This marks the 50th column I’ve written in this series.
It’s hard to believe on many levels: How long we have been restricted or locked down, that I am still doing this weekly when we figured we would need to do this for at best a few months, that there remain new things to write about (in fact, every week brings new information), that my publisher makes me pay for my own subscription.
I am very grateful to my readers who have given me useful feedback, my publisher for giving me a forum to spread this information, and to my daughter who is a real scientific editor and has helped me with advice and, at times, review of my work.
In celebration, I’ve decided to write a column with good news for a change. (This is NOT to mean that we don’t still have to be vigilant, maintain masks and social distancing, avoid crowds, etc.)
Just that there’s finally some good news to write about.
►In a study of 600,000 people in Israel, which has vaccinated a higher proportion of its population than any other country, there has been a 94-percent drop in symptomatic COVID-19 infections. The vaccinated group was also 92-percent less likely to develop the severe form of the illness if present.
I was asked to give a talk at the Center for Continuing Adult Learning recently in Oneonta. It was supposed to be on vaccine development and distribution, but two days before I was to give it, I was asked by a participant to address treatment of active COVID-19.
Up to this point I have avoided discussing this because each physician chooses treatment for each patient based on many factors, including recommended protocols, approved medications, and most important, consideration of each patient as an individual.
Nonetheless there is some general advice from the NIH (National Institute of Health).
The NIH divides severity levels for COVID-19 into five parts with their recommendations.
►ONE: Not hospitalized, mild to moderate COVID-19.
There is insufficient evidence to recommend for or against any specific antiviral or antibody therapy.
SARS-CoV-2 neutralizing antibodies are available for outpatients who are at high risk of disease progression.
Antibodies bind to the virus, block its ability to get into a cell, and trigger a response from white blood cells to come and attack the virus.
Antibodies could be natural or manufactured. Dexamethasone is a steroid anti-inflammatory which is approved in more severe stages and should not be used here.
►TWO: Hospitalized but does not require supplemental oxygen.
Dexamethasone should not be used. There are insufficient data to recommend for or against the routine use of Remdesivir. (Remdesivir is a drug specifically to treat viral diseases). For patients at high risk for disease progression, the use of Remdesivir may be appropriate. (Yes, I too find this statement very confusing.)
►THREE: Hospitalized and requires supplemental oxygen, but does not require high-flow oxygenation, mechanical ventilation, or an ECMO (extracorporeal membrane oxygenator – sort of like a heart/lung machine used in open heart surgery).
Use one of the following three options: Remdesivir for patients who require minimal oxygenation, Dexamethasone and Remdesivir for patients who require increasing amounts of supplemental oxygenation, or Dexamethasone alone when combination therapy cannot be used or if remdesivir is not available.
►FOUR: Hospitalized and requires oxygen through a high-flow device or non-invasive ventilation. Use one of the following options; dexamethasone or dexamethasone and remdesivir.
►FIVE: Hospitalized and require mechanical ventilation or ECMO. Use dexamethasone.
There are other drugs that have been considered for use in COVID-19.
One is Invermectin. Others are monoclonal (all one type) antibodies as described above. Another drug fluvoxamine (Fluvox) is a drug used for obsessive-convulsive disorder and was hypothesized to block excessive inflammatory reactions.
Bottom line if sick is, find a physician who you trust. A good physician will listen to a patient’s concerns and questions and then when you are comfortable with them, your best shot is to follow their instructions.
On Friday, Jan. 29, Janssen/Johnson & Johnson announced its vaccine had proven effective in Phase 3 studies. This brings a third vaccine on line in the fight against COVID-19 and potentially increases the pace of vaccinations by 50 percent.
Additionally, the J&J protocol is for a single dose and the storage requirements are much less stringent than those of the two vaccines already available in the United States, Moderna and Pfizer.
On the other hand, the statistics on efficacy for the J&J vaccine are not as high as those reported for the other two. It is reported as 85 percent effective globally against severe disease and 70
percent effective against moderate to severe disease.
Many scientists consider this on balance very good news.
If we remember back to last year the goal for efficacy was 70 percent which would have made that equivalent to the flu vaccine. Only because of higher numbers with Moderna and Pfizer do 85 percent and 70 percent seem low.
Furthermore, the J&J vaccine is a one-dose regimen and requires only basic refrigeration to last for weeks, making it much easier to distribute and complete a course of vaccine (i.e., only one shot).
This should especially help in people hesitant to get a shot at all.
Unintentionally but inevitably, and catastrophically, the Russian National Figure Skating Team has carried out an experiment that lets the rest of the world see what happens when you expose super-elite athletes indiscriminately to the risk of contracting COVID-19.
While not immediately fatal, it is not pretty and suggests what the long-term consequences of contracting the disease may be for other young people.
