Sunday, July 26, 2020

COVID-19 - Lessons for the Next Pandemic

The first case of COVID-19 in the United States was reported on January 20th.   Of course, this is akin to finding one termite in your garage and thinking that there are no others.  Of course, by January 20th there were an unknown number of infected Americans who were silently and efficiently transmitting the virus to others. 

It’s easy to say now what we all should have done then. 

The rapidity of the explosion of worldwide infections has been staggering and humbling.  Compare the known infections and mortality in America today with the state of affairs on January 20th, only 3 months ago. 

Just prior to posting this, the known number of U.S. fatalities to COVID-19 is 150,000.
For some perspective, our country lost over 58,000 individuals in the Vietnam War, but this horrible tragedy was the result of 8 bloody years, not just several months. 

The current diabolical enemy is a merciless adversary.  Like a terrorist, it scares those who have not been infected.  It makes us hide and hunker down.  It kills enough people to make us all feel vulnerable.  And, it has cratered our economy so deeply that it makes the post 9/11 economic damage seem like a modest downturn.

A deadly and invisible enemy.

But we will get through it. I was proud that it seemed that the country had largely come together to get to the other side.  For the first few months, we listened to our public health experts and sacrificed.  We were willing to participate in something that is so much bigger than ourselves.

But as time went on the public's patience waned.  Businesses demanded to be set free.  Masks became a divisive political issue.  Governors opened up their states with the hope of pulling an inside straight.  Many of them were forced to admit defeat and ordered an economic retreat.  And many Americans simply ignored the public health recommendations and filled up beaches and bars putting all of us at greater risk. 

Perhaps, when the next pandemic descends upon us, and it will, we will all recognize that immediate containment and contact tracing is a better pathway than delay followed by collective mitigation.  Will we have the discipline and trust in our leaders to fall in line?   How many shutdowns can the country and the world endure?

I hope and pray that the current experience has been so frightening and traumatic that we will do the right thing when COVID-22 or COVID-24 attacks.   And hopefully, the world’s scientists are learning now how to better design therapeutics and effective vaccines, which may ultimately be our most potent two-pronged weapons against invisible enemies that do not even exist today.

Sunday, July 19, 2020

Do I Have to Wear a Mask?

“I have my rights!”
“Don’t tell me what to do!”
“This is a freedom issue!”

All of us have rights.  Often, one person’s right to do or say something may collide with some else’s right.  One of our courts’ primary roles is to decide in these disputes whose has the better argument. These issues are not scored 100-0 in favor of the winner.  The decisions are nuanced as often both sides have a reasonable claim to argue. That's why the issue ended up in court.  And, as we know, the same set of facts might have led to a different result if a different judge or a different court had heard the case.

I have heard and read about individuals who have refused to wear a mask because they argue it encroaches on their personal freedom.  They have a right to determine their own dress code and the government has no right to impose its will on individual citizens. We’ve heard similar arguments offered by businesses who wish to open up faster than the government or public health officials have advised.

Some folks never leave the house without a mask.

I acknowledge that an individual who is required to wear a mask has a claim that his rights are being violated.  It is a governmental (or corporate) interference with an individual’s personal freedom.  And, this country, unlike many of our global competitors, was founded on individual rights, as chronicled in the first ten amendments to the constitution.   In other words, the guy has a case.

But, society also has rights and there are instances where their rights should prevail over that of an individual.  For example, if a parent decides for whatever reason not to administer recommended vaccinations to their children., should these children be permitted in public schools, recreational facilities, summer camps,  movie theaters, birthday parties or amusement parks?  An unvaccinated child, if given full access to society, could expose thousands of people, -  including the elderly, the very young and immunocompromised –  to the risk of serious illness.  These people also have rights.  In other words, these folks have a case.

Similarly, an unmasked man in the public square might be unknowingly infected with the novel coronavirus and could infect those who are near him.  Keep in mind that COVID-19 has no available vaccine or approved treatment yet.  The people who are in close proximity to the unmasked man also have rights.  They also have a case.

As I see it, both as a medical professional and a citizen, the public health argument triumphs. And, I don’t think that every dispute must be argued or litigated.   Regardless of your presumed legal right, why not simply do what is right?

Sunday, July 12, 2020

Is Coronavirus Different from the 'Flu'?

Early on, when the first coronavirus infections starting springing up in the U.S, I wondered if these infections and the threat they posed were truly qualitatively different from seasonal influenza.  As I became more informed, I recognized that the health experts were correct; this is not the flu.

I was not persuaded, however, by the high mortality rates which were initially quoted.  Even today, we will hear and read that mortality rate for COVID-19 may be 10 times higher than that of seasonal flu, which is in the range of 0.1%.  We simply cannot make such an assertion authoritatively. The truth is that may be grossly overestimating COVID-19 mortality for a simple mathematical reason – we simply don’t know the extent of infected Americans who have mild disease or remain asymptomatic.  With widespread testing, we will likely verify that the percentage of COVID-19 fatalities is much lower than originally thought.  In simple terms, the larger the population segment there is with mild disease, the lower the mortality rate will be.   When the dust clears, we may find that mortality rate to approach that of ‘the flu’.  Let's all hope so.

But even if the mortality rates are similar, the threat of the 2 viruses is quite different. 

The 'Flu' vs Coronavirus!

Experts have pointed out that the novel coronavirus is more contagious than seasonal flu.  An individual infected with seasonal influenza transmits the infection to 1.3 others.  In contrast, those infected with the novel coronavirus at it's peak was believed to be transmitting the infection to multiple people, although its contagiousness has been revised as more data accumulates.  So, coronavirus can reach a larger population more efficiently and deeply than the ‘flu’ can.

While the ‘flu shot’ is not an ideal vaccine, it does offer us some protection.  There is no vaccine against coronavirus.  And, many of us have some partial natural immunity against the ‘flu’, as we have been exposed to various 'flu' strains that descend upon us each year.  The novel coronavirus is new on the scene, so our immune systems are more vulnerable and less equipped to battle it.
And, finally, there are effective treatments for the ‘flu’ and very few therapeutic options for coronavirus, despite the false claims that chloroquine andhydroxychloroquine were gamechangers. 

What does all this mean?   Well, without natural immunity, a vaccine or any effective treatment, it becomes imperative to avoid infection.  Are you familiar with the phrase, social distancing?  It has been dismaying to see so many of us mingling closely in bars and restaurants without a mask in sight.  And, just this week, case rates in the majority of U.S. states are increasing raising fears of more illness, hospitalizations, deaths, economic lockdowns and fear.   Is wearing a mask and keeping one's distance really too much to expect?

Sunday, July 5, 2020

Independence Day 2020

This Independence Day is different from all others that I have experienced.
We are so bitterly divided.
We face the fury of a resurgent pandemic.
We cannot even agree if wearing a face mask is the right thing to do.
Tens of millions of Americans have been thrown out of work.
Our politics is increasingly poisonous. 
Anger and frustration over racial injustice has erupted.
How do we move forward?

Will we be able to celebrate the day with the 'bonfires and illuminations' that John Adams forecast?

The Whistleblower

”I am apt to believe that it will be celebrated, by succeeding Generations, as the great anniversary Festival. It ought to be commemorated, as the Day of Deliverance by solemn Acts of Devotion to God Almighty. It ought to be solemnized with Pomp and Parade, with Shews, Games, Sports, Guns, Bells, Bonfires and Illuminations from one End of this Continent to the other from this Time forward forever more.”

John Adams