Musings on Measles and Covid

The situation with Covid-19 is analogous. The current pandemic will end in only three ways. The first is if the virus spontaneously mutates to a harmless form. The second is if we develop a safe, effective vaccine. The third is when enough people are exposed to the virus to develop immunity so that so-called herd immunity is finally established. Once that occurs, the pandemic will end as all such pandemics have throughout history. What if that doesn’t happen? Well, then we are, pardon the expression, screwed. Of the three options, which one you bet on will determine your response to the current pandemic.

No one seems to be banking on number one. Quite a few people are betting on number two, but who knows when, of if a safe, effective vaccine will become available. These are the people who continue to socially distance, wear masks, and shut down the economy, in the name of “safety”. They place their trust in science and medicine to end the pandemic. I am all for science, but I know its limitations better than most. Those who are betting on number three place their trust in the best anti-viral measure known to man: a healthy immune system.

What is interesting about SARS-CoV-2 is its unique targeting of the most elderly and sick among us. Children under 15 are essentially immune to its effects. Healthy adults from 16 to 65 are highly unlikely to get really sick and die. Their risk is not much different than for flu, which we seem to be able to shrug off every year despite tens of thousands of deaths. Mortality rates really go up in the 70 and older population, and in those with certain chronic medical conditions or “co-morbidities”, such as obesity, diabetes, and chronic respiratory diseases.

We have known for decades that we are the unhealthiest population in the history of our country but have made no meaningful progress in reversing this. Now, with Covid, the chickens have home to roost and our mortality for this virus exceeds that of every other nation, spurring the national climate of fear and even panic.

In all the discussion of mitigation, avoiding “unnecessary” deaths “at all cost” and slowing the spread of the virus, what I have not seen are models comparing the numbers of deaths if we open  up society and protect the vulnerable versus slowing the spread by continuing to have everyone socially distance and wear masks, thereby delaying herd immunity. As long as our medical resources are able to handle the caseload (yes, they will be stressed, but it is only for the short term), is it better to lose 100,000 people over a few weeks nationwide or over the next six months? Let us not forget the toll of lives lost while the economy languishes from desperation, despair, deferred medical care, and domestic abuse? No one is addressing this aspect of the pandemic in our country.

I think those housewives in my old neighborhood knew something we seem to have forgotten. Our immune systems got us this far. They should be trusted to continue to take care of us, abetted by modern medicine and rational and proportionate measures to protect the elderly and vulnerable.

Richard T. Bosshardt, MD, FACS

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