Local Covid deaths, young children, and some remarkable optimism about the future

Cape Girardeau County Public Health

Here is a round-up of news about coronavirus in our region -- and the larger world.

Statistics underline that COVID-19 is dangerous to the elderly but less of a concern to young adults. Still, younger people who become infected can carry it to those most vulnerable, so vigilance is necessary. In Cape Girardeau County, according to the Oct. 15th COVID-19 Update, of 40 deaths attributed to the virus, there has been only one death of a person younger than 70. And the one exception was in his 60s. Meanwhile, the age group with the highest number of positive cases is 20-29 years old with a total of 628 cases; but only three of them needed hospitalization, and all have recovered.

For a sense of how dangerous it is to the elderly, though, according to the report: since the pandemic began there have been 136 confirmed cases of COVID-19 of 80-89 year olds. Twenty-six were hospitalized; and 15 died. That's a mortality rate of 11%. For those 90-99 years old, 14 of 67 infected with the disease have died.

If you are around the elderly, it is vital that you take precautions. Wear a mask. Keep social distance. This is especially true in retirement homes and long-term care facilities, where Cape County has seen the majority of its deaths.

Children and students

In good news, a new Yale University study of more than 57,000 childcare providers found that children in day-care programs present virtually no risk of transmitting COVID-19, as long as facilities "hew to sanitary guidelines like hand washing, small group sizes and staff wearing face coverings," the Wall Street Journal reported.

Lead author of the study, Dr. Walter Gilliam, said the research also showed that young kids were not a risk of infection to day-care teachers.

"It doesn't appear that working in child care leads to the spread of COVID-19," Dr. Gilliam said. "It is true that many child-care providers did get sick. Many of them even went to hospitals. But it was not the contact with children in child care that seems to be the source of that infection."

According to the Oct. 14 WSJ article, titled "Day-Care Centers Are Very Low Risk for Covid-19 Transmission," it is not clear why children under 10 seem less likely to spread the virus, "but some theories have included a smaller viral load in their airways, smaller fluid droplets expelled when they cough or sneeze, or simply that small children are closer to the ground and thus less likely to transmit particles to adults' airways."

Meanwhile, a study by Brown University economist Emily Oster, working with data scientists at the technology company Qualtrics, indicates that fears about school openings were "overblown." In a piece published in the The Atlantic on Oct.9 analyzing data on almost 200,000 kids in 47 states, Oster wrote: "Fear and bad press slowed down or cancelled [many] school reopenings... It's now October. We are starting to get an evidence-based picture of how school reopenings and remote learning are doing, and the evidence is pointing in one direction. Schools do not, in fact, appear to be major spreaders of COVID-19. Predictions about school openings hurting the broader community seem to have been overblown as well."

Oster continued: "[The] numbers are not zero, which for some people means the numbers are not good enough. But zero was never a realistic expectation. We know that children can get COVID-19, even if they do tend to have less serious cases. Even if there were no spread in schools, we'd see some cases, because students and teachers can contract the disease off campus. But the numbers are small ..."

Plenty of capacity at Cape hospitals

Hospital capacity in Cape Girardeau continues to be good. Although the number of COVID-19 hospitalizations in the region continues to rise slowly -- because the virus has entered retirement homes -- bed availability is not a concern. According to health sources, just over half of current capacity is being used and additional beds can be added if needed.

Europe now worse than U.S.

As the temperature drops and people spend more time inside, cases of COVID-19 are skyrocketing in Europe, with the number of cases per thousand in Europe now surpassing the United States. According to an Oct. 14 story in The New York Times, "The continent, which once compared favorably to the United States in its handling of the pandemic, is being engulfed by a second wave of infection. With an average of more than 100,000 new infections per day over the past week, Europe now accounts for about one-third of new cases reported worldwide."

