modulation makes a lot of sense, but we need to find the best therapeutic in each category, for the right patient population.” says Ramaswamy, who studied biology at Harvard, was a hedge fund analyst and earned a Yale law degree before he began building his innovative biotech firm in 2015. “For antivirals, is it a nucleoside, or an antimalarial which prevents viral propagation in a different way? For immune response modulation, is it anti-IL-6 or anti-GM-CSF? The answer may differ by patient population. Let’s sort those questions out quickly.”
Ramaswamy says that it’s difficult to have a national strategy for the coronavirus predicated on a vaccine that would provide immunity to COVID-19 because it will take a year to a year-and-a-half, optimistically, to have something ready for use on a national scale. But if latency occurs and the coronavirus becomes a perennial problem, akin to the seasonal flu, vaccines will be important.
Sanofi’s vaccine unit is partnering with the federal government’s Biomedical Advanced Research and Development Authority, piggybacking off work that was done on a SARS vaccine and its recombinant vaccine program. But Sanofi doesn’t expect trials in patients for about a year-and-a-half.
Johnson & Johnson has been working on COVID-19 vaccines since January. In late March it announced its Janssen unit would be pushing forward a candidate in a $1 billion partnership with the federal government with the goal of rapidly supplying more than one billion doses. J&J says its vaccine should be in human trials by September and that first batches could be used for front-line medical workers by early 2021.
Cambridge, Massachusetts biotech Moderna Therapeutics also signed a partnership deal with the federal government’s BARDA. It claims that it may be able to shorten the relatively long development time for a vaccine. Like Ebola and measles, COVID-19 is an RNA virus, meaning it has no DNA but instead uses the host’s cells to replicate itself. Moderna specializes in developing drugs based on RNA. In this case it is attempting to give messenger RNA the cellular machinery to make proteins that generate an immune response in the body, creating antibodies that could protect against the virus itself. By the middle of March, Moderna started testing its RNA-based vaccine in low doses in people in Seattle.
Moderna’s billionaire CEO Stephané Bancel says his company’s vaccine could be available to medical workers as early as this fall. In fact Bancel is so eager to speed up the process, and confident about Moderna’s vaccine, that the company is already dipping into corporate funds to gear up and prepare materials for later stage clinical trials even though it hasn’t cleared its first hurdle.
The issue with the messenger RNA approach is that it was initially designed to be used in much more targeted and small scale situations, like cancer and rare diseases, as opposed to infectious disease. In fact, an mRNA vaccine has never even been approved by the FDA. If Moderna’s vaccine is effective, manufacturing enough RNA to provide immunity for hundreds of millions could be a challenge. Still, Bancel insists that Moderna could produce millions of doses by the fall.
“We need to practice some measure of social distancing until we have vaccines,” says Peter Kolchinsky, cofounder of $4 billion biotech hedge fund RA Capital Management and author of The Great American Drug Deal: A New Prescription for Innovation and Affordable Medicines.
Kolchinsky doesn’t expect any large-scale vaccines until the first half of 2021, at earliest. As a result he thinks all establishments that rely on public gathering should remain closed until then — from restaurants and sporting events, to subways and maybe even schools. “We’ll know if any of the first wave of vaccines are working during the June to October 2020 window. We can make better predictions as we see that data roll out,” Kolchinksy says. He thinks the mRNA vaccine could become available by the end of 2020, but it will likely require multiple doses per patient, which could translate into hundreds of millions of doses needed per month. Says Kolchinksy, “I’m keeping an eye on vaccines that could take just one dose to work, which could be the case for J&J’s vaccine.”
Another important and perhaps more pressing front in the war against COVID-19 is therapeutics because they promise to have an immediate impact on people already afflicted by the influenza as well as tamp down the impact of an expected second wave of the pandemic. Former FDA Commissioner Scott Gottlieb is urging the federal government to set up robust partnerships with companies working on therapeutics, just as it has with the vaccine makers.
Kolchinsky says it’s too early to tell which of the many therapeutics being tested will work, but he expects drug combinations will emerge. He adds some drugs might start to be available by fall to treat the most serious cases and that doctors might alter the way available drugs, like antimalarial remedy chloroquine or hydroxychloroquine, are used as fresh data on their efficacy become available. Hydroxychloroquine is already being used in some hospitals in combination with antibiotic azithromycin, often used for bacterial infections like strep throat and bronchitis.
Kolchinsky says that the attention being given to the malarial drugs is warranted because the drugs have shown some efficacy in pre-clinical in-vitro work. So far the early studies in people have been mixed, but it appears they may work better if someone infected with Sars-CoV-2 receives it early in treatment, much the way Tamiflu is administered. The trouble is coronavirus can have mild symptoms often ignored initially until it suddenly gets much worse. Malarial drugs like hydroxychloroquine require a prescription, so by the time they are prescribed by a physician, their efficacy against COVID-19 could be diminished.
