SARS-CoV2 is everywhere. Where do we go from here?
Originally Posted on Medium - March 29th 2020
New York has almost 30 thousand positive cases of SARS-CoV2, and the United States is likely going to be hit harder than China, Italy, or Spain.
While millions of Americans have been living under shelter-in-place, the concern now is where do we go from here.
It has become undeniable that the new virus has affected more people than we had previously predicted, and like everyone in this dire situation, we want this to be over as soon as possible.
After consulting with many doctors, government officials, and scientists, I've blueprinted a few actions that we need to take now to find our way out of this crisis.
First, we need to assess what stage of the outbreak we are in now. For that, large-scale serological surveys are required in a broad and heterogeneous group of individuals selected randomly in all parts of the country.
Germany will issue COVID-19 antibody certificates to allow quarantined individuals to re-enter society, and we should follow suit.
The CDC, the Medical Military, or a private group of researchers should mobilize medical personnel across the country in every state and randomly test 1000 asymptomatic volunteers each. This way, we could accurately assess the prevalence of SARS-CoV2 in the population.
Assessing this would give us a spatial map of the extent of this epidemic in the next couple of weeks.
By running large-scale serological surveys, looking for antibodies or other proteins in the blood formed by the immune reaction to infection, we would have a better sense of "herd immunity."
Furthermore, we need to identify genetic pathways involved in the SARS-CoV2 development and look for potential disease-causing variants in protein-coding genes using whole-exome sequencing on genomic DNA.
Understanding this would potentially lead to new preventative and therapeutic strategies.
Besides, those patients who have recovered and are now immune and unable to transmit the disease could potentially return to work and resume many social interactions. This is how you start to reopen the economy.
Secondly, healthcare workers and people working on the front line of essential businesses are exposed and in constant risk of contracting the virus while unprotected.
Although prophylactic treatment options are being studied in clinical trials, the use of N95 masks should be made available and adopted immediately by this workforce. All efforts should be dedicated to producing them and making them broadly available.
In Asia, health authorities have encouraged all citizens to wear masks in public, and the Czech Republic last week made the use of nose and mouth coverings mandatory in all public spaces with already some positive results.
While surgical masks do protect a bit more than not wearing anything at all, high-grade N95 masks should be worn by everyone in public until the SARS-CoV2 vaccine is available for all.
Although controversial, this will help reduce community spread.
To help understand how the COVID-19 pandemic will affect their region, a group of data scientists and epidemiologists, started the project COVID Act Now based on epidemiology modeling.
Epidemiology models are used in every epidemic to understand better the consequence of disease incursions and the impact of control strategies. By studying the 'what if' scenarios and providing decision-makers with a priori knowledge, they can better allocate resources and assurance in response to the health threat.
COVID Act Now has been ringing the alarm about the widespread of the coronavirus and raising a red flag that the U.S. healthcare system is at a tipping point.
And as it turns out, doctors all across the United States have been struggling with the fact that most beds in ICU are occupied, and data shows that than half the counties in America have no intensive care beds putting over 7 million people who are age 60 and up at risk.
Notwithstanding, a concerning number is the millions of people who are most likely to require hospital care due to the pandemic.
There's an estimate of over 15 million citizens are currently living with cancer in the United States.
The American Heart Association surmises that over 120 million people have heart disease, approximately 70 million that are obese, whereas over 100 million people are living with diabetes or prediabetes in the country.
Understandably, these numbers very likely overlap; we cannot deny that the at-risk group accounts for a sizable group of people, and they should be protected.
While pharmaceutical and biotech companies are operating at full steam to get clinical trials up-and-running that focuses on immune modulation, cellular therapies, and repurposing other drug agents, a COVID-19 vaccine is far away.
In the meantime, actions like immune and viral testing, the widespread use of masks and gloves, rapid access to new drugs would be our pathway out of this crisis and reopening the economy.
We need to act now, and we should not allow perfect to be the enemy of good.
Dr. Leo Nissola, M.D., Auth.
Medical Doctor, Scientist, Published book author in Immunology.