Living in the Age of COVID-19 Part IILivingintheAgeofCOVID-19PartII

Main Points

• It could be 4-6 years before COVID-19 is controlled globally. That doesn’t mean that life as we’ve known it will be upended that long but that we’ll be fighting COVID-19 somewhere in the world for many years to come.
• By year-end, we could have a handful of vaccines that have gone through a clinical trial and have met the US Food and Drug Administration’s (FDA) low bar for efficacy – 50% -- and have begun to be tested against the higher bar for safety.
• We might have a vaccine within a year of detecting COVID-19. Development of therapeutic antibodies and antivirals has also been promising. The goal of a $5, 5-minute test with 99% sensitivity and specificity is not far away.
• Schools can be made safe, but it’s complicated, and there’s no room to cut corners. The first rule of safety is testing. Air filters should be changed often, Plexiglas barriers should be erected, and social distancing should be practiced at all times.
• Data is sparse, but children under the age of 10 have more virus in their nasopharynx, or upper throat, than adults. Children can presumably spread the virus. Most children will be asymptomatic, and a plurality will have mild symptoms, but for some the effects will be much more serious. Of children who are hospitalized, a high percentage – roughly a third -- end up in intensive care units. We don’t know pre-existing determinants that might predict the severity of the disease in children.
• In some instances, it’s possible to return to work. But if your work site has low ceilings, poor ventilation, limitations on social-distancing, and other challenges, it’s not a great idea. A safe return to the office, like a safe return to school, requires careful planning.
• Like smallpox, COVID-19 has systemic effects. Almost all symptomatic patients have acute then chronic pneumonia and difficulty breathing. About a third have enduring myocardial disease. Many develop kidney disease, others leaky capillary syndrome. It can cause swelling of the toes, and many lose their sense of smell. Many surviving patients are sick for months, and we don’t yet know what the lasting effects will be.
• The disease can be spread by someone who has not yet shown symptoms. The period of maximal communicability is four days before and four days after symptoms first appear. Eight or nine days after symptoms manifest, the virus transforms from a nasopharynx phenomenon to a systemic disease where autoimmune complications arise, and perhaps surprisingly, the virus becomes less contagious.
• Everyone should get a flu vaccine now. First, you want to reduce the possibility of contracting both the flu and COVID-19 at the same time. Second, mass flu inoculation should lower the risk of misdiagnoses – COVID-19 and the flu share early-stage symptoms, so someone infected with COVID-19 could be diagnosed as having the flu and vice versa.
• Rushing a vaccine for political purposes is dangerous and would likely undermine trust in health institutions. There is no possibility that we will know over the next couple of months that a vaccine is safe – it’s logistically impossible given the time it takes to assess reactions of many different segments of the population.
• To develop herd immunity from COVID-19 without a vaccine, 220 million Americans would have to contract the disease with the risk of millions becoming very sick or dying.