According to the Dec. 17 edition of The Wall Street Journal, the Russian Women’s National Ice Skating team is regarded as the very best in the world and has such deep reserves of young talent that it was expected to remain the best indefinitely.
They are a very close group, literally and physically. The members of this group have pretty much disdained rules and recommendations regarding avoiding disease spread up to now.
There are social media posts of them partying without spacing or masks, posts of competition venues where very many coaches, athletes, spectators and officials are wearing their masks below their mouth or not at all, while athletes are withdrawing from the national championships because of positive tests or complications from recent positive infection.
2018 Olympic silver medalist Evgenia Medvedeva is hospitalized with serious lung damage after testing positive in November.
European Champion Alena Kostornaia missed a competition earlier in December because of a positive test has not recovered sufficiently to compete according to officials.
The National Championship was won by Anna Shcerbakova a teenager. Scherbakova herself withdrew from a late November event citing “pneumonia.” She has now won the event three times but was noted to be having trouble breathing after her programs.
Other skaters performed well below expectation. Former world champion Elizaveta Tuktamysheva who was expected to finish better came in seventh. She had announced that she had tested positive. She was reported as looking sluggish and exhausted at the Nationals.
Many who did compete had been reported as having had the virus earlier in the season. Coaches, some of who are at high risk because of age alone, have reported positive and ill.
Up until now the Russian National Federation has progressed their season as if the virus didn’t exist. Any attempts at safety protocols seem to have been ignored.
So, what do we learn from this experiment? Young people do get the disease and, when they do, they may not die from it at the same rate as the elderly but they do have medical consequences, sometimes permanently.
Why do these symptoms seem so frequent in these Russian athletes while they have not been reported with the same frequency in our general public?
Part of the answer is that these people are under a publicity magnifying glass – when they can’t perform, it is noticed. The same is evident in our professional athletes.
These are also people who have trained to perform at the extreme limits of physiologic capability, who have increased their capacities beyond normal people and therefore any slight damage to their organs whether lungs, heart, muscle, etc., are readily noticed.
The same damage is most probably occurring in the average person, but the average person does not frequently try to perform at their extreme.
While some of the Russians (and others) will never perform at elite levels again, some will have long-term damage that will affect activities of daily living. Any damage in anyone will have long-term consequences that will have heretofore unknown effects on life expectancy and long-term impairment or disability.
To those who continue to underestimate this disease, stop it. Dying is not the only bad outcome of contracting COVID-19.
I said this in April and I say it again now. Stay safe. Wear a mask. Socially distant. Stay within your pod (and if any one member doesn’t, then you all aren’t). We are getting close to getting vaccinated. Don’t screw up now.
In the NFL the lowest of the low, the New York Jets, beat the previously postseason-bound Cleveland Browns. This gave the Jets a second win and seems to knock them out of the competition for worst record and therefore first pick in the draft, according to another article on the same Journal sports page.
How could this happen?
Well, the Browns lost all their first- and most of their second-string receivers due to contact-tracing protocols for COVID-19.
The fans of the Jacksonville Jaguars, formerly the next-to-worst team in the standings, were noted to be celebrating. Now they get to draft Clemson quarterback Trevor Lawrence.
Many people have asked me to explain vaccines to them, and specifically the ones for COVID-19. They are most concerned with how they work, when they will be available, and if they will be safe.
Hopefully, this column will help.
The terms vaccine and vaccination derive from the Latin name Variola vaccinae, which means small pox of the cow. Vacca is Latin for cow.
The term vaccine was first devised by Sir Edward Jenner in 1778 based on the fact that he used an inoculation with cowpox to elicit a protective reaction to smallpox.
In 1881, Louis Pasteur proposed that the term vaccine be used to cover all new protective inoculations that were developed in order to honor Jenner.
There are multiple types of vaccines and at least one of each type has been tried or is being developed for SARS-CoV-2 (the virus that causes COVID-19).
The following are the different types of vaccines that are administered to a subject to induce a protective immune response along with examples of each.
►INACTIVATED: a dead copy of the infectant, e.g., polio
►ATTENUATED: A weakened version of the infectant, e.g., yellow fever, measles, mumps
►TOXOID: an inactivated form of the poison made by the infected cell, e.g. tetanus and diphtheria
►SUBUNIT: a portion of the protein of the infectant that cannot cause the disease by itself, e.g., hepatitis B and HPV (human papillomavirus, causes genital warts and cervical cancer).
►CONJUGATE: Weak version of the infectant, coupled with a strong antigen for something benign to increase the immune response to the weakened version, e.g., Hemophylus influenza.
►RECOMBINANT DNA, where a stand of genetic material for part of the infectant is inoculated into the host’s cells and teaches the cells to make an antigen for part of the infectant.
