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Now we have to ask ourselves, ‘What happens next?’

COVID-19: Phase 2

Americans are starting to come to grips with the potential of the COVID-19 pandemic.

Different scenarios can occur. But much of what happens depends on what we do now.

There are two strategies. One is “mitigation” or social distancing to decrease the rate of transmission so as not to overwhelm our healthcare system. But even the best-case scenarios have unacceptable casualty rates.

The other is “suppression” and involves going on the offense against the virus.

Most rich nations have staked their bets on suppression, but both strategies are necessary.

One form of suppression is extreme mitigation with months of forced social distancing. This would generally be unacceptable in democratic nations and it would have a devastating effect on the economy, likely creating a global depression.

Conventional suppression would start with widescale testing for the virus. Some tests can now provide results in five minutes. They should be made available at hospitals, outpatient clinics, and drive-through facilities without charge. Antibody testing for a person’s immune status is being done in some parts of China. It could rapidly tell us if someone is immune and no longer a source of infection. This could free health-care workers and others crucial to fighting the pandemic to remain in the workforce. Patient status could be tracked with an app tied to a national database.

There are three things that determine whether someone exposed to this virus gets sick from it. One has to do with the virus itself. Second is the person’s resistance. The third depends on how much of the virus they get and where in their body they get it. This is often misunderstood. A virus is not a bacterium and has no means of reproducing outside of its living host cell, so viruses left on a magazine or food will only decrease in number and viability with time. The best evidence shows there is not much risk of transmission from eating.

Almost all transmission comes from breathing the direct viral-laden droplets from someone’s mouth or nose or getting infected hands in one’s eyes or nose and, to a lesser degree, the mouth.

If someone is vigilant about cleaning surfaces, but rubs their eye before washing their hands, they have negated all their good efforts. When a newly produced virus comes out of the cell of an infected person, it incorporates some of the person’s cell membrane into its viral capsule. This fatty membrane is exactly what soap dissolves in water. So, hand washing is superior to hand sanitizers. If used, sanitizers should contain at least 60% alcohol.

If you wear a mask as a non-infected person and scratch your nose under the mask or adjust your mask with viral-contaminated hands, you may provide the virus greater access to your upper airway. Masks are for health-care workers in more intimate contact with patients or for infected individuals themselves.

Studies from China show that of children testing positive for the novel coronavirus, 13.8% had no symptoms at all. Of people presenting to hospitals at the epicenter of the outbreak, almost 100% had fever, 70% had fatigue, and 60% had a dry cough.

There are currently about 70 drugs being tested to fight the pandemic. At least three antivirals may have potential. One was developed in Japan after the SARS outbreak in 2003 and is currently being used in a limited setting in China with “promising” results. At least two antivirals are HIV drugs.

Responding to infection by the novel coronavirus, the body’s immune system produces chemicals called cytokines. Some people may have an excessive response called a “cytokine storm” that has been responsible for most of the deaths. If proven effective, a cytokine-blocking drug currently used to treat inflammatory arthritis might save many lives. Artificial intelligence could also provide us with other mechanisms of action used by the virus that might direct therapeutic strategies.

Medicines can be rapidly tested in large randomized clinical trials. As terrible as the pandemic is, it provides the perfect opportunity for conducting the testing.

Several vaccines are already being tested in humans. One targets the virus’s RNA, but it would take time to produce. A more conventional vaccine is also being tested and could be produced more quickly.

Injectable antibodies to immediately fight the virus are in production. Some are extracted from humans who have already recovered from the infection. Others are made by genetically engineered rats.

This fall, there is about a three-out-of-four chance that the U.S. will have a second outbreak of the virus, but hopefully, we will be in an entirely different place by then with new tools to fight it.

The United States, and particularly Tennessee, have been slow to come to the table on this pandemic, but we can rise to the occasion if we make this the Manhattan Project of our time.