Every week, more is written on COVID-19 than any individual could possibly read. Collectively, the COVID19 Actuaries Response Group read more about the outbreak than most, so we’ve decided each Friday to provide you with a curated list of the key papers and articles that we’ve looked at recently.
Modelling – reports
Estimating the Infection Fatality Rate (IFR)
There have been various attempts to estimate the Infection Fatality Rate of COVID-19 – that is, the chance of dying once infected, with different approaches coming up with materially different estimates. It is important to understand this figure as countries start to emerge from lockdown, as it will drive decision-making.
We looked at fatality rates in an early paper based on Italian data. In our latest bulletin , we comment on some recent papers, and conclude that an IFR of around 1% appears to be a reasonable global estimate.
This paper notes that those who die from COVID-19 are often less healthy than the average for their age group, implying that the years of life lost from each COVID-19 death will be less than the average for the age group. The paper sets out a model structure to allow for the surviving population being healthier on average than the pre-COVID-19 population. The conclusion is that, all else being equal, the impact of COVID-19 on the mortality rates of the surviving population is likely to be modest.
This paper focusses on the spread of COVID-19 in Germany and uses Bayesian inference to detect points where the effective growth rate of COVID-19 changed – this appears to be a novel and interesting approach, although we have not validated its conclusions. The authors find that these change-points correlate well to the times of measures put in place to control the spread of the virus. This sort of approach may allow the impact of future interventions to be estimated with more confidence. Their code is freely available and can be adapted to other countries.
Clinical and Medical News
Vaccine Trial Results
Moderna, the US biotech firm, have released the first findings from the phase 1 trial of its mRNA vaccine (mRNA-1273) against novel coronavirus. The vaccine was found to trigger dose dependent increases in immunogenicity in trial participants. The levels of neutralizing antibodies at day 43 were at or above levels generally seen in the blood of those recovering from COVID-19 . Based on these positive interim Phase 1 data, the Phase 2 study will be amended to study two dose levels, 50 µg and 100 µg, with the aim of selecting a dose for phase 3 pivotal studies. (planned for July 2020).
Clinical Guidance for COVID-19
The National Institute for Health and Clinical Excellence (NICE) provides national guidance and advice to improve health and social care. Since January 2020, NICE have adjusted their usual approach to developing guidance for COVID-19 to provide guidelines in a fast and responsive manner. To date, they have produced around 20 clinical guidelines including recommendations on kidney disease, use of ACE inhibitors and steroids, and caring for young adults who are immunocompromised
To achieve this, NICE have temporarily removed some of the processes such as public consultations and systematic literature searches, identified in advance key resources for evidence, and conducting a pragmatic accuracy check for speedy sign off.
Convalescent plasma transfusion for the treatment of COVID‐19
Passive immunisation therapy has been successfully used to treat infectious diseases back to the 1890s. In this systematic review , the clinical effectiveness of convalescent plasma therapy (CPT) for the treatment of COVID‐19 was evaluated. Overall, this type of therapy was found to be safe, clinically effective, and to reduce mortality. An increase in neutralizing antibody levels and disappearance of SARS‐CoV‐2 RNA was observed in almost all the patients after CPT therapy.
Hydroxychloroquine has received worldwide attention after an in vitro study reported its potential activity against SARS-CoV-2. The drug has both antiviral and anti-inflammatory properties; however, results from clinical trials of its use in people with COVID-19 have been mixed. There are at least 30 clinical trials testing hydroxychloroquine currently in progress, exploring its potential as either a preexposure or postexposure prophylaxis.
However, as a treatment therapy, we already have research results from both a study assessing effectiveness in COVID-19 pneumonia patients requiring oxygen and in patients with milder disease , which do not find in the drug’s favour.
Antiviral Drug Combination
Antiviral drugs are designed to shorten the length of illness through reducing the rate at which viral replication takes place, hence there is great interest in their effectiveness in treating COVID-19.
The efficacy and safety of a combination of anti-viral drugs, interferon beta-1b, lopinavir-ritonavir, and ribavirin, was examined in a phase 2 trial conducted in Hong Kong . The participants were adults with COVID-19 randomised to the drug combination group (n=86), and to a control group (n=41). Treatment with the triple combination effectively suppressed viral load in all clinical specimens, and those in the triple combination group had a shorter time from treatment to NP swab than the control group (7 days vs. 12 days).
Human Mortality Database Short-term Mortality Fluctuations data series
The Human Mortality Database (HMD) is a widely-used data source for mortality in a large number of countries. They have recently made available weekly all-cause death counts, including deaths up to recent dates in 2020, for 13 countries including England & Wales, Germany, Spain and the USA . This is largely data that is available from other sources, but readers may find it helpful to have the data in one place and in a consistent format.
ECDC weekly surveillance report
We have previously highlighted reports from the European Centre for Disease Control (ECDC). They have now published their first weekly surveillance report, which can be found here .
This report summarises information about the intensity, geographical spread, and severity of the disease in EU / EEA countries and the UK, to provide an overview of COVID-19 epidemiology based on the available data.
In Issue 5, we looked at some options for livening up virtual meetings. As these are now so much a part of everyone’s lives, we’ve decided to re-visit the theme (the suggestions below are probably more suited to Friday team meetings rather than important pitches…)
Or, if you have the knowhow to set video backgrounds to your virtual meeting, you can walk in on yourself…
Today I made a Zoom background of myself accidentally walking in on myself in a Zoom meeting. pic.twitter.com/Rl2AsjfZ7V
— Dan Crowd (@itsdancrowd) April 3, 2020
And in a lower-tech variation on the theme, a man in the US has taken to photobombing his wife’s video calls by dressing as Batman, as well as various other characters (Link).
22 May 2020