The High-Priced Spread

 

So many people around the world simply dismiss the intensity of the pandemic, a factor that is most pronounced in the United States where dealing realistically with the novel coronavirus is a sign of disloyalty to Trump populism. This is especially true of people who do not know many people who are or have been infected, intensified that at any given moment since 40% of those infected by COVID-19 are (and may remain) asymptomatic. Unfortunately, when the virus hits a community, it spreads like wildfire on a hot gusty day. Learning the hard way can be terrifying. And the older you get, the less prepared your immune system is able to counter the virus. As a result, “Covid-19 patients who are 80 or older are hundreds of times more likely to die than those under 40.” New York Times, September 8th. 

If you would like a visual of the rate COVID-19 is spreading now, visit covidspreadingrates.org. Mark Wilson, writing for FastCompany.com (September 15th), puts it this way: “In Burundi, where a new COVID-19 case is found every 17 hours, that dial fills slowly—too slowly to see. But in the U.S., where a person is diagnosed with COVID-19 every 2.5 seconds, the graph is in a constant red spin. Since I loaded the [above web] page as I began writing this article, 339 Americans have tested positive for the virus. (The ticker isn’t displaying real-time diagnoses; it starts by analyzing the total COVID-19 cases tracked in each country during the week of September 7. Then it averages out the rate of those cases evenly through the day to make these ticking graphs. So it’s technically a simulation, but it’s built upon real, recent data.).” 

So younger, asymptomatic carriers – even those whose immune systems can push back against the disease – can infect older persons with devastating consequences, particularly those over 65. “That’s partly because [elders] are more likely to have underlying conditions — like diabetes and lung disease — that seem to make the body more vulnerable to Covid-19. 

“But some scientists suggest another likely, if underappreciated, driver of this increased risk: the aging immune system… When a virus infiltrates the body, cells in the first line of defense act swiftly and violently — sending out alerts and instructions to other cells, and provoking inflammation to start knocking down the virus… The ‘innate’ immune system, as it’s called, also happens to be responsible for cleaning up damaged cells, misfolded proteins and other detritus in the body, even when there’s no infection to fight. 

“In older people, such waste seems to outrun the immune system’s ability to clear it, however, said Dr. Eric Verdin, the chief executive of the Buck Institute for Research on Aging in Novato, Calif. The innate immune system grows overwhelmed, and slides into a constant state of alert and inflammation… At the same time, elderly cells in tissues throughout the body are thought to change with age, releasing inflammatory substances of their own… ‘They are not just benign, like old nice grandparents,’ Dr. [Arne Akbar, a professor of immunology at University College London] said. ‘They’re actually very cantankerous.’ 

“As a result, even perfectly healthy 65-year-olds usually have higher levels of immune proteins, like cytokines, involved in inflammation than younger people do. This heightened state of chronic inflammation, sometimes called ‘inflammaging,’ is linked to frailty — older adults with higher levels of it may be more fragile and less mobile. 

“And it also means that fighting off pathogens becomes more complicated: All of this baseline inflammatory chaos in an aging body makes it harder for the messages sent out by the innate immune system to reach their targets… On top of that, there’s the added danger that the innate immune system may overreact.” NY Times. 

Since the elderly are particularly vulnerable, they are mostly excluded from the clinical trials for most of the vaccines in development. The underlying notion, however, is that older people just might need different dosage or longer sequential treatment of the vaccine, if we do in fact deliver one, than the general population. This brings into question whether one of the most virus-susceptible segments of our population, those who need immunity the most, will even be able to be immunized by the initial wave of approved vaccines. 

The cost in lives and health, well beyond COVID-19 losses, is staggering generally in terms of whatever progress we may have made in improving global standards. “The Bill and Melinda Gates Foundation’s… newest Goalkeepers Report, an annual report that tracks how the world is advancing on the United Nations’ Sustainable Development Goals, the news is now grim: After years of progress, the pandemic is setting the world back on most of the goals. 

“The number of people getting vaccinated, for example, has dropped to levels not seen since the 1990s. ‘In other words, we’ve been set back about 25 years in about 25 weeks,’ Bill and Melinda Gates write in the report. Disruptions in healthcare mean that people with diseases such as HIV or TB are less likely to get treatment. The economic catastrophe caused by the virus means that people are struggling to afford food or keep a roof over their heads. Developing countries are finding innovative ways to help—India sent digital cash transfers to 200 million women soon after the pandemic began—but are still limited by budgets. As part of the report, the Institute for Health Metrics and Evaluation, a Gates-backed program at the University of Washington, calculated that so far this year, nearly 37 million people globally have fallen below the extreme poverty line of $1.90 a day… The situation can’t improve until the pandemic is under control, something that’s still far from happening.” FastCompany.com, September 15th. 

In the end, the quality of national and international leadership is determinative. Allocation of resources, a staunch reliance on scientific facts without politization and a willingness to make tough short-term choices for long-term survival are critical. There are no magic bullets, and as the above information illustrates, even a viable vaccine (if and when developed) has its own risks and limitations. If governments cannot garner popular support, even properly framed policies will simply fail. In particular, the United States needs to do so much more. Testing, contact tracing, containment and deploying effective rules to limit the most obvious risks of spreading the contagion. Whether we like it or not. 

I’m Peter Dekom, and expecting a short time to full recovery is without doubt most unrealistic, but failed leadership can drag this litany of COVID horribles on for so much longer.