We've learned a lot about the coronavirus these past seven(!) months. But keeping current has taken much effort, and I'm finding that persons I know are often unaware of many of the details that I regard as important to staying safe and healthy. Maybe you'll find them important too, because they could inform how you think about your own actions as we make our way through this trying time. I intend to cover some of them here.
Before we begin, I'll take note of where we stand. If you want to get right to the meat of the post, skip the commentary that follows in the next several paragraphs and go straight to the sections below that are headed in bold.
Coronivirus (a.k.a., SARS-CoV-2, a.k.a. COVID-19, but see the "note on terminology" below) is now the third leading cause of death in the U.S., behind cancer and heart disease. As I write this more 190,000 persons have died of the virus in the U.S. since the beginning of the pandemic. We have been plateaued at about 40,000 new cases and 1,000 deaths per day—a staggering toll. Epidemologists are on the lookout for a possible post-Labor Day surge. Most public health experts expect a difficult winter. There have been more than 6.5 million confirmed cases in the U.S., which understates the true infection rate by many multiples. A frequently-cited model from the University of Washington projects a mind-blowing 415,000 deaths by January 1.
Many schools and universities have been opening, which will continue to seed new outbreaks—something that's happening even as I write this. To cite just one example, nine fraternities and sororities are under quarantine at the University of Kansas, in my home state, and cases are surging in the city of Lawrence. It's the same story, and sometimes a lot worse, around the country.
[Update 09/17/20 - Yesterday the Big Ten athletic conference reversed itself and announced it will play a fall football schedule.]
Unlike other parts of the world, the U.S. seemingly has no ability nor obvious intention to contain disease spread. Dr. Anthony Fauci, the country's top infectious disease expert, says he'd like to see a baseline of 10,000 new cases per day, and preferably less, in order to bring the spread under control. At the current high baseline levels control is not possible.
There is no national policy to achieve control, and no immediate prospect that anything will change. If anything, policy is moving in the wrong direction, as indicated by the appointment of the shockingly unqualified Scott Atlas to the White House coronavirus task force. Dr. Atlas, who is neither an epidemiologist nor a public health expert (he's a radiologist whose prime qualification is appearances on Fox News), says it's a mistake to isolate lower-risk persons because, he argues, this just delays the buildup of immunity in the larger population. In response, former CDC director Dr. Tom Frieden said that "trying to get to herd immunity other than with a vaccine isn’t a strategy. It’s a catastrophe." Perhaps you can see why it's good to have experts in positions that require expertise.
[Update 09/17/20 - In an open letter, former colleagues and researchers at Standford Medical School, where Dr. Atlas once held a position, repudiated the "falsehoods and misrepresentations of science recently fostered by Dr. Scott Atlas," saying, among much else, that "encouraging herd immunity through unchecked community transmission is
not a safe public health strategy. In fact, this approach would do the
opposite, causing a significant increase in preventable cases, suffering
and deaths, especially among vulnerable populations, such as older
individuals and essential workers."]
Meanwhile there have been growing indications that the CDC, that most venerable of public health institutions, has been succumbing to political pressure from the White House. The CDC recently announced new testing guidelines that have drawn widespread rebuke from epidemiologists. The CDC now says that persons who have been closely exposed to infected individuals need not get tested themselves, despite the fact that asymptomatic spread of the disease is one of its important features. This new guidance meshes closely with President Trump's long and repeated insistence that he wants less testing, not more, in contradiction to his medical advisers and public health experts. And indeed, the country is now doing less testing than at its peak, at a time when epidemiologists continue to warn that more is needed.
[Update 09/18/20 - The New York Times broke the story that the much disparaged "CDC" guidance on testing was not written by the CDC, and was published on the agency's web site over the objection of CDC scientists. This never happens. Now it has. The politicization of the CDC and other national public health agencies has been stunning.]
[Update 09/19/20 - The CDC, reversing its previous guidance, said yesterday that anyone exposed to an infected person for more than 15 minutes should get tested.]
Perhaps most alarming of all, a Trump political appointee has been interfering with the CDC's "Morbidity and Mortality Weekly Reports," which have been referred to as the "Holiest of the Holy" agency communications. That political appointee, Michael Caputo, thinks CDC scientists are trying to make the president look bad. In our present dysfunctional political environment, our nation's most hallowed public health institutions have been hampered, muzzled, and at times have performed poorly.
[Update 09/17/20 - Mr. Caputo, who has apparently suffered a severe meltdown these past several days, announced yesterday that he's taking a 60-day leave of absence.]
