40% of world’s new COVID-19 cases came from the United States! But There’s Hope in “Herd-Immunity”
Guest in Central Time from Milwaukee
Host’s Intro: The Covid-19 coronavirus pandemic continues to escalate around the world. Dr. Margaret Harris, a spokesperson for the World Health Organization, told reporters on Tuesday, March 24, 2020, that 40 percent of new cases were from the United States. Does that correlate with your on-the-ground perspective as a doctor?
Q&A: ANSWER: It makes sense considering these are well known “hot zones” for COVID-19 and currently bearing the brunt of the increase. I have not seen such a dramatic surge in cases where I practice in Milwaukee, but Dr. Harris has access to data that I do not have.
QUESTION: Why is there such a disproportionate geographical increase in COVID-19?
ANSWER: There are a couple of reasons. Until the pandemic is contained, we know that each person infected with COVID-19 will infect 3 people with the virus. Simple math tells you that unchecked, 1 person can cause 4.7 million cases in 2 weeks. Second, the origins of COVID-19 in China was also the origin of the SARS epidemic 17-18 years ago; Asia remembers the panic that SARS created. I was there at that time and saw it up close. To the western world (not affected by SARS) the SARS outbreak was more of an abstract concern and so the memory is dim. When COVID-19 was recognized, at least after the initial mishandling by China, areas of Asia reacted promptly and vigorously and were able to contain this epidemic within their borders. However, there was a more sluggish response by the western world that has allowed this to become a pandemic.
QUESTION: Do you think this pandemic is the fault of the western world?
ANSWER: No not at all. This was a novel virus, meaning it was unknown prior to 4 months ago. This family of viruses, the Coronavirus family, was well known prior to this outbreak. However, the COVID-19 strain was not. When this began it was not recognized as being a big problem. This was compounded by where it started and the mishandling of the outbreak by the Chinese government officials who place constraints on science and medicine for political purposes. This allowed the outbreak to become an epidemic, and then a pandemic.
QUESTION: Where do we go from here? Are we all going to die?
ANSWER: The first rule of an epidemic is to protect the uninfected; that is how an epidemic does not become a pandemic, and how once a pandemic is present, it is contained. No, we are not all going to die from COVID-19. 98-99% of those who are infected will do just fine. We expect the death rate to be 1-2%. Also, there is encouraging news regarding treatment protocols. More data is needed to determine what is the best combination of drugs, who should get it, and how long should the treatment last. These medications have significant side effect profiles, so you don’t want the cure to be worse than the disease.
QUESTION: Are we coming down to choosing if we save lives or do we save the economy?
ANSWER: It is not a binary choice. President and his team are trying to find that balance. It is not either-or, but what is the best balance. If the economy is destroyed there will be tremendous suffering and lives lost from that. We should stay the course, continue prudent precautions to protect the at-risk population as well as those not as vulnerable. The development of “herd immunity” as well as a vaccine will be significant aspects in containing this pandemic.
QUESTION: We know about vaccines; but a COVID-19 vaccine may be a year away. Meanwhile, there is something scientists and researchers call “herd-immunity.” What exactly is “herd-immunity”?
ANSWER: The vaccine trials are underway in animal testing, and hopefully human testing will follow soon. COVID-19 vaccine development is being fast-tracked. “Herd-immunity” is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, whether through previous infections or vaccination, thereby providing a measure of protection for individuals who are not immune. For example, measles is much more contagious than COVID-19: the average measles patient will infect 12-18 people (vs. COVID-19 patients infecting 3 others). The reason that there is not a measles pandemic is because of “herd-immunity”; there is a critical mass of patients who have either had measles, or received the measles vaccine, and are thus immune. We know that people who have become infected with COVID-19 develop antibodies to it, which have been harvested in the plasma and used effectively in treating critically ill COVID-19 patients, with success. Most of those infected should be immune to COVID-19, and not subject to re-infection.
QUESTION: What percentage of the population is needed to have had the infection or the vaccine to develop effective “herd-immunity”?
ANSWER: As a general rule, 83-90% of a population is required to have been infected or vaccinated to develop “herd-immunity”. However, the level required for COVID-19 is still an open question since it is novel virus, and we are learning more about it every day.
Dr. Mark Bruce is an emergency room physician and the Ambassador to Belize and Canada for the American College of Emergency Physicians. His most recent book is ‘Jackie, a Boy and a Dog: A Warm Cold War Story’, about how First Lady Jackie Kennedy gave him a puppy when his dog died.
