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Ask Dr. Halverson: A look back at COVID-19

web 4 17 Halverson photo
By Dr. Jim Halverson 
March 11 marked the one-year anniversary since The World Health Organization declared the SARS-COV2 outbreak a pandemic.
The number of people affected since that time by death, lingering illness, emotional distress, financial loss or social isolation is staggering. Virtually no country has been spared the suffering of COVID-19. Here are the sobering statistics locally, in California, in the United States, and around the world as of March 11. 

VENTURA COUNTY 
Confirmed cases: 78,605 (nearly 1 in 10 county residents); 917 deaths; death rate — 1.2%; Ojai deaths — 24; Oak View deaths — 5. 

CALIFORNIA 
Confirmed cases: 3,520,333 (nearly 1 in 10 state residents); 54,878 deaths (greater than the number of people who usually die in the United States during a typical influenza year); death rate — 1.6%. 

UNITED STATES 
Confirmed cases: 29,113,651 (nearly 1 in 10 Americans and 25% of total world cases); 529,301 deaths (the greatest death toll of any event in U.S. history, except the U.S. Civil War from 1861-1865); death rate — 1.8% (annual influenza death rate in the United States is approximately 0.1%). 

WORLDWIDE 
Confirmed cases: 116,166,652; deaths — 2,582,528; death rate — 2.2%. COVID-19 has killed more people than all infectious disease outbreaks except the plague (Europe 1347-1351; estimated 75 million to 100 million deaths); the Spanish flu (worldwide 1918-1920; estimated 50 million to 100 million deaths); viral hemorrhagic fever (Mexico 1545-1548; 5 million to 15 million deaths), and HIV-AIDS (worldwide 1981-present; 35 million deaths and increasing). 
Yet there is hope that this terrible pandemic is beginning to come to an end, at least in countries that have access to highly effective vaccines, including the United States. Here is a look back at some of the ways we underestimated this new coronavirus and what those missteps may have cost us. In next week’s column, I will present a look forward to the possible future of COVID-19. 

MARCH 2020: NO NEED TO PANIC. IT’S JUST THE FLU. 
MARCH 2021: IT’S MUCH WORSE THAN THE FLU. 
The United States had a plan for responding to the pandemic. It was built around the flu. Very few people suspected a coronavirus could be this much of a threat for this long. In the past, severe diseases caused by coronaviruses such as SARS and MERS, proved to be manageable. They could be controlled. 
“What we saw with these other coronavirus infections, people are not really highly infectious until Day 5 or Day 6 of their illness and you can identify them, isolate them, and you could really shut down ongoing coronavirus transmission of either SARS or MERS,” said Michael Osterholm, Ph.D., director of the Center for Infectious Disease Research and Policy at the University of Minnesota. 
Early on, Osterholm said he realized this new coronavirus wasn’t sticking with that script. 
“For me, this was one of those really humbling moments because I went from ‘my worst fear is a flu’ to feeling reassured that it was a coronavirus to ‘oh my, this is a really bad, different coronavirus,’ and that was just a period of 25 days,” he said. 
At the end of February 2020, he published an Op-Ed in the New York Times calling the crisis a pandemic and warning that the virus was spreading through the air, a stance that was decidedly against the grain at the time. 
“I think probably more than any other time in my career, the amount of blowback I got was really substantial,” he said. 

MARCH 2020: MASKS AREN’T NECESSARY. 
MARCH 2021: WEAR TWO. 
In a Capitol Hill briefing on March 11, 2020, Lisa Maragakis, M.D., senior director of infection prevention at the Johns Hopkins Health System, told lawmakers: “This is another area where I think we need a lot of messaging to the general public because we do see a lot of images of people around the world wearing masks in public settings. The current guidance is that it is not necessary and in fact may not really even add to protection,” she said. 
In the midst of trying not to worsen severe supply shortages for healthcare workers, messages about masks got muddled. 
In fact, even at the time, there was good evidence to support the use of face masks. Most Asian countries were already using them. 

MARCH 2020: ASYMPTOMATIC SPREAD IS RARE. 
MARCH 2021: 40% OF NEW CASES COME FROM PEOPLE WITHOUT SYMPTOMS. 
In a Feb. 1, 2020 situation report, the World Health Organization said: “Asymptomatic infection may be rare, and transmission from an asymptomatic person is very rare with other coronaviruses, as we have seen with the Middle East Respiratory Syndrome Coronavirus. Thus, transmission from asymptomatic cases is likely not a major driver of transmission.” 
Evidence from cruise ships, homeless shelters and church choirs suggested otherwise. 
A review published in the Annals of Internal Medicine in September rounded this all up very nicely, estimating that 40% to 45% of coronavirus infections may come from people who aren’t showing any symptoms. 