►RNA: This is the approach that right now is the most promising in treating SARS-CoV-2. A portion of messenger RNA is inoculated into the host cells and tells the host to make a portion of the infecting virus. This technique has not been used for human diseases clinically before.
Typically, it takes 15-20 years to bring a new vaccine to market, and less than 5 percent of candidates will succeed. The speed in which the SARS-CoV-2 vaccine has come to be distributed really is warp speed.
The first regular immunizations begin a week ago Monday in Great Britain. This is less than a year from recognition that there was a new disease and 10 months from identifying the genetic code of the virus causing it.
Currently there is only one vaccine approved for use, the one made by Pfizer and BioNTech. This is awaiting approval along with that of Moderna in the United States. Pfizer’s was approved, distributed Sunday, and injection began Monday. Approval for Moderna may come later this week.
Both of these are of the RNA type.
There are several reasons that things have moved with lightning speed.
One, the unprecedented cooperation between pharmaceutical companies and academic and government research labs.
Two, the approval of governments to allow fast-tracking such that steps of the development are done in parallel. In my mind, there is no doubt the government’s Warp Speed initiative helped move the process along.
Three, scientists have been working for 10 years on what they call pandemic preparedness. In this case they had developed a template that would allow the development of vaccines for newly emerging diseases quickly. Essentially as one scientist called it, plug and play.
In my next column I will discuss plans for the roll out and how it has gone up to that point.
Normally, the time from submission of data to approval by a government agency takes two years. In the case of SARS-CoV-2 vaccines it is one week.
After approval, time to distribution takes more than a year while the pharmaceutical companies develop and implement manufacturing plans.
Amazing what we can do when everyone is desperately pulling in the same direction.
Like many of us this Thanksgiving, my family had a very truncated get together and dinner.
My daughter visited from Annapolis, Md. She had been self-isolating, had rarely gone out, always took precautions, and was tested the week before she decided to come visit.
We decided that the risk of being infected by her was very, very minimal after all of these precautions, and invited her.
I myself have been following precautions and avoiding contact except when absolutely necessary. My housemate works at Bassett Hospital. She takes all precautions and has refrained from unnecessary contact.
Once my daughter arrived Monday before Thanksgiving, our pod had no contact with any other individuals throughout her visit.
Nevertheless, we were instructed to self-isolate this past weekend.
My housemate, who has had a mild chronic cough for seven months, decided to go to the Bassett after-hours care center. She was evaluated, prescribed steroid medication and an antihistamine, and was told it was probably chronic bronchitis and she was discharged.
A COVID-19 test was taken and she was told that she needed to isolate and everyone else in her pod needed to isolate until the test came back and it could be determined whether it was positive or negative.
We were told this would take two to three days.
Personally, I felt that the probability that my housemate had active COVID-19 based on her history of present illness was no greater than that of the general population in this area.
The process she had was chronic, there were no acute changes, she showed no common symptoms of COVID-19, and she was afebrile.
Even if this had been triggered by infection with the virus, which itself was very unlikely, the active stage was long passed by many months ago.
Given the situation I was tempted and briefly considered whether the instructions were valid.
Nevertheless, we followed them to the letter and only today when the lab report came back “no detectable virus” did we stop our immediate self-quarantine.
My daughter, who had driven home is going through a two-week quarantine just for visiting, even though Cooperstown has one of the lowest rates of infection in the country right now
It’s tempting to say that we know better, we understand the odds better, or we don’t feel bad and ignore medical advice.
Nevertheless, it is critical to follow these instructions. It’s better to err on the side of caution then to assume that there aren’t any problems and proceed from that point.
The rate of infection has been going up constantly to new daily highs. The number of confirmed infections daily in the United States has been going up dramatically. The number of daily deaths is going up.
It’s still not clear how many people have actually been infected. A study last week from the CDC suggested that the actual infection rate may be up to eight times greater than the documented infection rate.
This, of course, would decrease the rate of death from the infection, since the number of deaths divided by the new number of total cases would be decreased. Nevertheless, it wouldn’t decrease the daily number of deaths due to the infection.
I was annoyed, in denial, argumentative, and generally all around ticked off to be told what to do when I didn’t think it was necessary. But that’s why we have medical professionals and of course a doctor who chooses to treat himself, has a fool for a patient.
Thankfully we got the all-clear today and we can go back to our lives albeit in the new normal. Before we did get permission to end quarantine a day of work was lost, several appointments had to be canceled or rescheduled and a pending important clinic visit for myself was in the process of being rescheduled. But it was necessary and correct in the fight against the virus.
The following were some of the definitions of the word “sad” from dictionary.com.
“Affected by unhappiness or grief; sorrowful or mournful, expressive of or characterized by sorrow, causing sorrow; somber, dark, or dull; drab; deplorably bad, sorry.” Thesauraus.com lists 46 synonyms for sad.
