Thoughts on Coronavirus-Covid-19

As of 2/29/20 eighty six thousand thirty two people worldwide have been diagnosed with Coronavirus (Covid-19). Thus far 2942 people have died for a case fatality rate around 3%.

I am not an infectious disease specialist but I have been in medical practice for 40 years. I would like to share my thoughts on Covid-19 and in the process hopefully save lives and prevent the spread of the virus.

I hope to allay fears and prevent panic which can exacerbate a trying and difficult situation. One thing I caution the most about is politicizing a very volatile and challenging event.

For starters one cannot predict with absolute certainty the extent and degree of the viral spread.

SARS (Severe Acute Respiratory Syndrome) which is also a Coronavirus and originated in China in 2002 was also of major concern back then but did not become the pandemic that was feared. It affected 26 countries but only 8000 cases were diagnosed in 2003.

The worst pandemic in American history was actually the Influenza (H1N1) outbreak of 1918-1920. It affected 500 million people (27% of the world’s population at the time) around the globe. Unfortunately, 40-50 million people died. The case fatality rate of 10%  was much higher than that of Covid-19. The Flu pandemic of 1918 hit young adults particularly hard because of “cytokine storm” which ravaged the stronger immune system of this age group. Covid-19 seems to hit those with medical conditions the hardest. Children seem to be relatively spared.

The high case fatality rate of the Flu pandemic of 1918 was due to malnourishment, overcrowded conditions and poor hygiene.

I will now discuss possible prevention and treatment strategies. Because Covid-19 is a new virus it’s impossible to say with certainty or scientific studies treatment options. It will be purely anecdotal. A vaccine is in the works but even working at lightning speed, it will take a minimum of 3 months to develop.

The best strategy at the moment is prevention and early detection. Hand washing with soap and water, as well as alcohol based hand sanitizers are crucial to prevention of all infectious diseases. Since Covid-19 can be spread by air droplet as well as contact many more steps need to be taken. Most of the surgical masks being used do not prevent viruses from entering into one’s respiratory tract. Masks must be properly and tightly fitted and be of the N95 type to be effective. Hand shaking, kissing, and touching contaminated surfaces like door knobs can spread the virus. Unfortunately, even asymptomatic individuals can spread Covid-19 which makes being extra careful essential. In addition, since viruses (no reason to think Covid-19 is different) can be spread in feces, toilets become a major source of contamination. Use of Bleach, Alcohol, and Glutaraldehyde products to disinfect the toilet after each use can be very helpful. Use of nitrile gloves can further prevent spread. Avoiding crowded areas and closed spaces can be helpful.

Although anecdotal, use of steroids helped some survive SARS. It might be helpful in Covid-19 infected symptomatic patients. Use of Anti virals which have been used against HIV infection have helped some survive Covid-19. Again, this is strictly anectdotal. A study is now underway by Gilead with Remdesivir which is an anti-viral. The drug is experimental and not yet approved to treat any disease.
Because some patients seemed to do better after treatment with anti-HIV medications, it raises the question of whether these meds should be used (at least in health care workers) prophylactically as they are to prevent HIV infection. Unfortunately, the cost of some of these medications can be exorbitant. For example the combination  drug Truvada used to prevent HIV infection costs $6000 for a 90 day supply.

If these medications have a chance at working they must be given as early as possible. Early diagnosis is essential. Local testing must be allowed and fully implemented as soon as possible. This has been one of the problems so far. The diagnosis should be made in hours, not days to fully contain the disease.
The take home lesson is that although Covid-19 is a significant challenge and threat, with proper attention to detail, preventative measures outlined and  early detection we can overcome.

About the Author
Joe Frager is a graduate of the University of Pennsylvania School of Medicine. He is a Clinical Assistant Professor of Medicine at the Albert Einstein College of Medicine in private practice. Currently he is the Chairman of American Friends of Ateret Cohanim and First Vice President of the National Council of Young Israel. For the past 25 years he has been the Organizer of the Israel Day Concert in Central Park after the Salute to the Israel Day parade.
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