Convalescent plasma continues to be used for treatment of covid-19, but demand is flat

 The WSJ has the story:

Wanted in Covid-19 Fight: ‘Superdonors’ of Convalescent Plasma--Blood banks and researchers are mobilizing to find recovered Covid-19 patients who have high levels of antibodies and are willing to donate regularly   By Amy Dockser Marcus

"Blood banks and researchers are mobilizing to find recovered Covid-19 patients who could be blood plasma “superdonors,” people who have high levels of antibodies against the disease and are willing to donate regularly.

"The hunt has intensified in the past month, after the Food and Drug Administration authorized the use of convalescent plasma, derived from patients who have survived the virus, as a potential therapy for hospitalized patients.

...

"Right now, demand for plasma overall is flat, said Dr. Claudia Cohn, chief medical officer for AABB, a group representing the transfusion medicine and cellular therapy community. She said it could reflect reservations about the strength of existing data, the waning of the pandemic in certain areas of the country, or concerns that the authorization was issued under political pressure from the White House—a suggestion the FDA has pushed back on but that continues to generate debate.

"Doctors said an expected upturn in demand for convalescent plasma didn’t materialize after the authorization, although they are prepared for one should infections surge later this year."

Human infection challenge trial(s) for covid-19 vaccine likely to start in UK in January

 The Financial Times has the story:

UK to test vaccines on volunteers deliberately infected with Covid-19--‘Human challenge trials’ intended to accelerate vaccine development programmes   by  Clive Cookson.

"London is to host the world’s first Covid-19 human challenge trials — in which healthy volunteers are deliberately infected with coronavirus to assess the effectiveness of experimental vaccines.

"The UK government-funded studies are expected to begin in January ...

"The researchers, who did not want to comment publicly ahead of the launch, said the trials would play a vital role in narrowing the large field of promising Covid-19 vaccines likely to move into clinical testing early next year.

"Volunteers will be inoculated with a vaccine and a month or so later receive a “challenge” dose of Sars-Cov-2, the virus that causes Covid-19, under controlled conditions."

"About 2,000 potential volunteers have signed up for challenge studies in the UK through the US-based advocacy group 1Day Sooner, which campaigns for Covid-19 infection trials and has enlisted 37,000 people worldwide. Traditional clinical trials need tens of thousands of participants and researchers would struggle to attract enough for multiple vaccine studies."

The unsharing economy: part time gig evicting people from their apartments

 Vice.com has the story:

Gig Economy Company Launches Uber, But for Evicting People--A company called Civvl says evicting people is the "FASTEST GROWING MONEY MAKING GIG DUE TO COVID-19."  By Ashwin Rodrigues

"In its Craigslist ads, posted across the country, Civvl explains the opportunity plainly: "There is plenty of work due to the dismal economy."

"Unemployment is at a record high and many cannot or simply are not paying rent and mortgages," the ads state. "We are being contracted by frustrated property owners and banks to secure foreclosed residential properties."

Civvl aims to marry the gig economy with the devastation of a pandemic, complete with signature gig startup language like "be your own boss," and "flexible hours," and "looking for self-motivated individuals with positive attitudes:" "FASTEST GROWING MONEY MAKING GIG DUE TO COVID-19," its website says. "Literally thousands of process servers are needed in the coming months due courts being backed up in judgements that needs to be served to defendants."

...

"The company, at first glance, appears to be some kind of _Nathan For You-_esque prank: siccing precarious gig jobs onto vulnerable people. But Civvl is connected to a larger—and real—gig economy company called OnQall, which describes itself as an app that provides "on-demand task services to non-urban communities beyond main city areas." OnQall is the developer behind other, more believable TaskRabbit-esque apps, like LawnFixr, CleanQwik, and MoveQwik. Given the fact that Civvl is advertising all over the country and that OnQall, though not popular, does exist, it seems as though Civvl actually is an attempt to simplify the process of evicting people who cannot pay their rent during a pandemic.

...

"There is a federal ban on evictions, declared by the CDC, but landlords are still attempting to press on. There is a penalty for violating the ban, which can include a combination of fines and jail time. Civvl did not respond to a question about how the company ensures evictions are legal, though based on the Terms of Service, it appears to pass all risk onto the companies using its platform, stating that it simply "provides lead generation to independent contractors," and does not actually carry out the work itself.  

