Dr. Robin’s Covid-19 Updates

Covid: The Science Will Save Us

Our Year in Review

Photo by Debby Hudson on Unsplash

In one of my earliest posts in March 2020, I wrote, “Science will save us.” It is still true.

It’s slower than most people want and all of us need, but the science is happening. What we have seen over the last year is one-patient-at-a-time scientific discovery in action. Questions are posed; hypotheses generated; and bit by bit the truth is revealed.

At the start of this crisis we knew nothing, less than nothing: only that some people had a “weird” pneumonia. By late January, we knew the bug, its gene sequence, and that it could move from person to person. By March we knew it was in Boston, big time. By May we knew that between most of Massachusetts sheltering in place and turning most of our hospitals into COVID-19 wards and ICUs, we had averted disaster here.

What do I mean by averting disaster? I mean, it kept the hospitals from being overwhelmed. It kept us doctors from having to institute “Crisis Standards of Care” (aka rationing). It kept us from looking like California where patients lie on gurneys in the gift shop and funeral homes are turning bodies away.

We’ve learned how coronavirus spreads, when, and from whom. We’ve learned what decreases the risk of it spreading (masks, being outside, air circulation, distance, decreased time, hand washing) and in some cases even how much (e.g., being inside is about 18 times as risky as being outside).

We’ve learned, after a false start, that surface transmission (getting it from groceries, Amazon boxes or take-out containers) doesn’t matter much and that frequent testing can decrease spread if it’s followed by quarantine.

We’ve learned that symptom checking or checking for fever is helpful in decreasing spread, but it is definitely not a guarantee. Why doesn’t it matter much? Because so many contagious people don’t have symptoms. Because this vexing virus is being spread by people who have no idea they have it.

This was a crucial thing to learn about this virus: that a person — you, or Uncle Maskless, or even your dinner table companion — can be sitting there feeling perfectly fine, chatting and laughing, but in actuality every time they exhaled they emitted the virus.

When you have a disease in which 40–50 percent of the time a person can be contagious — even though they don’t feel/look/sound sick — you have a really big problem.

We learned about Covid’s timeline. We’ve learned enough to be able to define an “exposure” — being around an infected person for more than 15 minutes in 24 hours, less than six feet away. We’ve learned that you can be infectious 2–4 days before symptoms occur, and usually for 4–5 days after symptoms. We’ve learned that most people don’t get symptoms until 5 days after an exposure, but sometimes as long as 14 days. We’ve learned that mildly ill people are almost never contagious 10 days after their symptoms start and even people who are very ill are seldom contagious after 20 days.

We’ve confirmed 85–90 percent of infected people will NOT end up in the hospital and that for many, it’s like a mild to moderate cold or flu. We’ve learned most adults have flu-like and respiratory symptoms (fever, fatigue, cough, shortness of breath) whereas little kids get more achy (headache, body aches, malaise).

We’ve also learned that a lot of people can have nausea or diarrhea or a sore throat, but we don’t see runny nose or nasal congestion or sneezing very often. We’ve learned that having any one of these symptoms plus a loss of smell/taste means it’s pretty definite you have Covid.

We’ve learned that Covid affects much more than the lungs, that it’s involved with clotting and brains and kidneys and hearts and the immune system in ways we’re just starting to tease out. We learned how older adults and people with significant chronic diseases are more at risk, and little kids seem to be less affected.

We learned a lot about making Covid tests. With HIV, it took years to create a good test, With Covid, it took days to develop dozens.

We learned a lot about treatment and how to keep people out of the hospital and how to keep them alive once they are there. We learned what worked but we also very importantly learned what didn’t work.

And then, of course, there is the amazing story of creating our vaccines. Decades of prior work on mRNA, gene sequencing, biochemistry, vaccinology, immunology, and buckets of money set the stage for the amazingly rapid development of vaccines that seem to be super effective with no permanent short-term side effects.

I think of most of the short-term reactions — tender arm, headache, fatigue — as being the same as sore muscles after working out at the gym. They shows you’ve done the right stuff and your body is reacting in a positive way.

In general, doctors usually don’t see long-term side effects in vaccines more than a couple of weeks after an injection. So far, this also seems true of our Covid vaccines.

Still, there’s a ton we don’t know — and what I write in January 2022 will be radically different than today’s report. We don’t know how often the vaccine will end up being given (once, twice, perhaps annually?). We don’t know all the details of how our body’s immune system responds after infection or a vaccine. We also don’t know what’s going to happen with the mutations or variants we have seen so far or those that are going to develop in the future.

Furthermore, we don’t know what’s going to happen to Uncle Maskless or Aunt Petunia. What will happen to us, or our beloved heroic health care workers, if we don’t double down on the hunkering down?

What we do know is the data will be forthcoming. Every infection will teach us. Every patient is a lesson.

My professors in medical school taught me that “data is patients with the tears washed away.” This has never been so true.

What we do know is that the science will keep going. The science is neutral — it doesn’t care who is President. The science is a slow swing towards the truth — it doesn’t read a calendar. The science is a triumph of logic and reason; it’s the wonders of the human brain over superstition and anecdote. The science is what will save us.

{Robin Schoenthaler, MD is a Boston-based cancer doctor who has been writing straightforward fact-based no-blame-no-rumors-all-science-all-the-time essays about Covid-19 every week since March 2020.}

Covid-Translator. Cancer doc: ~Three decades at MGH. Writer and storyteller: Moth Grand Slam Champion. Mom. www.DrRobin.org, @robinshome, robinshome2@gmail.com

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store