By now, we have all read ad nauseam about the novel strain of coronavirus that has changed our lives forever, SARS-CoV-2. This is the name of the virus while COVID-19 refers to the illness or disease caused by the virus. Y’all probably know that too. But you have probably wondered why we are treating this virus so different from influenza. After all, we have never shut down entire cities of businesses, schools and workplaces over the flu. Fundamentally, all viruses work the same way to make us sick; they use our own healthy cells, invade them and use the cell’s resources to reproduce hundreds more viruses. As more and more of our healthy cells are taken over, our bodies start to feel the distress. A major difference is influenza viruses replicate in our upper respiratory tract, while SARS-CoV-2 replicates in our lower respiratory tract.
What does that mean? Well it means that flu will cause a cough and sore throat pretty soon (2-3 days) after you are infected with the virus – these are the host cells being used. However, the coronavirus is settled lower in our airways with receptors that help to bind it to precious lung tissue, which means, we may not know we’ve been infected until we start to feel a deep dry cough or shortness of breath because our lung cells are being taken hostage (anywhere from 2-14 days). This also explains why pneumonia and Acute Respiratory Distress Syndrome (ARDS) are more common with COVID-19 then with influenza. It is this ARDS and the need for intensive treatment that is only available in hospitals that make this virus so problematic. Additionally, scientists know that the host cell interaction during replication is very different with coronaviruses than with other RNA viruses like influenza. So, it’s a gamble trying to figure out who will develop a severe form of illness and who will never show signs of illness. Obviously, those with underlying conditions are more susceptible to severe illness because their ability to fight the viral replication/host cell takeover is more taxing on their bodies but it is not a certain predictor of severe illness. “A lot of the disease that’s caused is actually the immune reaction—inflammation—and destructive things induced by viruses,” (Susan Weiss Microbiologist of the University of Pennsylvania1)”. There is no treatment for viral illnesses. When I say treatment, I mean scientists still do not know how to kill viruses. They have found ways to interrupt the replication cycle of some well-known viruses, but not coronavirus. If hospitalized with COVID-19, the care you receive is supportive care, which means the symptoms and bodily distress is being treated – like medications for fever, fluids for dehydration from the fever, and in severe cases, a ventilator to support the critical flow of oxygen to our bodily organs; but even the best doctors and hospitals can’t jump in the fight directly against the virus. If you knew this already, apologies for the repetition but really, we shouldn’t forget what we are up against and why it’s so critical.
Enter the Quarantine
When a novel virus is introduced into the population that means you have no idea how infectious it is, what the incubation period is, the severity of disease it can cause and the methods of transmission. While we know something of coronaviruses because of experience with SARS and MERS, this new strain can act completely different than any prior strain. In this novel virus environment causing widespread illness (epidemic), scientists scramble daily to collect and analyze as much data as possible to understand how the virus is impacting human populations and how infectious this virus really is. If you are familiar with statistical analysis, the problem is, you need a LOT of data to prove the causality or association of one thing to another with statistical confidence. With a novel virus, data collection is happening at the same time that decisions are being made on what to do to limit the devastation that this virus can cause. It makes for a very stressful and uncertain environment where sometimes, decisions have to be made around worst case assumptions about the virus. We know that transmission occurs through respiratory droplets and that large gatherings of people who may not yet show symptoms of illness but are infectious is the perfect combination for disease transmission and subsequently could lead to a large wave of persons with COVID-19; with an unknown number of those who will go on to require hospitalization, ICU care, and ventilator assistance to stay alive.
