article by Eduardo Dolhun, Ph.D. contributed by DemClub member.
Dolhun Clinic Dispatch MAY 1, 2020
Highly rated and well-respected Family Medicine Practice in
the San Francisco, CA area.
If March was shock and April acceptance,
May is the month of action.
Staying the Course
As we move forward, we are learning a great deal about our behaviors and what risks are conferred with each behavior, both personal and communal. Since we can’t control all group behavior—Georgia and Texas open up for business, frisbees are tossed on the beaches of California, my residential building placed hydroalcholic gel in the lobby one month ago (only to run out three days later), nails and cuticles are covertly manicured, a local grocery store is manned by a cashier whose proboscis casts a shadow onto his face mask—what’s a citizen to do?
Well, the answer is a lot.
Let me explain by taking a moment to step back and leverage nearly 2 months’ worth of experiential data. Early on in the pandemic the World Health Organization (WHO) was reluctant to apply the term “pandemic.” World leaders, store owners, talk show hosts, religious leaders, parents, and even doctors were reluctant to accept the breadth and scope-even in the face of the viruses vertiginous and proven spread. There was shock, disbelief. This is not unlike delivering a diagnosis of a terminal or terrible disease that will upend a life totally and completely.
Was the WHO slow and bureaucratic or was it methodical and deliberate? Was the small business owner ignorant or simply terrified that everything they had worked for over 25 years could collapse? Do some political leaders care less about the lives of voters from other parties or are they terrified that the economic fallout will lead to being voted out of office? Does the talk show host truly believe that China concocted a virus to accelerate world domination or is he simply appealing to a listener base that has a sizable proportion of listeners who believe the 1969 moon landing was a hoax and the earth is flat? Does a pastor truly believe that his conviction in a personal and invisible God will decimate decillions of invisible invaders or is he simply recklessly risking his life and the lives of his practitioners on false distinctions? Is the mother of three teenagers who starts drinking an extra glass of wine or two daily now an alcoholic or is she simply using a tasty and socially acceptable short-term solution to deal with the massive upheaval to her life in the early days of Shelter-In-Place? Does the doctor who thinks he has seen it all, and labels Covid-19 nothing more than the common flu, stupid or is he simply displaying his hubris?
I give these examples to illustrate a couple of things. Fear is a powerful force. It is powerful because it is often unconscious or not well-appreciated as a driver of decisions…at all levels of society. Franklin Delano Roosevelt addressed the phenomenon of unbridled fear in his inaugural speech on March 4, his 1933 presidential election campaign. It is worth listening to. Nothing to Fear but Fear Itself.
So, if March was shock and April acceptance, May is the month of action.
Governor Newsom took action to limit frisbee throwing on beaches. The bold and prescient Mayor Breed extended our Shelter-In-Place to build on success and to buy us more time, which, if nothing else, is an effective strategy (we now have a promising therapeutic and effective and available vaccination now seems more promising).
The GAP takes Action:
I would like to highlight the reaction and action of a locally based, multinational company (personal communications), the GAP. The brick and motor clothing industry has been devastated by the virus, on par with restaurants and the airline industry. There have been massive furloughs and now layoffs. That is the sad part. What is GAP doing now? Innovating. It is rapidly exploring UVC light technology, new store designs and novel use of materials that are antimicrobial. It is rethinking its entire business, top to bottom. It is also collaborating with other retail companies. Ultimately, we will have cleaner, less infective clothing stores.
These good examples of enlightened government and responsible business. But, I, as an individual, may have to navigate in other cities and states that have not embraced the same philosophy, I may enter stores that are not avant garde. Therefore, it is critical that I prepare myself for all possibilities at all times. If you do the following, your risk will be significantly reduced. Control what you can. Remember, this is far less contagious by than measles, for example.
My personal strategy is to avoid the virus at all costs whilst maintaining my medical practice. I am at slightly increased risk by virtue of leaving the house and then by going to work in a medical building.
I examined every single behavior of mine that might lead to me getting infected. I then thought through all of the things I need to do and the things I want to do. I then asked myself, can I do what I need to do and want to do in a safe manner. If the answer was no, I adapted.
I am now simply in execution mode. Most of my grocery shopping is now online. I am back to cooking for myself exclusively. I run steps and walk on streets with little to no pedestrians.