And I add an additional from other sources, pathetic. The following story is sad by almost all of these. This was originally reported by CNN.
Jodi Doering, an Emergency Room nurse in Dearing, S.D., out of severe frustration and feelings of being overwhelmed, tweeted Saturday that her patients were dying of COVID-19 but remained in denial of the pandemic’s existence.
She called it a horror movie that never ends. Besides treating patients who were dying and the stress that it caused her and her colleagues, they also faced the additional emotional toll of treating patients who despite being severely ill, who while dying, still refused to acknowledge that they had been infected with a virus that they said didn’t exist.
Patients on 100-percent oxygen would swear that it was not real and many would lash out at the nurses and doctors trying to help them for trying to convince them they were dying of COVID.
There were incidents of patients screaming that it was all a fraud and that the medical staff were only wearing PPE to confuse them, that there was no need for it, and demanding that they take it off.
Rather than communicating with their loved ones before they died, they would rant against anyone or anything that tried to convince them that they were critically ill with COVID.
Cases are skyrocketing in North and South Dakota currently at a rate that is the fastest in the nation.
In North Dakota, the Republican Gov. Doug Burgum pleaded with residents, “You don’t have to believe in COVID, you don’t have to believe in a certain political party or not, you don’t have to believe whether masks work or not. Just do it because you know one thing is very real. And that 100 percent of our (hospital) capacity is being used.”
On the other hand, Kristi Noem, governor of South Dakota, has continued to oppose mask mandates or closures and has joined in antagonism to mainstream medicine.
She hosted soon-to-be ex-President Donald Trump at a tightly packed Fourth of July celebration at Mount Rushmore. Even after the president acknowledged that he had COVID-19 last month, many of his supporters continue to refuse to acknowledge it is real.
Johns Hopkins University says that the Dakotas are currently the epicenter of the pandemic in the United States, according to their and the states own data.
Experts feel that the Sturgis Motorcycle Rally, which attracted over 500,000 to South Dakota, and was encouraged by Governor Noem, was a major superspreader event.
Most of the half million did not wear masks and did not socially distance especially in bars and restaurants.
How do we stop this when so many won’t even believe it is real, or dangerous, and won’t begin to cooperate in the protection of themselves and their families?
Last night I was talking to a close friend, a college classmate who is a family physician in rural Wisconsin. He is over 65 and male like myself but otherwise has no risk factors.
He and his entire family sustained COVID-19 in October.
They are not sure what the sequence of spread was; he, his wife, and his step-daughter are all in healthcare. He said it was the sickest he ever felt.
I admit I, who has a total of seven risk factors, am scared that I may become infected. If so, I have a very significant fatality risk. Hopefully I can stay safe until there is a vaccine available to me.
I suppose I can take solace in the fact that between those that don’t believe the disease is real or that it can make them sick, and those who will refuse the vaccine, I stand a reasonable chance of getting it within six months.
Joe Biden has announced his plan for dealing with the COVID-19 crisis. It will include a coordinated national plan of attack and he will be ready on Day 1, Jan. 20, 2021 to implement it. He has already announced his pandemic transition team.
Now the bad news.
One, Mitch McConnell has said the same thing about Biden that he said about President Obama in 2008, that he will oppose him in every way possible to ensure that he is only a one-term president and therefore don’t expect any cooperation from him in fighting the pandemic.
Two, Biden doesn’t take over for almost 70 days and the Trump Administration shows no signs of making any changes that could affect the acceleration of the disease.
Today (Sunday, Nov. 8) there were over 120,000 new cases nationally with over 1,000 new deaths. The estimate is that if nothing is done to change the trajectory of the disease in the U.S. then by the end of January, we could easily double the number of deaths seen so far.
In his acceptance speech Saturday night, Nov. 7., President-elect Biden said that he would name a group of leading scientists and experts as transition advisers to convert his plan into an action-plan blueprint that would start on Jan. 20, Inauguration Day.
His task force is to be led by former Surgeon General Dr. Vitek Murthy (who was fired by President Trump with two years left on his term) and former FDA administrator Dr. David Kessler.
Biden swore to empower scientists at the Centers for Disease Control & Prevention to help set national guidelines, to invest in vaccine research, and to function as one nation, meaning having a national rather than 50 individual state plans.
Ezekiel Emanuel, M.D. and adviser to Biden, said, “You’re going to have rigorous evaluation and constant refinement” of policies and strategies. There will be strict guidelines for slowing community spread.
The new administration said they would work with each governor to make mask wearing in public mandatory in their states. Current research says mask wearing alone could have saved over 100,000 Americans so far.
They plan to seriously ramp up testing. They plan to hire thousands of public health workers. They will help people to get health insurance.
