Tag Archives: Disease

WHAT REALLY KILLED ROBIN WILLIAMS

On August 11, 2014, entertainment genius Robin Williams took his own life inside his Paradise Cay, California home near San Francisco. The coroner initially ruled that Williams, age 63, died by suicide—asphyxia by hanging antecedent to, or caused by, clinical depression. However, when the final autopsy results were in, an entirely different picture played out. Robin Williams was in the advanced stage of a somewhat common, but almost always undiagnosed, brain disease called Lewy Body Dementia or LBD.

As Williams’ window, Susan Schneider Williams who now represents the Lewy Body Dementia Association, stated, “The disease was a terrorist in my husband’s head. Any way you look at it, the presence of Lewy bodies in his brain took his life. Depression was only a symptom. Unfortunately, we as a culture don’t have the vocabulary to discuss brain disease in the way we do about depression. Depression is only a side effect of LBD—it’s rooted in neurology. His brain was literally falling apart, and not one thing could be done about it.”

Lewy Body is a strange term. We’ll examine where that name came from, what exactly LBD is, what causes it, and how this always-fatal disease can be managed in its three progressive stages: early, mid, and late. But first, let’s have a brief look at this remarkable man’s achievements. Perhaps “remarkable” isn’t a powerful enough word for Robin Williams.

Robin McLaurin Williams was born on July 21, 1951, into an average American family. But from an early age, there was nothing average about him. He showed a God-given gift for improvision comedy and acting. By the early 1970s, Williams was in high demand as a San Francisco-based stand-up comedian, and he went on to be one of the funniest funnies of all time.

Few can forget many of Robin Williams’ outstanding character roles. He got his television start in Mork & Mindy and went on to film. Popeye. Hook. Good Will Hunting. Dead Poets Society. Good Morning Vietnam. The World According to Garp. World’s Greatest Dad. Night at the Museum. The Birdcage. Moscow on the Hudson. Jumanji. And, of course, Mrs. Doubtfire.

Williams also did voice-overs in Aladdin, Robots, and Happy Feet. He won numerous awards—six Golden Globes, five Grammys, two Primetime Emmys, two Screen Actors Guilds, and an Oscar for Best Supporting Actor. As well, Williams won the Cecille B. DeMille award in 2005.

Robin Williams had his struggles through life, though. He was addicted to cocaine and alcohol which set him into fitful mood swings. He was in and out of rehab for years. However, by 2010 he was stable and substance free, except for therapeutic prescriptions issues to combat what was thought to be clinical depression.

It was not. Robin Williams had an undiagnosed brain disorder. A disease that was only discovered after his death and was verified by brain sectioning at his autopsy. What was suspected to be Alzheimer’s or Parkinson’s in the last year of his life turned out to be Lewy’s Body Dementia—a condition under the general dementia umbrella and an extremely deadly disease.

You’re likely wondering what this weird name is and what it entails. Rather than me paraphrasing the information, let’s go to the best source available. No, not Wikipedia or ChatGPT.  It’s the website of the Lewy Body Dementia Association, and here’s what it says:

Lewy body dementia (LBD) is the 2nd most common type of progressive dementia after Alzheimer’s disease. The name comes from a discovery by Dr. Friedrich Lewy in the early 1900s of abnormal bodies or deposits of alpha-synuclein proteins in areas of the brain that can only be verified through an autopsy. These bodies alter the production of dopamine and acetylcholine that are vital neural transmitters.

LBD is not a rare disease. It affects more than a million people in the United States alone. Because LBD symptoms may closely resemble other, more commonly known disorders like Alzheimer’s and Parkinson’s disease, it is widely under-diagnosed.

LBD is an umbrella term for two related diagnoses:

  • A person with dementia with Lewy bodies will develop dementia and other LBD symptoms, one of which may be changes in movement, like a tremor (parkinsonism).
  • With the other form of LBD, people will present first with changes in movement, leading to a Parkinson’s disease diagnosis; over time many will develop dementia years later. This is diagnosed as Parkinson’s disease dementia.

As time passes, people with both diagnoses will develop very similar cognitive, physical, sleep, and behavioral symptoms. The earliest symptoms of dementia with Lewy bodies and Parkinson’s disease dementia are different, but both are due to the same underlying biological changes in the brain.

LBD is a multi-system disease and usually requires a comprehensive treatment approach with a collaborative team of physicians and other health care professionals like occupational, physical, or speech therapists. Early diagnosis and treatment may extend your quality of life and independence. Many people with LBD enjoy significant lifestyle improvement with a comprehensive treatment approach, and some may even experience little change from year to year.