I grew up in Wisconsin and went to medical school in Minnesota. When the temperature gets to minus 20 or below, you simply don’t leave the house without a coat, hat and gloves…or you get frostbite. At minus 40 your uncovered cheeks can get frostbite. That’s just what you do. The difficulty with the virus is that you are not getting immediate feedback, so it’s important to develop “triggers.” Every time you go outside make sure you have mask, gloves, and a hand sanitizer. Hug the ones you live with a lot more and resist touching those who don’t live with you, knowing that we will get back to embracing more of our loved ones in the future. This won’t last forever.
Lower Your Risk:
That’s it. If you practice these habits your risk of contracting SARS-CoV-2 plummets. You don’t want to contract the virus by some a random event, such as cocktails with friends outside your previous watering hole or having your kids go to the park to play with scores of unknown kids on the merry-go-round or forgetting your mask or not washing your hands or touching your eyes. You don’t want to contact the virus on a Tuesday and be left with long-standing health issues...just to have the vaccination be available to you the following Monday. And every day that passes, we get closer to proven therapeutics and a vaccination. We are tracking positive cases and mortality. We have yet to grasp the full extent of Covid-19’s morbidity-all of the damage this disease causes, short of taking your life.
Don’t let your guard down. Stay the course.
Human Immunity to SARS-CoV-2.
“it’s too early to state” whether exposure to and detection of antibodies floating around the blood confer immunity to a second infection. Again, they are being scientific-slow, deliberate and waiting for evidence (read “we need more time for proof”)
In the last Dispatch, I described some fundamentals of immunity. The immune system is exceedingly complex, second only to the brain, and thus it takes a while to grasp basic concepts, especially for those with no or little science background.
Here is a well-written excerpt from Rajat K. De and Namrata Tomar (eds.), Immunoinformatics, Methods in Molecular Biology, vol. 1184, DOI 10.1007/978-1-4939-1115-8_1, © Springer Science+Business Media New York 2014:
The defense system consists of a wide variety of cells and molecules that have evolved to protect animals from invading pathogenic microorganisms and cancer. Recognition and response are two major activities of immune system. Immune recognition is quite specific. Moreover, it is able to discriminate between foreign molecules and the body’s own cells and proteins. After the recognition of a foreign organism, it mounts an effector response through recruiting a variety of cells and molecules to eliminate the invader organism. Later exposure to the same foreign organism induces a memory response, characterized by a more rapid and heightened immune reaction that serves to eliminate the pathogen and prevent disease.
Historical perspective : The discipline of immunology developed through the observation when individuals who had recovered from certain infectious diseases were thereafter found to be protected from the disease.
The term “immunis,” meaning “exempt,” that is, the state of protection from infectious disease. The earliest literary reference to immunology goes back to 430 bc in writings of Thucydides, where he wrote that only those who had recovered from the plague could nurse the sick because they would not contract the disease a second time [ 1 ].
In 1798, Edward Jenner found that some milkmaids were immune to smallpox as they had earlier contracted cowpox (a mild disease). The next major advancement in immunology came with the induction of immunity to cholera by Louis Pasteur. He demonstrated the possibility of administrating a weaken pathogen as a vaccine through a classic experiment. In 1881, he first vaccinated one group of sheep with heat-attenuated Bacillus anthracis and then challenged the vaccinated sheep and some unvaccinated sheep with a virulent culture of the bacillus. All the vaccinated sheep lived, and all the unvaccinated animals died. In 1885, after applying weakened pathogen to animals, he administered a dose of vaccine to a boy bitten by a rabid dog and later found that the boy survived.
However, Pasteur could not explain its mechanism. In 1890, experiments of Emil Von Behring and Shibasaburo Kitasato led to the understanding of the mechanism of immunity. Their experiments described how antibodies present in the serum provided protection against pathogens. These experiments are described as milestone as the beginnings of the discipline of immunology.
The WHO and other medical bodies have come out and stated that “it’s too early to state” whether exposure to and detection of antibodies floating around the blood confer immunity to a second infection. Again, they are being scientific-slow, deliberate and waiting for evidence (read “we need more time for proof”) before they declare that any sort of infection grants full immunity. This should not be alarming. There is no reason to think that we will not be granted significant protection. How much and for how long is yet to be determined. You may know that folks vaccinated for measles and mumps have waning immunity after 40 or 50 years. We did not know this-or it was not common medical knowledge-even 10 years ago. So we muddle through. Trust in your immune system. It has evolved for even longer than Covid has been around and, at the species level, will prevail.