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Sep. 22, 2020 | Tuesday
Editorials and Opinions
Dr. Brown: The past and future with COVID-19
Dr. William Brown.

Dr. William Brown is a professor of neurology at McMaster University and co-founder of the Infohealth series held on the second Wednesday of each month at the Niagara-on-the-Lake Public Library.  

Dr. William Brown

Special to The Lake Report

This pandemic has been a steep learning curve from the get-go for all charged with managing, controlling and treating it. 

That applies to infectious disease experts, epidemiologists and modellers, those serving on the front lines of health care and politicians at all levels and of all stripes and all countries. 

It’s been tough. I’m especially sympathetic toward those in government, most of whose backgrounds didn’t prepare them for this, now forced to lean on experts, many of whom were making it up as they learned about a virus, that except in name and a proclivity for attacking the respiratory system, shared little with SARS or MERS, their antecedent coronavirus cousins. 

This virus turned out to be far more transmissible than SARS. Without timely and speedy imposition of lockdowns, social distancing and face masks, the disease spread unchecked, especially within large groups, jammed close together in crowded private and publc venues, close-quartered housing, nursing homes and refugee camps – and did so quickly.

Even a week lost imposing strict controls made all the difference between control and chaos, the likes of which we’ve witnessed in Brazil, India, South Africa, and sometimes wealthy countries with otherwise excellent, well-resourced health care systems. At its worst, this disease infected and killed more than the great flu pandemic of 1918, according to the New York Times. No one anticipated that one. 

The face of the disease also changed as frontline workers became more familiar with it. In the early days most of the attention was focused on the respiratory tract (loss of smell and taste, dry cough, shortness of breath and pneumonia).

Other clinical features were less-often reported – features which although less common, included widespread blood clotting affecting both large and small blood vessels, which when it affected the circulation in the lungs, increased the risk of severe hypoxemia, strokes, heart attacks and vasomotor changes in the skin.

Beyond these, there was cumulative evidence that virtually every system and organ in the body was vulnerable in some fashion, including the bowel, kidneys, eyes and brain – the last a source of persistent cognitive and affective symptoms long after the acute infection.

Care for patients has been a learning exercise on the fly – with trials of this drug or that – most reasonable bets, but without solid evidence to support their use.

But then, what were physicians to do sometimes for critically ill patients when a trial of a given drug made "sense" even if there weren’t gold-plated clinical trials to support their use? How do you get that evidence in the middle of a pandemic? Systems were overwhelmed and, more importantly, so were the frontline workers. 

We’ve learned a great deal about this virus’s genome and tracked how it changed as the disease swept around the globe, but so far, there is nothing to suggest changes in the behaviour of the virus or the development of vaccines and drugs to treat the virus. 

Epidemiologists continue to create computer models to forecast how this pandemic might play out in the future. The consensus view is that COVID is likely to become a permanent resident of human hosts for years, if not decades, much like the influenza virus.

And like the flu, annual or semi-annual vaccinations may be needed to keep up with changes in the infectivity of the virus and as the immunity to the virus wears off. 

Such a view would be consistent with what we know about other coronaviruses. That means there might be recurring surges, especially in winter months when most spend much of their time inside. 

However, we’ve learned that distancing and masks are very effective in preventing the spread of this virus and, incidentally, some other viruses such as the common cold, which thanks to distancing and masks, has all but disappeared this summer.  

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