Fix this now

I just checked clinicaltrials.gov. Right now, it seems that remdesivir is only anti-corona drug in US clinical trial. That is crazy.  Here is some China action.

Fix this now.  I mean you!

Comments

Drano might something to try.

I’m starting clinical trials of Irish whiskey.

That is some real prescience since the trial started decades ago.

I'm all for establishing a rum ration for medical providers. I suspect they'll need it.

Real men drink Scotch not that weak Irish crap.

We pay the most for healthcare because it makes our industry more innovative they told us but the socialists and communists in Europe and Asia are more innovative at least when it comes to the coronavirus than the United States and most of them have single payer, universal coverage. This is a sad development to the US's ideological thinking that is failing to be pragmatic.

The comet song:
https://youtu.be/BcDQ99N0-Ds

Before virtue signaling about sexy new drugs, America should address its toilet paper situation first. The USA is rapidly devolving into a 3rd world country. Americans can't even wipe their own asses in the 4th year of the Trump presidency.

We do the fixing we want to do, and not the fixing you want us to do.

Vote Trump.

Or not vote Trump. Jack Ma is sending 500k test kits to the USA. Hilarious that the once pround US is now taking handouts from communists for our broken ass healthcare system!

https://thehill.com/policy/healthcare/487535-chinese-billionaire-to-send-us-500000-coronavirus-test-kits-1-million-face

You? Could you be more specific?

Exactly. We're a bunch of useless center-right econ nerd libertarians with no real world skills. We can't create cures, give treatment, or solve any of the real problems. But we are good at talking about them on the internet.

Perhaps Trump is just trying to make social security solvent without cutting benefits.

#BoomerRemover

Been reading through BioRxiv on related publications for possible therapeutic options, almost all from Europe and Asia. Looking for stateside scientists working on this (I can help in bioinformatics, computational modeling, pharmacology)

America cut its funding to NIH and science in general so it is no surprise that we are firing blanks. We have a glut in PhDs but society has no place for them sadly. Imagine how useful they could be if they were supported by institutions like the ones in Asia and Europe. Something like this is more effective when there's steady funding. The contest and prize approach that this site likes isn't going to cut it here. Researchers have monthly bills to pay not random bills to be paid in event of lottery-like earnings that might not ever appear.

NIH and CDC funding have been both going up, not down. Funding additional bureaucracy no doubt.

NIH and CDC funding have been both going up, not down. Funding additional bureaucracy no doubt.

The glut issue is a separate discussion (maybe there should have been less trainees in my PhD program), but along those lines our "idle capacity" could readily work on urgent issues like this, although I fear some brain-drain of consulting and VC (biased by Cambridge/Boston area here) may sap some of the ability and energy.

As for compensation, that argument generally doesn't apply in emergency and disaster recovery efforts. Again, a separate discussion we would probably generally agree on (scientist compensation, agency funding, etc), although bigger barriers to respond in these situations come from data use/access (from my own experiences)

The US Government should offer to buy a patent for an effective treatment or vaccine for a rather vast sum of money. Probably a number of dollars with eleven decimal digits.

Does eminent domain apply to intellectual property?

Yes something like eminent domain does apply to IP. It is sometimes used for things with military applications.

I'd settle for just allowing the treatment or vaccine to gain fast-track approval.

Until circa 1980, government paid for a huge fraction of the patents on the most economy changing inventions, which were mostly in the public domain, the rest were top secret. If you were granted an important patent, the military might classify it as secret, but you were entitled to payment for use under the laws that mandated licensing after the disaster of the Wright Bros refusing to license their patents, which meant Europe leap ahead in aviation.

Since 1980, government funding of invention has been cut as a share of GDP, and patents paid for are not always in the public domain. This was supposed to increase the rate of invention, innovation, and reduce the price of new innovation. Instead it has increased prices and slowed products coming to market from the US, basically back to the Wright Bros era. Note, the Weight Bros tried everything they could to get the Federal government to fund their innovation after they got the key initial patents they hoarded. Socialize the cost, privatize the profiit.

I do a lot of MC for the industry:

The only things even worth Phase 1 trialing at this point are already known antiviral drugs that attack the ability of similar viruses to multiply.

