Sunday cartoon

The novel coronavirus once again reigns as the crisis of the hour — ironic given that, amid other societal upheaval across the state and nation, it’s never gone away and in fact has taken insidious advantage of our distractions, whether holiday weekends or racial injustice. Rapidly worsening numbers in Texas reached bleak milestones last week as the state surpassed 5,000 new cases in a single day for the first time, hospitalizations hit record numbers and other states imposed stinging travel restrictions on visitors from Texas. Even in Waco where community discipline and local regulations kept numbers enviably low throughout the spring, the mayor last week offered a somber look at new numbers betraying summertime complacency and overconfidence.

“For nearly three months, our community managed to keep the virus [spread] at an extremely low rate,” Waco Mayor Kyle Deaver said Wednesday. “We had our first confirmed cases in McLennan County on March 17. We registered six that day. We did not reach 100 total cases in our county till May 20 — 65 days later. We didn’t reach 200 total cases in our county till June 17 — 28 days later. We topped 300 total cases in our county on June 20, just three days after we had gotten past 200. And we topped 400 total cases in our county yesterday, just four days after we reached 300. We now have exponential growth in our community and that’s very concerning.”

By week’s end, Gov. Greg Abbott — caught in political crossfire over health restrictions within his own party — had issued an executive order ensuring hospital bed availability for COVID-19 patients amid the rise in hospitalizations. The order suspends elective surgeries at hospitals in Bexar, Dallas, Harris and Travis counties. And Friday he shuttered bars, returned to tighter restrictions on restaurants and closed down rafting and tubing businesses. He further expanded the power of local municipalities to contain viral spread, including outdoor gatherings of 100 or more people.

“As I said from the start, if the positivity rate rose above 10%, the State of Texas would take further action to mitigate the spread of COVID-19,” Abbott said Friday. “At this time, it is clear that the rise in cases is largely driven by certain types of activities, including Texans congregating in bars. The actions in this executive order are essential to our mission to swiftly contain this virus and protect public health. We want this to be as limited in duration as possible. However, we can only slow the spread if everyone in Texas does their part.” That, he stressed, includes physical distancing and, yes, the wearing of masks to deter viral transmission to other people.

In Waco, Dr. Jackson Griggs, speaking for the medical community, said that even with the astonishing rise in active cases locally, enough hospital beds remain. However, health-care officials are nervous given statistics such as a 1,600% increase in active cases in a two-week period ending last Monday or 73 new confirmed cases just between Friday and Saturday afternoon, making for 496 active cases this weekend with 742 people being closely monitored — numbers that would have been unimaginable in the county a month ago. “If the rate of rise continues unmitigated, we will be overwhelmed,” Dr. Griggs said. “There’s an expected delay of three to five weeks following widespread community behavior change before obvious rate changes in new cases and hospitalizations, meaning now is the time for the community to act to prevent a July disaster.”

Amidst this viral calamity, much of it avoidable weeks if not months ago, we all need to become far better acquainted with virology. The mysterious ways of viral contagions will be pivotal parts of our lives for the foreseeable future.

Viruses are a paradox of civilization. These protein-ensconced splinters of genetic material — animate only when infecting a host body — are so primitive that scientists cannot quite agree as to which side of the living/nonliving border they belong. There are endless viruses in our midst, made of either RNA or DNA.

DNA viruses, which exist in much greater abundance around the planet, are capable of causing systemic diseases that are endemic, latent and persistent. Examples are the herpes viruses (which include chicken pox), hepatitis B (hepatitis C is an RNA virus) and the papilloma viruses that cause cancer (totally preventable if parents would just vaccinate their very early teens). DNA viruses live with us and stay with us — they are lifelong. Vaccines have managed to eradicate one of the worst DNA viruses of all time — smallpox.

Retroviruses such as HIV have RNA genomes but behave like DNA viruses in the human host. RNA viruses have the simplest of structures and mutate rapidly, thereby maintaining advantageous traits. A virus that’s more promiscuous, more generalist, that can inhabit and propagate in lots of other hosts (think SARS-CoV-2), has a better chance of surviving. They also tend to cause epidemics such as yellow fever, measles, Ebola, Zika and a raft of respiratory infections, including influenza and coronavirus. They’re the ones that surprise us the most and do the most damage.

Coronaviruses were first discovered in the 1950s as the cause of infectious bronchitis in chickens. The coronavirus’ RNA, its genetic code, is swathed in three different kinds of protein, one of which decorates the virus’ surface with mushroom-like spikes, giving the virus the eponymous appearance of a crown. There are four common-cold viruses that might have come, long ago, from animals, but they’re now entirely human viruses, responsible for 15 to 30 percent of the seasonal colds in a given year. Humans are now their natural reservoir, just as bats are the natural reservoir for hundreds of other coronaviruses.

