Family wearing face masks. Credit: Getty Images

It has again been a couple of weeks. What has changed? What is encouraging? What isn’t? What should everyone know? I’ll try to break it down by categories.

But first, I want to clearly state what really bothers me. IT IS NOT OVER.

G-d has blessed us with wonderful daughters-in-law. They worry about us. They shop for us. When one recently asked for separate receipts, she was told to tell me that it’s over. IT ISN’T. And there is no guarantee that the next wave won’t be as severe, or worse, than the first. It is here until we have herd immunity. Florida and California and other states thought that the pandemic skipped them. They were wrong. COVID-19 is a tough opponent. It finds weaknesses in our defenses.

As we reopen — and we must reopen — we increase the risk. When people don’t wear masks properly, meaning covering both the mouth and nose, we increase the risk. When people get closer and closer to each other, we increase the risk. As kids return to school, we increase the risk. It’s all a measure of risk vs. benefit. We need to return to normal. Humans cannot live in a risk-free society. We can’t be isolated in our homes, not working, not socializing, not learning. Humans need contact with other humans. We need it emotionally. We need it economically. We shift the odds significantly by wearing masks and maintaining social distancing.

The topics I want to discuss are below:

Antibodies

 

  1. Antibody levels are decreasing or disappearing from many people. What this means is that having had antibodies at a point in time, or currently having antibodies, is not a guarantee of protection. Antibody testing should not be used to determine safety. The same is true for negative swabs. There are definitely false negatives. So, everyone should make the safe and responsible assumption: They and their family and friends may be vulnerable and/or may be shedding virus and be dangerous to other people. This means that, until proven otherwise, everyone must practice social distancing and wear masks. This is not optional and not a matter of personal choice.
  2. Whether this loss of antibodies means that there is a loss of (presumed) protection is unknown and won’t be known until either people get infected for a second time (and get sick) or until there is strong evidence of people not getting infected for a second time. As I mentioned last time, cell mediated immunity may play a significant role in protection. It may kill the virus and it may up regulate the protection of antibodies with a second exposure.
  3. Projections through October for New York show a very significant drop off in cases IF masks are universally worn and people social distance. That means no large parties no matter how significant the celebration is to you. It’s just not worth the risk. Some of the better projections show up to a five-fold increase if masks and social distancing are not used.
  4. This current national uptick is NOT the second wave. It’s still the first wave exacerbated by lack of social distancing, lack of masks, and lock-up fatigue. This uptick can very easily spread back into our area as people return to New York. This can occur very quickly.
  5. Look at death and hospitalizations, not number infected. This is the important statistic. The politicians who are trying to paint gloom and doom for political power and want to use this disease as a political tool look at cases of infection. If the number of infections goes up — but hospital stays and, more importantly, fatalities, do not go up — is that really the negative that they make it out to be? If anything, it may point to an earlier achievement of herd immunity.

 

Percentages of Positive Swabs

I don’t quite grasp why this is such an important criteria. I’m missing something. If everyone tested is positive, or if a large percentage is positive, that’s very bad news. I understand that, and it should drive health policy. It means the virus is busy infecting people. This is important to know. If no one is positive, that’s great news. That reflects a very small presence of the virus. But the number of uninfected people being tested, the denominator, has major impact on the percentage who are positive. If 10 people are infected and tested and are all positive, that’s 100%. If the same 10 people are positive, but 1000 people come for screening for jobs, schools, curiosity, etc. are also tested, that’s 1%. I don’t understand why small changes in single digit numbers are so important to so many people who set policy. I prefer to follow hospitalizations and deaths — both absolute numbers and percentages.

Directions of Research and Treatment

 

  • Anti-viral medications that will kill or limit viral damage are very attractive goals. There are numerous drugs already in existence for other illnesses that are being looked at for COVID and some are currently being used on a compassionate basis. Only time will tell if these are truly effective. I do think that they offer some degree of benefit.
  • Anti-coagulants can prevent organ damage from blood clots Blood clotting has been involved with multiple organ disease in some people. The use of anti-coagulants where medically indicated should cut mortality and the severity of disease even if infection numbers go up.
  • Immune modulating drugs regulate the immune system’s response to infection. An over response of the immune system has been implicated in organ damage in some people. Medications that reduce the immune response, running from steroids to biologics to chemotherapy agents to anti-inflammatory drugs, may be very beneficial. Even drugs like plaquenil (hydroxychloroquine) that were scoffed at are being looked at again. Some studies offer hope. We need to keep an open mind and keep politics out of these decisions. Also, please remember that not every publication is peer reviewed and therefore reports of breakthroughs may not be accurate.
  • HEPA filters are suddenly in the newspapers. The best of these can actually filter out viral particles. (That will not stop someone who is not wearing a mask who coughs, sneezes, yells, talks in close proximity to you, etc. from spreading the virus to you.) These can be used to suck in air through ventilation systems and clean it much faster than nature taking its own course.

Vaccines

There are vaccines heading for large scale human trials. There are many others a few steps behind. When will “the” vaccine be out?

Maybe never, if you define it as 100% effective.

More realistically, I do expect a vaccine that decreases the odds on catching the virus when exposed. It should be a reduction of 50% or hopefully greater. I can also see a vaccine that will decrease the severity of the disease and therefore save lives and debilitating outcomes. Both of these will be very, very good news.

The Moderna vaccine is news today. In a study it was given in two doses and there was evidence of protection in all subjects. The side effects ranged from mild to moderate. There were local reactions, swelling and pain, and more systemic reactions, such as fever, aches, and chills. These are passing reactions.

What should we do today?

  1. Wear masks whenever near people.
  2. Practice social distancing. Six feet is not a magic number. Ten feet is better. Five feet doesn’t mean that you will get sick. Six feet is a realistic goal.
  3. Do not go out if you’re sick with any illness. It’s just not fair to anyone else.
  4. If you’re coming from out of state or arrived from abroad, you should quarantine no matter how well you feel. Err on the side of caution, even if you’re legally allowed to move around.
  5. If you always assume your neighbor is an asymptomatic carrier and that you may be, too, we will all do well.

I trust the above is of value, and urge everyone to please stay well and safe.

Sincerely yours,
Marc J. Sicklick, M.D.

 

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