Understanding the Coronavirus

It’s Just a Virus, What’s the Big Deal?

How many times have you heard your doctor try to reassure an anxious parent with these words (and avoid giving an unnecessary antibiotic)?

Over the last 100 to 200 years we have conquered the dreaded viruses and bacteria that routinely devastated the human population time and time again throughout history.  The plague, smallpox, measles, cholera, typhoid fever, yellow fever, polio, tuberculosis – most of the practicing physicians in the U.S. have never even seen active cases of these illnesses.

Yellow fever nearly wiped out Memphis in the late 1800s.  Tuberculosis was a regular occurrence well into the 1950-60s and is still active but rare in this country.  Typhoid fever made regular deadly outbreaks until the early 1900s.  It’s still quite common in other parts of the world.  There are still outbreaks of plaque in the middle east and the southwestern US.  In the middle ages ½ of all the people of London died from the plague!  Cholera still is seen (Haiti 10-15 years ago.) The mid-1800s saw worldwide outbreaks of cholera, especially in Nashville and middle Tennessee.  President Polk likely died of the Cholera.  Polio was only brought under control in the 1950s—most of the 60+ year olds remember going to school on Sunday to get a pink sugar cube of new vaccine which almost eliminated the disease worldwide.  My grandfather trembled as he told me about being forced – by the doctor – to use scab from his older children to vaccinate the smaller kids. One of my aunts became very ill due to the vaccine.  The alternative was to risk death because of the local outbreak of smallpox and shortage of vaccine in the 1920s.

And then, along comes totally new viruses, like Ebola, HIV/AIDS, SARS.  We have to start all over and learn new tricks to protect ourselves.  It makes us think we’re not as smart as we thought.

A new version of an old disease showed up in the middle of the first World War.  It became known as the Spanish Flu of 1918-19.  It happened to be very easily and rapidly spread from human to human. And it happened to be deadly.  Spain was neutral in the war; they admitted to the world that they were dying in large numbers.  The French and British and Americans denied any problem.  Germany said, “Flu? What Flu?”  The soldiers were dying in the trenches.  Many days there were not enough healthy soldiers to “go over the top” and launch an attack.  But you don’t admit that to your enemy! New recruits at Ft. Dix died carrying their bedding from barracks to the infirmary.  More people died from influenza than died from the bullets and bombs and gas of WWI and WWII — and Korea and Vietnam!

We have not seen a flu like that in 100 years.  That is why we try to keep as many people as possible vaccinated against “the next big one.”

Seasonal flu is what we call the usual, every year, fall, winter, and spring outbreak.  For most of us, it can be an annoying bad cold or a couple of days in bed feeling like we’ve been hit by a truck.  For the elderly and people with other health problems (diabetes, heart disease, lung disease, kidney disease) the seasonal flu can be deadly. Some varieties can have the same bad outcome for young healthy men and women and for pregnant women.  The CDC notes the death rate for seasonal flu is about 0.1%.  That is one death for every one thousand people who get the flu.  That’s still a lot of people and a lot of people get the flu every year (moderate to heavy this year).

So, what is this “novel coronavirus”?  It is a new strain, not seen before in humans and not previously identified from animals.  Being a new strain, no one has resistance to it (unless they have had exposure to a very similar virus—which does not appear to be the case).

No one has resistance to it.

For many people, it will produce symptoms of a mild cold (coronavirus is one of the families of virus that are recognized as “cold viruses” along with rhinoviruses and enteroviruses).

So far, most children under 10 seem to be spared the severe cases (like other “childhood diseases”). This probably accounts for many of the “random” cases we are seeing in non-travelers – infected by people with very mild symptoms.  The CDC estimates the death rate in infected persons to be about 1%.  This is one out of every 100 cases. That is 10 times the rate of death from seasonal flu.

In less than four months since the discovery, this COVID-19 has now spread to all continents (except Antarctica) and to a large majority of countries around the world.  That is why it’s called a “pandemic” (pan meaning everybody or everywhere).

Because it’s new and has never affected humans or livestock, there is no vaccine available to give us immunity before infection. (Today’s news just reported the start of human trials for a vaccine!)  It will likely take 12-18 months to produce a good vaccine in enough quantity to stop the spread.

There are no known antiviral drugs or treatments for the infection.  We do have some good antiviral drugs for influenza and herpes viruses and for hepatitis and HIV, but none is known to work on COVID-19.

The South Koreans are trying a combination of an HIV drug and a malaria drug.  There are no reports of response to this combination.

At the present rate of spread, we can expect millions of cases of illness by June or July with hundreds of thousands of seriously ill patients and deaths.  This will overwhelm the hospitals, ICU’s and respirators—in the U.S. and around the world.

Hand washing, self-isolation of anyone ill, closing non-essential public places and canceling gatherings of more than 10 people (president’s current recommendation) are projected to slow the spread of the virus, to lower the peak of infections and to decrease the overburden on the healthcare system.  This worldwide level of caution may also lower the total deaths by some amount.

This is real.
This is here.
This will not go away soon.
A shot of Penicillin won’t help.
You are likely to be infected with this virus – eventually.
You are not likely to become seriously ill, but some will be.
Masks won’t protect you but may help keep you from spreading the virus if you are ill.
Social distancing and hand washing are our best methods of slowing the spread and protecting ourselves and those around us.

Wash your hands.
Give a fist bump or elbow bump (not a high five).
Avoid crowds.
Wash your hands.
Stay in if you have any cold symptoms or fever.
Keep your hands away from your face (if you get the virus on your hands, you don’t want to rub it in your eyes nose or mouth).
Keep in touch with family and friends.
Let someone know if you need any help.
Wash your hands.

Let the elders, staff, deacons, or any Estes family member know if you need anything.

If you have any questions or concerns that I can answer, let me know.

Dr. Paul Schwartz, MD is a community physician and elder for the Estes Church of Christ