From the Doctor’s Desk
Monkeypox is making noise, there’s the bizarre child Hepatitis worry, Ebola has reared its ugly head again in West Africa, BA.4 and .5 variants of COVID are taking rapidly over from older Omicrons especially in South Africa, there’s the pre-recession stock market crash happening. All this with the background of a deepening East-West divide and the food and energy supply crisis.
Don’t Panic!
Monkeypox in Humans: It’s related to the notorious but fortunately extinct smallpox, but to be clear this is absolutely not a new smallpox which is most deadly. Monkeypox is a disease that is normally found in animals, but occasionally found in isolated outbreaks in Central/West Africa spread by close proximity (through respiratory droplets) and more easily by intimate and sexual contact. It is fatal in 4% of cases, which is concerningly high, but most cases are in countries without great healthcare systems. What do we recommend? Clearly avoiding areas with outbreaks is a good idea though we have little idea precisely where those carrying it are. The symptoms can be unnoticeable. Smallpox vaccine, for those who may have had it many moons ago, may afford some protection for this family of viruses but is not widely available now. If travelling in outbreak areas, fly with a good mask, as with COVID, and avoid intimate contact with those whose health-awareness and transparency you can’t rely upon.
But the odds are low, and risk adjusted it should not change your life or plans. If you do get the symptoms and signs, call your physician, public health authority, or tropical disease specialist centre and get tested. Vaccine ramp up is happening as we speak and there are antiviral therapies effective in that family of viruses which health authorities are stocking up on just in case things get worse. We don’t think they will. Whichever way it goes, it’s remarkable how responsive and pre-emptive health authorities have become.
New COVID Variants in South Africa: News of more transmissive and dangerous variants have hit the headlines (BA.2.12.1, BA.4 and .5). In brief, while still of concern to public health authorities we have not seen sufficient evidence to alarm us that this causes lots more hospitalision, need for ventilation or deaths, at least from the UK data. There is some suggestion that hospital admissions are rising in South Africa coincidental with the replacement of older Omicron strains with these new ones. This may be due to the virus or waning immunity from the time since last vaccination. We don’t yet know but it has not changed our personal approach to social interaction nor the advice we are giving vulnerable patients. That said many have now all but abandoned the use of masks in any situation and are happy to fight a dose of COVID if it comes their way (or potentially silently pass it onto others). This is a rational approach to maintaining herd immunity but our view remains that if at all vulnerable or if you’d like to optimise the initial viral load of what you're going to get or give, keep testing and wear a mask on public transport.
Strange Hepatitis in Kids: Cryptogenic means we don’t know what’s causing it. The new hepatitis phenomenon is just that. It remains unclear why children are getting it though the majority of cases have an Adenovirus which may be causing it. It is super rare with only 300 cases reported worldwide as of last count. That said 10-15% need liver transplants and 9 children have died. It is not clear who gets the worst outcomes here but clearly that is devastating and the only consolation here is that there are a lot of children out there and a lot of that adenovirus given how far and wide this has spread. Hopefully this means that the number of children who have the potential for the disease is very large and the proportion developing the actual liver problem is very, very small. There is zero relationship seen relating to COVID or vaccines. There is no current cause to change how you are living life to avoid this rare disease.
Massive Crash in the Tech Markets: The stock market has taken a plunge and the worst hit is tech and biotechnology. Biotechnology in particular. But not Big Pharma. Why? We believe, from discussing with economics pundits, that technology and biotechnology companies especially are valued on the far future promise of very large investment returns. When the time it takes to realise potential returns seems a long long way away, and when it looks like inflation and interest rates are going up for the foreseeable future, this means that putting money into banks, bonds, bricks-n-mortar, bullion and liquid gold (oil, gas, etc.) will generate more likelihood of a higher return over the next ten years than in high growth private companies and stocks. This is causing a rapid drain in the faith and financing of the most important domain of innovation for human health and therapeutics. This is not an existential risk but it will slow the stunning advances made in computational biology, tech to speed up trials and novel bioengineering efforts to address harder to treat cancers and the diseases of ageing. Fortunately Big Pharma stocks seem to be holding up so investment will flow through strategic industry investment.
