If the rate of growth in coronavirus cases in the New York metro area continues, it will suffer a more severe outbreak than those experienced in Wuhan, China, or the Lombardy region of Italy.
There is no guarantee, of course, that current trends will continue. What has happened to this point cant be used to predict what will happen next. It is possible that social distancing will soon slow or arrest the growth of cases.
But what can be said is that the New York metro area has had less success in flattening the curve, at this point in its outbreak, than Wuhan or the Lombardy region did at the same point in theirs. And some other American metropolitan areas appear to be on a similar path.
Here are four ways to measure the size of the outbreak across the countrys metro areas.
The New York City area has more known cases per capita than any other metro area in the United States.
Figures as of March 26; includes micropolitan statistical areas
Pros of this measure Focuses on communities where the disease is prevalent.
Cons Varying testing rates make comparisons difficult. Not all confirmed cases are active.
In the early stages of an outbreak, the population size doesnt matter one infected person will probably infect a few people, whether that person lives in a metropolitan area of 100,000 or one of 10 million. But as an epidemic progresses, the number of cases per capita can provide a good measure of the prevalence of coronavirus in a community. Per capita measurements also give a sense of how strained a communitys health care system has become, since larger places tend to have more medical resources.
To make useful per capita comparisons, weve focused on metropolitan areas instead of countries or cities or U.S. states. Thats because metropolitan areas roughly correspond with the regions where the virus might spread quickly among families, co-workers or commuters. The New York City metropolitan area includes nearby cities and suburbs in Westchester, Long Island, and northern New Jersey, as well as sprawling, outlying areas that stretch even farther from the city.
As of March 26
Our tables include numbers from Lombardy and Wuhan to provide a benchmark for metro areas in the United States. The comparisons are illustrative, but not exact. Those outbreaks have been going on longer, which means their case numbers are spread over more time. In most of the U.S., cases are from only the last month.
The number of confirmed cases is an imperfect measure of what we really care about: the prevalence of the virus in the population, and therefore if it is early in the epidemic how many people are sick or may be contagious. The limited availability of testing in some places means that many people with coronavirus wont be counted among the confirmed cases. And the varying rates of testing across states and countries make it hard to compare the number of confirmed cases in different regions.
Deaths per capita are currently higher in the New York City area than in most other places.
As of March 26; includes only metro areas with three deaths or more.
Pros of this measure Coronavirus deaths are much more likely to be accurately counted than total cases.
Cons Death rates depend on the underlying health and age of various communities. They also lag infections by several weeks, so they dont tell us whats happening now.
Examining deaths can allow for a more direct comparison between communities, since it avoids many of the problems with variable testing. Testing differences matter less in measuring deaths because in most places with established outbreaks in the United States, the sickest patients are getting tested. (That may be less true in other parts of the world: Patients who die outside hospitals in Britain and Italy have, in some cases, been omitted from official data.)
But measuring only deaths has drawbacks, too. We know that the death rate from coronavirus differs depending on the age and health of the populations affected and the availability of medical resources, like ventilators. That means that per capita rates may look high in places where the virus has infiltrated nursing homes, for example, even if it has not spread widely through the rest of the community.
Because patients who die of Covid-19 tend to be sick for weeks first, counting deaths may also understate the current size of the outbreak in a given place if it is growing quickly.
As of March 26; includes only metro areas with three deaths or more.
The number of cases in the New York area is still growing quickly.
To assess the possible future of the outbreak, its helpful to look not just at the number of cases but also at how quickly they are increasing. The accompanying chart shows the growth rate of cumulative cases over time, averaged over the previous week.
Pros of this measure Growth rates help us judge whether the epidemic is getting better or worse in a given place right now.
Cons The timing of different outbreaks can make comparisons difficult. Case data quality varies a lot by place.
Here, we can see whether the trajectory of a local epidemic is getting better or worse. A growth rate of 40 percent on this chart means the cumulative number of cases is growing by 40 percent every day. A rate of 100 percent would mean that the number of cases was doubling daily.
Public health officials have been talking about the value of social distancing measures as a way to flatten the curve of the epidemic. Such a flattening would mean that the rates in this chart are falling, eventually to zero. New Yorks current growth rate is just over 30 percent, suggesting that its curve remains quite steep, and that the disease is continuing to spread rapidly throughout the region.
