We are social creatures. We gather by the tens of thousands to watch sporting events, listen to concerts, and participate in political rallies. We acknowledge that our gods, spirits, and ancestors can be addressed from any place at any time, and yet we build sanctuaries and memorials where we prefer to come together and address our dearly departed and presumptive guardians as a group. Even in an era of plague, we are willing to risk our lives and the lives of those we love or need or simply meet rather than isolate ourselves from the masses with whom we want to mingle. It is in our nature: it is in our genes.
Covid-19 has killed more than 800,000 Americans since it reached our shores (or airports). Over the past year and a half, we have learned that it spreads from person to person primarily, if not exclusively, through uninfected people inhaling microscopic, virus-laden droplets exhaled by infected people. The remedy is obvious: identify and isolate those with the virus from those without the virus. Before vaccines against Covid-19 were developed, this approach was implemented and failed. We should have known it would fail. History has repeatedly demonstrated that any lethal agent that relies on human to human contact of some sort will succeed in killing many of our fellow citizens, even if the spread of the disease can be stopped by restricting all human movement for a few weeks.
Obviously, there have been infections that attacked vast populations before they had any idea of what was causing the diseases or how they spread. Measles and smallpox were two such viral agents that seemed to come out of nowhere and attack randomly. There was no indication that an uninfected person had to be in contact with an infected person (or material from an infected person) to contract the disease. There were, of course, some diseases that had obvious mechanisms of transmission, but even these spread widely and quickly with the assistance of human practices and human nature. Syphilis is a prime example.
As with Covid-19, there has been longstanding controversy concerning the origin of syphilis, but the historical record indicates that sailors returning from Columbus’ invasion of Caribbean islands brought the germ, Treponema pallidum, to Europe. It was evident from the first years of its spread in Europe that it was transmitted through sexual intercourse. In addition to killing many of its victims, syphilis caused disfiguring lesions of the skin (pox) and was subsequently recognized as causing a slowly progressive dementia (general paresis). The spread of this horrific big pox could probably have been eliminated if each person had only one sexual partner. Humanity rejected monogamy, and syphilis spread from sexual partner to sexual partner and was even transmitted to the children of infected mothers. In 500 years, human nature has not changed.
This resistance to simple and temporary solutions to potentially complex and longstanding problems continues to frustrate efforts to protect humanity. After more than 100 years of carnage on the highways, automobile manufacturers are developing systems that will interfere with drunk drivers starting a car. There will certainly be a nationwide outcry against this initiative: sober Americans will find ways to enable them to drive while intoxicated. When hard hats were first mandated at construction sites, the uproar generated suggested that workers were being required to undergo castration to continue on the job. When seatbelts were mandated for automobiles, the vocal minority insisted that they had a constitutional right to risk smashing face-first through the windshield with front impact collisions.
The obvious objection to shutting down America for a few weeks and restricting travel is the economic hardship that would be faced by most of the population. Billions would be lost in salaries and sales. The poor would starve while the rich escaped on their yachts to their private islands. Unfortunately, the losses to the economy over the past one and a half years as a consequence of Covid-19 have eclipsed what might have been predicted with a nationwide shutdown. Also recall that during the prior administration Congress gifted some of us a trillion dollar tax break just when we could have used the money to protect those living from pay-check-to-paycheck from financial disaster.
A real shutdown, lockdown, travel ban was obviously never a viable option. Americans would riot in the streets before they would give up their mobility. As the omicron variant spreads from coast-to-coast, school and factory closings are not being discussed. Time will tell if this variant is more or less lethal than the ones preceding it. If it is more lethal, the schools and factories, markets and restaurants will close for lack of labor. If it is less lethal, we shall celebrate it as a New Year’s gift and falsely assume that the next variant will be equally or even more benign.
But what of the ongoing resistance to vaccination? It appears that the anti-vaxxers have won. Many have purchased forged vaccination cards. Others have insisted on religious objections or purchased letters from pseudo-religious facilities, despite the absence of any apparent religious basis for objecting. Many have been celebrated as heroes for standing up to the governments or employers that said they should or must get vaccinated. It is all quite weird but predictable. The man who does not hesitate to get a tetanus booster when he cuts his finger on a piece of glass will invoke all twenty-seven amendments to the Constitution when he is told he should get a vaccination to protect him, his family, and his coworkers from one of the most deadly viral infections the United States has dealt with in the past century. He will take penicillin to protect himself from a strep throat but will reject a Covid vaccine because he says it frustrates a Divine will.
And so, you must ask, what is the solution? My answer is, “Don’t get stuck on stupid.” When I have a patient suffering from an infectious disease, I consult an Infectious Disease specialist whose information has proved reliable over the years. I do not call an ophthalmologist (Senator Rand Paul), a TV celebrity (Dr. OZ), a televangelist (too numerous to name) or a veterinarian (remember Ivermectin…it’s for horses). We know what save lives. Will contact-tracing, mask-wearing, surface disinfecting, social-distancing, and vaccinations rid us of this plague? Perhaps, but only if these measures are adopted by considerably more of the population than currently. History indicates that we shall not stop gathering with our fellows, infected or not, facilitating the spread of this virus, but it also indicates we can succeed if we fight this scourge together. Remember, smallpox was once just as widespread and deadly as Covid-19, and it is gone.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.
