Boston Diary – Day 144

When I wrote my last column, ‘Run for the Roses’, the race for a COVID-19 vaccine was just getting underway. Now, the preliminary reports are coming in almost daily. Multiple projects, featuring diverse technologies, show early and encouraging progress. Large-scale clinical trials will demonstrate how well the different approaches work in large numbers of people. While the candidates apparently do elicit antibodies, one key question is effectiveness. Will the vaccine provide immunity; in what fraction of the population; and for how long? Achieving herd immunity for COVID-19 is estimated to require an immunity rate somewhere between that of flu and measles vaccines – and we still face significant unknowns in production and distribution.

As a time-honoured stop-gap measure, many hospitals throughout the world have turned to convalescent blood plasma for the more serious cases. Anecdotally, it has provided improvement in patient outcomes and did not potentiate cytokine storms. Post hoc analysis of immunoglobulin G quantitation and patient outcomes for matched subjects strongly suggest efficacy. However, donor plasma is a limited commodity. A number of biopharmaceutical companies have launched programmes to develop synthetic antibodies, which can complement vaccine therapy if they can be made cost-effective.

The soothsayer in Shakespeare’s play, Julius Caesar, was on my mind as the COVID-19 pandemic began to spread. The ‘Ides of March’ arrived, and my office started to work from home. In our region, as in many others, our state government provided guidelines for social distancing, business closures – except for essential operations – and other public health measures. The savings in auto mileage and daily commute time did have a certain appeal. Online meetings soon became the new normal. However, the excessive, back-to-back web meetings every morning get a little tedious.