For a more in-depth explanation of Lewy Body Dementia disease, here’s a trip to the medical research department at Johns Hopkins University:

Lewy Body Disease (LBD) is a complex and often misunderstood neurodegenerative disorder that affects millions of individuals worldwide. Characterized by the accumulation of abnormal protein deposits called Lewy bodies in the brain, LBD poses significant challenges to both patients and caregivers. In this article, we delve into the neurological aspects of LBD, exploring its development, detection, effects on the human body, and its associated symptoms.

Development of Lewy Body Disease

Lewy Body Disease primarily affects older adults, typically manifesting after the age of 50. While the exact cause of LBD remains unknown, researchers believe that a combination of genetic, environmental, and lifestyle factors may contribute to its development. Genetic mutations, particularly in genes associated with the production and clearance of alpha-synuclein protein, have been implicated in some cases of familial LBD. However, most cases of LBD occur sporadically without a clear genetic link.

Neurological Pathology

At the core of LBD pathology is the abnormal accumulation of alpha-synuclein protein, forming Lewy bodies within neurons. These protein aggregates disrupt normal cellular function and communication within the brain, leading to widespread neurodegeneration. Areas of the brain particularly affected by Lewy bodies include the substantia nigra, which plays a crucial role in movement control, and the cerebral cortex, responsible for cognitive functions.

Detection and Diagnosis

Diagnosing LBD can be challenging due to its overlapping symptoms with other neurodegenerative disorders such as Parkinson’s disease and Alzheimer’s disease. A comprehensive medical history, neurological examination, and a battery of neuropsychological tests are often employed to assess cognitive function, motor abilities, and psychiatric symptoms.

Brain imaging techniques, such as MRI and PET scans, may reveal characteristic patterns of brain atrophy and dysfunction associated with LBD. Additionally, a definitive diagnosis of LBD can only be made post-mortem through the examination of brain tissue for the presence of Lewy bodies.

Effects on the Human Body

Lewy Body Disease has profound effects on both motor and non-motor functions, significantly impacting quality of life. Motor symptoms include bradykinesia (slowed movements), rigidity, tremors, and gait disturbances resembling those seen in Parkinson’s disease. Non-motor symptoms encompass cognitive impairment, hallucinations, fluctuations in attention and alertness, sleep disturbances, autonomic dysfunction (such as orthostatic hypotension and urinary incontinence), and psychiatric manifestations like depression and anxiety.

Treatment and Management

While there is no cure for Lewy Body Disease, various treatment strategies aim to alleviate symptoms and improve patients’ quality of life. Medications targeting dopamine levels in the brain, such as levodopa, may help alleviate motor symptoms. Cholinesterase inhibitors, commonly used in Alzheimer’s disease, may improve cognitive function and psychiatric symptoms in some LBD patients. Multidisciplinary approaches involving physical therapy, occupational therapy, speech therapy, and psychological support are essential for managing the diverse array of symptoms associated with LBD.

Takeaway

Lewy Body Disease presents a complex clinical picture characterized by the interplay of motor, cognitive, and psychiatric symptoms. Understanding its neurological underpinnings is crucial for early detection, accurate diagnosis, and effective management of the disease. Ongoing research efforts aimed at unraveling the molecular mechanisms underlying LBD pathogenesis hold promise for the development of targeted therapies that can ultimately improve outcomes for individuals living with this challenging condition.

I’ll jump back to the Lewy Body Dementia Association for the diagnostic symptoms of the disease.

Motor Symptoms

  • Bradykinesia (slowed movements)
  • Rigidity (stiffness)
  • Tremors (usually less prominent than in Parkinson’s disease)
  • Gait disturbances (shuffling gait, balance problems)

Cognitive Symptoms

  • Fluctuating attention and alertness
  • Memory loss
  • Executive dysfunction (problems with planning, organizing, and problem-solving)
  • Visuospatial difficulties (problems with spatial awareness and perception)

Psychiatric Symptoms

  • Hallucinations (visual hallucinations are particularly common)
  • Delusions (often related to the hallucinations)
  • Depression
  • Anxiety
  • Apathy
  • Irritability or aggression
  • Sleep disturbances (REM sleep behavior disorder, vivid dreams, acting out dreams)

Autonomic Dysfunction

  • Orthostatic hypotension (drop in blood pressure upon standing)
  • Urinary incontinence or urgency
  • Constipation
  • Erectile dysfunction (in men)

Other Symptoms

  • REM sleep behavior disorder (acting out dreams physically)
  • Sensitivity to neuroleptic medications (may worsen symptoms)
  • Changes in sense of smell
  • Difficulty swallowing (dysphagia)

Note that not all individuals with LBD will experience all of these symptoms, and the severity and combination of symptoms can vary widely from person to person. Additionally, symptoms may fluctuate over time, with periods of relative stability interspersed with episodes of worsening symptoms. Early recognition and management of these symptoms are crucial for improving the quality of life for individuals living with LBD.