In some other metro areas, like Baton Rouge, La., the growth rate is high, but the number of cases is still low. That means the community may still have time to flatten its curve before the outbreak becomes widespread. But communities with a lot of cases and a high growth rate are on track to have a serious problem. A high growth rate on top of a large number of cases means that a still larger number of people are on track to become ill or die.
Case numbers in the New York area are also growing quickly given the size of its outbreak.
Pros of this measure Helps distinguish between places where cases are growing fast with few cases and places where cases are numerous and still growing fast.
Cons Hard to read. Relies on case data.
The chart above shows the growth rate by the number of cases in a given place. This measurement shows whether a community has succeeded in slowing the rate of growth before there are many cases. In other words, it shows whether a community is succeeding at flattening the curve.
By this measure, the situation in the New York area does not appear promising. The rate of increase in cases is far higher for the number of cases than it was in Wuhan or Lombardy, once they had reached similar numbers of cases. Other metropolitan areas, like Detroit and New Orleans, stand out as places where a coronavirus outbreak might escalate quickly without preventive measures. The Seattle and San Francisco areas, in contrast, seem to have made serious progress in flattening the curve.
The chart also helps avoid the illusion of success created by a slow, initial rate of growth. Many charts depict the growth of cases over time, and it can be easy to assume that the communities that get an outbreak quickly, and therefore appear above the pack on the chart, are faring the worst. But a community that experiences a high rate of growth with a large number of cases is in serious trouble, regardless of whether the outbreak occurs 10 or 100 days after it had its first cases.
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Only three COVID-19 cases have been confirmed in the 22 counties in state Rep. Drew Springers North Texas House district, and he said Thursday that a lot of people are just coming to the realization about why we need social distancing.
There were more people on the road in Gainesville and Muenster yesterday than in New York City, he said.
My constituents would have argued [earlier] that were drastically overreacting, Springer said. I think as they have started hearing more, theyre coming around. ... Im waiting to see whether the cases here, and the names of people who get sick, will change peoples opinions.
Pandemic is a word for a disease that is no longer local, that has taken on worldwide scope.
But the responses to the new coronavirus pandemic in Texas and elsewhere are distinctly local and vary deeply from the mostly voluntary shelter-in-place orders in effect in the states most populated cities and counties to the wait-and-see positions of governments and businesses elsewhere.
Those local differences help explain why statewide officials like Gov. Greg Abbott have been so reluctant to issue statewide stay-at-home orders. Metropolitan areas are aggressively putting social distancing rules in place, while less populated parts of Texas are more reticent.
Reports of COVID-19 cases might not be as prevalent outside of the metropolitan areas, and official actions have been slower and less restrictive.
In Midland, many residents have continued their normal routines, shopping in grocery stores and at busy retail locations. The city hasnt issued restrictive orders but has been talking about it. Theres a striking parallel between the places restricting social gathering and the political map, but thats not what some politicians see.
I dont know if its a red versus blue thing; its a human nature thing, said Jack Ladd Jr., a member of the Midland City Council. A lot of people want to see something like this before they react.
That visibility is increasing as cases pop up in Midland. And the county recorded its first death attributed to COVID-19, the disease caused by the new coronavirus, this week, which has prompted more discussion from public leaders.
At the same time Abbott was issuing his first set of emergency orders, Anderson County in East Texas was doing the same, barring gatherings of 10 people or more and asking people to limit their interactions.
County Judge Robert Johnston said the reaction has been pretty positive overall. He said some churches have pushed back, noting many of them dont have the kind of internet access that would allow online services to replace in-person congregation.
The order has limited gatherings but hasnt kept people inside, Johnston said. No, I dont think theyre staying at home. They are eating at home, still running errands, but there are fewer people out.
So far, the county hasnt reported any confirmed cases of COVID-19, either from its general population or from any of its five state prisons.
The county has no plans to impose a shelter-in-place order, he said, but suggested it might not be necessary. People know if were going to get a hand on this, were going to have to stay home.
Lubbock stopped short of telling residents to stay at home, but it did put restrictions in place. Lubbocks emergency order, Mayor Dan Pope said, is like the stay-at-home orders elsewhere, without the panic in it.
You know West Texas, he said. We have a little more common sense ... and a healthy sense of skepticism.
I would say people are in two camps those who have bought in and understand and are really staying home, and another group thats harder to reach, he said.
