Column: Let's continue to flatten curve, stop spreadMarch 23, 2020
By STEVE HOPF, MD
Spring is here with green grass and birds chirping. We have much to be thankful for although anxiety is high.
Simply put, the Coronavirus is a clear and present danger. While reportedly about 80% of people will have mild to no symptoms, it is the other 20% that prompts worry. With moderate to severe disease, the need for hospitalization, intensive care, ventilation with machines, and risk of death is real. We are better informed of the risk factors for those in the 20% group, but no one is immune from risk.
Flattening the curve: We understand the need to keep the curve (those needing special care, the 20%) below the capacity of our health systems. Social distancing and preventative measures are necessary in the short term to flatten the curve, so our intensive care units are able to care for all of us. More testing will be helpful.
Herd immunity: Immunity means a person has antibodies to the disease and is, therefore, protected. Two things provide herd immunity: having survived the disease or a vaccine. The above mentioned 80% will have immunity with little risk. A vaccine would provide an unknown percent of immunity. We should remember that a vaccine is not perfect and itself has some risks.
The perfect vaccine: The best case scenario is having a vaccine that is very effective and low risk of causing other problems. We now have “top people” working on it. A low risk, effective vaccine would be good for almost everyone. A higher risk, less effective vaccine would be more controversial and may not be recommended for healthy kids and young adults. However, a higher risk, less effective vaccine might be suggested and necessary for higher risk people.
Treatments: Any treatments that decrease the risk of moderate to severe disease provide another option to lessen the risk for infected people. The French study of only 30 patients that showed hydroxychloroquine plus azithromycin decreased viral DNA considerably in a few days’ time is encouraging. If this or another treatment helps to prevent moderate to severe disease, then we have another method to “flatten the curve” to help reduce the stress on the health care system and to help the infected person. This might render coronavirus risk similar to or even less than the flu (influenza) virus like we had hoped early on.
It seems once the curve is flattened, we might consider getting back to work and school. Even without a vaccine, those infected will start to provide herd immunity. Higher risk people will still need to social distance until there is a proven effective treatment or vaccine. We may need to get back to work and school to keep our supply chains intact. Getting back to work and school would certainly help the economy and our collective psyche. We have difficult decisions to make.
I am no expert and information is changing daily. My goal is to provide a framework for discussion so that we can be working together to make informed decisions.
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