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COVID-19 Mistakes to Avoid: Don’t Mix Up Prophylaxis and Cure

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COVID-19 Mistakes to Avoid: Don’t Mix Up Prophylaxis and Cure

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By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She is currently writing a book about textile artisans.

As I wrote yesterday, one depressing aspect of the COVID-19 pandemic is to see two of the usual suspects – Big Tech and Big Pharma – trying to distort what we hear, learn, and understand about the ongoing situation. Yesterday, I discussed the fallacy of conflating contact tracing with contact tracing by app – a mistake big Tech wants you to make so we all spend money on something that may not work all that well rather than relying on tried and tested methods of contact tracing. Similarly, Big Pharma wants us all to believe that the way to manage COVID-19 is with a new, expensive, proprietary patented vaccine; or with some new expensive proprietary drug, rather than with a tweaking of an existing therapy, or an off-the-shelf generic approach.

I’m going to try to pitch this post at a fairly general level and include what I think might be useful links for people to study: asking questions, rather than supplying anything like definitive answers. Why? Well I’m not a medical doctor or a scientist, and though I identify avenues that might look promising, I cannot hope to begin to supply answers (nor, to be sure, is the state of science such that there are answers to be supplied).

Vaccines

Today, the newspapers featured positive news about Moderna’s efforts to produce a viable COVID-19 vaccine (see this WSJ account, Moderna’s Covid-19 Vaccine Moves to Bigger Study and this report from Stat First data for Moderna Covid-19 vaccine show it spurs an immune response). Meanwhile, The Times of India discussed the efforts of Indian pharmaceutical maker Zydur to make its own vaccine in India’s Zydus begins human trials for potential Covid-19 vaccine,

Now, as you are no doubt aware, developing a new vaccine poses formidable challenges. And for surmounting those challenges, the rewards will be vast.

But two studies suggest some existing vaccines, the Bacillus Calmette–Guerin (BCG) TB vaccine, and the measles-mumps-rubella (MMR) vaccine, might convey some protective effect – which would be more or less immediate. It should be emphasized that neither of these approaches was developed to address COVID-19 directly. Nonetheless, there is some evidence that each may provide some benefit.

I was first informed about the MMR connection by my friend Dr. Sara Borwein, when I mentioned the interesting situation with the BCG vaccine. Sarah sent me a clip discussing the MMR connection, which originated in Kazakhstan, while noting the source was not the best. Permit me to discuss each in turn.

First off, how does the mechanism work. Believe it or not, a decent laypeson explanation is provided by The Daily Mail, Why experts think the MMR jab may save adults from: Childhood vaccine at heart of dramatic new trial:

Most of the 100 or so Covid-19 vaccine trials under way worldwide focus on specific targets unique to the virus itself, and are made either with traces of the ‘spike’ protein found on the surface of the virus, or fragments of its genetic material. The idea is the immune system recognises the virus material in the vaccines as foreign and creates infection-fighting cells (antibodies and T cells) should it then encounter Covid-19.

In other words, they are designed to work against Covid-19 and nothing else.

The same applies to most infectious disease vaccines. But a small group of vaccines, including the MMR, the BCG jab given to protect against tuberculosis (TB) and the oral version of the polio vaccine, are different.

These are made with ‘live’ but massively weakened versions of the viruses or bacteria (in the case of the BCG) themselves.

As well as priming the immune system to produce disease-fighting cells that target the infectious organism, live vaccines pep up the whole immune system so it’s more alert to any invading organisms.

It’s thought this is because the presence of any live virus or bacterium is enough to put the whole immune system on alert.

‘It’s a bit like an army putting all its snipers on duty, ready to take out anything that is a potential threat,’ explains Eleanor Riley, a professor of immunology and infectious diseases at Edinburgh University.

The best evidence so far for the efficacy of the MMR vaccine comes from the good ship Theodore Roosevelt. Again from the Daily Mail:

The protective potential of MMR hit the headlines when the crew of the U.S. aircraft carrier USS Theodore Roosevelt was struck by a Covid-19 outbreak.

More than 1,100 sailors on board tested positive, yet just one needed hospital treatment, (and later died) according to a report published last month in the journal mBio.

Even allowing for the likelihood that many were young and fit, researchers calculated it would still be expected that about 14 per cent (over 150 in this case) would need to be hospitalised.

But the sailors all had one thing in common; as new recruits mostly in their late teens or 20s, each had been given the MMR vaccine, in line with U.S. military policy.

Some scientists think the jab may have protected many crew members against serious illness and could also explain why so few children develop symptoms from Covid-19. In the UK, children make up less than two per cent of confirmed cases.

Between 80 and 90 per cent of all UK children, teenagers and young adults have had the MMR jab, their first dose aged one, and a booster, at three years.

Now the idea that the readily available and relatively cheap vaccine (it costs about £50 privately) could be used to protect millions of adults against Covid-19 is attracting wider interest.<

I’ll stop there, for as I said, questions, not answers.

