War of the Worlds and COVID-19

The opinions in this article in no way constitute personal medical advice. Any symptoms of illness you are experiencing should be taken to your local health care professionals.

“The War of the Worlds” is a fictional story by H.G. Wells written over a century ago.  It tells of Martian invasion, in which highly evolved aliens invaded earth in their tripod machines.  The Martians were technologically advanced but physically weak.  Our military technology was no match for theirs, and they massacred us.  

When all hope was lost, the Martians all died from infection by earth’s microorganisms.  The Martians had not coevolved with earth’s germs, and thus they were not fit for planet earth, and it destroyed them.  

Isolation and Weak Immunity

In the history of the world, the most isolated people have been the most devastated by infectious diseases when finally exposed to the infectious diseases of the larger world.  Prolonged isolation prevents evolving or acquired immunity and thereby lessens our immunity.  It is estimated that infectious diseases such as small pox, measles and influenza introduced by European colonization killed over 80% of the relatively isolated native population in The New World.   

The 1918 Spanish Flu spread over the planet and killed an estimated 50 million people, with the greatest mortality rates occurring in isolated communities.  The small isolated village of Okak, Labrador lost 204 of its 263 villagers due to the flu. 

In the Pacific, islands that were more isolated had greater mortality rates due to the Spanish Flu. Mortality rate on isolated Samoa was 22%, while the less isolated Hawaii was 0.4 %. Studies of Spanish Flu on isolated islands found that people that had already had contact with the outside world, and been exposed to many different respiratory pathogens, experienced less disease and less mortality. 

Infections with many different respiratory viruses prime and train the immune system to fight other respiratory viruses, including the new viruses and the more deadly viruses.  

Camp Funston, at Fort Riley, Kansas, during the 1918 Spanish flu pandemic

Recent studies have shown that as adults isolate themselves and age, they loose much of their immunity they once had, that might have otherwise protected them against respiratory viruses. Adults infected with common cold viruses are less likely to become ill if they are more socially connected.   

Why are Children Protected Against COVID-19 

Novel coronavirus that emerged in 2019 was named SARS CoV-2, and the disease it produced is called COVID-19. From here on I will simply use the term COVID-19 to mean both SARS CoV-2 and the disease it produces. As of April 2020, only 1.7 % of positive cases in the US are in people under 18 years. Children that do test positive also have more mild symptoms than adults.

Modern children get many more viral infections than adults.  Their physical activities, social habits, daycare and school attendance expose them constantly to infectious organisms.  Yet most of the time they get much less sick than older adults, despite the more frequent infections.  Respiratory Syncytial Virus (RSV) is a common cause of hospital stays in children, but deaths in Children from RSV are uncommon in the US, about 100-500 per year according to the CDC.  Among older adults deaths from RSV are more common, 14,000 annually in the US.  

Frequent viral infections and vaccines in children “train” the immune system to be more effective against a variety of different and new viruses.  Exposure and subsequent immunity to one type of virus helps protect against other similar viruses.  This is called cross immunity and is why influenza vaccine for one strain still helps to protect against other influenza strains.  

There are many strains of coronavirus.  Children are often getting exposed to and infected by these coronaviruses.  The high rate of exposure to these coronaviruses, and the ensuing trained immunity and cross immunity, is partially what protects children from COVID-19.  Other factors such as better overall health, and better regulated immune responses also greatly help the young not get as sick with COVID-19.  

Vaccines and Waining Immunity

Developing an effective vaccine would be the best possible solution for COVID-19, and there is hope.  It may take 18 months, if not years, to develop an effective coronavirus vaccine, and some doubt it will ever be possible.

Immunity to respiratory viruses wains over time, sometimes rapidly. That is one reason why we get flu shots every year (the other is that prevalent strains change from year to year). 

Coronavirus immunity seems to wain quickly in some people.  Some people may have already become ill with COVID-19 more than once. Coronavirus immunity may require either recurring infections or recurring immunizations to maintain.

Vaccines need to be safe and must go through extensive trials to ensure that they are effective and safe. Attempts to develop RSV vaccines have failed for 60 years. The initial vaccine for RSV was not only ineffective but caused a worsening of the disease in some. Our current vaccines for influenza are very safe and very effective with decades of development behind them.