HT: Sandro Ambuehl

The WHO proposal for allocating scarce vaccines: thinking of healthcare while dealing with politics by discussing ethics

From the Guardian:

'Landmark moment': 156 countries agree to Covid vaccine allocation deal--Covax plan will counter rising threat of ‘vaccine nationalism’, prioritising vulnerable healthcare systems and frontline workers  by Peter Beaumont

"A coalition of 156 countries has agreed a “landmark” deal to enable the rapid and equitable global distribution of any new coronavirus vaccines to 3% of participating countries’ populations, to protect vulnerable healthcare systems, frontline health workers and those in social care settings.

"The Covid-19 vaccine allocation plan – co-led by the World Health Organization and known as Covax – has been set up to ensure that the research, purchase and distribution of any new vaccine is shared equally between the world’s richest countries and those in the developing world.

"Sixty-four higher income economies have already joined Covax, which includes commitments from 35 economies as well as the European commission, which will procure doses on behalf of the 27 EU member states plus Norway and Iceland, with 38 more expected to join in the coming days.

...

"Recognising that the first useful vaccines to emerge may be in short supply, approved vaccines will initially be made available to a tightly targeted 3% of the population of participating countries, building over time to 20% of each country’s most vulnerable population.

...

"According to a document detailing the arrangement, under the scheme “all countries should gradually receive tranches [of vaccine] to cover each subset of their [initial] target groups … until they can cover 3% of the population”.

The document continues: “At this point of the pandemic, a reasonable scenario would be that, while the supply of Covid-19 vaccines remains very scarce, countries should focus initially on reducing mortality and protecting the health system.

“This … would enable, for example, the vaccination of frontline workers in health and social care settings in most countries … Additional tranches will follow gradually as more supply becomes available.”

**************

And this from the Washington Post:

World Health Organization unveils plan for distributing coronavirus vaccine, urges cooperation    By Emily Rauhala

"Under the plan, rich and poor countries pool money to provide manufacturers with volume guarantees for a slate of vaccine candidates. The idea is to discourage hoarding and focus on vaccinating high-risk people in every participating country first.

"So far, 64 higher-income countries have signed up, WHO officials said, but they added that 38 more are expected to do so in the coming days. Notably missing: Russia, China and the United States.

"China has not made an ann"ouncement either way. The White House said this month that the United States would not join, in part because the administration doesn’t want to work with the WHO, and will instead take a go-it-alone approach.

...

"The framework makes clear that each participating country can decide whom to vaccinate first, but it is based on the idea that doses for 3 percent of a country’s population could be used to vaccinate medical workers first and then other high-risk groups.

...

"“It seems like a compromise position,” said Thomas J. Bollyky, a senior fellow at the Council on Foreign Relations and the director of its global health program. “It’s not exactly what you would do if you were driven strictly by public health.”

"In a policy report this month for the journal Science, critics offered an alternate framework called the Fair Priority Model, which is critical of the country-based approach"

************

Here's the Science article:

An ethical framework for global vaccine allocation, by Ezekiel J. Emanuel1, Govind Persad2, Adam Kern3, Allen Buchanan4, Cécile Fabre5, Daniel Halliday6, Joseph Heath7, Lisa Herzog8, R. J. Leland9, Ephrem T. Lemango10, Florencia Luna11, Matthew S. McCoy1, Ole F. Norheim12, Trygve Ottersen13, G. Owen Schaefer14, Kok-Chor Tan15, Christopher Heath Wellman16, Jonathan Wolff17, Henry S. Richardson18

"The Fair Priority Model is primarily addressed to three groups. One is the COVAX facility—led by Gavi, the World Health Organization (WHO), and the Coalition for Epidemic Preparedness Innovations (CEPI)—which intends to purchase vaccines for fair distribution across countries (5). A second group is vaccine producers. Thankfully, many producers have publicly committed to a “broad and equitable” international distribution of vaccine (2). The last group is national governments, some of whom have also publicly committed to a fair distribution (1).

...

"The Fair Priority Model proceeds in three phases, preventing more urgent harms earlier (see the Table). Phase 1 aims at reducing premature deaths and other irreversible direct and indirect health impacts. Phase 2 continues to address enduring health harms but additionally aims at reducing serious economic and social deprivations such as the closure of nonessential businesses and schools. Restoring these activities will lower unemployment, reduce poverty, and improve health. Finally, phase 3 aims at reducing community transmission, which in turn reduces spread among countries and permits the restoration of prepandemic freedoms and economic and social activities."

On allocating scarce vaccines

 From the NBER working papers this week:

Do Black and Indigenous Communities Receive their Fair Share of Vaccines Under the 2018 CDC Guidelines?