In absolute terms, reported cases in Europe surpassed the United States last month. "But Europe is larger than the United States and only now has more cases relative to its population," reported the Washington Post in an Oct. 15 story. The newspaper cited more testing as one reason for the spike. Meanwhile, the United States, contrary to public perception, remains one of the world leaders in testing, according to the website Statista, testing more people per capita than any European country except the United Kingdom.

According to the Post article, "Across Europe, leaders have dismissed talk of national lockdowns and instead announced new restrictions targeting hot-spot communities. There is a widespread aversion to closing schools but more willingness to limit the operations of bars and restaurants and restrict the size of gatherings."

Among the most important steps, leaders identify, is wearing masks and social distancing.

W.H.O. now opposes lockdowns

In another recent story in The New York Times, a spokesman for the World Health Organization, David Nabarro, was quoted: "We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus. The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources, protect your health workers who are exhausted. But by and large, we'd rather not do it.

"We really do appeal to all world leaders, stop using lockdown as your primary method of control," Dr. Nabarro emphasized.

Nabarro described several potential tolls of widespread lockdowns, which have set off economic declines and higher unemployment rates, and have widened disparities in many parts of the world, including the United States.

Another spokesman for the W.H.O., Hedinn Halldorsson, added that a "package" of protective tactics is preferable to lockdowns, which should be only a last resort. That means: wear a mask, physical distance, test and contract trace.

Trump, Harris, Saban

Back in the United States, members of vice-presidential nominee Kamala Harris' staff were diagnosed positive for coronavirus this week, as was Alabama college football coach and six-time national champion Nick Saban. Harris and Saban have both been vocal about the importance of masking (as have I). President Trump, who had been relying on the testing of those around him -- rather than masks -- tested positive, was briefly hospitalized and has now recovered.

Lesson? No matter how hard people try to mitigate risk, this is a highly infectious disease. Without a vaccine or herd immunity, it's inevitable that people will continue to contract it, which is why developing therapeutics that treat the disease and vaccines that prevent it are so important. And on this score, the Trump administration's Operation Warp Speed is setting a record in developing such treatments.

In a remarkable column in The New York Times, Oct. 12, by its science and health reporter Donald G. McNeil Jr., who specializes in plagues and pestilences, a litany of positive accomplishments were highlighted. Usually, the Times is not kind to President Trump, finding much to fault in his leadership. Here are some excerpts from the piece.

"A Dose of Optimism, as the Pandemic Rages on"

By Donald G. McNeil, Jr.

Excerpted from The New York Times

"... Clearly, the pandemic has not ended. So far some 215,000 Americans have lost their lives to the coronavirus, and reliable estimates suggest that the number could reach 400,000. Health experts agree that, with stronger leadership, the death toll would have been far lower.

"Nonetheless, there is a collective accomplishment here worth acknowledging. In the Imperial College report, the authors underscored that their worst-case estimate would almost certainly not be realized, thanks to human nature: 'It is highly likely that there would be significant spontaneous changes in population behavior even in the absence of government-mandated interventions.'

"That prediction proved true, as millions of Americans agreed, however reluctantly, to accept the sacrifices involved in shutting down parts of the economy, keeping distance from one other and wearing masks.

"In the day-to-day fights over reopening schools or bars, it is easy to forget that there was a time when the idea of canceling large public gatherings -- the St. Patrick's Day Parade, the N.C.A.A.'s March Madness basketball tournament -- did not seem remotely necessary. That there was a time when leading health officials said that only sick people and hospital workers needed to wear masks.

"Today, and despite the president's own resistance, masks are widely accepted. Various polls show that the number of Americans who wear them, at least when entering stores, went from near zero in March to about 65 percent in early summer to 85 percent or even 90 percent in October. ...

"The slow but relentless acceptance of what epidemiologists call 'non-pharmaceutical interventions' has made a huge difference in lives saved. The next step is pharmaceutical interventions.

