Only six months ago, thoughts were of New Year’s celebrations, maybe even small family parties …think we’ll get back to that anytime soon?
Those of us who are caregivers already know better. Re-opening has us thinking about secondary cases and silent, “pre-symptomatic” risks.
Now that folks will be mingling more, some are predicting a new surge in CV19 cases. And we were just getting cozy, adapting in our little fragile cocoon of semi-isolation! [Remember that feel-good sci-fi / aging movie COCOON? Trailer link, click here]
Two weeks after our state’s lockdown, we felt that folks who hadn’t gotten sick by then (the 14-day COVID window, the vast majority) could come visit us with good handwashing and general distancing. Now, with over 20,000 cases documented in our state (and who know how many more), and re-opening imminent, along with new information, we feel that risks might actually be higher.
The “new” information is that the virus can be transmitted in those who don’t know they’ve been infected, and are still “pre-symptomatic.” So family members who will be seeing more people (as part of their jobs), even while wearing protective gear, will have to wear a mask if they come into our house, and wash their hands immediately. Once in and washed, they can unmask to eat if they stay six feet away from vulnerable people…
A few visitors sneeze regularly at our house, with allergies to our plants, or dust or the dog, so we’ve had to think about surfaces. On May 22,, the CDC announced that it was downplaying the risk of surfaces, saying “it may be possible….[to get the virus from surfaces]…but it is not thought to be the main way virus spreads…” It also downplays the risk from pets. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html
The point is, most of us who are vulnerable remain vulnerable. And the virus is still around, although it’s nice to think all the measures have slowed the infection and death rates. Our latest local numbers: more than 1000 dead, 90% of those older than age 60; more than 20,000 cases overall. For younger adults ~ 100 died.
So we plan to stay in our cocoon for awhile. Our issue is tiny compared to those confronting frontline health workers, heroes in so many ways, dealing with huge issues for their patients and for themselves. And they bravely took it on when so much was unknown. A major issue is just coming home after working with known CV19 patients, perhaps to family members who are vulnerable.
The biggest risk, it seems to me, is COVID-19’s “silent” period, being contagious without symptoms for several days, while the virus cooks along to do enough damage that finally makes a person have symptoms. This is described by “incubation period”:
[CDC]: “What is the coronavirus incubation period?
The incubation period for COVID-19 is thought to extend to 14 days, with a median time of 4-5 days from exposure to symptoms onset. One study reported that 97.5% of persons with COVID-19 who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection.”
More definitions from the CDC: “Recent…reports support the possibility of [viral] transmission from persons who are presymptomatic (SARS-CoV-2 detected before symptom onset) or asymptomatic (SARS-CoV-2 detected but symptoms never develop).”
Even now, we don’t know when a “pre-symptomatic patient” is most infectious to others. Furukawa and CDC colleagues tried to answer that question be looking closely at 34 papers already published on pre-symptomatic or asymptomatic transmission: https://wwwnc.cdc.gov/eid/article/26/7/20-1595_article; indirect viral methods suggest it’s most likely the last two days before symptoms appear.
Practically and realistically speaking though, even healthy looking friends with no symptoms can transmit the virus. Symptomatic persons can be “super spreaders” in certain situations:
At least two from this local choir practice died; https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm?s_cid=mm6919e6_w
Here’s a more detailed discussion of asymptomatic carriers, by an academic infectious disease doc (with a dish of a last name!), Dr. Wm. Petri: https://www.sciencealert.com/a-physician-answers-5-questions-about-asymptomatic-covid-19
For a bigger picture perspective, this is from an academic public health doc, Richard Cooper, MD, re: CV19…
“….Historians like to use the French expression the “longue duree” – taking account of an entire historical period where you can observe the beginning, the middle, and the end. Looking backwards so you can see forwards. In the US, since 1945 we had a long free ride on the American Empire, well into decadence…. As Toynbee described, we are into that period when the ruling class, the “elites”, have transitioned from creative problem solving (universal literacy, sanitation, railroads, land grant colleges etc.), to mega-wealth, a sole focus on finance capital and rent seeking, and go in for fantasy adventures about colonizing Mars… a combination of nostalgia for a past that mostly did not exist and a future that is a sure-fire formula for disaster.
…And this is just an opening chapter in this disaster. Things have changed. Definitively changed. We can’t go back, but can we go forward? …We need an army. Even if you can look beyond COVID 19, you see climate change – if you want to look, if you want to see. Over the last 20 years we didn’t want to see. We knew those huge houses and those huge cars and all those plane trips and mega-conferences and vacation islands . . were unsustainable, but . . . we were all along for the ride. Now we are forced to look. What a job for the next generation. Talk about being called to serve.
A little more down to earth, Tom Frieden [former CDC Director] has a nice brief summary of what happened to public health – and what we have to repair:
Governments have starved public health of funding for decades. The U.S. spent more than $11,000 per person on health care in 2018, but 40 times less – just $286 – for public health. Local public health departments lost 50,000 jobs between 2008 and 2017, and their budgets fell by a quarter. At the national level, the Prevention and Public Health Fund, intended to create stable public health funding for the Centers for Disease Control and Prevention, was repeatedly pillaged to fund other programs. And Covid-19 poses a terrifying challenge. The scale of effort needed to mitigate a pandemic of this severity seems inconceivable.
https://www.healthaffairs.org/do/10.1377/hblog20200425.195884/full/
Interesting times. A lot of work to be done. We are not yet prepared. But, people like us have been in times like these before. We could learn a lot from them, but will still have to invent most of what’s needed on our own. We are still a long way from the starting line. In small doses, we can move closer. With a lot of hope, a little optimism, and plenty of realism.
Addendum:
…As Dante said, on his way into Purgatory . ‘unequally distressed, we descend the circle . .”
…In addition to trying see the longue duree, and sorting through shards of 20th century history, I find myself grabbing books off the shelf that I haven’t read for 50 years. Poetry is a form of longue duree. I was thinking of TS Eliot’s “Four Quartets” (the only decent poem he ever wrote . .) and his image of the river as a “strong brown god” – a force of Nature, not to be denied. Like viruses. Like us.
I do not know much about gods; but I think that the river
Is a strong brown god—sullen, untamed and intractable,
Patient to some degree, at first recognised as a frontier;
Useful, untrustworthy, as a conveyor of commerce;
Then only a problem confronting the builder of bridges.
The problem once solved, the brown god is almost forgotten
By the dwellers in cities—ever, however, implacable.
Keeping his seasons and rages, destroyer, reminder
Of what men choose to forget. Unhonoured, unpropitiated
By worshippers of the machine, but waiting, watching and waiting.
. . . . .
The river is within us, the sea is all about us
And then went back to the wonderful poem by George Seferis, the modern Greek Nobel poet who was midwife to the rebirth of Greek literature 3,000 years after its glory days. [link below]. About another river, the Nile, the very origins of the entire “longue duree”, water in the desert, the source of “wisdom”. It begins –
And yet we should consider how we go forward.
To feel is not enough, nor to think, nor to move
https://www.poetryfoundation.org/poems/51357/an-old-man-on-the-river-bank
Richard Cooper, MD /Prof. and Chair, Public Health Sciences
Parkinson School of Health Sciences and Public Health, Loyola, Chicago “
