JUNE 2020 PARKER COUNTY TODAY
tory – I suspect the latter. Since this
was transmitted from bat to man, we
have not seen this virus before, so
we have no natural immunity to fight
it, therefore it can wreak havoc and
even cause death. We are indeed
in a worldwide pandemic. Since, to
date, we don’t have any meaningful
treatments for severe disease we must
depend on immunity to protect our
society.
Herd immunity is a form of
indirect protection from infectious
disease that occurs when a large
percentage of a population has
become immune to an infection,
whether through vaccination or previous
infections, thereby providing a
measure of protection for individuals
who are not immune. In the absence
of a vaccine, developing immunity
to a disease like COVID-19 requires
actually being infected with the coronavirus.
Being a realist, as much as I hope
we will have an effective vaccine by
this fall, I am highly skeptical that a
vaccine will be developed that will
create immunity. These RNA viruses
are extremely difficult to make
vaccines against, particularly since
these viruses mutate frequently and
have antigen drift. To put in perspective,
we have yet to develop effective
vaccines for HIV, Hepatitis C, RSV,
other coronaviruses (common cold),
Ebola, or, for all intents and purposes,
influenza also. It may be years, or
never, that we have a COVID-19
vaccine that works.
Therefore, this virus is going to
have its resurgences until it runs
its course and enough people have
gotten it to create herd immunity and
the coronavirus transmission will
be stopped in its tracks. In order to
achieve herd immunity, with a R 0
of
probably 2-3 with this virus, we will
need somewhere around 70% of
our community to get the infection
to protect the 10% that are high risk.
So, in Parker County alone, with
130,000 residents, over 90,000 will
eventually have to get infected with
this virus which will take a couple
of years. So, we expect we will over
time have at least 90,000 become
infected, well, we currently have 57.
The sooner the healthy get infected,
the quicker the virus will abate and
the vulnerable be protected.
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This is hard for people to hear
- get our kids back in school and
college. Let them do the things they
have always done, fully. They are
the ones that can safely achieve herd
immunity and will become the wall
of immunity to protect the ones at
risk of dying. Realizing nobody is
100% invincible, the CDC provisional
death rate for ages 0-24 is
exceedingly rare. Aside from a rare
Multisystem Inflammatory Syndrome
in Children (MISC) being reported
and possibly associated with COVID-
19, most all children are minimally
symptomatic or asymptomatic. We
do the same thing for the flu, and
heaven forbid, the flu actually takes
the lives of children (166 died this
season).
If you are young and fit and want
to protect other people, wear a (real)
mask or even better, get the virus and
stay at home while you are sick.
One last question, testing, testing,
testing. Should we be getting tested
for the virus and which test?
There are basically two major
tests. There is the PCR screening test,
which is the nasal or oral swab test,
that tells you if at that moment in
time whether you have virus in you.
You could be negative today, positive
tomorrow. So, it gives no assurances
about anyone’s status in an opening
society. The test is required in
hospitals and centers involving high
risk medical procedures. Our society
is currently in a phase of mass
testing, including drive through testing
for qualifying persons in Parker
County. Approximately 5% of at-risk
patients are testing positive in Parker
County, and source control ensues
for those that are positive to prevent
further transmission. Many tests hit
the market initially and some have
a compromised sensitivity (ability to
detect a positive case) at 70%. Could
be a lot better (flu test is 98%).
The second test, is the antibody
test (IgM, IgG), which is like a pregnancy
test on blood. The purpose
of this test is for an individual to
determine if they are susceptible
(antibody negative) or if they have
been previously infected and presumably
immune. If positive then you
have the neutralizing antibody and
could be a potential plasma donor
to give antibody treatments to the
ones severely ill with coronavirus. It
is still too early to tell whether this
test will reflect long term immunity.
Most cohort studies across the U.S.
show around 1-4% of the population
having the antibody, with New
York City being the highest at 14%.
Population density, when studied
around the world, and what I studied
for each of the 254 counties in Texas
and submitted to the Governor’s
office, makes a huge impact in infection
and immunity rates, and ability
to reopen society.
My opinion is that we should
never, never, never be using COVID-
19 testing to make public policies.
We should not use these for employment
criteria, business status, or one’s
ability to function freely in society.
However, testing should be done for
PERSONAL reasons to know your
status, and that information can be
used by our officials for population
analysis.
Any final comments?
One last thing. I want to emphasize
that physician and patient mental
health are big issues!!! People are
experiencing extreme fear, anxiety,
despair, depression, and social isolation.
This results in pathologic actions
of spousal abuse, child abuse, and
physical abuse, including drug and
alcohol abuse, and suicide. We need
to concentrate on physical distancing
but not social distancing. It is
our human nature to be social and
have a life of purpose and meaning.
Likewise, we are seeing in these difficult
times that doctors are faced with
isolation, uncertainty, moral distress
and burnout. It is an extremely sad
state of affairs, when I see patients
in the hospital (not from COVID-
19) actively dying alone! This is
inhumane. And further to not have
adequate closure with limitations in
funeral home visits, church services,
and internment, is an emotional tragedy
for all that is difficult to mend.
Furthermore, the current blame in
our society of translating guilt on a
person for giving a friend or family
member the virus (often unknowingly)
is absolutely unconscionable.
It needs to stop; it is not psychologically
healthy! We need to focus on
the mental health of our society and
do things to help us keep our own
resilience!!!! I encourage everyone to
enjoy your families and your passions
to their fullest.