Dr Charles Hurbis

Dr Charles Hurbis

It’s been over a month since our last column. Have we learned anything about containing the virus yet? I’d like to think that we have. Still, memories tend to be short, and 40,000 new cases daily would suggest that we forget quickly. How did the Labor Day weekend go? Well, if the other two holidays are any gauge (and they will be) we will see another holiday spike. The timing of a spike here couldn’t be worse as we are trying to open schools.

Oregon Governor Kate Brown has set criteria for school reopening. Our state rate for new cases has been hovering around 300 daily for weeks. For schools to open, the rate needs to drop to 60 cases per day or about 80% lower than current levels. After the expected Labor Day weekend spike, I’m guessing that goal won’t be achieved anytime soon. Is waiting the correct approach? Well, take one suburb of Atlanta, they decided to open early and currently have over 1,193 children under quarantine. Is that a successful opening? Clearly not.

Here’s another scary discovery. Some districts were so desperate to prove they could open successfully they are now hiding facts. On the first day of school in Camden County, Ga., local Facebook groups were already buzzing with rumors that a teacher had tested positive for the coronavirus. The next day, a warning went out to school administrators: Keep teachers quiet .... Seriously? That’s a dangerous situation we don’t want to be in.

People don’t like having their civil liberties restricted. Basically, the nation wanted to eat out again and now everyone is paying the price. There will always be a subset of people who do not want to follow the rules. This group hopes the solution is herd immunity, willing to let the chips fall as they may on the way there. But, as Fauci says, “The death toll in herd immunity would be huge." Consider that we have 195,000 dead with an infection penetration of only 2%. What would the death toll be if we reached the 60-80% required for herd immunity? It would be staggering.

Coronavirus cases are surging again worldwide as we enter fall, with Europe bracing for a new phase in the pandemic. In recent days, France, Germany and Italy have experienced their highest daily case counts since the spring. Spain is the new epicenter, finding itself in the midst of a major outbreak. Great Britain just this week is considering shutting down again if case numbers do not improve. This can only happen if people follow government mandates. Clearly, it’s not going well.

Most of the recent infections are involving the younger population. Although most are doing their best to stay safe, they clearly are not as concerned about becoming infected and therefore more willing to take risks. They are fairly certain that any infection will be mild or at least short lived, much like the common flu. The problem with COVID-19 is, once in your body it may decide to stay there. As we know, many viruses do. We do not yet know all the long-term implications of having been infected, but we do get some idea when we survey the “long haulers." What is a COVID-19 “long hauler"? Consider this quote: “They don’t know how to make me better."

One issue that is becoming clear is that not everyone completely recovers from a COVID-19 infection, even if it wasn’t fatal. What used to be thought of as a standard respiratory illness is now being viewed more as a vasculitis capable of wreaking havoc on the eyes, skin, heart and brain, long after the sore throat goes away. Many survivors of the virus, months later, find themselves battling a constellation of debilitating side effects that disrupt their ability to function. “Long haulers” describe nearly 100 chronic symptoms, from fatigue and body aches to night sweats and neuropathy. Of the changes people sustain, it seems one that is less threatening, the loss of smell and taste, is often the most devastating. Bottom line: The “long haulers” are not a group you want to join.

Wearing a mask is highly inconvenient, so are they at least worth the effort? Consider a hair solon in Missouri where both hairdressers tested positive for COVID-19. Between them they saw 139 clients. They had rigorously enforced strict masking and cleaning policies. Subsequent contract tracing of their clients did not identify one single case where the virus was transmitted. Yes, masks work. Think of your mask as a low-tech vaccine you can get today.

As for the vaccine: Some experts say to expect a vaccine by Nov. 1. But successfully rolling out a coronavirus vaccine by Nov. 1 will rely on clinical trials conducted at unprecedented speed, coupled with public release of research that shows it is both safe and effective, experts say. It’s quite possible that more than one type of vaccine will be available or needed, and that a series of vaccines may be required to confer adequate immunity for this virus. Even then, as with the common flu, being vaccinated will likely only decrease your risk by 50% and ideally make any infections a bit less dangerous. This will only be one additional tool to protect us, not the entire Swiss Army knife. Distribution of the vaccine will likely be prioritized initially, with first doses going to people with highest exposure and those who would benefit most because of medical conditions. Groups would likely include healthcare workers, the elderly and those with multiple medical conditions. The goal is to have the population fully immunized by early 2021. The more you follow the development process though the more you realize this goal may be pie in sky. There have been major setbacks with some vaccine trials completely shut down. While a vaccine will be nice, it won’t be like a polio, measles or hepatitis vaccine which will last a lifetime. The COVID-19 vaccine will more likely be similar to a flu vaccine which will need to be re-administered yearly.

So where does this leave us? The desire for normalcy is so great that it is even making the unthinkable, such as mass death, more palatable over time. Progress is being made in some areas although we are losing ground in others. As with contact precautions, the benefit of the vaccine to society can only be as good as people’s willingness to apply it. Like the non-mask group, if a subpopulation decides to refuse vaccination for some reason, the pandemic will only be prolonged. Hopefully, though, common sense will prevail, but doesn’t it feel that sense is becoming much less common in 2020? Here’s to hoping for the best. Stay safe out there.

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