Author Topic: COVID-19  (Read 275 times)

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Offline Ron Estey

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COVID-19
« on: June 09, 2020, 03:09:13 PM »
I listened today during our meeting to members commenting on Covid-19.

 I think that there is a great deal more to be learned about Covid-19 and it is still too early to draw conclusions about it. I am quite optimistic about our chances. Here are some of my thoughts, and some opinions of others, which might be of interest to some of you. These are thoughts and not medical advice.
 
For those of you who wish the short version - here it is:
If COVID-19 turns out to be a seasonal virus with low mutation capability, the peak has likely passed and we are unlikely to experience a second wave.. If, on the other hand, COVID-19 continues to live in the population like chickenpox or measles, we are at risk until herd immunity occurs, either by vaccination or much of the population becomes infected and recovers.

My personal belief is that for the members of the Golden Rods and Reels, smart social distancing is going to be recommended for a while. We are unfortunately at risk of serious consequences if we catch COVID-19 and thus must remain cautious.
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The long version is as follows:
First - an overview of human coronavirus infections:
Coronaviruses causing human illness and fatalities is a 21st-century problem and each of the 3 best-known ones have unique qualities.

Infection with SARS coronavirus (SARS-CoV) can cause a severe viral respiratory illness. SARS was first reported in Asia in February 2003, though cases subsequently were tracked to November 2002. SARS quickly spread to 26 countries before being contained after about four months. More than 8,000 people fell ill from SARS and 774 died. Since 2004, there have been no reported SARS cases.
SARS summary:
Pathogen: SARS-CoV
Total worldwide number of cases: 8,439, 21% of which developed in healthcare workers
Number of cases in Canada: 438 probable, with 44 deaths
Total number of deaths worldwide: 812
Case fatality rate: 9.6%
Mode of transmission: Droplets produced by coughing, sneezing, talking, or breathing
Mean incubation period: 5 days
Key symptoms: A cough (dry at first), a fever, and diarrhea in the first or second week of illness,
   or both
At risk groups: People with underlying medical conditions
Treatment: No specific treatment
Vaccine: No vaccine

Middle East respiratory syndrome (MERS) is a viral respiratory disease that was first reported in Saudi Arabia in September 2012 and has since spread to 27 countries, according to the World Health Organization. Some people infected with MERS coronavirus (MERS-CoV) develop severe acute respiratory illness, including fever, cough, and shortness of breath. From its emergence through January 2020, WHO confirmed 2,519 MERS cases and 866 deaths (about 1 in 3). Among all reported cases in people, about 80% have occurred in Saudi Arabia. Only two people in the United States have tested positive for MERS-CoV, both of whom recovered. They were healthcare providers who lived in Saudi Arabia, where they likely were infected before travelling to the U.S., according to the CDC.
MERS summary:
Pathogen: MERS-CoV
Total number of cases: 2,519
Number of cases in the U.S.: 2
Total number of deaths: 866
Case fatality rate: 34.3%
Mode of transmission: Droplets from person to person, unclear from camels to humans
Key symptoms: A fever, a cough, shortness of breath
At risk groups: Men above the age of 60, particularly those with underlying medical conditions
    such as diabetes, high blood pressure, and kidney failure
Treatment: No specific treatment
Vaccine: No vaccine

In January 2020, a novel coronavirus, SARS-CoV-2, was identified as the cause of an outbreak of viral pneumonia in Wuhan, China. The disease, later named coronavirus disease 2019 (COVID-19), subsequently spread globally. In the first three months after COVID-19 emerged nearly 1 million people were infected and 50,000 died. The coronavirus SARS-CoV-2 is the pathogen that causes COVID-19. The virus has a close resemblance to SARS-CoV. To date, cases of COVID-19 have been reported on every continent except Antarctica. Governments across the world have responded with varying degrees of social distancing measures in a bid to curb the spread of the virus.
COVID-19 summary:
Pathogen: SARS-CoV-2
Total number of cases worldwide: 6,826,950
Number of cases in Canada ; 96,614 and 7,895 deaths
Total number of deaths worldwide: 401,000
Case fatality rate: 1.38% to 3.4%
Mode of transmission: Droplets produced by coughing, sneezing, or talking,limited evidence of
   other routes
Mean incubation period: 5 days
Key symptoms: A fever, a dry cough, shortness of breath
At-risk groups: Adults aged 65 and over, and people of all ages with underlying medical conditions
Treatment: No specific treatment, although several candidate drugs are undergoing testing
Vaccine: No vaccine, although several candidate vaccines are in development.

Research evidence suggests that SARS-CoV and MERS-CoV originated in bats, and it is likely that COVID-19 did as well. SARS-CoV then spread from infected civets to people, while MERS-CoV spreads from infected dromedary camels to people. Scientists are trying to determine how COVID-19 spread from an animal reservoir to people.

SARS and MERS have significantly higher case fatality rates than COVID-19. Yet COVID-19 is more infectious — the underlying SARS-CoV-2 virus spreads more easily among people, leading to greater case numbers. Despite the lower case fatality rate, the overall number of deaths from COVID-19 far outweighs that from SARS or MERS. According to the WHO, about 80% of people recover from the illness without needing treatment in a hospital. However, they note that approximately 1 in every 5 people who get COVID-19 become seriously ill and may develop difficulty breathing.