A note on terminology. Correctly understood,
SARS-CoV-2 is the name of the virus, whereas COVID-19 is the name of the
disease that it causes. SARS-CoV-2 is closely related to an earlier
coronavirus, SARS-CoV, which was identified in 2003 and which caused
the SARS epidemic back then.
In the discussion here we'll not
distinguish closely between the disease and the virus, and we'll refer
to both variously as COVID-19, COVID, or just the coronavirus. My
purpose here is to describe important features of the virus and the
disease that often aren't well understood by the general public, and
which when better understood might change how we organize our lives
during these challenging times, with the objective of being around this
time next year to evaluate our circumstances.
An important
disclaimer is that I am not an expert, and you should take what I say
accordingly. On the other hand, I've tried to document much of what I've
said by referring you to authoritative sources. Let's get started.
Many people don't have symptoms, or have misleading symptoms. A
large proportion of persons infected with COVID-19 are asymptomatic or
are only mildly symptomatic. By some estimates the actual number of
infections could exceed the official case count by a factor of 10.
That's in part because it's mostly sick people who get tested. That so
many people infected with the virus don't develop significant symptoms
may at first blush seem to be positive, but there are reasons why it
isn't. Some are described below, and in sections that follow.
The classic symptomatic
presentation of COVID involves a dry hacking cough, fever, and then
progression to lung involvement including pneumonia. But early on
emergency room physicians began seeing peculiarities. Some patients
presented to the ER with cardiac symptoms, with subsequent testing
showing a COVID infection. It's likely that a number of early
deaths, and perhaps some later ones, were attributed to heart attacks
when the true cause of death was COVID.
Some persons develop
serious pneumonia even before experiencing the labored breathing that
one would expect from such a condition. Dr. Richard Levitan, an
internationally known airway specialist and emergency physician, was
volunteering at New York's Bellvue Hospital ER early in the pandemic.
"Even patients without respiratory complaints had Covid pneumonia,"
Dr. Levitan wrote. "The patient stabbed in the shoulder, whom we X-rayed
because we worried he had a collapsed lung, actually had Covid
pneumonia. In patients on whom we did CT scans because they were injured
in falls, we coincidentally found Covid pneumonia. Elderly patients who
had passed out for unknown reasons and a number of diabetic patients
were found to have it."
"And here is what really surprised us,"
Dr. Levitan continued. "These patients did not report any sensation of
breathing problems, even though their chest X-rays showed diffuse
pneumonia and their oxygen was below normal."
Dr. Levitan seemed
amazed: "A vast majority of Covid pneumonia patients I met had
remarkably low oxygen saturations at triage — seemingly incompatible
with life — but they were using their cellphones as we put them on
monitors. Although breathing fast, they had relatively minimal apparent
distress, despite dangerously low oxygen levels and terrible pneumonia
on chest X-rays." [my emphasis -mb]
Dr. Levitan calls this initial stage, where
blood oxygen saturation drops dangerously while breathing remains
substantially unlabored, "silent hypoxia." It's worth noting here that
individuals can easily monitor their own blood oxygen levels with an
inexpensive device called a pulse oximeter. You can buy one at your
pharmacy, or on Amazon. It's an easy to use device that could help with early detection
of pre-symptomatic COVID pneumonia. Persons who have been exposed or who have tested
positive might consider purchasing one and using it a few times per day. Not, mind you, that you should be taking medical advice from me.
According to Dr. Levitan, patients who had serious pneumonia even before developing breathing difficulties typically did
feel sick in other ways after becoming infected. But as described
below, it's shockingly common for young adults to incur lung damage
while having essentially no symptoms. This suggests there could be a
large amount of hidden damage, perhaps lifelong, that might not become apparent until much
later. It's a good bet that we have been substantially underestimating
the risk to young adults. Every time I hear acquaintances recount with a
shrug how they or their kids had the disease and it was no big deal, I
worry that the true toll is yet to be revealed. With many universities now back in session and experiencing widespread outbreaks, it's likely that unexpectedly high numbers of young people are sustaining lung damage without being aware of it. See the section on young people below for more on this.