Parag A. Pathak, Harald Schmidt, Adam Solomon, Edwin Song, Tayfun Sönmez, M. Utku Ünver

NBER Working Paper No. 27817   September 2020

Abstract: A major focus of debate about rationing guidelines for COVID-19 vaccines is whether and how to prioritize access for minority populations that have been particularly affected by the pandemic, and been the subject of historical and structural disadvantage, particularly Black and Indigenous individuals. We simulate the 2018 CDC Vaccine Allocation guidelines using data from the American Community Survey under different assumptions on total vaccine supply. Black and Indigenous individuals combined receive a higher share of vaccines compared to their population share for all assumptions on total vaccine supply. However, their vaccine share under the 2018 CDC guidelines is considerably lower than their share of COVID-19 deaths and age-adjusted deaths. We then simulate one method to incorporate disadvantage in vaccine allocation via a reserve system. In a reserve system, units are placed into categories and units reserved for a category give preferential treatment to individuals from that category. Using the Area Deprivation Index (ADI) as a proxy for disadvantage, we show that a 40% high-ADI reserve increases the number of vaccines allocated to Black or Indigenous individuals, with a share that approaches their COVID-19 death share when there are about 75 million units. Our findings illustrate that whether an allocation is equitable depends crucially on the benchmark and highlight the importance of considering the expected distribution of outcomes from implementing vaccine allocation guidelines.

Covid has slowed transplants in the UK

The Evening Standard has the story:

Organ transplant waiting list jumps to five-year high due to pandemic, new NHS figures show

by Naomi Ackerman 

"The number people waiting for an organ transplant has soared to five-year high as a result of the coronavirus pandemic, new NHS figures have shown.

"NHS Blood and Transplant (NHSBT) said this week that an estimated 6,700 people are currently in need of a transplant across the UK - up from 6,138 prior to the start of the pandemic.

"The health body has estimated that the increase in patients waiting - expected to be the highest since 2015-16 - comes after services were impacted by the effects of the pandemic.

...

"It is hoped that the waiting list can be shortened going forward following the introduction of a new law in May, making organ donation "opt-out" rather than an active choice.

...

"The law will see that families are still consulted before organ donation goes ahead - the reason is why health officials have implored people to make their wishes about donation known to their families.

"NHSBT has said that thousands of "transplant opportunities" have been missed in recent years. In 2018-19, it reported that 835 families declined to support organ donation - with many families saying they did not know what their relative would have wanted."

***********

HT: Alex Chan

Economies in the Time of Coronavirus (in English and Chinese)

 Here's a short essay I wrote for the Luhohan Academy in June, published on their web site in July in English, and the Chinese translation in the Caixin online magazine.

Economies in the Time of Coronavirus

by Alvin E. Roth

Here's the first paragraph:

"Years from now we will look back on the Covid-19 pandemic as a source of much new information, not just about epidemic disease and how to manage it, but about structural features of the world’s economies that were made clearer by the crisis and how it was handled, both well and badly.  In the meantime, we can begin to speculate about what we will have learned when the pandemic is history, and what we must still learn to prepare for dealing with its continuation, and with future pandemics."

...

here's another paragraph:

"Testing policies will have to keep in mind what economists know well, which is that there may be perverse incentives in play. Some people will be very eager to return to work, and might be willing to do so even when they risk spreading infection. Others may be happy to work from home (especially if there is risk of infection at work) and may not wish to return to work even when they themselves do not pose a risk to others. And if those who have been infected and have recovered  (e.g. who test positive for antibodies) are treated differently than others, some people may feel a need to expose themselves to infection in order to enter this privileged class. So who conducts the tests, and how they are reported and recorded, will be important."

and here it begins in Chinese (but gated):

阿尔文·罗思：新冠疫情时期的经济与政策 

2020年07月17日 10:59

T中

为应对疫情，我们要完成一些当下和短期目标，而为下一次大流行病做准备，我们面临一些更长期的任务

　　文|阿尔文·罗思（Alvin E. Roth）

　　 

Politics and medicine, at Stanford and in Washington--an open letter from Stanford docs about corona virus policies

 Politics and medicine can combine poorly, particularly in a politicized pandemic.

Here's an open letter from over a hundred faculty at Stanford's Medical school, disowning the positions about pandemic policies taken by one of their former colleagues, now in Washington, by way of Fox News. (Here's the letter in full; to see the signatories click on the link...)

An Open Letter from Stanford Doctors [Update: the letter has been taken down from the Stanford medicine website, but here is another copy...]