Older people, as well as those with underlying medical concerns, such as chronic lung disease, heart problems, diabetes, or cancer might be at higher risk of severe illness from COVID-19.

“Containment” due to lockdowns has been highly successful in isolated populations such as New Zealand, Iceland, Prince Edward Island, and Vancouver Island where there weren’t many active cases, to begin with, and they were easily tracked, and the lockdown commenced quickly. In fact, it is my belief that right now it is as good as it might ever be on Vancouver Island and for the majority of the population the lockdown is of no benefit. I believe social distancing has been very helpful for the most vulnerable to serious complications of COVID-19. Containment (lockdown) works well on less infectious viruses such as SARS and MERS. I believe that because COVID-19 is highly infectious, and the majority of people infected have no symptoms, containment might not be very successful.

There is some evidence that the peak of infectivity lasts only a couple of months in a population that has not used lockdown effectively. I will have links to that later.

In my view, and this is admittedly a gross oversimplification of a complex issue - virus infections typically run 2 courses - seasonal or continuous. Seasonal viruses such as influenza occur cyclically and the cycles can be annual, or spread out over years. Other viruses are with us all the time such as measles, chickenpox and polio, but are masked by herd immunity.

Influenza, the seasonal virus that we are most used to, occurs during  November to April on Vancouver Island. Influenza appears to mutate easily and as a result we are exposed to new strains every year. It travels slowly from west to east, with most strains seemingly to originate in China or other parts of Asia. This gives us Canadians an advantage, as by the time it gets to us the new strains have been identified and a vaccine has been tweaked to provide protection. Usually the vaccine we get protects us from more than 1 strain of influenza. Influenza is not as infectious as measles, and likely about as infectious as Covid-19.

What is really important to realize is that for many viruses, especially the more infectious ones, herd immunity is really important to protect our most vulnerable citizens. The elderly, and those with significant morbidities such as chronic lung disease, heart disease, inflammatory disease, chronic kidney disease and cancer (and old age) all have a poor response rate to immunization. Nevertheless, enough do get protection that it is advisable that all these people get vaccinated annually. However if everyone who lives with them, or looks after them, or visits them, is immunized, they are safe. This is herd immunity in action. This is why there is so much hope and effort directed at finding a vaccine for COVID-19. As it does not seem to mutate significantly ( similar to polio, measles and chickenpox), a long-lasting vaccine might be extremely valuable and might confer long-lasting immunity like what has worked for polio. 

There is another type of herd immunity that might be relevant to COVID-19. That is, the majority of the population gets infected, and becomes immune. After a significant amount of the population is immune, the virus basically stops spreading. This is likely what has happened and is continuing to occur in parts of the US, and Europe. This may have happened in New York and New Jersey, because containment efforts were too late to be genuinely effective. This type of herd immunity does work with less infectious viruses and some models suggest that COVID-19 might be one of these.

Several highly educated people have commented publicly about the futility of lockdowns, and were subject to much criticism for their thoughts, particularly as they felt that containment came too late for certain populations and was completely ineffective in many parts of the US and Europe. Please recognize that there is a difference between lockdown and smart social distancing. There is a message of optimism in their opinions - the worst is over for most populations...I am providing links to these people, as I think it might provide some balance to my dissertation.

Michael Levitt, a highly respected Nobel prize winner is one of them. Here is a link:
https://www.latimes.com/science/story/2020-03-22/coronavirus-outbreak-nobel-laureate
And a 12 minute YouTube critical of containment efforts in the US.
https://www.youtube.com/watch?v=icIfbmqvt0g

Isaac Ben Israel who predicted COVID-19 to be a 70 day epidemic in any given population.
https://www.timesofisrael.com/i-was-right-says-prof-who-predicted-pandemic-would-play-itself-out-in-70-days/

Ivor Cummins, as always, provides an engineer’s perspective
https://www.youtube.com/watch?v=-VLW0_XlWl4&t=15s

Carl Heneghan feels that the damage caused by the lockdown was worse that the epidemic in the UK https://ca.news.yahoo.com/lockdown-damage-outweighs-coronavirus-warning-121940675.html

Dr.. John Ioannidis
https://www.cnn.com/videos/tv/2020/05/01/making-sense-of-emerging-coronavirus-data.cnn

The more infectious viruses such as measles are only temporarily prevented by herd immunity if individuals remain without any immunity. Thus every few years pockets of measles occur in communities that are “anti-vaccine” believers.

If COVID-19 turns out to be a seasonal virus with low mutation capability, the peak may have already passed in BC, and we may be on the verge of returning to normalcy, with less ongoing concern for the most vulnerable for severe illness in our society. If, on the other hand COVID-19 continues to live in the population like chickenpox or measles, we are at risk until herd immunity occurs, either by vaccination or much of the population becomes infected and recovers.

My personal belief is that for the members of the Golden Rods and Reels, social distancing is going to be recommended for a while regardless of what sort of infection pattern COVID-19 has.