York County Medicine Summer 2020 - 31

YO R K C O M E D S O C . O R G

of 1918. Today we have immunizations against influenza. This
author gets it every year, and recommends it for most people, even
though it is not perfect.
Finally, we come to the current epidemic: Corona virus-
called COVID-19. It appears to be the most threatening epidemic
we have confronted in a century. The status of this epidemic
is changing rapidly, and aspects of it may be quite different by
the time one reads this article. The potential for mortality from
COVID-19 is high enough that we are taking extraordinary
societal measures to retard it, which tragically are incomplete,
inadequate, applied inconsistently, and have been started too
late. We have never previously practiced social distancing on a
large scale in my memory. The human race has not previously
encountered this virus, and has no resistance against it. The news
media refer to it as a "pandemic," which means everybody is
affected. At this writing less than one percent of the population
is known to be infected, so this author believes "epidemic"-a
disease upon the populace, but not infecting everybody-is more
appropriate. It has, however, been spread worldwide. In medical
school "CDC" was an abbreviation for "Communicable Disease
Center." That was changed to broaden its scope: it now stands for
"Center for Disease Control." To me this reflects that we had not
been seriously troubled by epidemics for decades.
It arose in China, in Wuhan, is highly contagious, appears to be
spread by contact with respiratory droplets, which one may inhale.
The virus can live in these droplets for a period after leaving the
body; so, it can be transmitted by touching surfaces contaminated
by infected droplets, and then touching one's food, mouth, nose or
eyes. It has also been found in sewage. It probably affects many
tissues in the body. The symptoms include joint and body aches,
fever, dry cough, sore throat, loss of sense of taste and/or smell,
shortness of breath, weakness, and others. When it affects the
lungs, oxygen transfer to the blood may be severely compromised,
reflecting respiratory failure and needing a ventilator to sustain
life. Five months into it we now know that it spreads rapidly
among groups of people such as church congregations, cruise ships
and navy vessels, prisons, nursing homes, some factories such as
meat packing plants, and probably schools. If one member of a
household contracts it, it is expected that everyone in the house
will become infected. If a member of a household goes forth
and acquires the infection, it will spread to everybody in the
house, including any elderly, who are at high risk of dying from
it. If an infected person visits his/her neighbor, that household
may become infected. Individuals can be infected and probably
contagious without having symptoms. There are reports that pets
may carry it, and could bring into a house.
The overall death rate may be as high as six percent. It has
been found that the elderly are much more likely to die from it,
especially those with chronic diseases, which include underlying
heart or lung disease, diabetes, and obesity. The death rate among
children and young adults is much lower, but not negligible. There
are clearly people who have tested positive, but who have not been

ill. It is suspected they are capable of transmitting the disease to
others. It is not known if surviving the disease confers long-lasting
immunity, or if one can get it again. There have been anecdotal
reports of persons benefitting from receiving convalescent serum.
It is not known how long one is contagious. A recent report
indicated it may be as long as five weeks. Shortly before this article
is drafted there are reports of the length of hospitalization being
shortened by Remdesivir from 15 days to eleven days, but it did
not convincingly reduce mortality. These persons are still in the
hospital for a week and a half. There is no vaccine yet. Testing is
far from adequate. We are left with social distancing as a way to
limit the spread of disease. Quarantine for two weeks, it is hoped
is sufficient for a person to lose their contagious potential, but
that may not be adequate. Wearing masks and staying six or more
feet away from others, washing hands frequently, and disinfecting
flat surfaces are measures we rely on to avoid dissemination of the
disease. These measures need to be complemented by widespread
testing, aggressive contact tracing, and rigorous enforcement of
isolation of infected individuals. The current program is retarding
the spread of the disease, but not yet containing it, as there are
more cases and deaths reported daily from most geographic areas.
If a community succeeds in eliminating it, that community is
at risk of having it re-introduced by an infected individual who
enters the community, whether that individual is symptomatic
or not. Currently there are municipalities and states that are not
mandating social isolation. At this writing the President has just
ordered that closed meat packing plants to be re-opened, despite
the dreadfully high rates of infection and positive testing among
those employees. Recent projections show a vast increase in cases
and deaths if we relax our precautions.
This article has discussed eight infectious diseases. We have not
mentioned a number of others such as cholera, typhus, typhoid,
hepatitis, yellow fever, Ebola, Zika, diphtheria, tetanus, common
childhood diseases, fungal and parasitic diseases, venereal diseases,
or surgical infections. We immunize against some of these, have
good therapies for some, and treat others with rigorous isolation.
Several of these are far more serious than COVID-19, but we
have been blessed in not being subjected to them because of
medical and public health advances. Closing down non-essential
business and gatherings for social distancing has been a response
unique to this epidemic. It is having serious economic, social,
and psychological consequences with which we do not have
prior experience. Until an effective vaccine or therapy becomes
available, all we have to control it is social isolation. If that fails or
is abandoned most of our younger population can be expected to
survive it and hopefully become immune, but a large fraction of
our elderly people will probably die of it. Ultimately it is hoped
effective immunization will become available to control it.
*La Boheme and La Traviata

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York County Medicine Summer 2020

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