By MARCELO EDUARDO BIGAL*
The epidemic is serious, it will be long, it will demand efforts and resistance
Six months after the start of the COVID-19 pandemic, the situation in the United States and Brazil, the two most affected countries, continues to deteriorate. Faced with the inability to manage the crisis, Donald Trump and Jair M. Bolsonaro invest heavily in misinformation. They minimize the danger of the epidemic (little flu), propagate drugs without scientific basis (chloroquine) and create the false dichotomy that either normalcy is restored, or the consequences for the economy will be worse than the epidemic, ignoring the economic losses of the opening/closing that the premature end of social isolation caused and will cause. This carefully planned misinformation creates an environment conducive to the emergence of myths that find fertile ground in an exhausted and unbelieving society. Let's look at some of them.
Myth: COVID-related mortality has been decreasing
The concept has spread on the internet that the virus has mutated into a more contagious and less aggressive form, which would explain a higher number of cases with a lower number of deaths. While we know that the genetic material of COVID frequently mutates, there is no evidence that it has become less dangerous. The sense of decreasing mortality comes from the United States, where cases have been increasing for more than a month but mortality has remained at around 400-600 deaths per day. Two facts explain this. In the first place, when social isolation was broken, young people took to the streets much more than the elderly. Mortality in young people is lower, but they transmit it to the elderly. Therefore, two transmission cycles were needed (young to young and then young to others) with a “double” period between the increase in cases and the increase in deaths (two contagious periods). Second, the first big spike in mortality hit a few states (New York, New Jersey) that were quickly overwhelmed. The current peak hits around 20 American states, which only now have their ICUs overloaded. A similar phenomenon can be seen in Brazil.
Fact: mortality in the US has risen again, as expected, and is once again approaching XNUMX per day, with a projection that, by the end of July, it will increase to around XNUMX new daily cases. The virus remains as deadly as at the beginning of the epidemic.
Myth: It is worth taking the risk, as the mortality is only 1-2%
COVID infection is mistakenly understood as a lung disease. It is actually a systemic disease, with profound vascular (thromboses, ischemia) and also pulmonary involvement. It is a deeply misleading fallacy that we see the end result as only dying or surviving (2% chance of dying and 98% chance of surviving). Many of those who do not die, including young people, develop sequelae. Possibly irreversible but sometimes undetected lung losses, ischemic attacks and amputations, among others, happen more frequently than death, and are not captured or feared when we look only at mortality. Post-COVID chronic fatigue syndrome has been reported a lot, especially in young people. Individuals feel like they have the flu that does not go away or get better, and they describe numbing of the senses, or “mental fog” that persists after months. Still, many survive after weeks in the ICU and on ventilators, with emotional consequences. Double lung transplants and heroic techniques have saved others. They don't die, but they keep the marks.
Fact: We should fear not only death, but sequelae and chronic complications.
Myth: Better to catch it soon and be immune
And who guarantees that immunity will last? As the pandemic is only 4-5 months old, no one is cured for more than those same months. Anthony Fauci, a great American immunologist who, all too wisely, is consistently ignored by Trump, when reviewing the data declared: “We can say that those who recover from COVID infection have a high chance of being protected from reinfection for a period of time finite, which may vary from person to person. Us We do not know how long will that finite period be, a year, many years, or just a few months.” Study published in the prestigious journal Nature suggests that 50% of asymptomatic carriers lose immunity in just three months! A second study showed that while between 83% and 93% of New Yorkers who recovered from COVID had neutralizing antibodies against the virus, immunity was modest in 56% of them. Even worse: we do not know the consequences of a second infection in the same individual. Would you remain modest? Or would it be more serious, like a second dengue infection?
Fact: The epidemic is still too recent for us to know about prolonged immunization and the consequences of multiple infections.
Myth: Once a vaccine is approved, normality returns
With 120 vaccines in development and some clearly showing potential, there is reason for optimism. So where is the myth? First, there is no guarantee that the promise of the vaccine will come true. How many scientific articles have shown progress towards the development of a vaccine for AIDS, another viral disease, which never came to fruition? How many decades did it take to develop the imperfect flu vaccine? Also, if the secondary immunity to COVID is transient, how long is the immunity generated by the vaccine? months? Years? I am optimistic about the success of this development, the myth is to think that it will happen for sure, and that it will be effective for sure.
Fact: The chances of an effective vaccine that provides temporary protection are good but not a certainty.
Myth: It is safe to go indoors as long as we keep our distance from each other
Originally, it was thought that the COVID released by saliva, for example, as we speak, did not remain in air suspension (aerosol), but quickly deposited, by gravity, on the floor or on objects. We already know that this is not the case, and that the virus, in closed environments, can remain in air suspension for more than 15 minutes. Imagine a bar, with lots of people talking and moving around. This microspray of saliva gets aerosolized into the air, and as people move around, they come into contact with these tiny droplets of saliva from lots of other people, which creates opportunity for super-transmitters. Not coincidentally they were spotted in bars, churches, weddings and funerals. Not at outdoor events.
Fact: Social distancing is protective outdoors, but not indoors. In an open environment, the wind prevents microaerosols, and distance protects. In closed environments, distance does not protect. We ended up invading the “salivary airspace” of many people.
Myth: As children do not develop the disease, it is safe to open schools
It's a fact that preteen children are much less likely to get the disease, so there's an argument to be made that we should reopen elementary schools. But these children can still transmit the disease by contact (hands), or be asymptomatic and transmit it through saliva. And since when do schools have only children? And the parents, who transport them? Teachers, staff, drivers, guards? Don't enter the equation? Still, about a hundred children in New York developed severe multisystem inflammatory syndrome after COVID, i.e. there is a risk for children too.
Fact: Although children are more protected, they are not fully protected and adults who interact with them are at risk. You need to think more deeply about the best course of action that meets the needs of the child, but does not simplify the problem.
Myth: If I take ivermectin, nitazoxamide, hydroxychloroquine, I will be protected
Good luck. Once again Brazil discovers the square of the wheel. And to think that the whole world missed out on that opportunity…
Myth: With so much information, we don't know who to listen to
Time to stop pretending. It doesn't take much strength to see who is malicious in this story. Either we do our part, informing ourselves, not passing on bad information, staying at home, wearing a mask, maintaining social isolation, or we must be considered part of the problem. The epidemic is serious, it will be long, it will demand efforts and resistance.
*Marcelo Eduardo Bigal, is a neurologist and researcher, with a doctorate in neurosciences from USP. He has 320 articles published in international scientific journals, and has published five medical books. He is CEO of a Boston-based biotechnology company dedicated to medical development in the field of immunology.