Why some
people don't develop symptoms is an open question. It might be because
of some inherent or acquired immunity, or that their immune system doesn't overreact in ways that can cause severe damage. Such immune system overreaction is involved in the most severe cases. Or it might be that they weren't
exposed to high enough levels of the virus to get very sick. There's a
suggestion that our tests are too sensitive, because the gold-standard
PCR test can detect extremely low levels of virus. The test goes
through a number of "amplification cycles" to find the virus, and lower
viral loads require more cycles. It could be helpful if the "cycle
threshold"—the number of cycles that were required to detect the virus's genetic material—was reported in
the results, but it typically isn't. Were it available, the cycle threshold might be a useful proxy for viral load. It's reasonable to assume that
persons with low viral loads aren't very infectious, but it seems we
still have things to learn.
None of this argues for less testing; quite
the opposite. As epidemiologist Michael Mina says, "we should be ramping
up testing of all different people, but we have to do it through whole
different mechanisms." Dr. Mina says "the decision not to test
asymptomatic people [per the latest CDC guidelines, which are apparently now politicized, and which continue to
change -mb] is just really backward."
[Update 09/19/20 - The CDC, reversing its previous guidance, said yesterday that anyone exposed to an infected person for more than 15 minutes should get tested.]
Because the virus is still
spreading out of control, and because we are still learning new things
about it, my own position tends toward caution, which means more testing. Perversely, it seems, we are currently doing less than even our previously inadequate levels. It is unclear to what extent reduced testing is reducing the number of confirmed cases being reported in the daily statistics.
Asymptomatic spread is common. In
at least two noteworthy respects, lack of symptoms does not mean a
person is not infectious, which is one of the most insidious features
of this disease. Persons can and do spread the disease without having
symptoms.
In particular, even persons who do become strongly symptomatic
are believed to be at their most infectious a day or two before
symptoms appear. It is therefore not possible to rely on the presence
of symptoms, or on temperature checks, to gauge whether an individual is
safe to be in the presence of others.
A study in South Korea published August 6 found that "many individuals with SARS-CoV-2 infection remained asymptomatic
for a prolonged period, and viral load was similar to that in
symptomatic patients; therefore, isolation of infected persons should be
performed regardless of symptoms." A related story in the New York Times said the study "offers more definitive proof that people without symptoms carry just as much virus in their nose, throat and lungs as those with symptoms, and for almost as long."
Young people get it too. A common misconception is that young people don't get the disease. That is a dangerous falsehood, for a number of important reasons.
Health
experts have been aware almost from the beginning that a small number
of children were afflicted with a COVID-related condition that's
referred to as multisystem inflammation syndrome (MIS-C). The condition,
which involves the heart and other organs, is similar but not identical
to a rare childhood syndrome called Kawasaki disease. As of the end of
June, two research groups found nearly 300 cases of the syndrome. 80% of
the involved children required intensive care, 20% required mechanical
ventilation, and 2% died. As of very recently, the CDC received reports
of 694 confirmed cases, with 11 deaths. Most have occurred in children
between 1 and 14 years of age. See this, this, and this.
Children are something
of an enigma. They get the disease at about one third the rate of
adults, and typically have few symptoms. Yet children often have much
higher viral loads in their airways compared to even very sick adults.
Even so, children under the age of 10 are currently thought to be
relatively inefficient spreaders of the disease, whereas older children
spread it as readily as adults. Children with very high viral loads
might be more infectious, but it seems we still have more to learn.
[Update 10/04/20 - A very large study in India published in the journal
Science found that children are readily infected and readily spread the
virus to other children. The study's discussion says that "social interactions among children
may be conducive to transmission" in settings such as schools. See also
this from NPR.]
Young
adults are likewise cause for concern. Based on outward symptoms, they
fare much better than older adults. But outward symptoms don't tell the
whole story.
Whereas the initial phase of the outbreak
occurred in older adults, the country's second coronavirus case surge,
in early summer, was driven by young persons who were contracting and
spreading the virus. According to Dr. Aileen Marty, Professor of
Infectious Disease at Florida International University, although they
were ostensibly asymptomatic, many were sustaining lung damage that
could have long term consequences.
"In our hospitals, we're seeing the
largest portion of our hospital patients are in their 30s, and
younger," said Dr. Marty on July 7. "They're asymptomatic as far as they
can tell. But when we do chest X-rays on these people, 67 percent show
lung damage. So they may feel great; they're not great. And the truth
is, they're having scar tissue forming in their lungs that may have
implications for their future. So even the young people, even the
children, when you do films, we see the damage. These are people we
don't hospitalize."
This is a sobering realization at a time when many colleges are reopening and some football schedules are going forward. Outbreaks have been flaring up on university campuses around the country, with anecdotal reports of 80 percent infection rates in some fraternity houses. Because the concern of hidden lung damage in asymptomatic young persons seems to have been largely overlooked in our public discourse, I was curious about whether Dr. Marty stands by her earlier claims from back in July. She does.
