In mid-March of 2020, the US imposed a travel ban, schools, restaurants and many other public places closed and people were ordered to stay at home in response to the outbreak in Wuhan, China of a new, very infectious and lethal coronavirus variant. This family of viruses is very common, but this was a very unique variant. The virus was named SARS-Cov-2 (Sudden Acute Respiratory Virus Coronavirus 2). This virus spread very rapidly around the world, and until we got a better handle on how to treat acute infections, many people died. It was quickly determined that this was a respiratory virus, easily spread not just by sneezing or coughing, but just by breathing, even without any other symptoms. Panic set in, and everyone was sterilizing their food, mail, hands excessively and we became very paranoid. We now know that this virus spreads very little from surface contact but it does hang around in the air for a short period of time.
We also quickly determined that unlike the flu, this virus was not seasonal and did not go away in the spring or summer.
The scientific community and world governments came together to allow for the rapid development, testing and subsequent administration of vaccines against this infection. These vaccines are credited for saving many, many lives and limiting the degree of infection and subsequent complications for many millions.
Despite that, as of this week, worldwide, 680 million people have been documented to have contracted what we called Covid-19 and 6.8 million have died as a result of the infection. A 1% death rate. A far cry from the death rate of other viruses like Ebola, SARS 1 or MERS, but because of the sheer numbers of infections, many more died from this virus. The US was affected disproportionately. With only 4% of the world’s population, we accounted for 15% of the cases and deaths. This may be somewhat skewed by our more accurate and reliable reporting infrastructure, but we still were affected to a greater degree than most other places. This is despite boasting the “best” healthcare system in the world. The simple fact is that we are the unhealthiest population on the planet, and as we determined risk factors for contracting and suffering from COvid-19, prior health status is the biggest risk factor. Just being overweight is the most common significant risk and 75% of Americans are overweight or obese.
Although case numbers, hospitalizations and deaths continue to slowly drift down, ~ 300 people a day continue to perish from this infection. It was the 3rd leading cause of death, behind cardiovascular disease and cancer but has now dropped to #7 behind accidents, lung disease, strokes and Alzheimer’s Disease.
Although death statistics remain accurate, case numbers are not since the reporting systems have essentially been dismantled. Johns Hopkins, relied upon by the world over for accurate data collection, is no longer tracking Covid and even the World Health Organization is only giving weekly reports. Many people are not even bothering to test anymore. Some employers and even schools are even discouraging testing since it would impact on people schedules and employment.
The attitude we now have about this virus and other infections is pretty pathetic. Schools don’t even want parents to test their kids. We just don’t want to know because it is a nuisance to deal with. This attitude will come back to bite us in the ars.
Wet market vs lab leak?
We will never know for sure, and it doesn’t matter. What matters is what we learn from this pandemic and how we prepare for the next one. And there WILL be a next one. There already are smaller “next ones”. As I write this, there are multiple outbreaks of the Marburg virus in Africa. The virus, transmitted through body fluids and has an 88% death rate. Imagine this death rate, combined with the infectiousness of the SARS-Cov-2 virus we are still dealing with!!! That is a nightmare scenario.
As far as where it came from goes, the majority of the data seems to be shifting back to the wet market in Wuhan, and a natural spillover from a wild animal as being ground zero for this outbreak. The lab-leak theory still has some support, but as genetic material continues to be revealed, the market and transmission from wild animals looks more culpable.
Initially, it was thought to come from bats, well known to harbor many viruses lethal to humans including coronaviruses, but now we have identified a number of other live, wild animals which were sold in that market which are known to harbor coronaviruses.
A lot of information is coming out now pointing to the Racoon Dog. This is neither a racoon or a dog, but a relative of the dog, having some similarities to the racoon. It is bread for its fur and meat. Other animals are also being considered. SARS 1 was carried by the Civet cat, a popular meat in Asia, and it also appears to carry SARS-Cov-2. Other contenders include the Malaysian Porcupine, Hedgehog and Bamboo Rat. All these animals were piled on each other in cages, and sold live. These unnatural environments and crowded conditions are breeding grounds for infections. And these wet markets are not limited to Asia. There were many in NYC and many other large US cities at the start of this pandemic and some have now reopened. We just won’t learn.
There is a lot more than just Covid out there.
Everyday, I see people with a variety of infectious ailments. But despite our experience with this pandemic, attitudes about illness transmission seems to have gone by the wayside. The simple practical recommendation to “stay home if you’re sick” is superseded by “I’ve been cooped up for 3 years so I don’t care anymore”.
I even see this attitude amongst some of my peers. They are not irresponsible physicians. They just seem desperate to want to get back to how things were. And quite honestly, things were not that great before the pandemic. Burnout and early exit out of healthcare was a problem before and it is even worse now.
As far as how we move on and deal with, not just Covid, but other infections, is to try to adopt a practical approach. This virus is still very much with us and continues to cause a lot of problems. It continues to mutate and it is unpredictable. Personally, I continue to mask in certain environments. Definitely in the office. Definitely at Wawa (just too much traffic through there). If I go to a grocery store at 7 am, I don’t, but at 4 PM, when there are many people around and many have gone through during the day, I do. I test myself before going to events where there will be others, especially if some are at greater risk of getting sick. In fact, I just tested myself this morning. I am joining my father and brother to go skiing at Gore Mountain in upstate NY this weekend and I want to make sure they are safe. At 84, my dad is a beast. Still skiing in the Rockies and playing tennis as often as he can (he is nationally ranked in Canada). A model of activity and positive approach to life.
I was negative this morning. For whatever reason, I continue to have been spared this infection, despite my significant exposures at work and some events I have attended.
If you are unfortunate enough to get Covid, the practical advice is to isolate for 5 days from symptom onset or positive test. But it is not over at that point. Then you must continue to wear an N95 mask for the next 5 days when around others. Remember that 15% of people remain infectious at day 10!!! Don’t bother re-testing. A negative test can be a false negative (false positives are much less common), and you can continue to have a positive home test for even a few weeks after you are no longer infectious. DO NOT RELY ON A NEGATIVE TEST AFTER YOU WERE INFECTED TO JUSTIFY EARLY EXIT OR UNMASKING!
Unfortunately (at least in my opinion) Covid booster vaccines are no longer offered every 6 months. Although that policy is being revisited for people at risk (which is really most people) as well as those in high risk environments. Only 16% of eligible people received a bivalent booster as it is.
It’s been 3 long years. But this disease is not gone and won’t be for a long time, perhaps never. It’s part of our environment and we need to deal with it.
Do what makes sense. Not what’s convenient.
Have a great weekend.
Stay Safe and Be Well.
AC