As of February 29, 86,032 people worldwide have been diagnosed with coronavirus (Covid-19). Thus far 2,942 people have died, for a case fatality rate around three percent.
I am not an infectious disease specialist, but I have been in medical practice for 40 years. I would like to share my thoughts on Covid-19 and in the process hopefully save lives and prevent the spread of the virus.
I hope to allay fears and prevent panic which can exacerbate a trying and difficult situation. One thing I caution the most about is politicizing a very volatile and challenging event.
For starters, one cannot predict with absolute certainty the extent and degree of the viral spread.
SARS (Severe Acute Respiratory Syndrome) which is also a coronavirus, and originated in China in 2002, was also of major concern back then but did not become the pandemic that was feared. It affected 26 countries, but only 8,000 cases were diagnosed in 2003.
The worse pandemic in American history was actually the influenza (H1N1) outbreak of 1918-1920. It affected 500 million people (27 percent of the world’s population at the time) around the globe. Unfortunately, 40-50 million people died. The case fatality rate of 10 percent was much higher than that of Covid-19. The flu pandemic of 1918 hit young adults particularly hard because of “cytokine storm” which ravaged the stronger immune system of this age group. Covid-19 seems to hit those with medical conditions the hardest. Children seem to be relatively spared.
The high case fatality rate of the flu pandemic of 1918 was due to malnourishment, overcrowded conditions, and poor hygiene.
I will now discuss possible prevention and treatment strategies. Because Covid-19 is a new virus, it’s impossible to say with certainty or scientific studies treatment options. It will be purely anecdotal. A vaccine is in the works, but even working at lightning speed, it will take a minimum of three months to develop.
The best strategy at the moment is prevention and early detection. Hand washing with soap and water, as well as alcohol-based hand sanitizers, is crucial to prevention of all infectious diseases. Since Covid-19 can be spread by air droplets as well as through contact, many more steps need to be taken. Most of the surgical masks being used do not prevent viruses from entering into one’s respiratory tract. Masks must be properly and tightly fitted and be of the N95 type to be effective. Handshaking, kissing, and touching contaminated surfaces like doorknobs can spread the virus. Unfortunately, even asymptomatic individuals can spread Covid-19, which makes being extra careful essential. In addition, since viruses (no reason to think Covid-19 is different) can be spread in feces, toilets become a major source of contamination. Use of bleach, alcohol, and glutaraldehyde products to disinfect toilets after each use can be very helpful. Use of nitrile gloves can further prevent spread.
Avoiding crowded areas and closed spaces can be helpful.
Although anecdotal, use of steroids helped some survive SARS. It might be helpful in Covid-19-infected symptomatic patients. Use of antivirals which have been used against HIV infection have helped some survive Covid-19. Again, this is strictly anecdotal. A study is now underway by Gilead with Remdesivir which is an anti-viral. The drug is experimental and not yet approved to treat any disease.
Because some patients seemed to do better after treatment with anti-HIV medications, it raises the question of whether these meds should be used (at least in health care workers) prophylactically, as they are to prevent HIV infection. Unfortunately, the cost of some of these medications can be exorbitant. For example, the combination drug Truvada, used to prevent HIV infection, costs $6000 for a 90-day supply.
If these medications have a chance at working, they must be given as early as possible. Early diagnosis is essential. Local testing must be allowed and fully implemented as soon as possible. This has been one of the problems so far. The diagnosis should be made in hours, not days, in order to fully contain the disease.
The take-home lesson is that although Covid-19 is a significant challenge and threat, with proper attention to detail, preventative measures outlined, and early detection, we can overcome.
Joseph M. Frager is a physician and lifelong activist.
