No Time For Snake Oil

 Another week has gone by and another year in the history books. The wheels on the Trump bus have come off and he is riding on the rims. Multiple Republicans are now distancing themselves from Trump (that took only four years, but whatever). Trump wanted a second debate, angrily backed out when it was made conditional on being a virtual debate, then jammed a town hall in on NBC when Biden at the exact same time had a town hall scheduled on ABC. The result was dueling town halls in which Trump was laid low by a genuine interviewer (Savannah Guthrie) while Biden was collected, rational, and stayed beyond time to answer questions from the audience with no cameras rolling. Crash and burn, Trump.

Meanwhile, the coronavirus pandemic continues. The United States has experienced an excess of deaths between March and July 2020 of some 225,000, of which at least 150,000 could be attributed to COVID-19. When compared to 18 other countries, the USA had excessive all-cause mortality which the authors felt may have been due to weak public health infrastructure and a decentralized and inconsistent response to the pandemic. A researcher at Harvard estimated the cost of the COVID-19 pandemic to the United States alone at $16 trillion dollars. As my son would say, that boggles the mind. 

While many people pine for a return to normalcy, it is clear that we remain far away from whatever a new normalcy will be. There is ample evidence in the Northern Hemisphere, as winter nears, that we are already seeing the next wave of COVID-19. Cases are rising at a faster rate in at least 39 U.S. states as well as in Europe. Pandemic fatigue is real. A problem is that crackpot theories will arise in an attempt to get society back on track and to rev up the economy. The Great Barrington Declaration is the latest. It purports to be protective of the vulnerable while getting the nonvulnerable out and about to restart the economy. One big problem: there is no one who is not vulnerable to infection and infected people spread the coronavirus to other susceptibles. One immunologist crunched the numbers and found that this strategy if used would result in over 500,000 deaths in its attempt to gain herd immunity. The libertarian think tank behind the Great Barrington Declaration also is funded by right-wing dark money, similar to what we have seen with think tanks and reports expressing doubt about the dangers of smoking and global warming. 

As the editorial board of The Washington Post puts it, “The notion that we can ‘resume life as normal’ right now is misguided and dangerous.” If we veer from a path guided by science to a path guided by economics, the pandemic will be prolonged and there will be additional morbidity and mortality as a consequence. Masking, social distancing, hand hygiene, and ensuring adequate ventilation (outdoors is safer than indoors but that is relative, not absolute) will remain key pillars in preventing COVID-19 for the foreseeable future. Testing is obviously key but linked to that must be behavioral changes; people who test positive for SARS-CoV-2 have a societal obligation to quarantine until they are no longer capable of transmitting the virus. Systems only work for us if we all work for the system. 

I remind readers that this is a new disease. We have learned much in the year 2020 but we have much more to learn. A nice article today in The Washington Post by Ben Guarino looks at the puzzle of why men die more often from COVID-19 than women. Some of it may be biology; the X chromosome has about 60 genes that are involved in immune function. Women have two X chromosomes but men have one; I have humorously referred to the Y chromosome as a “broken” X and may have been more correct than I thought. When I read the part that work from Akiko Iwasaki and her colleagues at Yale suggests that male T cell responses in their 30s and 40s is equivalent to female T cell responses in their 90s, I knew that the old trope about women being the weaker sex was all wrong! We should focus on what we know. We have measures to blunt the spread of COVID-19; we need political will greater than the Trump administration to implement it at a federal level. We have gotten better at therapeutics. Vaccines are on the way but the caution must be made that first-generation vaccines may not be a complete answer. COVID-19 is NOT an insurmountable problem. Stay the course and don’t be seduced by someone offering a quick solution; it is likely snake oil.