Even in an emergency situation it would be 8-18 months until the FDA approved an antiviral that was effective. There’s a failsafe, people like “sure” giving antiviral drugs to patients “off label” but it won’t happen until it’s shown to be effective. For good reason, and we should trust doctors like “sure”.

SARS and MERS were mostly not treated with antivirals, but instead attempting to prevent deaths via ventilation.

The cure for this disease is a high trust society with a functional non-rent-seeking public sector that can enforce public health measures while ensuring wage workers don’t suffer.

The cure for this disease is Singapore or Taiwan. The US is so far gone down the rabbit hole it’s guaranteed to fail. Low trust societies fail, always.

This: "Low trust societies fail, always."

Since when has Chinese society been considered high trust?

Or Singapore, for that matter? Very multiethnic, lots of government control, urban...somehow I doubt that's what Skeptical is advocating for.

People like Skeptical are extremely flexible, and always able to adjust the cut of their jib according to whatever whim is floating around at the moment.

Here's a politically incorrect answer but China ex Hubei is handling the crisis relatively well considering ground zero is right in the middle of the country. Japan has a population older than Italy and they too are doing okay. One is low trust and the other high trust. What do they have in common? Effective government response and a population that is experienced in epidemics. In the States, we have neither.

There is nothing more tragic than seeing someone lose their faith in public.

But don't worry, once America gets its act together, it will be amazing, and really beautiful.

I'm not sure what needs to be fixed. The blunt fact is antiviral research is very difficult and what works with one virus is not going to work with another one. There is also a lack of animal models for testing purposes. Derek Lowe's blog is the best resource for current research on corona virus: https://blogs.sciencemag.org/pipeline/ and he has posts on both small molecule and biological research on COVID. Look how long it took to develop oseltamivir for seasonal flu. It's not a panacea and has to be given very early in infection to do anything clinically. there has been much more success treating Hepatitis C but that virus doesn't pose the same morbidity/mortality issues that COVID-19 does.

Yep, Hep C is much worse, just slower so it can infect far more people, but that's true for all diseases that have serious and often fatal consequences.

An estimated 3.5 million in the US have active Hep C indicating perhaps 5 million cases based on the rate it is chronic, and each year about 20,000 die from Hep C complications. For all cold and flue infections, the annual population infected is a hundred million plus, and 100% have been infected more than once, but the number of deaths from complications is only 56,000 or so, certainly less than 100,000.

Maybe your point is a few dozen very rich people can fund drugs to treat their Hep C before they die decades later, but it's impossible to fund decade of research in the less than 50 days of life between infection with the common viruses and death, which include SARS, MERS, et al.

Still, Hep C treatment drugs are not profitable without big government big spending, and none would exist without hundreds of millions in annual government spending on Hep C research for several decades.

step one - fix clinical trials dot gov

An alternative graph, based on deaths, says the US is doing better than most. Almost as well as S. Korea

https://twitter.com/paulnovosad/status/1238276434956890113?s=19

Avoid gatherings.

I suspect that this a delay in reporting rather than an indication of what is being trialled. I suspect also that doctors mights conducting a lot of N=1 trials as well, repurposing existing products to treat life threatening presentations

Three potential anti-COVID19 medicines have been officially announced by Chinese authorities.
The first anti-viral drug for Coronavirus disease 2019 (COVID–19), also known as 2019-nCoV acute respiratory disease, has been approved for marketing by the National Medical Products Administration since the outbreak. Developed by Zhejiang Hisun Pharmaceutical Company, the drug is expected to play an important role in preventing and treating the outbreak which has now infected 70,553 in China (1,772 deaths), the government said on its official WeChat account.

more on

https://www.zmescience.com/science/first-antiviral-drug-coronavirus-0423/

How about we first get the diagnosis right before we do the therapy? CDC botched the first release of test kits with the wrong reagents. CDC also botched it again by directing that tests be performed initially on those from China, then Italy and Iran...instead of being based on clinical evidence.

Your comment is certainly crazy.

First a likely cure has to be discovered. Running a trial costs many millions, and there is always the risk of causing more harm than good in those taking part. This is not nearly as easy as getting an economics paper published.