Long term isolation and decreasing the overall exposure to respiratory viruses can result in waining immunity.  What duration of isolation will cause this to happen?  One year, five years or ten years?  It is relative; the longer we go without boosting immunity, the less immune we become. 

COVID-19 is here to stay.  There is a high probability that most of us will eventually get infected.  If that happens before a vaccine is ready, we will have to rely on our natural immunity. If we continue to practice isolation and social distancing for too long, will we and our children become less resilient to COVID-19, and other viruses?

Life in a Bubble

The consequences of living in isolation are incalculable. Loneliness, senility, earlier death in the elderly or those on hospice, depression, anxiety, suicide, decreased intellect, crime, homicide, joblessness, hunger, poverty, loss of fortunes, loss of small savings yet everything for some, loss of funds for humanitarian projects, children becoming obese, all of us becoming obese, diabetes, domestic violence, divorce, screen dependence, alcoholism, drug use, poor fitness, heart disease, emergence of vaccine preventable diseases, and death.

A good argument can be made that more people could die because of our responses to COVID-19 eventually, than from COVID-19 itself. No-one will ever know. No accurate models can be constructed either way.

Cancer patients are really in a conundrum. On one hand they are at very high risk of complications from COVID-19. On the other hand they are very dependent on the contact of medical personal and family members. In many centers they have to go to their appointments and treatments alone. They sometimes fear they are stepping into COVID soup when they enter a health care facility. They are often deeply afraid to be alone without that spouse or friend who typically helps them. My dear wife died of cancer, and I can’t imagine having been denied entrance into the cancer center to be with her and support her. Yet I would also be afraid of her being exposed to someone who was ill.

The poor and elderly are struggling in all ways. They suffer more from COVID-19 infection, but they also suffer more from the fallout of isolation.

We are willing to sacrifice much to save lives. It speaks well of humanity. We are sacrificing extended family relations, helping neighbors, making new friends, dinner parties, drinks with buddies, kind expressions, seeing smiles, handshakes, hugs, human connection, and real romance. There are educational and economic sacrifices: college classes, jobs, and business relations. We are not lifting others out of poverty, supporting the struggling street vendor or local small business. What happened to community service and freedom to assemble? People are very willing to sacrifice fun activities like group fitness classes, big races, sporting events, amusement parks, going to the beach, travel to new places, and the museum, but we miss kids at the playground, kids in a classroom, kids visiting grandparents with hugs, being with dying loved-ones, and holding a spouse’s hand when she is informed of terminal cancer. We are sacrificing mental health, physical fitness, cardiac health, joint health, and immunity, even skipping vaccinations.

Containment and Quarantine

Total containment of COVID-19 is unlikely.  COVID-19 is here to stay and will continue to spike off and on for unforeseeable years to come. We are now a global community and new highly contagious respiratory viruses spread to every nation. The spread is not anyones fault. No matter what, there were going to be hot spots in places like New York City where larger numbers of people were circulating the virus before anyone knew it was there, but we love to find someone to blame, the officials at CDC, the WHO, or whatever government official we despise. I believe they are all trying to do their best.

Quarantine is not what you think.  It is not what most of you are doing.  Quarantine is the isolation of people who have a disease, who have been exposed to a disease, or who have returned from a place where a disease is prevalent.  It is proper to use the word “isolation” when referring to isolating someone who has a known infection, and using the word “quarantine” to refer to isolating someone who may have been exposed. Quarantine or isolation of someone infected with COVID-19 is very smart.  State officials impose temporary quarantine/isolation of symptomatic people known to have COVID-19, high risk travelers, or others who have known exposure.

Ordering the isolation of all healthy individuals from each other regardless of exposure is not quarantine. Isolation of everyone will slow the spread of COVID-19, but it will not make it go away, and the cost is unmeasurable.

What Does it Mean to “Flatten the Curve”

In simple terms, to flatten the curve of an outbreak means to slow down the rate of spread.  It doesn’t mean decreasing the total number of cases, or the number of deaths, though it could have that effect.  In theory the same number of people may get the disease, the same number may die, but it will be spread over a longer time period, and delay disease and death for many.

