Thoughts on Covid-19: Domumention For My Grandchildren That I Was Wrong About Everything
I have had a few people ask my opinion about the Covid-19 pandemic recently – my predictions on treatments, lock downs, and opening up the economy. At the same time I have been reading the book The Great Influenza, by John M. Barry, about the influenza pandemic in 1918, which has reminded me of some features of infectious disease and virology that I had long forgotten from medical school. I am not an infectious disease specialist or a soothsayer, and my guesses and opinions on this pandemic are no better than anyone else’s. But the fact that, in some respects, I am at odds with both sides of debate on how to respond as a society to this pandemic makes me feel that at least I don’t have as much political bias contributing to my attitude as others might. So here are a few of my reflections from the last few weeks on the topic.
First of all, the world’s reaction to this crisis demonstrates how uncomfortable human beings are with things they cannot predict or control; and the genetic mutations and passage of the Covid-19 virus is something that is very difficult to predict or control. Also, when bad things happen, it is human nature to want to blame someone for it. And while hindsight is 20/20, there is no one, in all fairness, that is to blame for this catastrophe. (Except the Chinese Communist Party. They are all going to hell for this.)
Also, I have been reminded of two features of viral genetics, one that terrifies me, and the other that gives me hope. The first is the concept of Serial Passage of viruses. This is the phenomenon, both in vitro and in vivo, where when a virus first “jumps species,” that with each subsequent passage from host to host in the new species, it gets more efficient at infecting the next host, and thus more virulent. This is thought to be the reason that the first wave of the Spanish Flu, in the spring of 1918, was mild compared to the second wave in the fall of 1918. If this type of change is happening with Covid-19 it could also partly explain why the outbreak in China was not as bad as the one in Italy (more likely, China just lies), or why the west coast outbreaks in the US were not as bad as the east coasts’.
The second is the statistical and genetic concept of Regression Towards the Mean. When applied to infectious disease, this means that viruses and bacteria that are extremely virulent tend to mutate to less dangerous forms over time. There is already some evidence that this is happening to the Covid-19 virus. Researchers at my alma mater, Arizona State University, have found a strain of Covid-19 with a sizable deletion of genetic material. This deletion is similar to one found in the corona virus that caused SARS in 2003, which is thought to have weakened the virus to the point that we hardly worry about or talk about it anymore.
So, if we are currently between phases of this pandemic, and the virus is getting more virulent like the flu virus from 1918, then we may be in big trouble come next fall and winter. If the virus is regressing toward the mean, and the virus is getting weaker like the SARS virus did, then we have reason for hope. The trouble is, no one, even the smartest epidemiologists, know how this virus is going to behave.
My second musing on the Corona Virus Pandemic of 2020 is a reminder of why medical science is hard, takes time, should be done carefully, and only in times of crisis should be done in desperation. At the beginning of this pandemic I told a prominent Republican politician I know that, although I didn't have any strong criticisms to his response to this crisis, I cringed every time President Trump tried to speak like a doctor about it. He asked why. I told him that good doctors approach any new treatment for any disease with caution and skepticism, and is trained to try to ignore anecdotal evidence, and Trump just doesn't do that. That’s not say that we are not hopeful that new treatments for this virus will work. Heck, if there was evidence that essential oils worked against the Corona virus I would be recommending it and maybe telling people to strap an onion the their foot. But what happens in the real world is that in a vast majority of medical trials the null hypotheses are proven and the treatments are shown to be ineffective.
That being said, much of what we are doing currently to try to control this pandemic also has limited evidence. How well does social distancing really work? Are the draconian measures some states and countries are taking really more effective than less stringent measures? Do masks help? We might not know the answers to these questions for years.
So, with all this information and insight, and lack thereof, what should we be doing right now? I don’t know. I am still taking precautions myself– wearing mask when I go in public, trying to stay 6 feet away from people, screening and separating potential Covid-19 patients when they come to my clinic and wearing personal protective equipment when I see them. Despite the most optimistic predictions, I am not counting on a vaccine in the next 1-2 years. (They usually take over a decade to develop, but I hope we get lucky.) While we are getting antibody testing soon, we still don’t know how much protection we have if we have antibodies. At the end of the day, unless we all decide to huddle in our respective caves while our economies and civilizations collapses into the dark ages, we may, like our ancestors, have to learn to live with a significant risk.