He said Lubbocks two hospitals are well situated at the moment they can open another 40 ICU beds if needed and added that we dont have any stress on our health care system at this time. As of Thursday, the city had a drive-through testing center, and he said it plans to have a total of four by Monday. Lubbock County had 19 confirmed cases of COVID-19 on Thursday, he said.
Springers House District 68, which stretches from north of Dallas-Fort Worth across North Texas and into the Panhandle, is seeing a new kind of visitor he attributes to the pandemic: shoppers.
The odd stuff here is really the foot traffic, he said.
One meat market sold out in a matter of hours this week. Some of the stores are limiting sales, he said, to allow locals a chance to buy groceries and supplies before out-of-towners scoop them up.
He said the county clerks in Cooke and Montague counties have seen a rush of lovebirds from the D-FW area, where the courthouses are closed, seeking marriage certificates. The clerk has to actually see both people to issue a license, he said. Some of them dont want to wait.
The coronavirus pandemic, which has escalated dramatically in the last month, has upended most of American life and the polling industry is no exception. Social distancing requirements have closed most offices and the exponential growth of cases has meant that a poll can be outdated even just a few days after it's conducted due to the rapid shifts in public opinion.
Polling is conducted in numerous ways and with an almost infinite number of methodological choices to be made. Surveys can be conducted by phone with live people asking questions, online, by mail, in person, by phone with automated callers and many other options in between, each presenting their own pros and cons in the pandemic.
And now public opinion firms are combating issues such as conducting polls without a room full of people at call centers, an influx of interest in pandemic data and a news cycle that won't stay still long enough to field a poll.
But with rapidly changing data comes new innovations and strategic changes to the polling industry. In an effort to gauge public opinion, many call centers are working from home, while pollsters who are methodologically diverse are relying more and more on online polling to properly represent the nation, trying to keep their finger on the ever-moving pulse.
How to have a call center at home
"Our work from home infrastructure has been in place for more than a decade, thankfully. We had it all set up," she said. "So, with the recent coronavirus development, we've been transitioning as many of our interviewers as possible using that technology. If we had to build this infrastructure on the spot, I think it would've been difficult to do."
Without that infrastructure in place, companies may have been scrambling to properly equip the thousands of call center employees before sending them off, but Herrmann reports they've been prepared.
"A few years ago, we moved our phone operations to where people are able to work remotely and essentially use a virtual console to do dialing from their homes. So, we're able to have some consistency and some continuity in our phone operations," Jackson said.
Ipsos conducts polling in multiple ways: over the phone, their online panel, mail, face to face and more. Jackson said the company is "methodologically agnostic" despite being known for their Ipsos KnowledgePanel.
It's important that Ipsos' and other pollsters remain relatively consistent with their methodology since many surveys have a trend line dating far back in history, and a change from live phone to online could make surveys not directly comparable.
Those guidelines vary country to country, but in the US, Jackson said Ipsos is pivoting slightly by relying more heavily on their online panel. Herrmann reports SSRS hasn't changed their methods significantly, but is ensuring all employees are safe.
Increased response rates
Jackson told CNN that, anecdotally, he's seen an increase in the people responding to surveys.
"We've definitely seen a real spike in demand, especially for our online platform," he said. "We've been talking internally, and we think we've done -- across the entire company, around the world -- around over a million interviews over the past couple of weeks. People who are stuck at home have nothing else to do but answer surveys, right?"
While there aren't any hard figures on response rates over the past few weeks, all pollsters mentioned some preliminary numbers that showed a boost in phone responses, online responses, people ready to discuss the issue.
Herrmann noted how interested Americans are in discussing the constantly changing issue, saying, "People have been really engaged about speaking to us on these salient topics and current events we're asking about, particularly coronavirus, due to the obvious impact it's having on everyone's lives right now."
How quickly the data is changing
Pollsters already struggle to keep up with the news. Polls with a short fielding period take around three days, depending on what questions the pollsters are asking, and pollsters often run the risk of having their poll completely irrelevant by the time the data is released.
Upwards of 30 polls have been released on coronavirus since February, included a huge number this week alone. Many are repeat polls, trying to get a proper trendline to show how quickly concerns around coronavirus have surged.
Companies like Abt Associates -- another major survey outlet contracted by private and public sectors alike, including the CDC -- are seeing how far and wide the data can reach.