In private correspondence, Dr. Marty told me that "a large proportion of infected people do not develop detectable
symptoms, or symptoms are mild, or at worst a walking-pneumonia-like
syndrome, not requiring special medical attention. Studies of
asymptomatic persons indicate that nearly 30% show ground-glass
opacities on chest computed tomography and about 67% have abnormal
radiological findings in at least one lung." [Computed tomography is the formal name for CT scans. Ground-glass opacity refers to "the hazy, white-flecked pattern seen on lung CT scans." -mb] See also: this.
Not just the lungs. We continue to learn how COVID-19 can be a multi-system disease, and not all individuals
experience it the same way. As we have previously seen, some patients
were presenting early in the pandemic with apparent cardiac problems
that had an underlying COVID cause. More recently, Dr. Haider Warraich
wrote about how "Covid-19 Is Creating a Wave of Heart Disease."
Dr. Haider is a cardiologist and researcher at the Veterans Affairs
Boston Healthcare System, Brigham and Women’s Hospital, and Harvard
Medical School.
Dr. Haider noted that whereas we previously
believed COVID primarily affected the lungs, "now we know there is
barely a part of the body this infection spares. And emerging data show
that some of the virus’s most potent damage is inflicted on the heart."
Add to all the other emerging syndromes a new condition
called "COVID-19-associated myocarditis," which is an inflammation of
the heart muscle. Dr. Haider describes a study from Germany where
"researchers studied 100 individuals, with a median age of just 49, who
had recovered from Covid-19. Most were asymptomatic or had mild symptoms.
An average of two months after they received the diagnosis, the
researchers performed M.R.I. scans of their hearts and made some
alarming discoveries: Nearly 80 percent had persistent abnormalities and
60 percent had evidence of myocarditis. The degree of myocarditis was
not explained by the severity of the initial illness." [my emphasis -mb]
"Though
the study has some flaws," Dr. Haider wrote, "and the generalizability
and significance of its findings not fully known, it makes clear that in
young patients who had seemingly overcome SARS-CoV-2 it’s fairly common
for the heart to be affected. We may be seeing only the beginning of
the damage."
Other people have difficulty kicking disease,
with a baffling array of symptoms persisting for many months, even if
their symptoms were mild initially. Previous evidence from other,
related, diseases indicates that persons can experience a post-viral
syndrome with symptoms that manifest as chronic fatigue syndrome.
Dr.
Margot Gage, a professor of epidomiology, and herself a sufferer, said that "a lot of COVID long-haulers are reporting that their nails are
growing really long, but our hair is falling out. Other symptoms—for
example, I have ringing in my ears that I never had before." Also vision
issues. Strange rash-like skin issues. Sensitivity to the sun.
As a personal aside, an 87-year-old woman whom I know well, and who tested positive for COVID but seemingly (and amazingly) had no significant symptoms, was experiencing some mild but persistent coughing many weeks later. As we were talking, she—completely unprompted by me—look at her fingernails and remarked that they were growing faster than normal. I had heard the NPR report of this bizarre symptom just a few days earlier.
Some
severely ill COVID patients inexplicably remain in comas after coming
off the ventilator, prompting questions about whether they will ever
wake up, and whether to remove life support.
Dr. Brian
Edlow, a critical care neurologist at Mass General in Boston, says that
"because this disease is so new and because there are so many unanswered
questions about COVID-19, we currently do not have reliable tools to
predict how long it's going to take any individual patient to recover
consciousness." Dr. Edlow observed dozens of patients lingering in this
state. A research group at New York's Columbia Medical Center is trying
to determine how many COVID patients end up in this condition.
There's
a concern that hospitals overwhelmed with COVID patients are not giving
ventilator patients enough time to wake up before discussing ending
life support. In the midst of the crisis, some patients have surely died
because overwhelmed hospitals could not devote sufficient time and
resources to individual patients in that condition.
Hydroxychloroquine doesn't help. Anecdotal
claims of benefit from hydroxychloroquine surfaced in the early part of the outbreak. Early small, inconclusive studies were reported in
China and France. Large, well-designed studies were then commenced under
the oversight of the World Health Organization, the National Institutes
of Health, and others.