Detecting and verifying Lewy Body Disease (LBD) involves a comprehensive approach that combines clinical evaluation, neurological assessments, and diagnostic tests. Here’s a breakdown of the steps involved in the detection and verification process.

Clinical Evaluation

  • A thorough medical history is obtained from the patient and their caregivers, focusing on the onset and progression of symptoms.
  • A neurological examination is conducted to assess motor function, cognitive abilities, and psychiatric symptoms. This may include assessing gait, muscle tone, reflexes, coordination, memory, attention, and mood.
  • Careful observation of symptom patterns, including fluctuations in cognition and alertness, visual hallucinations, and motor symptoms resembling Parkinson’s disease.

Diagnostic Criteria

  • LBD is diagnosed based on established clinical criteria, such as the consensus criteria proposed by the DLB Consortium or the McKeith criteria.
  • These criteria outline the characteristic features and diagnostic markers of LBD, including cognitive fluctuations, visual hallucinations, Parkinsonism, and rapid eye movement (REM) sleep behavior disorder.
  • Criteria may also specify supportive features, such as neuroimaging findings and autonomic dysfunction, which further support the diagnosis of LBD.

Neuropsychological Assessment

  • Neuropsychological tests are administered to evaluate cognitive function, including memory, attention, executive function, and visuospatial abilities.
  • These tests help quantify cognitive impairment and track changes over time.

Neuroimaging Studies

  • Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans may be performed to assess brain structure and function.
  • MRI may reveal patterns of cortical atrophy and changes in brain volume associated with LBD.
  • PET imaging with radiotracers targeting dopamine transporters or amyloid plaques can provide additional evidence supporting the diagnosis and differentiate LBD from other neurodegenerative disorders like Alzheimer’s disease.

Cerebrospinal Fluid Analysis

  • Lumbar puncture may be performed to analyze cerebrospinal fluid (CSF) biomarkers associated with LBD, such as levels of alpha-synuclein protein and markers of neuroinflammation.
  • While not routinely performed, CSF analysis can provide supplementary information to support the diagnosis of LBD in some cases.

Genetic Testing

  • Genetic testing may be considered in cases of familial LBD or when there is a strong family history of neurodegenerative diseases.
  • However, genetic testing is not typically performed as part of routine diagnostic evaluation for sporadic LBD.

Multidisciplinary Evaluation

  • A multidisciplinary team approach involving neurologists, neuropsychologists, geriatricians, psychiatrists, and other healthcare professionals is often utilized to ensure a comprehensive assessment and accurate diagnosis of LBD.
  • Verification of LBD relies on the integration of clinical findings, diagnostic tests, and adherence to established diagnostic criteria.
  • Given the complexity and variability of LBD presentation, accurate diagnosis and ongoing monitoring are essential for effective management and supportive care.

Treatment Options

  • LBD is a multi-system disease and typically requires a comprehensive treatment approach, meaning a team of physicians from different specialties, who collaborate to provide optimum treatment of each symptom without worsening other LBD symptoms.  ​
  • A comprehensive treatment plan may involve medications, physical, occupational, speech or other types of therapy, and counseling.

Medications

  • There are many treatments that can help with the symptoms; all medications prescribed for LBD are approved by the Food and Drug Administration to treat symptoms in other diseases, like Alzheimer’s disease and Parkinson’s disease.
  • These medications can offer symptomatic benefits for cognitive, movement, sleep, mood and behavioral changes in LBD.
  • There are not yet any medications that slow or stop the progression of LBD.

Cognitive Symptoms

  • Medications called cholinesterase inhibitors are considered the standard treatment for cognitive symptoms in LBD.
  • These medications were developed to treat Alzheimer’s disease. However, some researchers believe that people with LBD may be even more responsive to these types of medications than those with Alzheimer’s.
  • These drugs sometimes help control behavior problems and hallucinations as well.
  • Another medication that may be helpful is memantine (Namenda).

Movement Symptoms

  • Movement symptoms may be treated with a Parkinson’s medication called carbidopa/levodopa (Sinemet), but if the symptoms are mild, it may be best to not treat them in order to avoid potential medication side effects.