"Not only do we need to maintain continuity for our current data collection, analytic, and systems support efforts, but we also have to continue providing urgent support to agencies attempting to understand the wide-ranging impacts of the COVID-19 pandemic on public health, homelessness, the education of our children, food security and the like, in addition to efforts to track the prevalence of the virus itself," writes Link.
Survey demand and employee safety
But increased response rates and a salient topic doesn't always mean easy going for the pollsters. Media attention spikes around coverage of emerging infectious diseases and pollsters are feeling the heat of a busy news cycle.
Herrmann told CNN that SSRS can anticipate this, but still says they're working long hours.
"Once you do polling, you're pretty accustomed to working quickly. Our teams are used to it. But it has been changing so quickly in this case," she said.
Herrmann specifically discussed concern for her employees at SSRS. After lamenting how much she misses the office -- they usually conduct their own daily poll around the coffee machine for questions like "favorite candy type" -- she said she's had to be assertive, making sure they aren't biting off more than they can chew and are keeping their own well-being at the forefront.
"But in terms of what has changed, it's mostly been from a personnel perspective, making sure we're doing things in the best interest of our staff. You have to be forceful about it and we're trying to keep everyone safe."
Jackson said he's been working long days but wants to get his data out there before it goes bad, since the dialogue has changed so quickly.
"It's a terrifying, yet fascinating time to be doing public opinion research," he said.
An organ transplant specialist has become the first working NHS surgeon to die from coronavirus.
Adil El Tayar, 63, died on Wednesday at West Middlesex university hospital in London, his family said.
The doctor, who had worked around the world, spent his final days volunteering on the frontlines against the outbreak in an A&E department in the Midlands.
He wanted to be deployed where he would be most useful in the crisis, his cousin, British-Sudanese journalist Zeinab Badawi, said in a moving tribute on BBC Radio 4.
It had taken just 12 days for Adil to go from a seemingly fit and capable doctor working in a busy hospital to lying in a hospital morgue.
Tayar started self-isolating at home after developing symptoms about two weeks ago, but was taken to hospital and placed on a ventilator after his condition worsened.
Four days later medics told his family that his lungs had come under attack from the virus and he could no longer breathe unaided.
Until I had learned of Adils death I had been fairly phlegmatic about the pandemic, Badawi said. But there is nothing like a death in the family to bring home the realities of what we are facing.
Badawi learned of her cousins death on Thursday, three minutes before she joined millions across the UK in applauding NHS workers.
She said: Clapping along with my neighbours engendered in me a feeling of unity that we are all in this together and that we sink or swim together.
Perhaps this transformation will be permanent. I hope it will be.
Former colleague Abbas Ghaznafar, a renal transplant surgeon at St Georges University in Tooting, described Tayar as a noble human being who was a hard-working, dedicated surgeon.
Dr Hisam El Khidir, another of the surgeons cousins, told the BBC that he suspected Tayar had caught the virus while working on frontlines.
The British ambassador to Sudan Irfan Siddiq tweeted: Saddened to hear of Sudanese doctor Adel Altayars death in the UK from Covid-19.
Health workers around the world have shown extraordinary courage. We cannot thank them enough. In this fight we must listen to their advice.
Tayar leaves behind a wife and four children, two of whom also work as doctors in the NHS.
El Khidir told the BBC: Adil was someone who was central to our family, who was well respected by so many people.
Since his death on Wednesday, I have had hundreds of text messages from his colleagues and friends. He will be sorely missed.
Pennsylvania has scant reserves and likely cant rely on them to bridge the gap: The states rainy day account could fund government operations for only about 3 days, even after a large deposit last year. The decision to extend the deadline prioritizes public health at a time when Wolf is urging Pennsylvanians to stay at home to help prevent the spread of the virus, said Jeffrey Johnson, a state Department of Revenue spokesperson.
Google has banned the Infowars Android app from the Google Play store, the company confirmed to Wired on Friday. Google also confirmed the apps removal to The Verge, and we couldnt find the Infowars app in a search on the Play Store this evening.
The app was apparently removed because of a video posted by radio host and conspiracy theorist Alex Jones that, according to Wired, disputed the need for social distancing, shelter in place, and quarantine efforts meant to slow the spread of the novel coronavirus. Before it was removed, the app had more than 100,000 downloads, Wired reports.
