"We have nothing to fear but fear itself."
"We can't let The Cure be worse than the disease."
History
On January 31, 2020, in an attempt to keep the Wuhan SARS-CoV-2 Virus and the disease it causes, COVID-19, out of the United States, President Trump ordered most flights from China stopped, and eventually those from other parts of the world as well. With little else to go on, he took the first steps to try to keep the virus out of the country. At about the same time, the US Center for Disease Control issued guidelines for people to follow to slow down the spread of the virus. Essentially, they amounted to "Stay away from other people as much as possible (by at least six feet), and Keep your hands clean and away from your face." Also, "Stay out of gatherings of ten or more people." This was given the name, "Social Distancing." And, "Be especially careful around the elderly or those with conditions known to make them susceptible to the worst ravages of the disease."
The outcome was a good part of society hunkered down in its homes, venturing out only to get food and medical treatment. Oh, and to carry out "essential" business, which some states eventually got around to defining. Many businesses (deemed unessential) stopped altogether, and others had to cut way back. The economy staggered to a crawl.
The US government has passed legislation promising to spend money on anything they could think of in order to keep citizens afloat, because this part of The Cure we've taken (reasonably) as a stop-gap measure has created a huge hole in the economy. Not knowing much about the virus or the disease, it was the logical thing to do. That's where we are today. We took that "cure," and we're suffering from the economic side effects.
The Cure I want to propose is aimed at more than the virus. It's aimed at getting us through and out of the pandemic of COVID-19 while avoiding the deep recession or depression that looks imminent if we continue to slam the brakes on the economy while pushing the gas pedal down on mitigation.
Prevention by separation
Without a vaccine to prevent people from catching the virus and coming down with COVID, the only strategy available in January was to try to separate people from each other. That was especially true because with COVID-19, people are contagious before they start to exhibit any symptoms, and in fact it's possible to acquire the virus and NEVER show symptoms.
The first separation action was to stop flights from China (or at least most people coming from China were stopped). If nobody carrying the virus were able to come in, we would be protected. Obviously, complete exclusion wasn't going to be possible, but the goal was really to reduce the number of carriers so the invasion would be smaller. The goal was always to keep it manageable. That was separation at the highest level, the national level.
Next, the CDC guidelines came into play. Keep individuals or family units separated from others. Again, impossible to do for everybody, but it has proven to cut down on the spread of the disease. "Keep six feet away." That separation helps prevent person to person transmission via coughing, sneezing, touching, and even breathing.
The same goes for "Keep gatherings small," but that also is an attempt to cut down on the NUMBER of people who might get infected if one of the group happens to be contagious. Instead of infecting one hundred people, he only infects nine. The 91 others have been separated out of that group.
Even "Wash your hands and keep them away from your face" is an attempt at separation on the personal level. The virus can be picked up on your hands or clothing without a high probability of infecting you if that's where the germs stay, or if you wash them away. They can't really go through your skin, unless you have an open wound. But they can easily enter if you carry them to your eyes, nose, or mouth, so "Keep your hands and face separated."
Even the use of masks is a form of physical separation. The mask prevents germs from spreading further away from the source and to some extent keeps the wearer from breathing them in if they're in the air. In effect, it extends your distance from the people around you.
All those levels of separation seem to have helped to "flatten the curve," which means they've helped prevent excess demand for hospital beds, ICU beds, and even ventilators. But they don't help us to get back to work. All except the masks and personal hygiene instructions actually make it harder to do that.
Notice that none of these actions do anything to the virus itself. They just attempt to keep it outside the body. They attempt to keep people from catching COVID-19, and they work very hard to succeed. The virus and the disease are their only targets.
Internal separation
Vaccines work by keeping a virus separated from what it wants to do--make us sick. They prevent it from successfully attacking cells, whether they be organ cells or blood cells, by creating antibodies in the blood to fight the virus off once the virus has been "caught." Our problem is that we don't have a vaccine. This is a new, a "novel" virus, as they call it. But we do have a medicine that works almost as well as a vaccine, only not by creating antibodies. We need to pull out all the stops to make that medicine available and in use by almost everybody. It is already in general use for this purpose in Europe.
Hydroxychloroquine
Hydroxychloroquine has been approved for daily use since 1955 for prevention of malaria, to treat rheumatoid arthritis, and for lupus. Patients take it twice daily for many years. Harmful side effects are practically non-existent. One study shows that it fights the SARS-CoV-2 virus the same way it wards off malaria. A summary of the ideas in that study are here. If it's accurate (and there are other studies being conducted to determine if hydroxychloroquine actually works), it could be a practical, available, and inexpensive Cure for the entire problem. The summary says about hydroxychloroquine,
If correct (and although the studies aren't all complete, observations are all positive; hydroxychloroquine indicates it can both prevent and reduce the effects of COVID-19), this means it could be the key to solving both parts of the puzzle problem: the pandemic and our attempts to mitigate it. Our targeted policy priority must very soon change from attacking the virus and the disease to restoring our economy to health.
