One of the tricky things about treating people who become seriously ill from the novel coronavirus is that sometimes their body’s own natural defenses work against them.
It’s not just a problem when people have a weakened immune system, which happens with age and why those 60 years old and up are at the highest risk from COVID-19. It’s also a problem when the immune system is too aggressive and doesn’t shut itself off after the invading virus has been conquered.
Experts in immunology say that as many as 15 percent of people battling a serious infection — coronavirus or otherwise — have an immune system that goes haywire once put on high alert. In a misguided effort to protect the body, it switches from attacking the virus to attacking multiple organs, including the lungs and liver.
In those cases, it’s not the virus that is killing the patient. It’s the response of the patient’s immune system that is doing it.
As a result, physicians treating a patient with COVID-19 have to perform a delicate balancing act. They need the help of the patient’s immune system — and whatever drugs they employ — to fight off the virus, but once the virus has been brought under control, they want the immune system to retreat.
Sometimes the doctors’ efforts to engineer that delicate balance backfire.
In 2003, during the SARS epidemic, another coronavirus-driven respiratory disease, one common treatment was to give the patient a drug combination of ribavirin to attack the virus and corticosteroids to suppress the immune response.
A couple of years later, when researchers were doing their analysis of the results, they determined that ribavirin didn’t work at all and the corticosteroids worked too well. The drug combination ended up being “worse for patients than doing nothing,” says Dr. Stanley Perlman, a medical researcher at the University of Iowa who has been studying coronaviruses for almost 40 years.
This tension between a potentially fatal disease and a potentially fatal treatment is a perfect metaphor for the conflict between the epidemiologists and the economists over whether throwing the world into a severe recession is a necessary, if painful, response to the COVID-19 pandemic or an overreaction that will end up doing more harm than the disease itself.
When I or others question some of the severe measures that have been taken to control the spread of the virus, we are portrayed as insensitive to the loss of human life. Maybe we’ve been inelegant in framing the discussion.
Unless it is a merciful end to human agony, most every death is tragic. That’s a given. It doesn’t matter whether the cause of death is a contagion or a car accident.
But it is not inappropriate, even while acknowledging that death is sad and terrible, to ask what cost is justifiable to avoid it and what is excessive. These are the kinds of decisions that human beings make all the time. We balance between safety and speed when we drive. We balance between physical health and personal enjoyment when we decide what to eat and drink. When we reach the end of life, we balance between prolonging it and its quality.
The response of the federal government and most state and local governments has been largely to make public health paramount over all other concerns. They have based their decisions on death projections that have been all over the place. At first, we were told that 200,000 to 1.7 million people in the U.S. might die if we didn’t practice social distancing, severely limit public gatherings and shut down a huge segment of the economy. Even as many of those steps were being taken, that number was revised downward to 100,000 to 200,000. Just this past week, it was lowered even further to 60,000.
Have the lockdowns reduced the projections? Or were the earlier numbers based on flawed assumptions, such as the preposterous notion that people might continue to go about their business as if nothing were happening even after COVID-19 deaths soared?
There still is much to learn about the virus and much to learn about the steps taken to combat it.
We do know that these lockdowns have reduced the flood of patients to hospitals — a highly desirable end. We don’t know how many lives, though, this will ultimately save.
We do know these lockdowns have cost almost 17 million jobs already. We don’t know how bad the fallout will be as the economic meltdown destabilizes businesses and households and sends the government debt soaring.
Just as the body’s immune system can transform from being a savior to a destroyer if it gets out of balance, so can an imbalanced approach to this pandemic create more misery than it mitigates.
It is one thing to emphasize hand-washing and other prudent sanitation measures, to discourage handshakes and large gatherings, and to isolate the demonstrably infected until they are no longer contagious. But the idea that we must also shield ourselves from those who have no symptoms treats every human being as a potential death threat.
Before we continue for much longer down that road, it is reasonable to ask whether it’s wise — financially or emotionally — to do so.
• Contact Tim Kalich at 581-7243 or email@example.com.