The war on COVID-19 continues in full force. It has been a devastating and painful process. This is a world war, but unlike the others, we all have a common enemy this time. In the US, the New York Metro Area has been hit the hardest. As of April 25, there have been 12,067 deaths from the virus in New York City alone. The total number of deaths in the United States stands at 54,964.
There has been a lot of second-guessing and finger-pointing. The media has played the role of Monday morning quarterback at every turn. The President and his task force have been laser-focused and have done an incredible job fighting a monster formidable foe. War is beyond horrendous. President Trump has been an admirable Commander in Chief in the middle of this raging and unpredictable war. The media for the most part never seems to see it quite that way. Historians, though, will. His ventilator triumph is the stuff of champions. His passage of trillions of dollars of relief bills is nothing to sneeze at. In point of fact, it is unprecedented and legendary.
Unfortunately, viruses do not surrender. They are an implacable enemy. They only stop when they run out of susceptible hosts. They are an armed combatant like no other. They do not follow the rules of the Geneva Convention.
We must rally around the President. Attacking him is counterproductive. We can defeat this insidious and lethal beast. We can indeed be victorious, but it will not happen overnight. The Spanish Flu pandemic of 1918 lasted for one and a half years. The second wave was worse than the first. It essentially ended when it had killed all of its potential hosts. Fifty to 100 million died worldwide. More than 675,000 died in the United States.
The President and his task force are to be commended for keeping the deaths to its current level of 50,000 to 60,000. Our health care workers and first responders have had a lot to do with keeping the death rate down.
Unfortunately, flattening the curve does not stop the virus. It only slows it down. It gives medical facilities time to catch their collective breaths.
Even though models predict that with the CDC guidelines in place the total death toll will top out at 60,000 in the United States, this is subject to debate. It will require super vigilance.
I was one of the very first proponents of widespread use of masks, and I continue to be one of its strongest advocates. The science is there. I would recommend that it be made mandatory. This is especially true on planes or in any closed, or under-ventilated space. The proper masks also would enable many other activities. Remember, when I go into my hospital, which is full of COVID-19 patients, the main PPE is the N95 mask.
Getting back on our feet will only be possible if masks are worn by all. Unfortunately, it will be necessary for longer than people would like. I would dare say it will be necessary until a vaccine is found. We live on a virus-contaminated planet. It is a fact of life. It is far better than wearing a space suit.
In the meantime, the CDC guidelines are a good starting point. American creativity and brilliance will help us overcome. I have listed some additional ideas and thoughts:
1) Testing: All agree that ramped up testing will help guide us back. Although antibody tests are still in their infancy, a positive test on a good platform should help first responders and health care workers have less anxiety when dealing with COVID patients. The immunity issue has not been settled, but I personally would feel a lot better if I had a positive test. Of course, I would continue to wear an N95 mask and follow CDC guidelines. I would recommend a quick swab test for anyone taking either a domestic or international flight. This would revive the airline industry. The TSA can administer the Abbott Lab swab tests to all travelers.
2) UV Light: Although last Thursday the President got flak about his questions posed to Bill Bryan of the DHS Science and Technology Directorate, who found that high humidity, high temperatures, and sunlight kill the coronavirus in saliva droplets on non-porous surfaces and the air, the media overlooked the valuable points being made. Presumably, it is the UV light in sunlight that kills the virus. UV light can be harnessed to potentially kill the virus on many surfaces including cell phones and clothing. This can be invaluable in decontamination and the opening up of society. UV chambers can be developed for this purpose.
3) Isopropyl Alcohol: Bill Bryan made it also very clear that the use of isopropyl alcohol is very effective in killing the virus. Just as in Asian countries, where one sees spraying disinfectant on sidewalks, storefronts, doors, knobs, and subway stations, certainly in New York City this should be done.
4) Clothing and Shoes: Surface contamination is an important source of spread of the coronavirus. Soles of shoes should be sprayed with isopropyl alcohol before entering one’s home or a store or office. Outer clothing should be removed and washed before entering one’s home.
5) Temperature Taking: Certainly a person with a temperature of 100.4 degrees (F) or higher should not be allowed into a store, office, plane, or stadium. Unfortunately, only one-third of patients had a fever before hospitalization in a recent study undertaken in New York and published in JAMA. It still offers some degree of screening ability, but it will miss quite a few.
6) Bathrooms: I have made this point over and over again. As a gastroenterologist, I am keenly aware of the abundant shedding of viruses in the feces. Flushing the toilet is one of the best ways to aerosolize COVID-19. The virus ends up in the air in high quantities as well as on surfaces. Closing the lid of the toilet helps some. Public bathrooms will have to be given special attention at decontamination.
I have tried to share some ideas of how we can open up society again. It is not a comprehensive list by any stretch. I hope it helps in formulating a very complex and challenging task ahead. In future articles, I will discuss prophylaxis, treatments, and vaccines. Studies are now underway in all of these regards. The main message is that we will indeed get back on our feet again, but it will take a great deal of thought, ingenuity, and patience.
Joseph M. Frager is a physician and lifelong activist.