"As infectious diseases physicians and researchers, microbiologists and immunologists, epidemiologists and health policy leaders, we stand united in efforts to develop and promote science-based solutions that advance human health and prevent suffering from the coronavirus pandemic. In this pursuit, we share a commitment to a basic principle derived from the Hippocratic Oath: Primum Non Nocere (First, Do No Harm).

"To prevent harm to the public’s health, we also have both a moral and an ethical responsibility to call attention to the falsehoods and misrepresentations of science recently fostered by Dr. Scott Atlas, a former Stanford Medical School colleague and current senior fellow at the Hoover Institute at Stanford University. Many of his opinions and statements run counter to established science and, by doing so, undermine public-health authorities and the credible science that guides effective public health policy. The preponderance of data, accrued from around the world, currently supports each of the following statements:

●  The use of face masks, social distancing, handwashing and hygiene have been shown to substantially reduce the spread of Covid-19. Crowded indoor spaces are settings that significantly increase the risk of community spread of SARS-CoV-2.

●  Transmission of SARS-CoV-2 frequently occurs from asymptomatic people, including children and young adults, to family members and others. Therefore, testing asymptomatic individuals, especially those with probable Covid-19 exposure is important to break the chain of ongoing transmission.

●  Children of all ages can be infected with SARS-CoV-2. While infection is less common in children than in adults, serious short-term and long-term consequences of Covid-19 are increasingly described in children and young people.

●  The pandemic will be controlled when a large proportion of a population has developed immunity (referred to as herd immunity) and that the safest path to herd immunity is through deployment of rigorously evaluated, effective vaccines that have been approved by regulatory agencies.

●  In contrast, encouraging herd immunity through unchecked community transmission is not a safe public health strategy. In fact, this approach would do the opposite, causing a significant increase in preventable cases, suffering and deaths, especially among vulnerable populations, such as older individuals and essential workers.

"Commitment to science-based decision-making is a fundamental obligation of public health policy. The rates of SARS-CoV-2 infection in the US, with consequent morbidity and mortality, are among the highest in the world. The policy response to this pandemic must reinforce the science, including that evidence-based prevention and the safe development, testing and delivery of efficacious therapies and preventive measures, including vaccines, represent the safest path forward. Failure to follow the science -- or deliberately misrepresenting the science – will lead to immense avoidable harm.

"We believe that social and economic activity can reopen safely, if we follow policies that are consistent with science. In fact, the countries that have reopened businesses and schools safely are those that have implemented the science-based strategies outlined above.

"As Stanford faculty with expertise in infectious diseases, epidemiology and health policy, our signatures support this statement with the hope that our voices affirm scientific, medical and public health approaches that promote the safety of our communities and nation."

*******

Here's a recent NY Times story on Dr. Atlas, a radiologist:

A New Coronavirus Adviser Roils the White House With Unorthodox Ideas

Dr. Scott Atlas arrived at the White House as a coronavirus contrarian, questioning controls like masks. He has angered top health officials while pushing a suite of disputed policy prescriptions.

By Noah Weiland, Sheryl Gay Stolberg, Michael D. Shear and Jim Tankersley,  Sept. 2, 2020

"Before joining the task force, Dr. Atlas pitched his ideas as a health commentator on Fox News, which is in part how he attracted Mr. Trump’s attention. His arrival at the White House has coincided with less visible roles for Dr. Birx and Dr. Fauci, the director of the National Institute for Allergy and Infectious Diseases."

**********

Of course, medicine isn't the only kind of science that has been caught up in Washington lately. (I write this from smoky California, where climate change seems quite real).

Nor is it the only part of medicine that has been caught up in politics around the world: I'm reminded of yesterday's post about the politics of global health care.  Science seems to be slowly gaining on politics there, and so I'm hopeful that's a general trend, although sometimes slow and uneven, with a high ratio of heat to light.

Human infection (challenge) trials for a covid-19 vaccine--Reason magazine interviews Josh Morrison (video)

 Reason magazine has a video story about human challenge trials, starring Josh Morrison, the founder of 1Day Sooner.  I make some comments as well.

 

 You can also find the video at reason.com here (along with a partial transcript), and on YouTube here.

**************

See all my posts on vaccines here.

Surrogacy in the time of covid travel restrictions

 The NY Times has the story:

Mothers, Babies Stranded in Ukraine Surrogacy Industry--Virus travel bans are wreaking havoc on surrogacy agencies that help same-sex couples build families  By Maria Varenikova

"In one of the more bizarre consequences of coronavirus travel restrictions, biological parents, babies and surrogate mothers have become scattered and sometimes stranded in multiple countries for months this year.