1 How Coronaviruses Cause Infection—from Colds to Deadly Pneumonia, Scientific American 5 Feb 2020 available:
https://www.scientificamerican.com/article/how-coronaviruses-cause-infection-from-colds-to-deadly-pneumonia1/
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If you’ve been tracking the cases in San Antonio you’re probably surprised that the numbers are so low for such a “big deal” virus. That’s because social distancing works! My dad likes to call the spread of the virus through people ‘stepping stones’ for the virus, he tells us over phone calls and text messages not to be ‘stepping stones.’ In epidemiology these are called disease vectors; any agent that can carry or transmit an infectious pathogen into another living organism. Vectors can be people, animals, mosquitos, and in some cases inanimate objects that carry the pathogen on its surface. If no measures had been put in place, there would have been devastating waves of illness and hospitalizations that would have overwhelmed our hospitals, and our morgues, and our funeral homes, and impacted our workplaces. The devastation would’ve occurred either in a chaotic un-prepared nature with impacts to the economy or in a semi-chaotic planned mitigation environment with impacts to the economy. Either way, pandemics are not good for the economy.
The San Antonio Transition Plan
The mayor established a Transition Team Workgroup charged with developing a safe plan to re-open SA businesses and other organizations. The report was released Monday (4/27). Click on https://www.sanantonio.gov/Health/News/NewsReleases/ArtMID/9362/ArticleID/18810/COVID-19-Health-Transition- Team-Releases-Guidance-on-Reopening-San-Antonio-Bexar-County.
The report outlines a Four Phase process for returning ‘back to normal.’ The first Phase is where we are now, “Stay Home, Work Safe” and we are transitioning to Phase II “Staged Re-opening by Risk Assessment” as early as Friday May 1s t. Phase III “Easing of Restrictions in the Context of Improving Conditions” would only occur if there are significant medical advancements in the treatment or prevention of COVID-19, like a new vaccine. Phase IV is a return to normal activity but actively working on “Pandemic Preparedness.” It is important to understand that Phase II will be monitored by four progress indicators and four warning indicators so that this plan remains flexible and could require a regression back to Phase I safety measures if enough warning indicators signal the need. In addition to monitoring these progress and warning indicators, the Phase II staged re-opening will be limited to locations/businesses with low to medium viral transmission risk and will be opened at reduced capacity for at least a 2 – 4 week period. Even so, businesses will have to enhance their sanitizing practices and people aged 2 and up should continue to wear masks when social distancing is not possible and practice frequent hand washing/sanitizing. Some examples of businesses that are considered low risk are retailers and malls while restaurants are considered medium-risk. Worship centers are considered high risk and are not recommended to re-open in Phase II. You can read more detail about the progress and warning indicators and the criteria for determining risk of establishments in the report online.
Extracts from the “COVID-19 Health Transition Team Report” page 18
Extracts from the “COVID-19 Health Transition Team Report” page 29
So what should YOU do?
The virus has had a devastating impact on our economy and our lives; on our church members who are out of work, or whose businesses are suffering. Besides the economic devastation, the mental health of our community is also suffering. The constant anxiety around infection control practices; wearing masks, washing your hands, cleaning any objects/groceries you bring home and missing hugs from loved ones. It’s exhausting and emotionally isolating. But please take this phase of reopening SA with lots of precaution. We are not in the clear yet.
Please Do Not
- Go to large public places or restaurants if you don’t have to or if you have existing health conditions. Curbside grocery pickup has improved tremendously and take out dining can be enjoyed at home.
- Have large birthday or anniversary parties. Even though the cut off for large gatherings is 50 people or more, I would still limit any in-person events to less than 10 and hold it outside and with plenty of spacing if possible.
Please Do
- Continue wearing non-medical cloth masks. We need to reserve the medical grade masks for healthcare workers.
- Wash your hands frequently.
- Sanitize surfaces like door handles, steering wheels, phones and all hand contact surfaces.
Blessings to you all,
Alicia Guerrero, MPH
My education is in the multidisciplinary field of Public Health but I have worked in Infectious Disease Epidemiology for the state of Texas where I was part of the Epidemiology Response Team and for the Department of Defense Lab based Sentinel Surveillance Program for viral respiratory diseases as a senior epidemiologist. I currently work in healthcare administration for the Defense Health Agency.
Congregation Member St. Paul Lutheran Church