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The DQYDJ Weekender - June 7, 2020

August 22nd, 2020 by 
PK

It's been a minute since our last Weekender. Unfortunately, since then, tragedy hit our family directly – I lost my grandmother to COVID a couple of weeks ago.

It's the story you've sadly heard before – supposedly, a staff member who later tested positive for COVID-19 brought it into her nursing home. They had been locked down since early March. 

Tragically, we've since heard that more than twenty residents have died at this point, in a roughly 90-120 bed home.

My Grandmother

I'm the oldest on that side of the family. Family lore claims when my mom brought me to meet her the first time, my grandmother tripped in excitement, and I was only saved from dropping by a stool in between her and my mom. (Our later interactions were much better!)

She unknowingly deserves a lot of credit for my early electronics and computer explorations. She used to find random junked computers and electronics from her town job and yard sales for me to tinker with and (usually) break. 

Inevitably, I got better. After I fixed her printer in middle school, she delivered the funniest compliment I've ever received: "I have mixed feelings when you're around – I never end up upgrading anything." 

We got a good laugh out of that one. (I hope you do too!) 

And it's not apocryphal – my wife can confirm, my grandmother told her that story the first time they ever met.

Nana was 87. Rest in peace.

Treatments and Vaccines

Some of the treatments we've talked about in the last few Weekenders have moved into prime time.

As of today, the NIH's standard of care (last updated May 12) includes Remdesivir. It's the only drug we have high-quality proof of efficacy – and it's maybe a 20-30% improvement. Convalescent plasma – plasma from recovered donors, presumably loaded with antibodies – also works well, but it's in short supply.

If I have one call to action from this post, if you recovered from COVID-19 – please consider donating. Your antibodies are legitimately the best treatment hope we have to date.

A Word on HCQ and CQ

Gin and tonic with lime
Politics and jokes of HCQ aside, there's still no substantial proof for or against the quinine-relatives in COVID.

We need to talk about these two, of course. And at this point, we've probably all heard about them...

Hydroxychloroquine and chloroquine (and related molecules, e.g., quinine... I hear your gin & tonic jokes) – the jury is still out. Currently, the NIH's stance is "insufficient clinical data to recommend either for or against." Read more of the details here and note that as of today, there are 58 clinical trials still ongoing or recruiting for the two (!).

I do hope the CQ/HCQ debate isn't "sucking the oxygen out of the room," at least vis a vis other promising drugs. The discussion is helplessly politicized at this point – between the president taking HCQ prophylactically and various sites actively rooting for or against efficacy (let that sink in), you need to short-circuit your usual information gathering for these particular molecules. 

(Present company included? Probably – read pre-prints straight off BiorXiv and watch the NIH).

I guess: watch the NIH's treatment guidelines and don't listen to screaming headlines. It isn't good, folks.

The Politicization of Drugs

In perhaps the most high-profile retractions since Andrew Wakefield's vaccine & autism studiesthe Lancet and New England Journal of Medicine pulled studies relying on the data from a company called Surgisphere which showed hard-to-believe and – allegedly, yet convincingly – fraudulent data arguing against the efficacy of HCQ and against the negative associations with ARBs and ACE inhibitors.

If it turns out some of this data is straight-up fabricated against certain drugs – even in prestigious journals with high-powered reviewers... who can you believe?

That's rhetorical, by the way. Keep getting your vitamin D, Zinc, and C, keep the weight off, and hope for new, better treatments.

(And if you recovered, donate your plasma!)

And where do I sit? I'd personally take Remdesivir over HCQ, if I had the choice and with what I know today, June 7, 2020. Who knows, tomorrow.

Why's that? All of the studies we have seen so far don't show much effect one way or another. Surgisphere aside, one UK trial also recently halted HCQ treatment due to a lack of improvement. Even if we later see HCQ/CQ/etc. show improvement, it doesn't look like a magic bullet in COVID-positive patients from here. I hope I'm wrong.

Of course, I'm guardedly optimistic it could work as a prophylactic of sorts, but it's obvious now that HCQ's no silver bullet.

Vaccines

Vaccines are a more hopeful topic. And let's be frank: if the top drugs are showing only 20-30% improvement (or barely showing signal despite many trials), we need vaccines, not arguments over treatment.

I'll outsource my vaccine commentary to Derek Lowe's In The Pipeline blog, which is an excellent read, especially now.

Here are ones to watch:

(May all of them "win"!)

Significantly, they're all ramping production before we make it through stage II and III trials. That means that once we see a signal – whenever that is – the companies and their distributors will be able to mail out many doses instead of only scaling production later.

Now, unless you're a first responder, any initial doses probably don't have your name on them – even if everything goes perfectly and emergency doses come this winter. 

But like we discussed last time, some people have more contact than others. Vaccinating a doctor, nurse, police officer, or similar first responder reduces risk more than someone sitting at home musing on their website (uhh...).

Masks

Yeah, they still work. I can't believe how much we argued over this.

The Annals of Internal Medicine retracted a study claiming surgical and cotton masks didn't reduce transmission of COVID-19 – an oft-cited study mask skeptics used in the early days of the mask argument.

They work, folks. Mask up, don't touch your face, and enjoy lower R0. And no, they probably don't help as much outside – don't exercise outdoors in an N95 or anything. 

But if you are going to a recently reopened business, bring a mask.

A Tough Year in America

After my grandmother died, I went dark on news and social media – and missed the beginning of the George Floyd protests

Racial disparities in policing have been an issue for a while – certainly well longer than I've been alive – and the video of Mr. Floyd's treatment was painful to watch. I can only hope that through these protests – and increased national attention – the country finds lasting, durable changes... and we can start to heal our wounds.

It's been a heavy few weeks, talking to my friends and coworkers while mourning my own loss. May we find ourselves in better days soon.

The WSJ has a list of initiatives, training changes, and legislation at the national, state, and local level to read through.

Can We Reset 2020?

This is a sad update, but – per tradition – my view of next year is optimistic. If 2020 leads to durable changes in race relations, a potent COVID vaccine, heightened awareness of public health, a new period of economic prosperity, and a boon in space exploration, 2021 will be a great year. 

(And we can start to put this terrible year behind us).

I hope you and your loved ones are staying safe and healthy. Take this seriously – every update validates how devastating this is, especially for older folks. I'll update you all again soon on finance topics – not another logging post (ha – remember, I take requests).

And please, consider donating plasma if you've recovered from this disease.

Don't Quit Your Day Job...

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