Changes are happening fast, so some of this might already be outdated.
I'd love to hear more from people who have facts - no Fox, CNN, MSNBC, Rush, Hannity, etc reports - only 1st hand info from professionals or from actual published studies.
Maybe we can keep this civil?
Tests
1) Abbot lab's 5 minute test - genetic test that is variation of PCR (which is already being used). Regular PCR has to cycle through temperatures (95C, 60C, 72C) over and over. Abbot developed chemistry so everything can be don at one temperature, therefore the process is way, way faster. They also simplified the readout - gives a + or -. No need for a lab or a tech - can be done bedside. This was repurposing existing tech, so already know it works. Problem is they only have 18,000 machines so far.
2) High throughput system from CEPHEID (developed by Rutgers professors) - takes 45 minutes. This system has been in use around the world to rapidly test for 5 different strains of tuberculosis. They quickly recognized it could be used for SARS-CoV2 (saw lead guy present this on March 5). 23K labs around the world, 5K in USA. Should be able to process 10s of thousands of samples per week.
3) Serological test being developed by many labs/companies should be available soon (weeks to a few months). This test determines if you have antibodies against the virus. If you do, you have already had the virus and have recovered, meaning you will not get it again. This will be huge since these people can go back to work, help the sick, bring me pizza, etc.
The problem with all testing is that even with 99% accuracy, we still will get 3.5M wrong results if we test everyone. False positive, no big deal. False negative and that person might infect my pizza.
Cures/treatments:
1) Chloroquine/hydroxchlorquine - despite the hype, I have read the literature and talked to those who should know and I can find little to zero that this works. Two sources are referenced - a Chinese study and a study from a lab in France. The paper on the Chinese study is one page that references a press release. The link to the press release did not work for me (plus its in Chinese). The French study is from Didier Raoult who publishes roughly 2 papers per week (my good years I publish 2-4 papers per year). The two papers on clinical trials for Covid 19 were in a journal who's editor works for him. He cites the Hippocratic oath as a reason for not have controls and people who get sick are dropped from the data analysis. Nonetheless, real clinical trials are underway over the last week or two. Therefore, we should know fairly soon (maybe weeks). Fingers crossed. Update as of today - unreviewed pre-print of small study from China was released that showed some impact on improving severity of disease in people with mild cases of COVID-19, which is encouraging.
2) Vaccines. New, unproven technology that was developed to create a vaccine against SARS-CoV is being repurposed to go after SARS-CoV-2. Also, since we got the sequence of the virus so fast from China and the protein crystal structure was done so fast, we know exactly where to target the virus by standard vaccination approaches. Tons of labs working on this. J&J has a 1 billion $ contract from the government, but they say they won't go into people until September. No information about what technology/approach they are going to use.
3) Engineered monoclonal antibodies. Antibodies work like a lock and key. There are many, many keys (antibodies) but only one (or a few) can fit in the lock (the virus). Antibodies, which are proteins, that work have been identified. Now these antibodies are being engineered to make them fit the lock even better. Regeneron seems like they are the furthest along (great company that I hear has moved a lot of their efforts to do this). This approach has worked for Ebola and certainly could work again. It would be given as an injection (like Humira). Months away.
4) Transfer of antibodies from someone who has recovered. This is old school, but it works for other diseases. Being tested, but I don't know where. ID doc I work with, however, was less optimistic than me that this would work.
5) anti-virals - again, having the crystal structure so fast makes it possible to design drugs that target key parts of the virus that it requires to function (like Tamiflu). The main target is the viral proteases. Drugs against other viral proteases are already being tested. This is likely to be the best, most effective drug once discovered. ID doc, however, told me that the anit-HIV drugs have failed clinical trials for SARS-CoV-2.
6) treatments against the symptoms are being trialed. One good bet is an antibody against IL-6 (Sanofi's is called Kevzara). The virus often causes the body to release huge amounts of the IL-6 protein, which can cause activation of lots of immune cells, even after the virus is gone. These "cytokine storms" can do massive damage to the body.
The reality, as far as I see, is that nothing is coming fast, but they will come. We have ~17 years of experience, trial and error, knowledge, etc. from working on SARS-CoV, Zika, Ebola and others. This combined with the recent advances in high throughput DNA sequencing, protein engineering, progress on biologicals as therapeutics, rapid high resolution crystallography, huge advances in understanding immune responses are as close to seeing science fiction become reality as I have ever seen.
The other thing to keep in mind is that the MDs are figuring out how to treat sick people better and better every day. Things like how and when to get people on ventilators, what supportive treatments are needed, who is crashing and who is stable. The experiences of the NYC docs will be used to save thousands across the world.
----------------
4/2/20 This report from Dr. Benjamin tenOever's virus lab at Mt. Sinai is very interesting (posted in non-peer reviewed site, bioRxiv, but this is an excellent lab that has been studying immune responses to viruses for many years). They find that SARS-CoV-2 does not induce type I and type III interferons. Interferons are among the first proteins released by the immune system in response to viral infections. They conclude "Taken together, the data presented here suggests that perhaps artificial means of boosting the antiviral response may be an effective option at treating COVID-19 so long as it does not further aggravate any pre-existing conditions."
------------------
4/2/20 For the somewhat harder core science crowd - here is a great, mostly lay person, summary of the current vaccine strategies (including J&J) from the journal, Science https://www.sciencemag.org/news/202...makers-take-their-first-shots-new-coronavirus
I'd love to hear more from people who have facts - no Fox, CNN, MSNBC, Rush, Hannity, etc reports - only 1st hand info from professionals or from actual published studies.