Visual Hallucinations

  • If the hallucinations are not disruptive, they may not need to be treated. However, if they are frightening or create challenging behavioral changes, a physician may recommend treatment.
  • Cholinesterase inhibitors are sometimes effective in treating hallucinations and other psychiatric symptoms of LBD. In addition, newer ‘atypical’ antipsychotic medications may be tried.
  • Most LBD experts prefer quetiapine or clozapine when treatment is necessary for safety or quality of life concerns.
  • Caution is required to find the lowest effective dose in this situation.
  • A newer medication, pimavanserin, was approved to treat psychosis in Parkinson’s disease; results from another clinical trial of this medication in people with dementia and psychosis are pending.
  • While older ‘traditional’ antipsychotic medications such as thorazine and haloperidol are commonly prescribed for Alzheimer’s patients with disruptive behavior, these medications may cause severe side effects in those with LBD.
  • For this reason, older traditional antipsychotic medications like haloperidol should be avoided.

WARNING: Up to 50% of LBD patients treated with any antipsychotic medication may have a severe reaction, such as worsening confusion, heavy sedation, and increased or possibly irreversible parkinsonism. If severe fever or muscle rigidity occurs, contact your doctor immediately; you may have a potentially life-threatening condition that is treated by stopping the medication.

REM Sleep Behavior Disorder (RBD)

  • RBD can be quite responsive to treatment, so your physician may recommend a medication like melatonin and/or clonazepam.

Medication Side Effects

  • Speak with your doctor about possible side effects.
  • The following drugs may cause sedation, motor impairment, or confusion:
  • Benzodiazepines, tranquilizers like diazepam and lorazepam
  • Anticholinergics (antispasmodics), such as oxybutynin and glycopyrrolate
  • Older antidepressants
  • Certain over-the-counter medications, including diphenhydramine and dimenhydrinate.
  • Some medications, like anticholinergics, amantadine, and dopamine agonists, which help relieve parkinsonian symptoms, might increase confusion, delusions, or hallucinations.

Surgery and Anesthesia

  • Be sure to meet with your anesthesiologist in advance of any surgery to discuss medication sensitivities and risks unique to LBD.
  • People with LBD often respond to certain anesthetics and surgery with acute states of confusion or delirium and may have a sudden significant drop in functional abilities, which may or may not be permanent.
  • Possible alternatives to general anesthesia include a spinal or regional block. These methods are less likely to result in postoperative confusion.
  • If you are told to stop taking all medications prior to surgery, consult with your doctor to develop a plan for careful withdrawal.

Other Types of Treatments

  • Lifestyle interventions include eating a healthy diet, exercising, and remaining socially active.
  • Physical therapy includes cardiovascular, strengthening and flexibility exercises, as well as gait training.
  • Speech therapy may improve low voice volume, poor enunciation, muscular strength, and swallowing difficulties.
  • Occupational therapy helps maintain skills and promotes functional ability and independence.
  • Music and aromatherapy may reduce anxiety and improve mood.
  • Individual and family psychotherapy may be useful for learning strategies to manage emotional and behavioral symptoms and to help make plans that address individual and family concerns about the future.
  • Support groups may be helpful for caregivers and persons with LBD to identify practical solutions to day-to-day frustrations and to obtain emotional support from others.

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This might be a lot of cut & pasted material—some maybe repetitive—however I think it’s important to be aware of Lewy Body Dementia.

So far, LBD is incurable but somewhat manageable if detected early-on. Our population is aging. Today’s demographics represent an ever-increasing older population, and the numbers are that many of our folks and friends around us, including ourselves, will develop some form of a degenerative brain disorder like LBD which is what really killed Robin Williams.

WHY IT TAKES SO LONG TO MAKE A CORONAVIRUS VACCINE

We wish it would just go away—this stupid Coronavirus/Covid-19 pandemic. You’d think with today’s medical knowledge and advanced technology all it would take is leading scientists around the world to come together, snap their fingers, and immediately slop-out an effective vaccine. Then, we could get back to the “Old Normal”.

Not so fast. There’s nothing quick or easy about making an effective Covid-19/Coronavirus inoculation.

When this thing started, I wrote a post titled Just How Deadly is Novel Coronavirus and Covid-19? Like a lot of pieces, I looked for an intriguing subject, researched it to understand the basics, then wrote it to share with others. Creating a Coronavirus/Covid-19 vaccine is an evolving issue, and I wanted to know more about how long it will be before a preventive treatment is widely available.

