Little by little the picture of this epidemic is becoming clearer and is gradually confirming what seemed likely from previous small clues. The disease seems very mild in the large majority of cases and because in most instances it is undetectable without testing, it is far more widespread than we had supposed. To be sure it can be lethal, rarely in young otherwise healthy people, but primarily in those susceptible to any illness. In fact, there is controversy over how to determine the cause of death in those who appear to die from a previous serious condition but have virus present on testing. Thus, considering the previously undetected large pool of those infected, the infection appears to have a mortality rate closer to the range of epidemic illnesses like the flu which we normally take in stride.
There are a couple of major differences however. First is its tendency to cause, in those more seriously affected, an extensive lung inflammation requiring intensive treatment. Second it is a novel virus with no previous community exposure and is highly contagious so that in some areas the medical system is greatly stressed. Moreover, a strong suspicion is emerging that the lung involvement is more a severe immunologic reaction to the virus rather than the infection per se leading to some new ideas about treatment.
Our country's response to the problem was to try to reduce the viral infectivity by limiting the opportunity for transmission, social distancing. This reduces the rate of illness but doesn't affect the virus survival so that there is fear that if social distancing is withdrawn a more severe epidemic will reemerge.
Development of a vaccine appears to be too far off to be useful at present. We are hopeful for effective treatments, but this remains uncertain. Another theoretical way to address the problem remains. We assume that the large majority of those minimally symptomatic have at least temporary immunity to reinfection and if the number of such individuals is large enough that viral spread will be limited. But allowing the infection simply to run its course to develop this so-called herd immunity is unacceptable because of the higher morbidity and mortality in some susceptible individuals.
One epidemiology expert from Yale University, Dr David Katz, has proposed that there could have been another alternative to the one we have taken of shutting down all but essential activity. In his scenario we could have directed all our resources to prevention of exposure to those susceptible to serious illness, but otherwise allow the contagion to proceed, thus allowing for widespread public immunity. He notes that, considering what has already been done it is too late to consider his approach. However, he presented his idea in the New York Times in late March. Much has happened since then. The curve has been flattened. We are now attempting to return from the economic abyss that has destroyed the livelihood of so many in our country. We have increasing civil controversy over what degree of restriction of our freedoms is reasonable and necessary. As we move into this phase I think Dr Katz's ideas should be considered as a way to proceed. I was interested to see that at his recent news conference Governor Cuomo had a similar thought.
Sent from Mail for Windows 10
No comments:
Post a Comment