Silver Linings in Every Cloud: Over the last month several members of our team were given the privilege to speak and attend events such as Google Zietgiest (London), Balderton (Munich), Latitude 59 (Tallin), Nobody (Marbella), and WIRED Health (London). We listened, learned and discussed the future of medicine with leading scientists, policy makers, technology giants and healthcare innovators in the world. Along with the sense that COVID was finally no longer a restriction to the joy of physically meeting human beings with photons instead of pixels, we officially enter the Northern Hemisphere’s Summer with a very optimistic view of the future for human health. Our positivity comes more from observing collaborative spirit thriving throughout COVID, with innovation, science and liberal ideals triumphing over adversity.
Highlights for us we will cover in depth forthwith, but the ‘trailer’ includes the remarkable breakthrough in Protein Folding by DeepMind, we spoke to Pushmeet Kohli, Science Lead for AI at DeepMind, about Alpha Fold last week. We learned how this remarkable company is solving some of the world’s hardest life-science problems with Artificial Intelligence. It’s hard to understand what predicting protein folding is and why it’s so important. So, here’s a bit of homework to watch before our deep dive in the coming weeks:
https://www.youtube.com/watchv=KpedmJdrTpY&feature=youtu.be
Our UK team were also given the privilege of presenting one of our projects which spans out of work in COVID testing in collaboration with Imperial College London, Chicago and Tartu Universities - Certific. Certific.co, now a growing company of 30 brilliant humans, is a digital (app-based) quality assurance system that helps patients take tests at home to ISO Accredited Medical Laboratory standards without booking an appointment or teleconsult with a professional. Vastly expanding patient Self-Care and authorising auto-prescriptions with follow-up to eliminate avoidable appointments is vital to offload health system burden and improve participation and experience of medicine. Certific, post COVID, has now launched UTI and STI self test-to-treat in the UK and EU. The promise of solutions enabling a patient to safely self-prescribe as a ‘Certified Self-Care Practitioner’ could be just a matter of months away. Authority to do clinical measurements to professional standards, autonomously, will also expand access to clinical trials.
Systems such as Certitic are essential components of future healthcare and research infrastructure. Decentralised infrastructure where, ideally, everyone’s medicine cabinet at home becomes a powerful toolkit for personal, family and public health management, connected to shared data repositories, and smart clinical support, will make the world a safer and more pandemic-resilient place. Companies like HUMA are proving this is possible with Hospital at Home systems saving money and time for both patient and health-systems. We must live with the reality of COVID and it won’t be the last new pandemic we’ll see. Whether it's the next Pox, Hepatitis or Coronavirus that hits us. We are in a far better position to learn how to early-respond, self-test, track and trace and self-care than we were before COVID. This, together with advances in antivirals and grand ambitions of CEPI aiming for just 100 Days to a safe, effective vaccine in the event of pandemics, it’s foreseeable that lockdowns and the economic meltdowns they cause, like the one that the markets are foretelling today, will not happen again. That said, pandemic response requires global cooperation. Relatedly, of more immediate and pressing concern, is the rapidly rising cost of living and the stark food and energy shortages that Southern Europe and North/East Africa are facing. Sadly, we are diverging from Lennon’s imagining that “... the world can live as one.”
We’ll close on a positive note regarding Trials. We had the privilege of meeting and presenting with Sir Richard Landry, architect and principal investigator of the UK RECOVERY Trial. RECOVERY was one of the biggest breakthroughs in the history of clinical trials. In a matter of days, tens of thousands of hospitalised COVID patients consented to take part in an adaptive randomised trial, essentially without any fuss or politics. RECOVERY established solid evidence for what works and what doesn’t eliciting the futility of hydroxychloroquine and the life-saving benefits of Dexamethasone as two examples. But it did this overnight. What we are now seeing is this methodology turning into a formal organisation to rapidly investigate other interesting drugs and repurposed medicines in and out of hospital for cancers and other diseases thus far proving difficult to progress in the standard clinical trials model.