A Turning Point In The Fight Against The Coronavirus?

Tuesday, April 28, it seems to me, will turn out to have been a turning point in the fight against the coronavirus. I don’t mean it will turn out to be where the battle was won. I mean it seems to me the point from which we will see a surge in new cases and deaths here in Philadelphia.

Kelley and I walk out most days in Fairmount Park here in Philadelphia along the Wissahickon, along Forbidden Drive and elsewhere. For these past few months we have been seeing people walking together in family groups, giving other people space. One day, a week or two ago, we walked past a bunch of college-aged kids who were hanging close with each other with no masks as if there were no need for social distancing, but they stood out as unusual in acting like that, and I could speak to them about it.

Tuesday for the first time, walking down near Rittenhouse Town to Forbidden Drive, the unusual suddenly had become common. College-age kids hung close in groups with no masks and no sense of social distancing. A pick-up drove by on Lincoln Drive with yahoos yelling, sounding to me like “Whoo-ee! We’re all going to die!” Last night the news showed a big crowd of people, many without masks, way too close to each other on the Art Museum steps watching the flyover by the Blue Angels. I’m seeing some of the workers at the Acme and Home Depot wearing their masks around their chins.

I think as the weather gets good and Trump and Pence and their idiot followers keep sending the message that we should all ignore the danger, some young people (and some stupid people of all ages) are saying to themselves: “The scientists probably don’t know any more than Trump! Nobody knows anything! We probably won’t die! It’s just the old people who will die!”

And it’s true that most of them as individuals won’t ever have devastating symptoms from the virus. But many of them even without symptoms are transmitting the disease when they congregate without masks, and the elderly in nursing homes are the ones who will be dying in increasing numbers.

Apparently it is just too difficult a concept to grasp for some folks, no matter how often it is explained, that by breathing or sneezing or coughing close to people, with no mask to protect them from you, you can be transmitting the virus even when you yourself have no symptoms.

The New York Times on Sunday published “Most Americans Who Carry the Coronavirus Don’t Know It” (https://www.nytimes.com/2020/04/26/opinion/coronavirus-test-asymptomatic.html), by Shan Soe-Lin, managing director of Pharos Global Health Advisors and a lecturer at the Jackson Institute for Global Affairs at Yale University; and Robert Hecht, professor of clinical epidemiology at Yale and the president of Pharos. They say:

“A small set of blood tests for antibodies indicated that as many as 2.7 million New Yorkers may have been infected without realizing it, Gov. Andrew Cuomo said on Thursday. That’s in line with other findings. A recent study showed that up to one-third of residents in Chelsea, a hot spot in Massachusetts, may have been infected, and only half of them could recall having a single symptom over the past four weeks. Another small study, of pregnant women in New York City, found that 15 percent tested positive for the virus, and 80 percent of them had no symptoms. Of the 840 cases on the aircraft carrier Theodore Roosevelt, 60 percent were asymptomatic.”

It really shouldn’t be hard to grasp. But I have no faith that everyone will follow the obvious precautions we should be taking to at least slow down the transmission rate so that hospitals will be able to take care of everybody as the cases explode. Until testing is more available and more reliable, nursing homes especially are going to be overwhelmed.

Testing is the key to being able to screen large numbers of people (like nursing home workers as they come to work every day). But Dr. Deborah Birx, the White House coronavirus response coordinator, says the United States will need a "breakthrough" in testing to screen large numbers of people (https://www.cnn.com/2020/04/27/health/antigen-tests-coronavirus-breakthrough/index.html).

She is saying the technology does not yet exist to do large-scale testing, which is of course in direct contradiction to Trump’s petulant false assurance that “Anybody that wants a test can get a test.” And people understand, I think – despite Trump’s false claims - that a vaccine may be a year to 18 months away. So social distancing and masks and hygiene are pretty much all we’ve got to slow this down for a year so that medicine can develop testing and treatments and vaccines before the death rate decimates the older half of our population.

The authority I have found most straightforward on the future of this public health crisis is Dr. Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He has been giving a consistent message on the national networks that, until a vaccine is available, we should expect the virus to move at some rate (more slowly if we protect ourselves through masks and distancing and hygiene) towards the point where sixty to seventy percent of the population has been infected and we have thus reached the level of “herd immunity,” which would itself slow down the rate of infections as fewer people are vulnerable. We should expect to have to exercise protective measures of rigorous distancing and masks and hygiene for 16-18 months, as the work to develop a vaccine races against the virus’s progress towards the full “herd immunity” level of infection. See https://www.nbcnews.com/meet-the-press/video/full-dr-osterholm-we-re-missing-the-mark-in-a-big-way-right-now-on-testing-82581573553.  

Osterholm says existing testing is unreliable, but that more reliable testing can be developed, and is key to protecting vulnerable populations like nursing home residents by screening health care workers. Testing is key because younger populations will, over the next 16 to 18 months, have to be allowed to return to school and work. Those populations are on the average less likely to develop life-threatening complications when infected, but their return to work and school will mean higher levels of infection in the population, which will present a higher likelihood of life-threatening contagion to older and sicker populations until reliable large-scale testing is employed to screen caregivers. See https://youtu.be/0Zixm-bB7e4?t=59&fbclid=IwAR014crCZwSabLtUb2hdhx8N-YSUennZV_o47f8ycNwF-fLSy3kDCNQNo3o.

My sense is that the primary factors in handling this pandemic are the development of reliable large-scale testing, the development of treatments, and, longer term, the development of a vaccine, which hopefully will happen before 70% of the population is infected and herd immunity is reached, because if it goes that far we will likely have a very large number of deaths.

But there is going to be a significant delay in achieving testing and treatment and vaccines, and until we have those tools, we are going to be dependent on social distancing, masks, and hygiene. The trend I am seeing of people abandoning these practices gives me the sense that in the next few weeks in the Philadelphia area there will be a spike in reported cases as many of the new people getting infected start to show symptoms.

Update: I have just seen an announcement by Dr. Anthony Fauci of some good news in the development of a treatment. See https://www.youtube.com/watch?v=yvBiU3rD6uc. He discussed the positive results for a drug trial on the drug remdesivir, saying the results were "opening the door" to possible coronavirus treatments. He seemed quite positive about the development. That treatment would probably be too late to prevent the surge of cases I anticipate in the next few weeks, but it is good news for the longer-term future.