Updated: May 26
This is the first in a series of blog posts about the coronavirus that will end in a final post just for cancer patients. But the rest is for everyone!
Fair warning: this post is the dry one. It's sorta like when your boss stands up at the beginning of a meeting and talks about housekeeping for 10 minutes. But I felt it was important to outline why I'm writing this, my background and my biases. At the end, I give a simple overview of viruses.
I’m writing this blog regarding the coronavirus for several reasons:
1) I'm deeply concerned about my friends and family and want to educate them.
2) As an independent patient advocate, my duty to cancer patients requires that I do all that I can to mitigate their risk. I became concerned about this virus in mid January and realized quickly that the media outlets and the politicians (on both sides) were horrible sources of information. My promise to you is that I will quote and cite the best medical journals and the World Health Organization. If I have to quote the media, it will be clearly stated.
3) To date, I have not seen any of the major cancer non-profits or governmental organizations (ASCO, NCI, etc.) give guidance to patients with cancer, which is quite surprising, given the panicked response we are seeing.
4) Some friends don’t know what to believe in the media and they have asked me my opinion.
This blog is a series, each answering question(s) about the coronavirus.
1) My background. My biases. Viral basics.
6) What should cancer patients plan for?
If you don’t want to read all of this, here is the upshot: I of course don’t know how severe this disease is going to get. No one does. Of course, the World Health Organization has declared that this is a pandemic. That means that this infectious disease represents a widespread, global emergency. It does not mean that we can't slow it down.
Some of my friends and colleagues are saying that they don’t want to panic. They correctly point out that this is nothing yet compared to a typical flu season and that SARS and MERS never really did much despite lots of media hype and fear mongering. They're implying that reacting to the news would make them a sucker. Personally, I’m happy to be a well-prepared sucker at the cost of a couple hundred bucks and a couple hours out of my day. Furthermore, we needed to obtain a few weeks supply of food and water anyways for earthquake preparedness. Regardless of where you live, natural disasters are a possibility so why not use this as an opportunity to prepare for one? I don’t think that obtaining tools to protect yourself means you are panicking. It means you are being smart.
First, am I qualified to write this?
A little bit, perhaps…
1) I was pre-med at Vanderbilt.
2) I was a science teacher.
3) I have spent hundreds of hours gowned up in highly specialized, expensive personal protective equipment while selling the world's first "artificial skin" for burn patients. I was in burn units and operating rooms constantly and had to understand the risk: when you don't have skin you are exceptionally vulnerable to infection.
4) Later, as a med device product and sales trainer, I had to know how salespeople increase infection risk in operating rooms; I was responsible for training a few hundred salespeople on how to mitigate that risk.
5) My public health education at UCLA (MBA program) was not expansive by any means, but we spent a few class sessions in Global Health discussing infectious/communicable disease.
6) I’m fascinated by all things healthcare and have read more than 200 articles on coronavirus since mid-January.
7) I’m a board-certified patient advocate.
This is hardly an ideal resume. I feel a little silly writing this post because I’m not a public health professional, virologist or infectious disease specialist.
But again, people don’t know who to trust. If you are confused by the media and our politicians, want citations to the best medical journals and to learn from a former science teacher who speaks in simple language, read on. (And if you are a doc or a public health pro please chime in if you have anything to add and I'll enthusiastically update this).
My Beliefs. My Biases.
We all have beliefs and biases. It’s only fair to share them. Here are mine:
1) I don’t trust Trump and I don’t trust the Democrats. It’s sad that this is so politicized. Merely days ago, Trump called this a hoax. You can see that on YouTube; go to 26 seconds into the video. Trump’s goal is to control the economy in order to stay in the White House. The Dems’ goal is to show that Trump is incompetent in times of crisis in order to take over the White House. According to AP Fact Check, Dems have already lied about this to harm Trump’s re-election efforts. But let’s be clear: this is NOT a hoax.
