It is my intent with this blog to measure the need for public health policy balanced against the protection of individual liberties as provided by our Constitution. Public health advocates in our government have heralded a “new normal” as a way to mitigate the effects of COVID-19. Their policy decisions however infringe upon our individual rights. This installment will attempt to explain the scientific reasoning behind the policy measures taken to date.
The science. A virus needs a host to survive. Achieving self-reproduction is the principal goal of any virus. Viral production begins soon after infection and the host may or may not survive. The virus however needs the host to survive long enough so that it may be transmitted to another host. Host survival depends on the three things: (1) the type of virus involved, (2) whether or not the virus and humans have had time to coevolve, and (3) whether or not ancestral humans of the affected host have previously had contact with the causative virus.
SARS CoV-2 is a coronavirus which is spread by respiratory droplets. When an infected person expels virus-laden droplets either by cough, sneeze, or simply talking and someone else inhales them, the coronavirus enters the nose and throat of a new host. Transmission may also occur through contact, whereby the virus passes from infected host to a new host by touch, and then the new host self-transmits by touching a mucous membrane, namely the mouth or nose.
Following transmission, SARS CoV-2 multiplies in the new host. The now infected person is typically asymptomatic, going about normal life, however is shedding virus. This is when the infected person is most likely to transmit the virus to a new host. The infected persons immune system may beat back the virus, however if it does not, the virus now in high concentrations marches down from the nose and throat to invade the lungs manifesting in the disease process known as COVID-19. Here, the battle between the virus and the immune system of the host may result in a fatal outcome.
SARS CoV-2 is new to humans, hence the term “novel coronavirus” which is often used in the media. Recall the factors of host survival listed in paragraph one of this blog. Given it is new to humans, host survival depends solely on the type of virus involved. Ancestral contacts and coevolution are not factors in host survival. In other words, none of us are immune nor are we protected.
Although it goes without saying, if the human host dies, SARS CoV-2 dies and cannot achieve its goal of self-reproduction. Thus, the virus needs the opportunity to find new hosts before overwhelming its present host. That opportunity occurs during the incubation period and subsequent prodrome. The incubation period is comparatively long for SARS CoV-2 and the prodrome is subtle. As such, some hosts never know they are infected and further fight the virus off without manifesting overt symptoms. However, some hosts progress and ultimately manifest the potentially fatal disease COVID-19. By contrast, the 2003 coronavirus, now labeled SARS CoV-1, which gave rise to severe acute respiratory distress (SARS) had a significantly shorter incubation period and more pronounced prodrome. SARS CoV-1 did not give the infected host time enough to transmit the virus to a new host before that infected host fell noticeably ill with SARS, which is why that virus ultimately failed. The most fortuitous time for the transmission of a virus from an infected host to a new host is during the prodrome. Further, the longer and more subtle the prodrome, the higher the risk. This is the case with SARS CoV-2.
The prodrome. Prodrome is derived from the Greek word prodromos, meaning “running before” and typically indicates the onset of a disease before more diagnostically specific signs and symptoms develop. What that means is we as hosts can be infected but not appear outwardly ill. Therefore, we carry on with our normal, rather than “new normal” lives which involves contact and proximity to a plethora of potential human hosts. This is a fantastic setting for the singularly goal oriented coronavirus interested only in achieving self-reproduction. The prodrome for SARS CoV-2 leading up to the manifestation of the outwardly noticeable disease process COVID-19 is one week to 10 days. This means you could be infected for a week and not know it. How many people do you have contact with in a week?
So, we as Americans are faced with a human-hopping novel coronavirus for which the only goal is self-reproduction. Given the virus is new to humans, there exists no ancestral human immunity. This means we are all at risk of contracting the virus and further all are able to serve as transmitters. We are most susceptible to becoming infected, and more importantly most likely to infect others during the prodrome when we are carrying on with our normal lives. As a result, some government officials have tried to define a “new normal” by issuing guidelines and drafting policy initiatives to avoid transmission. The result has been to encourage Americans to wear masks, social distance, limit travel, quarantine and further, in some instances, issue mandates to ensure such.
It goes without saying, the most notable resistance to guidelines, and the most difficult to understand, are those provided by the government which impact our lives when we are feeling well. It is hard to relinquish your individual liberties when you’re in good health and want to prosper. However, given what we now know about viral science and prodromes, are we more willing to accept the “new normal”? – at least for now? Are we willing to stand next to the healthy-appearing person at a gathering who is unwilling to accept the “new normal”?