An article on my HuffPost feed satisfied my curiosity, and it’ll inform you, too, about when we can expect an effective coronavirus vaccine. Unfortunately, the answer is no time soon. There are good reasons why it takes so long to make a vaccine. Rather than writing new content about this complicated issue, I’m sharing what I received from the Huff.

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As of the end of April, 2020, the World Health Organization was tracking 71 coronavirus vaccines in preclinical trials, with five additional candidates already in clinical trials. Given how recently the COVID-19 pandemic began spreading, it might seem promising that there’s already a lot of activity on the immunization front.

With so many potential vaccines in testing, you also may wonder why medical experts say it will take at least 12 to 18 months before one is ready to go. If a coronavirus vaccine did make it to market on such a timetable, it would actually be the fastest turnaround in history. Currently, that record belongs to the mumps vaccine, which was approved for use in just four years back in the 1960s. For Ebola, a vaccine took five years to develop.

More commonly, the development of a vaccine takes eight to 10 years. Can a COVID-19 vaccine be created any faster? There’s certainly hope, but no certainty.

“I’d say the 12 to 18 months that’s been bandied about by some experts is realistic, but it’s [also] optimistic,” said James Cutrell, director of the infectious disease fellowship program at the University of Texas Southwestern Medical Center in Dallas. “It is based on the assumption that each phase of trials goes according to plan, with an optimistic time frame at each of those stages.”

Here’s what goes into each phase of developing a vaccine.

We often think of vaccines as treatments for illness, but they’re not exactly that, said Kelvin Lee, a professor of chemical and biomolecular engineering at the University of Delaware and director of the National Institute for Innovation in Manufacturing Biopharmaceuticals. Vaccines are given to people who are well to keep them from getting sick.

“It’s very different from developing medicine where someone is ill and you are trying to make them better. In a healthy population, you don’t want the vaccine to have negative consequences,” he said.

First, Lee said, researchers will study the virus and attempt to determine which type of vaccine may work best.

Microscopic view of Coronavirus, a pathogen that attacks the respiratory tract.

There are several kinds of vaccines. Some have a tiny, weakened bit of live virus, which triggers a protective immune response in your body but does not cause the actual illness. Some contain inactive virus that creates a similar response in the body. And some utilize genetically engineered RNA or DNA, which carries “directions” to make the type of protein that can prevent the virus from binding to our cells and making us ill.

Once researchers decide which vaccine route they think will work best, they get to testing.

“This is where time really comes into play,” Lee said. “Even after you do lab tests to make sure it works in the proverbial petri dish, in many cases vaccines will undergo tests in animals to ensure that it’s going to be safe for humans and has the desired response. And then, where it really starts to take time is in the human clinical trials.”

To roll out a vaccine requires a lot of safety testing. During Phase 1, researchers take a small number of healthy volunteers and test the vaccine for serious side effects, Cutrell explained.

Phase 2 involves smaller studies looking at efficacy, he said. This includes figuring out the best dosage of the vaccine, the scheduling of dosages if you need multiple ones, and more. Scientists will consider whether the vaccine still appears safe enough and whether the immune response or antibody buildup is great enough to warrant moving on to additional clinical studies.

In Phase 3, you will see larger field studies.

“You would take a susceptible population, vaccinate some while having a control group, and monitor the effect over time and see if there’s any difficulty,” Cutrell said.

Here, researchers may look for common, short-term side effects and at what dosages those side effects pop up.

“All that has to be done first, and then if Phase 3 shows the vaccine is safe and effective, that’s when you’d look at licensing,” Cutrell said.

Even after you have a working vaccine approved by the Food and Drug Administration, it still takes time to mass-produce and distribute it across the country.

The goal is to vaccinate huge numbers of people, “so you then develop immunity in the community that would protect against larger outbreaks,” Cutrell said.

Testing and monitoring ― essentially Phase 4 ― continue even after the vaccine is generally available because it takes time to ensure safety, Lee said. “You don’t know if something bad is going to happen a month later, two months later, a year later.”

Common side effects of vaccines include redness and pain at the site of injection and maybe a low-grade fever; side effects like seizures or allergic reactions are extremely rare. But the bottom line is that scientists and doctors aim to develop a vaccine where the protective benefits far outweigh the risks.

While it’s hard to say when researchers will have a viable vaccine, there are a few factors that could speed up the timeline for this coronavirus vaccine. Traditional approaches to creating vaccines ― like the use of chicken eggs ― are proven but not necessarily speedy.

“You have some newer technologies that some companies are trying to leverage, where they were already prepared to respond to a pandemic,” said Lee. “You can shorten some of that discovery and early development timeline.”

