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Monday, June 14, 2021

Some Patients Reporting Long COVID Recoveries

 few months ago, Lana Lynch had resigned herself to never getting better. Months after testing positive for COVID-19, she still felt fatigued, still got daily headaches, still had to carefully regulate how much she exerted herself each day. She was coming to terms with her new normal—until she didn’t have to.

After receiving her second dose of the Pfizer-BioNTech COVID-19 vaccine in May, Lynch, a 32-year-old from Texas, noticed that she wasn’t quite so tired anymore. She could get through a yoga class without hitting a wall. “I felt like I had some energy,” she says, “but I didn’t want to jinx it.”

After weeks of waiting for the other shoe to drop, she says, “I feel confident enough to declare myself cured.”

In recent months, a small but growing number of people with Long COVID—the name adopted by those who develop lingering health problems after catching the virus—are experiencing improvements like Lynch’s. These stories are anecdotal and far from universal. But after months of debilitating illness, even small improvements can feel like a new lease on life for those lucky enough to experience them. “Just knowing that it’s not really anchoring me down,” Lynch says, “is a huge weight off my shoulders.”

Experts believe somewhere between 10% and 30% of COVID-19 patients develop long-term symptoms, including fatigue, chronic pain, brain fog, shortness of breath and gastrointestinal problems, though the severity of these can vary. Doctors still aren’t entirely sure how to treat Long COVID or even what causes it, though there are two main theories: either remnants of the virus linger in some people’s bodies, or certain elements of the immune system rev into overdrive after exposure to the virus, essentially causing the body to attack itself.

No two Long COVID cases are exactly alike, which complicates the search for treatments. In one July 2020 survey, a group of about 1,500 Long COVID patients affiliated with the support group Survivor Corps reported almost 100 different symptoms. Some patients have visible damage to a particular organ, such as the lungs or heart, while others have no obvious reason for their suffering—their lab tests and scans come back normal, despite how sick they feel.

Until recently, there weren’t many stories of Long COVID patients getting better. In previous conversations with TIME, multiple experts have said it’s possible that Long COVID could last for decades or even the rest of a patient’s life, similar to myalgic encephalomyelitis/chronic fatigue syndrome, another debilitating condition that can follow viral illnesses. That may end up being true for some patients, but others are beginning to report improvements.

Dr. Federico Cerrone is a pulmonologist and the co-medical director of Atlantic Health’s COVID Recovery Center in New Jersey, which has treated about 500 Long COVID patients since it opened in October 2020. Some of their patients simply improved with time, Cerrone says, while others have had luck after working with sleep or behavioral health specialists. Some—but not all—Long COVID patients with persistent respiratory symptoms respond to drugs like steroids and bronchodilators, adds Dr. Gerard Criner, director of the Temple Lung Center in Philadelphia. Doctors are also getting better at spotting syndromes that may overlap with Long COVID, like the autonomic nervous system disorder known as POTS. But there is still not a “cure” for Long COVID.

“There seem to be some individual success stories, but I don’t know if I could tell you that one thing fits all,” Cerrone says. “Sometimes it works, and sometimes it doesn’t work. We’ve learned a lot, but there’s still a lot to learn.”

COVID-19 vaccination seems to help in some cases. Akiko Iwasaki, an immunobiologist at the Yale University School of Medicine who is studying how COVID-19 vaccines available in the U.S. affect Long COVID patients, says getting a shot seems to lessen symptoms, at least a little bit, for some sufferers. But some people feel no relief, and others feel worse, she says.

Iwasaki and her team are taking blood and saliva samples from Long COVID patients before and after vaccination to monitor changes in their immune responses. By comparing those results with any changes in symptoms, her team hopes to determine if vaccination can help lead to recovery. It’s possible that the vaccine-prompted immune response overrides the body’s attacks on itself, or that vaccine-produced antibodies help clear any lingering remnants of the virus, Iwasaki says, but as of now, those are just hypotheses. Depending on what she and her team find, the research could be impactful not only for Long COVID sufferers, she says, but also for people with ME/CFS and other post-viral illnesses.

Netta Wang, a 24-year-old from California who tested positive for COVID-19 in August 2020, can’t say for sure that the vaccine helped her feel better, but she did notice an improvement in her symptoms after getting her second Moderna dose in March. Around the same time, her doctor recommended that she begin exercising again to help rebuild her strength and energy. Wang was nervous, since many people with Long COVID feel worse after physical exertion, but was pleasantly surprised that she was able to ride a bike without relapsing. Her strength slowly returned and she now considers herself 95% recovered, though she’s not sure whether that’s thanks to the vaccine, physical activity or pure chance.