The Cure that isn't worse than the disease
The steps aren't exactly easy, but they're conceptually simple.
First, modify standard hospital treatment.
On January 31, 2020, in an attempt to keep the Wuhan SARS-CoV-2 Virus and the disease it causes, COVID-19, out of the United States, President Trump ordered most flights from China stopped, and eventually those from other parts of the world as well. With little else to go on, he took the first steps to try to keep the virus out of the country. At about the same time, the US Center for Disease Control issued guidelines for people to follow to slow down the spread of the virus. Essentially, they amounted to "Stay away from other people as much as possible (by at least six feet), and Keep your hands clean and away from your face." Also, "Stay out of gatherings of ten or more people." This was given the name, "Social Distancing." And, "Be especially careful around the elderly or those with conditions known to make them susceptible to the worst ravages of the disease."
The outcome was a good part of society hunkered down in its homes, venturing out only to get food and medical treatment. Oh, and to carry out "essential" business, which some states eventually got around to defining. Many businesses (deemed unessential) stopped altogether, and others had to cut way back. The economy staggered to a crawl.
The US government has passed legislation promising to spend money on anything they could think of in order to keep citizens afloat, because this part of The Cure we've taken (reasonably) as a stop-gap measure has created a huge hole in the economy. Not knowing much about the virus or the disease, it was the logical thing to do. That's where we are today. We took that "cure," and we're suffering from the economic side effects.
The Cure I want to propose is aimed at more than the virus. It's aimed at getting us through and out of the pandemic of COVID-19 while avoiding the deep recession or depression that looks imminent if we continue to slam the brakes on the economy while pushing the gas pedal down on mitigation.
Prevention by separation
Without a vaccine to prevent people from catching the virus and coming down with COVID, the only strategy available in January was to try to separate people from each other. That was especially true because with COVID-19, people are contagious before they start to exhibit any symptoms, and in fact it's possible to acquire the virus and NEVER show symptoms.
The first separation action was to stop flights from China (or at least most people coming from China were stopped). If nobody carrying the virus were able to come in, we would be protected. Obviously, complete exclusion wasn't going to be possible, but the goal was really to reduce the number of carriers so the invasion would be smaller. The goal was always to keep it manageable. That was separation at the highest level, the national level.
Next, the CDC guidelines came into play. Keep individuals or family units separated from others. Again, impossible to do for everybody, but it has proven to cut down on the spread of the disease. "Keep six feet away." That separation helps prevent person to person transmission via coughing, sneezing, touching, and even breathing.
The same goes for "Keep gatherings small," but that also is an attempt to cut down on the NUMBER of people who might get infected if one of the group happens to be contagious. Instead of infecting one hundred people, he only infects nine. The 91 others have been separated out of that group.
Even "Wash your hands and keep them away from your face" is an attempt at separation on the personal level. The virus can be picked up on your hands or clothing without a high probability of infecting you if that's where the germs stay, or if you wash them away. They can't really go through your skin, unless you have an open wound. But they can easily enter if you carry them to your eyes, nose, or mouth, so "Keep your hands and face separated."
Even the use of masks is a form of physical separation. The mask prevents germs from spreading further away from the source and to some extent keeps the wearer from breathing them in if they're in the air. In effect, it extends your distance from the people around you.
All those levels of separation seem to have helped to "flatten the curve," which means they've helped prevent excess demand for hospital beds, ICU beds, and even ventilators. But they don't help us to get back to work. All except the masks and personal hygiene instructions actually make it harder to do that.
Notice that none of these actions do anything to the virus itself. They just attempt to keep it outside the body. They attempt to keep people from catching COVID-19, and they work very hard to succeed. The virus and the disease are their only targets.
Internal separation
Vaccines work by keeping a virus separated from what it wants to do--make us sick. They prevent it from successfully attacking cells, whether they be organ cells or blood cells, by creating antibodies in the blood to fight the virus off once the virus has been "caught." Our problem is that we don't have a vaccine. This is a new, a "novel" virus, as they call it. But we do have a medicine that works almost as well as a vaccine, only not by creating antibodies. We need to pull out all the stops to make that medicine available and in use by almost everybody. It is already in general use for this purpose in Europe.
