ANATOMY OF AN OUTBREAK – Part III: The Virus
By JOHN HOPKINS, DR.P.H.
On the head of a pin sit either a million angels or a million particles of corona virus 19.
The outbreak in China is well publicized but not well understood because of the obfuscation. Had American and other international medical experts and scientists been welcomed initially, the world would be different today.
Public health and preventive medicine have always taken a back seat to the more glamorous and financially rewarding fields spun off after World War II. Jim Hopkins, my father, was a smart Irishman, the legend goes, and was named the first administrator of one of the newly formed Veterans Administration programs, using GI Bill money to send a generation of young men and women through medical school, dental school, law school, business school…you name it.
The political power broker in Northeastern Pennsylvania after the war didn’t want a pork barrel, patronage-filled bureaucracy for the first VA. He asked his son to recommend an honest, smart, a-political candidate for the big job.
“That would be Jim Hopkins, a coal miner?s son from Pittston,” goes the story.
President Eisenhower warned of a “military-industrial complex.” He could have easily been speaking of a medical-industrial complex. Your favorite search engine will reveal the current third rail data on elderly health costs: % of people over 65, % of the GDP for health care, % of that going to the over 65 club and % of that expended in the last year of life.
The palliative care and hospice movements are flattening that growth curve, to borrow a popular phrase. Two thirds of my guests are on palliative or hospice care, as their dementias are inevitably fatal and I welcome hospice people with many other diagnoses.
The medical-industrial complex’s profit margins lie in acute care and diagnostics. The management of cross species transmissions and pandemics is not a Wall Street darling. Good public health practitioners don’t exclaim, “we told you this was coming.”
They suit up and get to work. The virus, by definition, always has a head start. If this were the Kentucky Derby, Covid-19 started at the 3/4s pole.
Virus are smart and lazy. When they cross species, they go small (head of a pin) and take the fast lane to reproduction: virus particles invade mouth and nose, start to replicate in the human host cells and head for the lungs where the best and easiest reproductive material awaits.
This virus likes kidney tissue too but kidneys are harder to get to than lungs.
Human immune responses, luckily for us, mobilize faster than society. When the virus reproduces to a certain but unknown and unique to the individual threshold, we develop a fever. God and Darwin collaborated on this wonderful and formerly mysterious mechanism called your immune response.
Just over the horizon in everyday medicine is the field that will take your cells and attach a cancer-fighting substance, for example and put it back in your system. That will change the head start of all diseases by five furlongs.
When small pox traveled the globe, it moved on foot and by boat (sail boat, actually). As in slowly; as in weeks to cross the Atlantic. Portsmouth, NH had an island in the Piscataqua River, called Pest Island, where European ships were boarded and examined for sailors with smallpox. The ship and sailors stayed out of Portsmouth and, hence, the rest of New England until there were no more new cases for some arbitrary but effective amount of time.
Quarantines work. They work best the earlier in an outbreak they are utilized. It?s still about the head start and the catch up 200 years after Pest Island.
Back to your lungs and immune system verses the head of the pin virus, which by now can be imagined as 100 pin heads. Using war as an analogy for your immune system?s response to a virus (or bacteria) is popular but over-rated. The war on this, the war on that; you know?
Your immune system kills the virus or the virus kills you. You have likely already transmitted the virus to other humans by the time you get sick. The virus is smart; it ensures its survival by enticing you to pass it on, then it tries to destroy you by pneumonia or weakening other vital organs like your heart and kidneys.
PART IV; NOW WHAT?