I enjoy listening to twiv, although I must admit I haven’t had time to listen as much lately as I used to. My husband sent me this research study because he is increasingly becoming concerned about the covid vaccines. I’m not entirely sure how to interpret it, as this is not my area of expertise. This UK based Dr. John Campbell (who is a nurse educator and has a phd in education I believe) has a YouTube channel where he looks at studies on SARS and the vaccines, and he believes we’ve all been lied to and manipulated and that the vaccines are more dangerous than the virus. I would love to hear your thoughts on this!
I am an avid TWiV fan and just listened to episode #983 with Scott Hensley. One of the things he mentioned is the paper showing that elderly people who had survived the 1918 pandemic as children are still able to produce an immune response to the 1918 strain 90 years later. But it strikes me that considering this fact to be evidence of a long lasting immune memory response is overly optimistic.
In TWiV #966, Jeffery Taubenberger asserted that all current strains of influenza are descended from the 1918 epidemic strain. If this is the case, then surely someone who survived the 1918 pandemic would have had their immune memory ‘boosted’ many times by repeated exposure to descendant strains. Further, ‘imprinting’ (or as Hensley would phrase it ‘original antigenic sin’) would seem to make it likely that exposure to descendant strains disproportionately raised sensitivity to the parts of the original strain which are preserved in descendant strains.
Similarly, if someone tests one of the survivors of the original 2020 Covid-19 strain 90 years from now, I would expect that they would find an immune response if only because it is likely that descendants of our past and current Covid-19 strains will be circulating for (at least) the next 90 years and that fact will mean that the immune response to the strain of original exposure will likely be repeatedly boosted.
However, I am not a virologist, just an interested non-scientist who loves both the informative parts of TWiV and the friendly banter. So please tell me — am I thinking about this incorrectly?
On TWIV 983, you repeated an outdated lament that industry ignores the development of antivirals because there is no market for them. In 2021, 3 of the top 20 selling drugs worldwide were antivirals, that’s in addition to 3 vaccines targeting viruses, and doesn’t include blockbuster drugs like Sovaldi, Harvoni and Tamiflu (https://www.fiercepharma.com/special-reports/top-20-drugs-worldwide-sales-2021 ). The future looks bright for new antivirals; many unmet needs with large potential markets, obvious drug targets, powerful new AI/ML drug discovery and design tools, no concerns about on target toxicity, and improved diagnostics so you can get the right antiviral early when it will be most effective.
This is in sharp contrast to antimicrobials where there is a real problem with market incentives. Anti bacterial and anti fungal drug development is a much harder problem. Microbes have been waging chemical warfare against each other for eons and are very good at resisting/degrading/excreting antibiotics (https://www.science.org/content/blog-post/antibiotics-not-easy-they-say ). When a new antibiotic is developed, we have infectious disease committees rationing use, essentially guaranteeing that there will be no market for the drug, and then new antibiotics are released to the ag market and used in massive quantities more or less guaranteeing that resistance will develop. It’s a problem. One potential route forward are nonprofits consortia like the TB Alliance which has developed a recently FDA approved new anti mycobacterial drug, pretomanid https://www.tballiance.org/content/drugs-regimens-transforming-tb-drug-development
David J States, MD PhD FACMI
Chief Medical and Science Officer
Angstrom Bio, Inc
(vr: actually what I said is that no pharma was interested in coronavirus antivirals after SARS because the outbreak was over, hence no market).
Love and look forward to your clinical updates. Unfortunately, it seems that the same folks are pushing it beyond COVID-19 despite the science! Apparently the money is good.
Keep up the good work!
I enjoyed the piece on CCP with Dr. Arturo Casadevall. Good to have confirmed my impression that the reason that studies of treatments such as CCP were so unimpressive was due to the long duration between Covid infection and treatment. I never expected any antiviral treatment to work well after a week of illness.
I have some problems with some of Dr. Casadevall’s statements, however. He implied that it is easy for doctors to order CCP when in fact it is not available at most centers. While we have access to FFP (fresh frozen plasma) which is the same product except that it has not had Covid antibodies assayed and is not indicated for Covid. It is used for coagulation problems, generally. While CCP may be easily available at large medical centers such as Johns Hopkins, very few blood banks have this. There really should be a correction to the implication by the good doctor that CCP is easily available.
Thanks for your excellent podcast. I have found it to be a beacon of light in the confusing Covid fog. You have helped guide me in my role as CMO at a very small hospital in Vermont.
All the best,
George Terwilliger, MD (he/him/his)
Chief Medical Officer, ED Director
Grace Cottage Hospital
A nice day in Chapel Hill, NC. About 70 F, sunny and I just got out of a great lecture given by Shane Crotty and ran into Ralph Baric. Just an excellent way to start a day.
This email was prompted by TWiV 987 and is a follow up to a letter of mine that you read on TWiV 942. My letter was about the biggest correctable mistakes we made during the COVID-19 pandemic. I said how long it took to get an EUA for remdesivir and most of the panel talked about testing. A big part of my bitching was about WHATs (Worthless Hopeless Antiviral Trials). How WHATs kept remdesivir from getting a timely EUA and how that cost lives. After listening to Arturo Casadevall, I would like to revise my opinion and say that WHATs were the biggest problem, and that remdesivir and convalescent serum were examples of why it was such a problem. Not only did WHATs delay the deployment of effective antiviral treatments, they poisoned the waters for those treatments, making them less likely to be used and muddying the waters so that ineffective treatments looked the same in many trials.
As for testing, if we do not have rapid testing, no antiviral is going to be effective. We need both good antiviral trials and rapid testing. If the CDC does a Not Invented Here mistake again, all of those in that decision chain need to be gone that very second.
It is just a coincidence that I met Dr. Baric today and I am writing this letter. The letter was planned two days ago.
Link to NPR story:
I was 15. The album was the most popular album among my friends. I still listen to it from time to time. I still wonder at times if I missed the starting gun.