COVID-19 Interest Group
May 4, 2020
CIG Bulletin #10 Covid-19: A World-Wide Lesson on an Infectious Disease by Pate Thomson
Essentially all of California has moved out of the Covid-19 exponential growth stage since the first two weeks in April. The Greater Bay Area (GBA) is in a slowly declining plateau, currently at 156 new cases/day in a population of 7.1 million, about 22 cases per million (cpm). The slow decline rate is about 2.4 cases per day. At this rate, it will take about two months for GBA cases to hit 10 per day.
California (as a whole) & LA are in a higher and wavy plateau, going up and down around an average of 40 cpm for California and 86 cpm for LA. Four counties in California (LA, Riverside, San Diego and San Bernardino) have 45% of population but 66% of the cases. I think N California and S California are in different stages. The oscillating behavior suggests that it is possible for them to return to exponential growth at least for a while, although the risk of that in N California (dominated by GBA) is less.
Covid-19: A World-Wide Lesson on an Infectious Disease Highlighting the Critical need to Protect the Public’s Health, Put Faith in the Scientific Process and to Cultivate Patience and Hope. By Pate Thomson
Permutations of an old, retired cardiologist who has never treated a case of Covid-19
What is this? When you are my age, a highly infectious agent that kills old folks with abandon, and some younger folks as well, is quick to capture your attention. Especially if it turns your world upside down, isolates you, disrupts your family life, your working life, and social life, gouges your retirement resources and brings the world economy to a stand-still. This is for real, and in some-ways it has been like a college course introducing us, all of us, to the important fields of public health and infectious disease, and the scientific process. Most importantly it teaches us a lesson on patience and the importance of maintaining hope. A cautious hope that is a key nutrient for getting through this.
The pandemic bug, SARS-coV-2 is new but has sister Corona viruses which cause severe respiratory syndromes Including SARS discovered in 2002 and MERS in 2012. It finds home in the respiratory passages where it, like all viruses, needs to enter the cells, replicate and in the process, disrupt the normal cellular machinery. It may work its way into the lung where it causes pneumonia and where it can elicit an excessive immune response called the cytokine storm. Once this develops the patients are very ill and mortality rate is high. The cytokines, protein cellular messengers, normally modulate a protective inflammatory response that elegantly fights off invaders. It can become overwhelmed and attack the body’s normal tissues creating a destructive response. In its storm phase it can destroy vital organs including the brain, lung, heart, liver, kidney, gut and when it disrupts the blood clotting process in can cause blood clots and/or bleeding just about anywhere. Hence the cytokines are a focus of intense study as treatments of this brand-new disease are being explored.
The Public Health Service steps up: Once the virus escaped confinement in China and community spread streaked worldwide, it literally brought the world to a stand-still in a way and with a suddenness that few could have imagined. Fortunately, not everyone was surprised. Since it could not be contained, a few leaders listened to the public health proposal to “mitigate” and we in the Bay Area were benefactors of bold action to shelter at home, physically distance ourselves and undertake enhanced hygienic measures. These are blunt extraordinary measures that stopped our economy in its tracks. At the same time, they slowed the rate of transmission and brought down the mortality rate and enabled our health care system to respond without being overwhelmed. More importantly it bought us some precious time. Time for our scientific community to drop what it was doing and focus all of its resources on this outbreak. With that comes the most precious of commodities………a hesitating patience and an essential hope.
Enter the scientific community: Using its many tools, its brilliant minds, its truthful, evidence-based knowledge and considerable resources, a process of unraveling the many mysteries of this new disease has begun and is rapidly advancing. As we develop an understanding of the biology of the virus and its effects on us, therapies are sure to come. They include medicines that interrupt the virus’s destructive behavior and vaccines that hopefully will make us immune. There are signs and reasons for optimism. Early results with Remdesivir show some promise and it is an early step with results that can be built upon. There are hopeful signs that a vaccine can be brought to bear in record time. We are not there yet but there are some 90 scientific projects world-wide working full throttle on vaccines. Let’s keep the faith that something good will come of it.
Enter our mental health stewards: If you are not anxious about all of this you need to check your pulse. Patience is a virtue we are told and we need to all tap deeply into it as this unfolds. One thing for sure is that this pandemic will come to an end and life will resume and the world will go on. Working to maintain our sense of community, our fellowship and our support of one another is key. As we go about this, follow the lead of mental health professionals and tenaciously, patiently and resolutely embrace the hope that this disease will become manageable. A measured dram of your favorite elixir and a cigar might help, but you did not hear that from me.
Stay safe, follow social distancing practices and continue washing your hands. Tina says “Stay on your best behavior” but this too you did not hear from me.