Presentation by Jonathan Mayer, Professor Emeritus, University of Washington, to the University Sunrise Rotary Club. May 14, 2020
COVID-19 continues to be a dire public health risk. It might never go away.
Globally, there are 4.4 million confirmed cases and nearly 300,000 deaths in 188 nations. In the US, there are nearly 1.4 million cases and over 80,000 deaths.
The US will reach 100,000 deaths in a few weeks.
These numbers are most certainly low as some regions have limited data. These regions include developing parts of the world and regions where testing has not been robust such as the United States.
An elevated cause for concern in the US, is increasing numbers of cases per capital in rural areas. Yakima County is a “real concentration” in Washington State. The Navaho Reservation and Four Corners area of the US Southwest, as well as Montana, South Dakota, Wyoming, and North Dakota have become areas of increasing concern. As of this date, COVID-19 remains “way under-reported.”
Urban areas remain hot spots. This includes Detroit and Chicago, as well as the entire corridor from Washington, DC to Boston.
The good news is that curve is flattening and the rate of increase in reporting of disease is diminishing.
But Dr. Mayer expects the pandemic to continue to plague humans until there is population “herd”) immunity (estimates for this virus are when about 60% of the population becomes immune from exposure) or an effective vaccine is being used.
We do not know if there is a seasonality aspect to COVID-19 yet.
No one in the medical community thinks that this will burn out. It is likely, at some level, to be with us forever.
Dr. Mayer discussed several of the ongoing research efforts to find effective therapies and vaccines.
Hydroxychloroquine: While there has been anecdotal evidence that this might be effective, the clinical studies thus far are “really disappointing.” Published research in the New England Journal of Medicine and the Journal of the American Medical Association do not demonstrate effect on reducing mortality or need for ventilators. There is still no definitive word on the therapy, he says, but concerns about side effects and the lack of positive research recently have made it very difficult to recruit patients into the clinical trials that could demonstrate effectiveness conclusively. This was the medication that was optimistically discussed by the President.
Remdesivir: While Dr. Anthony Faucci has called remdesivir a “game changer,” the published data so far does not yet support that conclusion. This could be an important new therapy. New data is expected to become known over the next several weeks which will help make that determination.
Convalescent Plasma: This therapy has shown mixed results with nothing definitively yet proved.
Vitamin D: There are no definitive studies with regard to its impact on COVID-19. Vitamin D does impact the immune system, but it is dubious if mega-doses will work on COVID-19. Still, Vitamin D supplements are “probably prudent” for most people at latitudes such as Seattle.
Vaccines: there are over one hundred vaccines in development. There are no vaccines that are imminent. In fact, Dr. Mayer lamented, we do not understand the immunology of this virus yet. It is certainly not known yet at the level where a vaccine, when approved, will be effective: 50% of the population? 98% of the population?
There is no credible scientific evidence that the coronavirus was engineered in a Chinese laboratory. It is most likely that it originated from a bat virus that spread into humans. But, he said, the epidemiology of the disease and the habitats of the likely source suggest that disease was much more widespread within China than has been reported.
“I think we can move forward,” said Dr. Mayer, “toward a more normal life.” But he suggested important safeguards. First, changes in restrictions should be based on the science. Second, far more testing is needed and fast. third, contact tracing could be a very important tool in limiting the spread of the disease, if combined with isolation of the infected. This will require, nationally, one hundred thousand trained workers.
Maybe it is time, he said, to let low risk individuals—people in the twenties and thirties, for example, go back to work—with assurance that they will not be in contact with high risk individuals.
Conclusion: Dr. Mayer was fantastic. He is incredibly knowledgeable about this topic and has the rare ability to communicate a complex topic to an audience. His talk was sobering, particularly with regard to the belief that the virus was not going to disappear—and that a vaccine might not be the panacea for which we hope. It might be a long road ahead of us.