Wake Me Up When September Ends

Optimism & Urgency in the race for a COVID-19 vaccine

5/11/2020

On August 31, 2005, the punk band Green Day officially released the 4th single from their American Idiot album, "Wake Me up When September Ends." By then, the song was already very familiar to radio audiences, because it was both good and controversial; the music video depicts a young couple wrestling with the fallout of the college-age boyfriend's decision to join the Marines, while his girlfriend experiences a whirlwind of emotions. I must admit that the song was powerful in my house, because on August 31st, 2005 I had just arrived in Anbar Province, Iraq with my Marine unit; my wife was 7 months pregnant with our daughter and had to adjust her route home to Texas from North Carolina because Hurricane Katrina had just vaporized a portion of I-10 north of New Orleans.

 That fall, my emotions ranged from pride at having worked with the Anbar poll workers to facilitate the election and sadness because of what I had missed back home. I was comforted by the genuine tears of gratitude as hundreds of poll workers returned to our base with giant carts filled with ballots, and the image of that stream, passing in the dark with ink-stained fingers held high, was not diminished by the proportion of volunteers who had bloody bandages as an additional souvenir.

The juxtaposition of tragedy and triumph is reminiscent of our current global predicament. Lost amid the emotional and political noise, this week saw a wave of positive developments in the fight to discover and produce vaccines and other treatments for COVID-19. The worldwide efforts are proceeding at record pace, with 3 or 4 American, European and Chinese firms already in advanced trials and several dozen other projects hoping to join the club. This article from Wired (5/8) discusses the current picture: https://www.wired.com/story/frontrunners-emerge-in-the-race-for-a-covid-19-vaccine/.

So, what will happen when September ends? Neither the question nor the song reference were randomly chosen - and the best way to understand the importance of that milestone is to glance back to the Swine flu pandemic in 2009. Although influenza and coronaviruses are not related, the H1N1 pandemic emerged in December/January, spread very rapidly during the summer, and lacked a specific vaccine - traits that SARS-nCoV-2 (so far) currently exhibits as the pandemic continues into its fifth month. My last post, the "CoronaVirus Conundrum," compares mortality trends with H1N1 and shows how different the death tolls would be if an identical number of infections materialized with COVID (11,000 vs. 1,083,000 with 57 million cases).

In early October 2009, the CDC estimates that 22 million Americans had contracted H1N1 during the pandemic. In early November, the new tally stood at 44 million. When September ends, the flu season begins, and under typical conditions COVID-19 could exponentially surge, dwarfing its current case numbers. Consider that 2 weeks ago, in the midst of an unprecedented global shut-down, COVID-19 surpassed the US record for flu deaths (48,000ish) going back to the first CDC records 50 years ago. It accomplished that feat in less than 50 days, even though a flu season is measured over six months or more. Globally, the H1N1 pandemic's 190,000 deaths is already 100,000 less than our current situation, and the only question is what tiny fraction of infections have occurred, relative to the 1 billion cases 11 years ago.

 Against that backdrop, I was surprised to hear almost nothing about the discovery that (in my opinion) was the most important research breakthrough this week: a Dutch-led team announced the discovery of a monoclonal antibody that has neutralized COVID-19 in a series of tests, both as a preventative medicine and treatment after infection. Published on 5/4, it was originally submitted 3/27 and passed peer review 4/23. https://www.nature.com/articles/s41467-020-16256-y Monoclonal Antibody therapy is not new, and many of the most effective treatments for cancers, Crohn's disease and Hepatitis C (often referred to as 'biologics' in commercials) in the last two decades were a product of this pipeline.

Because side effects can be more pronounced, vaccines remain the simplest alternative for typical pandemic infections, but I have no doubt that COVID-19 is deadly enough (for susceptible populations) to justify their use. The production timeline at full-scale is shorter as well. In sum, unprecedented efforts have been paying off, as the world races to develop vaccines and treatments in record time. The optimal response is for multiple treatments to emerge and be applied by the medical community as quickly and as broadly as possible. Our economies won't mentally recover until viable solutions are implemented, but our media and politicians have fueled the sense of pessimism instead of offering hopeful updates.

 My recommendation is for people and businesses to prepare for the worst this winter, but my gut tells me that the future looks brighter than it did a few weeks ago. Lastly, a poll of unemployment claimants (about two weeks behind today) revealed that more than 80% of the unemployment claims at the end of April were characterized by the individual as "temporary" / "furloughed;" should those numbers continue to play out, it would indicate that the economy can rebound much faster than the overall rate would suggest. How tragic it is, to see how few of our leaders are working to reassure us - compared with those seeking to exploit fear for their own purposes. At least we can look forward to expressing our will in November, since we will likely be close enough to the end of the tunnel for its light to illuminate our choices.