In Japan, Fujifilm Holding subsidiary Toyama Chemical’s antiviral favipiravir, also known as Avigan, is showing promise in reducing the severity and duration of COVID-19. In a limited test of patients from China, those treated with favipiravir, which was approved as an antiviral for use in Japan in 2014, tested negative for the virus after four days compared to the 11 days it took the control group to recover.
Gilead’s antiviral remdesivir has shown preclinical promise but it needs to be administered early and intravenously. The concern is that people infected with Sars-CoV-2 might get it too late in the cycle. Results from some of remdesivir’s clinical trials are expected as early as this month.
David Witzke, co-managing partner of Avidity Partners, a biotech and healthcare hedge fund firm, points to rheumatoid arthritis drugs that inhibit the pro-inflammatory protein known as cytokine IL-6 as being potentially promising for COVID-19 patients in later stages, often in ICU units and on ventilators.
These drugs could be effective in reducing the risk of a cytokine storm of the body’s immune system. Cytokines are molecules that signal cells to marshal an immune response. In some COVID-19 cases, particularly younger patients, the overzealous molecules actually cause the immune system to not only vanquish the virus but go on to attack organs like the lungs and liver, causing failures and ultimately death. Sanofi and Regeneron’s Kevzara are working on a therapeutic designed to prevent such cytokine storms.
“Anti-inflammatory drugs, the IL-6 antibodies, like Actemra at Roche and the products at Regeneron, seem to be helpful in patients when their lungs get full of inflammation,” says Witzke. “These are drugs on the market [today] so they are available and if they are helping these late stage patients that will be a benefit. We are more optimistic about those drugs.”
Another set of remedies known as JAK inhibitors reduce IL-6 antibodies, but also attack a whole host of other pro-inflammatory cytokines. Jakafi and barticinib are two arthritis drugs in development by Delaware biotech firm Incyte and pharmaceutical giant Eli Lilly that are now being studied. JAK inhibitors are riskier because they offer a broad attack, akin to firing a shotgun rather than a rifle, at the problem. But the JAK inhibitors could also diminish the risk of a cytokine storm. Data on JAK inhibitor effectiveness on COVID-19 should be available by summer. Roivant’s Gimsilumab targets another cytokine, GM-CSF, which has been identified as causing severe respiratory distress for COVID-19 patients in China who required intensive care.
Another hotbed for coronavirus cures are monoclonal antibodies, which are antibodies that bind to the spike proteins of COVID-19 and ultimately neutralize it. Monoclonal antibodies can be “cloned” from blood plasma and Regeneron is a leader in this effort. For the novel coronavirus it has cloned antibodies from the blood of mice, which have been infected and recovered from the disease. If Regeneron’s new treatment proves effective in clinical trials it could be available by the fall. This could be a game changer because monoclonal antibodies can be used both as a cure for infected patients, as well as a kind of vaccine for the general population.
Depending on the half-life of the monoclonal antibody, a person could have coverage for up to a month, which could be very useful for those with a family member who has come down with an infection. Regeneron, which is selecting two antibodies for its COVID-19 cocktail treatment, is following the playbook that worked for it against the Ebola epidemic in the Congo.
“Regeneron is one of the best protein engineering companies in the world and they have one or more monoclonal antibodies. What is very encouraging is the virus does not appear to be mutating at any great rate,” says Witzke.
Eli Lilly and San Francisco’s Vir Biotechnology, are also using monoclonal antibodies to create their cure but they are harvesting their antibodies from human patients who have survived COVID-19. Antibodies naturally produced against the virus are being engineered into a remedy that the companies hope to mass produce. Vir said in March that it has identified multiple human monoclonal antibody development candidates that effectively thwart the virus and anticipates that human trials could begin within three to five months.
In a way, Vir and Eli Lilly are putting a modern spin on treatment that has been around for more than a century—using plasma and its antibodies from patients who have recovered from a viral infection and giving it to patients infected with the virus. In fact using convalescent plasma for treatment was effective against diptheria in the 1890s and scarlet fever in the 1920s. What drug companies like Vir and Eli Lilly are doing today is much more targeted because their researchers are actually picking out the specific antibody.
In the meantime, U.S. blood donation centers are already ramping up efforts to collect plasma from recovered coronavirus patients the old-fashioned way while the efficacy of such efforts is still being studied.
“If I was a patient, I would be interested in it. It’s a quick way to get antibodies from survivors into you and you can do that immediately,” says Witzke, noting that he is an investor with no training in medicine. “I would rather have a more targeted approach like what Regeneron is doing but if you’re in a tough place today, I would turn to [plasma] immediately.”