Newer biotechnology-based methods, sometimes called “cell culture methods,” could make for more rapid development, he said. Additionally, with a pandemic circling the world, American researchers are hardly alone.

“You’ve got private companies and scientists trying to work together on the vaccine. That collaboration can certainly help accelerate the timeline,” Lee said. “Scientists will still want to minimize risks and ensure the safest possible rollout of a vaccine. “But given the outbreak globally and the impact it’s having, I can imagine there are ways to design trials to accelerate testing,”

There could also be an unconventional study design for the coronavirus vaccine, according to a new report published in the Journal of Infectious Diseases. In place of traditional Phase 3 trials, volunteers at low risk of developing a severe form of COVID-19 ― healthy people without chronic conditions in their 20s, for instance ― might opt in for a “human challenge study.” They could be exposed to the coronavirus, monitored closely and given the best care.

This type of study would involve fewer participants and could be done in less time than a traditional Phase 3. Of course, the idea would need to be rigorously discussed beforehand as ethics rules generally forbid deliberately infecting human beings with a serious disease.

Besides vaccine trials, researchers are testing potential treatments for COVID-19. Instead of preventing the disease, these aim to make sick people well again.

“One of the treatments that has gotten a lot of attention is remdesivir, but the data available so far is fairly limited,” Cutrell said. No trials comparing use of the antiviral drug against a control group have been published so far. That said, studies are coming, including a National Institutes of Health clinical trial comparing remdesivir against a placebo.

There are also drugs that could potentially address the immune system’s response to the virus.

“A lot of times patients with this virus get sicker in the second week of their illness ― and it’s not the virus, but the immune system that makes them get quite sick,” Cutrell said. “They experience an exaggerated state of inflammation or ‘cytokine storm.’”

Some drugs that might dampen the immune system’s effects are currently in clinical trials. Then there’s the now-controversial drug hydroxychloroquine, which has long been used for malaria or inflammatory conditions like rheumatoid arthritis or lupus. Although the drug received a lot of early attention, the studies showing potential benefits for COVID-19 patients have been mostly anecdotal with no control groups to compare against.

“There are also concerns about safety, including cardiac issues and arrhythmias that give doctors pause,” Cutrell said, noting that the FDA recently advised Americans not to use hydroxychloroquine outside of a hospital setting.

Finally, COVID-19 might be treatable with convalescent plasma.

“This is where people who have had the disease and recovered donate plasma, and that plasma is given to someone with an active stage of disease,” Cutrell explained.

The antibodies and proteins in that plasma could potentially help someone with COVID-19 recover. (You may be able to donate plasma if you have recovered from the coronavirus.)

Until we have a vaccine or meaningful treatment, we need to proceed with caution, ramp up testing and isolate the sick quickly if we hope to get back to some “semblance of normalcy,” Cutrell said.

“In my opinion, before we have effective treatment or vaccine, we will have to behave similarly to South Korea, Singapore or Hong Kong, with widespread access to testing, contact tracing and isolation, quarantining people in cases of potential contact,” he said. “In doing this, they’ve been able to stave off having large scale epidemics in their country and are allowed to be a little more open than other places where those things are not in place.”

“Of course, those countries have not yet seen second waves of the virus.”

“That approach requires constant vigilance,” Cutrell acknowledged. But even as scientists and doctors work to develop effective treatments and a vaccine, he said “thoughtful and incremental” strategies can help us move forward to “a period of more normal activities.”

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Note from the HuffPost: Experts are still learning about the novel coronavirus. The information in this story is what was known or available as of the end of April, 2020, but it’s possible guidance around COVID-19 could change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.

Here’s the link to my first DyingWords post titled Just How Deadly is Novel Coronavirus and Covid-19?

JUST HOW DEADLY IS NOVEL CORONAVIRUS AND COVID-19?

There’s a new viral kid on the block and he’s mean. Real mean. He goes by Novel (New) Coronavirus (SARS-CoV-2), and gives you the previously unknown disease termed COVID-19. That’s the biological term for Corona Virus Disease identified during the dying days of 2019. Now, in two and a half months, this nasty bug has virally spread from a small shop in China to the far corners of the world. It’s on an unprecedented multiple-mutation path, and that’s what makes it so deadly.

Severe Acute Respiratory Syndrome caused by the Coronavirus of 2019 (SARS-CoV-2) is particularly dangerous for people with compromised immune systems. That profile takes in newborns, the elderly, folks with immunity disorders and those in generally weak health. This combined demographic comprises a huge part of the human population.