 

MARCH 2020: WE DON’T THINK THE VIRUS IS A THREAT TO YOUNG PEOPLE. 
MARCH 2021: SADLY, THAT IS NOT TRUE. 
In his March 11, 2020 address from the Oval Office, former president Trump stressed the need to take precautions to protect the most vulnerable, including the elderly and those with underlying health conditions that put them at increased risk from infection. 
“Young and healthy people should expect to recover fully and quickly if they should get the virus,” he said. 
Over the summer, adults under 30 accounted for more than 20% of all COVID cases in the United States, according to the Centers for Disease Control. More than 12,000 Americans under the age of 45 have now died from COVID-19. 

MARCH 2020: WE DON’T THINK THE VIRUS STAYS IN THE AIR VERY LONG. 
MARCH 2021: AVOID POORLY VENTILATED INDOOR SPACES BECAUSE THIS VIRUS DEFINITELY HANGS AROUND IN THE AIR.  
In a scientific briefing published in March 2020, the WHO cautioned that there was no evidence that the virus was lingering in the air and making people sick, though recent experiments at that time suggested that it might be doing just that. 
Scientists who studied aerosols were dumbfounded. In July, more than 200 of them signed an open letter to the WHO urging the organization to “recognize the potential for airborne spread.” 
As a result, in July, the WHO revised its guidance on coronavirus transmission saying the virus could remain aloft in indoor, crowded and inadequately ventilated spaces such as restaurants, gyms, nightclubs and places of worship, to name a few. 
We have to be humble when we deal with these viruses. 
What we didn’t realize on March 11, 2020, was that the catastrophe unfolding in Europe was already here. The virus had already seeded itself across the country. Scientists later estimated the 500 cases and 19 deaths across 34 states that were known to the CDC at the time of the pandemic declaration were only a fraction of the actual number in this country. 
After years of starving our public health system of funding, the United States was caught ill-prepared to deal with a disaster on this scale. Though experts agreed the best way to stop the virus was to test, trace and isolate infected people, the United States did none of that effectively, partly due to lack of political will and inadequate resources, and partly because public health experts underestimated the virus. 
“Putting aside rampant disinformation and political interference, the real tragedy was not having any COVID-19 testing for the first two months of the U.S. pandemic, which promoted diffuse spread of the virus across the country and we’ve never been able to contain it since,” said Eric Topol, M.D., professor of molecular medicine at Scripps Research. “That was the unforgivable mistake … a fatal mistake for thousands of Americans.” 

VACCINATION UPDATE 
Of course, it wasn’t all bad. The development of the vaccines, which happened with unprecedented speed and remarkable success, was a dazzling achievement. 
“It’s astounding, you know, and it’s a testament to the scientific community, the medical community, the regulatory community, the pharmaceutical community, you know the fact that everybody was able to do this,” on such an accelerated timeline and without compromising safety, “was a very happy surprise,” said Mark Heise, Ph.D., a professor of genetics at the University of North Carolina at Chapel Hill who studies host-virus interactions. 
Now everyone is hoping we can get them rolled out in time. 
In Ventura County, our population age 18 and above is approximately 650,000. As of March 12, 73,000 have been fully immunized (11.2%) and another 100,000 have received their first dose (15.3%). Dr. Robert Levin, our Ventura County Public Health officer, told me on March 9 that our region (Ventura, Santa Barbara and San Luis Obispo counties) is now estimated to have nearly 32% of our adult population immune to SARS-COV-2 virus by vaccination or prior infection. We are making progress toward our goal of achieving 70% to 80% immunity in our county (and across the United States), which should bring this pandemic in our country to an end. Of course, some cases will continue to be reported following that time. More on that next week in this column. 
Many more of you became eligible to receive the vaccine on March 15 and it appears all adults will be eligible as of May 1. Stay persistent in your efforts to receive the vaccine. Visit venturacountyrecovers.org. or call the vaccine registration phone number at 805-477-7161 for more information and to register to receive the vaccine. 
Stay hopeful, stay diligent, stay properly informed, stay safe and stay well. 

— Dr. Jim Halverson of Ojai is a longtime Ojai physician who writes a weekly column on COVID-19 for the Ojai Valley News.

 

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