Dr. William Brown
Special to The Lake Report
As the New England Journal of Medicine put it in its editorial on Feb. 20, “for the third time in as many decades, a zoonotic coronavirus has crossed species to infect human populations. … The others included severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV).”
This latest invasion by a coronavirus – COVID-19 – spread worldwide quickly and created pandemonium everywhere it went, as much from the fear stoked by the media and uncertain leadership at the top, as the disease itself. Even so, the disease and the attempts to contain it, shut down China, South Korea, Iran, Italy, Spain, France and threatens to do much the same to the United Kingdom and now North America. And that’s only the beginning – it’s a frightening pace.
Although the genome of COVID-19 was quickly sequenced, effective vaccination and antiviral drugs are probably several months off in the future, possibly as much as a year away, or about the time the virus will probably have run its natural course. So, we shouldn’t look for a quick fix anytime soon.
In the meantime, management of the COVID-19 pandemic is all about slowing the spread of the disease, or as some epidemiologists put it, “flattening the curve” to minimize overloading Canada’s health care systems, by reducing the pressure on intensive care services and their staff, and protecting the most vulnerable. The latter include those in their 70s and above and others of any age who suffer from one or more chronic disease, such as diabetes, or those that affect the lungs, heart or compromise the immune system.
COVID-19 is highly infectious and spreads chiefly by contact with infected individuals whose sneezing and coughing spray the virus onto nearby surfaces, or those nearby in airplanes, cars, subways, taxis, buses, theatres or coffee shops, to name a few.
Making matters worse, infected patients may be asymptomatic for several days, to as much as two weeks, before they develop symptoms such as a dry cough, sore throat or feel unwell – long before fever develops. Checks for fever probably miss many infected but asymptomatic patients.
Without barriers in place to limit the spread of the disease, the spread appears to be exponential. For example, if one infected person transmits the disease to two others and each of those, to two more each, and so on, it’s obvious that the number of infected people in successive cycles increases in bounds from two to as many as 1,000 persons within 10 cycles – and that’s only doubling with each cycle.
Imagine if each infected person, infected five or more per cycle – the math is terrifying. That’s why it’s so important to separate those with the infection from those not yet infected, especially the most vulnerable among us.
All three coronaviruses, COVID-19, SARS and MERS attack the lungs. In the case of COVID-19, the virus characteristically targets the far reaches of the lungs where gas exchange takes place – hence the ominous early development of shortness of breath – especially in the elderly and those with chronic diseases.
The overall mortality rate varies between 1 and 3 per cent but the scary part is that it roughly doubles every decade beginning with those in their 50s at 1.3 per cent, and rising to 15 per cent for those in their 80s. Reasons for the higher mortality rates as we get older include a weaker immune system – even among the most fit of us – and the compounding effects of coexisting chronic diseases in later life.
So, what can we do? Not much, other than general supportive measures supplemented by antibiotics should secondary bacterial infections develop and ventilatory support as needed – given that so far, there are no current effective antiviral agents, and effective vaccination is at least a half a year away, although there’s reason to hope that both may become available earlier.
In the meantime, the most effective measures include self-quarantining, social distancing and frequent handwashing. Social distancing means keeping away from potentially infected patients, which because we don’t know who they are, means keeping a minimum of six feet from everyone.
It also means staying away from gatherings of more than 10 participants, avoiding travel, especially international travel for now, shopping in off hours when there are fewer people about and hopefully something left on the shelves, and as one site put it – living like a hermit – and another site, taking control of our lives. And if you think you might have coronavirus infection, please phone the doctor’s office first, don’t go there.
On the hygiene front, what about masks, cleaning hands and surfaces? Masks work best for those who are infected, to prevent them spraying their surroundings when they cough or sneeze. For the rest, masks discourage the natural tendency of many of us touch our faces, which unfortunately increases the chance of the virus entering our body through our eyes and mouth.
Soap and water for washing the hands beats anything else because the soap breaks up the fatty protective outer coat of the virus, unlike any other prep. Because the virus can survive several hours on surfaces such as tabletops and chairs, it makes sense to wipe them down regularly, especially in public venues.
The Centers for Disease Control (CDC) and the National Institutes for Health (NIH) in the United States carried out worst-case projections for the United States for this pandemic: for Canada, divide by 10 to approximate Canadian numbers.
For the USA with a population of 330 million, the worst-case scenario is that somewhere between 160 million and 210 million Americans will become infected, of which 2.5 million to 20 million could require hospitalization and the number of deaths might range somewhere between 200,000 and 1.7 million. That’s the worst-case scenario: hopefully we’ll never get there but given the importance of effective early monitoring and action – give the U.S. and Canada a grade ‘C’ so far.
The longer we wait before truly effective action by governments at all levels and personal decision-making, the worse this pandemic’s impact could be. It’s ultimately up to each of us to change our behaviour and make the right decisions about social hygiene and distancing. Without compliance on all fronts by each of us, we’re all going to be in trouble.
There is a social cost to the pandemic created by social isolation. This is especially so for those in their later life who find company in conversations with others in get togethers in the post office, stores, churches, community centres, coffee shops, exercise facilities, breakfasts, lunches, dinners, movies and theatres which make up much of the social calendar, almost all of which has been curtailed. Without these options, the quality of life for so many seniors will be seriously affected.
It isn’t all about mortality rates and health care costs. There’s a social cost to everyone’s health that doesn’t have a dollar sign on it and hasn’t been factored into the plans of governments or the health care professions, yet.
See the following resources with the most up-to-date information regarding COVID-19 in Canada and the CDC in the United States: Niagara Region Public Health https://www.niagararegion.ca/health/covid-19/default.aspx , Ontario government https://www.ontario.ca/page/2019-novel-coronavirus , federal government https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html , CDC https://www.cdc.gov/coronavirus/2019-ncov/index.html
Dr. William Brown is a professor of neurology at McMaster University and co-founder of the Infohealth series held on the second Wednesday of each month at the Niagara-on-the-Lake Public Library.