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An Antibody “Cocktail” for COVID-19: Bottoms Up!

By Shlomo Maital

             In medical research, sometimes old tried-and-true ideas become new.

             In HIV AIDS research, researchers tried to find an antibody that would defeat the virus, if injected or consumed by patients. It didn’t work. The virus always found a way. The solution? Cocktails – combinations of antibodies, which taken together the virus could not defeat. And to this day, those who are HIV positive do quite well, relatively, when they regularly take the new ‘cocktail’. One of those drugs is called “Retrovir”. David Ho is generally regarded as the HIV cocktail pioneer, supported by the Rockefeller Foundation.

           A similar approach proved effective with the Ebola virus. Late last year it was reported that: “ …a team of scientists demonstrated that a two-antibody cocktail called MBP134 could fully protect nonhuman primates and ferrets against lethal Ebola virus infections.”

           Now comes a biotech company called Regeneron, which has embraced the same principle. According to CNN and Peter Sullivan, writing for thehill.com:

   Regeneron is testing a cocktail of two antibodies to both treat and prevent the coronavirus, developed using people who have recovered from COVID-19 as well as genetically modified mice.   The company did not give a firm timeline for its work, but these antibody cocktails could be ready sooner than a vaccine.   A competitor company also working on the idea, Eli Lilly, said its antibody treatment could be as ready as early as September; it started trials earlier this month.  

“We have created a unique anti-viral antibody cocktail with the potential both to prevent and treat infection,” Dr. George Yancopoulos, chief scientific officer of Regeneron, said in a statement.   The antibody cocktail “could have a major impact on public health by slowing spread of the virus and providing a needed treatment for those already sick — and could be available much sooner than a vaccine.”

    We learned from treating HIV AIDS that a two-pronged approach is needed: Develop anti-viral drugs, while you develop anti-viral vaccines.  To this day no vaccine for HIV has been found.

      This is happening with COVID-19 as well. Drugs and vaccines.  Meanwhile, a vast army of hard-working scientists all over the world are collaborating, sharing results, and working day and night, to defeat this wily virus.

    They give us reason for much hope.

Don’t Count Too Much on a Vaccine

By Shlomo Maital  

Dr. William Haseltine

   The Tyee is an independent online Canadian news magazine that primarily covers British Columbia. [Thetyee.ca].   Contributing writer Andrew Nikiforuk writes about a world-leading virologist Dr. William Haseltine, vilified in the past for doubting an AIDS vaccine could be produced (apparently, it can’t), and now sharing doubts about a COVID-19 vaccine. His views are worth heeding….   Warning: This blog is 1,000 words, twice as long as usual!

   “William Haseltine: People should regard everyone they meet as infected and act accordingly. ‘That’s the only safe assumption you can make. And don’t assume that if you’ve been infected, you’re protected.’

   When William Haseltine told a group of fellow scientists in 1986 that an AIDS vaccine would be unlikely because of the difficult nature of the virus, he was booed off the stage. His colleagues even threw stuff at him. “But we still don’t have a vaccine for AIDS,” he recently told Reuters. “We don’t know for sure that a [COVID-19] vaccine won’t be developed, but I can say with the same conviction — don’t count on it.”

   In the last couple of weeks the virologist also has offered some jarring observations on the nature of the coronavirus, self-promotion by drug labs, the hazards of rapid reopenings and our global unpreparedness for what is yet to come.

Here are Haseltine’s eight key observations…

  1. Beware of those who purvey premature hope.

   Haseltine’s years of experience cause him to caution against being manipulated by emotion. A number of firms have been giving “a false impression of progress” on the vaccine front, he worries. Cambridge-based Moderna, for example, made headlines last week with news of a safety trial on just eight healthy individuals for its vaccine. The value of the company’s stock exploded. Although the company said their experimental vaccine raised neutralizing antibodies, it said nothing about levels

  1. Even a vaccine that works likely won’t solve the pandemic.

Haseltine also wants citizens to appreciate this bit of wisdom: a vaccine will not likely end this pandemic for several reasons.

   For starters the most affected population, people over the age of 60, are the most difficult population to develop vaccines for. As the immune system ages, the effectiveness and duration of vaccines wanes with it. “It is very difficult to develop a vaccine for older people,” notes Haseltine.

Second, coronaviruses make difficult vaccine candidates because they produce many proteins that allow them to trick and evade the immune system.

