A Discussion About Pandemics with Emphasis on COVID-19

Pandemics have a long history. The Black Death of the fourteenth century is well known — the veritable archetype of disease outbreaks. Spread by fleas carried by rats and other mammals, it entered Europe at the port of Messina in Sicily in 1347. It ended as many as 200 million lives in Asia, Europe, and North Africa, peaking in Europe (where the best records remaining were kept) during the period 1347-1351. It exists today, affecting some 3,000 people every year. It is extraordinarily painful, extraordinarily deadly, and has an extraordinarily short incubation period.

Fragmentary evidence suggests pandemics were common throughout human history. A house in a Chinese village was found to be filled with skeletons of all ages. The house was burned down about 5,000 years ago, and the village was abandoned. Multiple plagues were brought by European explorers to the Americas, beginning in the sixteenth century. Cities in Europe suffered their own plagues during the same period, fostered by crowding and poor sanitation.

Passing over plagues in Europe, I turn to America. A yellow fever epidemic struck Philadelphia in 1793, carried by mosquitos which thrived in that year's unusually hot, humid summer. A flu pandemic spanned the globe in 1889-1890, followed by an American polio epidemic1 in 1916, then by the so-called Spanish Flu (which was worldwide) in 1918-1920. Another flu pandemic was the Asian Flue of 1957-58. It spread from China to kill 1.1 million people worldwide and 116,000 in the United States.

Since it was identified, AIDS has claimed an estimated 35 million lives. No cure is available,2 but steadily improving medications allow sufferers to live normal lives with regular treatment. Today, about 64 percent of these live in sub-Saharan Africa.

In spring 2009, a new strain of flu called H1N1 came out of Mexico to sweep the world in 2009-2010. According to the CDC, it infected 1.4 billion people and killed between 151,700 and 575,400. The highly virulent disease Ebola ravaged West Africa during 2014-2016. Fortunately, it was not very contagious and infected only 28,600 people (with 11,325 deaths.)

From South America in 2015 came the Zika virus, another mosquito-borne disease.3 Its primary impact is on developing fetuses; it often afflicts them with birth defects including microencephaly — a stunted brain. It is still active, and its full impact will not be known for some time.

Which brings us to America's current outbreak of disease: COVID-19, caused by the virus formally designated SARS-CoV2. This is a worldwide pandemic, and a bad one. As of this date it has infected 1.4 million people in the U.S., and killed at least 90,000. Initially, it was found to affect the lungs, causing them to fill up with fluid so that oxygen exchange was prevented, bringing suffocation. Then other symptoms began to appear, and soon it was clear that this virus could attack almost any organ system in the body. (However, an overreaction of the immune system appears partly to blame.) Children and young adults were though to be immune; but a number of children have succumbed to strokes caused by swarms of blood clots, and in rare cases a massive inflammation similar to Kawasaki disease4 can occur. (Unlike Kawasaki disease, it is not limited to children aged 5 and younger.)

Neither cure nor vaccine for COVID-19 exists at present. Progress is being made (summarized in the table below.) However, nothing is expected soon.

Treatment & Source

Development & Uses

Side Effects

Status & Prospects

Remdesivir
Gilead Sciences

Developed in 2009 for hepatitis-C, for which it was ineffective. It was then tried for Ebola and Marburg infections. It was found to have limited effectiveness against Ebola, and later to act in vitro against multiple filoviruses, pneumoviruses, paramyxoviruses, and coronaviruses.

Side effects include: nausea and vomiting (common with antiviral drugs); possible liver damage.

In January 2020, showed action against SARS and MERS in animal models. In April 2020, became one of four compounds evaluated in international trials. Early data from a U.S. NIH trial suggest it shortens recovery time for seriously ill COVID-19 patients. The NIH ended its trial and approved the drug for "compassionate use." Gilead began restarting its remdesivir production line in January 2020 and also reactivated contract manufacturers. On 2 February 2020 it shipped its stock of leftover drug to its dose-preparation plant. Gilead stated that it expects to have 500,000 courses by October and 1 million courses by the end of 2020. On 12 April it licensed five generic drug makers to provide the drug to 127 countries.

