Shreds of hope in the pandemic

A Covid vaccine that’s in development could, potentially, create sterilizing immunity.

Sterilizing immunity? That’s the kind that prevents infection, which means a disease not only can’t get you sick, it also can’t use you to pass itself along to anyone else. If we could get enough people vaccinated with a sterilizing vaccine, we could stop this sumbitch in its tracks.

The snag, of course, is hidden in that word potentially. The thing’s still in development. But if all goes well, it could work on both the existing variants and any new ones and could create immunity even in people whose immune systems sleep through the current vaccines, through bouts of Covid itself, and through math class.

How does it work

The SARS-CoV-2 subunit vaccine (PreS-RBD) developed at MedUni Vienna is based on a structurally folded fusion protein consisting of two receptor binding domains (RBD) of the SARS-CoV-2 virus and the PreS antigen from hepatitis B, which serve as immunological carriers for each other, thereby strengthening the immune response.”

Allow me to translate that for you: It’s magic. Don’t worry about it. Although you might want to know that it involves a series of shots to build up to full immunity, and the first trials could start this year. But that depends on funding. 

Irrelevant photo: an ornamental cherry tree. Or I think it’s a cherry.

What doesn’t depend on funding?

Hmm. Dunno. As society’s organized, not much.

Why do I ask so many questions? They’re a cheap and easy way to organize a piece of writing. 

See? Even that depends on funding.

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A second shred of hope is that researchers have found a monoclonal antibody that could potentially be a treatment for all Covid variants as well as for SARS and MERS (if they reappear), and for some versions of the common cold. But there’s that word potentially again. So far, it’s gone through animal studies. Next they have to capture some humans and test it on them.

It’s being combined with another monoclonal antibody, and the two together are going by the name AR-701 cocktail right now, but before they’re released into the wild someone will have to give them a less pronounceable name to make them sound more scientific. 

The plan is for people to inhale it, and it could–again, that word–potentially last for a year. 

Covid and male fertility

A very (very) small study raises the possibility that catching Covid could have long-term effects on male fertility. 

Long-term effects? When someone says that,they’re never talking about  good long-term effects. In this case, it means that men who had recovered from Covid had lower sperm counts, more misshapen sperm, and sperm with lower motility than the comparison group. 

Again, it was a small study, so don’t go off the deep end with it. But I can’t help thinking that if you want to discombobulate someone who’s pounding the table about vaccines messing with women’s fertility–

Nah. I’m not going to suggest that. I’ll leave it to you to sink that low.  

News about Covid tests

Two rapid, accurate Covid tests are in development. I’ve written that sentence so many times before, changing only the number at the beginning, that I’m not even going to give you the details. But testing’s another area where–out of sight of the general public–work’s going on that could have an impact on the way this mess plays out.

 

Covid and the sense of smell 

Omicron’s less likely than the Delta variant to mess up the senses of smell and taste, but a failed attempt to lower people’s viral load–that’s how much Covid they carry around–turned out to protect patients’ sense of smell and taste. It also left them less tired than the patients who got a placebo.

They were using a drug called camostat mesylate, and it’s not clear yet whether it would help restore smell and taste to people who’ve lost them. You can live without both of them, but taste and smell are not minor losses.

The drug will need more testing–which in turn means more time, not to mention more money–before it can be used this way. 

An update on Covid in Africa

One of the mysteries of an already pretty weird disease has been its impact on Africa. According to a World Health Organization’s estimate, 65% of people in Africa have been infected by Covid. That’s something like 100 times more cases than have been reported. Covid cases are undercounted everywhere, and more so in Africa, because so many people have no symptoms. 

When they say “estimated,” they’re not talking about an educated hunch. They’re basing it on blood samples from around the continent. It’s not as accurate as counting every head, but it’s not pulling numbers out of thin air either. 

Earlier in the pandemic, the fear was that Covid would devastate Africa, but it’s turned out to be one of the least affected parts of the world. Multiple explanations are on offer. It has a low percentage of people with risk factors like diabetes, high blood pressure, and heart disease. It has a relatively young population. And some studies suggest that having been infected with other diseases, including malaria, may be protective, but that hasn’t been confirmed and rushing out to buy yourself a case of malaria is not recommended.

But being one of the least affected parts of the world doesn’t mean Africa’s unaffected. It’s had 250,000 Covid deaths. Or known Covid deaths–they also tend to be underreported worldwide. Only 15% of Africa’s population has been vaccinated, and that may mean only one vaccination, since the article doesn’t say “fully vaccinated,” which is the phrase that usually pops up.

The Covid testing dilemma

England’s pushing mass testing as a way to contain Covid. It’s free, it’s government approved, it’s somewhere between uncomfortable and painful, and it may or may not be a good idea. Let’s tear the numbers apart and see what we can figure out.

Since the schools reopened, secondary students–those are the older kids–have had to do quick Covid tests twice a week, and that’s been a bulwark of the program to keep the schools open while not letting the virus get out of control. 

The tests, unfortunately, have a reputation for being unreliable, especially when done by non-experts. Since the kids are doing their own tests, or asking their parents or three-year-old sisters to stick the swabs up their noses and down their throats, these are in the hands of the distilled essence of non-expert. One fear about relying on the quick tests has been that false positives will send a lot of people into isolation unnecessarily. So half of the positive tests were sent to a lab to be confirmed by the slower, more reliable tests, and only 18% of them were false positives. 