Microscopic view of Coronavirus, a pathogen that attacks the respiratory tract.

There are two parts to this pandemic that’s scaring the pants off people. One is the virus itself which is a brand new member of the Corona genus. The other is the disease it causes which everyone now recognizes as the name COVID-19. How bad this will get is anyone’s guess, but the world health authorities are preparing for panic.

There is little need to panic, though. The key to surviving this outbreak and “flattening the curve” as the containment process is called, is knowledge and caution. Properly protected, you can minimize your exposure of viral transmission and respond quickly if you’re contaminated. Keeping your distance in social settings, washing/decontaminating  your hands and shielding your face (eyes/nose/mouth) are the most important things you can do—they’re the three top tools to tackle the threat.

What is the Novel Coronavirus?

A virus is a microscopic speck of organic non-cellular material that sits on the fringe of being alive and being inert. On its own, a virus has a limited existence unless it finds a host of organic cell matter. That can be human, animal, plant or any other life form that replicates itself through cellular division.

According to information from the National Center for Biotechnology Information (NCBI), there are millions of different viruses above, on and in the Earth. NCBI has identified 75,000 separate viral genome sequences and has 5,000 of these described in detail. Coronavirus-19 was new to them, and they’re doing everything in their power to figure this one out. It’s not coming easily.

To survive and thrive, a virus must find its way to a host and invade its cells. In humans, that happens through absorption into your airways, eyes or an opening in your skin. Once a virus attaches itself to your cell, it transmits encoded instructions to make the cell copy the virus’s genetic profile and essentially produce clones.

The Coronavirus of 2019 isn’t satisfied with cloning itself. It wants to mutate and create biologically diverse offspring. That presents an enormous challenge to epidemiologists who get a vaccine made for one strain, only to find the bug is far ahead of them with mutants.

The Coronavirus-19 is perfectly suited for mutating. It’s a single-strand ribonucleic acid (RNA) based bug which is simple, quick and cheap to reproduce. Many other viruses are double-strand deoxyribonucleic acid (DNA) creatures. They’re much harder to duplicate and change form.

The RNA-based Coronavirus-19 presents another problem. Its specialty is attacking the lungs and causing acute respiratory disease. This results in pneumonia.

Pneumonia is a deadly disorder. It’s usually the coup-de-grace for virally-infected people who have no natural ability to fight back. It’s also extremely difficult for medical professionals to treat pneumonia. Combined, pneumonia is a serious development in deteriorating health.

Where Did Coronavirus-19 Originate and Where is it Going?

Medical investigators are certain that this virus first infected a human being at a marketplace in Wuhan, China. The market is primarily a seafood shop, but it does deal in live animals. One worker was exposed to the virus there in mid-December of 2019, and medical experts feel it’s highly likely the bug came from a bat.

Normally, viruses don’t easily transmit from animals or plants to humans. There are exceptions like the swine flu that came from pigs and the bird flu that started in fowl. However, this seems to be the first bat-related viral outbreak except for rabies infections which can also be deadly.

Once the epidemic became a pandemic, it spread like wildfire. By the way, an epidemic is a local outbreak that defies containment. A pandemic (from the Greek words “pan” meaning “all” and “demos” meaning “people”) is a word-wide viral fire that’s out of control.

That’s the current situation with the world fighting the Coronavirus-19 pandemic. (This piece was published on March 21, 2020). No one knows where it’s headed. The only certain thing is that it’s highly contagious and not at all contained.

Two days ago, the Governor of California wrote to the President of the United States with a plea for federal help to curb the COVID-19 pandemic. Clearly, the Governor sees this as a crisis of monumental proportion. This is a quote from the letter:

“California has been disproportionately impacted by repatriation efforts over the past month. Our state and health care delivery system are significantly impacted by the rapid increase in COVID-19 cases. Our case rate is doubling every four days. We project that 56 percent of California’s population—25.5 million people—will be infected with the virus over the next 8 weeks.”

The Governor states the situation is grave. He tells the President that California’s health care resources will be so overloaded with COVID-19 response that they won’t be able to address critical acute care needs like heart attacks, strokes and vehicle accidents. He also equates the crisis as threatening all of America.

It’s not just America that’s in peril. It seems China has some reprieve after taking draconian steps to quarantine people, however, countries like Italy are getting it bad. And it’s not just “first world” places like Europe and North America that are going to suffer. This bug is now everywhere except Antarctica.

Why is Coronavirus-19 and COVID-19 so Threatening?