Now more than ever, combating misinformation on the Play Store is a top priority for the team, a Google spokesperson said in a statement given to The Verge. When we find apps that violate Play policy by distributing misleading or harmful information, we remove them from the store. Infowars was not immediately available for comment.
Last week, Alex Jones was ordered by New York Attorney General Letitia James to stop selling Infowars products that were marketed as a treatment or cure for the coronavirus. [Alex Jones] latest mistruths are incredibly dangerous and pose a serious threat to the public health of New Yorkers and individuals across the nation, James said in a statement.
Tech companies have also publicly committed to cracking down on coronavirus misinformation. Google has an SOS Alert in place for searches for COVID-19, the disease caused by the novel coronavirus, that points to resources from the CDC and local governments at the top of search results. And a group of companies that includes Facebook, Google, LinkedIn, Microsoft, Reddit, Twitter, and YouTube said theyre jointly combating fraud and misinformation about the virus in a statement issued on March 16th.
Apple permanently banned the Infowars app from the App Store in September 2018, citing App Store guidelines that forbid content thats offensive, insensitive, upsetting, intended to disgust, or in exceptionally poor taste.
As the worldwide spread of the COVID-19 virus continues, with countries facing lockdowns and hospitals dealing with unprecedented demand, a research team at the USC Viterbi School of Engineering is working around the clock on a new vaccine, the school announced Saturday.
The team is also looking at isolating the human antibodies that can successfully fight the viral infection in order to create working therapeutic treatments to improve recovery times for COVID-19 patients, according to researchers.
The research is led by Prof. Pin Wang, Zohrab A. Kaprielian Fellow in Engineering and Professor of Chemical Engineering and Materials Science and Biomedical Engineering. Wang's lab specializes in the emerging field of immunobioengineering, which uses engineering tools to better understand the immune system and develop novel molecular and cellular immunotherapies.
Local news from across Southern California
To create the vaccine, Wang and his team have engineered a hybrid virus, the core of which is based on that of the vesicular stomatitis virus; a family of viruses which includes rabies among others. The surface of the hybrid virus is then covered with spike proteins derived from the COVID-19 virus.
"The reason that this hybrid virus can be a good vaccine format is that by having the COVID-19 surface protein, this can hopefully trick our immune system into recognizing it," Wang said. "That way we can induce the neutralizing antibody to stop the virus from infecting us in future."
Wang said the team is "hoping we'll have a very potent product compared to other vaccine platforms."
This type of vaccine is known as a vectored vaccine and does not contain the harmful components of original viruses, and thus has safety benefits as opposed to vaccine forms using live-attenuated viruses, he said.
Wang said the vaccine research was also looking into ways in which cells' immune response works to combat the virus so that this process can be replicated in the development of therapeutics to manage COVID-19.
"If we can immunize animals like mice, then we can isolate the B cells that can generate antibodies; antibodies that can neutralize the virus," Wang said.
COVID-19 is new and scientists understand little about how it behaves and spreads. The cost of creating a vaccine to protect people against the new coronavirus will run into billions of dollars and could take many months. Here are some of the reasons why.
Technology is enabling new methods of exploring vaccine candidates for trial, but there are already a few tried and tested ways to make them.
In all of them, scientists try to stimulate the bodys immune system to combat invasive pathogens. Thats commonly done by creating something so similar to the pathogen that the body begins to create antibodies to fight off the real thing.
The most common way of doing this is to make whats called attenuated vaccines those that are made of weaker strains of the actual pathogen. Reared on animal cells outside of human bodies (some flu vaccines are cultured on chicken eggs), they are then extracted and injected in a single tiny dose.
Vaccines for measles and tuberculosis are created in this way.
The number of US adults who would be vaccinated against COVID-19 grew between February and March.
Image: Statista
Inactivated vaccines, on the other hand, are derived from identifying the active proteins in a virus that enables them to invade human cells. Thats done by taking dead samples of the pathogen and studying their genetic make-up so that scientists can replicate them en masse. When injected into a human, the body gets to work again constructing the necessary antibodies.
Often such vaccines require multiple doses over time, including those to protect against such diseases as rabies and polio.
Then there are nucleotide-based vaccines, which seek to replicate the genetic material DNA and RNA of a virus. This method stimulates the bodys own creation of this viral material in order for it to produce the necessary antibodies.
A DNA-based vaccine for Zika virus, which was declared a public health emergency by the World Health Organization in 2016, was ready for clinical trials seven months after it was designed, but that is unusual.
