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COVID-19 - The Beginning of the End

Dec 14, 2020, 13:37 PM
Infectious disease specialist, Dr. Mark Wallace shines a light on the COVID-19 pandemic.

By Mark Wallace, MD Infectious Disease Specialist
On staff at Skagit Valley Hospital 2014 to 2019

COVID-19 burst onto the scene in late 2019 and has transformed 2020 into a year we can’t wait to end. Worldwide, at least 55 million have been infected and 1.3 million have died, while in the United States there have been 11 million confirmed cases and close to 300,000 deaths. The long-term effects in survivors remain unclear, but worrisome data indicates that many may have long-lasting lung, heart or neurological issues (brain fog, headaches and weakness). Aggressive efforts to limit the pandemic and avoid the overrunning of medical systems have caused major collateral economic and social damage.

Doctor in PPE with patient in hospital

Currently, the northern hemisphere is in the grips of the predicted fall/ winter surge. This has been triggered by cooler weather, crowded indoor settings and “pandemic fatigue.” Governments are reinstating closures of businesses and offices and advocating abandonment of holiday gatherings. These broad-brush social measures will no doubt prove effective (as they did last spring), but will once again extract a painful cost.

This new surge differs in important ways from what occurred in the spring and summer as we now know much more about the virus. Most importantly, multiple studies have shown that half or more of all infections are asymptomatic and even those who develop symptoms are able to transmit virus two days or so prior to illness. Given the virus’s ability to spread without symptoms, efforts to control it cannot be limited to isolation of the sick.

The virus spreads primarily by respiratory droplets and that indoor crowding, coughing, singing and talking facilitate transmission, several simple measures are available which can dramatically slow this epidemic over the next few months: social distancing, hand washing and quarantine when indicated, are of proven value.

Masks, initially controversial, have been shown to be effective in three critical ways: First, they reduce viral spread from an infected person, and, remember, any of us can be infected without symptoms and inadvertently spread the disease. Secondly, masks reduce the risk to the wearer of contracting the infection; and, third, even if you do contract the virus through your cloth mask, it is likely the resulting infection will be less severe as fewer viruses will be inhaled.

Some have argued that masks can’t work as the viruses are much smaller than the weave of a cloth type mask. This is incorrect as most viruses are attached to the much larger respiratory droplets expelled by an infected person and even a cloth mask can effectively reduce inhaled (or exhaled) viral particles.

During the first several months of this pandemic, we were limited to these effective broad-brush methods of control (shut downs, masks, social distancing, frequent hand washing); however, multiple major innovations are now available. Testing has become faster and more accurate, allowing screening of vulnerable populations, rapid confirmation of infection and improved contact tracing. Therapies have been tried, and, though some have been found ineffective (e.g., hydroxychloroquine), we are now using a range of effective interventions, including antiviral drugs and monoclonal antibodies which target the virus and can be useful early in the disease, as well as steroids, used in the most severe hospitalized cases, which save lives previously lost to COVID. Better antivirals and inhaled interferon may bring additional benefit in the near future.

Adult receiving vaccineThe bright light at the end of the tunnel is, of course, vaccines. In recent weeks, two U.S.-produced vaccines (Moderna and Pfizer) have reported early efficacy data and have reported that 95 percent of vaccine recipients were protected from clinical disease when compared to those that got the placebo. The Russian vaccine, Sputnik 5, has reported a 92 percent efficacy. This speed of vaccine development is unprecedented.

In December 2019, the first cases of COVID-19 were identified, and by January 2020 the causative SARS-2 virus’s genetic sequence had been published. Now, only 10 months later, three vaccines are clearing the final hurdles before widespread use and several more will be reporting results in the coming months. Side effects of the vaccines have so far been minimal and the FDA continues to closely monitor the safety and efficacy data pending final approval. While we now know for certain that the vaccines prevent disease, it isn’t clear if this is sterilizing immunity, meaning we don’t know yet if a vaccinated person exposed to virus may still develop an asymptomatic infection and spread the virus even while protected from clinical disease. Also unclear is how long the vaccines will protect, though most experts expect at least a year.

Given the imminent rollout of multiple effective vaccines, what is important now is to redouble our efforts to avoid infection until widespread use of vaccines interrupts this pandemic sometime in 2021. It is worth remembering that the most poignant casualties of the Great War were the thousands of young men killed and wounded in the six hours before the scheduled armistice at 1100 on November 11, 1918. These lives were needlessly lost in a war whose outcome had already been decided. Let’s make certain that we and our families avoid a similar fate. Though front-line workers and those living in crowded conditions may be unable to avoid some viral exposure, most of us have the opportunity to dramatically reduce our risk.

The end of this pandemic is now within sight and our use of the simple tools available to all of us can help us make it to the vaccine-mediated end of this devastating pandemic.

Mark Wallace, MD Infectious Disease Specialist

Mark Wallace, MD Infectious Disease Specialist

A Skagit County native, Mark Wallace, MD, graduated cum laude from Saint Louis University School of Medicine. His residency was at the University of Washington, where he was named Resident of the Year, followed by a fellowship in infectious disease at Naval Medical Center San Diego. Dr. Wallace possesses extensive training and experience in tropical medicine, including field work in the Middle East, Africa and South America. He was a clinical professor at three medical schools and published more than 200 articles in peer-reviewed literature.