They would strengthen the Affordable Care Act and immediately reopen the Market Place, something Trump has refused to do. They would create a caregiving workforce and develop resources to help health care workers with their own needs.
Most important: They would choose science over fiction.
So, Joe Biden has a very commonsensical plan for dealing with the crisis but he can’t do anything about it until Jan. 20. And then he will need the cooperation of McConnell and the governors to carry it out.
The fact that if an aggressive program is carried out then the economy can more thoroughly reopen quicker does not seem to register with a lot of politicians. And, if it does, it takes a back seat to winning future elections.
Divided government works great for the stock market and investors, at least that’s what I’ve been told and I have read. But a government that doesn’t function without a unified intent and purpose has a grave disadvantage in going to war, whether against another nation or a submicroscopic virus.
The good news is that the president seems to be doing OK medically.
The bad news is that people around him are being put at risk because of his refusal not only not to restrict himself in any manner but, in fact, his flaunting his ability to do anything he wants, whenever he wants.
So many of his senior staff, their staff, Secret Service, White House workers and people who were at his recent campaign events are turning up positive or exposed and they have to restrict themselves.
Also, the FDA and CDC which are both supposed to function based on science, are making decisions based on politics.
If you have friends and family members who have died, or have been very sick, you look at this very differently than if you are young and healthy. Though how anyone could consider greater than 210,000 excess deaths in the United States from COVID-19 reasonable is beyond me.
Tell me that the mortality rate is acceptable when it’s your close relative. My cousin’s father and aunt have died from it. Remember my column from last week about the 28-year old doctor who died of it.
I read the criticisms of my column posted on Monday, Oct. 5, and found myself agreeing on some points. But if the person writing remembers that over two months ago I said that, if everyone wore a mask all the time outside of the home, almost all restrictions could have been dropped by now.
I would be comfortable in that situation. Instead we are averaging over 35,000 new cases daily in the U.S. over the past two weeks.
The president is probably getting care available to no one else on Earth but himself. He is on at least two and possibly three experimental medicines. They haven’t been released for general care and no one has any idea if they have unforeseen complications when taken together.
He is still highly contagious. He has multiple risk factors. If I was his doctor, I would have put myself on the line in order to keep him in the hospital. I would have refused to do something I knew defied standards of care. Nevertheless, he is the president.
The White House medical unit can create an environment equivalent to an ICU if need be if it doesn’t already have an ICU bed standing by at all times. The care he will get there is world class.
Basically, it is equivalent to Walter Reed but without the immediate access to special testing capabilities or surgery.
If he needed something it would probably take 30 minutes. But with a medical versus a surgical diagnosis this is not much of a risk.
The biggest problem with turning the White House into a Walter Reed annex is the cost. The hospital is already set up for this but hey, it’s only money.
Try as might I can’t bring this down to just medical issues. We know some, but only a little about the president’s physical exam, disease course, and labs. He certainly looks better than someone who is very sick and I’m hopeful that there is no relapse.
It’s hard to tell if he is manifesting side effects from the steroids which is very common. Dexamethasone is associated with psychological changes including mood changes such as increased aggressiveness.
There is also dizziness and headache among other side-effects.
Bottom line; I still have no idea which direction the president’s illness is going. He is getting great care, better than you or I ever could. If there are no negative changes by Monday, he should be out of the woods. If things change, I will update.
I graduated from the State University of New York at Buffalo School of Medicine in 1978.
Adeline Fagan graduated from the SUNY Buffalo School of Medicine in 2019. She started a residency program in obstetrics and gynecology in Houston. She died from COVID-19 Saturday, Sept. 19, age 28.
She most likely became infected working a shift in her hospital’s
emergency room in the late spring.
From what I’ve read, Adeline was lovely young woman. Since childhood she knew she wanted to be a doctor. The second of four sisters she had matched to a training program in Houston in 2019. She was a delightful caring person.
According to her sister whom she lived with, she always went to work with a smile on her face even if she had a 12- to 16-hour work shift ahead of her. She volunteered and served on three medical missions to Haiti before completing medical school. She played lacrosse. She was a good sister, daughter, and friend.
She was one of over 1,100 healthcare workers who died from COVID-19 in the United States.
Adeline became symptomatic in the first week of July. She was hospitalized on July 14. In early August she was placed on an ECMO (extracorporeal membrane oxygenation) machine. This is similar to a heart-lung machine which pumps blood out of the body where it is then oxygenated allowing the heart and lungs to rest. In her case her lungs were not adequately functioning to get oxygen to her body.
She fought courageously for two months. Much longer than most people last but eventually effects of COVID-19 and complications of the ECMO overtook her and she died. She was unable to say goodbye.
I repeat, she was 28 years old. I repeat, over 1,100 healthcare workers have died from COVID-19 in the United States.
