The Corona Virus
and
the House in the Country
We have been in the country now for over six weeks. Here social distancing is almost the norm. We are far away from a public road and have plenty of room to take walks. The UPS truck was here twice. The driver put the package on the outside porch and left, just waving a hello. In the time of the corona virus, I would say that this is an ideal setting. Indeed, as the death toll rises by the hour in the New York metropolitan area, the flight to the countryside by panicked urban/suburban residents has been truly astonishing. These corona virus refugees have cleaned out the stores of paper products, cleaning supplies, tuna fish, pastas, tomato sauces, sugar, flour and many dry goods.
Many of the properties here are second homes or occupied by elderly locals, whose children have left for non-rural careers in metropolitan areas. Now, wherever we go, properties where we never see cars parked except on weekends, or where there would typically be only one or two for the elderly residents, now have cars stacked up- many with out of state plates, as extended families hunker down with the grandparents.
Our information about the world we get from the radio, the internet and speaking to our friends. I feel we are up to date with the news, but I realize more and more that in the media, facts about a virus are often presented in a wrong way and can cause confusion
Our information about the world we get from the radio, the internet and speaking to our friends. I feel we are up to date with the news, but I realize more and more that in the media, facts about a virus are often presented in a wrong way and can cause confusion
Covid-19 is the virus that has been causing the pandemic which is now in more than 185 countries. It is a brand new infection for the human population. Although we believe it is harbored in bats, we still don’t know enough yet to make anything more than educated guesses. Until today, we - that also means the scientists, have no idea how it infects the human body. The recommendations for our protection, given out by the government, are suggestions. They are based on the experience of the medical community. Whether they really work we will find out in a year or so. This is normal in this kind of situation. It may be maddening for us not to be able to get definitive guidance from our governments, but there hasn’t been enough time to study the progression of the disease and how it is transmitted, to make coherent policy decisions. Right now, there are only good guesses as to how to proceed.
President Trump has been doing daily briefings to the country to explain what the government is doing. He announces ever-changing policies and mentions drugs, vaccines and therapies that are being considered. He is then followed by medical experts that seem to contradict or recast much of what he says. Is this incompetence or lack of focus? NO! It is because none of them- not federal, state, or local officials (in any country for that matter) know enough about this virus yet. The medical experts rightfully (disappointingly) stick to their training and always insert caveats that ‘things aren’t proven yet’. This is not what a fearful world wants to hear! But it is what they have to say.
Normally when a new virus crosses over into humans from an animal reservoir where it has been possibly living for thousands of years, it causes enough of an outbreak of disease to be noticed by health care workers. It then falls to epidemiologists to isolate and identify it. Studies then have to be done- according to scientific methods (otherwise the results are meaningless), to prove how it is transmitted between people, when during the course of infection a person is shedding the disease so others will be infected, how it acts on the body (does it only affect the respiratory system, or also other organs and how, e.g.- inflammation, cell death, etc.), and what therapies or drugs that we already have available which might be used. If there are none, which existing remedies can be redesigned, or must we start from scratch.
As these facts are established, they can then start to design randomized, double blind studies and assemble a meaningfully large enough group of test subjects to study. The accepted length of time for these trials will vary, but they usually go on for about a year to make sure there aren’t any latent bad outcomes. If the results are positive, then the FDA will usually like to see another group of researchers in a different setting or country replicate the methods and results, before they give any drug or therapy an approval. How long does this take? Usually one to two years.
Trump keeps implying that this lengthy process will be shortened, maybe by cutting through regulations and the proven review process, and the experts keep following him and saying that won’t happen. The proper follow up questions reporters should be asking should focus on how this process can be streamlined to save lives now. The process is sound, but the need for change is dire.
Trump keeps implying that this lengthy process will be shortened, maybe by cutting through regulations and the proven review process, and the experts keep following him and saying that won’t happen. The proper follow up questions reporters should be asking should focus on how this process can be streamlined to save lives now. The process is sound, but the need for change is dire.
We’ve had none of this done yet. There hasn’t been enough time. So read between the lines when you hear Dr. Fauci and others stress that ‘... hasn’t yet been proven to work’. This is what he is saying, not that a specific drug or therapy shouldn’t be considered or tried.