There are already at least 35 companies and academic institutions racing to make a COVID-19 vaccine, with at least four candidates in the animal-testing phase. And one will enter human trials soon. But thats just one hurdle cleared.
As Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases in the US, said: A vaccine that you make and start testing in a year is not a vaccine thats deployable. [It will take] a year to a year and a half, no matter how fast you go.
Vaccines must be rigorously tested to ensure they not only work but will not cause other dangerous side-effects.
The trial methodology consists of three phases:
1. Testing on a small number of healthy adults
2. Testing on a larger number of adults in an area where the disease has spread
3.Testing on thousands of people in an area where the disease has spread
Each of these steps can last between six and eight months, but even if the vaccine candidate gets that far many are abandoned or fail before then they must then be studied by regulators before approval is granted.
Constricting the whole timeline of going from concept to a product that can be distributed into a year or two is really a herculean endeavour, said Jon Andrus, an adjunct professor of global vaccinology and vaccine policy at the Milken Institute of Public Health at George Washington University.
A new strain of Coronavirus, COVID 19, is spreading around the world, causing deaths and major disruption to the global economy.
Responding to this crisis requires global cooperation among governments, international organizations and the business community, which is at the centre of the World Economic Forums mission as the International Organization for Public-Private Cooperation.
The Forum has created the COVID Action Platform, a global platform to convene the business community for collective action, protect peoples livelihoods and facilitate business continuity, and mobilize support for the COVID-19 response. The platform is created with the support of the World Health Organization and is open to all businesses and industry groups, as well as other stakeholders, aiming to integrate and inform joint action.
As an organization, the Forum has a track record of supporting efforts to contain epidemics. In 2017, at our Annual Meeting, the Coalition for Epidemic Preparedness Innovations (CEPI) was launched bringing together experts from government, business, health, academia and civil society to accelerate the development of vaccines. CEPI is currently supporting the race to develop a vaccine against this strand of the coronavirus.
Once a candidate vaccine passes through those hoops, the challenge is to produce it in the volume necessary to end a pandemic.
A number of organizations are helping to fund the process. Among them is Norway-based CEPI, the Coalition for Epidemic Preparedness Innovations.
It was first launched at the World Economic Forums Annual Meeting in Davos in 2017, with the intention of bringing together public, private, philanthropic and civil organizations to develop vaccines against epidemics.
Backed by the Bill & Melinda Gates Foundation, among other donors, in 2020 CEPI announced a new partnership to develop a vaccine for COVID-19.
It has issued an urgent call for $2 billion of new funding, to expand the number of vaccine candidates at the outset to increase the chances of success, and to fund the clinical trials.
Our ambition is to have at least three vaccine candidates, which could be submitted to regulatory authorities for licensure for general use/use in outbreaks.
CEPI has already provided funding to several organizations and institutions working on vaccines, including:
It remains to be seen how long it will take until there is a workable vaccine against COVID-19. For the time being, the best way to ensure you reduce your risk of infection is to follow the World Health Organizations advice on handwashing and social distancing.
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The views expressed in this article are those of the author alone and not the World Economic Forum.
For biotechnology companies, responding to a sudden public health crisis, like the coronavirus, can be risky business. It can take more than a year to develop a vaccine or treatment. By that time, the threat may be gone, leaving little or no demand for a drug.
The current coronavirus pandemic appears to be different.
The race to beat the pathogen is on, with many biotechs now expecting a large market for coronavirus therapies in 2021 or beyond.But the starting gun didn't fire right away when the virus began spreading late last year.
"There were a lot of companies that kind of felt once bitten, twice shy," saidJose Trevejo, chief executive of SmartPharm Therapeutics in Kendall Square.
Companies were shy because drug makers have been bitten in the past when they've hustled to confront an outbreak, only to see the danger subside and their efforts go to waste. That's what happened during a previous coronavirus scare the SARS outbreak of 2003, which ended before any vaccine maker could earn a buck.
"There was also Ebola, and then a lot of people forget about the swine flu the H1N1," Trevejo said. "So, I think a lot of big pharma were a bit hesitant to plunge fully into coronavirus."
In recent weeks, the industry's view has changed. At LabCentral, the shared workspace where Trevejo's gene therapy startup operates, more than a dozen companies have turned their attention to the coronavirus, including SmartPharm.
