HOW TO DEFEAT COVID-19, LESSONS WE HAVE LEARNED FROM HISTORY

This is a novel experience for the whole world, no pun intended. The last time we saw anything like this was over 100 years ago. “We” may be an exaggeration, as I still had 25 years to go to exist. From historical accounts, we are handling it far better than the country did then, with the possible exception of St. Louis, which in 1918 shut down the entire city, including schools, bars, most businesses except coffin makers and embalmers.  Theater owners and musicians were the most vocal opponents, claiming their livelihood was being destroyed. When all was said and done, and the quarantine lifted several months later, St. Louis had only 31,500 of its inhabitants that contracted the flu, and only 1,703 deaths in a city of 800,000.  The rest of the country did not fare as well, 675,000 Americans died. Many towns had so many deaths they had to stack the bodies on the sidewalks outside the mortuaries.

We are currently, 3/24/2020, in the exponential growth phase, with a doubling of cases every three days in our community, and no obvious blunting of the curve.  I still see a lot of traffic on the road, plus people standing in line very close to the person in front of them, and the young who, out of school, are heading for the beach.  It seems we are not taking this very seriously yet!  Although I am an optimist, we are not following the mandate very strictly. We need to tighten up the transmission rate.  I suppose it will take some law enforcement methods to get people to comply.  The R0 is still above 1. 

The concept of R0 (pronounced R naught) is the number of people a single person with the disease will infect.  If R0= 1, then the disease will stay at its current level.  If it is less than 1, it will eventually burn itself out.  But if it is any number greater than 1, it will grow, the speed of growth dependent on that number.

Author of chart: Kiera Campell

The R0 of COVID-19 is probably around 2 now.  When you are #2 you need to try harder as the saying goes.

The current public health measures include: 

• Frequent hand washing (for 20 seconds), and clothing especially cover clothing.
• Keep two yards distance between individuals
• No more than ten people in one group (that includes going to Houses of Worship)
• Stay home and work from home
• Cover coughs and sneezes
• Disinfect surfaces touched by people (countertops, door nobs, etc.) The virus stays infectious for at least 4 hours on copper, but maybe for three days on stainless or plastic surfaces. A recent report from one of the Princess Cruise Ships had viral particles that were still infectious 17 days after the ship had been evacuated!
• Don’t touch your face (where the virus gains entrance to your body)
• Avoid contact with sick people

Notice, masks are not on the recommendation list as the regular surgical masks are not sufficient to filter out the virus when inhaling. However, a sick person who wears such a mask will limit the particulate spray if they cough or sneeze.  It takes a better mask (the N-95) to actually filter out the virus, which is currently recommended for health care workers only.  The general public is discouraged from using them as they are in short supply, thus taking away masks from those that really need it.

These are not all the measures that could be taken.  More confining measures may become necessary.  The shutting down of services could be much more severe. Food sources could be centralized and restricted to one member of a family.    An entire city or region could be shut down with armed military control of egress and ingress—the less contact of people with other people, the less chance to transmit the disease. Testing of the population, as South Korea has done, would identify the people who are at the greatest danger of spreading the virus and emphasizing the isolation of those people. One problem would be identifying those people because individuals start shedding the virus before they develop symptoms, and some remain asymptomatic, which would require largescale testing of everyone. That would require massive testing centers, and special hospitals to relocate large segments of the population and contain them.  The more stringent the measures, the more adverse the effect on our Country’s economy would result.

At this point, opening the economy back up, as suggested by some, would cost lives. What good does “Social Distancing” do? That question was answered 102 years ago. If we compare the 1918 St. Louis death rate of 31 deaths per 100,000 population per week, with strict social distancing, to Philadelphia at 257 deaths per 100,000 population per week, during no public health measures, gives us an over eight times greater mortality. Are we willing to trade loss of lives for fully stocked shelves of toilet paper? Besides, there would still be significant panic, and it would be nowhere near normal.  We have no drugs that will attack the virus, nor do we have vaccines that will prevent infection at this time.  Currently, several medications will be tested, however, to determine if there is any efficacy for them to use either as a treatment or prophylactically to prevent infections. 

Chloroquine and hydroxychloroquine are both drugs that have been around for several decades.  Their original use was for malaria treatment and prevention, as well as rheumatoid arthritis.  The Chinese experience, as well as the French experience, suggests that these drugs reduce the viral load.  This, however, has not been confirmed by rigorous scientific studies, and may just be another toilet paper fairy tale at this point.

Ritonavir/lopinavir, a combination drug for HIV, has been in use since 2000.  It impedes the replication of the virus and has shown efficacy with the MERS virus in animal studies, but when tried in China was not useful.  This drug combination is also being tested in combination with interferon-beta.  No clear results are available from that study yet.

Immunologic treatments with serum from recovered Covid-19 patients has also given hopeful results.   Ultimately making our own antibodies, stimulated by a vaccine, will be the answer.  Several vaccine trials are in Phase 1 trials.