I’m calling attention to a new post by my physician, Dr. Alex Lickerman—part of his continuing series on the pandemic and the virus. In this one, he lays out guidelines about how a business should operate to be opened safely if it’s allowed to and wants to; but he emphasizes at the outset that he is not recommending that businesses reopen:
If we consider the public health perspective only, maintaining the stay-at-home order still makes the most sense. We still don’t have a vaccine or effective treatment that lowers the mortality rate of COVID-19. Whenever large enough groups of people gather, there will be increases in the number of cases. Flattening the curve by maintaining the stay-at-home order spreads those increases out over time so that the healthcare system isn’t overwhelmed and everyone who needs a ventilator gets one.
and adds this:
So our purpose with this post isn’t to tell you whether or not reopen your business—that’s a judgment each of you have to make on your own—but rather to provide recommendations that will minimize the risk to your business and your employees if you do decide to reopen. We recognize that people are afraid both of contracting COVID-19 and of worsening economic disaster. Both fears are legitimate. But we think all decisions should be made based on science and statistics, not emotion. Our intent, then, is to provide you with the most accurate, up-to-date evidence-based statistics possible.
In fact, most of the post is devoted to discussing whether a useful vaccine is in the offing and what your chances are of contracting the virus from others, including those who are asymptomatic. The guidelines for opening a relatively safe business is at the end of the piece, and I’ll let you read that for yourself.
Click on the screenshot to read. Alex will be reading the thread from time to time, so feel free to ask him questions.
The stuff that interested me are two issues?
1.) What’s the story with a vaccine? And it’s worse than I thought. Not only will it take time to develop any vaccine, but it may not be possible to produce an efficacious vaccine at all:
Some have been thinking that we can’t fully reopen the economy until we have a vaccine. But how soon might that happen? We don’t know. We might never. We still don’t have one for hepatitis C or HIV. But even if we do develop one (and many are currently in the works), proving it both to be safe and effective will take time. To deliberately infect volunteers who’ve been vaccinated against SARS-CoV-2 to see if they’re immune would be unethical given the fact that the disease is fatal in some cases (you can do this with animals, but animals aren’t humans). Instead, once we have a viable vaccine candidate that’s passed Phase 1 and 2 trials, we immunize a large group of people and follow them through time, comparing their rates of COVID-19 infection to a matched group that hasn’t been immunized, all while observing for complications that didn’t show up in the Phase 1 or 2 trials.
Unfortunately, sometimes the treatment is worse than the disease. Studies show that when given immunizations to some diseases—dengue, respiratory syncytial virus, and SARS, for example—a paradoxical phenomenon occurs: subjects develop more severe disease. There are thought to be two mechanisms that cause this: 1) antibody-dependent enhancement, where a virus leverages the antibodies that we generate in response to vaccination to aid infection, and 2) cell-based enhancement, where immunization leads to severe allergic inflammation that can cause worse disease outcomes.
Unfortunately, vaccines used to induce mice to produce antibodies to the virus that causes SARS—a coronavirus similar to the virus that causes COVID-19—were shown to place the mice at high risk for life-threatening cell-based enhancement. Fortunately, when researchers altered their vaccine strategy and aimed to create a vaccine against only a portion of the spike protein of the SARS virus, cell-based enhancement was blocked. Sadly, funding dried up just as researchers were about to proceed to clinical trials in humans. Now, with the COVID-19 pandemic, that research is restarting.
Not only that, but even if you recover from the coronavirus, you may not have sufficient antibodies to mount a response to re-infection, much less show up on a test as having recovered from an infection. Alex’s bottom line is this:
We still don’t have a vaccine or know when or even if we will have one. We also don’t know if infection produces immunity, for how long that immunity might last, or if infection predisposes to a more severe course from re-infection.
2.) What kind of exposure to the infected or to asymptomatic carriers do you need to get the virus yourself? Here the news is a bit better: it appears that you need pretty sustained exposure to someone who’s infected or to an asymptomatic carrier to get a high risk of getting the disease. In other words, you need “close contact”. Now that can be someone sneezing in your face or coughing at you, but simply being in the presence of others for a short while without those things happening (especially if you wear an effective mask, and cloth masks, while better than nothing, are not nearly as effective as surgical masks), doesn’t put you in extreme danger. A few excerpts:
Thus, it seems even when people ignore current social distancing guidelines, the risk of transmission is, in fact, low, and—given the much higher rate among household contacts—largely determined by amount of contact time a person has with an infected patient. This is likely because with more contact time, higher risk scenarios are more likely to occur, i.e., coughing without a mask on, touching shared surfaces and then one’s face, and so on. It seems it’s not quite as easy as many think to encounter an infectious dose of the SARS-CoV-2 virus.
. . . . What does all this mean? First, transmission rates from contact tracing studies seem to cluster under 1 percent or around 10-20 percent. The difference may be due to behavior differences in study subjects, to differences in average contact time of close contacts with index cases, or to methodological differences in the studies. Whatever the reason for the differences in attack rates, all the studies suggest that when you have close contact with an infected person, the risk of becoming infected is, in fact, relatively low. Consider also that what defined “close contact” behavior in the studies above is behavior that most of us are now doing our best to avoid (e.g., being closer than six feet to others for a prolonged period of time or having unprotected direct contact with infected secretions).
. . . .What this means, among other things, is that everyone must become strict about self-quarantining once they show any infectious symptoms whatsoever (including: sinus congestion, runny nose, sore throat, ear pain, cough, vomiting, diarrhea, fever, chills, body aches, loss of smell or taste, discolored toes). In America, we’ve endured a culture of going to work while sick that must now end.
As for asymptomatic carriers, the chance of getting it, even when you work in an office with someone (and who is doing that now), is also low:
How likely would you be to catch COVID-19 from an asymptomatic person working in the same office as you? Research suggests that if you do have the kind of sustained close contact with asymptomatic cases that occurs in households (a reasonable surrogate for a workplace), the risk of catching COVID-19 is only 0.33 percent (compared to a risk of 3.3 percent for sustained close contact with mildly symptomatic cases, a risk of 6.2 percent for sustained close contact with severely symptomatic cases, and a risk of 13.6 percent for sustained close contact with someone who’s coughing and expectorating, meaning bringing up phlegm).
So we have some bad news (vaccine) and some good news (you’re not in as much danger of being infected as you thought).
Here are Alex’s previous posts on the coronavirus:
- Coronavirus February 2020—Part 1 What We Know So Far
- Coronavirus March 2020—Part 2 Measures to Protect Yourself
- Supporting Employee Health During the Coronavirus Pandemic
- Coronavirus March 2020—Part 3 Symptoms and Risks
- Coronavirus March 2020—Part 4 The Truth about Hydroxychloroquine
- Coronavirus April 2020—Part 5 The Real Risk of Death
- Coronavirus April 2020—Part 6 Evaluating Diagnostic Tests
- Coronavirus April 2020—Part 7 The Accuracy of Our Antibody Test