Coronavirus – the science: The case for crushing Covid-19 rather than living with it

This is a series of regular updates from Irish Times Environment & Science Editor Kevin O'Sullivan on scientific initiatives and developments on coronavirus. Previous editions can be found here

The need to crush it:

The longer the pandemic maintains its grip, the more disagreement emerges on the best way to deal with it. Within the world of science, perhaps the most significant divergence is between the “flatten the curvists” and “Covid-19 crushers”. The latter group advocates short, sharp additional restrictions.

There are two critical aspects to this. Firstly, any seasonal benefit – such as warm weather and high humidity (great for killing off flu) – may be cancelled by humanity’s vulnerability to the virus.

"One should not assume that we are going to be rescued by a change in the weather. You must assume that the virus will continue to do its thing," declared Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases and member of the White House coronavirus taskforce, on ABC's Good Morning America. Fauci is the man who causes Donald Trump's teeth to grind whenever he gives his latest update.

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The second difficulty is the “flatten the curve goes on for years” in the absence of a vaccine. That is why we need to weigh up balances, especially in the context of beginning to ease restrictions.

A key assumption of the flatten strategy is that around the same number of people will eventually be infected with Covid-19, but just over a longer time period. Many models predict this period, which could require intermittent lockdowns, might last for up to two years.

Dr Harvey Fineberg, past president of the US National Academy of Medicine, is in no doubt a different path is needed.

“The aim is not to flatten the curve. The goal is to crush the curve,” he wrote in the New England Journal of Medicine.

New Zealand is held up as the best pupil in the class. It has had just 1,049 confirmed cases and four deaths since February 28th. Just 14 people were in hospital with the virus as of Saturday, April 11th.

RCSI infectious disease specialist Prof Sam McConkey has summarised in a tweet what that might entail, and interestingly noted it would have to be on all-Ireland basis if we were go that route:

“In Ireland, should we follow New Zealand, eliminate SARSCoV2 from the island through 60 days of contact-tracing and self-isolating in <3h, use GPS location data, 14-day quarantine for travellers, cloth reusable masks for all, phone app to show status, phased openings, all with NI.”

Ireland v. UK:

A big question is why the pandemic has played out in the State in a discernibly different way to the UK, and to some extent Northern Ireland.

Yes, we moved quicker to physical distancing and restricting movement, while it’s almost as if there was a strange, three-week delay in hard but necessary messaging across the water, trying to catch up on the lack of urgency and clarity early on. But there is more to it than that.

Researcher Elaine Doyle, who specialised in the history of medicine, made telling comparisons on twitter. It started out with health systems roughly on a par; for instance the UK had 6.6 ICU beds per 100,000 people; the Irish equivalent was 6.5.

Then deviation becomes more evident. Ireland has performed 8.69 tests per 1,000 population; the UK equivalent is four.

Currently, UK death rates are more than double those in Ireland; 14.8 deaths per 100,000 people compared to 6.5 here (More than 10,000 deaths in the UK compared to 334 deaths as of Sunday in the State).

The UK hit 1,000 deaths in a single day, coinciding with 2,000 deaths a day in the US. Remarkably, it is accounting for 10 per cent of global deaths from Covid-19, while the US daily death record is in a country with five times the population of Britain.

Global race update:

The race against the common enemy continues with unprecedented intensity on three fronts: to produce a vaccine; to generate antiviral treatments and to engineer a validated antibody test kit to show if a person has had Covid-19.

A team in Oxford University led by Prof Sarah Gilbert is confident a vaccine against coronavirus could be ready by September with human trials due to begin in the next fortnight. It seems to have stolen a march on CureVac in Germany. who flagged trials would be ready to start in June/July.

Pfizer and BioNTech are laying plans for manufacturing their candidates for trials by late April. BioNTech and CureVac are reported to be hard at work trying to get regulators to rewrite the rules on human trials.

Meanwhile, the first results from Gilead’s late-stage testing of remdesivir (normally used to treat Ebola) are expected this month. If results are positive, expect regulatory approvals to come quickly – again raising ethical issues around fast-tracking. It’s quite possible the drug could become the standard of care for Covid-19 at least for a while.

The necessary urgency at a time of pandemic is tempered by those scientists who say “not so fast”, given in “normal times” proving a vaccine works safely can be painfully slow.

But as the scale of the pandemic becomes clearer, a provocative, ethically complicated proposal to shave months off that timeline is gaining traction, which advocates giving people an experimental vaccine and then deliberately try to infect them.

Rubella vaccine inventor Stanley Plotkin of the University of Pennsylvania told Science magazine a carefully-designed "human challenge" trial could offer clear proof of a vaccine's worth at blinding speed.

“We’re talking two, three months,” said Plotkin, who has co-authored a proposal which describes how this might be ethically done (his took six years, by the way).

But “people who are faced with a terrifying problem like this one will opt for measures that are unusual. And we have to constantly rethink our biases,” he added.

The problem is Covid-19 is so new. It’s not clear how often the virus makes people seriously ill or leaves them with long-term complications. Where you’re going to give somebody a virus on purpose, you really want to understand the disease so that you know that what you’re doing is a reasonable risk.

Grounds for optimism:

– R0 moves in right direction: Much hinges on the R0 value of an infectious disease. If it's three, a typical person who is infected will spread it to three people during the period they're infectious. Ireland has brought its Covid-19 R0 down from six in early March to close to one – in the US, it's currently at six. If we get it below one, the pandemic will begin to fizzle out. The national effort has shifted to the next task at hand; bringing the R0 as close as possible to zero.

– Wins that matter: Let it be known April 9th was the day we reached a big milestone. It was best encapsulated by Prof Liam Glynn of UL in a tweet:

“We are no longer on an exponential growth curve and this have prevented many #Covid-19 cases and deaths...Comparing our rates to some other countries our early actions saved lives...”

But he did not allow room for complacency, adding: “We need to do more.”

– Irish optimism ratings: Pragmatic optimism is needed as people face into weeks more of lock in amid much uncertainty over what Ireland will emerge once restrictions are eased. More than 60 per cent of adults were optimistic in the most recent analysis by Core Research. This positive level of optimism "is being influenced by the solidarity of actions from all stakeholders in society", it concludes. Another action that delivers.