Courtesy Eli Lilly and Company
Amid a pandemic, it’s comforting to have one of the world’s most storied pharmaceutical firms headquartered in your backyard. Indeed, since March 18, when Eli Lilly and Company announced a partnership with the Indiana State Health Department to accelerate testing for the novel coronavirus, the company has tested more than 20,000 Hoosiers for COVID-19—a third of 61,142 tests performed across the state. And this week, they’ll increase testing of essential workers from 1,500 to 2,000 a day.
The man behind that effort is Dan Skovronsky, Lilly’s mild-mannered chief scientific officer. If you could pick an expert to have on your team—in your town—Skovronsky would be near the top. It’s probably the reason his phone has been blowing up lately. “Because of what I do, my job, people who are worried about COVID-19 and get tested, they’re often likely to call me and talk to me,” he says.
It’s fashionable these days to villainize Big Pharma execs, a fact Skovronsky conceded at a speech last year at Purdue University. “I didn’t come here today to absolve the pharmaceutical industry,” he said. “I’m not going to tell you that some companies in it have not made mistakes. Some of our unpopularity may be self-inflicted.”
In an interview, he explains why life might not be back to normal anytime soon, and how the company is developing two therapies that could, if approved, ease patients’ virus symptoms.
Walk me through the testing process.
The analysis of the test samples is what you do in a laboratory, but there’s another bottleneck, which is getting the patient sampled. So, the current process that almost everyone uses is called a nasopharyngeal swab. You can think of it as a very long Q-tip almost, but it’s flexible and soft, that goes up the nose into the back of the throat to sample the cells that could harbor the virus.
How did Lilly pivot so quickly to begin testing for a novel coronavirus?
We built a drive-through facility here, inspired by what had happened in South Korea. I remember reading early in March an article that South Korea had built a drive-through testing facility that could test 300 or 400 patients in a day. We didn’t really know more information than that, but we set out to build a drive-through test facility that could test a thousand patients a day.
One of the big questions that we have is how many people have COVID-19 and don’t even know it, because it starts out pretty mild and they think they’re having allergies or don’t notice any symptoms, but yet the virus is replicating in their body and presumably they’re spreading it.
We literally just built this from scratch. We thought about what would be the most efficient way to do it that could get people through. We built a call center to answer phone calls and we had programmers write a database to collect the information and we, in just a couple of days, put this together. Early on, I had a rule that to work there, you had to be a volunteer. So nobody would be told by their boss that you would do this—you’d just volunteer and work for a couple of hours, and we filled an army of volunteers who created this drive-through that’s just remarkably efficient. You read stories about drive-throughs where people are spending the night in their car waiting for their turn to get tested. Ours is nothing like that. We meet the demand each day in the city that people need to get tested, get tested, there’s no lines to wait in, it flows pretty quickly. The test itself just takes a few minutes, and then the patient drives home and they get their results in a very timely way. Many patients in one day or two days later, can get their test result. Of course, we do it completely free. This is just a service to the community.
Do you ever envision a time when anybody in Indiana who wants a test can get a test?
We’re pretty close to that, to be honest. So, the drive-through is open for healthcare workers and first responders. Those are the first two groups that we opened it to. Then we opened up to essential workers—that’s a pretty broad definition from the state. We just use the state’s definition of essential workers. So essentially anyone who’s still going to a place of work must be an essential worker, otherwise they’re not allowed to do it. So initially, we focused the essential workers on people who have interaction with the public as part of their jobs. So people like grocery store workers, or food delivery workers, or people who come to your house to fix things—plumbers and people like that. Daycare providers or elder-care providers. But since then, we’ve broadened it to any essential workers who’ve come into contact with other people.
Lilly has launched a trial to study asymptomatic carriers of COVID-19. How did you decide to set that in motion?
One of the big questions that we have—we, broadly scientists who study COVID-19—is how many people have COVID-19 and don’t even know it, because it starts out pretty mild and they think they’re having allergies or don’t notice any symptoms, but yet the virus is replicating in their body and presumably they’re spreading it. So, we had an idea that there would be quite a number of people who fit in that category. I know that from reading the literature, what’s happened in China and in Europe, and now the United States, but also from personal experience. I know people who contracted COVID-19 from another person who was asymptomatic at the time.
We want to know the depth of that issue in Indiana and how it changes over time.
How critical over the next month or so, as Indiana looks to reopen, is increased testing?
