LIVING WITH COVID — 19
The virus is not going away anytime soon so we have to adjust how we live in order to cope.
By Allan Maynard – June 12, 2020
We have been living with the CoVid-19 virus for over 6 months now and it is still a mystery in many ways. While governments around the world are looking at ways to open up their economies, the scientific community is urging caution and trying its best to keep current with developments. New information is published almost daily – in what many are calling ‘fast science’. Unfortunately, scientists are also having to battle misinformation and wishful thinking coming from some political leaders along with wacky conspiracy theories that are multiplied through social medial platforms – (see previous article on this web site).
The CoVid-19 pandemic presents one of the clearest examples in modern history regarding the critical need for evidence-based decision-making. In terms of leadership around the response to this pandemic, we are witnessing first-hand – the good, the bad and the ugly. And leadership is critical. Some areas are now benefitting from flattened coronavirus curves. Meanwhile, parts of the US, India, Russia and Latin America are still recording thousands of new cases every day. The first wave of the coronavirus is not over. If anything close to this trend continues, we have to wonder what the threshold will be for many areas to reinstate stay-at-home orders and close businesses again, just as they are starting to reopen.
The future shape of the pandemic will be decided by informed leadership, human action in the form of social distancing and hygiene, testing and other traditional methods of disease control, but also gaining more knowledge around several unanswered questions about the nature of the virus itself.
WE KNOW WHAT WORKS TO LIMIT INFECTION RATES — For countries that implemented highly effective interventions such as testing and contact tracing, this first wave of coronavirus cases may be the last they experience, at least for some time. For one example, New Zealand, has managed to virtually eradicate the virus, acting early to implement a lock down and installing robust systems to monitor outbreaks. The country will likely be able to avoid future waves until a vaccine arrives.
Countries with small populations and isolated geography such as New Zealand and Australia may be able to pull this off. South Korea and Taiwan also provide examples whereby virus detection and suppression systems may be advanced enough to smother any future outbreaks. But this will be extremely difficult for most countries, especially those with large populations and porous borders.
We have been fortunate to have such good leadership in BC. We are successfully entering the first phase of re-opening and the numbers of new cases are falling significantly. Moreover we were able to avoid overwhelming our medical facilities. So again – early intervention, science based leadership, adequate testing and contact tracing proved successful. It is worth looking at some numbers (from June 11, 2020) for BC, Canada, USA, Washington State (as this is closest to BC) and New Zealand as mentioned above.
|Jurisdiction||Cases /M population||Deaths/M population|
M – million
We can see how successful New Zealand has been even though it is an isolated country and had some advance warning. However it is clear that strong and effective leadership, made the difference. That applies to BC as well. The messaging has been factually constant, consistent, and considerate of people’s concerns. In the messaging, kindness to one another was constantly emphasized and most BC residents have cooperated without reservation.
To further re-enforce this message of what works is a large study recently published in “Nature” concerning 11 European countries. The authors state the following: “We estimate that, across all 11 countries, between 12 and 15 million individuals have been infected with SARS-CoV-2 up to 4th May, representing between 3.2% and 4.0% of the population. Our results show that major non-pharmaceutical interventions and lockdown in particular have had a large effect on reducing transmission. Continued intervention should be considered to keep transmission of SARS-CoV-2 under control.”
UNDERSTANDING TRANSMISSION – From the early days of this pandemic, the experts have recommended wearing masks, staying at least six feet away from others, washing hands frequently and avoiding crowded spaces. What they’re really saying is: Try to minimize the amount of virus we encounter. It’s likely that a small amount of virus particles will not make us sick as our immune system would react and vanquish the invaders.
But how much virus is needed for an infection to take root? What is the minimum effective dose? A precise answer is impossible, because it’s difficult to capture the moment of infection.
Not surprisingly, the current body of knowledge is clear that the worst-case scenario for outbreaks have occurred in care homes, cruise ships, prisons, factories, places of worships, large office settings and more – all as a result of people indoors and in close quarters, for a period of time. One oft-quoted case was a choir practice in Washington State wherein one infected person spread the virus to 87 percent of the choir members – with 2 members dying. Recently, in BC Provincial health officer Dr. Bonnie Henry revealed the isolation of an outbreak that erupted as a result of a family dinner inside (and outside) a residence. Of the 30 people at the gathering, 15 have become infected.
There is now a growing concern that the recent protests in cities around the world will also cause spikes in infection rates. Especially worrying is the use of tear gas, which makes people cough whilst in close proximity to one another. There are also major concerns about the prospect of political rallies related to the upcoming election in the US. The first one – an indoor event, is planned for June 19th in Tulsa, Oklahoma. This plan goes against all scientific advice, as it’s likely to produce a virus fog within the facility. The organizers know this and in fact those planning to attend the rally will be required to indemnify the Trump campaign and others involved in the event so they will not be able to sue if they contract coronavirus.