Dr. Hassan Sajjad, a pulmonologist involved in post-COVID care at Iowa’s Mercy Medical Center, says some of his patients have also had luck with physical therapy and physical activity. Physical therapy can help rebuild strength, improve organ health and minimize the risk of complications like inflammatory blood clots, he says. Still, as is typical with Long COVID, it’s not entirely clear why movement helps some people and makes others feel worse.

“I got very lucky. Health and bodies are very random,” Wang says. “I know lots of people who are still [sick] a year on, and I don’t think they’re doing anything wrong.”

With so little known about their condition, some Long COVID patients have taken recovery into their own hands. “[Doctors] can’t explain it themselves,” says Sherri Klipowicz, a 35-year-old from Colorado who got sick with what she believes was COVID-19 in March 2020, “so they’re really listening to us.”

Klipowicz started to feel better in February 2021, after months of tinkering with her diet, sleep and physical activity. She now practices restorative yoga, takes supplements like magnesium and glutathione, and follows a diet heavy on plants and low on gluten and dairy. She’s also working with an insomnia specialist, since she’s noticed her symptoms are worse when she sleeps poorly, and has tried ozone therapy, a controversial practice that involves infusing the blood with ozone gas. Ozone therapy has not been endorsed by the U.S. Food and Drug Administration, though some Italian researchers have suggested it could be used as a potential COVID-19 therapy.

Though Klipowicz can’t put her finger on what, exactly, worked for her, she says she now feels about 90% recovered after a night of good sleep. (Klipowicz received both doses of the Pfizer-BioNTech shot but doesn’t think it made the difference, since her improvement began before getting vaccinated.) She still struggles with shortness of breath, and doesn’t feel confident enough in her health to return to her consulting job—but, she says, “I’m able to be active. I’m able to go out for walks more, work in the yard. I can drive now because my cognition is better. I have independence back.”

And with each day her symptoms recede, Klipowicz says, she can more clearly envision a future without COVID-19, something that seemed impossible just six months ago.

Wang can relate to that feeling of hopelessness. She remembers desperately searching social media, looking for a single example of a person who’d recovered from Long COVID, and finding little comfort. And even though she feels she’s largely recovered, and has a lot to look forward to—after graduating from Stanford this month she’ll start an internship and begin job hunting—she recognizes that there are still scores of patients searching for relief. “I don’t want to forget about all the people that might have [Long COVID] for a long time, and all the other chronic pain patients that are still struggling and had been struggling before COVID,” Wang says. “Their situations don’t fit into our neat stories of getting sick and getting better.”

https://time.com/6072264/long-covid-recovery/

With Iteos, Glaxo pays handsomely to join the Tigit chase

 That Glaxosmithkline was prepared to part with $650m up front for Iteos’s phase 1 anti-Tigit MAb EOS-448 shows that the pharma giant considers this a ‘must own’ immuno-oncology mechanism. The terms point to a highly competitive process, which also means that there must be other large developers shopping in this space. The big three I-O players already have assets in their pipelines, but there are plenty of others, like Astrazeneca and Pfizer, which would presumably be interested. That is great for news for those unencumbered projects – it is no coincidence that Mereo shares opened up 15% today, a surge that soon settled down to a 5% rise. Still, while the Glaxo-Iteos deal sounds rich, it is worth remembering that the small biotech has agreed to pay 40% of the R&D costs associated with an “aggressive” pre-agreed global development plan; in return, Iteos will jointly commercialise EOS-448 in the US and get 50% of the profits from the region. A further $550m is available if certain clinical and regulatory hurdles are crossed, with another $900m attached to sales milestones. The tiny Belgian developer has long been a proponent of Tigit and this deal certainly justifies its enthusiasm – Iteos shares surged 30% in early trade.