WHO ended its "Solidarity Trial" in early
July when it became clear that the drug had no mortality benefit, and
that there were "some associated safety signals in the clinical
laboratory findings." The NIH ended its trial in late June after
its data monitoring and safety board overseeing the trial concluded
(after its fourth interim analysis) that the drug was unlikely to be
beneficial to hospitalized patients. The NIH study was blinded,
randomized, and placebo controlled. Another large, randomized,
high-quality study, the UK RECOVERY Trial, reached the same conclusion.
One outlier study was conducted by the Henry Ford Health System, a network of hospitals in the Detroit area. The study
seemed to show a significant benefit from hydroxychloroquine, but it had
multiple significant flaws that have been well publicized. One of the most befuddling was that patients treated with
hydroxychloroquine were also more frequently administered steroids.
Administering steroids (particularly dexamethasone) to seriously ill
patients is one of the major advances in COVID treatment to emerge in
recent months.
If hydroxychloroquine is unlikely to benefit
hospitalized patients—a conclusion that's becoming increasingly
definitive—what about using it for prophylaxis? A large number of
trials to investigate whether pre- or post-exposure use of
hydroxychloroquine to prevent disease has benefit have been launched,
but results are maddeningly (to me) inconclusive or incomplete. One study of postexposure phrophylaxis involving 821 health care workers did
not show that hydroxychloroquine prevents illness. A long and
rambling commentary suggested we should not yet rule out benefit, but
did not demonstrate any conclusively.
The safety profile of
hydroxychloroquine is also debated, and where one comes down seems at
least in part to depend on whether or not he is a devotee—in a non-expert sense—of the drug.
Unfortunately, this has become a politically fraught discussion, and
needlessly so. On the one hand, experts conducting carefully designed
studies find no benefit. On the other, non-experts, including the
U.S. president, hype anecdotal claims. If you believe the claims, then
potential safety issues seem a small price to pay. But if the drug truly
has no benefit, then widespread use in the general population is
reckless.
Hydroxychloroquine
has a long list of possible and possibly dangerous side effects. Yet it
has been used more or less safely for decades for the treatment of
malaria and autoimmune conditions. Surely the layman is in no position
to exercise judgement on how to resolve this question. Nor, for that matter, is the president. Fortunately, we
have experts who are tasked with making these very determinations. But un-fortunately, in the current politicized environment, those experts are often
disparaged and denigrated. Throughout this epidemic, the politicization
of the public health system has been as harmful and unfortunate as it
has been unprecedented.
According to The American College of Cardiology, "known harms of chloroquine in patients without COVID-19
include (but are not limited to): cardiovascular (cardiomyopathy,
electrocardiographic changes); hematologic (aplastic anemia,
thrombocytopenia); nervous system (seizures, psychosis, extrapyramidal
disorders); and ophthalmic macular degeneration." The ACC said on July
27 that "we should not use chloroquine or hydroxychloroquine alone or in
combination with azithromycin as prophylaxis against COVID-19 due to
known harms and no available evidence of benefits in the general
population." The ACC recommends against using the drugs both as prophylaxis and as a
treatment.
The Food and Drug Administration's mandate is to
assess the crucial balance between drug safety and efficacy. On June 15, the FDA revoked the emergency use authorization (EUA) that had been granted
on March 28 for hydroxychloroquine in the treatment of COVID. "In light
of ongoing serious cardiac adverse events and other potential serious
side effects," said the FDA, "the known and potential benefits of chloroquine and
hydroxychloroquine no longer outweigh the known and potential risks for
the authorized use. This is the statutory standard for issuance of an
EUA."
This was not an arbitrary determination. The FDA said
it was "aware of reports of serious heart rhythm problems in patients
with COVID-19 treated with hydroxychloroquine or chloroquine, often in
combination with azithromycin and other QT prolonging medicines." It also said that it had "determined that the legal criteria for issuing
an EUA are no longer met."
"Hydroxychloroquine and chloroquine
can cause abnormal heart rhythms such as QT interval prolongation and a
dangerously rapid heart rate called ventricular tachycardia," said the
FDA. "These risks may increase when these medicines are combined with
other medicines known to prolong the QT interval, including the
antibiotic azithromycin, which is also being used in some COVID-19
patients without FDA approval for this condition. Patients who also have
other health issues such as heart and kidney disease are likely to be
at increased risk of these heart problems when receiving these
medicines."
The FDA said that its "actions will be guided by science."
"Recent
results from a large randomized clinical trial in hospitalized
patients, a population similar to the population for which chloroquine
and hydroxychloroquine were authorized for emergency use, demonstrated
that hydroxychloroquine showed no benefit on mortality or in speeding
recovery. This outcome was consistent with other new data," said the
agency. The FDA's detailed safety review (pdf) is here.
