THE ENTIRE WORLD IS THE NEW HOT ZONE
By Steven Stiefel
Here’s what you need to know to protect yourself from COVID-19 — and the virus that causes this illness.
What should you do if you start to feel as though you’re getting sick?
You should assume that you have COVID-19. Act accordingly from the instant you suspect you have the illness and may be contagious. Consider these strategies as you fight COVID-19:
- Immediately sequester yourself. That’s true even if you live with others—try to stay away from them until you have gone at least 72 hours without a fever after your illness peaks. This will help prevent your loved ones from contracting your illness. While the illness can “recur” it is unlikely to do so after 72 hours.
- Contact your doctor remotely. Call your doctor’s office and set up a telemedical/telehealth appointment. Your doctor will provide you with guidance for monitoring your illness to help you determine if you should be seen in person. Do not go to the emergency room without calling ahead to alert them that you’re coming as you may be turned away.
- Take your temperature a few times a day. Monitor your fever carefully. People experience rises and dips in fever throughout the progression of this illness. Even a 24-hour reduction in temperature is not necessarily a sign that you’re fully on the mend. Many people have experienced significant spikes after a dip—and some have had to be re-hospitalized after being released. That’s why it’s crucial to follow the 72-hour rule.
- Continue to take antioxidants to fight the virus. These include vitamin C, vitamin D, and zinc. These nutrients support your immune system, which has a complicated reaction to the COVID-19 virus—more about this below. Also make sure to continue to consume plenty of fluids and electrolytes (especially sodium and potassium).
- Monitor your blood oxygen levels. One of the most dangerous symptoms associated with COVID-19 virus is your blood’s reduced ability to carry oxygen throughout your body, and this can lead to organ failure. Having a pulse oximeter on hand may help you determine if you have reduced oxygen delivery, which indicates a more severe condition. Tracking oxygen levels may also be beneficial in determining if your condition is improving or worsening.
- Consider using a hyperbaric chamber. While hyperbaric chambers are not readily available, it’s good to be informed about the potential use of them to support recovery from COVID-19. Some hospitals have begun to use these with patients, and researchers have begun to study their effectiveness. The more we learn about COVID-19, the more we begin to associate recovery with proper delivery of oxygen. While ventilators have been used for the most severe cases it’s not clear that they are the most effective way to treat the illness. Both CPAP machines and hyperbaric chambers provide additional possibilities for effective treatment of COVID-19. This will be particularly beneficial information if/when another outbreak occurs.
YOUR TAKE AWAY: If you suspect you’re ill with COVID-19, then contact your doctor or his/her office by phone or email. Stay home, avoid close contact with those you live with and monitor your symptoms closely.
What causes people to die from COVID-19?
6,185 deaths from COVID-19 were reported in America on April 14. The 3-day average from April 11-13 was 1,631. What explains this massive jump? It’s due to a slight increase in COVID-19 deaths per day, but it also reflects the inclusion of those who died from “other” conditions that were brought on by severe COVID-19 illness. This includes those who died from cardiac arrest in the midst of COVID-19 infection. Likely, these people would not have died so soon due to their underlying conditions if not for COVID-19, and nearly 4,000 people who died in New York on or before April 14 were also included in this day’s total. The reason for recording this increase is to more accurately track and trace COVID-19 and understand how people die from it.
Others, though, have died primarily and/or exclusively from COVID-19, including many young people. One reason for the death of young people may be genetic, depending on an individual’s level of ACE2 gene receptor. This theory is not definitive as of publication, but scientists and researchers at the National Institute of Allergy and Infection are exploring it. Of interest, some biochemists believe that Caucasians may have a lower expression of ACE2 receptors than other races, causing them to be more vulnerable. The virus targets an ACE2 receptor to initiate cell infection, allowing it to proliferate. This may partially explain why the illness has so effectively traveled in Europe and the United States.
While black and Latino Americans have died in disproportionate numbers in many hotspots, this may be caused more by socioeconomic issues, underlying conditions (such as heart disease and diabetes) and the fact that blacks, Latinos and women are disproportionately represented in frontline occupations such as nursing, medical technicians, and grocery store clerks.
Another factor is that COVID-19 causes an extreme immune response in many of those who die. While it’s generally beneficial to have a strong immune system, it’s also crucial that your immune system targets the outside invader, the COVID-19 virus in this case. Sometimes, though, your immune system overreacts, causing a “cytokine storm.” This is a flood of proteins that are supposed to kill invaders, but end up going overboard. These immune responders surge, attacking the lung tissue they should be protecting. Doctors have begun to understand this, and when they recognize this condition they have begun to treat some patients with immune-suppressing drugs to try to prevent the patient from dying from this extreme immune response.
YOUR TAKE AWAY: While many people die directly from COVID-19, others die from underlying conditions (such as heart disease) brought on by the stress of COVID-19. It’s important to consider both as part of the COVID-19 pandemic.
When will the COVID-19 pandemic end?
The answer to this question is unknown in terms of time or date, but we have a fairly clear sense about the events that need to occur for COVID-19 to be stopped. Remember that other pandemics such as smallpox and polio were ended by effective measures including quarantining and ultimately an effective vaccine. It often takes years or decades to develop a vaccine, but current estimates are that a vaccine could be available in 18 to 24 months, and possibly sooner. That will go a long way to completely destroying the COVID-19 virus, but it’s more complicated than many understand.
