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Update on viral infections

Dr. Conway McLean, Journal columnist

It would be an understatement to say the coronavirus is big news. It’s everywhere you look; you cannot get away from it. (Well, actually, I hope that you can!) But there is a lot of misinformation out there, and a lot of uncertainty. It takes time to learn the behavior and characteristics of a new viral disease. But be careful of your information source, and discerning that what you read may not be entirely accurate or accepted as scientific fact. This is a brand new disease.

We are at least certain the disease, officially titled COVID-19, is caused by a virus. Viruses are strange little things and very different from better known bacteria. We’re really aren’t sure if they qualify as a life form, yet the afflictions they cause are many. Bacterial infections can be severe, even life-threatening, but we have a certain advantage in the battle against diseases that are due to bacteria. They are called antibiotics and many of them kill those darned little bugs, so once a bacterial problem has developed, we have at least some means of quelling the infection.

Not so with viral infections. Once an individual has become infected with the latest flu bug or, more recently, the newest corona virus, we have no medicine or drug able to rid the body of the offending organism. The hope is the body will mount a sufficient response, using our innate, built-in, defense mechanisms, referred to as the immune system.

What would life be like without antibiotics? Minor skin trauma not infrequently ended in amputation, even death, not that many years ago. Infections were a large contributor to overall mortality, with diseases such as diptheria and typhus rampant, often deadly. All those alive today can only imagine such a world, but maybe not for long. The increasing resistance of many bacteria to our antibiotics is frightening. Infectious disease experts say we may be approaching, once again, the day when a cut can kill you.

The discovery of the first naturally-occurring antibiotic was the result of a fortuitous accident. A Scottish researcher, Sir Alexander Fleming, is credited with the discovery of penicillin while experimenting with the flu virus in a lab. When he returned from a two-week vacation, he found that a mold had developed on a culture which had accidentally become contaminated by a staphylococcus bacteria (aka staph). Upon examining the dish, Fleming discovered the mold had prevented growth of the bacteria where the mold lay.

Fleming did not set out to revolutionize medicine but many would say he did. Every school child is taught the story. In reality, this perception is inaccurate. Fleming merely made the observation that a mold could kill a colony of bacteria. Fleming did not have the chemistry background, nor the resources, to take this discovery any further. Many critical steps were needed, such as isolating the active ingredient, purifying it, determining what bacteria were susceptible, and especially important, how it should be used.

This task fell to Dr. Howard Florey, a professor of pathology at Oxford University, who masterfully administered a complex lab, staffed by a large assortment of bright young scientists. Florey had long been interested in the interactions between bacteria and mold, fascinated by their ability to kill each other. He happened upon Fleming’s paper while perusing some back issues of a science journal, one of which contained Fleming’s paper. Florey and one of his biochemists, Dr. Ernst Chain, began their landmark work in 1938. Together, they produced a series of crude penicillium-mold cultured extracts, which ultimately led to the production, fitfully at first, of the antibiotic, penicillin.

Although there has been some unfortunate discourse of late concerning the benefits of vaccines, they remain our greatest defense against viral diseases. Vaccines are widely credited with nearly eradicating many virulent maladies including polio, diptheria, measles and mumps. Vaccines have the benefit of preventing a (viral) infection, as opposed to vanquishing one already present, such as with antibiotics. But antibiotic medications are effective only against bacteria, having no effect on a viral problem.

Unfortunately, we have no vaccines for the corona virus. Developing a vaccine takes research, money, and lots of time. COVID-19 has spread globally, largely because it is a novel virus, meaning it is new. No one has ever had this virus before. And being new means our bodies do not recognize it and so have no defense against it. Our immune system needs to be taught to recognize some alien agent (which is what a vaccine does), so it is equipped to fight it.

Covid-19 has been classified as not just an epidemic, but a pandemic, certainly an intimidating term. A pandemic is a global outbreak of a disease. Pandemics happen when a new virus emerges without pre-existing immunity against it. Consequently, the Corona virus was able to spread worldwide, truly a global problem.

A number of physicians on the front lines of the battle against COVID-19 have related a very recent finding of some importance. Take note: many people with documented cases of the virus lost their sense of smell and/or taste prior to any other signs or symptoms. Should you or family member suddenly develop a loss of smell, you should contact your primary care provider, as well as informing the health department.

Naturally, we turn our attention to treatment. Just as when someone in poor health gets the flu, keeping one’s temperature down and maintaining hydration are critical. But unlike the typical flu, the respiratory complications of COVID-19 can become severe, even life-threatening. Supportive measures are critical when breathing difficulties occur. Sometimes being placed on a ventilator is necessary.

But in the truest definition of the word, there is no “cure”, only prevention. How does one not get the infection? Everyone seems to be aware that not being exposed to the virus, abstaining from contact with someone who is infected, is the best way. But what if the person infected doesn’t know they are…… because they have no symptoms. This is the case with COVID-19: the infected won’t develop symptoms for up to 2 weeks. This provides ample time and opportunity for the virus to spread.

Another means of prevention is to be vaccinated. As mentioned, developing and manufacturing one is a difficult process. We would be much closer to having a vaccine if funding for pharmaceutical research weren’t driven by monetary rewards. SARS, another corona-type virus, sprang up in the early 2000’s but had run its course by the time a vaccine had been developed. Consequently, there was no funding for human clinical trials and the complex process went no further. If we had, we might have a coronavirus vaccine already.

Americans are asking how soon can we start vaccinating people? Unfortunately, as discussed, it is a complex process and will likely take 18 months. And when one is developed, will the vaccine’s distribution resemble the embarrassing efforts to distribute coronavirus tests? Does the US government have the capacity to produce and distribute a vaccine as quickly as needed? This question was asked in a Senate hearing recently and the answers were not encouraging. Once again, humanity’s protestations are for naught: nature will have its way.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments at drcmclean@outlook.com.

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