I had no intention of writing anything until there was a major breakthrough. Unfortunately, the numbers are going up and I’m feeling a sense of both gloom and urgency. If I don’t say something, if I’m not in the almost unanimous chorus of physicians warning and begging people to take this seriously, I fear I will be guilty of standing silently by and I will have a hand in the potential disaster. We cannot allow ourselves to forget the horrors of April.
As we sit here, about six months into the COVID pandemic, the only certainties are that it’s not over, the numbers are going up after a quiet summer, and that people are sick in increasing numbers today.
Will it be over in a few months with a successful vaccine? Will it take another six months or a year or longer? The best guesses are just that, educated guesses, not facts.
Collective and individual anxiety is caused by the unknown. The unknown is more stressful than bad news. Purgatory is worse than hell. We are in purgatory.
No one wants to be like the last Japanese soldiers who were found 30 years after the war still fighting the war, and no one wants to come out of their bunker while the risk is still high.
So where do I think we are now?
From my vantage point, we are in the middle of the pandemic and staring a possible second wave. Any breakdown of social distancing and failure to wear masks will reignite what had been under control. The start of school is a necessary risk. But it is a risk. The upcoming High Holidays are also a risk. For those who are not wearing masks and not social distancing, it is an unnecessary risk.
The next 4-6 weeks will give us much more information.
I don’t think that the second wave will be as devastating as the first one was. To many, that’s a small consolation.
Why do I feel that it won’t be as bad?
We have learned to use anti-inflammatory and anti-clotting drugs, together with some anti-virals. Passive immunity, getting someone else’s already made antibodies from plasma, is another option being evaluated.
While none of these approaches is a cure, they all work better than the complete dependence on ventilators that was prevalent in March and April.
We also, unfortunately, have lost the most vulnerable, in large part because of the horrible decision to put infected people into nursing homes. So we are left with a stronger population. The disease today seems to be hitting younger people, and they should fare better than older people with risk factors.
These realities do not mean that we won’t have deaths and very sick people, some with long term disability. One death or disability is too many. If we could prevent these and we don’t, that is an unspeakable tragedy.
The University of Washington’s current projection for New York shows a significant uptick through the fall, but only to about a third of the spring’s peak. That is still horrible. We had almost 1,000 daily deaths at the peak. We have less than 10 per day now. They project up to 300 a day by December if we don’t wear masks and don’t distance.
Prevention is everyone’s responsibility. Even if you, individually, don’t want to be masked, as a member of society you do not have the right to make decisions that can cost someone else their life. Numbers can go up in our community very quickly and until there are hospitalizations and deaths, many of us will refuse to see it. That delay can be very costly, as it was in March.
Prevention means no large parties. We have all attended zoom weddings and engagement parties and bar mitzvah parties and other get togethers, and we have all seen too much closeness and too many faces that are maskless. Every day I get calls to tell me about a wedding party or shiva that spread COVID. Some attendees know they should be isolating and others who attend know they should be quarantining. This is a very sad reality.
This behavior is beyond the comprehension of any physician who has had to deal with COVID and has seen the death and devastation.
There may be two sides involved in deciding to take a new vaccine when it comes out, but there are not two sides when it comes to wearing a mask or social distancing. There is a real risk-benefit ratio calculation that will need to be made before a vaccine is released, but the risk-benefit ratio with masks and social distancing is very obvious. The real risk ratio is inconvenience or annoyance vs. death or permanent injury.
Again, as numerous physicians have stated, while there are few documented cases of second time illness yet, as time goes on and immunity wanes, more are bound to happen. No one needs to be that case. In addition, there is no proof that someone with antibodies cannot transmit the disease to someone else. We just don’t know.
Everyone has read about the temporary hold placed this week on the Astra Zeneca vaccine trial. One patient in Europe who was enrolled in a study developed transverse myelitis, an inflammatory disease that can be a significant issue. Out of an abundance of caution, a time out has been taken to evaluate this finding. Is it vaccine related or did it just happen in an enrolled patient by chance? If it is vaccine related, what are the odds on it happening? Is it 1 in 10,000 or 1 in a million? If it saves a million lives and hurts 10 people, does the benefit outweigh the risk? Is it only this vaccine? (The vaccines being developed have different approaches.) All of these questions will be addressed and answered.
This has not halted other vaccine studies. I still expect a vaccine to be released before the end of the year, something that a few months ago I felt would be impossible. I also still feel that a vaccine is needed to stop the pandemic.
I cannot yet see the end of the pandemic. I hope that by next summer, or maybe the spring, things will start returning towards normal. I do not expect the 2020-21 school year to be normal. I do expect 2021-22 to be closer to normal.
The world has changed and will not go back to where it was. Businesses will continue to have people working from home and this will continue to cut down on other contagious diseases. The suburbs will grow while the tightly spaced cities will shrink. This evolution is a result of COVID. We will have a semblance of normal, a new normal.
For now, though, it is not over. The virus is not disappearing. It is still spreading. It can maim and kill. So be careful and please follow the rules, even if you don’t want to.
Marc J. Sicklick, M.D.