Are we willing to keep up “The Good Fight” against the Coronavirus? Bill Gaertner. MD, MS 5/24/20

Fact: We are be relaxing our restrictions on the virus, but the virus isn’t relaxing it’s virulence on us. (Virulence is the medical term for potency, strength, ability to kill its victims!)

It’s the Memorial Day weekend & it seems that “Reopening Fever” has captured the minds & hearts of most Americans. Though that may be good for the economy & for our corporate mental health, it may not be good for our corporate & individual health & well-being.

This weekend is looking like a real test of people’s conviction in the face of fatigue, & willingness to stay strong in the life & death battle we wage with C-19. Some have gotten battle weary, depressed with “cabin fever” or overcome with anxiety. But others have just thought that since the country is open, we’ve won the battle, & the war is over. Wrong!

When the WI Supreme Court rescinded Gov. Evers “safer-at-home” order on 5/13. Some people couldn’t resist the urge to rush to their favorite bars, Lake Geneva was packed with Il. residents, & to our credit, most of us stayed home, awaiting further medical recommendations!

My main goal in this essay, is to remind & inform you of the reality that, wish as we may, the war is far from over, & the enemy; this new corona virus; is every bit as formidable as ever.

Even the staunchest of scientist will admit that society can’t stay locked down forever, (the economic & mental health costs were becoming obvious). Yet it’s these same scientists who are most concerned that this new found freedom, w/o safety precautions, could cause an ^ in cases that could swamp the health care system. Our health care workers are stressed enough!

The 5/17/20 Mil J-S cover story reminded us: “ C-19 has spread like wildfire, killed people of all ages, & all health conditions, baffled doctors, defied guidance, & conventional wisdom, & produced an unprecedented array of symptoms. There’s never been a virus like it!” Reality!

At 1st the C-19 virus was thought to mostly be a risk to older adults & people with chronic illnesses. Then 30 & 40 y/o’s with it began dying of strokes (esp. if they were obese). Now we have > 40% of hospitalized patients < 55 Y/O. Its primary target was the lungs. Now we know it also affects the brain, kidneys, heart & skin. Recently a small number of C-19-infected children have died of a rare illness resembling Kawasaki Disease (an inflammation of the blood vessels, including the coronary arteries in young children). This seems to be a hyper-immune response of the body to the virus rather than a direct effect of the virus. Some of the adult deaths also result from a ^ immune response. Hydroxychloroquine limits this in some inflam’ry conditions, but when studied in C-19 pts., it was found to cause too many heart arrhythmias & attacks.

Remember, a virus is not even a living organism. It’s a small piece of genetic material (DNA or RNA) wrapped in a fat & protein coat. When it gets past our body’s immune system defenses,

(& our lifestyle choices determine this – remember good sleep, exercise, nutrition & stress management?) it enters a cell & takes over the cell’s DNA so that instead of the cell’s DNA doing its usual job, it gets hijacked & forced to exclusively manufacture virus particles which spread throughout the body & repeat the process in other cells & organs. Simple, but deadly!

In the 5 mos. since it started, C-19 has infected > 4.5 mil. people, WW; killing > 300,000 WW, (including killing almost 100,000 in US & > 500 people in Wisconsin). Brazil just passed Russia as #2 in +cases 347,000 vs 344,000. We’re # 1 with > 1.6 mil. + cases at this time). Reality!

Few viruses are more contagious or more deadly. C-19 is estimated to be >10 X’s more contagious than the flu virus, & 9 X’s more deadly. Once the C-19 virus enters the lungs, it causes many of the millions of air sacs in the lungs to fill up with fluid - Pneumonia, leading to Acute Respiratory Distress Syndrome, the usual cause of death of C-19 patients even from people on respirators – who by the way only have about a 50:50 chance of living from time.)

We’re still learning of the many ways the C-19 virus can kill people. The virus has been found in stool samples & in the semen of some men (>15%) infected with C-19. Even among 30 Y/O’s some have no symptoms & some are dying on respirators. We still are learning why this is.

Back to the “Virulence (deadliness) of C-19. (Brief version: It’s the most virulent virus there is)

When a person gets exposed to the C-19 virus, their fate depends on the battle between the fitness of their Immune System (I.S.) & the amount of exposure i.e. the # of particles, over the amt. of time). That’s why older people with chronic diseases are at highest risk. Their chronic diseases weaken their Immune system. Healthy older people seem to have only a slightly higher risk of getting sick that healthy younger people because the immune system does get slightly weaker with age.) Vags, even though some are older, have strong Immune systems.

The CDC has recently downplayed the risk of contracting the disease from surface contamination, but they still recommend that we disinfect surfaces & advise people to not touch their mucus membranes (eyes, nose, & mouth) after touching possibly infected surfaces.

Droplets & aerosols remain the main way that C-19 & all respiratory viruses spread. That’s why Social Distancing (SD) remains the #1 way to avoid the spread of C-19. (because most droplets drop harmlessly to the ground before reaching 6 feet from the source). Estimates of droplet release are: breathing - 20 virus particles/min., speaking – 200/min. Shouting or singing - 2000/min. & sneezing or coughing 200 mil. virus particles per episode! So if an infected person is breathing near you, it would take 50 min. to get into your lungs. If talking 5 min. but if shouting or singing near you only 30 secs. 0ne sneeze or cough near you could be enough. So the best way to limit the spread is SD! It worked in the past, & it will keep work’g!