   Third, Haseltine doesn’t think an adenovirus-based vaccine such as the one proposed by CanSino Biologics, and now being tested in Halifax, will do the trick either.

  1. A flattened curve is not a road to victory.

Haseltine also thinks many people aren’t taking the disease seriously enough. The veteran virus fighter compares COVID-19 to polio. It, too, was a cold virus with a nasty bite. One in 200 people infected came down with paralysis and of those 10 to 15 percent died of muscle paralysis. It, too, spread through what white coats call “the oral-fecal route” on people’s hands and contaminated surfaces.

As the world experiments with reopening after the first wave, often without adequate testing, contract tracing and isolation facilities in place, people should regard everyone they meet as infected and act accordingly.

“That’s the only safe assumption you can make,” he said. “And don’t assume that if you’ve been infected, you’re protected.” He advises people not to let down their guard or stop wearing a mask in crowded places until their city and region hasn’t recorded a COVID-19 case for a month.

  1. ‘Herd immunity’ is a dubious prospect.

Haseltine also thinks you can forget about herd immunity as some kind of saving grace. There is a reason that we all get colds every year and that’s because immunity to the four corona viruses that cause colds doesn’t last long.

“There’s no such thing as herd immunity for this disease. I doubt it will ever exist,” Haseltine said in a Reuters interview, because “people who have had it are getting reinfected.” He thinks Sweden made a bad mistake going for herd immunity, and then cites the nation’s death rate which is higher than any other Scandinavian country.

  1. We remain woefully unprepared.

The next thing Haseltine wants you to think about is our chronic and ongoing lack of pandemic preparedness. COVID-19 caught the world with its pants down because governments and corporations ignored all the warnings. If you want to know how predictable pandemics can be just watch the film Contagion, says Haseltine.

Nearly 15 years ago the emergence of SARS and then MERS demonstrated that coronaviruses could be an existential threat. Although researchers started work on 20 potential drugs for these coronaviruses, they all got shelved.

“Those drugs lay dusty on the shelves in China, in Singapore, in Hong Kong, in Europe, in the United States, and in the [United Arab] Emirates and Saudi [Arabia] where they were discovered and shown to work in animal models of both SARS and MERS.” The reason: there was no economic model to develop them. Haseltine thinks it is more likely researchers will find a suitable drug treatment for the virus before they develop a safe vaccine.

  1. Nature is not nearly as controllable as we wish.

The pandemic is also sending people a deep and profound message, says Haseltine. “We are part of Nature. We don’t control Nature. Do we control volcanoes? Do we control hurricanes? Viruses are part of nature and their job is to grow in us,” Haseltine recently told Reuters.

  1. Much bigger threats loom.

Globalization and human population growth have created pretty good ecosystems for new colonizing viruses. Every day the viral world makes trillions of random mutations and some of these mutations produce viruses that can adapt to human environments better than others. More pandemonium is coming, warns Haseltine.

“It is only a matter of time before a coronavirus that is far more lethal and contagious than this one emerges to ravage the world’s population,” says Haseltine. “When that happens, we will no longer be talking about a global death toll in the ‘mere’ hundreds of thousands.” He also suspects the world is overdue for a deadly influenza outbreak capable of removing one to two billion people from the planet.

  1. Changes in behavior can save us now. And far more certainly than any vaccine.

Last but not least, we should pay more attention to the most important part of this story: changing human behaviour can stop COVID-19 dead in its tracks.

 

 

 

Tzameret Fuerst: Pass It Forward!

By Shlomo Maital

Tzameret Fuerst    PrePex

            Tzameret Fuerst                               PrePex

   Tzameret Fuerst is a highly-popular Israeli inspirational speaker, who travels the world telling her story.   Here it is, in short.

     She read about how HIV/AIDS is killing millions in Africa. In Botswana, one in every four persons has HIV.   Unlike the rest of us, she decided to act. She read about WHO research showing that circumcision greatly reduces exposure to HIV, by 70%, because removing the foreskin takes away the HIV virus’ favorite place to hide and invade (foreskin cells are sensitive, prone to abrasions and cuts, easy for the virus to invade). But so what? There is no way we can circumcise millions of African men.

