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How lethal the coronavirus can be? The seasonal flu that we deal with every year has a mortality of 0.1%. The stated mortality, of the coronavirus, including China, is about 3%. It first started at 2%, and now it is 3%.
If you count all the cases to the smallest case that Showing symptoms or not showing any symptom, that probably brings the mortality to somewhere around 1%. And that means it is 10 times more lethal than the seasonal flu.
If we are complacent and don’t take aggressive and fast containment, the number can go very high and be involved in huge death tolls. If we taught to contain we could splatter it, we have to change our lifestyle. We have to assume that we are going to get hit and prepare for the worst case. That is why we must talk about making mitigation and containment in a much more aggressive way.
We can hope that as we get into warmer weather, it may go down. That is what we see every year with influenza. As you get to March, April, and May it actually goes way down. The common cold often does that. So if someone considers that might happen, with coronavirus as well, when actually it is reasonable.
Anyway, We can’t predict the future, We don’t know how the virus is going to change its behavior. We should pray that as we get to warmer weather, it would go down. But we can’t proceed under that assumption. We have got to assume that it is going to get worse and worse and worse. With an outbreak that has community spread, Which means by definition that you don’t know what the index case is. The only way you can approach it is by contact-tracing.
When you have enough traces and data, then it becomes a situation where you are not going to able to efficiently contain it. Although we are containing it in up to some level, We still keep getting people coming in from other countries. We have seen that in many of the states that are now involved. And then when you get community-spread, it makes the challenge much greater. So, we will see more cases, and things will get worse than they are right now.
How much worse will get depends on our ability to do 2 things.
To contain the people who are infected and coming from the other countries
And the ability to contain and mitigate already infected people within our own country.
If you have someone who has a reason to believe that they are infected, either that they have symptoms or they have come into contact with someone who is either traveled-related or who is, in fact, documented to have been infected or exposed. That is something you go to a physician, you get a test and you find that if an individual is infected.
The other that was discussed is a surveillance type where you are not looking to see. If anybody is being exposed, but you want to find what the penetrance of this particular infection is. And that is a different thing than the physician-patient relationship. That is trying to get a feel for what is out there. To get an idea for getting the people who think they may be infected who actually is infected.
With regards to vaccines, we were able to very quickly go from an understanding of what this virus was to what the genetic sequence was to actually develop a vaccine. But yet, there is a lot of confusion about developing a vaccine. It would take around 4 weeks or so. to go into what is called Phase 1.
A clinical trial is done to determine if one of the candidates is going to work on this situation. And there are probably at least 10 or more candidates. That is at various stages of development. One candidate that mostly focused on is the one that involves in the platform called messenger RNA. But it really serves as a prototype for other types of vaccines. That is simultaneously being developed.
Getting it into phase 1 in a matter of months is the quickest. Anyway, the process of developing a vaccine is much time-consuming. So, if we go into Phase 1. It will take about 3 months to determine if it is safe. That will bring us 3 or 4 months down the pipe. Then you go into an important phase called Phase 2 to determine if it works.
Since this is a vaccine, you don’t want to give it to normal healthy people because it may
- hurt them or
- not work
So, this phase of determining if it works is the most critical. That will take at least another 8 months or so. So to deploy the vaccine we must think of a year to a year and a half timeframe. Now anyone who thinks they are going to get it more quickly than that. I believe will be cutting corners that would be detrimental.
With that timeframe, the next months, the next several months, we are going to have to rely only on public health measures to contain this outbreak. The timeline for therapy is a little bit different. The reason it is different is that you are giving this candidate therapy to someone who is already ill. So, the idea of risks and how quickly you determine if and when it works is much more. There are a couple of candidates that are now already in a clinical trial. Some of them in China and some are right here in the United States.
So, in summary, the work that is being done at the NIH is involved both in the development of the vaccine in the long term and in the development. Hopefully, of therapies in the shorter term.