“I’m mad as hell and I’m not going to take this anymore.” Actually, I haven’t really taken it well so far.
People who claim COVID-19 is a fraud, a conspiracy, not really dangerous, and refuse to protect themselves or their families, other people, and me: Please have the integrity to be consistent and not ask for care when you and yours get sick.
Get to the back of the line when vaccines are being given out, (but ultimately get the vaccine to protect
the rest of us).
Taking care of you puts all healthcare workers and first responders at risk.
Now that you realize it is real, just crawl into bed, isolate yourself and your family, avoid direct contact with anyone not fully protected, cross your fingers, and pray.
Healthcare workers are already burned out, just like pretty much everybody else but even more so. They really don’t want to take care of people who had no respect for them.
To all the clowns at SUNY Oneonta who flagrantly defied social distancing and mask rules, you need to carefully read about the life and death of Adeline Fagan. Shame on you. Adeline was your contemporary.
For those still able to read about her, you are very lucky not to have contracted COVID-19 or if positive, get sick or die from it.
To those of you who assumed that students would behave responsibly and let that be your plan, shame on you.
To those so inclined, please join me in contributing to the GoFundMe page set up by Adeline’s sister. The money collected will help to pay their expenses that have accrued, loss of income of her family over the past three months, and funeral expenses.
Go to gofundme.com, hit search (the magnifying glass), and enter Adeline Fagan’s name.
One thing is very clear when dealing with a pandemic, it is very important to have good statistics in order to determine a plan of attack. Without good numbers it’s hard to say what to do next. It’s also important to understand what these numbers mean.
With COVID- 19, it has proven difficult to determine its morbidity and mortality rate and its infectivity. Additionally, we’re not sure exactly what the tests that are being done mean. There’s a great deal of controversy about accuracy, especially about the antibody test which shows people who have the disease.
Some people die of the disease. Many of these people have pre-existing conditions. This is obviously common in elderly people. Some people have absolutely no pre-existing conditions and are dying of COVID-19 solely. Many people who contract the infection will survive it but may have long-term health consequences.
We have no idea what this percentage will turn out to be. Some people contract the virus that are totally asymptomatic. They have no illness at all. Unfortunately, they are probably still contagious and can infect others who become symptomatic.
When we have good numbers of the size of a population, the number of people affected, number of people who die, and the number of people who develop permanent medical problems, we can start to develop good plans.
Unfortunately, we now recognize that we don’t have a good handle on these basic statistics.
We were able to determine what percentage of those who were tested and confirmed with COVID-19 died. The problem with that is many people who died during this period went unrecognized as having
COVID-19 because the algorithm to decide who would be screened did not recognize that most infected people wouldn’t have classic symptoms. This makes the statistic of the percentage who died unreliable.
In Italy, it initially looked like 10 percent of the victims were dying. In Germany, it looks like less than 1 percent of the victims are dying. In the United States it looks like at least 5 percent die.
To figure out the real infection, fatality and morbidity rates, we are going to have to know the size of the population, what percentage of the population actually contracted the disease, and what percentage was symptom-free.
A study in New York City, which Governor Cuomo frequently refers to, shows that approximately 20 percent of the population have antibodies to COVID-19, which indicates that they were infected and implies that they have some level of immunity even if only temporary.
The official numbers of New York City are approximately 204,000 cases and 16,400 deaths. This represents a fatality rate of approximately 8 percent. But there seems to be a number of patients “missing”: 20 percent of 8 million is 2 million. Where are the missing 1.8 million cases?
If we take the number of deaths and divide that by the total number of cases, assuming those numbers are close to accurate, we get 16,400 divided by 2 million. Which is only 0.8 percent. This has to be adjusted for the deaths that haven’t been officially determined.
It appears that the disease is more prevalent and a lower mortality rate than initially thought. It also appears that as much as 90 percent of the population infected are not diagnosed.
A retrospective research paper that I read from a specialty hospital in New York City showed that otherwise healthy patients that were scheduled for surgery in April 2020 and did not warrant testing had an infection rate of approximately 12 percent, of which 58 percent remained asymptomatic even with the stress of surgery.
Whether it is determined by statistical methods or by formal scientific studies it is clear that a very significant percentage of patients with COVID-19 never show symptoms.
In summary, it’s clear that we do not have very good statistics which makes it more difficult to make informed decisions.
Hopefully, the statistics will improve. But the important point to take away from this is, regardless of the percentage who have the disease, a large number of people are dying from it.
Even if the fatality rate is only 0.5 percent, if we don’t get a vaccine, we can expect 70 to 80 percent of the population to contract the disease, which in the United States would be more than 200 million people and therefore 1 million people will die.
Let’s hope we can keep the curve flat until a vaccine is found.