Maybe we can keep this civil?
Tests
1) Abbot lab's 5 minute test - genetic test that is variation of PCR (which is already being used). Regular PCR has to cycle through temperatures (95C, 60C, 72C) over and over. Abbot developed chemistry so everything can be don at one temperature, therefore the process is way, way faster. They also simplified the readout - gives a + or -. No need for a lab or a tech - can be done bedside. This was repurposing existing tech, so already know it works. Problem is they only have 18,000 machines so far.
2) High throughput system from CEPHEID (developed by Rutgers professors) - takes 45 minutes. This system has been in use around the world to rapidly test for 5 different strains of tuberculosis. They quickly recognized it could be used for SARS-CoV2 (saw lead guy present this on March 5). 23K labs around the world, 5K in USA. Should be able to process 10s of thousands of samples per week.
3) Serological test being developed by many labs/companies should be available soon (weeks to a few months). This test determines if you have antibodies against the virus. If you do, you have already had the virus and have recovered, meaning you will not get it again. This will be huge since these people can go back to work, help the sick, bring me pizza, etc.
The problem with all testing is that even with 99% accuracy, we still will get 3.5M wrong results if we test everyone. False positive, no big deal. False negative and that person might infect my pizza.
Cures/treatments:
1) Chloroquine/hydroxchlorquine - despite the hype, I have read the literature and talked to those who should know and I can find little to zero that this works. Two sources are referenced - a Chinese study and a study from a lab in France. The paper on the Chinese study is one page that references a press release. The link to the press release did not work for me (plus its in Chinese). The French study is from Didier Raoult who publishes roughly 2 papers per week (my good years I publish 2-4 papers per year). The two papers on clinical trials for Covid 19 were in a journal who's editor works for him. He cites the Hippocratic oath as a reason for not have controls and people who get sick are dropped from the data analysis. Nonetheless, real clinical trials are underway over the last week or two. Therefore, we should know fairly soon (maybe weeks). Fingers crossed. Update as of today - unreviewed pre-print of small study from China was released that showed some impact on improving severity of disease in people with mild cases of COVID-19, which is encouraging.
2) Vaccines. New, unproven technology that was developed to create a vaccine against SARS-CoV is being repurposed to go after SARS-CoV-2. Also, since we got the sequence of the virus so fast from China and the protein crystal structure was done so fast, we know exactly where to target the virus by standard vaccination approaches. Tons of labs working on this. J&J has a 1 billion $ contract from the government, but they say they won't go into people until September. No information about what technology/approach they are going to use.
3) Engineered monoclonal antibodies. Antibodies work like a lock and key. There are many, many keys (antibodies) but only one (or a few) can fit in the lock (the virus). Antibodies, which are proteins, that work have been identified. Now these antibodies are being engineered to make them fit the lock even better. Regeneron seems like they are the furthest along (great company that I hear has moved a lot of their efforts to do this). This approach has worked for Ebola and certainly could work again. It would be given as an injection (like Humira). Months away.
4) Transfer of antibodies from someone who has recovered. This is old school, but it works for other diseases. Being tested, but I don't know where. ID doc I work with, however, was less optimistic than me that this would work.
5) anti-virals - again, having the crystal structure so fast makes it possible to design drugs that target key parts of the virus that it requires to function (like Tamiflu). The main target is the viral proteases. Drugs against other viral proteases are already being tested. This is likely to be the best, most effective drug once discovered. ID doc, however, told me that the anit-HIV drugs have failed clinical trials for SARS-CoV-2.
6) treatments against the symptoms are being trialed. One good bet is an antibody against IL-6 (Sanofi's is called Kevzara). The virus often causes the body to release huge amounts of the IL-6 protein, which can cause activation of lots of immune cells, even after the virus is gone. These "cytokine storms" can do massive damage to the body.
The reality, as far as I see, is that nothing is coming fast, but they will come. We have ~17 years of experience, trial and error, knowledge, etc. from working on SARS-CoV, Zika, Ebola and others. This combined with the recent advances in high throughput DNA sequencing, protein engineering, progress on biologicals as therapeutics, rapid high resolution crystallography, huge advances in understanding immune responses are as close to seeing science fiction become reality as I have ever seen.
The other thing to keep in mind is that the MDs are figuring out how to treat sick people better and better every day. Things like how and when to get people on ventilators, what supportive treatments are needed, who is crashing and who is stable. The experiences of the NYC docs will be used to save thousands across the world.
----------------
4/2/20 This report from Dr. Benjamin tenOever's virus lab at Mt. Sinai is very interesting (posted in non-peer reviewed site, bioRxiv, but this is an excellent lab that has been studying immune responses to viruses for many years). They find that SARS-CoV-2 does not induce type I and type III interferons. Interferons are among the first proteins released by the immune system in response to viral infections. They conclude "Taken together, the data presented here suggests that perhaps artificial means of boosting the antiviral response may be an effective option at treating COVID-19 so long as it does not further aggravate any pre-existing conditions."
------------------
4/2/20 For the somewhat harder core science crowd - here is a great, mostly lay person, summary of the current vaccine strategies (including J&J) from the journal, Science https://www.sciencemag.org/news/202...makers-take-their-first-shots-new-coronavirus
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