Our Best Thinking on COVID-19: Everything we think, know, and can prove about the virus.
To help me process all this information coming at us, here’s another update on COVID19. You can find the first one here (https://bit.ly/34LiNWS). I’m going to use the same approach, separating out what we THINK from what we KNOW or what we can PROVE.
The focus today is on “When is this over???” Or put another way...and then what??
WHEN DOES THIS END?
We KNOW that pandemics end only one of a three ways: #1) We get a vaccine that give immunity; #2) We all get infected and then get herd immunity (70-80% of people having immunity), #3) We keep distanced from each other long enough that the infection dies out (social distancing).
We can PROVE (https://bit.ly/3etTM75 ) that #3 worked for SARS and MERS, the last two novel coronaviruses. They died out after the cases were isolated and the virus stopped spreading. We KNOW that #2 has mostly worked for Chicken Pox which is still circulating but only in people who haven’t had it already (namely kids). We also can PROVE (https://bit.ly/3csqUdE ) that #1 worked in cases like Small Pox and Measles (provided everyone gets vaccinated).
As for COVID19 we THINK we’re still in the early stages of this pandemic. We KNOW that we are not anywhere near herd immunity yet because 70-80% of people you or I know have not yet had COVID19. We THINK that this virus has been circulating around the US perhaps since December 2019. So we THINK that we have a long way to go still before we get to #2.
We’re currently using #3, social distancing, but we can PROVE (https://brook.gs/3bguh76) at great cost to our economy. More on that later but we KNOW we only have this option because we cannot test and isolate cases. Without accurate and timely testing, we KNOW that the virus will just keep spreading and growing unless we use social isolation.
We KNOW that our economy however won’t withstand prolonged isolation intact. We KNOW and can PROVE that everything we do has effects and side effects. In healthcare we always have to balance the number of patients helped with the number of patients harmed. We KNOW and can PROVE (https://bit.ly/3ev12zG) there’s always some who are harmed, no matter how innocuous the treatment. In this time of social isolation/distancing we KNOW that there is an increase in domestic violence and also depression. Since I am a clinician, I focus on life saving but I am not blind to the human and economic side effects of #3 (social distancing).
Furthermore #3 isn’t a perfect tool. We can PROVE that the COVID19 virus spreads easily and can take 14 days or more to show symptoms. We can PROVE (https://bit.ly/2RLzdt3 ) there are asymptomatic spreaders, we THINK maybe 30% or more. We THINK this social distancing is just buying us time to (hopefully) come up with better testing and tracking. We KNOW that the US doesn’t have anywhere near enough capacity to test for or track COVID19 cases right now. We THINK that testing/tracking is the way back to restoring our economy however we don’t KNOW that and can’t yet PROVE it (. There’s a concern that asymptomatic spreaders would make testing/tracking useless.
If we do not social distance, then we KNOW (https://bit.ly/2Vi7pyM ) the virus will grow exponentially beyond our ability to control it. We KNOW this is what happened in Italy, Wuhan, Spain, and what is currently happening in Flagstaff. Whatever we choose to do, we KNOW will have to live with this virus until we reach one of those three endpoints. Furthermore, I THINK that people work on the speed of trust. We KNOW from Gallup polls (https://bit.ly/2VAuJXb) that most people do not trust that they will be safe until there is a vaccine. So we THINK that even without social distancing our choices as consumers will still reflect a world with a potentially lethal virus.
AREN’T THERE TREATMENTS NOW?
So we KNOW that both Hydroxychloroquine (HCQ) and Remdesivir are being used to treat patients since we KNOW we have little other options. We also KNOW that we have precious little data on wether these medications work. We KNOW that HCQ is being widely used but also had one study (https://bit.ly/2XIpaIV ) stopped due to harm from fatal cardiac arrhythmias. We also THINK that elderly people are more at risk for those arrhythmias if treated with HCQ. It doesn’t look good if you end up hurting someone when you’re trying to save their life.
As of this morning we THINK that Remdesivir might be another treatment. There’s a story you likely heard of that its saving lives. What I KNOW is that we don’t have enough data to say yes or no. More on this in another post but let me get to my point.
Treatments are great if they save lives. I’m hopeful we’ll find something soon. However, even if I have a treatment we KNOW that many people are still vulnerable to getting the virus. That means we KNOW we still have the chance to have our healthcare system overwhelmed. Maybe you wonder what’s the big deal with that? Well that will need another post later. Whatever the case, even with a treatment we THINK we’ll have to live in a world with social distancing unless we get much better testing and case isolation (or we get a vaccine).
WHAT CAN WE DO?
What I THINK we can do is ask our leaders how they plan on getting us to one of those three endpoints. Specifically for Arizona, if we aren’t under the social distancing then what’s the plan? Do we have the ability to do widespread testing? Can we track COVID19 cases and inform people if they were exposed? How are we going to do tracing over urban, rural, and tribal Arizona?
My goal is to help increase understanding during a difficult time. You don’t have to agree with me, but I hope we can use solid information to make better decisions as individuals and as a people. Until next time, stay safe.
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