COVID-19: Epidemic or Pandemic?

medical

Has the world over-reacted, or under-reacted to the Covid-19 viral Coronavirus outbreak?  Dr. Mark Bruce, an Emergency Room Physician who is on the front line in the expected escalation of the novel coronavirus to puts the outbreak in perspective.

 

Orethapedia: Is this whole think overblown or are we looking at an epidemic or pandemic?

Dr. Bruce: It is not unreasonable to call COVID-19 an epidemic which is properly defined as a widespread occurrence of an infectious disease in a community at a particular time.  I don’t think we can say it is a pandemic since it has not overtaken an entire country (that we know of) or the entire world, although the potential does exist.

 

Orethapedia: The Coronavirus story is #1 in world news media. Are we over-reacting?

Dr. Bruce: It is easy to over-react when you don’t know what is going on. Sadly, there is also the dynamic of political bias and a very uncivil political discourse, particularly in our country in an election year.

 

Orethapedia: In contrast to over-reaction in the U.S., might we be correct in calling the initial Chinese response an under-reaction?

Dr. Bruce: The under-reaction by China leaders seems to have been in the initial stages of this outbreak in China.  From what we can ascertain, local officials did not want to look bad to their superiors by asking for help.  Then those higher-ups did not want to look bad in the world community by admitting the failure of their system, or their need for help.  China is not an open and transparent society.  Any time there are political constraints on the scientific and medical communities, it is a recipe for a disaster.  We saw this in the USA during the early stages of the HIV crisis in the 1980’s, and we are still dealing with the repercussions of that.

Orethapedia: You have talked about the COVID-19 outbreak being a ‘perfect storm’. Explain what you mean by that.

Dr. Bruce: The timing of this Covid-19 outbreak was during the Chinese New Year.  This is the peak travel time in Asia, and many other parts of the world.  So, a novel virus got a free ride, with no existing testing procedure or treatment since it hadn’t been recognized or identified before. It was a healthcare disaster’s perfect storm: No scientific/medical constraints applied for political reasons; it was something not seen before; it was during a time of maximum travel to and gatherings in, resource limited environments; all of this with an incredibly divided American political leadership, which is struggling to find consensus on how to lead the world in providing a soft landing for this crisis.

 

Orethapedia: Now that the genie is out of the bottle, so to speak, that should be the medical order of the day?

Dr. Bruce: The first rule of any epidemic is to protect the uninfected.  That is how you keep an epidemic from becoming a pandemic.  The problem with Covid-19 is that it is a novel virus, meaning that we haven’t identified it before.  We do know about the family of viruses that this is part of, the coronavirus family, most notably in the SARS epidemic of 2003.  SARS, or Severe Acute Respiratory Syndrome, also created widespread panic.  I was in Asia during that outbreak and witnessed it up close.  This was mostly contained in Asia, where the Covid-19 outbreak also began.

Orethapedia: What do we know about COVID-19 and how it differs from prior similar bugs?

Dr. Bruce: The coronavirus family has an affinity to lungs/lower respiratory tract and causing pneumonia. Viral pneumonias are not treated with antibiotics like bacterial pneumonias, but rather with supportive measures, like oxygen, pulmonary hygiene, and dealing with the other issues that respiratory compromise can cause. In contrast, most ‘cold’ viruses have more of an attraction to the upper respiratory tract, the nose, throat, and bronchial tubes.

Orethapedia: What demographic is most vulnerable to COVID-19?

Dr. Bruce: Patients who are vulnerable to viral infections (both the coronavirus and most traditional “flu” viruses) are the patients in the extremes of age:  very old and very young.  But there are many patients with either chronic diseases, or who are immune compromised because of a disease state (cancer, HIV), or because of the medications that they are taking (chemotherapy, biologics), that are also vulnerable.  Knowing who is at risk and protecting them will go a long way toward keeping the community well.

 

Orethapedia: China is a closed society, not too dissimilar to the USSR in the 1950’s and ’60’s, even until the iron curtain fell in 1989. As a physician who has treated patients on multiple continents, I believe you have some perspective here.

Dr. Bruce:  I remember an incident where the Soviets blamed an outbreak of pulmonary anthrax on contaminated American beef; but the outbreak was near a Soviet bio factory which had an explosion, and the only way to get pulmonary anthrax from beef, is to snort it.  A lack of transparency lends itself to suspicion and mistrust, to over- and under-reacting. There are still lingering questions regarding the perplexing proximity of a Chinese bio lab being located at ground zero of the COVID-19 outbreak.

 

Orethapedia: Speaking of international relations and politics, tell us your remarkable story of a unique gift you received from a famous Presidential family.

Dr. Bruce: The space pup, Pushinka, the gift of state from Khrushchev to the Kennedy family at the 1961 Vienna Summit Conference, was a step toward building a trusting relationship during the apex of the Cold War between the Soviet Union and the United States.  In a similar way, albeit on a less grand scale, the Kennedys’ gift of the pupnik named Streaker to me as a child was a way to build relationship between a Midwestern, Protestant, Republican family and an East Coast Elite, Catholic, Democrat family.  Any relationship requires nurture, and that is what Jacqueline Kennedy Onassis and I did through the 60’s, 70’s, and 80’s. I chronicled that story in my book, Jackie, A Boy, and A Dog:  A Warm Cold War Story, just released on March 1, 2020.

Orethapedia: How does that circle back to China, the United States, and Covid-19? 

Dr. Bruce: There were hopeful strides in building a trusting relationship at the beginning of the Trump administration, with the Chinese head of state meeting with Trump in Mar-A-Lago.  However, it appears no significant steps are being taken since by China to build trusting relationships with the West, specifically with the United States.  The health and the economies of the world have become so intertwined that when China or the United States sneezes, the rest of the world catches a cold.  Now China has sneezed, we had best take steps to protect the uninfected from catching their ‘gift’ to the world: The COVID-19 coronavirus.

 


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