I think the opportunity here is exponential growth, which doesn’t mean one lab getting bigger and bigger. It means one lab setting up three other labs and those three other labs setting up three other labs. That’s where we need to go. The conclusion is not guaranteed. I’m not sure whether it will be successful or not. There are many challenges and constraints, but we’ll try our hardest. If you think about the key ingredients to containing this virus, testing is one, two, and three, and then four, five, and six are tracking the contacts of people who test positive and are isolating. There’s a lot more work to do and we have to be super diligent, super strict about, Oh I know you’re feeling fine, you’re healthy, but you’ve been in contact with somebody who we now know has COVID-19, you need to isolate yourself and stay home.
When will Indiana—or our world, for that matter—get back to normal life?
I don’t foresee us going back to the way things were anytime soon. I sort of think of this a bit like September 11. After 9/11 people kept saying, “Well, when are things going to go back to normal?” And they never really did. We live our lives differently now. We still lead good, full, redeeming lives, but things are a little bit different. I think after COVID-19, things will be different. In the short term, they’ll be very, very different. In the longer term, it might be smaller things that we’d all get used to. I don’t see us going back to work in Indiana, or in most parts of the United States, in the next few weeks. That doesn’t make any sense. Although cases might’ve peaked, there are still as many people getting infected today as there ever have been, right?
[pullquote align=”left” caption=””]I don’t foresee us going back to the way things were anytime soon.[/pullquote]We still have so many people catching this virus every day. So this is not a time to let everyone back out again. But in time, if we continue on this trajectory, we will have less and less virus shredding in our community. That’s what we’re focused on achieving.
Then, I don’t think we’ll eradicate it. So we will have a position where we try and bring people, waves of people, people who are most essential first, back to work, and yet there will still be a virus. So there will be little pockets of an outbreak.
So that’s the machinery we have to get in place. Then when we get that in place, we can start going back to work, but we’re not there yet.
The second big change happens—and this is probably the most important thing that we can do as a company—the next key change happens when we have a way of preventing COVID-19. So we’re really working hard on that therapy, we’re working on a couple of different therapies to help people who are suffering with COVID-19, but probably the most important one in the long run is a program we have to develop an antibody that we will administer to patients.
Tell me about some of the possible solutions you’re working on.
The first therapy is baricitinib. It turns out that people who are in the hospital and going into an ICU, their immune system is having an over-exuberant reaction to the virus, we think. Therefore, it might make sense, although it seems surprising, but it might make sense to dampen your own immune system, to try and curb damage to your lungs and the organs.
[pullquote align=”right” caption=””]I don’t think we’ll eradicate it. So we will have a position where we try and bring people, waves of people, people who are most essential first, back to work, and yet there will still be a virus. So there will be little pockets of an outbreak.[/pullquote]Another molecule we’re looking at is a drug that we had been testing for cancer. It’s complicated, but in COVID-19 patients, sometimes when they get really sick, they go into a lung condition called ARDS, or acute respiratory distress syndrome, which has many different characteristics, but one is that the vessels in their lungs become leaky and that interferes with their ability to breathe. So this is a drug that may have an effect there, so we’re testing that in patients right now, too.
The third: We were able to get blood from one of the first people in the United States who survived coronavirus. So this was a person who had coronavirus very early on, recovered, and then by looking at their blood, we were able to find the part of blood that probably helped them fight off coronavirus and survive.
Now, we’ve taken this antibody so that we can just make doses for people. We’re going to test that and if that works, that could be huge.
We’re working with AbCellera Biologics Inc. and the National Institutes of Health, so that’s moving along quickly, at a pace we’ve never seen before, to have these kinds of purified antibodies that are mass-produced into patients for clinical trials, in the next couple of months—by July, actually. So that’s really fast.
So you could have potentially viable therapy by, say, September?
Sure—if everything works, yes. But this is a risky business, and many times things fail or become more complicated, or take longer, or become more difficult, but we’re moving as fast as we can.
Is Lilly in danger, economically speaking, with this likely global recession we’re expected to see?
Our business has never felt more real or more important. We create medicines that help make people feel better. So when we see a global healthcare crisis like we’re in today, it’s natural that companies like Lilly will respond. This is what we do. We come to work every day looking to see how we can help sick people get better. So the response in COVID-19, it might seem remarkable from the outside. From the inside, this is what we do.