"Ukraine, with its relatively permissive reproductive health laws and an abundance of willing mothers among a poor population, is a hub of the international business, executives in the industry and women’s rights advocates say.

"But Ukrainian law bans surrogacy for same-sex couples or for clients who wish to select the sex of the child. In response, a branch of the Ukrainian industry began moving women to other jurisdictions for impregnation and birth, often to legal gray zones like the largely unrecognized, Turkish-backed, splinter state of Northern Cyprus.

...

"The women travel to have an embryo implanted, return to Ukraine for seven months of pregnancy, then travel again to give birth.

"Virus travel restrictions drew attention earlier this year for blocking heterosexual parents from retrieving their babies inside Ukraine. At one point, 79 babies were stacked up in Kyiv, cared for by nurses, in cribs at a hotel.

...

"It is a very common illegal business in such countries as Northern Cyprus, Transnistria, Abkhazia and other unrecognized statelets, said Sergii Antonov, a lawyer and authority on reproductive law in Ukraine.

"In Northern Cyprus, the Ukrainian mothers give birth without a legal surrogacy contract. Instead, they renounce custody after birth, which allows the genetic parents to adopt the children. It is a legal process that can stretch for several weeks.

"In February and March, 14 Ukrainian mothers, fearful of being stranded by virus travel bans, left Northern Cyprus after giving birth but before completing the transfer to the genetic parents, leaving behind a crop of babies in legal limbo.

The ethics (and some economics) of paying participants in Human Infection Challenge Studies, for a coronavirus vaccine

 

Here's a paper (that is perhaps not too long when you divide by the number of authors) seeking to provide some background for payment decisions in connection with  human infection studies (i.e. challenge trials) of covid-19 vaccines.

Lynch, Holly Fernandez and Darton, Thomas and Largent, Emily and Levy, Jae and McCormick, Frank and Ogbogu, Ubaka and Payne, Ruth and Roth, Alvin E. and Jefferson Shah, Akilah and Smiley, Thomas, Ethical Payment to Participants in Human Infection Challenge Studies, with a Focus on SARS-CoV-2: Report and Recommendations (August 14, 2020).  

Abstract: To prepare for potential human infection challenge studies (HICS) involving SARS-CoV-2, this report offers an expert analysis of ethical approaches to paying research participants in these studies, as well as HICS more broadly. The report first provides an overarching ethical framework for research payment that divides payment into reimbursement, compensation, and incentive, focusing on fairness and promoting adequate recruitment and retention as counterweights to ethical concerns about undue inducement. It then describes variables relevant to applying this framework to any type of study, including the prospect of direct medical benefit, early participant withdrawal, study setting and location, pandemic circumstances, study budget, and participant perspectives. We conclude that there is no need for a unique payment framework specific to HICS or SARS-CoV-2 HICS, but that there may be features of particular relevance to ethical payment for these studies. Participants have varied motivations for enrolling in HICS, including financial considerations, altruism, and other interests, but undue inducement does not seem to be a significant problem based on available evidence. Payment in these studies should reflect the nature of participant confinement, anticipated discomfort from induced infection, risks and uncertainty, participant motivations, and the need to recruit from certain populations, as relevant. Where HICS involve significant risks and highly contingent social value, special review confirming the ethical permissibility of these studies can help promote confidence in the ethical permissibility of offers of payment to participate in them. We do not propose specific payment amounts for potential SARS-CoV-2 HICS, as these will be highly variable based on the relevant factors described in the report. Instead, we note that it is reasonable to start from payments offered in other similar studies, while adopting a systematic approach based on the ethical framework herein, as reflected in a pragmatic payment worksheet describing goals, coverage, factors to consider, and potential benchmarks.

Organizing tests of drugs to treat, and vaccines to prevent, coronavirus

 Here's a story on some of the difficulties in drug testing: among the difficulties are that positive test results for infection are taking too long after testing to allow prompt treatment...

Clinical Trials of Coronavirus Drugs Are Taking Longer Than Expected  By Katie Thomas

Aug. 14, 2020

"Antibody trials sponsored by Regeneron and Eli Lilly are off to a slow start because of a dearth of tests, overwhelmed hospitals and reluctant patients."

...

"While much of the world’s focus has been on the race to create a coronavirus vaccine, new drugs could also help curb the pandemic by making the disease less deadly. Because drugs are typically tested in sick patients in smaller clinical trials, they can also be developed more quickly than vaccines.

...

