Continued from the May 2020 Bulletin

Alex GranokMay UPDATE on the COVID-19 Pandemic

Our Medical Specialist Answers THREE Frequently-Asked Questions
by Alex Granok

[Editor’s note: In the March 2020 issue of the Jewish Community Reporter of New Hampshire, Alex Granok wrote an article on p. 14 explaining what is known about the pandemic, and further expanded on that info in a Zoom presentation sponsored by the Jewish Federation on Sunday, April 19. The Editor contacted him and asked him to summarize that article and then give us the most recent updates. See below. Please also see the NOTE for the author’s bio and credentials.]

As of April 29, 2020, there have been almost 3.2 million confirmed cases of COVID-19 worldwide, with over 226,000 deaths. The U.S. alone has experienced 1,035,000 confirmed cases and 60,000 deaths. Here in New Hampshire, we’re closing in on 2010 cases, and 60 deaths.

If you want to check on reliable sources for future updates, I suggest these:

Keep in mind that the first case in the U.S. was reported in January 2020, and the first case in New Hampshire was seen in early March. Also keep in mind that a significant portion of those infected with SARS-CoV-2 (the name of the virus which causes COVID-19) have few or no symptoms at all, yet can still pass the virus on to other people (some estimates are 40%, some are even higher).

Finally, while people in all walks of life can be infected, the virus takes a disproportionate toll on our most vulnerable—namely, those over the age of 60 and those with underlying health conditions.

These are some of the reasons that our scientific experts have recommended, and our political leaders have adopted, our current strategy of stay-at-home orders (with the closing of nonessential services), social distancing, and universal mask use when in proximity to others. These measures will not only decrease the likelihood of an individual becoming infected, but will also “flatten the curve,” decreasing the day-to-day burden on our hospital systems.

I will now attempt to answer a short list of frequently asked questions. As fast as this pandemic has moved, our knowledge has struggled to keep up, and my answers may be imperfect as a result.

“I’ve heard about medicine X, Y, or Z. Does this work?”
Unfortunately, we went into this situation without an effective, pre-existing medication to treat coronaviruses. Early on, we hoped that certain medications—such as hydroxychloroquine—might possibly have a role in the treatment of this disease. However, the effectiveness of hydroxychloroquine still remains unproven. Many of these medications carry the risk of serious potential side effects.

Randomized, clinical trials are currently underway. Another antiviral medication that was in development (Remdesivir) has now been used in a very large clinical trial, and results are due out within the next couple of weeks. It may give those hospitalized with this infection a real chance at better outcomes: we’ll have to wait and see.

“When will we have a vaccine?”
Again, there were no pre-existing coronavirus vaccines before this pandemic. Scientists rapidly figured out the genetic code of this virus, and developed a candidate vaccine within a couple of months. That speed, like everything else about this pandemic, was unprecedented.

However, vaccine trials are a long process. First, we need to make sure that the vaccine is safe in a relatively small number of volunteers; and that it does what it’s supposed to do—namely, make an immune response against the target.

We also need to determine most effective doses. Then, the vaccine needs to be studied in a larger group of people for side-effects and development of an immune response.

Finally, the vaccine is taken out into the field, to determine whether it actually protects against the disease, and whether it’s as safe in a real-world setting.

Even when conducted at breakneck speed, this process will likely take a year and a half to two years. Most likely the virus will still be around then to some degree, which means those people not infected this time around will still benefit, and ultimately, the knowledge gained will be helpful when the next coronavirus pandemic occurs (which is a matter of when, not if).

“When will things go back to normal?”
This is perhaps the most difficult question to answer, for several reasons. This virus has led to significant changes in the way our healthcare system operates. These changes are likely to be with us for a long time, perhaps forever. Our interactions with our doctors (e.g. tele-health) and our hospitals (screening for infections before undergoing surgeries; guaranteeing our supply chain for personal protective equipment) are not likely to go back to the way they were. We now realize those methods were largely inadequate for a true public health emergency.

The decision as to when to suspend stay-at-home orders and social distancing is a difficult one, and our leaders have to balance the public health with our society’s economic health. Most people don’t have the luxury of not being able to work for three or four months, and unfortunately, our social safety net isn’t up to the task.

However, coming back too soon will lead to a spike in infections and deaths, and will again threaten to overwhelm our healthcare system.

What we need to see first of all, for a return to “normalcy” to occur, is a falling infection rate, to below some threshold level. Remember that what we see today is actually a reflection of what took place a couple of weeks ago, with respect to transmission of the virus, and what we’ll be seeing two weeks from now is really more important than what’s going on right now!

Second, we need the ability to rapidly test anyone who might be infected. Currently, we are still focusing on higher-risk individuals, like those who work in healthcare (since they could spread the infection to their patients) or who live in high-risk settings, like nursing homes. We don’t have enough tests, yet.

Third, once a patient with the disease is identified, we need to be able to isolate not only that patient, but everyone who’s had close contact with that patient, until it’s clear that they too haven’t contracted the disease. There are still too many cases, and too few contact tracers, to accomplish this last goal.

Epidemiologists at the University of Washington have given estimates as to when each state will likely achieve these goals and can then begin to relax their policies, the best guess for New Hampshire is May 16, 2020.

But I stress, things can change.

The important things to remember about our current situation are that it won’t continue like this forever, and that the vast majority of people who catch this disease will recover. We’ll get through it.

I hope we will emerge with a greater appreciation of what it takes to tackle such a large problem, and a stronger sense of community.

NOTE: Author’s credentials and bio: Dr. Alexander Granok is an infectious disease specialist with Infectious Disease Specialists and Travel Medicine in Merrimack. He is on the medical staff of Southern NH Medical Center, St. Joseph Hospital, Elliott Hospital, and Catholic Medical Center. He, his wife April Shaw, and their son Eadric Granok have been Manchester residents since 2001, and members of Temple Adath Yeshurun since 2004.


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