Hi Maloja Sake-
Glad that you are enjoying our conversation.
I'm just trying to get a sense of the possible paths forward on the cure for the virus itself + immunization + treatments for side effects, etc.. That for guidance on when partially or unrestricted travel might begin. Mark's perspective as a practicing physician is extremely valuable for me because, as I noted before -
"A little knowledge can be dangerous."
<<"Is is possible to do drug efficacy analysis on Covid 19 (a completely
new human virus emerging in the last few months) before knowing
population testing results (both kinds) or at least sample results that
could be statistically projected to larger groups. ">>
I certainly don't know the answer. However, I think that the answer is "Yes." You may question my credentials, of course. They are a bit thin.
I do know that this virus is only "new" in the sense that there is apparently no native immunity in the majority of the population, as exists for some other viruses. However, it is in one sense not a completely new virus causing disease in humans and animals.
This well written article offers a useful perspective on the point of novelty, and on the last sentence of your questions, as well:
<<" For example, do we
have any idea what percentage of people contract and survive Covid 19
without knowing it; ie asymptomatically? Wouldn't we need this knowledge
prior to doing any effective drug testing?">>
In theory, one can argue it would be required. But,that is a purist's approach. The best question, IMHO, is-
How well we can do with only partial information?
That data base is certainly growing rapidly, by the way.
I'll add an opinion purely as a layman in medical issues. I speak as a scientist, a discipline in which I worked at chemical research and development at a professional level. And, although no longer gainfully employed in that work, I still have a useful perspective on creation of "new" technology. Even after I'm retired.
Just as engineers can design and create things without perfect knowledge of all of the fundamental aspects of the needed technologies, some of which knowledge may not exist, I submit there there is enough relevant knowledge to get started effectively on this problem. I'd like to have that opinion refined or refuted by anyone more knowledgeable in the field than I.
Since the time for results of tests is measured in days or weeks, not just in months or years, a lot of knowledge-based empiricism can be quickly applied, tested, published, tested again, and discarded or pursued. The various studies mentioned in this thread testify to that belief. The gold standard of statistically valid large double blind studies with perfect test equipment may well be involved for a "final" solution. But, a less than perfect solution can be sufficient. In my opinion.
You are certainly correct that the best way to understand results is to have testing. Chemists are lucky...they have that luxury, in general. Physicians may have to practice without it. In this Covid-19 case, excellent tests suitable for clinical research already exist. Further, Abbott Labs - a substantial and highly capable provider of lab test technology - has commercialized a kit for use with the existing installed base of their test equipment. Also, they have introduced a faster test/kit/apparatus, that can give results in 5 minutes or so, and more thorough results in 15 minutes or so. Even though this is not suitable for mass screening of thousands of patients per day or hour...not enough of the equipment, yet........patients in trials can be tested frequently as therapies are tested. (That is being done in the tests of off-label drugs such as the much-hyped hydroxychloroquine). They were being deployed in Asia and Europe while the USA was failing at developing its own test. [In that case it seems that the initials NIH stand for "Not Invented Here" syndrome instead of "National Institutes of Heath."] Specifically apropos your question, two serological tests also have been announced that allow determination of whether a patient has been exposed to the virus. That helps answer your question, too.
And, the symptoms of a case of the Covid-19 disease can certainly be observed often in patients of normal good health, once they have the disease. Most of them survive, possibly needing supportive therapy, some without hospitalization. Even if there exists a percentage of asymptomatic people ( many of whom have been shown to eventually develop symptoms), they can be treated with a test drug and tested to see if the viral infection is eliminated. Tests exist, and I believe that are available in sufficient quantity for that purpose. That narrow purpose needs less testing capability than does mass screening...which , as you imply, is also needed eventually ( or sooner). So, to answer your last question, with limited knowledge of the specifics, I still believe that practical success can be achieved by the methods in place, or coming into place. Eventually, more tests will add to the precision, but there are enough now to do the clinical trials...as far as I can tell from my reading. I'm a layman in medical issues, remember.
To summarize, there are two kinds of needs for test. Small volume for clinical trials (which I believe exists, and large volume for mass screening ( which as been delayed more than it should be). The distinction is meaningful.
The part of this situation that particularly worries me is the group of patients whose immune symptoms become overactive, as the body "fights' the virus, and consequently die of autoimmune destruction of vital organs. ( Hydroxychloroquine and the IL-6 blockers being tested are aimed at curing that category of patient). Other patients die of bacterial infections (such as some kinds of pneumonia) that would normally be treatable with antibiotics, but whose immune systems cannot help contribute to a cure.
Those are deaths that are not caused by the virus infection, per se. And, if a population known to carry the virus (even if asymptomatic) is treated empirically, and a high percentage survive, especially in the class of patients with compromised immune systems, that in fact that is a success. In the Ranitidine trial mention by Mark, about 30% were cured quickly, a bit less than 60% had normal progression, and about 15% died. Although Mark did not say, I am sure that people chosen for that study were all clearly infected and had symptoms of the infection and/or positive tests for the virus, in order to be allowed into the study.
So, in any trials of a population that test positive for the presence of the virus result in zero deaths ( or as Mark pointed out "few" deaths), or normal progression of the viral infection or its consequent symptoms/ conditions is arrested in "most" , that is a success. How much is enough? Opinions will shift as success approaches.
Compared to what I have seen in chemistry, there is a lot of empiricism in medicine, and it works. Medicine is an art, as well as a science. And, there are a lot of knowledgeable and motivated people working on the problems. I don't lack optimism about eventual success,which will followed by years of greater understanding arising from all of the studies - fundamental or empirical. It will help get ready for the next one. I'm just hoping that the systems get in place to allow safe travel/normal life for old people like myself. In simple terms, that means that a cure is readily available wherever I happen to be. For a start, I'd like that to be Connecticut, New Hampshire (relatives), a small part of Massachusetts ( the highway between those other two states). Then Switzerland, and airline routes to and from.
The broader social issues will have to be solved, as well...probably means a vaccine, as you have discussed.