Ask the Pharmacist

Q) I cannot even begin to describe how sick and tired I am of all of this social distancing. I’m young and healthy. I should be fine even if I do catch this virus. Why shouldn’t I just get it over with now and get on with my life?

A) This viewpoint is certainly understandable, perhaps especially among the young who are seeing seminal events in their life (weddings, graduation ceremonies, travelling before the burdens of middle aged commitments take their toll….) put on hold indefinitely. Yet, there are a number of strong arguments against pursuing the strategy both for their own benefit and that of the greater society around us.

The first thing one should consider is that less risk does not equate to ‘no risk’ when it comes to surviving a COVID-19 infection unscathed.

The CDC (this stands for the Centres for Disease Control & Prevention, the experts when it comes to infectious diseases) in the U.S. recently did an analysis of all cases reported (4,226) between February 12th and March 16th. Their research found that among people aged 20 to 44, 14% to 21% of the cases were admitted to hospital with 2 to 4% of those eventually deteriorating enough to require treatment in the intensive care unit. This unfortunately resulted in between 0.1 to 0.2% of these young adults succumbing to COVID-19 related complications.

While this is indeed a small percentage when that number is multiplied by the number of cases in this age range (as of June 14th in Canada there has been approximately 26,770 cases in this demographic) that equates to an uncomfortable number of deaths in people who should be enjoying the prime of their lives. To put it in a different perspective, experts believe that the coronavirus is five to ten more deadly than the flu in those between the ages of 0 and 44.

So, is your risk low of having a life altering event as a result of COVID-19 if you are young and healthy? Yes. But please do not confuse that with no risk at all.

Another reason not to rush out and get this all over with now is that as time passes our ability to treat this continues to improve. Doctors have already incorporated new guidelines into their practices since early May, such as the utility of ‘proning’ (patients lay in prone position on stomach with back facing up), delaying intubation of patients and being more vigilant for the risk of thrombosis (i.e. blood clots) particularly in young adults. Our use of ventilators has also rapidly changed as we have learned new best practices the hard way.

With time, most experts feel we will eventually have real safe and effective treatments that will continue to reduce the number of patients who become extremely sick or even die. At this time, the International Clinical Trials Registry Platform of the WHO has recorded 536 clinical studies in various stages of development, all looking at ways of treating patients with COVID-19. There are over 300 potential therapies one or more of which might soon be proven to be a game changer when it comes to treating this infection. Statistically speaking, it is more likely than not that at least one of these treatments is going to at least modestly improve our treatment outcomes of this infection and hopefully we will get a true breakthrough such as we eventually did when we developed an effective treatment for AIDS.

None of this takes into account the strong prospect that a vaccine may soon be developed that will help prevent us from ever contracting the infection in the first place. While there is no defined time limit as to when a vaccine may become available (if ever admittedly) numerous drug companies, biotech firms and university research groups are busy in the process of developing 159 vaccine candidates thus far.

In fact, one Canadian expert who was involved in the development of the vaccine for the Ebola virus says he believes that there is “a very high likelihood to see a coronavirus vaccine emerge in the next, hopefully months…”. While this is not to say we should have an effective solution before year end, it does offer strong hope that sometime in 2021 we may all be as safe from COVID-19 as we are from the measles and small pox, infections that once wrecked havoc on society but are all but forgotten now.

Another strong argument against just “embracing” this infection is that there is no guarantee the goal you wish to achieve, long-term immunity, is even possible. A new study just released in the last few days out of China found that just eight weeks after being released from hospital, patients who had previously been infected with COVID-19 had, on average, a 70% decline in their circulating IgG antibodies to the virus. In fact, 40% of patients who had no symptoms during their infection and 13% of symptomatic patients had no evidence of any IgG antibodies whatsoever.

IgG antibodies are the most common type of antibodies found in our circulating blood and, by binding to the virus molecules, they were created to inactivate the virus rendering us immune. This seemingly rapid decline in IgG levels has lead some experts to question whether long-term immunity is likely, as these sorts of rapid decreases were not seen in SARS or MERS. This might explain why some people have reported contracting the virus twice although this has yet to be scientifically proven.

Regardless, engaging in any action for which there is some degree of risk and for which there may be no tangible benefits seems like lunacy. This is particularly so when one factor in the risk is that you would bring it to others. Yes, when you are young and healthy you will more than likely “sail” through this infection. Unfortunately it is just as likely that you will spread this infection to others, less able to fend it off, during your pre-symptomatic stage (the time frame between becoming infected and exhibiting symptoms such as a fever) or if you remain asymptomatic (i.e. no tell-tale symptoms at any point despite being infected) throughout.

If enough other individuals pursue this reckless strategy, there is a chance of a real surge in our infection rate in our vulnerable populations that could overwhelm our hospitals’ abilities to treat the very sick (you may remember from a previous article that Canada has about half as many intensive care beds as the average-developed country). We live in a free country which allows us to make our own decisions. However, when one weighs the risks to one’s self, the uncertain benefits and our moral imperative to protect those who most need it, it is clear to me that the only wise decision is to err on the side of caution by continuing to follow the recommendations from Health Canada and other governing bodies. For more information about this or any other health related questions, contact your pharmacist.