As the coronavirus continues to present new and ever-changing challenges to our community, we have again asked Lawrence resident and prominent immunologist and NC OEM Liaison Dr. Marc Sicklick to share his professional and personal insights with our residents:
Marc J. Sicklick, M.D., F.A.A.A.A.I., F.A.C.A.A.I.
Allergy, Asthma, and Immunology
123 Grove Avenue, Suite 110
Cedarhurst, NY 11516
May 13, 2020
I’m going to try to address updates over the past two weeks, my advice, my regrets over mistakes that were made, and my vision for the future, both short term and long term. These are my personal opinions.
I hope they are helpful.
Don’t jump on every news article about a breakthrough or failure. It will create an emotional roller coaster that is not compatible with emotional stability. We’re all already on edge. Newspapers need readership, radio stations need listeners, and television needs viewers, so whatever will get your attention will be there. A handful of people die from a newly reported complication is a headline. Ten thousand people don’t is not a headline. Keep that in mind. Also realize that everyone doing research wants to find THE cure. And everyone doing research honestly believes that their research is the correct way to go. Statements, picked up by the press, on breakthroughs or drugs that appear to work should not be taken as fact until proven or until the approach is verified by someone else. And even if a new drug does offer some benefit, the potential toxicity and other risks need to be evaluated. It’s good to be educated and aware, but keep an even keel until something is reality.
- Vaccines- Everyone can and does give predictions. Doctors, researchers, politicians, barbers, bartenders, clergy, in-laws, etc. Some are based on information, some on hope, but no one has inside information on what will be the truth.Time will give us the answer, not speculation.
- A vaccine may not be developed.Not every attempt to make an anti-viral vaccine has been successful.I’m not saying that one won’t be developed.I’m saying it may not be developed.I’m still leaning to the side that expects a vaccine, and my best guess is 12-24 months from now. I will be very happy to be wrong and to have it in under 12 months.There are some really smart people working on this and I am optimistic. Getting a vaccine out in less time will increase the risk.Someone has to make the very tough decision on risk:benefit and, since their intentions are to do the right thing while working in a layer of darkness, it would help us all if they were to receive immunity from lawsuits if their best intentions aren’t perfect.
- A vaccine can be successful without being 100% effective.If it prevents infection in part of the population, that will be a very helpful boost towards herd immunity.The more people who are immune, the less people that can spread it, and the better it is for everyone. We don’t need a perfect, totally effective vaccine.
- Some vaccines make a disease milder without preventing infection. This would also be very beneficial.
- A single drug may not be the answer.Perhaps a combination of drugs, a cocktail, will work better than the individual components.Many diseases need several drugs at one time to effect a cure.
- A combination of a drug or drugs for those who get sick plus a vaccine would be great.
- A note on remdesivir- this week’s hot new drug.It is not THE cure.At this point it seems to decrease the length of illness by about 30%.That means from a 14-15 day illness on the average to about 11 days.While that is something, it is not everything.It is not clear if it prevents death.It may.It may not.A few weeks ago, hydroxychloroquine and/or Zithromax were the cure.This new hot drug is this week’s choice.It may be. Let’s see if it has staying power in a few weeks with a good risk:benefit ratio.Would I recommend using it now?Probably.But we really don’t know how beneficial it will prove to be.
- Treatment with plasma from recovered COVID-19 patients is being studied. Giving someone else’s antibodies against a disease because of exposure is called passive immunity.It is a short term boost of immunity (Short time means that the half life of IgG, which is basically the time until most of the IgG is no longer present in a working form, is about 3 weeks.)This approach has been used for decades for other disease exposures.(Conversely, infection or vaccine lets people make their own antibodies.This is called active immunity, and usually has more staying power.)
- Be realistic.The disease will not disappear overnight and it will spike significantly as the country reopens.Hospitals will be very stressed again. We cannot stay hidden in a fallout shelter for years, or even months.The purpose of staying home was to flatten the curve, to not let hospitals get overwhelmed.That happened.The curve was flattened.It was not to eliminate all risk. It won’t eliminate the virus. That won’t happen.
- In my opinion. schools and businesses have to open.When I was in elementary school, there were epidemics of measles and polio. (The Salk vaccine for polio, discovered by a graduate of Far Rockaway High School, came out in the early 1950s and the measles vaccine came out in the early 1960s.) The death rate from measles was somewhere between 1 in 500 to 1 in 1000. These were children. Those who were sick stayed home.The rest of us went to school because our parents and government leaders understood that the benefit to society outweighed the damage. We didn’t have politicians waiting to blame people for the natural world’s status.Nor did the press look to blame people for a disease. That doesn’t mean that mistakes can’t be pointed out and that gross negligence should be ignored. But the fear of criticism and blame makes difficult decisions even more difficult.Inertia will tend to rule. That hurts us all.
