CoVid-19: an Evolving Presentation Thomas Britt, MD, MPH 10 May 2020 CoVid-19 is an evolving Global Pandemic, that has recently revealed that the United States is now the epicenter (initially Washington State and now, the State of New York, primarily New York City). CoViD- 19 is a made-up word, an acronym … Co means coronavirus; Vi for virus; D for disease and 19 for the year it was discovered. Coronaviruses has been around since the mid 1960s. There are several types or strains of this virus. The new or novel type that is wreaking havoc world-wide is CoViD-19. Because this virus is new, virologist, scientists and physicians are just now learning, in real-time, the various intricacies of its pathogenesis, communicability, that has adversely impacted our ability to test, isolate, contain, vaccinate and treat this global calamity. Arguably, mismanagement of this dire public health catastrophe has also led to the worse economic demise since the Great Depression of 1929-1933. Further, it should be noted, that we are now immersed in a perfect storm , i.e., a public health pandemic coupled with a deep recession, coursing inexorably towards depression. Reportedly, the first U.S. case was in Washington State with a link to Wuhan, China, where most would say was the origin of this viral disease. The controversial first U.S. death was early in February 2020. As of 8 May 2020, the CDC has reported that the confirmed U.S. Cases were more than 1.2 million with more than 75,000 thousand deaths. These numbers clearly represent exponential growth … from 1 to 1.2 million cases and 1 to 75,000 deaths in a span of four months. The reader, casual or not, should note and ask why . Why is it, that the U.S. is about 4% of the world ’ s population, yet has nearly 33% of the world ’ s CoViD-19 cases. Again, you should ask why . Without effective medication, our ability to prevail through this viral onslaught, is first and foremost, an intact immune or host defense system. Your immunological system is tasked with the responsibility of defending and fighting-off new and known pathogens . The integrity of this system is contingent on the individual having good nutrition and leads a non-sedentary lifestyle. Food and exercise supports and stimulates your immune system. Poor nutrition, sedentary lifestyle and advancing age adversely compromises our immune system. Elders and persons with chronic disease(s) are at a greater risk for increased morbidity and mortality, than are the healthier, younger and general population. No one however, is immune from contracting and dying from this disease. Herein are a few things that everyone one can do, to improve their immunological system: Consume a plant-based diet, with adequate proteins, multiple vitamins and minerals Regular exercise or physical activity Stop smoking Decrease alcohol ingestion Maintain a healthy weight Get adequate sleep … this is the time for growth, development and repair Avoid being in the presence of infectious diseases, especially CoViD-19 As you read and observe media reports on this pandemic, there are a few terms worthy of definitions: Epidemic – outbreak of a disease in a given location Pandemic – widespread disease outbreak; global pandemic is outbreak occurring in multiple countries Death Rate is a major category with a few subsets o Mortality Rate – number of deaths per 100,000 o Case Fatality Rate – number of deaths divided by the number of cases of that disease. Example … if you use 75,000 deaths from 1.2 million cases, that yields a CFR of 6.2%
Herd Immunity is a type of immunity that occurs when most of the population, i.e., 70-90% is immune, secondary to either vaccinations or having survived the infectious disease and developed protective antibodies. Again, it should be mentioned that we do not yet know, that this antibody development to CoViD-19 will confer extended or lifelong immunity, as usually happens with other contagious diseases such as measles, mumps, rubella. Kawasaki ’ s Disease has recently been mentioned with some suggested association to CoViD-19. It is an illness that causes vascular inflammation in children less than 5 years, and is more common in males. In this group it is a leading cause of heart disease due to inflammation to the coronary arteries that supply blood to the heart itself. Compromised blood flow to the heart is incompatible with life. Some of the signs or symptoms of Kawasaki ’ s disease are elevated fever (>101 0 F), rash, swelling of the hands and feet, swollen glands in the neck, swollen tongue, joint pain and nausea, vomiting and diarrhea. These are not necessarily specific, however with a high index of suspicion, driven by prolonged and unexplained fever, rash and swellings, the parent or guardian should contact their physician without further delay. In conclusion, we live in a global community, linked together by a few hours via airplane. Therefore contagious disease anywhere, can lead to dire infectious disease everywhere. Public health practitioners have to monitor, be vigilant and act in concert … globally, nationally and locally, pursuant to the preservation of life and the public health of global citizens. This novel coronavirus has exposed and exploited the faults in our societies, not unlike other major and historical catastrophes. CoViD-19 has opened a political and socioeconomical space to study and reset the intentional disparate and antiquated policies. A return to normal is misdirected … normal was never, quite so normal for so many. We now have the opportunity, indeed the responsibility to reset. This can be done if and only if we define and control the narrative. This reset must be pursued with dispatch. In the meantime, we must advocate for aggressive testing, tracing, isolation and maintenance of keeping effective spacing between those who may be infectious. Testing and Contact Tracing can facilitate disease mapping which are prerequisites for reasonable and cautious reopening of select segments of our society. The methodology of specimen collection, result turn-around time, and efficacy of testing has to be improved. Equally important, testing has to become universally available, accessible and comprehensive. Since we are virtually defenseless against the novel coronavirus, we must continue to stay out of its non-discriminatory pathway through social distancing and other methods advised by the CDC … go to www.coronavirus.gov. Contact Tracing is not unimportant, especially in areas of low population density and presumably low viral penetrance. However, in areas with known high incidence, prevalence and morbidity / mortality, why not adopt an aggressive (all-in, nobody out) screening policy. In the latter case, it might be more efficacious if trained Contact Tracers or Community Healthcare Workers are deployed to help navigate said population to hospitals, physician offices, community health centers or CoViD-19 screening sites. In the former, community areas where there appears to be low viral penetrance, contact tracing is paramount, if and only if, it leads to improved testing and requisite isolation of confirmed positive individuals as well as their contacts.
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