COVID-19: The Silver Lining

To paraphrase Shakespeare, “I come to praise SARS-CoV-2, not to bury it”. Well not exactly to extoll its virtues, as there is quite enough to curse in this terrible snippet of RNA. And as a doctor for more than four decades, if I could assassinate the virus I surely would; this is especially the case as we in Israel head once again down the rabbit hole of a lockdown. However, oddly enough, looking up through a scientifically adjusted telescope, one can catch glimpses of a silver lining in the swirling storm clouds above. Clearly, anything positive that comes out of this pandemic is most unlikely to come close to outweighing the damage it has wrought. But it might just help to get us through the days and weeks (months? years?) ahead by practicing a little counterintuitive “sixteenth-full” thinking. It is easy enough to consider how empty the glass actually is.

First, what hasn’t happened? Despite its bad press, the virus does not usually kill, with 98.6% surviving infection; at any age, most are either asymptomatic or suffer few symptoms.

Given the pandemic nature of the coronavirus, and its appearance almost exactly a century later, much has been made of an analogy with the 1918/19 influenza contagion. Although both are respiratory viruses and spread primarily by droplets, the two illnesses are still very different. For example, the 1918/19 ‘flu pandemic primarily affected younger, otherwise healthy people – peak age 28. Every death is the loss of a universe and one should never be indifferent to the untimely death of elders, but imagine if today most of the mortality was in children and those in the prime of their lives.

Even if one is unfortunate enough to fall ill, today we enjoy excellent supportive care.  As long as they are not overwhelmed, modern hospitals will save another large proportion. Again, contrasting this contagion to the flu pandemic of a century ago, it is worth gazing upon the horrifying picture painted by Dr. Victor Vaughan, dean of the University of Michigan medical school during the 1918/19 influenza pandemic. As recounted recently in the Atlantic,  “I see hundreds of young, stalwart men in the uniform of their country coming into the wards of the hospital in groups of ten or more,” he wrote. “They are placed on the cots until every bed is full and yet others crowd in. The faces soon wear a bluish cast; a distressing cough brings up the blood-stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood.”

This  clearly is not the case today.

Furthermore, the science is progressing extremely rapidly. Back in January the SARS-CoV-2 genome was characterized in just a few weeks.  A century ago  it took 15 (!) years before we learned that influenza was a caused by a virus. This is the first time that so much of the world’s scientific effort has been focused on just one problem. With respect to the Holy Grail of an effective vaccine, there are presently over 130 candidates in animal models (an early  step in vaccine testing)  with 30 hopeful contenders entering  clinical trials on humans. If we are very lucky, a jab might be ready by the end of this or early next year.

To paraphrase once again, this time Churchill, “Never will so much be owed by so very many to so many.”

Science isn’t marching on, it is sprinting.  The amount, speed and facilitation of international scientific collaboration is unprecedented with journal editors noting a ten-fold increase in submissions. True, a significant minority is junk science and some “studies” have even been  fabricated. But these outliers (outliars?) are the exception.

Medical education is being examined anew – not just telemedicine or virology. Many now realize the value of my own specialty, geriatric medicine given the shock of the mortality spike in older persons and mass nursing homes deaths observed in Europe and North America.  The scientific literacy of the general public is also being uplifted. Despite the ravings of the anti-Vaxxers, most reasonable people want to understand the situation. In the past few months I have given more mini-lectures to friends and relatives on statistics, virology, ageing and the ethics of triage than in my past 45 years of practice.

We are observing necessary changes in general education as well.  For example, there has long been discussion of the benefits of distance learning and working from home. However, at warp speed, in so many ways we have learned to manage, however imperfectly. These adjustments will not disappear after the pandemic. And just observe the reduction in the burning of gasoline, the decrease in traffic accidents and the lighter carbon footprint of this period. The skies over so many cities have never been so blue, the clouds so white – all the better to catch the silver.

One surprise comprises the unexpected drastic falloff of disease caused by flu viruses throughout the southern hemisphere which is going through its winter. Somehow the coronavirus may be “crowding out” most other respiratory viruses. Or perhaps via social distancing, masks and improved hygiene, the chance of catching all such respiratory viruses has been reduced.  And if this phenomenon is maintained into our fall/winter season, a much feared double peak (coronavirus and ‘flu) may be mitigated.

To ease the significant socio-economic damage of the pandemic and especially from the steps needed to suppress it, most of the world (even the US) is practicing some kind of a socialist approach. True, this largesse cannot go on indefinitely assuming we do not descend into a Great(er) Depression. Perhaps a useful new discipline will be borne, economic epidemiology.

Many understand the need not only for a strong state (not always good news) but a beneficent one (obviously better). Clearly we are passing over a significant, one-way threshold. One can hope that the post-COVID-19 world might be a kinder, gentler place although history offers less optimistic scenarios. But to remind, I wish to praise not bury.

While we all feel the loss of our normal social lives, we are still most fortunate to have had this disaster take place during an era in which technology allows us to see and talk with each other with great ease and cheaply. Imagine had this dire event happened just 15 years ago, before skype or 10 years ago just before ZOOM.  Not to speak of how many people are remaking connections with long lost family and friends. At virtually no cost, these tools have facilitated social intercourse (albeit limited) as well as the vital communication that has led to the unprecedented scientific work alluded to above.

All epidemics rise (bad news), then fall (good). In the meantime we need to mitigate harm. As well, although admittedly not fun, it is worth marveling that we are truly living through an historical moment. Our grandchildren will ask how we got through this epoch. I am preparing my answers already.

In another context, Sir Winston urged us to “[N]ever let a good crisis go to waste”. Hopefully the shafts from the silver linings can light the way to help illuminate and manage the terrible effects of coronavirus pandemic. From Shakespeare to the more contemporary Carter Family, singing right through the Dirty Thirties, again not the most optimistic era:

“Though we meet with the darkness and strife
The sunny side we also may view.”

Re the COVID-19 catastrophe, this is still a very bright image.