It has been months now since we were attacked by the SARS-CoV-2 virus that one way or the other was brought to us from China. So let’s review a little bit of history before we figure out if we are indeed rounding the curve of this dreaded illness as it pertains to the U.S.
Since the coronavirus was first officially acknowledged by Chinese officials on December 31, 2019 many, many questions remain unanswered about the origins of this virus that may never be answered. Such questions as to when it actually started in China and how it started in China are not likely to be answered by China even though they may have the answers. The disease probably began several weeks before December 31, 2019 in China, but was not acknowledged by the Chinese authorities. An article in the South China Morning Post, said that Chinese authorities had identified a case as early as early as November 17 of 2019 – weeks before they actually announced the emergence of this new virus.
The first confirmed case in the US was on January 20, 2020 in Washington state. Eleven days later on January 31, 2020, President Trump suspended entry of foreign nationals who had traveled to or resided in mainland China within the past 14 days in spite of many people labeling him as a xenophobe. Exceptions were made for returning U.S. citizens, immigrants lawfully in the United States, and immediate relatives of U.S. citizens. That move saved thousands of lives.
On March 11, 2020, President Trump issued a suspension of foreign nationals traveling to the U.S. from a majority of Europe. He then extended this suspension to the United Kingdom and Ireland a few days later. That move again likely saved thousands of lives. Nonetheless in spite of these early precautions to prevent the virus from coming to the U.S., which parenthetically again caused the President to be falsely labelled as a xenophobe, the virus spread like wildfire. To date in many European countries the spread of the Sars-CoV-2 has been even more severe and catastrophic than it has been here in the U.S.
It is unclear why the virus spread so rapidly in this country and so many others in spite of precautions such as limiting international travel from countries with high rates of infection. There may be several reason for the disparities:
- The virus was apparently carried by people traveling from Wuhan, China. So a lot of the dispersion of the virus initially depended on where these people were going whether it be the U.S., Europe or elsewhere.
- The demographics of the countries receiving these travelers from China varied greatly. Some of these countries have an greater elderly population more susceptible to infection.
- Some countries and also some locales within these countries have a greater population density and cultural characteristics which makes it easier for the virus to spread.
- Some of these travelers coming from China and elsewhere may have been so called “super spreaders” of the virus.
- The virus itself may have several strains some of which may be more lethal and contagious than others.
The bottom line in terms of infectivity and spread is that the situation was unpredictable and remains unpredictable. Keep in mind that data concerning the prevalence and death rate of the virus in this country and elsewhere is in a constant state of flux for a number of reasons including the following:
- The fundamental data is often unreliable. For example, there have been many instances wherein deaths have been mislabeled as Covid when they are not conclusively due to Covid alone.
- The testing may have been unreliable, inconclusive or inaccurate. It is now getting better.
- Treatment protocols are evolving and were different in different parts of the country. As we learned more about the virus and how to treat it, survival and recovery have been drastically improved and treatment protocols have become more uniform.
So what is happening now? The U.S. currently with death rate of 13.7 per million as of October 28, 2020 is doing a lot better than many other countries across the world. Bear in mind that the reporting of cases and deaths is often inaccurate or misrepresented. Take a look at this recent article in the New York Post that tries to put some of this reporting in perspective. The CDC estimated that about 177,000 Americans died during the 2017-2018 flu season, from either the flu itself or by complications of pneumonia. That’s not to far off from the total death toll to date for the Covid -19 though this should not be taken to minimize the severity of Covid-19. Furthermore, two recent peer-reviewed studies also showed a sharp drop in mortality among hospitalized COVID-19 patients in the U.S. The drop was seen in all groups, including older patients and those with underlying conditions, suggesting that physicians in the U.S. are getting better at treating this disease.
Where do we go from here? First, consider that case numbers may be increasing, but death rate is definitely going down. There may be flare ups of the virus in various regions for many different reasons, and the fact that case numbers are increasing is also due in large part to increased testing. That’s only logical. The more you test, the more cases you find. Moreover, in a somewhat paradoxical way having more cases may not be as terrible it sounds. The more people who have the had the virus, particularly if they are not very ill or not ill at all as most people who have had the virus seem to be, then the greater the degree of “herd immunity.” With all due respect to Dr. Fauci who seems to have played down the concept of herd immunity, many epidemiologists would disagree with him in that regard. Bear in mind that we actually get herd immunity in two ways: by natural infection and by vaccination when it is available. The vaccines have yet to be proven though in all likelihood they will be very helpful in arresting this pandemic. Nonetheless, the herd immunity will likely be due to a combination of both of these factors not just vaccination alone. Second, consider that we have made great strides in treating this disease. We know a lot more about how to treat the cytokine storm which can be a devastating sequela of this infection leading to respiratory failure, other organ failure and death. We have learned more about when and how to ventilate patients better when needed. We have a variety of therapeutics, more are on the way, and we have several vaccines about to be launched. That is not to say that we will not see more cases and more deaths particularly among those who are more vulnerable, but to answer that question as to whether we are “rounding the curve” I believe we are, and the data seems to substantiate that.
So what’s next? We stay the course and continue to move forward by:
- Maintaining social distancing and wearing masks when appropriate. I don’t think that should mean absolutely no socializing. Socializing is important for many reasons including mental health, but take reasonable precautions. Try to socialize in open areas with good ventilation and wear a mask when you can’t maintain social distancing until the virus is under better control. Take a look at some of my earlier Blogs about the proper use of masks for more information about the role of masks. It makes little sense to wear a mask when you are out in the open away from people such as walking on a beach, a country road or a park. I think doing so just promotes a sense of paranoia when we are already fearful.
- Opening up our businesses and schools wherever possible. If we lock down the country for long, unreasonable periods of time we will no longer have a country, and we will not be able to address all the other medical, social, and business issues that we need to address as a country.
- Continue our therapeutic research. We must develop new medicines and vaccines not just for Sar-CoV -2 virus but also for others that my be coming down the pike. This virus may be just the beginning, but a stream of therapeutics will have to be developed just like we did for bacterial infections decades ago. We know how to do this. It’s just a matter of focusing our research attention on this.
Most importantly we have to remember that we will see twists and turns with this disease. There will be flare ups that we will have to deal with, but that doesn’t mean we’re losing the battle. It just means that we have to keep on fighting until we get complete control which we will eventually and the sooner the better.
So to answer the question “are we rounding the curve” ? I think we, are but there will be more twists and turns before we see the straightaway.