Irrelevant photo: Rhododendrons. Photo by Ida Swearingen

But wait, because we’re not done yet. Those numbers are from March, and Covid rates have fallen, at least in parts of the country. (Some hot spots remain, and I don’t know if numbers are falling there as well. Just put that possibility off to one side. The recipe may call for it later. If it doesn’t, we’ll stick it in the freezer.) The point is that where the number of cases is lower, everything changes

Why? Because the tests will crank out the same number of false positives, no matter how many people are infected. Find yourself a population of people who’ve never been exposed to Covid and the test will swear on any religious book you like that some of them are infected. 

I’m about to throw some numbers at you, so if your allergies are bad today just skip a few paragraphs.

Ready? In London, the southwest, the northeast, and the southeast of England, the prevalence of Covid ranged from 0. 08 to 0.02. In England as a whole, it was 0.12%. Using those figures (I’d assume that means the England-wide ones), it would take 16,000 tests to find one infected person. If the tests cost £10 each, that means spending £160,000 to find that one person.

Is that worth it? If we were trying to stamp the disease out and keep it stamped, as New Zealand is, it would be. Given that we treat stamping it out as the silly thought of irresponsible day dreamers, probably not. 

Meanwhile, in leaked emails (I do l love a good leak) “senior government officials” are talking about scaling back mass testing, although the Department of Health and Social Care says it has no plans to end the program. One in three infected people, they remind us, show no symptoms but is still contagious. 

That brings us neatly to the question of whether the rapid tests will spot that one person. In other words, it’s time to talk about false negatives. Administered by an expert, the tests pick up 79% of infections. Or to put that the other way around, they miss 21%, and those are mostly people with a low viral load. Or to put that another way, they’re most likely to miss people who don’t have symptoms, who are just the people the testing program is looking for.

Administered by secondary school students or their three-year-old sisters, they’re more likely to pick up 58% of infections, or to miss–umm– I think that’s 42%. Although estimates of the number of cases the test misses vary. It might be as high as 50%. 

The government denies that it has any plans to scale back anything ever and Boris Johnson is urging everyone to get tested twice a week. Even though his advisors say that in areas with low infection rates, only 2% to 10% of the positive results may be accurate. 

But what the hell, guys, we’ve got these tests. Someone’s cousin has the contract for them. Use them, will you, please? For the good of the nation.

 

News of an accurate rapid test that’s in development

A new test is being developed that’s both fast and accurate. It also tracks variants and tests for other viruses that might be mistaken for Covid. It can screen 96 samples at a time and within 15 minutes it starts to report the samples as negative or positive. In 3 hours, it will have sequenced all its samples. 

It’s also small and portable. It doesn’t make coffee, but it just might be able to make you a cup of tea.

Juan Carlos Izpisua Belmonte, a professor in Salk’s Gene Expression Laboratory where it’s being developed, said, “We can accomplish with one portable test the same thing that others are using two or three different tests, with different machines, to do.”

That’s the good news. But will it go from development to being manufactured and used?

Market analysis would be required to determine whether the initial cost of commercialization—and the constant tweaks to the test needed to make sure it detected new variants or new viruses of interest—are worth it.”

I believe that translates to “maybe.”

It’s called NIRVANA, which doesn’t seem to stand for anything, so I don’t know why it’s in all caps. 

 

High- and low-tech approaches to Covid

In New Zealand, they’re trying out an app that connects to smart watches and fitness trackers, monitoring people’s heart rate and temperature. It’s called an Elarm and the developer claims it can spot 90% of Covid cases up to three days before symptoms appear.

Does that include people who don’t go on to develop symptoms? I’m have to give you a definite maybe on that, because the article I found doesn’t address it. The company’s own website doesn’t answer the question either but says it will also let you know about stress and anxiety, although you might notice those without needing an app. Basically, it figures out your normal levels and lets you know when you’ve wandered off them, so you could end up going into isolation over the flu as easily as over Covid. That would scare the pants off you but would, at least, take a lot of the punch out of flu season.

So how do you use this? New Zealand wants its border force to try it out, since almost the only cases of Covid there are in incoming travelers, who have to go into quarantine, meaning the people who work for the border force are in the front lines.

When New Zealand says quarantine, by the way, they actually mean quarantine. It’s one reason they’ve been able to contain the virus.

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On the other end of the scale comes the recommendation that we open windows in public places to minimize Covid transmission. It’s cheap, it’s simple, and–

Oh, hell, how many public places these days have windows that open? Okay, ventilation. The air in public indoor spaces needs to be replaced or cleaned. 

We’ve heard a lot about keeping two meters (or yards) away from people to avoid contagion, but in addition to the heavier droplets people breathe out, which can carry Covid, the tiniest particles that we breathe out can also carry it, and they can stay suspended in the air for hours. The goal is to run them outside and get some fresh air in. 

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If you’re looking for a low-tech way to decide how far from people you should be standing, you can think of it this way: If you can smell that they’ve had garlic or peanut butter for lunch, you’re too close. 

 

Drug news

An asthma drug, budesonide, has been shown to shorten people’s Covid recovery time –and it can be used at home without anyone involved needing welding gloves, a deep-sea diver’s helmet, or a set of allen wrenches. It’s relatively inexpensive and comes in an inhaler. It shortened people’s recovery time by three days and at the end of two weeks the people who used it were in better shape than the control group.

It’s not clear yet whether it made hospitalization less likely. In the budesonide group, 8.5% were hospitalized. In the control group, that was 10.3%. That sounds like a result, but the problem with interpreting the numbers is that hospitalization rates are dropping in Britain. If you want to understand why that makes the numbers hard to interpret, you need to talk to someone who actually knows something.

Everyone in the test was over 50 and had underlying health problems. The drug can be used in the early stages of infection.