Covid 19 took the world by surprise. Few countries had plans for dealing with the virus, but they should have. It also took a very long time to realize for the world to understand what was happening, although it was, sadly, all pretty predictable. I want to continue to share my thoughts about the virus.

Flattening the curve-delay is not cure

The purpose of fattening the curve is primarily to make sure that the hospital system is not overwhelmed. Assuming that it is not and that patients receive the same care they would get if the curb is no longer flattened, there is no need for measures like social isolation, except for those that have underlining conditions that make them highly vulnerable. Likely, we will not get a vaccine for 12-24 months. Most likely, herd immunity, which will require an infection rate of 60-70%, will happen before that. There is another benefit of such a delay. We might learn more about how to treat those that are infected. For instance, I have been an advocate of using CPAP to assist breathing. We don’t know if this is helpful, but I suspect we will find out it is.

The importance of testing and tracing

If we can detect the disease early and trace the people that have interacted with the person who has contracted the disease, we can reduce the spread, which also means we can take more risks with opening the economy. But the testing has to be done quickly. Many patients are asymptomatic. There have been studies that show that these people can transmit the disease, but I have not seen any studies that show what the rate of transmission for these people is. This would be important to know, and I suspect we will know eventually.

Herd immunity will have significant economic benefits

Herd immunity will allow things to get close to what was normal. The economic benefits are enormous, allowing governments to spend money to help those that need to be isolated until there is a vaccine. We don’t know the number of people that have been infected but not tested. We need an antibody test to know that. It is essential to have this information to develop strategies.

The strategy has to be local.

It is nuts to talk about the curb in a country the size of the USA. Even in Israel, where I live, the curb for the country is a summation of the curves of very different communities. At one time, 50% of the cases in Israel came from a religious community that made up only 10% of the population. They would have their peak much earlier than the rest of the country. Probably another 30% are those in nursing homes. They would also peak much earlier.

The USA is made up of very different regions. It did right not have a national lockdown, I think. The problem in a country like the USA is that people can easily migrate from one area to another. When NYC got their challenge, many New Yorkers, including friends of mine, move to other states and likely carried infection with them. I am not sure how this should be handled.

The importance of viral load

The amount of virus one gets is a significant factor in how sick one gets. It only makes sense. If you have a small amount of the virus, your immune system has more time to build up antibodies before the virus count is too large.

I think two factors account for how ill one might get. The first is the exposure, and the second if the strength of the immune system. The exposure is a function of how contagious someone is. For instance, if someone has a large viral load and is coughing and sneezing, my guess is they have a high viral load. The distance from them and the amount of time exposed will impact the viral load. The distance has an exponential decline. That means at 6 feet distance; almost no virus will be present. But I would think that at 3 feet there much less than two feet. Time, on the other hand, is linear. Sitting next to someone that is sick for an hour has twice the exposure as sitting next to someone for 30 minutes.

Masks are crucial

They play two roles. The mask can significantly reduce the transmission rate from someone that is ill but wearing a mask. A mask worn by someone that is not ill will significantly reduce the chance that the virus will be picked up by the hand and transmitted to the mouth, nose, and eyes.

The virus is not going away when it is warm

There seems to be no data supporting this. I hope I am wrong. But we will see an uptick in the fall and winter because flu and colds will weaken immune systems.

How will identify those that have had the virus

I believe that having the virus confers immunity. We will end up with large populations of people that no longer have to be concerned. How will we identify them, and will this create two classes of people? Can you imagine job posting that requires the person to have had the virus?

Travel

Air travel will happen when there are fast tests that can be done at the airport. I think this will be in Sept. These tests must be done before people get on the flight. Perhaps the day before.

Quarantine

We don’t know the life cycle of being contagious. It may be that the last week of a two-week quarantine does not confer much more protection.

We need science but we also need judgement

We need our best scientists working without political consideration but our elected leaders must use some judgement and weigh the pros and cons of various actions. They should reach out to the smart people that are not in the government but would give substantial amounts of their time to help if asked.