The Achilles Heal – in understanding transmission is the fact that people who are asymptomatic or pre-symptomatic are nonetheless spreaders of the virus. For example, one study published (early June) in the Annals of Internal Medicine suggested asymptomatic people seem to account for 40 to 45 percent of CoVid 19 infections and they can transmit the virus to others for an extended period of time. Another study found 23 percent of transmissions in Shenzhen, China were from asymptomatic people. Also, a study published in Nature found people shed the virus most when their symptoms are mild (likely pre-symptomatic).
Apart from avoiding crowded indoor spaces, most experts are now claiming the most effective protocols are to practise good hygiene and to wear masks. Even if masks don’t fully shield us from droplets loaded with virus, they can cut down the amount we receive, and perhaps bring it below the infectious dose.
SO MUCH MORE TO LEARN – There is so much more to learn about the CoVid 19. It is reassuring to know that there are significant research undertakings on many fronts and in many countries that should provide better tests, drug therapies, a clear understanding of immunity and hopefully an eventual vaccine. All this will take time. Some points:
- Immunity — Recent data shows that fewer than 10% of populations in countries studied have developed the antibodies that would be evidence of having caught the virus and, in theory, becoming immune for at least a short time. That also means the vast majority of populations remain susceptible.
- Immunity – There is not yet a clear understanding of immunity to the CoVid 19. Resistance to some earlier discovered coronaviruses has been thought to fade within a year. This could be a concern with respect to a vaccine if the resulting immunity is short-lived.
- By age – CoVid-19 is definitely a disease of the elderly. Recent analysis is showing that the chance of a person over 75 dying from this disease is 10,000 times likely than it is for a 15 year old.
- Children – Emerging evidence suggests children are not significant transmitters of Covid-19. These data, coupled with the enormous adverse impacts of continuing closures, argue for reopening schools by fall of 2020. Of about 400,000 Covid-19 deaths worldwide, only about two-dozen children are known to have died. Moreover reports of serious complications among young people are statistically rare and, if detected early, most afflicted youths recover within weeks. It is hoped that more will be learned from the recent partial reopening of schools in many locations that can thereby help to aid in decisions for a more widespread opening.
- Drug Therapies – Trials are now under way for a number of antiviral drugs that were developed to deal with other diseases but are now being repurposed in the hope that they can be used to tackle Covid-19. Results are expected in a few months. If successful, some of these could help cut death rates. It should also be noted that hydroxyl-cholorquine, despite the very strangely hyped promotion by President Trump appears to be an unlikely therapy and may even cause heart issues when used.
- Vaccines – the holy-grail – At last count there are over 100 initiatives around the world to develop a successful and effective vaccine. With testing underway on five short-listed experimental vaccines in China and four in the United States, the race to produce a vaccine for Covid-19 has taken on political dimensions that echo jockeying for technological dominance during the Cold War. Moreover – both countries are also taking huge financial risks to scale up production of possible vaccines even before they know any are safe and effective — a gambit to ensure their citizens won’t have to wait. “We’re going to start manufacturing doses of the vaccines way before we even know that the vaccine works,” Anthony S. Fauci said in an interview with the Journal of the American Medical Association. Most experts agree though – the prospect of a vaccine is IF – not WHEN. They also predict that it will be at least another year away. But who knows, perhaps with so much effort worldwide, it could come sooner. We can only hope.
- Seasonality – Most influenzas spread more easily in the winter because the virus is thought to prefer dry air over humidity, and because people in cold environments spend more time indoors and close to each other. Existing coronaviruses (common cold) also follow seasonal patterns. If this coronavirus behaves in the same way – and there is not yet strong evidence that it does – we could see some improvements at least in the Northern Hemisphere. However these is significant information to contradict this hypothesis. CoVid 19 infections are increasing in many warm climates – such as Brazil, Texas and Arizona. The point is, the vast majority of people around the world are still susceptible.
It can seem very discouraging indeed to face the prospect of having to deal with this pandemic for an undetermined period of time. However there’s a degree of hope with respect to drug therapies and vaccines. Moreover we know what we must do to control and even contain this virus. We are learning to take the needed intervention measures and yet still return to some semblance of normality. We should in time be able to safely open schools, do some limited local travel, have small groups visitors in our homes and most importantly see loved ones that we have been separated from. However, we must be prudent to note that most of society is still susceptible. Thus – a return to political rallies, major sporting events, concerts, extensive air travel, cruising, and hosting large gatherings, will (or should) not be considered for some time. Our elected leaders must recognize this reality and adhere to the advice coming from the medical experts. As we can see from the numbers presented in the table above – leadership and societal cooperation make the difference.