It is estimated that it only takes around 1000 C-19 virus particles to get infected. (By comparison, it takes 10,000 particles of another corona virus, MERS virus, particles to get sick.)

The amount of time that you are exposed to the virus is an important factor in its spread. It sounds obvious that the more time you spend in contact with the virus, the more likely you are to get it. That’s why the quick trip to the store, (wearing your mask), is a low risk activity! Restaurants & church services where strangers are inside for nearly an hour are not so safe.

Speaking about being inside, being in close proximity to an infected person for a considerable amount of time as in a shared office, music concert or movie, dining in a restaurant, or flying in a plane, are all high risk activities. Just like with safe sex, we now must consider safe activities.

Another advantage of being outside, besides the good ventilation & easier SD, is that the UV Sunlight does indeed seem to have a disinfectant effect on the virus, killing it in 7-15 minutes.

To sum all this up, we’re reopening with attention best being paid to various levels of safety vs risk. To avoid getting C-19, we need to put ourselves in as many low risk environments for as short a time as possible. As far as environments are concerned, the safest ones are outdoors, with good social distancing, & the worse have to be in bars or restaurants where people are shouting. Plus anywhere that alcohol is served, we have the added risks of loss of inhibitions. So if you have to drink, the outdoor beer garden is much safer than the indoor bar/restaurant. I’d hope that the chance we’ve all just had to reevaluate our priorities would favor sobriety.

I haven’t said much about the mask controversy yet. It’s not a political issue, it’s a common sense safety issue! I see masks as the 2nd most important protection to slow the spread of C-19 (behind SD). Sure most non-medical masks can’t protect us from getting sick, but they are 2nd only to Social Distancing when it comes to stopping the spread of the virus throughout the community.

Dr. Debra Birx, MD spoke definitively on this on 5/24 when she said: “There is clear scientific evidence now, by all the droplet experiments, that a mask does prevent droplets from reaching others.” Better yet was her answer to what she would say to people who say it’s their right to not wear a mask in public: “Out of respect for each other, as Americans that care for each other, we need to be wearing a mask in public when we cannot social distance.”

I am tempted to simply say: You obviously don’t have enough respect for other people to do the simple act of wearing a mask in public to trap your droplets from spreading. I sincerely hope that you “get social consciousness” b/4 you or yours get the virus & it’s too late.”

Since there is the distinct possibility of asymptotic spread (spread of the virus in the days before infected people have any symptoms – the “Latency Period”), she summed up her best general recommendations as: “So you don’t know who’s infected. And so we want to be clear all the time that social distancing (6 ft.) is absolutely critical. And if you can’t social distance & you’re outside, (in public) you must wear a mask. These are items that are really critically to protect (other) individuals.” I can only hope that our social concern > our self- interests!

A word of caution about “Toxic Masculinity”

You may have heard this term used in relationship to the “Me Too” movement, & that’s where it gained some recognition as the predominately male (yet basically human) attitudes of entitlement, inconsideration, self-centeredness, & down-right selfishness i.e. I’ll do what I want!

I hope that I can speak with some credibility about this topic because, for the past 75+ yrs, I’ve been male, & for the past 40+ yrs. I’ve been a Fam, Physician (with an interest in maleness)!

Few things about the C-19 pandemic have been debated, scrutinized, fought over & even died over than masks! Since April 3rd, the CDC has been recommending that healthy Am’s. wear masks to “protect people around you if you are infected, but do not have symptoms”. Projection models have shown that if 80% of people wear them, C-19 cases, which now top 1.6 million in the U.S., may plummet. Like all things prevented, it’s hard to the #’s of people saved!

Now to the science (that Dr. Brix was referring to above)” A recent online study was conducted of > 2,459 people in the U.S, & U.K. who were given various messages intended to promote wearing face masks, & then questioned about their intentions. The researchers concluded that “men < women intended to wear face covering” & that the 2 driving forces are that men are less likely to “believe that they will be seriously affected by the C-19 virus, & that they consider masks “shameful”, not cool & a sign of weakness”. Hey guys, we’re talking lives being saved!!

A noted author on masculinity, Matt Englar-Carlson, from Ca State U. at Fullerton, says that masks are just the most recent iteration of a longstanding issue. “Decades of research on men’s health has shown disparities between men & women in health behaviors. These disparities exist around preventive measures such as self-exams, helmet use for cycles, using sunscreen, seat belts, preventive health care & seeking health care services, but also taking life-threatening risks. Men tend to engage in more risk-taking behavior, & not wearing a mask or downplaying the risk of C-19 is a considerable health risk.” Know anyone like that?

He concludes that there are many positive aspects of masculinity (far too many for me to mention here!), but this one seems to fall under the category of: TOXIC. “The notion that men need to always appear strong & show no weakness, & when that is rigidly adopted & not adaptable to the environment or new information - allows a man to be consistent with his notion of maintaining his sense of masculinity, but it comes at a significant cost.” I Agree!

So I end with my hope that you do get out & safely enjoy the better weather, physical activities, (Dr. Brix even said to walk, bike-ride & play tennis), nature, family & friends (just do it at a safe distance w others w masks.)

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