"Some are already modestly successful, such as the antiviral drug remdesivir and steroids like dexamethasone. But in the near distance are what Dr. William Schaffner, a preventive medicine specialist, has called 'the cavalry' -- vaccines and monoclonal antibodies. They are likely to be far more effective.

"Since January, when I began covering the pandemic, I have been a consistently gloomy Cassandra, reporting on the catastrophe that experts saw coming: that the virus would go pandemic, that Americans were likely to die in large numbers, the national lockdown would last well beyond Easter and even past summer. No miracle cure was on the horizon; the record for developing a vaccine was four years.

"Events have moved faster than I thought possible. I have become cautiously optimistic. Experts are saying, with genuine confidence, that the pandemic in the United States will be over far sooner than they expected, possibly by the middle of next year. ..."

We know what to do

"The final death toll from Covid-19 will depend both on how we behave going forward and how quickly innovations arrive," McNeil continues.

"Already the United States is faring much better than it did during the Spanish influenza -- the worst pandemic to hit the country to date, and the one to which this one is often compared. It began in early 1918 and did not completely fade away until 1920, when herd immunity arrived, at the cost of 675,000 lives. The country's population at the time was 103 million, so that toll is equivalent to 2 million dead today.

"Pandemics don't end abruptly; they decelerate gradually, like supertankers. The Centers for Disease Control and Prevention has estimated that about 10 percent of the American population has been infected. As that figure grows, and as people begin to get shots after a vaccine is approved, transmission should slow.

"Every Covid survivor and every vaccine recipient will be a broken link in the chains of transmission. There have been rare cases of people becoming infected twice; this happens even with chickenpox. But scientists assume that almost everyone who recovers from Covid cannot get or transmit the virus, at least for many months. Even by spring, we will not be entirely safe, but we probably will be safer.

"In the interim, as the pandemic runs its course, the percentage of infected people who die from the virus has been falling. The reasons are many.

"The average age of each new person infected is almost 30 years lower than it was in March. Fraternity brothers may be reckless, but few older Americans are.

"Nursing homes have become better at protecting their wards. The death rate per nursing home resident in states that were hit by the virus in late summer is about one-quarter the rate in the northeastern and southern states that were hit first.

"Simple interventions like pulse oximeters are detecting pneumonia before it becomes life-threatening. Steroids like dexamethasone have lowered the number of deaths among hospitalized patients by about one-third. Rolling patients onto their stomachs and delaying ventilator use also helps.

"Each lesson learned saves lives."

Winter is survivable

McNeil: "Another good omen: Although in the spring health experts were fearful that a bad winter flu season could send thousands of patients to hospitals, all competing for ventilators and medical attention, the possibility of a 'twindemic' of coronavirus and influenza now seems far less likely.

"Flu is 'seeded' in the United States each year by travelers from the Southern Hemisphere after the winter there ends. But this year their flu season was almost nonexistent -- because they were socially distancing and, in some countries, wearing masks. And in this country, flu shots became available earlier than usual; so many Americans are rushing to get inoculated that spot-shortages are developing. If flu does arrive, those shots and our masks should blunt it.

"Another intervention that might make a big difference is monoclonal antibodies.

"Two weeks ago, most Americans had no idea what they were. Now, President Trump is touting them as his 'miracle cure' and, whether or not he is ultimately cured, monoclonals are famous ...

"Early testing in animals and humans suggests that a dose a fraction the size of the one Mr. Trump received can protect an uninfected person against the virus. If that finding holds up, the antibodies could be used like a fast-acting vaccine, lasting just a month or so but providing a crucial 'bridge' to the arrival of the new vaccines.

"Such a treatment could protect people at highest risk, such as health workers and nursing home residents. Or, in a "ring vaccination" strategy, antibodies could be given to the household contacts of known cases. Ring vaccination was how smallpox was defeated. ..."

Engaging warp speed

McNeil: "Sometime in the next three months, health experts say, the F.D.A. is likely to begin granting approval to vaccines now in the works.