Hydroxychloroquine
Novartis et al.

An extract from the bark of the cinchona tree was long used in Peru to fight fever and chills. Imported into Europe in 1633, it began to be used against malaria, In 1820, quinine was derived from this extract and also used against malaria as a more reliable treatment. Chloroquine was discovered in 1934 at the Bayer laboratories; however, it was ignored for a decade as it was considered too toxic for humans. The analogue hydroxychloroquine was developed in the United States and approved for medical use in 1955 as a safer alternative for treatment of malaria. Because it can suppress the immune system, it is also used against inflammatory diseases like rheumatoid arthritis and lupus. This appears to be the benefit it may provide to sufferers of COVID-19.

Although less toxic than its parent chloroquine, hydroxychloroquine (HCQ) still has significant side effects. It can cause nausea, stomach cramps, and diarrhea. More serious effects, especially with high doses or chronic use, are retinopathy, possibly permanent damage to the eyes, as well as liver damage and heart problems. Chronic use can bring a host of less serious but unpleasant side effects.

Note that HCQ to date is not approved for general use against COVID-19 in the U.S. Clinical trials are under way in several countries. The U.S. NIH has begun two trials:

On 9 April, a trial of HCQ alone
(See NIH Press Release and NIH NHLBI Press Release.)
On 14 May, a trial of HCQ with Azithromycin
(See NIH Press Release and NIH NIAID Press Release.)

Both trials provide standard-of-care treatments as a matter of course. Estimated dates of completion were not announced.

There is a variety of anecdotal evidence that HCQ and Azithromycin, usually with zinc, have remarkable success in stopping COVID-19 in its early stages. However, this shares the typical defects of anecdotal evidence.

Vaccines
AbbVie, GlaxoSmithKline, Moderna, Novavax, Sanofi, Takeda, Vir Biotechnology, etc.

The question of COVID-19 vaccine development is a complex one, both because of the novelty of the viral agent and the number of organizations involved (some 80 companies and institutes worldwide, IIRC). I have listed only some of the U.S. companies. Developments are proceeding with unusual speed, but still the best estimates put any working vaccines a year or more away.

The downsides of any vaccine, as I understand it, are: it either fails to work, or (as happened in some cases with polio vaccine) it causes the disease it is supposed to prevent.

All I can say here is: stay tuned.

Novocebo
Gilligan Sciences

TBD

A 3-hour cure...

Things are very much in flux with this pandemic, both on the scientific and political fronts. This page, therefore, is a work in progress. Until medical countermeasures are available, the wisest course is to follow the expert advice:

Beyond that, the best defense is to be well-informed. Below is a link to selected books and films (works of both fact and fiction) that should shed some light.

1 Polio continued to ravage American citizens until the Salk vaccine, developed in 1954, became widely available. The last U.S. case of polio was reported in 1979.

2 Two people have been cured of AIDS, apparently by something in their own constitutions.

3 Zika can also be spread by sexual intercourse.

4 Kawasaki disease is an inflammatory disease charaterized by high, persistent fever, "pinkeye," reddened tongue, and often redness of the palms of the hands and soles of the feet, which then crack and peel. It affects children younger than six. It has no known cause, but is thought to be mediated by a genetic susceptibility. In Japan, where it was first identified, it affects 124 children in 100,000; elsewhere it is less common. With supportive treatment, patients usually recover in weeks. Here is a clinical description of Kawasaki disease

5 A manufacturing error at Salk vaccine maker Cutter Laboratories led to the "Cutter Incident," in which live polio virus in the vaccine caused 10 deaths and 164 cases of permanent paralysis. See The Cutter Incident: How America's First Polio Vaccine Led to a Growing Vaccine Crisis and Deaths following vaccination: What does the evidence show? (Elaine R. Miller, Pedro L. Moro, Maria Cano, and Tom Shimabukuroa; Immunization Safety Office, Centers for Disease Control and Prevention, 23 May 2015)

To Open The Sky

A Brief History of Pandemics, with Emphasis on the 2020 Version

Selected Books and Films About Pandemics

Sources