Columnist Jay Fleitman: Not the first rodeo

  • Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, listens as President Donald Trump speaks about the coronavirus in the James Brady Briefing Room, Wednesday, March 25, 2020, in Washington. (AP Photo/Alex Brandon) Alex Brandon

Published: 3/30/2020 2:45:08 PM

This is not my first epidemic. I was born in 1952, which was the apex of the polio epidemic in the United States. That year, there were 58,000 cases of polio in the U.S. with 3,000 deaths.

I spent my childhood during the waning years of polio. It is hard to imagine the anxiety of parents at that time that their children would be paralyzed or crippled by this disease. I remember getting vaccinated for the first time. My parents were in the room with me, and I could sense their relief when I downed the sugar cube that carried the vaccine.

People of my vintage likely remember school classmates who carried the mark of polio with them. There were those among us who walked with braces or crutches following their brush with polio.

The person I remember most vividly from those days was Sophia, who came from the other side of town and so I first met her in high school. She was petite with fine features and high cheekbones, warm brown eyes and curly chestnut hair. She usually sported a broad smile and had a high birdlike energy. She would hold out her hand with muscles that were wasted from the nerve damage of polio, her fingers in a chronically flexed position because she no longer had the strength to straighten them, and she would grin while threatening us with “the claw.” I had a serious high school crush on Sophia.

The AIDS epidemic in the U.S. started in 1980. I was there. I was an intern in the intensive care unit at a city hospital in New York with a patient who was known to be an intravenous drug user, and he was on a ventilator with respiratory failure due to a pneumonia that would not get better. He ultimately had a surgical biopsy for diagnosis, and he proved to have pneumocystis pneumonia.

This is a peculiar organism that is not quite a fungus and not quite a parasite, which at that time was only known to occur in people with malignancies of the immune system and in starving orphans in postwar Germany. There were six other cases in New York City at that time that were exactly the same, and this was described in an article in the New England Journal of Medicine in early 1981. Pneumocystis pneumonia proved to be the hallmark infection of what became the AIDS epidemic, and my case was a harbinger of the outbreak.

It was a frightening time in the U.S. as a steadily increasing number of cases rolled into hospitals. No one then knew how contagious AIDS would be, and no one was exactly sure how it spread. Health care workers worried for themselves and their families. We did know one thing about this disease, however; it was universally fatal. It was not a matter of if, but when an infected person would die.

We thought AIDS was caused by a virus, but it would take years before the virus was identified. It took many more years to devise effective treatment. Now AIDS takes more the form of a chronic illness needing long-term management.

We are still in the middle of a Lyme disease epidemic that seems to be increasing in spread. Hepatitis C remains endemic. This viral infection causes a slow long-term destruction of the liver, and in some infected people triggers a cancer of the liver. We now have medications to cure this.

Influenza roars in every fall and winter. In the 2017-2018 flu season, over 800,000 people were hospitalized in the United States, with over 61,000 deaths from the flu, 84% of which were in people over the age of 65, according to the U.S. Centers for Disease Control. Last year, there were almost 500,000 hospitalizations with 34,000 deaths in the US, 75% of which were over the age of 65. We make it through every year and we don’t panic.

Now we are in the COVID-19 pandemic. We use the measurement of mortality rate as a marker of the viciousness of the infection, and the mortality rate of COVID-19 (current 1.7%) is worse than influenza (.14%) in the U.S. Like influenza, COVID-19 is a threat if you are older and sicker to start. However, we are not in Ebola territory, with a mortality rate of 67%.

There are varying estimates of how contagious the two viruses are, and in general they seem to indicate that the viruses are similarly infectious, though there are some estimates that influenza spreads more quickly than COVID-19. What makes COVID-19 different is that it is a “novel” virus not seen by humans before and therefore there is no underlying immunity as occurs with influenza. There is no current vaccine, and even though the influenza vaccine may only be 40-50% efficacious, that still means there are 40-50% less cases of influenza as would have occurred without a vaccine.

In other words, even though COVID-19 may not be terribly more severe or contagious than influenza, we are going to have a larger number of people who will get it. If a mass of people who need medical care show up at a similar time, then our medical resources are overwhelmed and not available to everyone who needs them. 

We are not dealing with an Ebola outbreak or AIDS or the Black Death, a 14th century outbreak of bubonic plague. COVID-19 is more of a numbers problem. This is what the “flatten the curve” effort is about: Spread out the cases over time so the medical resources are available, and buy some time to develop a vaccine and/or treatment.

We as a people have lived through this repeatedly, and should keep history in mind while in the middle of the COVID-19 outbreak. This history includes solutions to these infections, such as medications and vaccines, and our science is breathtakingly more advanced than even what was available a short time ago when AIDS first struck. Keep the faith, batten down the hatches and we ride out the storm. The ship is not going to sink. Follow the guidelines and we will save some lives.

If I may be so bold, I would make one mental health suggestion. Do not get your news about the COVID-19 outbreak from network or cable news. They are melodramatic bordering on hysterical. The talking head physicians they usually engage also seem overwrought. Listening to them will make you unnecessarily anxious. I would advise watching the daily briefing offered by the COVID-19 National Task Force. Drs. Anthony Fauci and Deborah Birx are reasoned and they are pros. Though they may or may not get it all right, at least they are not out there selling  time to advertisers.


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