"The fast-moving disease has presented opportunities and challenges for the researchers testing antibodies. As the number of infections mounted in states like Florida, Texas and Arizona, there was no shortage of patients who would be eligible for trials. But at the same time, the outbreaks overwhelmed the very hospitals that would be overseeing the studies.

...

"“That doesn’t happen when you’re setting up diabetes trials or cancer trials,” he said. “We’ve had investigators say: ‘Look, I’d love to do research, but I don’t have time to set up a new trial. I’ve got an I.C.U. full of patients.’”

...

"Both the Regeneron and Eli Lilly trials require giving the drug within three days of taking a positive test.

"But with turnaround times in some areas lagging for five days or more, keeping within those time frames has proved difficult."

**********

With conventional (non-challenge) vaccine trials, having a high level of infection is important, to allow the effectiveness of vaccine candidates to be tested.  So, Brazil (and the U.S.):

 Coronavirus Crisis Has Made Brazil an Ideal Vaccine Laboratory  By Manuela Andreoni and Ernesto Londoño  Aug. 15, 2020

"Widespread contagion, a deep bench of scientists and a robust vaccine-making infrastructure have made Brazil an important player in the quest to find a vaccine."

...

"Some 5,000 Brazilians have also been recruited to support a vaccine trial conducted by AstraZeneca, a British-Swedish pharmaceutical company in partnership with Oxford University. An additional 1,000 volunteers in Brazil were recruited to test a vaccine developed by New York-based Pfizer.

"Researchers need countries with large enough outbreaks to assess whether a vaccine will work. Some volunteers are given the potential vaccine while others are given a placebo, but they have to be in a place where enough virus is circulating to test the vaccine’s efficacy.

"Brazil, where the virus has infected more than three million people, has clear conditions for these trials. And it will be the only country other than the United States to be playing a major role in three of the leading studies as an unparalleled quest for a vaccine has led to unusually fast regulatory approvals and hastily brokered partnerships."

Social distancing during the plague

 The Washington Post has the story (as a tourist destination...)

Restaurants in Italy are reopening ancient ‘wine windows’ used during the plague

The coronavirus pandemic has inspired a comeback for the socially distant invention.

By Natalie B. Compton Add to list

"In the 1300s, Europeans lived in fear of the plague claiming lives across the continent. In 2020, Europeans face the threat of the coronavirus, a pandemic that has killed more than 728,000 worldwide.

..."Between the wrath of the Black Death in the 1300s and the Italian Plague in the 1600s, wine merchants in the Italian region of Tuscany built “wine windows” to protect buyers and sellers from coming into close contact."

"The socially distant precaution was ahead of its time."

Is convalescent plasma useful for treating covid-19?

The reported results on convalescent plasma are so far still quite incomplete, and mixed.  If I had to summarize, I'd say that a growing body of evidence suggests that treating early stage (e.g. just hospitalized) covid-19 patients increases and speeds the chance of recovery, while there is little convincing evidence that convalescent plasma helps more severely ill patients who have begun to have serious complications.

Here is a recent WSJ article:

Convalescent Plasma Reduced Death Rate Among Covid-19 Patients, Study Data Signals

Hospitalized patients who got earlier transfusions of blood plasma rich in antibodies to the coronavirus show a lower mortality rate

By Amy Dockser Marcus

"Hospitalized Covid-19 patients who received transfusions of blood plasma rich with antibodies from recovered patients reduced their mortality rate by about 50%, according to researchers running a large national study.

...

"The researchers said they saw signs that the treatment might be working in patients who received high levels of antibodies in plasma early in the course of their illness. They based their conclusions on an analysis of about 3,000 patients."

************

Here's a recent paper in JAMA on a very small randomized trial in China that doesn't find statistically significant effects on patients who 

August 4, 2020

Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial

Ling Li, MD, PhD; Wei Zhang, MD; Yu Hu, MD, PhD; Xunliang Tong, MD, PhD; Shangen Zheng, MD; Juntao Yang, PhD; Yujie Kong, MD; Lili Ren, PhD; Qing Wei, MD; Heng Mei, MD, PhD; Caiying Hu, MD; Cuihua Tao, MD; Ru Yang, MD; Jue Wang, MD; Yongpei Yu, PhD; Yong Guo, PhD; Xiaoxiong Wu, MD; Zhihua Xu, MD; Li Zeng, MD; Nian Xiong, MD, PhD; Lifeng Chen, MD; Juan Wang, MD; Ning Man, MD; Yu Liu, PhD; Haixia Xu, MD; E. Deng, MS; Xuejun Zhang, MS; Chenyue Li, MD; Conghui Wang, PhD; Shisheng Su, PhD; Linqi Zhang, PhD; Jianwei Wang, PhD; Yanyun Wu, MD, PhD; Zhong Liu, MD, PhD

  JAMA. 2020; 324(5):460-470. doi: 10.1001/jama.2020.10044

Abstract: This randomized trial compares the effects of convalescent plasma therapy with standard care vs standard care alone on time to clinical improvement among patients with severe or life-threatening COVID-19 disease in China.