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Last post : 11/24/2021

COVID-19 - The Beginning of the End

Dec 14, 2020, 13:37 PM
Infectious disease specialist, Dr. Mark Wallace shines a light on the COVID-19 pandemic.

By Mark Wallace, MD Infectious Disease Specialist
On staff at Skagit Valley Hospital 2014 to 2019

COVID-19 burst onto the scene in late 2019 and has transformed 2020 into a year we can’t wait to end. Worldwide, at least 55 million have been infected and 1.3 million have died, while in the United States there have been 11 million confirmed cases and close to 300,000 deaths. The long-term effects in survivors remain unclear, but worrisome data indicates that many may have long-lasting lung, heart or neurological issues (brain fog, headaches and weakness). Aggressive efforts to limit the pandemic and avoid the overrunning of medical systems have caused major collateral economic and social damage.

Doctor in PPE with patient in hospital

Currently, the northern hemisphere is in the grips of the predicted fall/ winter surge. This has been triggered by cooler weather, crowded indoor settings and “pandemic fatigue.” Governments are reinstating closures of businesses and offices and advocating abandonment of holiday gatherings. These broad-brush social measures will no doubt prove effective (as they did last spring), but will once again extract a painful cost.

This new surge differs in important ways from what occurred in the spring and summer as we now know much more about the virus. Most importantly, multiple studies have shown that half or more of all infections are asymptomatic and even those who develop symptoms are able to transmit virus two days or so prior to illness. Given the virus’s ability to spread without symptoms, efforts to control it cannot be limited to isolation of the sick.

The virus spreads primarily by respiratory droplets and that indoor crowding, coughing, singing and talking facilitate transmission, several simple measures are available which can dramatically slow this epidemic over the next few months: social distancing, hand washing and quarantine when indicated, are of proven value.

Masks, initially controversial, have been shown to be effective in three critical ways: First, they reduce viral spread from an infected person, and, remember, any of us can be infected without symptoms and inadvertently spread the disease. Secondly, masks reduce the risk to the wearer of contracting the infection; and, third, even if you do contract the virus through your cloth mask, it is likely the resulting infection will be less severe as fewer viruses will be inhaled.

Some have argued that masks can’t work as the viruses are much smaller than the weave of a cloth type mask. This is incorrect as most viruses are attached to the much larger respiratory droplets expelled by an infected person and even a cloth mask can effectively reduce inhaled (or exhaled) viral particles.

During the first several months of this pandemic, we were limited to these effective broad-brush methods of control (shut downs, masks, social distancing, frequent hand washing); however, multiple major innovations are now available. Testing has become faster and more accurate, allowing screening of vulnerable populations, rapid confirmation of infection and improved contact tracing. Therapies have been tried, and, though some have been found ineffective (e.g., hydroxychloroquine), we are now using a range of effective interventions, including antiviral drugs and monoclonal antibodies which target the virus and can be useful early in the disease, as well as steroids, used in the most severe hospitalized cases, which save lives previously lost to COVID. Better antivirals and inhaled interferon may bring additional benefit in the near future.

Adult receiving vaccineThe bright light at the end of the tunnel is, of course, vaccines. In recent weeks, two U.S.-produced vaccines (Moderna and Pfizer) have reported early efficacy data and have reported that 95 percent of vaccine recipients were protected from clinical disease when compared to those that got the placebo. The Russian vaccine, Sputnik 5, has reported a 92 percent efficacy. This speed of vaccine development is unprecedented.

In December 2019, the first cases of COVID-19 were identified, and by January 2020 the causative SARS-2 virus’s genetic sequence had been published. Now, only 10 months later, three vaccines are clearing the final hurdles before widespread use and several more will be reporting results in the coming months. Side effects of the vaccines have so far been minimal and the FDA continues to closely monitor the safety and efficacy data pending final approval. While we now know for certain that the vaccines prevent disease, it isn’t clear if this is sterilizing immunity, meaning we don’t know yet if a vaccinated person exposed to virus may still develop an asymptomatic infection and spread the virus even while protected from clinical disease. Also unclear is how long the vaccines will protect, though most experts expect at least a year.

Given the imminent rollout of multiple effective vaccines, what is important now is to redouble our efforts to avoid infection until widespread use of vaccines interrupts this pandemic sometime in 2021. It is worth remembering that the most poignant casualties of the Great War were the thousands of young men killed and wounded in the six hours before the scheduled armistice at 1100 on November 11, 1918. These lives were needlessly lost in a war whose outcome had already been decided. Let’s make certain that we and our families avoid a similar fate. Though front-line workers and those living in crowded conditions may be unable to avoid some viral exposure, most of us have the opportunity to dramatically reduce our risk.

The end of this pandemic is now within sight and our use of the simple tools available to all of us can help us make it to the vaccine-mediated end of this devastating pandemic.

Mark Wallace, MD Infectious Disease Specialist

Mark Wallace, MD Infectious Disease Specialist

A Skagit County native, Mark Wallace, MD, graduated cum laude from Saint Louis University School of Medicine. His residency was at the University of Washington, where he was named Resident of the Year, followed by a fellowship in infectious disease at Naval Medical Center San Diego. Dr. Wallace possesses extensive training and experience in tropical medicine, including field work in the Middle East, Africa and South America. He was a clinical professor at three medical schools and published more than 200 articles in peer-reviewed literature.