Chasing Tigit: few unencumbered assets remain
Available to the highest bidder? 
ProjectCompany

Project source and status

Available to the highest bidder?
OciperlimabBeigeneIn-house; wholly owned, in ph3
EtigilimabMereoOncomed originated; Celgene turned down option in July 2019, now wholly owned, in ph1/2
IBI939InnoventIn-house; wholly owned, in ph1
SGN-TGTSeagenIn-house; wholly owned, in ph1
COM902CompugenIn-house; wholly owned, in ph1
AGEN1327AgenusIn-house; wholly owned, preclinical 
Already wrapped up…
Tiragolumab RocheIn-house; wholly owned, in ph3
VibostolimabMerck & CoIn-house; wholly owned, in ph3
DomvanalimabArcusGilead option; data and decision due soon. Otsuka owns certain Asia rights, in ph2/3
BMS-986207Bristol Myers SquibbIn-house; Ono owns certain Asian rights, in ph1/2
M6223Merck KGaAIn-house; wholly owned, in ph1
EOS-448IteosLicensed to Glaxo in June 2021 deal, in ph1
AGEN1777 (bispecific)Agenus/Bristol Myers SquibbLicensed to Bristol Myers in May 2021, preclinical
AB308ArcusGilead has an option under a 2020 deal, in ph1
Source: Evaluate Pharma & company presentations.  

https://www.evaluate.com/vantage/articles/news/snippets/glaxo-pays-handsomely-join-tigit-chase

7 High Frequency Economic Indicators

 These indicators are mostly for travel and entertainment.    It will interesting to watch these sectors recover as the pandemic subsides.


----- Airlines: Transportation Security Administration -----

The TSA is providing daily travel numbers.

TSA Traveler DataClick on graph for larger image.

This data shows the seven day average of daily total traveler throughput from the TSA for 2019 (Light Blue), 2020 (Blue) and 2021 (Red).

The dashed line is the percent of 2019 for the seven day average.

This data is as of June 13th.

The seven day average is down 27.7% from the same day in 2019 (72.3% of 2019).  (Dashed line)

There was a slow increase from the bottom - and TSA data has picked up in 2021.

----- Restaurants: OpenTable -----

The second graph shows the 7 day average of the year-over-year change in diners as tabulated by OpenTable for the US and several selected cities.

IMPORTANT: OpenTable notes: "we’ve updated the data including downloadable dataset from January 1, 2021 onward to compare seated diners from 2021 to 2019, as opposed to year over year." Thanks!

Move Box OfficeThanks to OpenTable for providing this restaurant data:

This data is updated through June 9, 2021.

This data is "a sample of restaurants on the OpenTable network across all channels: online reservations, phone reservations, and walk-ins. For year-over-year comparisons by day, we compare to the same day of the week from the same week in the previous year."

Note that this data is for "only the restaurants that have chosen to reopen in a given market". Since some restaurants have not reopened, the actual year-over-year decline is worse than shown.

Dining picked up during the holidays, then slumped with the huge winter surge in cases.  Dining is picking up again.  Florida and Texas are above 2019 levels.

----- Movie Tickets: Box Office Mojo -----

Move Box OfficeThis data shows domestic box office for each week and the median for the years 2016 through 2019 (dashed light blue).  

Blue is 2020 and Red is 2021.  

The data is from BoxOfficeMojo through June 10th.

Note that the data is usually noisy week-to-week and depends on when blockbusters are released.

Movie ticket sales were at $95 million last week,  down about 53% from the median for the week.

----- Hotel Occupancy: STR -----

Hotel Occupancy RateThis graph shows the seasonal pattern for the hotel occupancy rate using the four week average.

The red line is for 2021, black is 2020, blue is the median, dashed purple is 2019, and dashed light blue is for 2009 (the worst year on record for hotels prior to 2020).

The 4-week average occupancy is now above the horrible 2009 levels.

This data is through June 5th. Hotel occupancy is currently down 14% compared to same week in 2019). Note: Occupancy was up year-over-year, since occupancy declined sharply at the onset of the pandemic. However, the 4-week average occupancy is still down significantly from normal levels.

Notes: Y-axis doesn't start at zero to better show the seasonal change.

----- Gasoline Supplied: Energy Information Administration -----

gasoline ConsumptionThis graph, based on weekly data from the U.S. Energy Information Administration (EIA), shows gasoline supplied compared to the same week of 2019

Blue is for 2020.  Red is for 2021.

As of June 4th, gasoline supplied was down about 14.1% (about 85.9% of the same week in 2019).

Two weeks ago was the first week this year with gasoline supplied up compared to the same week in 2019.

----- Transit: Apple Mobility -----

This graph is from Apple mobility. From Apple: "This data is generated by counting the number of requests made to Apple Maps for directions in select countries/regions, sub-regions, and cities." This is just a general guide - people that regularly commute probably don't ask for directions.

There is also some great data on mobility from the Dallas Fed Mobility and Engagement Index. However the index is set "relative to its weekday-specific average over January–February", and is not seasonally adjusted, so we can't tell if an increase in mobility is due to recovery or just the normal increase in the Spring and Summer.