No one can be 100% safe. Those of us who are most vulnerable must have the self-responsibility to be more careful. Those who have a lower risk for bad outcome still have to be careful. We don’t know all that this virus can do. There are now reports of a small number of children getting a multi-organ failure disease. We see reports of kidney failure, new onset diabetes, high blood pressure, nervous system changes, and more. I don’t know how numerically significant these are or will be, but it does underscore the need for everyone to be careful.
- Virus mutation occurs naturally.We pray that it mutates to a less contagious and less virulent strain.We really pray that a mutation doesn’t make those who have already been sick become susceptible and that a mutation doesn’t make a potential vaccine less effective.Hopefully, this will not be a problem.
A brief word on testing. Antibody testing is becoming more available. I prefer a test that gives a level, not a yes or no. As I mentioned last time, having antibodies does not mean that someone is immune. We simply don’t know. There is a presumption, a hope, based on past medical experiences and that these antibodies do give immunity. But, for now, everyone must continue to assume that they are vulnerable and that all non- household contacts are shedding the virus. This is the safe approach.
A recent paper from a group in Mt. Sinai showed that a significant number of people tested antibody negative despite having a really good story for having had the disease or very close exposure. When the test was repeated a couple of weeks later, it was positive. It is important to not do the IgG antibody test too early.
It will be nice to see if the antibody levels persist after weeks and months. This will be helpful in trying to understand how long protection, if it does exist, may last.
The nasal swab is a test for current infection. It has too many false negatives to be the final, definitive answer. Like a throat culture for strep, nothing is 100%, so negative swab does not rule out infection.
The concept of repeat swabs after clinical recovery to see if the virus is still being shed has undergone a lot of discussion recently. It may be that the swab is picking up virus or parts of the virus that are no longer contagious. If this is true, it may remove a negative swab as a requirement for re-entering the world.
Newer articles point to mistakes that were made. It seems that New York City has been the epicenter and the source of spread around the country. It took much too long for New York to lock down. We were being told to go to the theatre, to ride buses and subways, to go to the Chinatown celebration to show solidarity with them and to not be xenophobic. All of this was, in retrospect, bad advice and led to spread around the country. I regret that this happened, but I also understand that no one deliberately wanted to hurt anyone else.
We saw public debating between the mayor of New York City and the governor over who calls the shots, who can close the city. All the while the clock was ticking. I regret that this happened.
I am particularly disturbed by what was the policy to return COVID-19 positive people from hospitals to nursing homes. We all have seen the numbers in nursing homes. If only this could have been changed. I understand that nobody wanted to cause harm. There was no evil intent. The mistake was not erring on the side of caution. We need to learn from these mistakes and practice social distancing until all uncertainty is removed.
MY SENSE OF THE FUTURE:
I do expect to see a vaccine or vaccines of some degree of efficacy, but not tomorrow or next week or next month. I still think that 12-24 months is the range, but sometimes corners will be cut for the greatest good to shorten the testing phase. This may account for the optimistic comments from Dr. Fauci about possibly less than one year.
I also do expect to see drugs, either alone or in combination, that will help. This will be in the shorter time frame.
WHAT STILL BOTHERS ME:
Finally, I’m back to what really bothers me. It’s people out the streets not observing social distancing, not wearing masks, including some who know that they may be shedding the virus. We have the responsibility to worry about our neighbors and to not put them at risk. It’s the walkers. It’s the groups on bicycles riding in packs without social distancing who then stop to talk. I’ve received many emails and calls about this, asking me to say something- again. It’s not the majority. It’s a minority, but they place everyone else at increased risk.
Please, stay a distance from non-household members and wear a mask if you’re near anyone else. If everyone wears a mask, it will be much more difficult for the virus to spread. We need to buy time until we have herd immunity.
As a last comment, we’re all seeing discarded gloves and masks on sidewalks and streets. Please dispose of these potentially infectious objects properly.
I am cautiously optimistic that we will come out the other side sooner rather than later.
Marc J. Sicklick, M.D.
While Dr. Sicklick addresses the COVID-19 menace to our health, Village government continues to monitor other threats to our safety, including broken sidewalks, overhanging tree branches and intrusive bushes that hinder and endanger increasing pedestrian traffic.
Working with homeowners, Village Building Inspectors are making certain, through enforcement, that sidewalks are in good repair and walkways are clear of any obstacles.
We appreciate your cooperation and assistance as, on so many levels, we come together with dedicated volunteer residents, such as Dr. Sicklick, and devoted Village staff, to protect every Village resident.
Very truly yours,
Alex H. Edelman