Inside Covid-19: First successful vaccine; DA tackles lockdown “irrationality”; Prof exposes cig “disaster”. Ep 35

A bumper edition of Inside Covid-19 with good news as the first human coronavirus vaccine tests deliver promising results while other medical treatments are being uncovered at a rapid clip; DA leader John Steenhuisen explains why SA’s official opposition political party is going to court to stop what it calls “lockdown irrationality”; we hear from the UCT prof whose research shows the cigarette ban has been a disaster for everyone except the underworld; concerns that SA’s 7,000 sit-down restaurants and the 1m people they support face impossible odds of survival if current regulations continue; and as the lockdown slowly eases in SA, nations around the world are fretting about a possible second wave of infections. – Alec Hogg

In the Covid-19 headlines today:

  • South Africa’s curve flattening days are over with the confirmed infections starting to rise at a rapid rate with 1,160 new cases reported on Sunday taking the total to 15,500, of which 8,245 are active. There were three more deaths on Sunday, putting the total at 264. Globally, total confirmed cases are now close to 5m and deaths at 320,000. While the US remains the hardest hit nation with over 90,000 deaths, Brazil’s numbers are rising rapidly with 252 deaths today taking its total to 16,370, sixth highest behind America, the UK, Italy, France and Spain. Russia now has the second highest number of infections at 290,000 behind the US’s 1.5m Brazil at 244,000 is fourth after the UK’s 247,000. On the upside, with the exception of Brazil, all the other countries where mortalities have been highest are now displaying significant declines from their peaks – the US from 6,000 new daily cases to 865; the UK from a peak 8,750 to 3,400; Italy from 6,500 to 675; and Spain from 9,600 daily infections to 515.
  • South African-controlled luxury goods multinational Richemont reported a 19% reverse in sales during the three months to end March, a direct result of coronavirus-related lockdowns in mainland China and Hong Kong. The group said business has picked up in recent weeks after its 460 stores in China re-opened. Richemont’s business was hit by the higher gold price – which made it more expensive to produce its expensive watches and jewellery – and its online business Yoox Net-A-Porter was hurt by increased e-commerce competition. Richemont chairman Johann Rupert said the pandemic will cause a re-set for the global economy, rather than the pause some were hoping for. In line with this, Richemont cut its dividend by half to conserve cash, a significant development considering the group did not cut its payout during the 2008 Global Financial Crisis. In related news, South Africa’s leading life assurer Old Mutual, which celebrates its 175th anniversary this year, will break new ground when it hosts the first digital Annual General Meeting on May 29th. The group is also planning to create Africa’s biggest digital classroom to help the continent address the challenge of access to education.
  • Moderna, a Nasdaq-listed biotech company, today announced positive data from the human testing of its novel coronavirus vaccine by the US’s National Institute of Allergy and Infectious diseases (NIAID). In March, eight people received two doses each of the first vaccine to be tested in humans. They all stimulated an immune response against Covid-19, making antibodies that were able to stop the virus replicating – the key requirement for an effective vaccine. The company also said preclinical results of a study in mice was also successful, the vaccine preventing viral replication of Covid-19 in the lungs of the animals. Moderna says it will accelerate testing with the next phase to involve 600 people. There is currently no vaccine against a coronavirus. US share prices rallied sharply on the news, gaining around 3% and wiping out last week’s losses, which were the worse in two months. The oil price jumped almost 10%, helping push JSE-listed Sasol up R8 a share to its best level since early March.

There was a big move in the United States markets today and a huge jump in the oil price and it’s all to do with a company called Moderna, which has done the first clinical trials of a vaccine for the coronavirus. It appears to be successful, well appears is what amateurs think, not to Dr Noluthando Nematswerani who is the head of the clinical Policy Unit at Discovery. Nolu, on the face of it, in the way that the investment markets have reacted, this looks like a huge breakthrough from Moderna?

At this point, we are all looking for some positive news around the vaccine. If you listen to everyone we always speak about when the vaccine comes this is what will happen. We are expecting to regain a bit of normality and it all has been anchored around the emergence of the vaccine, which is why there is such a positive response around what has been reported thus far. It’s important for us to unpack a bit of what has been reported. So these are Phase 1 human trials. It means the patient numbers are still relatively small and there’s still a long way for us to go before we can get to a point where we’ve got commercially available vaccines that can be accessible to everybody else. The reports as you would have seen, reports some promising outcomes on only 8 patients. We need significant numbers of patients to be tested before we can get to a place where we can say we’ve got a vaccine that is safe and efficacious. Promising results are showing, we are seeing that the antibody response specifically neutralising antibodies that are aimed at killing the virus have been observed in those patients and they have been likened to what is seen to those people who have actually recovered from Covid-19. What still needs to be shown though is the duration of the immunity that may be conferred by those antibodies. It’s early days, but any bit of positive moves towards the right direction is welcome and it creates promise even to the many other companies that are working on vaccine trials and are hoping to actually find some breakthrough as part of the trials that they are running at the present moment.

