@bhauthemphasizes the difficulty of studying transmission of “colds” because there are over 200 different virus strains responsible for what we consider “a cold”, in response to my recent post.
I want to dig into the question of feasibility a bit more:
But it’s not feasible to do human studies of so many virus types—consider how hard it was for society just to realize that COVID was transmitted via aerosols!
Ok, but why isn’t this feasible? Certainly it’s the case that nobody has tried, but I don’t think it’d be prohibitively expensive, at least on the scale of medical research.
Some quick back-of-the-envelope math...
How much would it cost to find and pay qualified volunteers for challenge trial like Dick et al., 1987 today? My guess is that this is doable for $7k per volunteer[1].
How many volunteers would we need? In the pessimal case—the one where we’re actually just going to test every single virus strain separately, rather than doing something more sensible[2]...
My off-the-cuff guess is that 300 volunteers per virus would be enough to draw quite strong conclusions, with good experiment design[3].
That’s 60k volunteers, for a $420m price tag, not including other study costs.
Housing, feeding, and otherwise taking care of each participant—idk, let’s be conservative, and call it $300/participant-day? If we’re going with ten days per participant that’s $300 * (60k * 10) = $180m.
Clinical staff costs—conservatively, 2-3 hours per day per participant, but mostly not the super-expensive PI time, but mostly RNs/coordinators/etc. Maybe $250/participant-day? $250 * (60k * 10) = $150m.
Lab work costs—I think you get a lot of benefits of scale, here, but let’s say $2k/participant, so $120m.
I have no idea how to get accurate numbers for how much it’d cost to manufacture enough GMP-grade virus stock for each virus; LLMs converge on a $1-5m range per virus. Unfortunate, but even at the top end, that’s $1.5b.
$420m + $180m + $150m + $120m + $1.5b = $2.37b.
And this is the dumb brute-force solution! Now, maybe it actually turns out that they’re all different and nothing generalizes, so that mechanistic investigations into figuring out if we can predict a given virus’s transmission methods without running a full human challenge trial on it, say by looking at its physical features, just doesn’t work. I still think that a sane civilization smashes that button for a couple billion dollars. Are there higher priorities? Sure, we should do those too.
A COVID challenge trial paid volunteers $6200 in mid-2021, but the viruses we’d be testing are in-expectation substantially less harmful and unpleasant than COVID, especially the variants that existed at the time. Some of the difference will be eaten up by sourcing costs, though.
Like testing a smaller number, looking at those results, coming up with mechanistic hypotheses that try to explain why [virus x] spreads effectively by transmission method [y] but not [z], ideally ones where we can try to falsify them more cheaply than running a full human challenge trial, and repeating until we actually understand how particular viruses spread (to the point where we can make reasonably accurate predictions about future viruses based purely on their physical characteristics, or other easily-testable traits), rather than just knowing the mere fact of their propensity to spread via some method.
@bhauth emphasizes the difficulty of studying transmission of “colds” because there are over 200 different virus strains responsible for what we consider “a cold”, in response to my recent post.
I want to dig into the question of feasibility a bit more:
Ok, but why isn’t this feasible? Certainly it’s the case that nobody has tried, but I don’t think it’d be prohibitively expensive, at least on the scale of medical research.
Some quick back-of-the-envelope math...
How much would it cost to find and pay qualified volunteers for challenge trial like Dick et al., 1987 today? My guess is that this is doable for $7k per volunteer[1].
How many volunteers would we need? In the pessimal case—the one where we’re actually just going to test every single virus strain separately, rather than doing something more sensible[2]...
My off-the-cuff guess is that 300 volunteers per virus would be enough to draw quite strong conclusions, with good experiment design[3].
That’s 60k volunteers, for a $420m price tag, not including other study costs.
Housing, feeding, and otherwise taking care of each participant—idk, let’s be conservative, and call it $300/participant-day? If we’re going with ten days per participant that’s $300 * (60k * 10) = $180m.
Clinical staff costs—conservatively, 2-3 hours per day per participant, but mostly not the super-expensive PI time, but mostly RNs/coordinators/etc. Maybe $250/participant-day? $250 * (60k * 10) = $150m.
Lab work costs—I think you get a lot of benefits of scale, here, but let’s say $2k/participant, so $120m.
I have no idea how to get accurate numbers for how much it’d cost to manufacture enough GMP-grade virus stock for each virus; LLMs converge on a $1-5m range per virus. Unfortunate, but even at the top end, that’s $1.5b.
$420m + $180m + $150m + $120m + $1.5b = $2.37b.
And this is the dumb brute-force solution! Now, maybe it actually turns out that they’re all different and nothing generalizes, so that mechanistic investigations into figuring out if we can predict a given virus’s transmission methods without running a full human challenge trial on it, say by looking at its physical features, just doesn’t work. I still think that a sane civilization smashes that button for a couple billion dollars. Are there higher priorities? Sure, we should do those too.
A COVID challenge trial paid volunteers $6200 in mid-2021, but the viruses we’d be testing are in-expectation substantially less harmful and unpleasant than COVID, especially the variants that existed at the time. Some of the difference will be eaten up by sourcing costs, though.
Like testing a smaller number, looking at those results, coming up with mechanistic hypotheses that try to explain why [virus x] spreads effectively by transmission method [y] but not [z], ideally ones where we can try to falsify them more cheaply than running a full human challenge trial, and repeating until we actually understand how particular viruses spread (to the point where we can make reasonably accurate predictions about future viruses based purely on their physical characteristics, or other easily-testable traits), rather than just knowing the mere fact of their propensity to spread via some method.
Though I’m not sure how establishment-compatible it is.