Some level headed, expert opinion here:
Covid-19 Small Molecule Therapies Reviewed
and here:
Covid-19 Biologic Therapies Reviewed

Thanks, good summary. It looks like there are no magic bullets out there. Remdesivir may have some efficacy if taken early in the infection.

A claim that vitamin D supplementation has protective effects against acute respiratory tract infections.
https://www.bmj.com/content/356/bmj.i6583

I wouldn't say "crazy". I'd say astoundingly ignorant and stupefyingly hysterical. Although, it is possible that this added stress has tipped him into non-compliance with his prescribed antipsychotics...

Here is one vaccine being fast-tracked:

https://www.livescience.com/coronavirus-vaccine-trial-no-animal-testing.html

along with requisite Orwellian critique that such fast tracking reflects "pressure to suspend rights". I guess he thinks our right-to-try threatens some right-to-be-protected-from-accessing-treatments-and-vaccines. Critics also don't want to "burden people [volunteers, actually] to be in a study if the intervention is not going to help". I guess burdening all of society with months of social distancing, effectiveness still to be determined, is fine. Btw, under the normal process, "vaccine development can take 15 to 20 years, start to finish."

There has never been a vaccine like Moderna's that has been licensed or tested in humans. The platform technology has been known for several years and the knowledge that a pandemic would hit sooner or later was a good argument for doing some preliminary safety testing and whether the vaccine elicits antibodies. This could have been done on the quiescent MERS or SARS viruses that are similar to the current COVID variant. The fact that it was not done is a failure of imagination and will ultimately cause delays.

And this is posted on the clinical trials site so maybe TC's search abilities are lacking:
https://clinicaltrials.gov/ct2/show/NCT04283461

Why are you checking US clinical trials to see if an drug treat is available for one of many very common viral infections?

Most of the global population is outside the reach of either the US regulatory system or the European regulatory system.

You should be checking what treatments are on the market in Asia, Africa, Eastern Europe.

We live in a global market which means innovation, research, and development is competitive with opportunity available to 7 billion people, not just the 5% in the US, to deliver an "anti-corona drug" to the market.

Why don't you trust the market which is predicting that a anti-viral drug is either impossible, or not worth the cost if one is possible?

What are you when asking the question? A leftist, big government, high tax and big spender, central planner?

It is interesting that, in recent times, many have implored us to defer to scientific experts. However, many of those same people think we should defer to government bureaucrats at the FDA over the scientific and medical experts that actually develop drugs. #TrustAllScientists but #TrustGovernmentMore?

In the kindest way, I think you are somewhat overestimating your commentariat.

It is possible that one of the more interesting effects of a pandemic are starting to be seen, effects that are then forgotten regardless of how well documented at the time, qua the madness of crowds.

I'm going advocate the British approach, but with the modification of public distributions of free Xanax.

I like that. +1 or whatever. Enough anti-anxiety pills no one will worry about it.

This reminds me of the time in 2009 when Tyler was completely freaked out about H1N1, and literally could not post about anything else.

Oh wait....

Who wants to gamble? Which will kill more Americans, H1N1 or the Wuhan Virus?

The fact that you have to think about it speaks volumes.

I'll bet you this virus will create more dirty asses by the end of the week than H1N1 ever did.

Of course Tyler freaked out about the N1H1 virus! He's an historian, not a biologist.

Wikipedia says the 2009 H1N1 pandemic killed 12,000 people in the US.

COVID-19 will kill many more than that in the US. It's not a flu, but it's much more comparable to the 1918 flu than the 2009 flu. Chinese-style containment measures will first be infeasible, and then too late.

This reminds me of the time in 2017-18 when you were completely freaked out about the death rate of the flu season. "On February 10, 2018, Fortune reported that influenza in the United States was killing up to 4,000 Americans a week, likely to far outstrip the rate of deaths in the 2009–2010 season"

Really, it is amazing to think that Hannity viewers are better informed than you. "Another ploy of Hannity’s is to compare the coronavirus to the flu, even though experts have noted that the former is about 10 times more fatal than the latter. “Now, let’s put this in perspective. In 2017, 61,000 people in this country died from influenza, the flu. Common flu,”

The 2017 flu is over and 61,000 is its 'final score'.

