Immunity

By

Leonard Zwelling

         After all, that’s what we’re all talking about. The debate is not whether the new coronavirus is a public health threat. It is. The debate is how we move from being 100% susceptible to the illness covid-19 (if we really are and there is evidence that we aren’t because some of the infected don’t get sick) to being at least relatively immune as a population as we are to smallpox.

         One way to do that is to eliminate the virus from the Earth. That’s probably not going to happen. Whether it emanated from a bat in an outdoor market or from a bat in a Wuhan lab, it’s out there now and not going to be contained.

         A second way is to have an effective vaccine that once given bolsters each person’s immune system to ward off any invasion from the novel coronavirus, thus preventing illness and death. Many biomedical companies, national governments, and academic labs are pursuing this strategy. Once a candidate vaccine has been identified (several have) they will be safety tested and efficacy tested. The former may not take too long, but the latter may as many people have to be inoculated with the vaccine. Many may need to get a placebo. Then the resistance of the two groups to natural infection must be compared. There are those who are advocating challenge testing where the vaccine is given then followed by purposeful injection or inhalation of the coronavirus. It’s a quick way to get to the answer (and it worked in monkeys), but I am not sure giving a disease to a well, human volunteer is ethical. Wait. Yes, I am. It’s not.

         A third way is to loosen interpersonal restrictions in the population and allow the natural acquisition of herd immunity while protecting vulnerable populations likely to succumb to the virus like the elderly. That’s kind of what Sweden did and we will see if that country fares better in the long run than other countries, particularly in Scandinavia.

         And, really, that’s about it for the choices. That is we can wish for a miracle, develop a vaccine, or let nature take its course with some moderation to decrease death if not infection.

         Why can’t America choose for America chose none of the above?

         First, there was New York. Clearly New York and particularly New York City are aberrancies. Whether they just got a virulent strain of corona from Europe, or live on top of one another, or ride in trains in tubes packed like sardines, New York was an outlier. What needs examination is why and whether or not the praise being heaped on Andrew Cuomo is really due him at all given all the death and disease surrounding his state.

         Second there was the garbled response in Washington where both the president and vice president chose not to wear masks when they are advocating for others to do so. Now the entire White House staff is to wear masks. Will Trump and Pence? Doubtful. Furthermore, the Coronavirus Task Force established perfectly reasonable guidelines for reopening America and many states just ignored them in the rush to restore commerce. I hope someone is keeping track of which states do what and what works and what blows up in the governors’ faces.

         Third, the experts, both medical and economic, were largely ignored by the White House and by Congress. The national response to this crisis can only be called inept. There was no leadership only bloviation and  a smattering of science from Fauci and Birx to the extent allowed by the boss. The CDC is MIA. And Fauci et al. are not being allowed to testify before the House.

         The coronavirus crisis has not been America’s finest hour. It has unmasked the weakness of our leadership and the divisions in our population. It’s been a long ride since 1945. We have endured the Kennedy Assassination, Vietnam, Watergate, burning inner cities, Iran-Contra, 9/11, Afghanistan, Iraq, and now this. The country is in desperate need of healing and it only seems to be getting sicker and more divided.

         One would have hoped that the latest crisis would have brought us together. Other countries like Germany, South Korea, Taiwan, and even China have fared better than we have. We have accumulated the death. We are still groping for a guiding philosophy of public health and governance.

         When we finally gain the immunity from the virus, we should attempt to gain immunity from our discord. As hard as the former is, the latter maybe harder.

Leonard Zwelling