THREAD: If we'd taken certain steps in winter - and recognized #coronavirus had characteristics we always feared in its balance between transmissibility and lethality - we may be in different position now. Let's not have to say in the fall we wish we'd done more in the spring.

We'll win this round, at an almost unbearable cost in treasure and in souls. But #COVID19 won't recede permanently. It'll most probably become epidemic in the southern hemisphere and return to us in September. This is a pathogen that wants to infect 40% of the world's population.

We need a massive surveillance system to detect spread early so we can rely and case-based strategies to isolate sick people and close contacts. But we also need a drug. And there are only a handful far enough along in development that can be good enough to make a real difference

The antiviral Remdesivir from Gilead is one. Used early in disease it may have robust enough treatment effect to impact outcomes. Other strategies are monoclonal antibodies that target virus directly. They can be used as treatment or prophylaxis - a bridge until we get vaccine.

If we don't have effective drugs, #COVID19 will circulate in background of society, and some consumer activity won’t return. There will be no "V" shaped recovery. The marginal customer won't come back to restaurants, conferences, or airplanes. We'll be operating an 80% economy.

We should put everything we have into developing an effective medicine. It should be a coordinated, deliberate, urgent industrial policy. There's no room for sluggish political leadership when it comes to this urgent priority. Everything depends on our rapid success.

There are four main antibody programs underway in U.S. by Lilly, Regeneron, Vir, and Amgen. Regeneron may be furthest along and have the best chance of doing this at the scale required. We need to place bets. This is a time for focus on possible winners, move them quickly along.

We need to let science lead. These drugs need to prove they're safe and effective for intended use. The worst outcome would be fools gold: A drug touted as cure that doesn’t deliver benefit. We'll be worse off for that. Regulators must be allowed to do their jobs. Trust FDA staff

I wrote on this topic in today’s Wall Street Journal. There are high odds that one of these antibody drugs will succeed. They can be developed quickly because the basis for their safety and effectiveness is already well understood. They deserve attention https://www.wsj.com/articles/bet-big-on-treatments-for-coronavirus-11586102963

Past attempts at antibody drugs found that antibodies didn’t penetrate the lungs well. But much has been learned, and the science for engineering these medicines is much better. Manufacturing at scale will be an issue. Spare capacity is scarce. We need to plan for that right now.

None of these drugs is a complete solution. But they can be a bridge to vaccine and interim step powerful enough to restore confidence; save lives. Coupled to tools of public health, with a drug in our bag, we can make #COVID19 a manageable threat. The stakes could not be higher.