First, the vaccine must be effective. While a vaccine can be developed for a specific strain of a virus, it’s essential that it also address mutated strains in order to be fully effective. We’ve seen flu seasons where the vaccine ultimately didn’t do that much good because people were getting sick from a different strain or virus altogether. Second, the vaccine must be safe. While this seems to be a “no-brainer,” it’s crucial not to rush a vaccine into the marketplace that can do as much — or more — harm than good.
In the meantime, it’s crucial to ramp up the science and technology we currently have at our disposal to prevent surges after we’re able to flatten the curve, returning it to zero. This includes:
- Dramatically increase testing for the COVID-19 virus. While we have tested nearly 3.5 million people in the U.S. as of April 16, this is merely a drop in the bucket. Some experts suggest that we need to test about 1 million people a day for up to about a year to fully understand who has the virus in order to stop resurgence. This would include testing some frequently if they come in contact with the public—this includes those who work in essential services
such as grocery stores and factories that produce food and other necessary products such as toilet paper.
- Require temperature checks before entering public buildings/gatherings. This technique was used in countries that were exposed but recovered quickly, including Taiwan and South Korea. As we try to regain a sense of normalcy it’s crucial that those with an elevated body temperature be checked before making broader contact with others. Those with elevated temperatures should be asked/required to return home and tracked.
- Institute robust contact tracing of flares ups. When subsequent outbreaks occur—and they will—it is imperative to trace them and respond quickly. People can be traced by their phones and by interview, revealing others they’ve come in contact with. These people can then shelter at home without inducing widespread shelter-in-place orders, as we’re currently experiencing. These “micro quarantines” may prove effective in preventing a large-scale second wave of pandemic.
- Continued use of facemasks in public. At the beginning of the pandemic we were advised not to wear masks. Fairly quickly the science community began to understand that facemasks helped reduce spread of the virus and that masks were especially necessary for healthcare workers. As availability of masks increases, all of us will be able to wear higher quality masks like those medical professionals seek. This will reduce spread and help flatten to zero.
- Increased use of antibody tests. This test is already available, and it shows whether or not your body developed antibodies to the COVID-19 virus. It is likely that many more people became infected with this virus than we’re aware of. That it is a good thing, as these people may have a certain level of immunity to catching and spreading the virus. While this has not been determined at this time that has been the case with other coronaviruses that bear a strong resemblance to the one that causes COVID-19.
- Reduced contact in public. Until there is a vaccine, we will not be able to have the types of public gatherings we had before the pandemic without risking a resurging outbreak. We will slowly begin to have larger gatherings, but it’s crucial that all of the other strategies on this list are in effect before we can resume congregating at large events such as concerts and sporting events.
YOUR TAKE AWAY: The pandemic will dramatically reduce as we ramp up testing for the virus itself and for antibodies, and follow behavior guidelines based on these results. The virus itself will not be eradicated until a safe and effective vaccine is administered to all.
What is the risk in opening up society too quickly?
The medical community faces enormous pressure from the public and the government to return to normal as soon as possible. Yet that risks a resurgence that could be even more deadly than the pandemic we’re currently experiencing. That’s because second rounds of pandemics are often more severe because viruses are adaptable.
One reason for this is that viruses mutate readily, primarily because RNA sequences are more subject to replication errors than are DNA sequences. As of now, it appears that there are at least 8 variant strains of the virus that causes COVID-19. One advantage of these varying strains is that they help scientists track infection paths. And this virus has also mutated at about 1/8 to 1/10 the rate of a typical influenza virus. This means that we are more likely to develop a vaccine that remains effective for longer because there is less change in the virus while it is still traceable.
On the other hand, the longer the pandemic lasts, the more opportunity the virus has to mutate. When a person gets ill, the virus replicates as many as a trillion times within that host. Each of these is an opportunity for a small shift. These mutations don’t necessarily cause a separate strain—that occurs when the mutated version enters another person or host, and then that version begins to replicate. When a virus replicates as effectively as the COVID-19 virus does it increases the chance of mutant strains over time. That makes it crucial for the medical community to work quickly and efficiently to create a vaccine before the virus mutates to a version that is resistant.
On the other hand, humans are adaptable as well, and antibodies help to create “herd immunity.” Herd immunity is the state where enough people have been exposed to the virus and survived that it makes it difficult for the virus to proliferate through a population. It doesn’t matter whether a person was severely ill or asymptomatic so long as they developed antibodies that make them immune to infection.
A caveat to this: Research performed at Stanford University indicates that the COVID-19 virus may not be as easily thwarted by herd immunity as other coronaviruses have been. At this point we are not certain that people are “immune” to COVID-19 after they fight off the illness, creating antibodies. More research is needed along these lines to determine the effectiveness of antibodies in preventing recurrence and supporting herd immunity.
Soon enough we’ll know if antibodies provide immunity that is lifelong, fairly long-term (a few years) or short term—only a few weeks to a few months. While antibodies to most other coronaviruses have provided immunity, it’s not clear whether or not that will be the case with this coronavirus. This will take more scientific study, but we should understand this more fully in the coming months.
In addition, a vaccine will eventually be developed. While the current estimate is 18-24 months, it could be considerably shorter based on the enormous energy being poured into the effort. And this effort will only increase as the curve flattens to zero and the primary emphasis shifts to eradicating the virus for good.
YOUR TAKE AWAY: We must be abundantly cautious in re-opening society because we do not know, yet, how effective “herd immunity” will be in preventing a second wave of the COVID-19 pandemic.