Blake D. Prescott: Stay smart, stay apart and keep the culprit from spreading

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As pointed out in The Lancet (medical journal), the worst place for information is the social media. It is a site for misinformation and malformation.

This is a dynamic situation, constantly changing, and presenting differently in different locales. As the virus afflicts a host, it replicates, and changes. We have identified at least five major changes, or mutants, thus far.

One prefers the GI tract and specifically ACE2 receptors which are found in the stomach, bowel, liver, heart and elsewhere; another is a respiratory variant but not the same as the original one from China. As the virus mutates, some forms are likely to become milder (choosing such milder mutants is how we developed the Sabin polio vaccine) and others become more severe (e.g., rapidly progressing fibrosis). So, at this time it's like having five different strains of flu out there — all at once.

The GI form is transmitted through fecal-oral transmission, i.e., dirty hands, like travelers' diarrhea, and gives us the warning, "boil it, cook it, and eat it hot; peel it carefully or eat it not."

The respiratory form is transmitted through droplets. Inhaling these from the air or after having contaminated your face with dirty hands allows the virus to then spread through the respiratory tract.

At least one form is capable of being caught by and further transmitted by dogs. Presumably, other animals may be so afflicted. Indeed, the start of this was in wet markets — presumably from pangolins — and we know it is carried by bats as well. Sonia Shah's "Pandemic" is an excellent read on this.

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Different forms are expected to have different degrees of contagiousness (how easily it spreads) and virulence (how severely it attacks). The incubation period is expected to vary — usually shorter correlating with more contagious. Thus we have a great range of incubation noted from less than two days to over 20 days, milder forms where the person doesn't know they are ill, and severe forms where even respirators are not enough and blood has to be oxygenated outside the body (ECMO).

Spread can be through "fomites," i.e., by the virus being on a doorknob, ball, railing, food or package, contaminating the next handler. Recent information indicates that the virus can live for up to two hours on steel, 24 hours on cardboard, and two to three days on plastic.

This emphasizes the need for frequent and proper hand washing with soap (which breaks the lipid capsule that holds the virus), scrubbing, and washing with suds for sufficient time (the four "S"s for at least 20 seconds). It further admonishes us to practice hand hygiene: keep our hands away from our faces, don't handle things that a compromised person might then handle, wear gloves where need be, use wipes when you can't wash, but wash even after wiping. Chinese surgeons are having trouble adequately feeling what they're doing due to wearing multiple pairs of gloves at once. Stay away, i.e., keep two arm-lengths away (six feet), isolate if ill, and self-quarantine if in doubt. Protect the compromised. Other countries won't let older doctors on the front lines due to weaker immune systems. Folks with chronic disease, pulmonary difficulties, immunosuppression, and other compromising problems like being on a steroid, need special attention and protection. We need to help them without contaminating their environment. Stay smart, stay apart and keep the culprit from spreading.

We are playing "catch up" with this virus. Of the different coronaviruses, there have been two really bad actors: MERS and this one. MERS surprisingly died out on its own. If a milder mutant prevails where people not only have less risk but also gain immunity, that would be a sort of "natural vaccine." We are faced with change; we are learning every day. Singapore, South Korea, and Senegal were smarter in their preparation; we need to learn from them and others, learn quickly, and practice the best preventative measures possible.

Dozens of studies in a variety of countries are being carried out in order to delineate better treatments, possible vaccines, the need for extraordinary measures in some cases, and how to best protect care givers, let alone everyone else. We need to cooperate and coordinate with these countries and follow the music of the experts. We need not to disguise our foe, but to know him and know him well.

Blake D Prescott is a retired physician living in Newfane. The opinions expressed by columnists do not necessarily reflect the views of the Brattleboro Reformer.


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