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A Year Has Gone by Since COVID-19 Changed Our Lives ... And We Still Know Virtually Nothing!

THE DOCTOR IS IN--While it's quite evident that we know and can do a bit more for the Virus That Changed the World than a year ago, our knowledge is frightfully limited (almost pathetically so) for a variety of reasons: 

1) Viruses aren't alive--they're DNA or RNA packed in protein, and their genes predominantly code only for the ability to bind onto a host cell to parasite that cell's resources to build more viruses. Outside of a host cell, they're inert. They don't eat, they don't replicate, they don't poop/pee, and they don't move.  

So how do we kill something that isn't alive? You can't! 

2) Either natural immunity, or vaccination to promote natural immunity, is the only way a person can overcome that virus--the immune system is primed to make antibodies (B-Cell, or humoral, immunity) and/or promote an immune response with immune cells (T-Cell, or cellular, immunity) or a bit of both.  

That's why we don't use antibiotics for viruses. We can limit the spread with certain medications, but it's usually "take two aspirins and call me in the morning". In the case of herpes virus infections and chickenpox/shingles, acyclovir (which prevents viral replication in that subset of viruses) and its second-generation counterparts is the happy exception. But it's an exception. 

3) It's usually NOT the virus, but your own body's responses to that virus, that hurts you, makes you feel lousy, or even kill you. The reason you feel lousy with viral infections is that your body is making substances such as interferons that make you feel just awful (but it's necessary to engage your immune system to fight the virus), and also pyrethrins (which cause an elevation in body temperature that will hopefully not allow a virus to replicate). 

So, if you get a mild response, or even a not-so-mild response but you survive, then that's great whether it's COVID-19 or not. However, if this virus causes you to go into a "cytokine storm" caused by a host of cytokines (which crank up your immune system against viruses and also cause autoimmune syndromes), then YOUR OWN BODY WILL KILL YOU. 

Enter COVID-CONFUSION 101: 

1) Hence, we have a lot of data, but it's all over the place, and anyone who tries keeping up with current literature will literally find articles in a single day that has BOTH an article promoting a given medication to treat COVID-19, as well as another article proving that the same medication has little to no benefit in treating patients with this virus. 

2) Some people will respond to a given drug, while others will absolutely not. Some people will respond to a given drug only if it's given early, while others will never respond to that drug. Hence we had the plaquenil/azithromycin/zinc effort that was grasping at straws and MAY have helped some early in the disease, but--by and large--was not realistic in treating most patients. 

Plitidepsin is just the latest antiviral medication proposed to stop COVID-19, but it's worked predominantly in cell lines and in the lungs of mice, so we still don't know about that option, despite the hope that it will work. 

3) The same drugs that are used to suppress or modulate the immune system will save a person's life, or even protect them from the severity of the virus if they get it...because those drugs will keep that person's immune system from killing them. So, for those of you on drugs to treat rheumatoid arthritis, psoriasis, lupus, etc.) who've stopped them without telling your doctor... 

...you are NOT beefing up your chances at surviving the virus, you're reducing them! In theory, if we were all given drugs to immunomodulate our bodies, we would limit the severity of any COVID-19 human host response.  

(And to any doctor or other provider stopping these medications to save patients with autoimmune diseases from getting COVID-19...knock it off or go to a conference or something. Because you will KILL your patients who NEED their hyperactive immune system kept in check!) 

4) The main exception is oral corticosteroids, which for any patients using them long-term results in a greater affinity to catching the virus. Yet what is one of the few FDA-approved medications for early-onset COVID-19? Dexamethasone, a steroid that dramatically reduces immune response and hyperresponse to the COVID-19 virus! 

(Hence, we have this obnoxious confusion of cause vs. effect of a given treatment, or why things work great for one patient, but not for another). 

So, in January 2021, a year after the first impeachment of then-President Donald J. Trump (and when we SHOULD have been focusing on the biologic tidal wave sweeping the world), we know almost nothing with certainty as we enter the second impeachment of former-President Donald J. Trump. 

Yet here's what we do know: 

1) Anyone can get nailed by COVID-19's ability to cause a person's immunity to kill that person, but if you're overweight, male, have atrial fibrillation, diabetes, or any other comorbidities, you will be more likely to be harmed by COVID-19. Why? Because those comorbidities have immunological ramifications that can lead a person's response to explode when the virus is introduced. 

2) If you get exposed to a teeny, tiny amount of virus (an inoculum), your body will have a better chance of overcoming or walling off the virus. If you are in a superspreader event, then it's almost certain you will get a full-blown exposure that leads to the "Russian Roulette" of a small versus a large versus a lethal response to the virus. 

The analogy is that of being shot with a 22-caliber pistol. One shot usually doesn't kill you...but ten shots almost certainly will kill you. 

3) The Moderna and Pfizer vaccines only exist because their mRNA technology, never used before, allows vaccine formations to be created faster than ever in our history. They are custom-made for a given virus (such as COVID-19), and because they immunize a person from the genetic material of a virus, that person is by far more likely to be immune from any new mutations of the virus. 

4) The likelihood of somebody getting an allergic reaction to a vaccine, or even having a major event, is exceedingly smaller than getting COVID-19. For ANY medication or vaccine, there will be someone unlucky...but the chance of a serious response to these vaccines is less than that we face every day when getting in an automobile with respect to car crashes. 

So, it comes down to this--it's a race between getting infected and getting the vaccine. The latter has better long-term protection against both the virus and any new mutations by far more than an actual infection. Washing hands, social distancing, mask-wearing, etc. is of course a must...but if you don't want a vaccine, get out of the way and let others who want it get it! 

Finally, my greatest sadness as a physician is for those sick and dying when they're weeks or months away from getting vaccinated. I've known many providers and nurses who got sick and know of a few patients or patients' relatives who've died merely weeks to months before they could have been saved by the two vaccines that are now out there. 

I have one Moderna vaccine shot behind me, and one more to go--in theory I am 80% protected for about a year, but after the second shot that number goes up to 95%. My arm hurt and I got sleepy for 2-3 days because that's what happens when you crank up the immune system (like muscle pain after you work out). 

But I feel miserable because most of YOU reading this aren't where I'm at. I may be a physician, but I'm not any higher lifeform than any other human being.  

And we should all demand that local and state officials, and our medical groups, fight like hell to make sure that any possible vaccine can enter a human being's arm/shoulder ASAP. 

Because the ONLY DAMN THING WE KNOW is that a vaccination is the only way OUT of this nightmare that is the COVID-19 pandemic.

 

 

Kenneth S. Alpern, M.D, is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud husband and father to two cherished children and a wonderful wife. He was termed out of the Mar Vista Community Council (MVCC) twice after two stints as a Board member for 8-9 years and is also a Board member of the Westside Village Homeowners Association. He previously co-chaired the MVCC Outreach, Planning, and Transportation/Infrastructure Committees. He was previously co-chair of the CD11 Transportation Advisory Committee, the grassroots Friends of the Green Line (which focused on a Green Line/LAX connection), and the nonprofit Transit Coalition, and can be reached at [email protected] The views expressed in this article are solely those of Dr. Alpern.).

-cw