With Meg Tirrell, Biotech and Pharmaceuticals Reporter for CNBC
Steve spoke with Meg Tirrell, biotech and pharmaceuticals reporter for CNBC, about how dangerous the coronavirus is and has the potential to be. The two also discussed what drug companies are doing to try to combat the disease. This includes drugs that can be used for the outbreak now and in the future.
The Severity Of The Coronavirus Situation
Meg related the current state of things regarding the coronavirus. As of February 12th, 2020, there are more than 45,000 confirmed cases of the coronavirus and over 1,100 deaths. This means the disease has around a 2% fatality rate. Meg cautioned “But every expert will tell you that we can’t call this the definitive fatality rate because we’re, unfortunately, still pretty early on in understanding the disease.” The true fatality rate is anticipated to be much lower once more cases are reported, including the milder cases, which aren’t being covered as extensively. But for the time being, the rate is 2%, but it’s higher the closer you get to the epicenter of the outbreak, Wuhan, China.
Steve asked Meg to compare the coronavirus to other outbreaks, such as SARS. Meg explained that SARS is in the same virus family, but the fatality rate with SARS was closer to 10%, though it didn’t affect as many people. MERS, another coronavirus, had a fatality rate of around 30%, but that’s primarily because it infected an even smaller population. H1N1 is probably the outbreak that most people are familiar with. But it’s entirely different because it was a flu pandemic and infected a huge number of people. The fatality rate for H1N1 was lower than 1%. As these statistics make clear, we have to wait for the numbers to roll in on the coronavirus before we lock down any rates or percentages.
It’s also important to keep in mind that while around 20% of coronavirus cases are deemed severe—meaning they progress into pneumonia and respiratory distress—most of these individuals are older or have suppressed immune systems, either because of other illness or because of their age. And 99% of these cases have occurred at the epicenter of the outbreak in Wuhan. Meg stated, “We’re at a time where there is a window of opportunity to contain this in countries outside of China, but people and public health systems really need to be on alert and acting quickly to try to do that.”
Creating A Drug To Fight The Coronavirus Now
Steve turned the conversation to the topic of drugs to fight the virus, noting that there are two categories to consider—drugs to fight the virus for infected people and vaccine drugs. He asked Meg to comment, in particular, on the efforts of the major biotech company, Gilead.
Gilead is definitely in the forefront of developing antivirals. “They’ve cultivated a collection of hundreds of thousands of compounds over the years,” Meg pointed out. “So, in looking for ways to treat the coronavirus, they surveyed their compound collection to find ones that had good antiviral activity and honed in on one they’ve called Remdesivir.” Gilead had actually identified this drug before the outbreak of the coronavirus, but retrospectively they realized it would be a good candidate to treat it.
This, of course, is preclinical evidence, meaning it hasn’t been actively tested on humans yet. But it was given compassionately to the first case of the coronavirus in the U.S. The individual sick with the novel coronavirus disease was given the drug and rapidly improved in a short amount of time. And while you can’t deduce a huge amount from one successful patient treatment, the drug is showing a lot of promise in lab trials. Meg added that there are now two clinical trials of the drug underway in Wuhan, which means more data will be coming in quickly.
Other Ways Drug Companies Are Trying To Fight The Coronavirus
Gilead is looking at existing compounds to see if they might be effective in treating the coronavirus now. “We also know that AbbVie and Johnson and Johnson are looking at their HIV drugs, which could potentially be helpful,” Meg said.
Some companies are doing other forms of research to find ways to create new drugs that might help protect people from being infected by the novel coronavirus in the future. According to Meg, “A company called Vir Biotechnology is screening libraries of antibodies which were collected from SARS survivors to see if they might also be helpful with the coronavirus. Another company, Regeneron, is trying to create new antibodies to the novel coronavirus itself.”
Steve noted that Regeneron actually has a pretty unique and interesting story and approach to creating and testing new drugs. One of the biggest issues is creating something for humans while not being able to test it on humans. To this end, “Regeneron engineered a mouse with a fully human immune system,” Steve mentioned. It sounds like a science fiction experiment, but they actually did this a few decades ago. They literally broke down a mouse’s DNA and removed the portion which generates its immune system, replacing it with the DNA sequence of a human’s immune system. Once this mouse is exposed to a pathogen, its immune system responds in the same way as that of a human. This has drastically affected how quickly and efficiently the company can create drugs that are beneficial to humans.
Some of these techniques could potentially be used to create vaccines that would hopefully stop a person from being infected with the coronavirus or, at least, prevent it from developing to a more serious degree. This is obviously a developing story, yet to play out.
If you’d like to learn more from Meg Tirrell, check out her page on CNBC’s website.
