The Fight of Our Time: COVID-19
Unprecedented Pandemic and the Critical Information We Need In Order to Make Informed Decisions
Why would I read another article about Coronavirus that doesn’t include breaking news or a catchy-yet-terrifying headline, you might be asking yourself? We are living in the midst of a movie script riddled with moments of reality. We are living amongst stacks of excessive paper goods, non-perishables, and cleaning supplies you’ve never used before, lining the halls of your apartment, if you’re like me stuck in quarantine in New York City. We are living with the news on in our homes twenty-four hours daily and every conversation overheard on the street is about “the virus”. But, we are grateful we are safe and should count ourselves lucky we live in a country where we can be properly informed.
You’re taking a second to read this so you can be prepared and knowledgeable about the situation at hand. The first step to smart thinking in an unprecedented time like this is to have the correct information, and who knows? Under our current leadership, our questions don’t seem to be answered and if that, they’re approached without factual information.
But, why would you listen to me? I get that too. I’ll make it brief — I’m one of those immunocompromised people they talk about on the news who are more likely to be affected by COVID-19. But, I also spent a year indoors during what was supposed to be my freshman year of college from 2016–2017. I wasn’t able to speak or walk due to the effects of Lyme disease so I remained in my own quarantine of sorts until I was well enough to speak once again and walk of my own accord.
So, while I’ll be the first to tell you your self-quarantine ensures the slowing of transmittance of the virus and the protection of people such as myself and those who are far more immune-challenged, I will also be the first to tell you that self-quarantine is very difficult. I’ve done it out of necessity because I wasn’t well enough to leave the house and in order to make it bearable, a routine needs to be instilled and moment of laughter need to be cherished.
To discuss illness, disease, and outbreak is not something I can do without consequence of lack of disrespect, but I’m going to go ahead and try to explain this situation from my perspective. As most of us are living in a state of perpetual uncertainty, confined to our countries, states, cities, buildings, apartments, and bedrooms while others are living in ignorant bliss traipsing through the streets of their respective cities, in and out of bars and crowded places, we wonder: what should we actually be doing? As I sit in my bedroom for the fourth day straight of self-imposed-quarantine besides a walk or two around the block many meters from possible hosts of the virus (other human beings), there is information I have been reading that I wanted to put in one place. With an explosion of media coverage of Coronavirus, what in actuality do we know? Because we sure don’t seem to know a lot.
First off, what really is Corona, besides the beer college students are sipping at a bar on an island off of the coast of the United States for their Spring Break? Coronaviruses are a family of viruses that induce respiratory symptoms; some are run-of-the-mill colds and others come from animals — this is the type we will be discussing. The type of Coronaviruses which stem from an animal (also known as a zoonotic disease) — meaning in order for a human to contract Coronavirus initially, the human needed to ingest an animal with the virus — this is the strain causing COVID-19. They’re called Coronaviruses because they look like a fuzzy ball with push-pins stuck all around them — thus the origin of the word comes from the concept of a crown. Feel smarter already? I’ll keep going…
To be specific with wording, as it seems nothing has been specific at all and that is partially why the entire world is in a panic and toilet paper has all but disappeared, COVID-19 (also known as 2019-nCoV) is actually a disease, not a virus. COVID-19 is one of many Coronavirus diseases, so let’s start with the specificity there. Beyond the disease, COVID-19, is the virus that causes the disease: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sound familiar?
This may ring a bell to those who have lived through the SARS epidemic in 2003 and MERS a decade later. SARS and MERS were originally contracted through bats infecting a middle animal, more formally called an intermediary host, of which was then able to infect a human. Both of these epidemics proved far more fatal, faster than our most current pandemic has been… That doesn’t mean COVID-19 isn’t as fatal, as the numbers rise and more tests are being facilitated (which is almost a joke as there are more than 330 million people living in the United States and less than 50,000 COVID-19 tests have been run) those numbers will increase drastically, and if we don’t slow down life as we know it, the number of those needing hospital attention and critical care will eventually not have access to those life-saving resources. COVID-19 will prove to be the deadliest outbreak in modern history.
Our needs will surpass our available resources — that’s the curve everyone is talking about needing to flatten— if we stay self-quarantined and reduce the rapid rise of infection rate, our healthcare system will be able to treat those who need care. If we don’t, our infection rate will overwhelm the hospital system and incomprehensible, unthinkable choices will have to be made.
Who gets the ventilator? Who do we choose to save?
At this point, you’re probably thinking, but how did this all happen so fast; can we sleep this nightmare off and think it was just a bad dream? It’s still a mystery as to the source of COVID-19, finding the origin through epidemiology can take some time. Initial speculations and research are saying COVID-19 is thought to have come from an animal called a Malayan Pangolin (1), an animal that looks like a cross between a rodent you’d find on a subway track and the scales of a mermaid. Look it up, the visual is fantastic.