At the moment the scientists in the Corona Task Force are collecting data not only from the United States, but also from all the other countries on the globe. They face problems because not all countries use the same method to report data, and also they have not tested enough patients in their country. Even in the U.S. more testing has to be done to have enough data to work with. The goal should be to test almost all people. Then we would also find out who had the virus with mild symptoms and who did not go to the doctor. Scientists also suspect that some people were infected but did not know it. So it will be important to test as many people as possible to get a clear picture. We did not have a test for this virus sitting on the shelf. It’s new and one has to be developed- which also takes time. Doing this and also testing the blood for antibodies (also a new test) will tell the ultimate story, and takes time.
At the moment the scientists in the Corona Task Force are collecting data not only from the United States, but also from all the other countries on the globe. They face problems because not all countries use the same method to report data, and also they have not tested enough patients in their country. Even in the U.S. more testing has to be done to have enough data to work with. The goal should be to test almost all people. Then we would also find out who had the virus with mild symptoms and who did not go to the doctor. Scientists also suspect that some people were infected but did not know it. So it will be important to test as many people as possible to get a clear picture. We did not have a test for this virus sitting on the shelf. It’s new and one has to be developed- which also takes time. Doing this and also testing the blood for antibodies (also a new test) will tell the ultimate story, and takes time.
The models the Task Force are using can only be as good as the data that will be put in. When the data collection is closed, all our questions have a chance to be answered. I’ve seen news outlets try to misconstrue information that I listened to ‘live’ in the briefings. This is no time for sensationalism to boost ratings or sales, but it is out there. There have been reports here and abroad, that governments are purposefully under and over reporting the number of deaths, for nefarious reasons. While I am sure that this is happening in some countries, it is a theme being promoted by some reporters either based on ignorance of the scientific method, or willful sensationalism.
One of the first things our scientists must determine are the actual causes of death. These data are crucial for mapping the spread and behavior of this virus. The data is being gathered from all over the world. But there are difficulties in this seemingly simple and straightforward data point. Not all countries are reporting things in the same way or with uniform health codes. Also, this virus seems to be more lethal in people that have certain - but very different, underlying conditions, and mostly in the elderly. So how was a death recorded? Was it a heart attack, liver failure, COPD? Were these already afflicted people living with the condition for years and only died when infected with corona? In which case should it be classified with corona or heart disease? All these disparate facts need to be properly and uniformly recorded before we can begin to look for answers.
One of the first things our scientists must determine are the actual causes of death. These data are crucial for mapping the spread and behavior of this virus. The data is being gathered from all over the world. But there are difficulties in this seemingly simple and straightforward data point. Not all countries are reporting things in the same way or with uniform health codes. Also, this virus seems to be more lethal in people that have certain - but very different, underlying conditions, and mostly in the elderly. So how was a death recorded? Was it a heart attack, liver failure, COPD? Were these already afflicted people living with the condition for years and only died when infected with corona? In which case should it be classified with corona or heart disease? All these disparate facts need to be properly and uniformly recorded before we can begin to look for answers.
In a recent press conference, when I listened to Dr. Birx announce that we were collecting such data from all over the world to better inform our policy decisions, she helpfully mentioned that we were adding a new code for corona virus to our health care data. She went on to explain that other countries did not have such a code, so we would be adding this code to their data for analysis. This is perfectly legitimate and necessary. Later I heard many reporters- citing those statements of hers in that same press conference, as evidence that the government was trying to over or under report corona deaths, depending on which outlet was doing the reporting!
We will find out whether “social distancing” was the savior. It is just a policy guess based on how similar viruses behave. It might not be once we have a better understanding of the method of transmission. The leveling of the curve may only be a coincidence. All viruses have one evolutionary imperative- to reproduce. They need a living host for that. In the end, killing every host they infect doesn’t work. So viruses generally become more benign over time. The bell shaped curve is typical for viral outbreaks where no mitigations or therapies are introduced. So as this curve flattens, it may or may not be due to anything we are being told to do. It is too soon to tell.