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Steve Pomeranz: With coronavirus all over the news, I wanted to get a good idea of what drug companies may be doing in order to create new treatments for this drug. So I’ve asked Meg Tirrell from CNBC to join me. Meg joined CNBC in April 2014 and covers the development of new drugs for Alzheimer’s and cancer and rare diseases, and she’s tracked public health emergencies from Ebola to Zika. So I think she has something to add to the discussion today. Hey, Meg, welcome back to the show.
Meg Tirrell: Thank you, Steve.
Steve Pomeranz: So the news is developing fast, but as of now—now we’re recording this on February 12th—the news is how many cases have been announced and how many deaths, and what percentage of the known cases have actually died from it?
Meg Tirrell: So the current numbers are more than 45,000 confirmed cases and more than 1100 deaths. So that’s about a 2% fatality rate. However, what experts will say is that we can’t really call that the real-case fatality rate because right now we are still pretty early on in understanding the disease. And probably a lot of milder cases aren’t being counted, so a lot of people think that that fatality rate will actually be lower once we have a better understanding of what this disease looks like. But right now, it is 2% and the rate goes higher the closer you get to the epicenter of the outbreak and Wuhan, China.
Steve Pomeranz: And how does that compare to other outbreaks like SARS, H1N1, and so on?
Meg Tirrell: So SARS, which is in the same coronavirus family had a case fatality rate of closer to 10%, but it infected a lot fewer people so it didn’t seem as contagious. MERS, which is another coronavirus, the Middle East respiratory syndrome, that had a higher fatality rate of more than 30% but infected even fewer people. H1N1 is different. That was a flu pandemic, infected a huge number of people, but the case fatality rate appeared to be less than 1% there.
Steve Pomeranz: Isn’t the bottom line that a lot of the people who are getting gravely ill are older or may have some suppressed immune systems to begin with or something of that nature?
Meg Tirrell: Yes. Right now, it looks like about 20% of cases are thought to be severe, so progressing to pneumonia and respiratory distress, and most of those people are older and have other health issues that they’re also dealing with that makes it hard for them to also counter this virus.
Steve Pomeranz: It looks like China has a massive effort to try to contain this. How much has actually spread outside of China now?
Meg Tirrell: So right now, we are seeing in other countries, but the number is just warped by the number of cases in China. 99% of cases are still in China right now, but public health experts I’m talking to are pointing to potentially worrying signs of outbreaks in other countries, particularly in Singapore. And what they’re nervous about is that these cases can’t be tied back to travel to China.
So what that implies is that it is spread in the communities there with no travel history. The World Health Organization earlier this week talked about potential sparks that could lead to a bigger fire. And they were talking about cases in the UK and in France and really saying we’re at a time where there is a window of opportunity to contain this in countries outside of China, but people and public health systems really need to be on the alert and acting quickly to try to do that.
Steve Pomeranz: So there are two ways to fight this in terms of the pharmaceuticals. There’s a drug that would treat the virus right now and then there’s creating a drug that is essentially a vaccine. Let’s talk about the first one to get off the bat here. Now I know that a company by the name of Gilead has created antiviral drugs that have been incredibly effective against hepatitis C, for example. Tell us a little bit about that.
Meg Tirrell: So Gilead is a massive biotech company here in the United States. They’re based in San Francisco. And they are known for their HIV drug franchise and for their hepatitis C drug franchise. So really experts in antivirals. What they’ve done is, years ago, they surveyed their entire collection of hundreds of thousands of compounds that they created over the years to try to find ones that have good antiviral activity. And they honed in on one that they’ve now called Remdesivir. And that was before we even knew about this novel coronavirus. But they found that it could be a potentially good drug to treat other kinds of viruses. And in fact, they did test it in the field for Ebola. However, it didn’t work as well as some other drugs.
Now, there has been some early testing showing this has activity against coronaviruses like SARS and even now in the novel coronavirus outbreak, some preclinical—meaning before human testing—evidence that it may be helpful against the novel coronavirus. And in fact, it was used on what’s known as compassionate-use basis in the first patient in the US to have the novel coronavirus in Washington State. And if you read the New England Journal of Medicine paper, it says he got it after being in the hospital for a week and the next day he rapidly improved. Now we’ve talked to the doctors involved in treating that patient and they and other experts say you cannot deduce anything from just one patient, but that looks very promising. But now they’re testing it in two clinical trials in Wuhan, China. So we should get some more data potentially in a month or more.
Steve Pomeranz: Well, it’s very interesting because there’s companies in China now that have reverse engineered this drug and now are producing it on their own. And there is some talk about a promise to come up with a patent with Gilead, but that has not happened yet. So there’s worry about intellectual property concerns. What can you tell us about that?