And that's just one lab in Cambridge.
The number of companies pursuing coronavirus drugs is constantly growing, according to Yasmeen Rahimi, co-head of biotechnology research at Roth Capital Partners, an investment banking firm in Newport Beach, Calif.
"I track COVID-19 on a daily basis," she said. "Almost every day we get 10 or 12 companies that are coming."
Rahimi said the most notable may be Moderna, another Cambridge biotech. It's the first company to begin testing a potential coronavirus vaccine on humans in the U.S.
Moderna didn't respond to an interview request. But in a public document this week, the company said that "a commercially-available vaccine is not likely to be available for at least 12-18 months."
Moderna doesn't think the virus will peter out by then. Instead, it is "scaling up manufacturing capacity toward the production of millions of doses per month."
That may not be enough, according to Dr. Lee Wetzler, an infectious disease specialist at Boston Medical Center.
"Just like the flu vaccine, you're talking not just millions of doses," said Wetzler, who is also a professor at Boston University School of Medicine. "Tens tens of millions of doses and even more."
Then again, Wetzler added, it's hard to predict what this previously unknown virus will look like a year from now. It's possible that the pandemic will be under control, which would be good for the world but maybe not so good for companies, like Moderna and others, investing in drugs to stop it.
There's a cautionary tale in theonce-hot biotech Vical, which received federal money to chase vaccines for anthrax, SARS and Ebola. The fear and the funding always faded before Vical could cross the finish line, said John Carroll, editor of Endpoints News, a biotech publication.
"What Vical did was just flame out," he said. "They weren't able to come up with a vaccine and, after repeated failures, they just couldn't make it anymore."
The risk of failure is well understood by James Sietstra, chief business officer of Totient, one of the startups at LabCentral that have shifted to the coronavirus. But he maintains that working on the coronavirus won't be futile, even if the disease runs its course before Totient can bring a drug to market.
"As a business case for us, this is a great proof point for the power of our platform," he said.
Sietstra said the same method Totient will use to attack the coronavirus could also be used against other diseases including the company's original target, cancer.
Everyone agrees that a vaccine will be essential to stop the global spread of COVID-19, the disease caused by the novel coronavirus. But Ofer Levy, a physician-scientist at Boston Childrens Hospital, worries that vaccines being designed today are not going to be effective enough for the people who need them most: older adults.
Whatever we develop, weve got to make sure it works in the elderly. Otherwise we dont have our eye on the ball. And right now, the way vaccines are developed, the eye isnt on the ball, says Levy, an infectious disease doctor who directs the Precision Vaccines Program at Boston Childrens. Initial data suggest the virus that causes COVID-19 most severely affects people who are older than 60 and those who have preexisting medical conditions such as diabetes, heart disease or lung disease. A vaccine that protects young people would slow the viruss spread, but one that protects the most vulnerable will directly save lives, he says.
On the eighth floor of the Harvard Institutes of Medicine building, Levy and his colleagues are aiming to design a vaccine that will work for people of all ages. Their strategy involves testing candidates in a more realistic setting than most laboratories use and adding an adjuvanta substance that boosts the vaccines effectiveness while allowing the minimum possible dosage.
In banks of freezers kept at 80 degrees Fahrenheit, the researchers lab has stored hundreds of samples of cells donated by older patients who were treated at the nearby Brigham and Womens Hospital before the current outbreak. In a neighboring freezer are newly arrived samples of the viral protein that the vaccine will target. Those samples will allow Levy and his collaborators to test vaccine-adjuvant combinations directly on cells from older people. By contrast, most vaccine research instead starts with cells from young mice, grown in blood products from cows.
Dozens of labs around the world are working on vaccine candidates, but it is too early to know which ones will advance far enough to win approvaland that could take at least 12 to 18 months, experts say. Time will tell if any of them will work well on older people, says Seth Berkley, CEO of Gavi, the Vaccine Alliance, a private-public partnership that provides vaccines for nearly half of the worlds children. The reality is: we need many shots on goal here, he says.
Levys program at Boston Childrens had focused on flu vaccine research, but it began to pivot to coronavirus work on January 1, when David Dowling, a vaccinologist and immunologist in the group, started hearing about a strange outbreak of pneumonia in the Chinese city of Wuhan. When he learned that the virus mainly affected older people, he started to worry. I said, Everyones going to make a big mistake. Theyre going to be developing a vaccine that works in a normal, healthy population, and theyre going to miss the elderly. And were all going to lose a year, Dowling says. He started thinking about how he could look for a vaccine-adjuvant combination for this novel pathogen.
