March 21, 2020 Update
Dear All,
Here is today’s update.
Once you’ve had COVID, are you immune to getting it again?
We don’t know. However, one of the leading experts on this from Yale, Nick Christakis, recently addressed this. The full article is available here but selected pieces pulled out below:
“Probably as many as 40% of humans will be exposed to COVID19 over the next 2-3 years, judging from past pandemics. Not everyone will actually get it. Only some (probably <1.0%) of those who get it will die. The rest will recover. And, almost all of them will be immune.
But we don’t know how long this immunity lasts. For some diseases (like polio or chickenpox), you are basically immune for the rest of your life. But for many others, that’s not the case. This is a complicated area in immunology.
We know from prior research that antibodies against viral antigens render us immune, but we do not yet know how long the immunity will last (to learn this will require follow-up time, and we are still only at the outset of the epidemic).
Hence, the duration of immunity to a new coronavirus like SARS-CoV-2 is very difficult to know. We will just have to ‘wait and see' -- which is an expression that I find myself using so often with COVID19 and that is so frustrating for all of us.”
My hope is we will have a blood test to look for antibodies in the next few months which will inform us who has already been exposed to COVID since some folks will have picked it up but never developed symptoms. But, we won’t know with confidence how long you are immune to being re-infected if you do have circulating antibodies for a while.
How long are we going to have to socially distance? Put another way, how long is this going to last?
I have received several emails from folks of all ages asking how long life will be disrupted. Whether it’s an elderly person who’s now having to live in isolation or a young person who’s worried about their job, to a mom/dad who’s now at home having to watch their young kids 24/7 with no school or babysitters, the same question is eating at them: How long will this last before life returns to normal?
As with many of my answers, we just don’t know. My best guess is that we will be in a socially distanced world for a period of months as opposed to weeks. I would mentally prepare for life to be significantly different until the mid-to-late summer.
I know this is not the answer many of you want to hear, but my advice would be to start identifying strategies that will help you cope with this for months. For some, that may mean having to go back to using babysitters or grandparents to help with child care. For others, it may mean having to let an elderly parent or grandparent move in with you so they don’t have to live alone or remain isolated for several months.
For many, it will mean coping with a new normal that may lead to increased stress and/or anxiety. It may be necessary (and appropriate) to speak with your primary care physician virtually to discuss your increased stress, anxiety, or uncertainty if you’re feeling overwhelmed. Take your own and your family’s mental health seriously as the pandemic unfolds and find a strategy that will enable you to cope for several months in case it does persist that long.
An article from former CDC Director Dr. Tom Frieden talks about his predictions for the next few months and they are sobering. Selected portion below:
We learn more about this virus by the day, often by the hour and most of the news is bad. Here are five things we've learned in the past week:
· The virus is much more infectious than influenza or the SARS virus, which it closely resembles. This week, new data showed that SARS-CoV-2, the virus that causes Covid-19, can live on contaminated surfaces as the SARS virus can, so it may spread, sometimes explosively, from doorknobs, elevator buttons and contaminated surfaces in hospitals and elsewhere. But we also learned that, unlike SARS, patients become highly infectious before they become seriously ill, explaining at least in part why Covid-19 acts like a super-SARS, far more infectious than its vanquished cousin.
· It's not just older people with underlying conditions who become very ill and can die. Younger adults, previously healthy people and some children develop viral pneumonia. Although prior reports suggested that 80% of people got only mild disease, it now appears that about half of these people, despite not needing hospital admission, have moderately severe pneumonia, which can take weeks or longer to recover from.
· Explosive spread will almost certainly overwhelm health care capacity in New York City and elsewhere, and lead to the inability to save patients who could otherwise have been saved. Today's severe cases are in people infected 10 to 14 days ago who got sick five to six days ago and have steadily progressed to severe illness. That means cases will continue to skyrocket for weeks after spread stops. Not only won't there be enough ventilators, there won't be enough supplies for the ventilators, hospital beds to support patients -- or health care workers to help patients.
· Health care workers are in peril. Thousands were infected in China, more than 3,000 have been infected in Italy, protective equipment is in short supply in the United States, and as health care becomes overwhelmed, it becomes harder to provide care safely.
· It's going to get a lot worse. Not only is the global economy in free-fall but supply chains for essentials, including medicines, are disrupted. Even China, which has successfully tamped down spread, is only now reopening its economy -- which produces components of many medicines people rely on -- and very slowly.
What are you most worried about today?
New York City. As testing has increased, the number of confirmed cases has been rising dramatically. We are now over 22,000 confirmed cases with the true number almost certainly higher than that given the continued testing shortage. The hardest hit areas continue to be Seattle, California, and New York City. New York remains the most concerning with a population of 8.6 million and only 3,000 ICU beds. Of the 22,000 confirmed cases nationally, about a 1/3 (~7,000) are in New York City. While NYC still has time to build additional capacity, I worry it is only a matter of time before demand outstrips supply.
And, here’s an opinion piece from a pediatric surgery fellow in New York City for those who are interested.
What was the most informative read of the day?
The CNN article from former CDC Director Dr. Tom Frieden referenced above.
Will be back Monday with the next update.
Stay safe,
Harry