"Among patients with severe or life-threatening COVID-19, convalescent plasma therapy added to standard treatment did not significantly improve the time to clinical improvement within 28 days, although the trial was terminated early and may have been underpowered to detect a clinically important difference."

**********

My last donation had high enough antibodies to qualify me for another: I hope these are going to patients for whom they will be useful.

Josh Morrison and health policy activism: kidneys and covid

Here's a profile of Josh Morrison, one of the most interesting health care policy activists I've encountered.  I first met him when he was the general counsel of the kidney exchange organization The Alliance for Paired Kidney Donation, and since then he's created new organizations (with evocative names) and new policies.

One Man’s Quest to Infect People With Covid-19 for Science

Inside the movement to launch a human challenge trial for Covid-19

by Andrew Zaleski

"Morrison donated a kidney in 2011, months into his job as a corporate attorney. A few years later he abandoned the law for a more mission-driven career helping people find kidney donors, eventually starting the nonprofit Waitlist Zero in 2014.

"In his telling, his parents “really hated” the idea of being a live organ donor. What he’s planning next terrifies them: Morrison wants to give himself Covid-19 for the sake of science.

...

"The 35-year-old from Brooklyn is the leader of 1Day Sooner, a grassroots organization he co-founded in the spring with a radical idea: Speed up vaccine testing by giving the coronavirus to willing recruits. Including Morrison and his co-founder, 22-year-old Stanford human biology graduate Sophie Rose, more than 30,000 people from 140 countries are signed up — a pool of applicants offering to enlist in what’s known as a human challenge trial.

...

"Human challenge trials involve deliberately infecting small groups of vaccinated volunteers. In a time of social distancing, mask-wearing, and the public’s general leeriness of contracting Covid-19, some researchers, doctors, and ethicists say challenge trials are worthwhile. Unlike traditional Phase 3 clinical trials, which sign up thousands of participants, inject some with a vaccine and others with a placebo, and then wait for people to encounter the virus in everyday life, there’s no waiting on people to catch a virus in a challenge trial. This means it can be completed in weeks instead of months or years, potentially yielding data on vaccine efficacy much more quickly.

"On July 15, human challenge trials for the coronavirus received their biggest endorsement. Adrian Hill, director of the Jenner Institute at the University of Oxford in the U.K., announced that Oxford scientists — already hard at work on a promising coronavirus vaccine — want to launch a challenge trial."

Stanford campus in lockdown--pictures

Stanford is under-crowded in these coronavirus lockdown days of July...

Open letter supporting human challenge trials for COVID-19 vaccines

Here's the website of the advocacy organization 1 Day Sooner (where you can read about human challenge trials, and volunteer for one). It was founded by Josh Morrison (who also founded the kidney transplant donor advocacy organization Waitlist Zero) and Sophie Rose.

Here's the open letter they recently sent to Dr. Francis Collins, at the National Institutes of Health
 Challenge Trials for COVID-19

Here's the press release:
1Day Sooner Open Letter Press Release
"15 NOBEL LAUREATES, OVER 100 PROMINENT FIGURES, AND OVER 2,000 1DAY SOONER VOLUNTEERS SIGN OPEN LETTER TO DR. FRANCIS COLLINS IN SUPPORT OF COVID-19 HUMAN CHALLENGE TRIALS

"Adrian Hill, Director of the Jenner Institute at the University of Oxford, writes that “Oxford’s Jenner Institute and 1Day Sooner are collaborating on work towards the production of a COVID-19 human challenge virus,” and “collaborative human challenge studies should be feasible and informative in the coming months.”

I'm one of the signers of the open letter, and the quote that goes along with my picture in the press release is
“A safe and effective vaccine will be incredibly valuable, and the sooner the better.  Challenge trials make sense. We should prepare carefully, and proceed bravely and gratefully.”
************

Earlier posts:

Friday, May 29, 2020

Human Challenge Trials for COVID-19 vaccines

Friday, May 8, 2020

Human Challenge Trials (aka Controlled Human Infection studies) for corona virus vaccines

The fall and rise of food supplies in Covid-19 India, by Matt Lowe and Ben Roth

Pandemic lock downs gave food supply a shock in Indian markets, but they have recovered.