The human immune system, Dowling says, completely transforms during the first weeks after birth and changes dramatically again in old age. So, a vaccine that is effective in healthy adults may not work well at either the beginning or end of life.
For example, pharmaceutical giant GlaxoSmithKline developed a malaria vaccine at a cost of about $2 billion that was shown to protect 30 to 50 percent of adults and about 19 percent of babies, Dowling says. But it seems to provide less protection to infants under the age of six monthswho are at the highest risk for dying from malaria. In a 2016 study, Dowling and Levy found that the white blood cells of infants do not mount a strong response to an adjuvant similar to the one in the malaria vaccine, suggesting the need to identify adjuvants with greater activity in early life.
Levy and Dowling are now beginning to develop and test adjuvants combined with various COVID-19 vaccine candidates. Levy says their menu of adjuvants, a portion of which the team had already been testing as part of its flu vaccine work, includes some they buy off the shelf, some that are homegrown (based on screening studiesof small molecules supported by the U.S. National Institutes of Health), and some that other academic centers or companies are developing and have asked the group to evaluate.
The team at Boston Childrens is not the only group testing adjuvants. This week, for example, Dynavax Technologies, a biopharmaceutical vaccine developer in Emeryville, Calif., andClover Biopharmaceuticals, a China-based biotechnology company, entered into a research collaboration to study a vaccine-adjuvant combination against COVID-19.Clover is developing a protein-based coronavirus vaccine candidate called COVID-19 S-Trimer, and Dynavax is providing technical expertise and the companys adjuvant CpG 1018, according to a joint press release from the companies.
Although Levy and Dowlings project is still in the planning stage, they aim to test a vast number of possible vaccine-adjuvant pairings in cells from older adults. The plan is to find promising candidate combinations before moving them on to mouse testing, which is generally important for federal approval. There are so many variables involvedwhich host cell proteins to target, which adjuvants to use, the way the vaccine is formulated, the different populations that need to be addressedthat it would not be feasible to test every possible combination in large clinical trials. Instead evaluating these combinations in a cell culture could accelerate vaccine development and lower its risk, Levy says. The researchers hope to eventually test their candidate vaccine-adjuvant pairs in elderly individuals across the globe to make sure that the finished product will work in as wide a range of people as possible, he adds.
Many other groupsincluding at least 40 companies around the worldare working on their own COVID-19 vaccines. Cambridge, Mass., biotech company Moderna, supported by the NIH, has developed a candidate using the genetic sequence of the virus, and it is already being tested in the first patients. Modernas approach, which is based on protein-making instructions called messenger RNA, or mRNA, has never been employed in an approved vaccine. But before the COVID-19 outbreak, the technology had been tested in about 1,000 healthy people, and it effectively generated an immune response against other diseases, said Tal Zaks, Modernas chief medical officer, in an article I published in late January. He added that side effects were minimal and that older people benefited as much as younger ones. Based on the fundamental immunology and the initial data we have, my expectation is that it will work in older adults as well as it does in younger adults, Zaks said.
But Dowling is skeptical that such a novel tactic can be used to make the billions of doses that will be needed worldwide. And he is less confident than Zaks that it will protect older, vulnerable people. We might have a vaccine that works but cant be scaled or a vaccine that doesnt work and can be scaled, Dowling says.
In another approach, Natasa Strbo, a microbiologist and immunologist at the University of Miami, has been collaborating with Heat Biologics in North Carolina, to research a protein called gp96, which triggers both a targeted immune response and a broader, innate oneespecially in the lungs, gut and reproductive tract. The proper activation of innate immune responses is what is driving your successful vaccine immune response. Theres no doubt about that, Strbo says. In a sense, she adds, gp96 acts as both a vaccine and an adjuvant, so it will hopefully work well in those older than 60.
Levy and Dowling admit that other vaccines are further ahead of their efforts, with some already starting human testing. But the researchers think their work will be more efficient in the long run because they will leave the lab with a more effective product. What is faster, Levy asks rhetorically, finding a vaccine-adjuvant combination in a lab or doing 50 complex and expensive clinical studies and finding out later which vaccine worked best for the most vulnerable among us?
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