"Hydroxychloroquine is the most disappointing, disavowed drug that researchers keep studying for COVID-19," writes one reporter. "Can We Just Stop Wasting Time on Hydroxychloroquine," asks a peer-reviewed post in REBEL EM, a clinical blog focusing on research appraisal. And in Science News: "Hydroxychloroquine can't stop COVID-19. It's time to move on, scientists say."
So we shall.
The virus is spread primarily through the air. Our
understanding of the likely modes of viral spread has changed a lot
over the months. Early on, it was believed that very close contact and
touching surfaces ("fomites") was a principle means of exposure.
Officials even advised against mask wearing in the early going, although this seems at least in part
because there was such a severe mask shortage that recommending masks would
have been pointless, and would have made it harder for health workers
and first responders to obtain the protective equipment they desperately
needed.
Later it was thought that the virus was also transmitted
in large droplets, such as during coughing. Such droplets are so heavy
that they fall to the ground quickly, and therefore don't travel very
far. Thus the 6-foot separation recommendation you've heard so much about. Officials soon began to
reverse themselves on masks, and the CDC even recommended simple cloth
face coverings as better than nothing. Such coverings arrest at least some amount of
expelled virus, and helpfully blunt the shape and trajectory of what
gets through.
It was not until early July that more than
200 scientists wrote an open letter (pdf) to the World Health Organization
arguing that the virus spreads through the air not just in heavy
droplets but also in aerosols. There had been some resistance inside WHO regarding this route, but WHO soon got on board, and the plausibility and even likelihood of the aerosol route of
transmission has become increasingly accepted.
Aerosols are
minute, very light particles that can remain aloft for a long time—even hours—and which can potentially be circulated by air-handling systems
in buildings. Confined indoor spaces are especially problematic,
especially areas where large numbers of people congregate, such as bars,
casinos, churches, prisons, meat packing plants, and Trump rallies. Importantly, 6-foot spacing is much less relevant to aerosol spread than to large droplet spread, because aerosols can travel greater distances while remaining airborne.
All
forms of airborne transmission are far less likely outdoors than in, so
you're much safer outside. Better ventilation indoors (such as by
opening windows) also reduces risk. Indoor activities where people congregate should be moved outdoors whenever possible.
It's now presumed that airborne spread is the most frequent route of exposure, although touching surfaces remains a
possible route. Hand washing, and refraining from touching your face,
is still recommended. Because spread is largely through the air, mask wearing is particularly important.
I should add that the amount of virus to
which you're exposed can affect the likelihood of getting sick. Longer
contact with infected persons, and remaining longer in high risk areas,
increases your risk.
Don't ingest bleach. Or alcohol. Or disinfectants. Yes, I'm being facetious. But really, don't. And
work to elect a president who won't spew such stream-of-consciousness
nonsense that might cause persons less bright than you to harm
themselves.
Conclusions. The most important takeaways are these. The virus can be spread asymptomatically, which
is why physical distancing, mask wearing, and careful hygiene are so
important. Absent testing, you just can't know whether you or somebody else is
infectious. The virus spreads primarily through the air, but touching
surfaces might also be dangerous. All age groups participate in the
disease in one way or another, either by spreading it, by being harmed
by it, or both. More people are affected and harmed than is generally understood, and the presence of symptoms is not a reliable indication of harm.
Very young children seem the least likely to be harmed, but a very small
fraction experience extremely dangerous organ inflammation. Young
children also seem to be the least contagious, but can carry enormous
viral loads that should give us pause. Young adults absolutely do get
infected and readily spread the disease, and they also might be
incurring long term lung damage even in the absence of symptoms. And
there's increasing evidence that COVID damages not just the lungs, but
other organs too, particularly the heart. Quite a disease, all in all.
Much more could have been said here, such as what relief we can expect from a vaccine, and how our lives are likely to unfold over the next year or two. Vaccine development is crucially important, but for a variety of reasons will not be a game changer in the short to mid term. Maybe more on that in a later post.
Much
of our understanding has, unsurprisingly, evolved over time. So it's
reasonable to assume there are still things to learn. Because of this,
and because the disease's effects are distributed much more widely than we often realize, caution in all things, as a default stance, is warranted—even though it isn't
practiced nearly enough. My advice, for what little it seems to be worth
to the people I interact with personally, is to keep yourself alive and unharmed,
and live to fight another day.
Copyright (C) 2020 James Michael Brennan, All Rights Reserved
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