COVID Lockdown: How India's Food Supply Chain First Tightened and then Recovered
"Food supply shortages, if any, are driven by state level policy making, rather than consumers’ and suppliers’ fears of contracting COVID-19."
by Matt Lowe and Ben Roth

"In mid-April, the supply of fruits and vegetables at Azadpur, Asia’s largest fruit and vegetable market, had fallen about 50% since the start of India’s nationwide lockdown.

Two months later, updated nationwide data shows that India’s food supply chain appears to have recovered, operating at levels comparable to the same time last year. The story of the recovery is best told with four food facts, the sum of which tell its own tale of governance during the COVID-19 pandemic times.

Food fact 1: Food volumes took a huge hit post-lockdown but have steadily recovered.

...

Food fact 2: Food prices increased post-lockdown but have steadily fallen.

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Food Fact 3: The early disruption to the food supply chain was highly correlated with the incidence of COVID-19 at the state level, but all states appear to be recovering.

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Food Fact 4: Within states, there was no relationship between the incidence of COVID-19 and the health of the food supply chain, even in phase 1.

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Earlier post: 

Thursday, April 16, 2020

Corona lockdown, and the food supply chain in India, by Matt Lowe and Ben Roth

Pandemic policies work differently in different places

Here's a recent largely empirical paper by many authors, looking at the actual and counterfactual impact of different pandemic responses in different cities, with the aim (among others) of mapping the employment/mortality frontier of different policies.  They build on GPS and payment data for modeling movement and interpersonal contact, and electronic health records for hospitalization and deaths.  Thus, for example, they find that in Chicago, different policies can make big moves along the employment/mortality frontier (allowing only essential workers to go to work reduces deaths and increases unemployment, both by a lot), while in a more sparsely inhabited city like Sacramento, it's hard to change the mortality rate (but only allowing essential workers still causes lots of unemployment).

Socioeconomic Network Heterogeneity and Pandemic Policy Response
Mohammad Akbarpour, Cody Cook, Aude Marzuoli, Simon Mongey, Abhishek Nagaraj, Matteo Saccarola, Pietro Tebaldi, Shoshana Vasserman, Hanbin Yang
NBER Working Paper No. 27374
Issued in June 2020

Abstract: "We develop a heterogeneous-agents network-based model to analyze alternative policies during a pandemic outbreak, accounting for health and economic trade-offs within the same empirical  framework. We leverage a variety of data sources, including data on individuals' mobility and encounters across metropolitan areas, health records, and measures of the possibility to be productively working from home. This combination of data sources allows us to build a framework in which the severity of a disease outbreak varies across locations and industries, and across individuals who differ by age, occupation, and preexisting health conditions.

"We use this framework to analyze the impact of different social distancing policies in the context of the COVID-19 outbreaks across US metropolitan areas. Our results highlight how outcomes vary across areas in relation to the underlying heterogeneity in population density, social network structures, population health, and employment characteristics. We find that policies by which individuals who can work from home continue to do so, or in which schools and firms alternate schedules across different groups of students and employees, can be effective in limiting the health and healthcare costs of the pandemic outbreak while also reducing employment losses."

Market designers and ventilator allocation, by Pathak, Sönmez, and Ünver

I recall when a big part of practical market design was explaining to skeptical listeners why they should listen to economists...

June 19, 2020
Improving Ventilator Rationing Through Collaboration With Experts on Resource Allocation
Parag A. Pathak, PhD1; Tayfun Sönmez, PhD2; M. Utku Ünver, PhD2
JAMA Netw Open. 2020;3(6):e2012838. doi:10.1001/jamanetworkopen.2020.12838

"In our study of ventilator rationing guidelines,2 we have not seen task forces include input from experts on market design, a field of economics that studies the allocation of scarce resources. In many settings, price plays a central role in allocation when demand exceeds supply; however, this instrument is often not available in public health emergencies with extreme scarcity. During the last 2 decades, substantial research activity and policy developments have taken place regarding allocation environments where price-based tools are either unavailable or considered repugnant. Two noteworthy examples are the organization of kidney exchanges in the US and the assignment of seats at public schools. Because research in market design incorporates ethical considerations and operationalizes these objectives with an allocation mechanism, scholars in this field can be valuable for transforming various trade-offs between ethical principles into specific allocation procedures."