COVID Email: June 3

I was recently asked by a patient, “So what’s new with COVID? Is there anything we’ve learned recently?” Ok, maybe I’m paraphrasing a bit, but that was the gist of it. The question made me realize that perhaps it’s a good time for a quick review of where we stand now. To keep it simple(r), I’ll do this in a bulleted fashion.

COVID Email: June 3

What have we learned?

I was recently asked by a patient, “So what’s new with COVID? Is there anything we’ve learned recently?” Ok, maybe I’m paraphrasing a bit, but that was the gist of it. The question made me realize that perhaps it’s a good time for a quick review of where we stand now. To keep it simple(r), I’ll do this in a bulleted fashion.

  • The degree of risk after infection is dependent on a patient’s baseline health. Those with pre-existing conditions and certain metabolic health concerns are more likely to suffer severe illness or death. Conversely, if you are healthy, fit, and active, you are much more likely to have a mild case, should you become infected.

  • There was a time when it seemed that possibly large numbers of infected individuals were asymptomatic throughout the course of infection. As more data has been gathered, we now know that unlikely to be the case. Instead, there is a fairly lengthy pre-symptomatic time frame, when an infected person may spread the illness without demonstrating current symptoms. However, most people who contract SARS-CoV-2 will have some degree of symptoms eventually.

  • The primary means of transmission remains respiratory droplet spread when people are in close contact for extended time periods. While it may be possible to walk past someone and contact the virus in lingering aerosols, it is unlikely that this is a frequent mode of transmission. Likewise, it seems that spread via surfaces may not be as worrisome as initially thought. This is related to a concept called “viral load”, which describes how much virus a person is exposed to. Aerosols and surfaces may not provide enough viral load to reliably cause infection. That said, this is no reason to stop washing your hands or to start licking public countertops. Hygiene is still king! The real take-home is that you should be selective about who you spend extended periods of time around, as that is likely the highest risk activity.

  • Long-term lung and heart injury is possible after infection, even when otherwise healthy individuals contract the illness. The specifics are not intimately understood, but this should provide rationale for not “just going out, getting the virus, and being done with it.” The risk of such ongoing disability is very low, but it exists.

  • Infection generally confers some degree of immunity. There are surely some individual determinants of how long that immunity lasts and how robustly it manifests. It is estimated that most recovered patients will enjoy months or years of immunity, and they will likely have milder cases should they contract the illness again later.

  • A “second wave” is almost a certainty. No one knows whether it will be a large spike or a more attenuated one. Perhaps a bigger question involves how society will respond. Will we shut down again? Will we instead choose to shelter only those who are vulnerable? I suspect it will be a piecemeal response in the US, running the full gamut with little overarching coordination. Could get interesting!

  • A safe, effective vaccine is still quite a ways off, but progress is being made. In the past weeks, announcements have been made regarding various projects, and often times stock prices for these biotech companies jump upon such announcements. However, these are early trials, often trying to establish safety in small groups of 10-50 people. You might imagine, that’s a far cry from having data to suggest safety and efficacy across a population. We’re getting there, but I don’t suspect we’ll see a safe, effective, widely deployable vaccine in this calendar year
or perhaps even next year.

  • Ultimately, we may need to move toward “herd immunity”, but we are still a long way from approaching this. Given the sickly nature of our general populace, we need to proceed with measured pace. This is where, unfortunately, our country’s poor health handicaps us economically. In the end, payment is always due.

  • We are only a few months into this pandemic! It may seem like forever, but the pace of scientific advance has been incredibly fast when we consider the timeline. There is much yet to learn, but don’t discount the fact that we have been progressing by leaps and bounds, in a manner not typically seen in immunologic and public health science.

As things progress, I will send updates when it makes sense. At this time, I don’t see a need for weekly or even biweekly emails. However, as always, please contact me with any question that may arise. We may do some COVID specific podcasts in the coming weeks and months as well, especially if there are any topics you’d like me to dig into with more depth.