If 10M people get a virus with a 0.6% mortality rate (lower figure from S. Korea where they seem to be on top of it), that's 60,000 people. But in 2017 it wasn't 10M who got the flu, it was 45M. That would be 270,000 deaths.

And that's 270,000 *more* deaths. It's not like the flu has said "OK guys, I'm taking this year off to vacation with my wife and kids, my cousin Covid-19 will do the job this year". People are still getting killed by the flu (as well as diabetes, cancer and everything else).

If the mortality rate is 3% rather than 0.6%, you're talking about 1.350M deaths. WWII was 400K+ deaths spread over years. If that many Americans die before the year is out you are looking at a huge change in our culture.

Hannity makes about as much sense as someone on 9/11 noting how many people die in car accidents each year.

It's more about having a bit of perspective about it. And that's in short supply.

Economists are so qualified in pharmacology and drug interactions that we should just rely on their judgment.

I wouldn't buy medication from an economist

I have a difficult time swallowing their advice.

And the lay person is so knowledgeable about all of economics, including the unpopular part about budget constraints, that he should ignore economists' thinking.

And which doctor can I trust to not shade his or her clinical decisions in favor of their own income?

And which public health official can I trust to not make decisions insulating him or herself from risk rather than the general public?

Must I go on?

Yes, ignore economists they are intellectual idiots.

A doctor that doesn't want to go to jail.

An official that wants to keep their job.

No. Stop while you are ahead.

Watch that budget constraint! :-)

TC has just written in the following post about testing that the price of tests will be zero, and they will be available in apparent infinite supply.

Trust an economist to make a mockery of economics better than anyone else.

https://nypost.com/2020/03/14/hoarding-bros-hoping-to-profiteer-off-coronavirus-stuck-with-17k-bottles-of-hand-sanitizer/

Anyone see this ?

Yeah but the crowd here thinks price-gouging is doing the Lord's work.

There are something like 60 clinical trials going on in China. Chloroquine (malaria treatment) was apparently so effective that the Chinese immediately adopted it as a part of their standard treatment, before the trial could finish.

I believe South Korea is using a version of chloroquine as well.

There are a little over 200 viruses known to infect humans.

Vaccine research is conducted constantly, yet we only have vaccines for (IIRC) around 25 - all of which have varying degrees of effectiveness and many of which have to be tweaked often because the virus they are supposed to protect against has changed in some way.

The level of hubris required to demand that a vaccine for *your* virus be created *right now* is pretty damn high - like Everest high...

And I am afraid that no amount of begging, pleading, force, prize money, or anything else is going to help. This is one of those real life problems that you can't simply throw money at and make it go away - or cover it up.

It doesn't just happen to poor people or people in some God forsaken village on some far away continent. It doesn't care about what you want or how much money you have or how much you donated to some cause or how much you've virtue-signalled on Facestwitsteagram.

It is going to do what viruses do:
It's going to be fruitful and multiply.

Until it's run out of places to do so.

LOL. You can't just decree things into existence like Trump's fake news about Google. Economists are clueless about how things really work. You pushed for idiotic policies that rewards investment banks, private equity, and hedge funds but left table scraps for actual science. Now you have a nation of house flippers that can't even do basic science. Sadly your health care is the world's costliest and is the world's worst value. Your laughable pandemic response is to tell everyone to wash their hands and wait until April. You reap what you sow and no the markets won't fix it. What's broken is your thinking. You have to fix that now.

Studies, however, are not the only source of knowledge. Just about any drug that's on the market can be used off label and doctors have been trying off label drugs like tamiflu. In addition a host of studies was reportedly launched in China (until recently they had almost all the cases after all). Whether or not they get registered on clinicaltrials.gov in a timely manner is an issue but action is happening here.

I thought the antimalarial medicine chloroquine with the HIV drug Kaletra was showing some positive results in Chine

Since this is now global, multiple experiments for cures can take place, and breakthrough might come from less regulated places. I don't know how much stock to put in this, but the hospital is well known in that part of the world: https://timesofindia.indiatimes.com/city/jaipur/city-docs-cure-corona-patient-with-hiv-drugs/articleshow/74584859.cms

I would pay closer attention to the agents being studies. China is taking a throw everything at the wall and see what sticks. Lots of those drugs are anti-cancer meds that don't make sense for patients who are not severe.

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