America and the other 194 countries of the world are under siege of what has been described by Scott Gottlieb, MD., former commissioner of the FDA, as “maybe a once-in-a-generation pathogen that straddles that terrifying area between being contagious enough that it can spread pretty efficiently, but still virulent enough that it can cause a lot of death and disease”.
Viruses have been around since the beginning of time. Their purpose in life is to replicate their RNA and DNA within host cells. The more efficient the replication, the more successful the virus. If a virus is too efficient, killing the host, replication could be less successful over time. Ideally, a living host will support the growth of a virus.
World’s Deadliest Viruses – A Primer
Marburg- Identified in 1959 by scientists who saw the infection appear in research laboratory workers in Germany handling chimpanzees imported from Uganda where 25% died. Other outbreaks occurred in the Congo 1998-200 and Angola in 2005 where 90% of those infected died. Ebola – a close cousin to Marburg Virus has various strains, transmitted by monkeys, and the blood or tissue of humans infected. Sudan strain has a 71% mortality rate.
Rabies-spread by the saliva of infected mammals, foxes, raccoons, rats, dogs, cats etc. Is almost 100% fatal since it destroys the hosts brain. Pet vaccine developed in the 1920’s has eradicated the disease in the developed world but still a problem in Africa and India.
HIV- originated in the Republic of Congo in 1920’s jumped the gap to humans with the disconcerting practice of butchering and consuming monkey meat. Traveled slowly around the world with human to human contact. Identified at the Pasteur Institute in France in the 1980’s. Over 32 Million people have died globally of AIDS caused by HIV. Third World still devastated by the illness with 1 in 25 adults living in Africa infected.
Smallpox- a disease that killed 1 in 3 people infected for literally thousands of years. Spread outside Europe by explorers and settlers. 90% of native Americas populations died having no resistance to the virus – in the 20th century 300 million people died as the spread of the disease followed colonization and the growth of civilization. Contracted from direct human contact, specifically droplets from sneezing and coughing. Last case was in 1978. Vaccine has eradicated Smallpox from the world. Only two laboratories still hold the virus samples, the CDC in Atlanta and VECTOR Institute in Koltsovo, Russia.
Hanta- contracted from exposure to the aerosolized particles of fecal matter, urine or saliva from infected mice, rats and squirrels. First case in the United States was recorded in 1993 in New Mexico where 600 people sickened and 361 died. An earlier strain was identified in the 1950’s during the Korean War when 3000 G. I’s became ill with the disease. 12% died. There is no specific treatment and no vaccine.
Influenza- According to WHO, typical flu season annual kills 500,000 people globally. Most deadly was the 1918 flu pandemic sickening 40% of the world’s population and killing 50 Million. (Read the October 15 Blog posting to learn more ) See our blog on the flu and handwashing.
Dengue – Carried by mosquitoes, appeared in the 1950’s in Thailand and the Philippines. Is now prevalent throughout the tropics. 40% of the world’s population live in areas where Dengue is endemic with 50-100 million people getting sick from this virus annually. Global warming will extend its reach. Mortality rate is lower than other virus’ 2.5% but left untreated death rate is 20%. FDA approved a vaccine in 2019 for children aged 9-16 years living in an area of contagion and who have confirmed Dengue. Some countries have vaccine available for those aged 9-45 but recipient must have had Dengue in the past. Vaccine can trigger severe Dengue if given to someone who has not previously contracted the disease.
Rotovirus – severe diarrheal illness attacking those under five years of age. Capable of spreading rapidly it’s a killer in the developing world. WHO estimated in 2008 453,000 children succumbed. There are now two vaccines available which has resulted in a sharp decline in hospitalization and deaths of young children.
SARS – Severe Acute Respiratory Syndrome sparked in 2002 in Southern China. Originated in the Chinese Horseshoe bat, intermittent host likely the civet. Spread to 26 countries worldwide infected over 8000 people and killing 770 people over a two-year period. Estimated mortality rate is 9.6% No approved treatment. No vaccine, according to CDC. Since 2003 the nine outbreaks that occurred where attributed to laboratory accidents in Taiwan and Singapore and exposure to an animal source. In 2013 researchers published in the Journal of Infectious Diseases that SARS was officially gone, however the WHO cautions it could reappear if a laboratory mishap occurred or transmission from an undetected animal source to humans.
MERS – Middle East Respiratory Syndrome sparked in Saudi Arabia 2012 camels were the intermittent host with animal of origin mostly probably bats. Appeared again in South Korea in 2015. The MERS virus belongs to the same family of viruses as SARS-CoV and SARS-CoV-2, and with a mortality rate of 30-40% is considered the most lethal of the Coronavirus family capable of jumping from animals to people. No approved treatment. No Vaccine.
Now, we are intimately familiar with the newest emerging coronavirus family member, namely, SARS-CoV-2 aka COVID-19 as it cuts a wide swath of misery and economic devastation across every corner of the globe.