We know that most of these viruses are transmitted by close human contact. Some may be transferred by skin contact with infected surfaces. Most people are shedding a virus for a day or two before they show symptoms, and that makes sense for the virus’ reproductive mandate. In order to reproduce, viruses must evolve a method of reaching new hosts. It can be through touch, or aerosolized droplets (coughing and sneezing), delivered by mosquito, or in food or water. With flu viruses, studies have shown that people are most contagious right before they show symptoms. Why does this make sense? A flu will be far less likely to reproduce after the victims stay at home sick. This is why we have the 15 day quarantine policy. So if you go to a party with a lot of close friends and engage in lots of hugging and kissing, and you wake up the next morning and feel a cold coming on, guess what. Someone you hugged there didn’t give it to you. More likely, you gave it to all of them!
Viruses have been with us for billions of years, ever since they infected the first single celled organisms or bacteria. They evolve with us. When a virus first crosses over from an animal into humans, they tend to be very deadly because we have no immunity or defenses. As some or most of us survive, our bodies develop antibodies and these get passed on until enough of us are protected, so that those who haven’t been exposed (or vaccinated) are no longer at much risk. This is known as ‘herd immunity’. Those at risk are surrounded by enough protected individuals that the virus doesn’t reach them.
Sweden is taking this approach. They are not social distancing or closing down businesses. New viruses tend to burn quickly through an unprotected population. So they are taking the view that they need only to shelter their elderly for a brief period of time, until enough of their people have been exposed and develop antibodies, to get the herd immunity effect. It is a bold move and we will see what happens. Many there are very angry, saying that they did not give their informed consent for the government to take such a great risk with their health.
Sweden is taking this approach. They are not social distancing or closing down businesses. New viruses tend to burn quickly through an unprotected population. So they are taking the view that they need only to shelter their elderly for a brief period of time, until enough of their people have been exposed and develop antibodies, to get the herd immunity effect. It is a bold move and we will see what happens. Many there are very angry, saying that they did not give their informed consent for the government to take such a great risk with their health.
As a side note, and just to give you an idea of how much we don’t know about these things, there is a growing number of scientists, that are becoming skeptical that some disease transmission isn’t as passive as we lead ourselves to believe! Recently, in the field of parasite epidemiology, research is beginning to show that parasites have evolved ways of influencing the behavior of the hosts they infect, to enhance their chances of reproducing. There are scores of examples, some incredibly elaborate and involving more than one type of animal host in a single cycle of reproduction. And it is possible that it is even true for flu viruses as well. This would mean that in the case of corona, it is possible that it would make a host more sociable during that narrow asymptomatic window for transmission. This is a very controversial theory and there is very little data to support it. Why? Because for randomized double blind trials it would almost be impossible to find funding, and it is unethical to infect people with live viruses.
But two enterprising researchers found a way. To test the theory, Janice Moore and Chris Reiber designed a trial around a flu vaccine (because it has most of the virus’ molecules, but without the infectious bits), which became most contagious 2-3 days after exposure, but before symptoms developed. They used 36 subjects who were unaware of what they were tracking, and rated their sociability before and after inoculation. The results were astonishing! In the first three days after inoculation (the most contagious period), the subjects interacted with other people twice as often as before the injection! Reiber said that “...people who had very limited or simple social lives were suddenly deciding that they needed to go out to bars or parties or invite a bunch of people over”. Why did their behavior change? We don’t know. Despite many anecdotal cases, it is a very hard thing to research. So maybe we’re on to something with extreme social distancing- just in case.
So take all the advice and guidance with a grain of salt. We won’t really have any answers for maybe a year at best.
But two enterprising researchers found a way. To test the theory, Janice Moore and Chris Reiber designed a trial around a flu vaccine (because it has most of the virus’ molecules, but without the infectious bits), which became most contagious 2-3 days after exposure, but before symptoms developed. They used 36 subjects who were unaware of what they were tracking, and rated their sociability before and after inoculation. The results were astonishing! In the first three days after inoculation (the most contagious period), the subjects interacted with other people twice as often as before the injection! Reiber said that “...people who had very limited or simple social lives were suddenly deciding that they needed to go out to bars or parties or invite a bunch of people over”. Why did their behavior change? We don’t know. Despite many anecdotal cases, it is a very hard thing to research. So maybe we’re on to something with extreme social distancing- just in case.
So take all the advice and guidance with a grain of salt. We won’t really have any answers for maybe a year at best.
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