     Well – why not?   Fast forward. Fuerst started Circ MedTech and tackled the problem with passion, and her company developed PrePex. PrePex is a device placed on the penis, that cuts off blood circulation to the foreskin; within a week it drops off. Simple. It has four parts: A placement ring; an elastic ring; an inner ring, and a verification thread. A nurse can install it; no need for surgery or a doctor. It has FDA approval and today, the Gates Foundation, WHO and the World Bank plan to get the device to 20 million men, saving 3.4 million lives and some $16.5 billion.  

     A crucial milestone came when Fuerst, stalled in her efforts to disseminate PrePex, got on a plane and flew to a conference she knew was attended by Bill Gates. She approached him, said “ May I have a few moments of your time, outside?”. Gates agreed. She persuaded him to cut the red tape and help move PrePex forward.

     There is a very personal angle. Fuerst divorced her husband, who was Chair of her company. She felt that as CEO she could not continue, as a result. So she resigned, for the good of the company and its device. She now travels the world, gave a TED talk, and tells her story to inspire others.

     How many of us can say that our energy, persistence, empathy and creativity have saved millions of lives?   Thanks, Tzameret. Your name, in Hebrew, means “summit” or “top”. And you are.

     

Curing AIDS in New-born Infants: Breakthrough!

By Shlomo  Maital     

           baby AIDS

    Few things are more tragic, and more unfair, than new-born infants born with AIDS, acquired from their mothers.   I was stunned to learn that every year, 250,000 babies worldwide are born infected with the AIDS virus! 

   It is tough enough for many babies to make their way in the world, without the lifelong struggle with AIDS, starting at birth. 

   But a creative doctor may have found the answer.

   According to a report in the New York Times,  *    “When scientists made the stunning announcement last year that a baby born with H.I.V. had apparently been cured through aggressive drug treatment just 30 hours after birth, there was immediate skepticism that the child had been infected in the first place.   But on Wednesday, the existence of a second such baby was revealed at an AIDS conference here, leaving little doubt that the treatment works. A leading researcher said there might be five more such cases in Canada and three in South Africa.  And a clinical trial in which up to 60 babies who are born infected will be put on drugs within 48 hours is set to begin soon, another researcher added.  If that trial works — and it will take several years of following the babies to determine whether it has — the protocol for treating all 250,000 babies born infected each year worldwide will no doubt be rewritten.  “This could lead to major changes, for two reasons,” said Dr. Anthony S. Fauci, executive director of the National Institute for Allergy and Infectious Diseases. “Both for the welfare of the child, and because it is a huge proof of concept that you can cure someone if you can treat them early enough.”   

    Let’s applaud Dr. Audra Deveikis.  Here is how she made the breakthrough discovery:   “ A baby girl born at Miller Children’s Hospital in Long Beach, Calif., is now 9 months old and apparently free of the virus that causes AIDS. Her mother, who has advanced AIDS and is mentally ill, arrived in labor; she had been prescribed drugs to protect her baby but had not taken them.   Four hours after the birth, a pediatrician, Dr. Audra Deveikis, drew blood for an H.I.V. test and immediately started the baby on three drugs — AZT, 3TC and nevirapine — at the high doses usually used for treatment of the virus.    The normal preventive regimen for newborns would be lower doses of two drugs; doctors usually do not use the more aggressive treatment until they are sure the baby is infected, and then sometimes not in the first weeks.   “Of course I had worries,” Dr. Deveikis said in an interview here. “But the mother’s disease was not under control, and I had to weigh the risk of transmission against the toxicity of the meds.”   “I’d heard of the Mississippi baby, I’d watched the video,” she added. “I knew that if you want to prevent infection, early treatment is critical.”   The Long Beach baby is now in foster care, she said. The mother is still alive as well.

It may take some time. But perhaps, many of those 250,000 babies born to AIDS moms will be spared the illness, thanks to  Dr. Deveikis.  

    Dr. Deveikis simply broke the rules, broke the protocol for treating AIDS babies – and may as a result have saved many lives.   And of course, she read the literature and case studies.   

    Thanks, Dr. Deveikis!   It took courage to defy the conventional protocol, and you may even have endangered your career in doing so.   Perhaps one day you will get a Nobel Prize.   I wonder why no other doctors thought simply to administer the large doses of anti-AIDS drugs to newborns at risk?   I guess it’s really hard to think out of the box. 

Blog entries written by Prof. Shlomo Maital

Shlomo Maital

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