Covid 19: August Update

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“I HAVE antibodies, I had a positive antibody test,” said 20s-something budding actress R.P., who had never experienced symptoms of Covid-19. “I’m safe, and I don’t need a mask.”

But “immunity is a Rube Goldberg machine, a choreography of different proteins and cells that results in the body fending off a pathogen,” according to STAT —one reason to question, at least for now, the idea of an “immunity certificate” for anyone who has recovered from the virus or had a positive antibody test.

“The immunity that develops naturally during infection is suboptimal and short-lived in most people,” said Yale viral immunologist Akiko Iwasaki.  While coronavirus antibodies may be effective for only two to three months in individuals who have been infected, their endurance may be even less in those who were asymptomatic.

As of late July, the date for expecting a safe and effective vaccine may be as soon as late December or early next year, according to NIH infectious diseases expert Anthony Fauci—with wide availability “several months” into 2021. But caveats remain about the possibilities that a vaccine will offer only short-lived protection and that adequate production, especially for a vaccine that requires two doses, could take up to two years.

Meanwhile, numbers are rising of Covid-19 “long-haulers”–those with lasting heart damage and post-viral symptoms similar to Chronic Fatigue Syndrome (CFS), which occur even in those who were asymptomatic.  More than 80% of survivors of the earlier coronavirus SARS reported long-term symptoms.

Of 100 young Germans returning from ski vacations who had recovered from the virus, changes in the heart, such as inflammation, showed up on MRIs of about 75%, compared with those of controls.

Fauci compares a group of post-Covid-19 symptoms to CFS (also called myalgic encephalomyelitis, or ME/CFS), whose sufferers number about 2.5 million Americans—many of whom trace their illness to an acute episode of infectious disease, including mononucleosis and flu.

The cardinal symptom is “post-exertional malaise”—not fatigue alone but “a prolonged relapse of exhaustion, cognitive dysfunction and other symptoms after a minimal amount of activity,” according to STAT. While British physicians in the past advised CFS patients to resume regular activities as soon as possible, many now view the treatment as outdated and harmful.

Also outdated is concern about fomites, surfaces that spread the virus. “Surface transmission of Covid-19 is not justified at all by the science,” according to Rutgers microbiologist Emanuel Goldman, whose research just published in The Lancet showed erroneous conclusions came from studies using “unrealistically strong concentrations of the virus.”

“As many as 100 people would need to sneeze on the same area of a table to mimic [the] experimental conditions,” according to the Atlantic. In a famous March outbreak in a Seoul skyscraper, about half the members of a call center located on one side of the 11^th floor got sick, but despite sharing elevators, less than 1% of 1,000 workers and residents throughout the rest of the building contracted the virus.

To counter both the “prevention fatigue” of people getting too much information and the false security conveyed by constantly spraying surfaces, Goldman advocates focusing on airborne transmission—notably in bars, indoor restaurants and gyms, “where patrons are huffing and puffing one another’s stale air.”

Finally, breathing practices now feature among the prescriptions given by some British physicians to improve respiratory health, both to help protect against the virus and to combat the disease in those who become infected, according to James Nestor, author of the forthcoming book Breath: The New Science of a Lost Art. 

At Queen’s Hospital in London, the director of nursing recommends a breathing routine that involves taking an abdominal breath—breathing deeply enough that the lower abdomen expands—followed by a short breath-hold, repeating five times, and ending with a cough. The “perfect breath,” according to Nestor, involves taking about 5.5 breaths a minute—with each inhale and each exhale lasting about 5.5 seconds—which can help the diaphragm drop lower and rise higher, allowing more air to enter the lungs.

People today tend to over-breathe, taking 12 to 20 breaths a minute, which can stress the heart and nervous system. Nestor also recommends breathing through the nose, which produces nitric oxide (NO) that improves both the lungs’ ability to absorb oxygen and the transport of oxygen throughout the body—and can kill bacteria.

Researchers are studying inhaled NO treatment for Covid-19 patients—to dilate the arteries to increase blood flow, dilate the airways to increase oxygen delivery and directly inhibit the growth and spread of coronavirus in the lungs.

Wearing a mask is still the best protection against this coronavirus. Even masks that don’t protect perfectly can lower the viral dose, which means less severe illness.  In the Czech Republic, for example, which required masks starting in mid-March, the death rate remained flat even when case numbers occasionally increased—meaning those who became infected didn’t get severely ill.

What might spur more vigilant mask wearing are the 14-day quarantines now required for people traveling from high-risk locations —a list on which D.C., Maryland and Virginia joined more than 30 other states in July. The definition of high risk is more than 10 new cases a day per 100,000 people in a rolling or moving average—updated every day—of the previous seven days.

In D.C., for example, with a current population of 705,749, more than 70 new daily cases on the rolling average means that District residents traveling to New York must quarantine after arriving—as must anyone traveling to D.C. from states like Delaware. By early August, D.C. decreased its case numbers far enough to be removed from the list, as did Delaware.

More than 25 cases per 100,000 people means a community should issue stay-at home orders, according to Harvard ethicist Danielle Allen, although many experts argue that “only a nationwide lockdown can contain the virus now.”

—Mary Carpenter

Well-Being Editor Mary Carpenter is on a mission to keep us updated on Covid-19. To read more of her posts, click here.