Buege, Larry

A vaccine would be nice, but it will not salvage our economy nor stop this pandemic. The two, now-famous, bell-shaped curves have two features in common. Both have the same area under the curve, which means an equal number of people are infected, and in both scenarios the infection ceases when seventy percent of the population is infected to provide herd immunity.

It may make political sense to brag about a vaccine by the end of the year, but few scientists or medical providers without political baggage find this timeline realistic. Scientists have been working 40 years on an HIV/AIDS vaccine without success.

There is no guarantee this vaccine will be any easier. With an estimated fatality rate between 1% and 4%, one million Americans could die before we obtain a workable vaccine. These are depressing statistics. Now for the good news.

It isn’t necessary to prevent COVID-19 infections to return our economy and our lives to normal, but we do need an efficient treatment plan. HIV/AIDS was once considered a universally terminal illness. Everyone who got the disease died. We have flattened that curve with safe sex, although we still don’t have a vaccine. We did develop an efficient treatment protocol, and it is now rare for people to die from AIDS. Magic Johnson is approaching 30 years since he announced his infection.

The corona virus is barely six months old, yet we already have a wealth of information about its molecular biology and its effects on human physiology. It took three years to discover the virus that caused AIDS. In the first month, the Chinese not only identified the coronavirus, but they had mapped its entire genome and provided it to the World Health Organization.

Some people suggest the coronavirus is similar to the common flu, however the flu has never forced hospitals to consider triage where caregivers must choose who shall live and who shall die. That is the difference between the coronavirus and the flu. If we can significantly reduce the mortality rate, the corona virus could become comparable to the common flu.

Our original treatment plan was limited to supplemental oxygen and assisted ventilation for severe cases. We have made significant strides toward improving this treatment plan. We can expect this trend to continue as we learn more about the virus.

We now know that ventilators insert their own risks with few people surviving, but the simple act of turning the patient to the side or stomach can lower the need of a ventilator and improve outcome. We have learned that the disease is more than a respiratory infection. Many people die from blood clots in the heart, brain, lungs, or kidneys. Anticoagulants are already in our medical arsenal.

We know how they work and the risks of using them. Now we must decide when to use them. Do we reserve them for the most serious corona illnesses or do we provide all patients with a 30-day supply for prophylactic use?

Recently remdesivir was found to reduce hospitalization of severely infected patients by 30%. That means 30% less PPE needed and 30% less exposure for hospital workers. It also reduced the number of deaths by 3%, although this was not statistically significant. Will remdesivir be even more effective when given earlier in the disease process?

We have a large pool of recovered patients whose plasma is filled with antibodies to the corona virus. That is why the patients recovered. In the near future, these antibodies will be harvested for treating severe infections. Early studies offer promising results.

An antiviral drug, known as interferon-alpha2b, speeds up recovery of COVID-19 patients. The drug has potential serious side effects, but like remdesivir this drug is already in our arsenal and the side effects are well documented.

And best of all, we are finally getting sufficient test kits to do contact tracing. Eventually, we should be able to quarantine only the virus shedders and not the healthy population.

There are many other promising treatment plans under study. Healthcare providers and scientists are significantly reducing the fatality rate, but they need our help. They need time to replenish masks, gowns, and gloves in case we are hit with a second wave. They don’t want to be caught with their scrubs down like they were for the first wave. They need time to fine-tune their treatment protocols and to investigate new treatment plans.

With a few changes in our life style we can buy the time they need. We may think this is impossible, but we survived the inconvenience of seat belts and now think nothing of it. We will need to forego large gatherings. (Yes, I also miss church.)

If one person potentially infects 100 worshipers or a beach with hundreds of people, it will be impossible to do contact tracing, and we will be back to quarantining everyone and not just the virus spreaders.

Is it really that hard to remain six feet from other people and skip hand shaking? We can shed the virus during normal talking, but the virus laden water droplets normally fall to the ground in less than six feet.

This will not protect a person from an energetic cough or sneeze that can send the virus particles a dozen feet or more. That’s where a simple face covering comes in. Do non N-95 masks really provide protection? Try blowing out birthday candles from two feet away while wearing a face mask.

I rest my case.

Editor’s note: Larry Buege is a retired physician’s assistant who worked many years in emergency rooms.