The first coronavirus that has emerged and proven deadly is SARS, closely related to the new coronavirus we face, and which has now been labeled SARS-CoV-1 to distinguish it from our current coronavirus pandemic due to SARS-CoV-2. COVID-19 is the disease caused by SARS-CoV-2.

A new analysis by the Scripps Research Translational Institute of data from 16 diverse cohorts of COVID-19 patients from around the world found that a surprisingly high percentage of patients with the infection are truly asymptomatic. They’re not just pre-symptomatic (having no symptoms when RT-PCR tested but later developing symptoms) but actually test positive and remain without symptoms — often even with CT imaging of their lungs showing the characteristic changes of lung disease (as seen in 54% of 76 asymptomatic people on the Diamond Princess cruise ship). Among more than 3,000 prison inmates in four states who tested positive for the coronavirus, a stunning 96% remained asymptomatic.

Further review also reveals that these asymptomatic individuals are able to transmit the virus for an extended period of time, perhaps longer than 14 days. The viral loads are very similar in people with or without symptoms, but we don’t yet know if their infectiousness is of the same magnitude. I suspect not but we simply don’t know.

Downside: There may be far more people with asymptomatic COVID-19 in the general population than we initially suspected. Upside: We may more quickly sprint toward “herd immunity,” defined as 60-70% of the population having had the infection and conferring immunity for the population as a whole. Who really knows? We may reach herd immunity before an effective SARS-CoV-2 vaccine can be developed and administered, at least in the United States.

While numerous questions remain, enough is now known to justify smart decisions such as cities requiring (with Abbott’s blessing) masks of employees and customers in commercial settings, even as many individuals relentlessly politicize the issue. Some people spread conspiracy theories such as 5G networks spreading the coronavirus or the U.S. Centers for Disease Control and Prevention deceptively manipulating COVID-19 figures to undermine the president’s re-election. Some show animosity to citizens dutifully wearing masks. A 44-year-old critic (and recent California refugee) at last week’s Waco City Council meeting charged that the local June 19 mask order violated his First Amendment “freedom of choice.” A pregnant woman with a 1-year-old toddler declared she refuses to practice physical distancing or wear a mask as a point of principle regarding this “unlawful” act. (She also predicted Waco would “see a peak in people yelling at fellow citizens” over face masks.) Another blamed COVID-19 deaths on patients’ underlying health conditions rather than the virus and encouraged the City Council to abandon “oppressive” mask regulations and “let our immune systems do their job.”

On the other hand, a “frontline health-care worker” encouraged city efforts: “As leaders in our community, the mayor as well as the Waco City Council have an obligation to protect the public from themselves at times, and this is one of those times.” A nurse practitioner lamented rampant misinformation and resistance: “There is so much misunderstanding with our public right now about the importance of masks and the proper way to wear them, despite the great information being provided to us all. I sense many people feel they are the exception for all the wrong reasons. I fear unless there are repercussions to businesses that do not insist on their patrons wearing masks, it will likely not be followed.” During last week’s press briefing — held days after the mayor issued his mask-wearing order — someone asked what statistics would justify the lifting of this order regarding commercial entities.

“When we had our City Council meeting yesterday, [infectious disease specialist] Dr. [E. Farley] Verner said plainly if the masks are effective, that may be the last thing we should lift,” Mayor Deaver said. “While it feels personal and intrusive, if it allows us to operate our economy and allows our kids to go back to school in the fall and all of the things we want to get back to, we may have to get used to wearing masks till there is an effective treatment and/or vaccine.” His sober judgment: “We’re a ways off from saying it’s time to lift the mask order.”

The most compelling argument I’ve seen regarding the wearing of masks: a Washington Post article about a Springfield, Missouri, hairdresser who worked at a salon eight shifts over nine days despite showing COVID-19 symptoms. She was diagnosed in late May, having directly exposed 84 customers who sat just inches from her face for up to 30 minutes each. The following day, a second stylist at the same salon tested positive for coronavirus. She worked on 56 clients.

Kicker: Both hairdressers and all of their customers wore masks that had been mandated upon the reopening of hair salons. The health department expected five to 10 new cases as both hairstylists wore cloth masks and customers wore a mix of different masks, and one of the stylists had worked despite having COVID-19 symptoms. Despite an offer of free testing, just 46 of the 140 customers got tested, and all proved negative. To date none of the customers of the hair salon have come down with COVID-19.

Moral of the story: Wear masks!

Dr. Rodney Richie is a retired Waco lung and critical care physician, now splitting his time between hiking at his home in the Colorado mountains and treating patients at the VA Hospital in Cheyenne, Wyoming. With his kind permission and cooperation, this column constitutes an expansion of a post he made to Facebook.

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