As for the BCG vaccine, I’ll once again begin with a popular account. this from yesterday’s Hindustan Times, TB vaccine averts severe infections, deaths from Covid-19: Study:

The inexpensive and widely-used Bacillus Calmette–Guerin (BCG) vaccine that protects against childhood tuberculosis also prevents severe infection and death from coronavirus disease (Covid-19), concluded two peer-reviewed studies released last week, including one led by Indian researchers from the Jawaharlal Nehru University (JNU) Delhi.

The JNU study from India found that the quality of protection depends on the BCG strain used to make the vaccine, with Mixed, Pasteur and Japan strains being superior to the three other strains which together account for more than 90% of the BCG vaccines being used in the world. The peer-reviewed study was published in Cell Death and Disease, which part of the Nature group of journals. The second study from the US, published in the Proceedings of the National Academy of Sciences, also linked BCG vaccination with reduced Covid-19 deaths.

“Those who got BCG vaccination, not just in India but in other countries, are more protected than those who were not, shows this analysis of data for countries with over 1,000 reported cases. We think BCG-mediated immune response would help in lowering both incidence and severity of infection,” said study author Gobardhan Das, chairperson, Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi. Around 100 million children around the world get the BCG vaccine every year.

Again, rather than targeting the aim of reaching any definitive conclusions, I’ll just refer interested readers to the two underlying studies, BCG vaccination policy and preventive chloroquine usage: do they have an impact on COVID-19 pandemic? in Cell Death and Disease; and BCG vaccine protection from severe coronavirus disease 2019 (COVID-19) in Proceedings of the National Academy of Sciences.

Now, unsurprisingly, big Pharma is, to my knowledge, not promoting further exploration of either of these vaccines, as either an interim or stopgap if and until a COVID-19-specific vaccime emerges. Why not? Each has been around for a while, in the case of BCG, for more than a century. And while these options might prevent or lessen suffering from COVID-19, no one is going to get rich from making and distributing them. Whereas the profit potential from a new vaccine…..Well, the sky looks to be the limit there.

Cure and Prophylaxis: What About Hydroxychloroquine (HCL)?

From the onset of this pandemic, I’ve been hearing about the efficacy -or lack thereof of HCL, sometimes combined with zinc and azithromycin, either for treatment of COVID-19 or prophylaxis. By now, the scientific record is muddied and for a while, the reputation of two  respected medical journals, The Lancet and the New England Journal of Medicine was damaged by their publication of studies based on dubious data from the US company, Surgisphere. The studies led to a shift in World Health Organization (WHO) policy (see Surgisphere: governments and WHO changed Covid-19 policy based on suspect data from tiny US company). HCL is something that has become highly politicized, partly because Donald Trump has advocated its use and continues to do so. You can’t be for HCL if you’re anti-Trump. You can’t be pro-mask if you are pro-Trump. Which is obviously ridiculous. These are scientific questions, not political ones. But many Americans have lost their ability to think seriously about scientific questions – if they ever had it in the first place.

But without getting too foily, i can’t help but think that it’s big Pharma that benefits most from all this confusion about HCL, and I wonder whether this is an accident. I guess it all boils down to which general approach to history one takes. Big Pharma won’t profit if this cheap, widely available generic drug proves to  have a COVID-19 protective effect; it barely costs $1 per dose.. But someone certainly benefits from the use of remdesivir, which even at concessionary rates, is priced so I believe they still make out very well from each course of treatment, according to Stat, Gilead announces long-awaited price for Covid-19 drug remdesivir:

For all governments in the developed world, including the U.S. government’s Indian Health Services and the Department of Veterans Affairs, Gilead will charge $2,340 for a five-day course. U.S. insurers, in addition to Medicare and Medicaid, will pay 33% more, or $3,120. Countries in the developing world will get the drug at greatly reduced prices through generic manufacturers to which Gilead has licensed production.

And the drug is in short supply -so that in Hong Kong, where along with interferon, it is the preferred therapy, doctors can’t secure enough to treat patients.

Now, one very basic issue I’ve noticed with HCL studies is a failure to appreciate and distinguish its use as a prophylactic from that of a cure, especially once massaged and presented in the press. Many studies have looked at its use as a cure for those who have late-Stage COVID-19, and those poor results are extrapolated to conclude the drug has no utility whatsoever.

India thinks otherwise, and has combined HCL does with use of PPE to reduce the COVID-19 risk of its healthworkers (see this India Today account  4 or more hydroxychloroquine doses reduced risk of coronavirus in healthcare workers: ICMR study). I can’t help but think that the muddy scientific record is partly because big Pharma doesn’t benefit from clarity here,

Imagine, for example, we made the same type of logical mistake in evaluating the efficacy of birth control pills, e.g., conflation of the use of something as a cure, and as a prophylaxis. Assume you waited ’til week 24 of your pregnancy to take your birth control pills and then concluded that the drugs didn’t work very well: they didn’t prevent pregnancy at that stage and for all I know, their use might lead you to bring to term a damaged fetus or spontaneously abort. Whereas, if you used the drug as directed – taking them regularly, before and after you have sex, they work just fine.

The Indians seem to think that the same applies to HCL and perhaps it does – even if Donald Trump thinks so.

But no one at big Pharma will get rich if that is the case. So there’s a whole lot of conflation of prophylaxis and cure going on with people who should know better.

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