There remains a lot about SARS-CoV-2 and COVID-19 that we don’t know. What was “common knowledge” yesterday could be proved wrong tomorrow. The risk of morbidity and mortality in children was one of the things we thought we knew but now appears that we didn’t.
SARS-CoV-2, the currently accepted scientific name for the coronavirus that causes COVID-19, appears to be the precipitating cause of a newly recognized syndrome that causes destruction of multiple organ systems in children.
This syndrome is so recently recognized it is still referred to by many names, Pediatric Multisystem Inflammatory Syndrome, P-MIS (how the state Department of Health has been referring to it up to now), Multisystem Inflammatory Syndrome in Children, MISC (Center for Disease Control designation since this weekend), Kawasaki Disease-like syndrome, and Toxic Shock-like Syndrome. For all I know by the time you read this there will be an agreement on one of these or something totally different.
MISC was recognized only a few weeks ago. May 5 an article in the New York Times talked about a mysterious ailment in children possibly related to COVID-19. At that time, it was recognized in 15 hospitalized children with no deaths. As of Sunday May 17, there were 137 recognized cases with three deaths in New York. Other countries and regions having been alerted to this phenomenon are now reporting this.
At first children presenting with symptoms of this were misdiagnosed. They had none of the hallmark symptoms of COVID-19, i.e. viral pneumonia and other respiratory symptoms. They appeared to have Toxic Shock Syndrome or Kawasaki Disease but no reason for developing that was found. They hadn’t been recently ill.
Nevertheless a few specialty physicians in children’s hospitals thought to test these children for SARS-CoV-2 and some tests came back positive. Later in the approximately first hundred children recognized with MISC in New York, 40 percent had a positive test for SARS-CoV-2 and 60 percent had a positive antibody test which as most of us are aware of means it was highly probable that they had the disease even if there weren’t respiratory symptoms.
While so far there appears to be only a 2-3 percent risk of fatality in children with MISC we do know that there is damage to critical organ systems in the body: heart, lungs, vascular, kidneys, liver, etc. There is a very good argument that this may lead to permanent impairment of these organs such as in the case of many other infectious diseases in children in which initial symptoms appear to fully resolved. For example, scarlet fever, rheumatic fever, Lyme disease, and viral cardiomyopathy.
While there only appears to be a relatively small number of these cases so far (small statistically but what solace is that to a parent whose child develops this) it is totally unclear what long-term health consequences may occur in sub-acute forms of this syndrome. It is quite possible that a child who is infected develops this but not badly enough to be brought to a physician and diagnosed. Considering how Americans get upset about potential disease processes that have demonstrated miniscule risk, what response can we expect if this is now recognized as a long-term consequence of a child who is infected with SARS-CoV-2.
So, what can we do? One should seek immediate medical care for a child who has:
• Prolonged fever (more than five days)
• Difficulty feeding (infants) or is too sick to drink fluids
• Severe abdominal pain, diarrhea or vomiting
• Change in skin color – becoming pale, patchy and/or blue
• Trouble breathing or is breathing very quickly
• Racing heart or chest pain
• Decreased amount of frequency in urine
• Lethargy, irritability or confusion
Early recognition by pediatricians and referral to a specialist including critical care is essential.
Additionally, we need to reopen smartly. Based on news reports, pictures, and videos there appear to be a very large number of people who haven’t gotten the message about the requirements to remain open.
One, things will close down again if the transmission rate of the disease goes above 1.0. If we close down after opening because of a spike of cases many economists say that economic disruption could be worse than we have seen so far. Therefore, prevent spread!
This can be easily done by following all social distancing regulations and recommendations. Flaunting these may make someone feel empowered but it is only putting their health and the health of all those around them at risk. Possibly more important to those who are behaving badly, flaunting will lead to more infections which will lead to a new shutdown which will lead to continued economic pain.
In 1882, John B. Finch, then chairman of the Prohibition National Committee, wrote “… your right to swing your arm leaves off where my right not to have my nose struck begins.”
This seems like a very appropriate commentary on the current argument between those who are concerned about easing COVID-19 restrictions now and those who want to open the economy immediately.
Sadly this, like almost all things in this country, has become highly politicized with each side having its own facts. Interestingly, there appears to be a reasonable compromise to allow rapid and safe recovery of the economy while decreasing risk of propagation of the disease: Everyone wears a mask while in public, all the time, everywhere.
I am indebted to Martin and Meg Tillapaugh for directing me to the article “Masks for All? The Science Says Yes” by Trisha Greenhalgh and Jeremy Howard.
In it the authors, in very easy to understand language, discuss the epidemiology of disease spread, the physics of droplets and aerosols, the material science of masks, the mathematics of disease transmission, the politics of mask wearing, mask-wearing experiments, the behavioral science of mask wearing, the economics of mask wearing, and the anthropology of mask wearing.
