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As the official U.S. death toll from COVID-19 passed 10,000, Surgeon General Jerome Adams warned that Americans should brace for the hardest and saddest week of their lives. During a press appearance over the weekend, he called the coming days our Pearl Harbor moment, our 9/11 moment. Inside New Yorkarea hospitals, the prospects match his grim tone. In addition to struggling with widely-reported supply shortages, working seemingly endless shifts, and struggling to manage the influx of patients, infectious disease experts say that even as theyre racing to develop an effective vaccine, they are essentially learning on the job.

The infection itself does have some perplexing features, said Dr. Megan Coffee, a clinical assistant professor at the NYU Grossman School of Medicine specializing in infectious diseases and immunology, who coauthored a study about an experimental A.I. tool that predicts which patients with the virus will develop a serious respiratory illness. She listed just a few of the many unanswered questions: We dont yet know what we can do to prevent this immunologic response. We also dont fully understand why some, who are healthy, go on to have severe disease and others, with more risk, do not.

Specific characteristics of the virus likewise remain a mystery. The pandemic of 1918was associated with bacterial as well as viral pneumonia, which does not seem to be the case with the novel coronavirus, said Dr. Joseph M. Vinetz, a professor at Yale School of Medicine who also specializes in infectious diseases. But we still dont know whether coronavirus can lead to secondary or superimposed bacterial pneumonia in addition to [causing] immune damage to the lungs, which is the primary cause of severe illness and death. This coronavirus, he said, is puzzling due to its unique combination of asymptomatic infectiousness, and the delayed onset of severe disease. Very perplexing.

Dr. Sandra Gelbard, a Manhattan-based internist who specializes in preventative medicine and one of the first doctors in New York City to begin COVID-19 testing, described the current epidemic as way, way more concerning than the first two coronavirusesSARS and MERSwhich is surprising because the first two were more lethal. But those viruses were contained. With this novel coronavirus, 25 to 50% walk around without symptoms. It is the right combination of lethality and transmissibility. This makes this virus a real global threat.

Dr. Coffee concurred. This is the disease weve always feared as infectious disease doctorsa respiratory-borne virus that spreads easily person-to-person, but with a high mortality, she said. Those of us who have worked on Ebola and other crises have feared for a while [that] this would be worse than anything we have ever seen.

The results, said Dr. Gelbard, could be more devastating than current predictions suggest. If we did intense social isolation like they did in China and South Korea, the number might have been around [100,000 deaths], but we missed the boat on that, she said. I dont expect it to be 100,000 to 200,000 people dead. It could easily be 1 million.

She added, we really dont know the mortality of this virus. Were assuming at best its somewhere around the 1% mark. We cant know at this point. No one knows.

Meanwhile, as it spreads, the virus is changing. The issue is that [it] is mutating, said a New York Citybased doctor treating COVID-19 patients. We cannot predict what strain it will mutate to, and in some populations strains may be more virulent than others, so all we can do is prepare for the worst. She added, Its scary because it is a disease that is ever-evolving. Just when we think we have figured out the pathophysiology of the disease process and how to manage it effectively, we realize there is a new loophole or nuance that the disease presents us with.

More here:
Worse Than Anything Weve Ever Seen: Frontline Doctors Race to Learn the Mysteries of a Deadly Virus - Vanity Fair

This entry was posted on April 7, 2020 at 9:42 pm and is filed under Preventative Medicine. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed. |