"Despite the chaos in day-to-day politics and the fighting over issues like masks and lockdowns, Operation Warp Speed -- the government's agreement to subsidize vaccine companies' clinical trials and manufacturing costs -- appears to have been working with remarkable efficiency. It has put more than $11 billion into seven vaccine candidates, and the F.D.A. has said it will approve any one that is at least 50 percent effective at preventing infection or reducing its severity.

"Moncef Slaoui, Operation Warp Speed's chief scientific adviser and a former pharmaceutical executive who has overseen the development of 14 vaccines, has said repeatedly that he expects some of the candidates that he picked to have 75 to 90 percent efficacy and at least two to win approval by early January.

"By then, Dr. Slaoui has estimated, the factories under contract will have produced enough vaccine for 30 to 40 million people, and then another 80 to 90 million people every month after that. Assuming nothing goes wrong, he said, there will be enough doses for all 330 million Americans to be vaccinated by next June. Bill Gates, who is not part of Operation Warp Speed but works with it to develop vaccines for the world's poor, has agreed with that timetable.

"There will inevitably be distribution problems, but the military is standing by to help. The chief operating officer of Operation Warp Speed is General Gustave F. Perna, a logistics specialist."

Vaccine skepticism may fade

McNeil: "Some health officials fear that when a vaccine arrives, many Americans will be reluctant to take it. Indeed, about half of Americans have told pollsters that they feel this way. Nonetheless, I believe that hesitancy may dissipate, if no major safety problems emerge as the first few million Americans are inoculated. ...

"No vaccine is 100 percent safe. 'The most effective one may have the greatest risk if it stimulates the immune system enough to create the risk of autoimmune disease,' said Dr. George D. Yancopoulos, an immunologist and founder of Regeneron Pharmaceuticals. 'There will be some risk-benefit calculations to make.'

"But the alternative to being vaccinated is to risk a nearly 1 in 100 chance of death, as well as unquantifiable but still worrying threats of heart disease, lung damage and even brain damage. Not to mention the prospect of being unable to return to work, having to home-school one's children for years and not eating in a restaurant, flying on an airplane or watching a movie in a theater without the specter of anxiety.

"Those are strong motivations to take a chance on a vaccine, especially if one's friends and relatives have had it and fared well."

The whole world must be safe

McNeil: "Until [vaccines or herd immunity], masks and caution are our best alternative. If we rigorously protect ourselves and each other, we can starve the virus of new hosts until our national epidemic finally evaporates.

"Then we must help other countries get vaccines too; until they are protected, we cannot venture beyond our borders as tourists or business travelers, nor can others come here. No country can be forgotten; charitable motives aside, their tourists fill our hotels. ...

"Many economists think our national recovery will be rapid, like those that followed the first and second world wars, rather than what followed the financial crashes of 1929 and 2008. China, having beaten the virus, has a growing economy again. Among Americans who have not lost their jobs, personal savings are at record levels. Despite loan defaults in this recession, banks are flush with cash and, if need be, can borrow from their thriving Asian counterparts. When the moment is safe, loans to revive restaurants, hotels and other small businesses should flow.

"In the interim, as we hunker down, Congress must find ways to ensure that millions of Americans who are out of work do not go hungry or get evicted.

"And once the pandemic is over, one more mission lies ahead: to make sure this does not happen again. We must search for the viruses in nature that are most likely to infect us, and spend the billions of dollars necessary to create vaccines and designer antibodies against them. So that next time we are ready."

Special thanks to The New York Times, Washington Post and Wall Street Journal for their coverage of COVID-19. There is much to be hopeful for. In the meantime, especially because vaccines and better therapeutics are on the way, it makes even more sense to take the basic precautions now: wear masks, especially when shopping (and please, cover your nose); social distance; wash hands frequently; take care of the elderly; and please stay home when sick.

Jon K. Rust is publisher of the Southeast Missourian.