Dr Charles Hurbis

Dr Charles Hurbis

So, what has happened in the country since our last column? Well, Memorial Day festivities, black lives matter rallies and further opening up of the country. Where has this left us now a few weeks later? Well, exactly where we’d expect to be. The virus is spreading uncontrolled through new parts of the country and only plateauing in others. The overall trend, if you exclude early success in New York, continues to escalate up quite a bit. Most areas of the country are setting records daily. A virus spreads through contact. The more contact the more cases. It’s pretty simple. As a good example, New Zealand shut down quickly in this pandemic to prevent contact, isolated their known cases and is now safely opening up. Currently, they are experiencing one new case per week. By contrast, the U.S. has jumped back up to 23,000 per day (actually, now well over 45,000 by press time). When correcting for the population difference, our daily rate is over 4,000 times that of New Zealand.

Does this sound like a country that needs to be opening up even more? With the upsurge in cases, certain establishments are independently rethinking their reopening plans. Many restaurants are closing again, going back to a carry-out only model. They feel that the risk is too high for their employees and that it is difficult to remain profitable with the distancing rules. Movie theaters are starting to backpedal, now insisting that patrons wear masks, major sports franchises are cancelling pre-season training and Apple has started to close some of its retail stores again.

But as Pat Benatar says, were our efforts a little too little, a little too late? And, is America now giving up on curtailing this pandemic? Perhaps the genie is already out of the bottle? It seems that we are now headed down the path of “herd immunity” instead of containment. This will require a large number of people becoming infected (50+ %), letting the chips fall where they may. But, is this a good approach? Not if you look at countries which decided to adopt this approach from the get-go. One such country is Sweden. Sweden, as would be expected, has sustained a much higher level of infection and death than any other Scandinavian country by a huge margin. The problem is, “herd immunity” seems hard to come by, and has been developing at a much slower rate than most had expected. As it turns out, a mild infection does not necessarily produce immunity at all. COVID-19 is an entirely new infection. We do not truly understand it yet.

Also, there are already multiple strains of this virus circulating, so immunity may become a moving target. It seems different parts of the country have circulated varied forms of the virus. The New York strain has been mostly respiratory specific in its attack. In Chicago, researchers have identified two unique strains. According to Dr. Egon Ozer of Northwest University, “The genetic differences in the viruses are associated with the characteristics of the infections they cause." Each form of COVID will exhibit its own unique virulence, which explains, at least in part, why this virus may affect different populations differently. They may vary in transmissibility, severity of the infection, systems attacked, the potential for long term sequelae and the ability to develop host immunity.

Back to “herd immunity," is this truly what we want? The post infectious sequelae are the issue here. Maybe the death rate is “only” 4%, but what is the quality of life of those left behind? The longer this pandemic persists, the more we learn about the consequences of surviving? This virus has proven the potential to produce long-standing issues with hypercoagulability leading to delayed emboli, neuralgias, renal dysfunction, pulmonary compromise, cardiac issues, permanent smell and taste loss, memory loss, anxiety, panic attacks and episodes of sudden death long after “recovery." Even those who don’t suffer these more severe sequelae describe themselves as seemingly “living in a fog," as if with a perpetual hangover. Is this what we want for over 50% of our population? I’m thinking no? This doesn’t even consider the horror of going through the infection in the first place, an experience described with the following quotes in a recent NY Times article: “Feeling of an anvil on my chest," “Like I went 10 rounds with Mike Tyson," “Like having my body taken over by aliens, one organ at a time," “It seemed like new fires were starting everywhere," “Would keep relapsing just as I’d start feeling better," “You never know where the virus is going to take you next," etc. This goes on for two-to-eight weeks.

Worldwide, there is a new surge in cases with the WHO issuing a “dangerous phase” warning. Hotspots now are Brazil, India and interestingly China again. China, where they had once declared victory over the virus, is now having a large breakout in Beijing. Interestingly, they immediately imposed travel restrictions and new lockdowns. It seems the country that brought this gift to the rest of the world doesn’t want it back now. Only 36 countries are seeing declining or stable numbers, compared to 81 with increasing numbers, some parabolically. In the U.S., the sunbelt as well as the warmer eastern areas such as Florida, South Carolina and Oklahoma are seeing a substantial surge in new cases. This is especially interesting as we were originally told the virus wouldn’t do as well during the summer heat and cases would likely taper off by June.

Regarding Oregon, we are hitting daily records of coronavirus cases, averaging over 200 per day. There is an Episcopal Church in Union county that boasts over 236 members with the virus. Clearly, this extreme example likely involved multiple “super spreaders” as they are called and a highly virulent strain. But since you don’t know who those people are going to be, reopening clearly wasn’t the answer.

Just because something is allowed does not mean it is safe (or necessary). Should I be hanging out in a bar, go out in close company with a group of friends? Part of being human is interaction. We have been denied this now for months and it’s getting harder to tolerate. Responsible people do take risks every day, but we need to seriously consider who else our actions may impact and what the consequences may be. Most of those dying are the elderly, and if you infect an older relative because of your immediate need for a margarita, was that a selfish choice?

Also consider the 600 healthcare workers who have died because of this pandemic. These people had families and lives they’d expected to live out. When they die because of something we “just wanted to do," was that a selfish choice? I’m hoping most of us would say that it was.

Let’s continue to work together on this one. It’s not going to be over for a while. Make wise choices, protect yourself and stay safe. But first and foremost, think of others.

Doc H

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