The bottom line is that most of the scientific evidence supports mask wearing and, to quote Governor Cuomo, “It’s disrespectful to me (for you) not to wear a mask.”
In my opinion it would be much easier for me, someone who has six co-morbid conditions for complications with COVID-19, to accept opening things up more if everybody did everything
reasonable to protect each other.
The arguments against mask wearing that I’ve heard include its uncomfortable, it looks funny, I’m not at risk, kids and young people don’t get it, it’s a free country, I don’t have to do what anybody tells me, and it’s a Democratic conspiracy. None of these are valid in this situation.
Well, we are all at risk. We are all at risk of spreading it to friends, loved ones, other human beings, and of becoming infected, contracting the disease, getting sick, and dying.
Children are not immune. They can become very ill and die or transmit it to someone else who becomes sick and dies. One form of the disease in children, Pediatric Multisystem Inflammatory Syndrome, is particularly nasty.
If the number of children dying of this wasn’t overshadowed by the unfathomable numbers dying overall there would be public uproar of why we weren’t doing more to help these poor children.
Trying to out yell or politicize this disease is not going to lead to solutions. Marching on state capitals while refusing to social distance and not wearing masks, thereby putting everyone including the children present at risk, and carrying semi-automatic rifles which in that context can be for no reason but intimidation, which no government could capitulate to, doesn’t win any additional support.
On the other hand, if everyone who wanted to see everything open up quicker than it has so far, and that should be about everyone, were to wear masks whenever in public, transmission rates would drop, new cases would drop, and deaths would drop, all strongly supporting allowing a return to normalcy.
To quote a famous American, “Why can’t we all get along?” If we all work together and compromise in what we are saying to each other and in what we are doing, we will find that all win. This would not be a you or me, win or lose, but win/win all the way around.
Richard Sternberg, a retired Bassett Hospital orthopedic surgeon, has agreed to provide his professional perspective while the coronavirus threat continues. Dr. Sternberg, who is also a village trustee, resides in Cooperstown.
By RICHARD STERNBERG • Special to www.AllOTSEGO.com
Over the last several days I reviewed a great deal of material regarding COVID-19 and the novel coronavirus. I looked at videos. I read scientific and lay papers. I scanned media reports. All to determine what to write about.
It was like drinking from a fire hose.
But the Monday, March 30, announcement by Dr. Deborah Birx, response coordinator for the White House Coronavirus Task Force, acknowledging that the best case scenario would be 100,000-200,000 deaths, made me really angry.
That’s not only because it is unacceptable that so many innocent lives will be lost, or because I know a great number of healthcare providers, first responders and public servants will be among them because of lack of proper protective equipment.
What made me angry was that again government officials kept painting a relatively rosy picture of problems either being or coming under control.
The last two months has shown the continued denial by America’s so-called leaders and lack of preparation that will probably lead to hundreds of thousands of unnecessary cases and deaths.
Why did they not learn from the outbreak in China and its response to it? In this modern age how could they begin to believe that it would not come to the United States? Why did they not prepare?
Dr. Anthony Fauci, director of the National Institute of Allergy & Infectious Disease who has generally been the voice of comfort, reason, honesty and reconciliation, has been repeatedly heavily criticized by some people in that he was not sufficiently loyal to President Trump.
This might be the man who has been really holding everything together at least on a national level. His numbers and statistics have been doubted and called fraudulent. My God, I wonder how we would be doing without him advising the president.
For several weeks, New York City Mayor Bill DiBlasio told New Yorkers they didn’t have to inconvenience themselves significantly during this outbreak. Where was he getting his information from and why was he contradicting the experts?
Many of our leaders have failed us. I can think of some exceptions, especially locally.
Otsego County Board Chairman Dave Bliss and Bassett Healthcare under the leadership of Dr. William Streck both started planning relatively sooner than many others. Bassett, in fact, began its planning way back in January before the first cases were reported in the United States. More on these in subsequent columns.
Right now, I don’t know what to believe. There are professionals, epidemiologists and statisticians, who provide data to support real predictions on how this will turn out. We all need to seek out these sources and then trust them.
I feel that at this point the only public figures I can trust to be straightforward and honest with us are Dr. Fauci and Governor Cuomo.
In the meantime, there are many good places to get information relevant to those of us in Otsego County. The bassett.org website (hit the link on top of the home page) has all the information Bassett has put out along with some excellent videos.
The state Department of Health, health.ny.gov, and the governor’s daily news conferences are also excellent sources of information.
I know that being angry is not going to help but it is the way I feel right now. I hope that other areas of the country stop their denial and learn from New York State’s experience.
I can also hope for some early breakthrough in treatment or immunization but that does not appear likely.