Hydroxychloroquine
Hydroxychloroquine has been approved for daily use since 1955 for prevention of malaria, to treat rheumatoid arthritis, and for lupus. Patients take it twice daily for many years. Harmful side effects are practically non-existent. One study shows that it fights the SARS-CoV-2 virus the same way it wards off malaria. A summary of the ideas in that study are here. If it's accurate (and there are other studies being conducted to determine if hydroxychloroquine actually works), it could be a practical, available, and inexpensive Cure for the entire problem. The summary says about hydroxychloroquine,
The same mechanism that stops malaria from getting its hands on hemoglobin and gobbling it up seems to do the same to COVID-19 (essentially little snippets of DNA in an envelope) from binding to it. On top of that, Hydroxychloroquine (an advanced descendant of regular old chloroquine) lowers the pH which can interfere with the replication of the virus. Again, while the full details are not known, the entire premise of this potentially ‘game changing’ treatment is to prevent hemoglobin from being interfered with, whether due to malaria or COVID-19.
If correct (and although the studies aren't all complete, observations are all positive; hydroxychloroquine indicates it can both prevent and reduce the effects of COVID-19), this means it could be the key to solving both parts of the puzzle problem: the pandemic and our attempts to mitigate it. Our targeted policy priority must very soon change from attacking the virus and the disease to restoring our economy to health.
The Cure that isn't worse than the disease
The steps aren't exactly easy, but they're conceptually simple.
First, modify standard hospital treatment.
- Hydroxychloroquine, with or without additional medicines attached, should be administered to every hospitalized COVID patient. It has been shown to shorten their hospital stay and lessen the severity of their symptoms. Obviously, this will reduce the capacity pressure on hospitals.
Second, modify outpatient treatment.
- Hydroxychloroquine has already been approved for "compassionate use," which really means that any doctor can prescribe it for off-label use if he wants to. Doctors should be encouraged to prescribe it for anybody who asks for it, whether they have symptoms or not. This should result in fewer of them needing hospital care.
- They should at the same time be tested for the disease or for the presence of SARS-CoV-2 antibodies in their blood. Both tests are relatively quick and easy, and they will, we are assured, help us greatly by increasing our knowledge of how the virus behaves. The first test is the Abbott Labs test for the virus. The second test for antibodies is already available. Both should be our top priority to manufacture enough to meet our needs.
Third, modify public health procedures.
- Allow everyone who wants to go back to work to be tested for COVID and antibodies. For those who don't show antibody-driven immunity, give them prescriptions for hydroxychloroquine or one of its spinoffs. These tests and prescriptions should be made available by doctors or at city and county health departments, with tests available at pharmacies.
Those are all medical attacks on the virus, but a bigger problem we have now is the economic one which we created in trying to slow the spread of the disease. Still, the disease must be brought down to an as yet unknown "acceptable" level before it will be politically viable to turn to concentrate on the economy. Fortunately, the first modification can be accomplished by a top-down push and completed in a matter of days or weeks, not months. It can turn the numbers that we look at first (deaths and hospitalizations) to acceptable ones very quickly. Controlled tests of step one have already started in some New York hospitals.
Also fortunately, the second and third modifications help the process of putting people back to work, safely. They have the effect of a vaccine without being a vaccine, protecting the non-hospitalized worker. The major problem in accomplishing them is the logistics of getting the medicine and the tests distributed to doctors and health centers all around the country, quickly. But when they get under way, they prepare us to return to work.
Return to work
Fourth, approve a return to work for all, even if it must come in stages.
- Allow those who have been tested and are not contagious to go back to work. Allow businesses that want to, to re-open without being designated as "essential," if they can comply with new procedures to minimize the possibility of viral spread, even without continuous six-foot separation of people. This could include temperatures being taken at the beginning and middle of the work day, wearing masks, having hand sanitizer readily available, regular disinfecting of shared work surfaces, and physical separation of workers when possible. Whatever procedures are adopted, it would be up to the business to determine how long to keep them in place and how to enforce them.
- Some situations are special and will face special challenges. Elevators. Mass transit. But those are both still in use, so whatever was done to mitigate proliferation in these places may simply stay in place, with alterations to fit the increased usage resultant from return to work. Spectator sports may be the toughest to bring back.
- Pass national legislation to hold businesses harmless in relation to the virus, the disease, and workplace accommodations made to allow people to work while preventing viral spread. Protect them and their employees and customers from lawsuits resulting from employees or customers catching the virus.
The key to all of this is that hydroxychloroquine or an equivalent works as expected. Something like this series of actions MUST happen to start the return to normal, and it MUST start soon. I have to believe that such plans are already underway, waiting only for enough improvement in the outlook for COVID in the US, and for some kind of breakthrough in the acceptance of hydroxychloroquine by the President's medical advisors. Since it already exists, is inexpensive, is already proven to be safe under prescription, and continues to perform well in all the current trials, all the arguments that have been mounted against it fail to persuade. Still, our top-level medical advisors appear to be waiting for some kind of proof of efficacy that no other medicine is close to attaining.
The process has to start very soon. There is really no time to waste.
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