No Quick Return to Normal How SF Dodged the COVID Surge Chloroquine Quality Concerns

Donald McNeil predicts there won’t be a quick return to our previous lives in the U.S., based on interviews with nearly two dozen experts.

The path forward depends on several factors, including a staggered approach to reopening, widespread testing and contact tracing, an effective treatment, adequate resources for healthcare workers, and eventually a vaccine, McNeil writes.

Our economy needs to re-open slowly, and the possibility of the immunization “passports” discussed in Germany could be a reality here, too — even if that means at-risk people will be tempted to get infected so they can get back to work.

“My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,” Michele Barry, MD, of Stanford University in California, told the Times.

Over the next 2 years, the economy can recover in fits and starts as more immune people can get back to work, experts told the Times. That still requires massive testing — at least hundreds of thousands of tests daily — and being able to isolate those who are sick and trace their contacts.

Currently, the CDC has 600 contact tracers, and state and local health departments have about 1,600 total. Former CDC Director Tom Frieden, MD, MPH, estimated that the U.S. will need at least 300,000 people to do contact tracing.

Making an effective vaccine will be a slow process, and even if successful, producing hundreds of millions of doses will be even more difficult. Most American vaccine plants make 5 to 10 million doses a year, but the U.S. would need 300 million doses for a one-time vaccine, and double that for a two-dose vaccine.

Treatments are more likely to arrive first, and convalescent serum is at the top of the list for many experts, the Times reported.

McNeil allows for some optimism at the end of his report. After both world wars, he noted, incomes became more equal and social safety nets improved. If a vaccine saves lives, Americans may become “less suspicious of conventional medicine and more accepting of science in general — including climate change.”

“The blue skies that have shone above American cities during this lockdown era could even become permanent.”

How San Francisco Avoided the Surge

A longstanding alliance of public health officials pushed the Bay Area’s early lockdown, sparing it from the surge seen in many other parts of the country, Kaiser Health News reports.

On Sunday, March 15, members of the Alliance of Bay Area Health Officials jumped on a conference call to discuss the growing cluster of coronavirus cases in Santa Clara County, and ultimately decided a lockdown was necessary — especially knowing that St. Patrick’s Day celebrations were only 2 days away.

The next day, the group issued the nation’s first stay-at-home order for the seven counties surrounding the San Francisco Bay Area. It had the authority to do so, since county health officers in California have vast power to act independently in the interest of public health. They can issue legally binding directives without needing the approval of governors, mayors, or county politicians, according to KHN.

The group, which includes 13 health officers from counties in Northern California, from Napa to Monterey Quick Return, formed in the early days of the AIDS epidemic, and has established camaraderie and frequent and open discussions.

The counties represented by the alliance have reported 215 deaths from COVID-19, and their hospitals haven’t been overwhelmed.

“I was concerned that we might get a lot of resistance and it might get interpreted as alarmist and overreach,” Matt Willis, MD, Marin County’s public health officer, told KHN. “Time has shown that it was really a vital step to take when we took it.”

Chloroquine Quality Concerns

Reuters investigation raises serious questions about the quality of a chloroquine product donated to the U.S. by the drug company Bayer.

Anonymous government sources said there was reason to be concerned about the product Quick Return, branded Resochin, and its manufacturers in India and Pakistan. Neither have been registered with the FDA, or underwent an FDA inspection.

Pakistani regulators found a “gross failure” in manufacturing practices at the plant in 2015, when a whistleblower complaint revealed that 21 million tablets were of lower potency than labeled, Reuters reported. As for the Indian plant, FDA inspections of facilities operated by the same company showed deficiencies, they found.

Bayer donated 3 million tablets of the drug to the U.S. national stockpile, and an FDA spokesperson told Reuters the drugs were evaluated and met appropriate standards.

A series of leaked emails shows health officials requesting a photo of some of the product when it landed at J.F.K. Airport in New York, Quick Return for publicity purposes. Joseph Hamel, manager of strategic innovation and emerging technology for the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services, asked: “How do you want to handle? FDA win? ASPR win? Happy either way, please let us know.”

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