Esther Kim@k_thosandCarl T. Bergstrom@CT_Bergstrom / CC BY

Some would argue that the longer we stretch out that curve the better, and maybe a vaccine will be developed, maybe better treatments. Maybe being able to manage the disease in a controlled manner will lead to fewer deaths.  

Others would argue that isolation for too long could result in declines in mental health which would result in more death. A vaccine for COVID-19 may take years or decades to produce, if ever. Prolonged isolation could cause a decline in immunity and result in even more severe cases, not just to COVID-19 but to many viruses. Fallout from economic decline and social-political turmoil would also result in more death.  

Living with Germs

We need to live with germs, and become immune.  We knew this pandemic was coming, and have been talking about it for decades.  We didn’t know what virus it would be, but we knew we were overdue for something like this.

If we could magically wipe out all human respiratory viruses, new ones would eventually continue to evolve from animal hosts and infect us. If we didn’t evolve to live with the viruses, they might infect us with devastating effects because we would lack acquired and cross immunity.  

Immunization rates are rapidly dropping already as people fear coming in for wellness visits.  Will we see a whooping cough outbreak? Will meningitis cases increase again? Absolutely, yes and yes if we don’t increase vaccination rates again. All deaths are tragic, but bacterial meningitis in a child should really scare you. It is over a thousand times more deadly than COVID-19 in children, and survivors usually have permanent brain damage such as severe intellectual disability, deafness, or seizures.

Vaccines, clean water and good sanitation are the biggest three measures preventing disease, and are responsible for billions of saved lives.  Vaccines have resulted in the elimination of Polio and small pox.  We should absolutely practice these examples of the best ways to live in a world of germs and survive.  

“Vaccination against polio began with the Salk vaccine in 1955. In 1952, nearly 3,000 people had died from polio and children in “iron lungs” populated wards in most hospitals. By 1991, however, the disease had been eradicated in the Western hemisphere.” - The U.S. Food and Drug Administration / Public domain

Hope and Advise

The most important additional advice I can give to all my family and patients is to go to bed early. That is the very best way to keep your immune system strong in the short term and it should be emphasized more. Exercise, social connection and healthy eating habits also strengthen immunity.

Wash your hands before you touch your face or after you touch something contaminated. Stay away from anyone who has a cough or fever.

I estimate that I have had over 50 thousand encounters of patients with respiratory infections over my career. I have seen that people have very complex lives, and human well being is more complicated than simply stopping one respiratory virus.

Children are suffering in many ways: anxiety, depression, domestic violence, poverty, poor social skills, poor learning, obesity, lack of sleep, and declining resilience to infections. Those with the fewest resources are suffering the most. They need to go back to school in a way that encourages optimal learning and socialization without barriers to developing friendship. They also need to develop immunity.

If a vaccine is developed I will be the first to celebrate, but I don’t think hinging our hopes on that, and delaying our return to living in a way for optimal health should be extended for long. We are already seeing much suffering from our isolation policies that I believe will exceed our suffering from direct COVID-19 infection.

A Question

My writing is biased by my self interests and ideology. Ideology blinds and biases everyone, especially those that don’t recognize it in themselves. I know in some ways I will error, but I am trying to see a much bigger picture. The scientific community is full of ideologues producing biased research and coming to biased conclusions. Their conjectures are more often wrong than they are right.

I look to my colleagues and other highly learned and humble experts to help sort this out. I expect them to be broadminded and farsighted, to consider all aspects of human wellness, and to recognize their own biases, and not be blinded by ideology.

I would ask them this question again, “What are the long term consequences of isolation on our physical and mental health, and what effect will long-term physical isolation and social distancing have on our future ability to be resilient and immune to all types of illness.”

Further Reading:

Pacific islands which escaped the 1918–1919 influenza pandemic and their subsequent mortality experiences

Epidemiological isolation causing variable mortality in Island populations during the 1918–1920 influenza pandemic

The 1918 Spanish Flu

Is COVID-19 receiving ADE from other coronaviruses?

Will children reveal their secret? The coronavirus dilemma

Social Ties and Susceptibility to the Common Cold

COVID-19 (coronavirus) vaccine: Get the facts

Can We Really Develop a Safe, Effective Coronavirus Vaccine?

You’re Likely to Get the Coronavirus

The Untold Toll — The Pandemic’s Effects on Patients without Covid-19

The Unequal Cost of Social Distancing