So far, the numbers are eye popping: worldwide 3,075,000 cases with 212,000 deaths.
In the United States we have (as of this writing) 1,005,147 infected and 57,505 souls departed.
Every State in the union is affected, some more than others, but all are challenged by patchy availability of personal protective gear for healthcare workers (PPE). Further, testing for Covid-19 has met with mismanagement and non-availability of testing equipment, response times, where to send the test, who to administer to the test to.
Hospitals everywhere have found themselves ill prepared and understocked for the equipment necessary to engage in viral combat.
As supply chains faltered, stretched and ultimately broke, so has the healthcare system. Physicians and support professionals reported they were not provided with the protective wear necessary to safely do their jobs even as they worried about their own families. In the midst of this crisis, these institutions began to furlough their staff, closing down other areas of medical practice, cancelled all elective procedures and suspending work at non-essential departments while at the same time, applying for federal aid to maintain their services. Patients found out quickly their booked surgeries cancelled and other testing and procedures were put on hold.
Healthcare workers are reporting high anxiety, fatigue and moral injury a newly coined term replacing “burn out’. Physicians and other healthcare professionals experienced significant moral injury before the COVID-19 pandemic. Barriers were already in place blocking the care physicians knew their patients needed as healthcare has become increasingly corporatized with focus on revenue generation. A demand to see more patients in a decreased appointment time allocation, while enduring increased time on electronic records management and reporting and still more time away from their patients handling insurance company red tape. Paperwork ahead of patient care.
Moral injury is defined as “"…perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations"
Physicians have had to triage care in response to COVID 19 ‘hotspots’ finding they had limited medical resources – a scenario discussed in scientific communities for at least the last five years. Telemedicine hasn’t traditionally been used in response to public health crises, but that is changing with COVID-19. Only now in the midst of a pandemic are government and private insurance companies making policy changes to promote its use.
Covid in New Hampshire:
While the Covid fires raged in New York, Washington, California, Illinois, Massachusetts, Florida and Louisiana, our Granite State resolve held firm, until in March we too shut down our state with the Governor’s Stay at Home order, still in effect. We have not been immune, although from a country-wide perspective, New Hampshire looks like a pretty safe place to live. Only two of our counties, both with larger populations; Manchester and Nashua, are experiencing anything close to a surge, but the worst may still lurk on the horizon.
New Hampshire has prepared various temporary sites around the state to cope with an influx of sick people thus lightening the load at area hospitals. The numbers change daily but still and all we have lost far less citizenry than other harder hit areas, our mortality rates are minuscule in comparison to other neighboring states.
We all know the mantra:
Wash your hands frequently
Wear a mask when in public
Keep your distance – 6ft from your neighbor
Covid Free at Peabody Home:
At Peabody Home, we’ve been on high alert since late February. Our leadership is in constant communication with NH department of Public Health, and we deploy latest recommendations from the CDC immediately upon release.
Protocols now include:
Temperature screen every employee, every day, every shift and complete a questionnaire before starting their shift.
Each resident has their temperature and oxygen levels checked twice daily.
We have sequestered the house into three pods to avoid co-mingling of residents and staff. Each pod eats, lives, and enjoys activities separately.
Suspended all visitor activity
Suspended the volunteer program
Suspended resident family socials and visitation (painful but necessary)
Suspended our Adult Daycare program
Suspended our Respite Program
Limited new admissions
Cleaning every touch point/surface every two hours
Suspended staff meetings and now hold them via phone
Hold remote meetings via internet or phone access
Asked our staff to limit their private lives outside of Peabody
Weekly telephone conferencing for families- every Friday at 10:30 a.m
Until such time as Covid dissipates and a vaccine is developed, we should be thinking about how our lives will be conducted after this pause which, for many, has been as traumatic as anything experienced by our predecessors during World War II.
Will we be more polite? Will we be patient, take our time, drive less? Will we stop the endless consumption of ‘cheap stuff’ made half way around the world? Will we be more mindful, eat healthier, eat local and support local enterprise more?
It’s a safe bet there will be a slow return to hugging and handshaking.
We won’t take for granted spending time outside, meeting up with friends.
Maybe that objectionable practice of ‘ghosting’ will disappear entirely from our conduct towards our fellow man.
The simple joy of spending time with family, socializing, cooking and eating together, celebrating Thanksgiving, Christmas, Easter other public holidays will be embraced wholeheartedly because all the forced isolation and social distancing we’ve been living under has brought into sharp contrast how much we actual love each other.
Travel habits might change. Perhaps we will demand a more humane experience, one not akin to loading and herding us like cattle.
We’ll relish working for a living and honor workers for their toil. Maybe the minimum wage will increase? Toilet paper will be plentiful again!
Health Bar Code apps will track where we are.
We’ll practice empathy and kindness. Until those days return, stay safe.