These animals are smuggled into and sold in Chinese open-air markets for the supposed medicinal properties of their scales, wildlife regulations on these exotic animals aren’t well-enforced. According to a preliminary report, a study has been done which shows Malayan Pangolins could indeed be the intermediary source of COVID-19 according to the identification of their genes in comparison with the disease (2). This isn’t conclusive data, as there is still a variance on one specific gene, but, it’s one step closer to understanding what actually happened that day in a Wuhan market when the world changed.
Side note for all of those who aren’t geography experts: Wuhan is a provincial capital of Hubai which is a province in the center of China. Wuhan serves as a transportation hub and thus has open-air markets, quite common to China. The first cases of COVID-19 emerged in sellers amongst this open-air market, although there is a conspiracy theory evolving on Twitter by a Chinese Politician (the deputy director of Foreign Ministry Information Department) that the US Army actually brought COVID-19 to Hubei.
But, let’s get back on track: how did we not know these animals contain the virus? Simply put, they don’t contain COVID-19. Remember how we talked about SARS and MERS? Malayan Pangolins suspect of transmitting COVID-19 to patient zero in Wuhan were intermediary animals between a bat and a human. There were only eight positive cases of SARS in the US and two cases of MERS in the US according to the CDC (4&5). Right now, in the US there are more than 7,000 positive cases, that number has been increasing by nearly one-quarter each day(3).
Now that you know the conception, let’s talk about what’s going on in our country under the inefficient leadership of our President. COVID-19 is present and active in the United States, which most of us know because we are holed up in our apartments sitting by the window for a glimpse of the sun. Don’t complain. Italy has been doing this for over a week, and according to some reports they have an entire month to go. In order to get groceries or pharmaceutical supplies they must fill out a form to go outside, only one family member is able to, and on the streets and standing in line for these stores citizens must remain one meter apart from one another. Their lives have entirely shut down because the situation wasn’t addressed fast enough by the government and citizens alike. The virus spread faster than the system could handle it, and that’s not just in Italy. That could be us very soon if every single one of us doesn’t take it upon ourselves to follow the rules and hold each other accountable.
But, the lack of availability in testing juxtaposing White House reports saying if you want a test you can get one, is proving fatal. Friends of mine and family members who have wanted to get testing because of apparent symptoms are denied them, stating they didn’t travel outside of the country recently, don’t live in a community with a high caseload, are under the age of eighteen, have a high enough oxygen level, a low-grade fever, and haven’t been in direct contact with someone who tested positive. At this point community spread is real, and if you feel you need a test there needs to be a faster approach to getting a patient tested. There is an initiative coming out of the White House setting up drive-through testing sites with the help of major companies: Walgreens, CVS, Target, and Walmart. We heard about this program last Friday, but still, there isn’t enough developed achievement on that front. Meanwhile, here in New York Governor Cuomo has created his own drive-through in critical areas where people suspected of having contracted the virus can be tested. It seems like the whole country is looking to Cuomo for advice which should be coming directly from the White House.
These numbers we are seeing are expected to climb, drastically. So, the sea of rubber-gloved hands in the produce aisle of your local Trader Joe’s and the apocalypse-talks you’ve probably been having with your friends jokingly, are only going to escalate. It’s not like it was during Hurricane Sandy where we prepare, experience tragedy, and rebuild, we are still in the midst of the time prior to the critical moment.
COVID-19 patients are already dying at drastic rates and the amount of patients is going to skyrocket before it gets anywhere closer to resolution. Pandemics get horrifically worse before they resolve, but it’s up to our collective humanity to make sure the peak of cases happen under the threshold of what it is the health-care system can handle.
This is called human responsibility. The older generation physically went to war for our country. They fought in the Korean war, the Vietnam war, some even lived through the Great Depression, and all that’s being asked of us younger folks are to self-quarantine and stay at home to protect them. That’s something I have faith our country is more than capable of doing.
I know, I know. This is a lot of information, so why do you actually need to know this?
I’m sharing this because I want you to make informed choices. Our healthcare system often fails us with a lack of communication between doctors and patients; I know it’s failed me time and time again, so I’m giving you all the information you need to know in order to protect yourself, your loved ones, and everyone else out there in the world. While I know Spring Break would be wonderful and a flight on a plane for $50 to get a tan is tempting (trust me, I had to cancel my awaited trip to Miami) not going is a way to keep people safe and get this pandemic resolved faster. If you think you are untouchable (I’m jealous!) think about someone you care about who is elderly… or immunocompromised… You might ask “why you should put them before yourself if you feel fine, and if I feel fine, why do I have to self-quarantine”? A symptom-free host can still be a carrier of the disease which can affect someone whose immune system isn’t as resilient.