I am a senior editor at Forbes who likes digging into Wall Street, hedge funds and private equity firms, looking for both the good and the bad. I also focus on the intersection of business and the law.
Several biotech firms are racing to develop an effective COVID-19 vaccine. One company in San Diego, California, says it may already have a viable product. But there are several challenges to getting it on the market
Austria is set to be one of the first countries in Europe to ease its lockdown against the coronavirus outbreak. The conservative-led government announced plans on Monday to start reopening non-essential stores next week, after reaching a downward trend in the growth rate of new infections. The government will also extend a requirement to wear face masks in supermarkets to include public transport and stores that reopen.
Austria recorded 12,058 cases of the coronavirus and 220 deaths as of April 6, fewer than its neighbors Italy and Switzerland. More than 6,300 per one million people (55,863) in Austria’s population of nine million have been tested. The growth rate of daily new infections has already decreased by 2.8% from over 40% in mid March, health authorities said. While the number of people in hospital has stabilized, Chancellor Sebastian Kurz said during a 30 March news conference that intensive care capacity could be exceeded as early as mid-April.
Kurz presented a timetable on April 6 to restart the Austrian economy, outlining a series of phases to normalize life while minimizing the risk of a surge in new infections. “There will be a step-by-step reopening,” Kurz told a news conference. Non essential stores of less than 4306 square feet (400 square meters) and DIY shops will be opened on April 14, followed by all shops, malls and hairdressers on May 1, he said.
“At first, the public discussion seemed to be all about public health, but now it appears to be moving more towards damage to the economy because of the measures taken by the government,” says Florian Peschl, a Vienna based political advisor to the New Austria and Liberal Forum (NEOS) parliamentary group.
Austria introduced major restrictions on March 16, closing schools, restaurants, bars, theatres, non-essential stories and banning gatherings of more than five people. Residents were told to stay at home and work from there if possible.
“Streets have been almost completely empty. Even though more people have been coming out because it’s sunny, most people seem to be on the side of the government and are abiding by the rules. There’ll be no doubt be relief about the easing of restrictions, but at the same time there’s a lot of caution. We know this can be quickly revoked if it doesn’t go well,” says Peschl.
Various other governments across Europe have begun preparations to roll back the lockdowns. Spain, France, Belgium and Finland are among many countries that have set up expert committees to examine a gradual relaxing of social restrictions, but up against enormous uncertainties, officials have yet to commit to a strategy.
The Austrian plan also makes clear that months of restrictive measures still lie ahead. Kurz urged Austrians to cancel any plans to celebrate Easter this week and emphasized that restrictions could only be eased if orders were strictly followed. “Keep to the measures, avoid social contacts, keep your distance in public space,” he said.
More than 160 New Jersey Police officers have tested positive for the coronavirus, New Jersey State Police said Sunday in a press release. (New Jersey State Police issued a correction after the head of the agency “overstated” how many personnel tested positive for the COVID-19 at a press conference held by state officials on Saturday.)
Acting State Police Superintendent Col. Patrick Callahan had said on Saturday that about 700 police were reported as having the disease. “During a recent COVID-19 press conference, Col. Patrick Callahan overstated the Law Enforcement Statewide Positive cases,” the agency said in the statement on Sunday, noting that so far, across the state, 163 personnel had tested positive for the coronavirus and 1,272 had been quarantined.
“There’s more than 700 police officers quarantined at home and there’s about the same amount (…) that have tested positive from all 21 counties,” Callahan had said.
Callahan said authorities “track every single police officer” who test positive for COVID-19 but did not elaborate on what departments were most affected or provide an exact number of how many police personnel tested positive.
Callahan also indicated that two police officers who were reported as being in serious condition are improving.
U.S. Government Working on Guidelines to Assess Local Coronavirus Risk
Federal officials are developing guidelines to rate counties by risk of virus spread, as he aims to begin to ease nationwide guidelines meant to stem the coronavirus outbreak.
The U.S. has more than 124,000 COVID-19 cases and New Jersey is second only to New York in the number of cases it has so far reported, according to a tracker from researchers at Johns Hopkins University. As of Sunday morning, New York has reported about 53,500 cases and New Jersey has reported about 11,000 cases.
On Saturday, the U.S. Centers for Disease Control and Prevention issued a domestic travel advisory, urging “residents of New York, New Jersey, and Connecticut to refrain from non-essential domestic travel for 14 days effective immediately.”
By Sanya Mansoor Updated: March 30, 2020 1:46 PM EDT | Originally published: March 29, 2020 10:53 AM EDT