Interesting point you make that there were 8 patients that were involved in this, Moderna talks of now doing it with 600. Is that the way it usually works?

Yes. Phase 1 trials are usually a handful of patents. Remember they didn’t actually do the trial on only 8 patients, but I think they have results for the 8. They’ve also done other studies on mice, where they looked at the response of the virus when they administered the vaccine. They looked at the lungs of the mice and they saw some positive response. In terms of the human trials, they looked at about 45 patients but then the results that they were able to report were on 8 patients. It’s the nature of clinical trial phases, in the smaller phases you also want to test the amount that you need to be giving to these patients to get a response, the dosing is also something that is tested early on so you know what you can administer when you then expand your trials. By the time you get to thousands of patients in the clinical trials, you would at least know what doses work best and what side effects you are expecting to get once you administer the vaccine. They did report some of the side effects that they observed in those patients and the various doses, there is more of a move towards the smaller dose to achieve the same outcome without using the higher doses that may elicit some side effects that may be unwanted. In the early stages, it’s about testing those issues around the dosing, adequate dosing and also looking at the side effect profile of the vaccine to ensure safety and efficacy in the long term.

We had an interview with Professor Adrian Hill just over a month ago from Oxford University. They’ve been supported by the British government and they’re also doing trials. We haven’t heard anything positive from them yet though. So this is really the very first successful bit of news from one of the vaccine makers. How many other companies or how many other organisations are trying to do the same thing?

It’s a relatively long list of companies, maybe close to ten or more. There’s been quite a lot of activity around this space in vaccine development and finding treatments for Covid-19, those are two main areas of focus right now. If we’re going to expect the vaccine to be available maybe by next year people are looking at what else can be done in the meantime to reduce the fatalities that could be related to Covid-19. In terms of vaccine trials, it’s quite a number of other companies that are busy with these trials. It’s a lot of activity right now. Early on there was a company in Israel that announced their success in the labs in terms of formulating a vaccine that they felt would be beneficial. Everybody now is going to be embarking on human trials. Any positive responses I’m sure people are going to be sharing with the media to create some positive news, bringing a bit of hope to those who are at the forefront of fighting with this virus and for us as the broader public, want to know that there is some activity taking place with vaccine development.

Names like remdesivir and chloroquine have been mentioned very often. The one seems to be quite positive, the other not so much. Can you bring us up to date with those medications and what seems to be working?

There are quite a few. I’ll just mention some of the drugs that have been listed as some promising agents early on and also those that are in clinical trials at present. Most of the drugs that are currently being tested are called repurposed drugs because they’ve been registered for other indications before and are now being tested in the treatment of Covid. Hydroxychloroquine is known as a drug that has been used a lot in the treatment of malaria. In the early days, it was one of the drugs with the most promise, which is why we always caution because it is based on a small number of cases and then people get this false sense of hope that proper trials have been done, but there are results that have not lived up to their expectations. There’s been caution around the side effect profile of the drug that reported more toxicities rather than benefits. There are other antiretrovirals. There are other antiretroviral agents like lopinavir-ritonavir that have been used in the management of HIV. They are also in trials and found in earlier reports in some parts of Asia and have not really shown any promise but they are still in the basket of drugs that are being tested right now. We also know of a drug tocilizumab, marketed as Actemra. It is a drug that has been used as an anti-inflammatory for some of the autoimmune conditions, it is still being trialled out and has also been reported to show some benefit. Hydroxychloroquine has been used in combination with antibiotics. If you look at clinical protocols in some of the hospitals they still include some of these agents in their basket of items that they are trialing out in some patients who are presenting with severe disease. Remdesivir is a Gilead product that saw some early reports in the US, and the FDA granted it some emergency use access. It has not been fully approved but because of some promising results, it has been allowed to start using it in the defined population of patients in hospital. There was another trial that was done in China which didn’t show the same results that the US trial showed. There’s work being done in the vaccine space but there’s also a lot of work being done to find treatments that are effective in the management of patients with Covid-19. It’s always important to make sure that in the absence of a vaccine at least we can minimise the mortality and morbidity that the disease brings specifically when we look at the vulnerable populations, our elderly patients and patients with underlying chronic conditions. There is activity and we remain hopeful we will find effective treatments that are going to assist patients in the fight against Covid-19.

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