Testing, testing 123
The most important news in healthcare: Tuesday, April 28th
Good morning. On the docket today: the administration’s plan for increased testing, a mass prison release in Afghanistan, and a new vaccine candidate with an unprecedented timeline.
Trump reveals plan to test 2 million Americans per week by the end of May
The pulse:
The administration will team up with private companies like Walgreens and CVS to push testing capacity to 2 million per week – the lower end of what experts predict the country will need to safely reopen.
What is the state of testing right now?
About 5.6 million Americans have been tested, according to the COVID Tracking Project. That number has ramped up significantly in the past seven days, during which 1.5 million tests have been administered.
How many tests do we need to safely reopen?
Increased testing capacity improves our ability to safely reopen in three ways:
Rapid identification of new cases
Rapid isolation of these cases
Use of these cases to track down, via contact-tracing, others who may have been exposed
Expert estimates for the number of tests needed to adequately achieve these goals range from roughly 3 million to a few tens of millions per week. The White House, for its part, has estimated that 30/1000 people per month, or 2.5 million people per week, should get tested.
Should states that have been harder hit be bearing more of the testing burden?
Likely, yes. One model, created by STAT News and the Harvard Global Health Institute, predicts that NY will need 130,000 tests per day by May 1st to safely reopen. Georgia, which has already begun to re-open, is estimated to need around 9,000-10,000 per day.
So did Georgia meet that threshold prior to re-opening?
No -- despite currently falling short of that number and averaging around 4000 tests per day, Georgia has allowed non-essential businesses like hair salons and gyms to begin opening. Critics, including President Trump, have said the numbers do not support this move and that it’s likely too early for a return to quasi normalcy.
Bottom line it for me
Testing capacity is increasing, but we are more than a month away from what experts would begin to consider “safe” to reopen.
Afghan government releases 100 Taliban prisoners. Source: Reuters.
As virus spreads, Afghanistan in the process of releasing 60% of its prisoners
The pulse
On Monday, the Afghan government announced that it will be giving 12,000 prisoners a get out of jail free card, bringing the total amount of inmates freed in the country due to the virus to 22,000. The country currently has 36,000 inmates -- far more than its capacity of 18,000.
Have these prisoners been freed permanently?
It seems like it. The most recent set of 12,000 releases have received “pardons” for their crimes. Earlier releases focused on the elderly and the ill.
These releases do not include the government’s recent peace deal with the Taliban to free 5,000 of its members. The Taliban has been continuing to conduct over 50 attacks a day in Afghanistan, even as the government has been releasing members in small lots of 100. It’s unclear how many Taliban members will be freed as part of the most recent mass release and what effect this will have on the country’s security.
Will other countries free their prisoners?
They’ve already been doing so. Brazil and Indonesia have freed 30,000 inmates, Turkey has freed 45,000, and Iran has freed 85,000 detainees. It’s likely this trend will continue -- at least 125 countries have more prisoners than their correctional systems were designed for.
Could this happen in the U.S.?
The issue of prison population is largely one that states must deal with -- state facilities hold roughly 1.3 million people, while federal facilities only hold 225,000. California and New York have already taken steps to release nonviolent offenders, and New York City now has its lowest jail population since WW2. Still, given poor jail hygiene and the susceptibility of the imprisoned population to disease, larger scale releases may be on the horizon.
Bottom line it for me
Across the world, the coronavirus is forcing correctional facilities that have long been stretched over capacity to evaluate the tradeoff between incarceration and public health.
Oxford scientists claim they could have a coronavirus vaccine available by September
The pulse:
Scientists at Oxford’s Jenner Institute say they could have a “few million” doses of a COVID-19 vaccine available by September of this year. If true, this would be the fastest timeline currently proposed for any of the 100+ current vaccine candidates.
What are the timelines for the other vaccines?
Most other vaccine manufacturers have been setting optimistic roll-out dates in mid-to-late 2021, which is still far quicker than normal: vaccines usually take upwards of a decade to develop. The Jenner Institute’s timeline has some incredulous.
How is this Oxford vaccine so ahead of the pack?
Their scientists say they had a head start — they had been previously testing this vaccine to address MERS, a coronavirus from the early 2010s that caused an epidemic. A clinical trial in Britain had already demonstrated the safety of the vaccine.
How well does it work in COVID-19?
Small scale testing in six rhesus macaques who were vaccinated with the Oxford vaccine and then exposed to COVID-19 suggests that the vaccine is protective against the virus, with all six of the monkeys healthy nearly one month after exposure.
Does that mean it’ll work for humans?
Not necessarily, but the Oxford group is currently working on demonstrating efficacy in humans. They began a Phase I clinical trial last week involving 1,100 people and plan to inject more than 6,000 people with the vaccine by the end of next month. Professor Sarah Gilbert, who is leading the Oxford vaccine team, has said she’s “80% confident” the vaccine will work.
Bottom line it for me
This is an unprecedented timeline for a vaccine that, if realized, would allow states and countries to safely reopen much more quickly than anticipated. Oxford has a lot on its side — safety data in human trials, animal studies, and ongoing clinical trials. If initial trial results are promising, it’s likely that the regulatory process will be accelerated.
Rapidfire
Kevzara, an arthritis drug, is the latest casualty in the ongoing battle to find a successful treatment for COVID-19. Experts hoped that Kevzara would suppress some of the inflammation and fluid-build up seen in severe COVID-19 patients, but a recent Chinese trial showed no benefit.
COVID-19 seems to be more deadly for men than for women. Now, doctors are starting to wonder whether women’s naturally higher levels of estrogen are protective against the virus, and are even starting to give male patients estrogen to see if it can help them fight off the disease.
Compass Pathways, a Peter Thiel-backed mental health company, has just received $80 million in funding for its psilocybin trial. Psilocybin is the psychoactive ingredient in magic mushrooms, and Compass plans to test the compound for treatment-resistant depression. They’ve had to pause their trials, so no word yet on just how magical the results are.
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