From the beginning of time, humanity has encountered pandemics and pestilence, be it Plague, Smallpox, Syphilis, Influenza, Viral Hemorrhagic Fevers, HIV, Yellow Fever, Malaria, and since 2002 to the present time, coronaviral infections of SARS, MERS and COVID-19, spattered with outbreaks of Ebola, Cholera, Zika and H1N1 Influenza.
Infectious epidemics and pandemics grab the headlines, constrict economic prosperity, and empower national, state and local governments under the “police powers statutes” to mandate closures of schools, businesses, gatherings, social distancing, the use of masks, all in the name of public health and interest. Despite the number of deaths from COVID-19, over 90% of those with the infection completely recover. Like all diseases, there are high-risk groups based on age, co-morbid medical conditions – heart, lung and renal disease, diabetes – poverty, access to health care, urbanization vs. rural, immune competency and genetics, which factor into adverse outcomes of a disease process.
We are all endowed with an innate system of protection receiving little media attention that nevertheless is the foundation of human health and well-being, your immune system. This human fortress is continuously besieged by foreign invaders, some known, some unknown, bacteria, viruses, fungi, parasites and toxins. The team of defenders have the capability of recognition, containment, destruction, coordinated communications and maintaining a database for early recognition and response through the production of antibodies.
It is this last process that is the cornerstone for vaccinations. A vaccine is an attenuated antigen, protein material, that will not cause the disease but prime the immune system to produce antibodies, which rapidly target and neutralize the natural pathogen, ameliorating symptoms, reducing deaths and suppressing further transmission. This only works for those who have never been exposed and not obtained natural immunity. The difficulty with vaccinations is finding the correct antigenic response to elicit protective long-lasting immunity and the time taken for mass production of the vaccine. The panacea of finding a “cure all” drug does not replace the vigilance of the human immune system. Not having a reservoir host except humans, Smallpox was eradicated through vaccinations. This is not the case with many zoonotic infections, including SARS CoV-2/COVID-19, which is maintained in the bat population.
On a global scale, daily, 150,000 deaths – in the U.S. 8,000 – are due to chronic diseases such as cardiovascular diseases including heart attacks and strokes, cancer, diabetes and lung disease. These numbers dwarf anything COVID-19 can do or has done. Yet for the scale of deaths due to chronic disease we invest a pittance into prevention and do not shut down our economy.
Understanding the strategy for “flattening the curve” only helps reduce the surge related to overwhelming the hospital system. It does not lower the number of deaths, nor does it reduce the number of individuals who develop COVID-19. The area under the curve remains the same. With containment polices you are reducing surge at the expense of lengthening time. We would expect periodic spikes in COVID-19 for the next few years as the current infection accounts for less than 0.01% of the U.S. population. The numbers with diagnosed COVID-19 is an underestimate due to mildly symptomatic people not being tested, the lack of access to testing and the variable reliability of current test kits. Suffice it to say, 99% of the population lacks immunity, so this virus is here to stay for a while.
As science has been ambiguous, politics has been the reality. For those dissenters who feel medical containment measures take precedence over the economy, I say they are interconnected and the true public health disaster will be those who lost their jobs, businesses, homes, health care benefits, savings and are having to make difficult choices between taking their medications and putting food on the table. I hope the generosity of a stimulus package from a community, locality, state and federal government provides a safety net for those most affected by this disaster. Politicians and government will be judged at the ballot box not on the mistakes they have made, but on their failure to understand the social and economic determinants of health.
Dr. Lawrence W. Gernon, MPH & Tropical Medicine, is a former diplomat and regional medical officer with the U.S. Department of State.