2) Anti-vaxxer parents really love their babies and are rightfully scared by a (sometimes untrustworthy) pharma industry. But these parents go too far, are sadly misguided and don’t understand science, especially herd immunity. They could be an important key to all of this if the disease spreads widely and a vaccine is developed. (But if you talk to them, be nice. They really love their kids and people who call them “murderers” won’t be able to influence their flawed thinking.)
3) CNN, MSNBC and Fox News do very well financially by scaring us and by telling us what we want to hear. None of them can be trusted.
4) I am a spiritual person with a higher power. I pray every day and I applaud those who pray for a miraculous removal of this virus. But there are some caveats: First, I feel that God’s/His/Her/Its will is going to be done—not yours and not mine. Second, I believe that God created science for the good of humankind. Third, God is not going to wash your hands for you.
So who do I trust?
I trust the World Health Organization (WHO). As an international organization, they don’t have a dog in the 2020 election fight and are probably the least biased.
Some media outlets are reporting that Trump is not allowing CDC officials to make comments without going through the White House first. Dr. Anthony Fauci (who has been the CDC's infectious disease specialist for the last five or six presidents--and widely known to those of us in healthcare) supposedly wasn't allowed to go on weekend news shows. I of course don't know if that's true, but since then, the CDC itself is has been riddled with mixed messages.
So I've mostly transitioned to the WHO for my news. (This is the last thing I'll say about politics for this entire blog series).
For medical perspective, I will only cite the top three medical journals in the world: the Lancet, the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine.
A virus is an infective agent that is so small it can’t be seen under a microscope. It isn’t technically a living thing because it cannot reproduce itself and cannot generate its own energy. It can only reproduce itself once it’s inside a host’s cell.
So it might sound like science fiction, but viruses are foreign invaders that can’t really do much on their own, nevertheless, they are “smart” enough to hijack a cell’s machinery to replicate it thousands of times over.
Coronaviruses are a family of a certain type of virus. The common cold is often produced by a coronavirus, but the virus causing this epidemic is different. This novel coronavirus, SARS-CoV-2, causes a disease called Covid-19.
Let’s define some of those words:
· Novel: It simply means "new." This virus has been identified for the first time in a human population. Because of this, there is no vaccine to prevent it and no drugs are available to cure it once you have it.
· SARS-CoV-2: SARS stands for Severe Acute Respiratory Syndrome. CoV stands for CoronaVirus. 2 indicates that it is the second coronavirus that leads to SARS.
· Covid-19: ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. 19 is part of the name because this was discovered in late 2019.
The virus spreads from person to person through droplets that come out of our mouth or nose. That means sneezing and coughing pushes the virus into the air.
In addition to seeing it in our respiratory system (nose, mouth, windpipe and lungs), scientists have detected the virus in the gastrointestinal tract (that includes everything in the path between our throat and our anus). So it's in our feces. It's also in our saliva, urine and blood. (The New England Journal of Medicine and JAMA both agree on this). However, it is unclear whether or not these are avenues for further infection. Nevertheless, it's wise to treat these bodily fluids as if they could transmit infection.
A Simple Metaphor For How A Virus Operates
Imagine a car—a very different kind of car. The car holds two important things that normal cars don’t have: a blueprint for itself and a highly specialized key.
But here's where things get crazy. The car manufacturer doesn’t actually own any factories! So, it uses its special key to get into someone else’s factory. Once it’s inside, the blueprint is read by the factory’s machines and hundreds or thousands of cars are built. Once they are all done being built, all the new cars drive away and the factory explodes just as they hit the highway.
The car is the virus. The factory represents the cells in our body. The specialized key to the factory symbolizes proteins on the outside of the virus that unlock pathways into cells that have that particular keyhole. Finally, the blueprint corresponds to genetic information that gives the cell instructions on what to make so that the virus can multiply. Then they leave and often "lyse" (destroy) that factory (the cell that made it).
They then repeat this over and over again and at some point, the person begins to start to feel symptoms as our immune system responds to fight the infection.
In the next post, I'll start to address how widely this may spread.