But what does that actually mean? They’ve been saying it so many times and haven’t properly explained it…
As we age, our respiratory system ages alongside us, meaning pulmonary ventilation decreases, alveolar-blood gas exchange (capacity to move oxygen to blood and remove carbon dioxide in exchange) slows down, and there is a decrease in cellular and humoral immune defense (the immune response in our bodily fluids). COVID-19 is a disease of the respiratory system, thus the elderly and immunocompromised are more at risk because they produce less naive lymphocytes (T-cells found in the bone marrow) and fewer memory lymphocytes (a mixture of B- and T-cells) than a healthy younger person. Basically, this is a fancy way of saying as we age (note: those who are immunocompromised have a physiologically older immune system than their numerical age) our “army” a.k.a. the immune system, ages with us. Our frontlines become more scarce so we become more susceptible to illness and are far less able to attack when we need to most. That’s where it gets scary.
If a host transmits a disease to an average of 2.8 people in one day, there’s a good chance it’s getting transmitted to someone who doesn’t have the ability to fight the illness. They don’t have the ability for their immune cells to kick into overdrive to prevent their lungs from tightening. Note: the lungs operate very similarly to wet sponges — when we inhale they open up and upon exhale they squeeze shut. COVID-19 in severe cases forces the water out of the sponge so-to-speak and the sponges dry up leaving less mobility upon each breath, thus the need for a ventilator.
Healthcare professionals can help to minimize the symptoms and buy time while the immune system fights the virus. Viruses have no cure. Think back to high school when you all of your friends shared water bottles during lunch or bottles of cheap booze at a backyard party, and one person contracted symptomatic Mono. That friend of yours probably needed to take time off of school to get better (I know I did). This was time where their immune system could start working to fight the Epstein Barr virus, which causes the Mono. I’m sure there were many of you who had Mono from that night in your system but were asymptomatic because your immune system could handle it without a greater symptomatic response. We are in this situation, but it’s a million times worse. Literally. 1.7 million people at least are predicted to die in the US alone from this virus. That’s a huge number.
Why is what’s happening in Italy, happening? And, now similarly in Germany? Because their cases spiked from the hundreds to the tens of thousands over the course of a week, now at more than 24,700 needing critical care.
No one took it seriously until the healthcare system was overrun and inaccessible. No one paid attention until it was too late. No one followed advisories until there weren’t enough beds and oxygen ventilation equipment to serve the needs of each patient. There won’t be enough beds and resources for us here in the United States — in NYC we are already converting dorm rooms to hospital overflow accommodations, but without more ventilators, those rooms will be useless.
We will start to have to choose between who gets care, and who doesn’t.
The whole concept of “if you need care you can receive it” hasn’t been met in Italy. There simply are too many sick people. And, that’s terrifying, but for most of us, it seems so far away. Another country. Another family. Across the ocean. No. That’s the completely wrong mentality.
This is an unprecedented war we all have to fight, collectively. Yes, that means not going to the gym. Yes, that means not running around the city taking Instagram photos because the streets are empty. Yes, that means ending your Spring Break.
I educated myself on COVID-19 so I could help inform others about their options. It informed the conversation I just had with my grandmother explaining why she shouldn’t go over to a friend’s house to play card games and the discussion I had with a friend of mine on whether or not she should leave her college campus and go home.
We are making decisions and our options are harder than ever.
We can acknowledge life is getting increasingly difficult: living with looming unknowingness is anxiety-provoking and staying cooped up at home isn’t easy. Contemplating whether or not you should return home fearing you might be a carrier and get the rest of your family sick, is a real issue. To fly, or to drive across country home to California where the rest of our family is, is something my father and I have been thinking about for a few days. We’ve decided to stay put in NYC, where hour-by-hour we approach an impending lockdown.
No question has an easy answer, and each decision weighs heavily. We have never done this before, so if we cannot put ourselves first, we need to think: “could the choice I’m making negatively impact the person sitting next to me? And, if someone else made this choice and sat next to my grandmother on a flight, or accidentally touched my immunocompromised friend, how would I feel?”.
Our generation’s war has arrived faster than we ever could have thought possible, without any warning whatsoever. The small part we can play by staying away from others, staying mostly in our homes, and not going out unless necessary can play a huge role in lowering the peak of this pandemic and will determine how detrimental COVID-19 will be on our country.
There’s so much more that is unknown: how school online is actually going to work, how long this will last for, will we ourselves get infected, the effect on businesses and our economy, how long do we sit and wait?
Let’s do what we can with what we have, and start to make informed choices. This can be the conception of a modern discussion with informed decisions on our collective healthcare. Let’s make smart choices not only for the good of ourselves but for those who might not be so lucky as to be making their own choices. Let’s make choices we can be proud we made when we look back on this extremely difficult time. Let’s make choices that can potentially save lives. Let’s make informed choices and talk about our fears and stresses, poor mental health can be detrimental to the immune system’s response. Remember, even if you are healthy and symptom-free, the decisions you are making can easily affect someone who isn’t able to freely make the same choices.
Resources:
2. https://www.biorxiv.org/content/10.1101/2020.02.17.951335v1
3. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
4. https://www.cdc.gov/sars/surveillance/index.html
5. https://abcnews.go.com/US/coronavirus-compares-sars-mers-recent-viral-outbreaks/story?id=69329364