Meg Tirrell: Yeah, so we also know in addition to this Chinese company that’s trying to manufacture the drug that a Chinese university has applied for a patent for it in China, Gilead is really not taking a stance on that. It’s saying what it’s focused on now is figuring out if this drug works and can be helpful, but clearly, this is going to raise some concerns about how China treats IP from American and other Western companies. That has always been a concern of companies working in China and in recent years the drug industry there has become a lot friendlier to American companies, and you’re seeing huge expansion of American companies work in China. So right now, we’re clearly not in a normal situation with this massive outbreak there, but people will be wondering what precedent this is setting and whether that will affect the relationship of these companies in China, hopefully, after all of this ends.
Steve Pomeranz: Well, you can’t really blame the Chinese for wanting to get something that works now and not waiting and sending on ceremony and waiting to come up with some kind of an agreement with Gilead or any other company. But it is something that we’re all going to be watching in the future to make sure that original patents are respected and so on, and that’s a new situation that basically has arisen. What other companies are in this space now trying to come up with a cure?
Meg Tirrell: So in addition to companies looking at existing drugs the way Gilead is doing, we also know Johnson and Johnson and AbbVie are looking into whether their HIV drugs could potentially be helpful. So that’s one bucket. Then the second bucket is companies that are trying to develop new drugs for the novel coronavirus and in that bucket, there are a couple of companies called Regeneron and Vir Biotechnology, and some pretty interesting research going on at these companies. At Vir, they’re actually screening libraries of antibodies that they collected from survivors of SARS to see if those antibodies could be helpful toward fighting the novel coronavirus. Over at Regeneron, they’re actually trying to create new antibodies to this novel coronavirus that could be helpful in treating the disease.
Steve Pomeranz: Now the antibodies, does that create a vaccine or is that for current use now?
Meg Tirrell: It’s designed to be used to treat the disease rather than to prevent it. But Regeneron will tell you you could think about it either way. If you’re giving it an advance to try to prevent the disease, it would be like a vaccine. If you’re giving it after infection to fight the disease, it’s a treatment.
Steve Pomeranz: All right, so they’re not really that different. It’s to some degree a matter of when the drug is administered?
Meg Tirrell: Mm-hmm (affirmative).
Steve Pomeranz: Okay. Regeneron has a very interesting story. You and I were talking about this off air. So one of the problems with developing a drug is that you’re developing it outside a human organism, like in a Petri dish, so to speak. And then when you apply it to the human or whatever animal you’re testing on, all sorts of other things can happen because those entities have their own immune system. Now what Regeneron has done is they have engineered a mouse to have a fully human immune system. Well, what else can you tell us about that?
Meg Tirrell: So it sounds like a science fiction book, but this is something they did a few decades ago, and when you really drill down into it, the science, of course, it’s complicated to do, but the idea is very simple. They looked at the mouse’s genome; they took out the part that creates the immune system, the DNA that is the mouse immune system; and they put in DNA for a human immune system, the code for a human immune system. And so when you have these mice and Regeneron’s chief scientific officer, Dr. George Yancopoulos, likes to refer to them as little humans running around, but they still look like mice. When you introduce them to a pathogen, their response is to create a human antibody to that pathogen.
Steve Pomeranz: They’ve already been successful with an eczema drug, right?
Meg Tirrell: Yes. They’ve created a number of antibodies that have been incredibly successful. Their newest is this drug called Dupixent, which treats very severe forms of eczema and other allergic auto-immune diseases. They’ve developed drugs for cancer and lots of other things. So this is a whole technology that they’ve been applying for years and because they can do it so quickly, it has been helpful before. They actually developed a drug for Ebola that was shown in that same trial where Gilead’s drug was tested to work very well, so they’re hoping they can do the same thing.
Steve Pomeranz: So there is hope. Now I understand that the cases themselves have started to decline or at least the announcement of new cases. Are you seeing the same thing?
Meg Tirrell: Yes. We saw a dramatic decline over the last two days in the case counts, particularly coming out of Hubei province, which is the area where Wuhan city is, it’s the epicenter of the outbreak. The CDC was talking about those numbers today, and they said they wanted to be optimistic and believe that the numbers are coming down because of measures that China has been taking.
But there are multiple other interpretations people can take about this. One is that we know that China changed the methodology for how it is counting a confirmed case to only include cases that both test positive and in which people are showing symptoms. So if you’re asymptomatic but you test positive, you’re no longer a confirmed case. So the case counts have come down by 500 to a thousand and some say that could be because the Chinese government wants to make the numbers look lower. We just don’t know right now.
Steve Pomeranz: Right. And I think we’re going to leave it at that. So much is not known. But we’ve asked Meg Tirrell from CNBC to join us to help elucidate us. Meg, thank you so much for joining me today.
Meg Tirrell: My pleasure.