By Zachary Moser, Pharm.D., BCPS (Board Certified Pharmacotherapy Specialist)
Is it Hydroxychloroquine? Face coverings? Herd Immunity? Nuclear Winter? We will explore the options in this article.
The Basics – What is COVID-19?
COVID-19 (herein referred to as Covid, C-19, Coronavirus, Corona, etc) is primarily a respiratory virus in coronavirus family, which is related to SARS, MERS, and some strains of the common cold.
Covid has been reported to have myriad signs and symptoms, ranging from mild cough to acute respiratory distress syndrome. Though it most commonly affects the lungs, it also appears to have some general vascular effects as well. There have been reports of increased blood clots and syndromes caused by clots, like stroke. Some infected people have even required amputation of fingers and toes.
How do I get it?
Even though Covid affects multiple body systems, the primary method of infection is by breathing in viral particles. There are three main ways Covid can be transmitted.
Fomite Transmission
- What is it? This is when someone sneezes or coughs and viral particles end up on the doorknob or counter. When you touch the doorknob, then touch your face or mouth, you can infect yourself with the virus
- How do we prevent it? Washing your hands and avoiding touching your face are almost completely effective at preventing this type of transmission.
Respiratory Droplets
- What is it? This is when someone sneezes or coughs and viral particles float in the air on tiny but not microscopic droplets. These usually fall to the floor or other surface relatively quickly, but they can be propelled as far as 6 feet by talking, singing, sneezing, or coughing. If you are within this 6 feet, breathing in these respiratory droplets will transmit coronavirus. This is the most common method of transmission.
- How do we prevent it? Face coverings are highly effective at preventing this type of transmission. By blocking the droplets from being expelled further away, the chance of transmitting the virus to someone else is greatly reduced. In addition to social distancing when possible, consistent face mask usage has been associated with a 40% drop in infection rate.
Aerosols
- What is it? This is when someone sneezes or coughs and viral particles themselves become suspended in the air. These can stay suspended for long periods of time, though it is not currently known how long the virus stays infectious in this condition.
- How do we prevent it? This is the most difficult to prevent. Face coverings will not block aerosols in either direction. However, many aerosols are generated by dispersion of respiratory droplets, so masks can still help by reducing the number of droplets. In hospitals, N95 masks and negative pressure rooms reduce the risk from aerosols. In public, social distancing, face coverings, and hand hygiene are the best options.
So How bad is it, really?
Well, we haven’t really figured out the best way to answer that question, yet. We know that it seems to be more severe in the elderly and those with other pre-existing diseases, such as heart disease and obesity. Low-income and minority groups also seem more susceptible than the general population, likely due to less access to healthcare. However, there have been cases and deaths in all age groups and demographics. No one is completely safe from Covid, even if you’re already had it once.
The Numbers
View the CDC interactive tracker here.
The current death rate in the United States is 3.4% of positive cases.
Only about 1.5% of Americans have tested positive.
You mean, I have a 97% chance of recovering? Why should I care then?
Well, one study out of Germany showed that 78% of the study participants had long term structural changes to their hearts. Other studies indicate that Covid causes long term lung scarring (pulmonary fibrosis) that is irreversible and cannot be healed in about 30% of those infected. People infected with Covid are likely to experience lung problems in the future, leading to an increased risk of death from future illnesses.
The Numbers (Again)
Let’s pretend for a minute that we let COVID-19 “run its course,” as some people have suggested. Scientific estimates show that we would need about 60-80% of the population to be infected for us to develop herd immunity. For the purposes of this thought experiment, we will look at the numbers assuming a 70% infection rate and a slightly lower 3% death rate.
- 230,000,000 positive cases
- 6,900,000 deaths (more than the population of the entire state of Missouri)
- 170 million Americans with long term heart changes.
- 60 million Americans with long term lung damage
This approach would wipe out the population of an entire state.
This approach would wipe out the population of an entire state. How do you think that would affect the economy? How many Americans would lose someone important to them too soon? Sure, there will still be about 160 million Americans who are totally fine after it’s all said and done. But that means that nearly one out of every two Americans will be permanently affected by Covid. Luckily there is a better way.
One of every two americans will be permanently affected by Covid.
Here is how to Beat it
Hand Hygiene and Social Distancing
It’s almost impossible to get Coronavirus if you stay at home. Even when you must go out, staying at least six feet (or two meters, the further the better) away from others greatly reduces your risk of being exposed to the virus. If you must be closer than 6 feet, wearing a face covering also reduces the risk.
Also, keep in mind that the amount of time you are exposed to someone increases your risk of transmission. This is why eating inside a restaurant is considered high risk, but going to the grocery store is not as risky. You may pass by many people in the store, but you don’t typically stand in their space breathing their air for 15 minutes at a time. When you think about it like this, it becomes more clear what activities are high risk and what is lower risk.
Face Coverings
As discussed above, face coverings are a simple and effective method of reducing Covid transmission. The pandemic has been much less severe in countries that have widespread mask usage.
See the following links for more reading and evidence.
Vaccine
There are currently more than 165 vaccines in clinical trials. There are many different ways of making a vaccine, so it is good that we are testing many different versions at once. Usually the process would take much longer because they would do each of these iterations separately, but instead they are doing them all side by side. The vaccine is still going through trials and will still have the same safety and efficacy requirements before the FDA will approve it.
With the huge number of infections needed for herd immunity, and the unfortunate news that natural antibodies don’t seem to last very long, a vaccine is likely our only long term chance at returning to normalcy. There will be many concerns about the safety of any Covid vaccine, and rightfully so. But I believe that any vaccine will be exponentially safer than a world without the vaccine.
What we Can’t Rely on
Hydroxychloroquine
This will not go away. Watching my professional colleagues continually “move the goalposts” on hydroxychloroquine has been terribly disheartening. First, it only worked in combination with azithromycin. Then, when that was shown to be harmful, it was HCQ by itself. Then, it was “given too late” to do anything. Then, when it was studied prophylactically, it turned into “you have to give it with Zinc.”
This is exhausting. We have more than enough evidence to show that HCQ does not work. Get over it.
Remdesivir
Though I am a pharmacist, I won’t be supporting any pharmacological therapy for Covid. I don’t believe anything we currently have has the slightest chance of working against this new coronavirus. Remdesivir is no exception. So far, the evidence has been unconvincing at best. There is still a chance, but it’s becoming increasingly unlikely. Prevention, not treatment, is where we will make the most progress on this pandemic.
Thoughts and Prayers
As we discussed in our thought experiment above, doing nothing is simply not an option. Unless we want to to create another generation of Americans permanently scarred by a disease, we cannot leave it up to chance or the survival of the fittest. These are not just 7 million anonymous faces, they are 7 million grandparents, mentors, brothers, sisters, pastors, teachers, and much more. They are people. They are worthy of our protection.
So let’s protect them. Wear your mask if you go out. Stay home when you can. Wash your hands. Stay safe.