Apple Mobility DataThis data is through June 12th for the United States and several selected cities.

The graph is the running 7 day average to remove the impact of weekends.

IMPORTANT: All data is relative to January 13, 2020. This data is NOT Seasonally Adjusted. People walk and drive more when the weather is nice, so I'm just using the transit data.

According to the Apple data directions requests, public transit in the 7 day average for the US is at 90% of the January 2020 level and moving up.

----- New York City Subway Usage -----

Here is some interesting data on New York subway usage (HT BR).

New York City Subway UsageThis graph is from Todd W Schneider. This is weekly data since 2015. 

Most weeks are between 30 and 35 million entries, and currently there are over 12 million subway turnstile entries per week - and generally increasing.

This data is through Friday, June 11th.

Schneider has graphs for each borough, and links to all the data sources.

He notes: "Data updates weekly from the MTA’s public turnstile data, usually on Saturday mornings".





Alibaba Health-backed LinkDoc files for U.S. IPO

  LinkDoc Technology Ltd, a medical data company backed by a subsidiary of Alibaba Health Information Technology Ltd, filed for a $100 million initial public offering in the United States on Monday.

The Beijing-based company, which offers cancer-focused healthcare services, reported a 41% jump in revenue for the three months ended March 31, according to the filing.

For the same period, net loss attributable to LinkDoc widened to 135.4 million renminbi ($21.17 million) from 61.6 million renminbi a year earlier.

The company’s listing plans come despite the U.S. introducing measures that could result in foreign companies being delisted from American stock exchanges within three years if they do not comply with the country’s auditing standards.

LinkDoc said it will use the proceeds from the offering to strengthen its research and development capacities and for investments and acquisitions, among others.

https://www.reuters.com/article/linkdoc-ipo/alibaba-health-backed-linkdoc-files-for-u-s-ipo-idUSL3N2NW2MG

Anavex Alzheimer's Candidate Mechanism Of Action Explained In Medical Journal

 

  • Anavex Life Sciences Corp (NASDAQ: AVXLhas reported that ANAVEX 2-73 (blarcamesine) and ANAVEX3-71 (AF710B) are featured in a new peer-reviewed publication in the journal of Expert Opinion on Therapeutic Targets.

  • Scientific Paper Highlights:

    • Sigma-1 receptor (SIGMAR1)'s expression increases with age. However, in Alzheimer's disease (AD), it decreases and coincides with an age-related decrease in autophagy.

    • The SIGMAR1 may compensate for the loss of receptors and autophagic machinery during healthy aging.

    • ANAVEX-compounds activate SIGMAR1 and induce autophagy, a phenomenon that clears damaged cellular organelles and misfolded proteins.

    • Activation of the SIGMAR1 can induce cytoprotective autophagic pathways.

    • ANAVEX-compounds have also exhibited to block toxic Aβ, tau, and neuroinflammation.

  • https://finance.yahoo.com/news/anavex-life-sciences-alzheimers-candidate-135104637.html

Fusion Pharma: Prelim Safety, Dosimetry Results in Phase 1 Cancer Study

 Product candidate FPI-1434, administered at three different dose levels, demonstrated a favorable safety profile with no drug-related serious adverse events or dose-limiting toxicity

Imaging shows drug uptake across multiple tumor types

Enrollment in multi-dosing cohorts continues

Fusion also reported preclinical data showing the combination of FPI-1434 with olaparib resulting in synergistic efficacy against colorectal and lung cancer xenografts, and combination with immune checkpoint inhibitors demonstrated enhanced efficacy in colorectal cancer models

Data featured in oral sessions and posters at the SNMMI 2021 Virtual Annual Meeting

https://finance.yahoo.com/news/fusion-pharmaceuticals-announces-preliminary-safety-201000673.html

Lilly: New breast cancer data from Verzenio and oral SERD programs at ASCO

 

  • New exploratory analysis of a pre-specified subgroup of patients with HR+, HER2- high risk early breast cancer who received neoadjuvant chemotherapy in the monarchE trial showed Verzenio plus endocrine therapy resulted in a 6.6% absolute difference in invasive disease-free survival versus endocrine therapy alone
  • First results from investigational oral selective estrogen receptor degrader (SERD) LY3484356 demonstrate pharmacokinetics, safety, and efficacy consistent with preclinical design
  • Two Phase 3 trials to be initiated in 2021: Verzenio eMonarcHER trial in HR+, HER2+ high risk early breast cancer and oral SERD EMBER-3 trial in ER+, HER2- advanced breast cancer