Coronavirus: The Current State of our Knowledge
On Friday afternoon, July 24, 2020, Rev. Dana Hughes and Peter Hulac had a conference call with Dr. James Todd. Jim says that there is new learning all the time, and there is still so much we do not know.
For this particular virus, there was no preexisting immunity in the community. Current community immunity is probably 10 or 20%. It would take 80 to 90% to achieve herd immunity, and we do not know if an individual’s antibodies will last long enough to be protective. That means that COVID will continue to roar through in cycles.
Kids younger than 10 years old are less likely to acquire the virus and are less likely to spread it. (See below.) The fact that older people suffer more with this virus seems to be explained by as yet, poorly-understood exaggerated immune responses.
The biggest route of transmission is airborne spread in droplets, but smaller, non-droplet virus particles are also vectors. These particles remain longer on surfaces and in the air.
Even if everyone wears a mask, infected people can still spread the virus, although at a lower rate. Forty to to 50% of people with the virus have no symptoms or are presymptomatic, but still able to transmit it to others. This is what makes this one so nasty and so difficult to trace.
More than 4 million Americans have been officially diagnosed with COVID. The real number is probably much higher.
The risk of infectivity is increased with longer length of exposure and with proximity between people. Exhaling with force (singing, exercising, playing a wind instrument, and yelling at a rally or at a sports event) is a significant problem. The risk is decreased if there is a mask on the infected person; to a smaller degree if the mask is on the uninfected person.
There are two kinds of testing. Both have challenges.
Testing for current infection involves looking for the virus or for genetic evidence of it.
There are false negatives and false positives.
Even if a patient’s test is negative on a particular day, it is still possible that a test obtained a day or two later will become positive.
There are sometimes long delays in getting results.
Antibody testing looks for evidence that a patient has had the infection in the past and has made antibodies to it. We do not fully understand the predictive value of either positive or negative results.
With COVID-like symptoms a person must be in isolation for at least ten days; and we must trace contacts. If a person is exposed to someone proved to be positive, each exposed person must be in quarantine for 14 days.
What is new in prevention and treatment?
Maybe convalescent plasma (being studied in Colorado, including at Children’s Hospital Colorado). Current supply is low, so it is rationed to people who are further along in the illness and are sicker. In other illnesses, like chickenpox, treatments like this are useful only if given early. Studies are continuing, but convalescent plasma might not in the long run be proven to be helpful.
Antiviral medications like remdesivir. Remdesivir was reported in one study to help hospitalized patients go home earlier, but there was no change in the risk of death. There is no evidence that it will help if given early in an illness.
Steroids, like dexamethasone (Decadronᴿ), might be helpful for severely ill patients.
New vaccines are being studied in accelerated protocols, but there is still some chance that they will not meet the dual, important criteria of safety and effectiveness. It is difficult to count on any projected date of either when a safe vaccine will first become available or when quantities will be large enough to establish adequate herd immunity.
How about gathering for worship?
There are dozens of well-documented examples of post-church service infections. There is a published CDC report about the aftermath of an Arkansas congregation’s worship service in the early days of the pandemic. Of 92 people in attendance, 35 people became infected and 3 died. There was also evidence of further disease spread in the wider community. https://www.cdc.gov/mmwr/volumes/69/wr/mm6920e2.htm
There are some reasonably good efforts at protecting worshipers, but many church members are in highly vulnerable populations. Reasonable choices are really tough. We cannot make the risk “0.”
Here is some guidance: Remote worship is still best. Outside worship is better than inside. Masks are mandatory. There should be no congregational singing, no passing of the peace or other touching. There must be at least six feet between worshipers or worshiping household clusters. No objects should be shared, e.g., communion elements, bulletins, or hymnals. Inside is much different. If a church building has good HVAC, open windows, and reasonable cleaning: there might be lower risk.
Other, More Esoteric Facts:
Each virus particle is tiny. 250,000 of them lined up in a row would extend to only one inch on a ruler. They cannot be seen with regular light microscopes, only electron microscopes. Each particle has many spike-like protrusions. In aggregate, the spikes make the virus look like a crown, thus the name. (One scientist described coronavirus as a “crown of thorns.”) These spikes attach themselves to “receptors” in individual cells lining the respiratory tract. This connection allows an individual virus to invade and take over an attacked cell. Young children do not have as many receptors on the surfaces of the cells in their respiratory tract, which explains why nearly all children are less susceptible to the illness and are less contagious.
There is, nevertheless, a rare childhood syndrome associated with this coronavirus. It was first described in the UK by Dr. Michael Levin, who did his Infectious Disease fellowship with Drs. Mimi Glodé and Jim Todd here in Denver. https://www.imperial.ac.uk/people/m.levin He first described it as “Pediatric Inflammatory Multisystem Syndrome, “PIMS.” https://www.imperial.nhs.uk/about-us/news/kawasaki-like-syndrome-linked-to-covid-19-in-children-is-a-new-condition Our CDC later changed the name to MIS-C, Multisystem Inflammatory Syndrome in Children. It has been diagnosed in children who have had earlier infections with this coronavirus. The age range is between two and fifteen years. It is caused by post-infectious inflammation in blood vessels, including those supplying the heart muscle. It is very rare but serious, and it usually responds to treatment.
Other Resources Suggested by Dr. Todd:
An explanation of the “model” developed by the Colorado School of Public Health. It helps project the impact of specific favorable and unfavorable strategies upon the future course of the epidemic. https://coloradosph.cuanschutz.edu/resources/covid-19/modeling-results
The Colorado Emergency Operations Center and the state Department of Public Health and Environment website is continually updated with new information for the public. https://covid19.colorado.gov/
For all who grieve that the pandemic has interfered with their love of live opera, Jim also offers this website as a potential substitute. The quality of the performances is exceptional. https://www.metopera.org/