COVID: Public health and medicine

I was looking forward to writing about something other than COVID-19 and there is a lot to discuss. But first, let’s put the delta variant into some context. General Colin Powell once said, “The enemy always gets a vote” and hopeful situations can change, even if the enemy is a virus. A month or two ago we were optimistic about our ability to contain SARS-Cov-2, but then the delta mutation appeared and attacked the unvaccinated. Vaccinated people can be affected and pass on the virus; they do not get very sick, and rarely die, but that distinction is often lost on people who passionately oppose vaccines. The image of a congressman thundering on in the well of The House of Representatives about how the vaccine does not work sticks in my mind.  

Unvaccinated people can get very sick, and some of them are children. In Louisiana every pediatric hospital ICU bed is occupied. The medical system, whose nurses and physicians have proved their valor, do not like seeing children unnecessarily ill. Hospitalization costs a lot in human anguish for patients, staff and their families. The cost in dollars is immense. The most affected Southern states seem to be getting that message and vaccination rates are up, but even if everyone in Louisiana, Texas and Florida got a first dose tomorrow, it would take weeks to see an effect. The governor of Florida has vowed punishment of school districts or businesses or cruise lines that require vaccines or masks. People should understand that public health measures are the only ways to contain a local epidemic and to save an economy. Mr. DeSantis is bluffing and has already been called out by local school districts. He wants to be president and in some people that desire corrupts judgment. The pandemic in Florida will not end well for him or many of Florida’s people. 

What do we mean by public health? As a subject it covers everything from clean water to vaccines. Public health workers deal at country- or city-wide scale to find the sources of illness and contain them. If a city has contaminated water, all the antibiotics in the world will not help. If the water is contaminated with lead, PCBs or arsenic, that will also lead to calamity. If an area is infested with disease-carrying mosquitoes, ticks or tsetse flies, the people will get debilitating diseases; they will suffer and so will the economy. Any population-wide affliction is the concern of public health workers. They also make sure that patients carrying infectious diseases follow their course of treatment and do not spread drug-resistant tuberculosis or COVID-19. At the beginning of a pandemic, public health measures, including quarantine, are the most effective tools we have. The late New Yorker writer Berton Roueché celebrated these public servants in his book, “The Medical Detectives.” Anyone interested in a career in medicine or public health should read it. Mr. Roueché helped direct a lot of us toward medicine and biological research.

COVID-19 is the medical event of our times and I have been writing about it for a year and a half. I have done my best to unify these essays to describe the evolution of the pandemic in an article that appears online, with illustrations. Where my predictions were wrong, I say so. Where our officials failed us, I also give an opinion. I have described the virus and how it works. I have included information on how our immune systems work, including the innate immune system and the adaptive immune system. Warm-blooded life would be impossible without them. Where there are mechanisms common to all infections, I write about them. I have covered the ways in which industry and basic scientists collaborate and what each does best.  Above all, we must plan for the next pandemic and make sure it does not kill 610,000 people in the United States alone, as COVID has. I describe my first scientific experience more than 50 years ago with a virus called T4. T4 infects bacteria rather than humans but at a certain level, a virus is a virus and T4 taught us a lot about molecular biology. The essay, with illustrations, “A Brief History of the SARS-CoV-2 Coronavirus Pandemic” is on my website, www.RichardKessin.com. 

Richard Kessin Ph.D is Emeritus Professor of Pathology and Cell Biology at the Columbia University’s Irving Medical Center. He lives in Norfolk. Email him at Richard.Kessin@gmail.com.