One reason—probably the main reason—that COVID-19 is so threatening is because humans have no natural immunity to animal-transferred viral invasion. There is nothing that can be done about COVID-19 except riding it out while your body naturally fights it off. That takes time, and many infected people simply can’t afford the luxury of time.

There is no medicine or vaccine to treat Coronavirus-19 infections and COVID-19 disease. At least not yet. Your body only has two options. One is for your immune system to directly attack and kill the viral copies and mutations. The other is for your immune system to cut off and kill compromised cell tissue.

Coronavirus-19 is a lung killer. Its habitat is the respiratory system and, once in place, your body will create mechanisms to fight the lung invasion. That means making fluids and this is what pneumonia is. If you’re in an overall weak condition, your body cannot control your lung fluids. You slowly drown, and there’s little can be done—even if you’re in intensive care.

Another factor in why Coronavirus-19 is so threatening is that it has an unusual rate of mutation. So far, scientists have isolated two distinct Coronavirus-19 strains. One is the “S” stain which occurs in about 30 percent of diagnosed cases. The other is the “L” strain conversely found in 70 percent. Alarmingly, the L-strain is much more aggressive and it mutated from its S cousin.

Epidemiologists around the world are extremely concerned that more strains of Coronavirus-19 are in the works. In perspective, the S-strain Coronavirus-19 is ten times more potent than the seasonal influenza virus which makes an annual visit. No one knows how strong these projected “superbugs” like L-strain will be.

How Does the Coronavirus-19 Spread?

The Coronavirus-19 requires physical contact to spread between bodies. It requires an infected person to give it to another directly or indirectly. Direct contact examples are sneezing and breathing in droplets, handshakes or sharing infected objects. Indirect contamination occurs when a droplet of human body fluid (usually mucous) lands on a surface where it’s picked up by another party.

Common surfaces like public pin-pads, handrails and doorknobs are ideal spots for a Coronavirus-19 to hold on and wait. Cash is another filthy substance that flows between hands and harbors the fugitive. In fact, cash can be a worst offender, both paper and coin.

How long the virus stays volatile is a good question. Current literature suggests a virus like this one can stay active for anywhere from a few hours to many days. Temperature, humidity and surface composition are factors in virus survival. So is air movement and competing contaminants like chemicals and other pathogens.

The Coronavirus-19 is a tiny, tiny particle. It’s so small that it can only be seen through an electron microscope. However, it’s big in numbers and there can be an enormous amount of individual virus particles in a single drop of snot.

All it takes is one single virus particle to infect you. From there, the Coronavirus-19 virus has a rapid rate of multiplying. You can pick up a virus and be symptomatic in no time. You can also be infected and be asymptomatic throughout your infectious period.

There simply isn’t enough known about this novel virus to write a playbook for it. As a virus rule-of-thumb, most people are contagious for a 14-day period from scooping the bug till it’s over. That, however, is not a done deal. You can be a walking viral machine and not know it. That goes for the person beside you.

What Can be Done to Stop the Spread of Novel Coronavirus-19?

The short answer is “lots”. It starts with isolating people with infections until the bug has run its course and they’re no longer contagious. That’s a bitter and expensive pill to swallow, but it’s the only thing that works. At least until a vaccine comes along and that’s some time out.

Total isolation, or quarantine actions, are harsh steps. However, they’re nowhere near as harsh as the other alternative which is spectacular sickness and death. If quarantine/isolation measures aren’t practical, then social distancing is the next best measure. A distance suggestion is 3 to 6 feet or 1 to 2 meters, but the further the better seems the safest.

Washing your hands frequently or using an alcohol-based hand sanitizer is mandatory. Soap and ethanol are mortal enemies to the Coronavirus-19, and it’s hand-to-face contact that really spreads this guy around. There are no known scientific studies to determine where hoarding toilet paper fits into your viral protection plan, but there’s plenty of proof suggesting TP is helpful for other bodily functions.

Gloves, on the other hand, are excellent protectors for one-time or single use. That’s provided you refrain from touching your face while being gloved-up which is easier said than done. Bear in mind that your skin is as good a protector as a latex covering. The trick is washing your hands or discarding your gloves between contacting your mucous membrane orifices.

There are varying opinions about mask effectiveness. Some feel masks are better defenses to protect others from you than vice versa. The Coronavirus isn’t often airborne except for an immediate expulsion in close range. If you peel off your mask while still having contaminated hands or gloves, it’s pointless protection. Also, conventional surgical masks, or even regular respirators, don’t protect your eyes. Full face shields are much better.

It’s all about limiting exposure, keeping your distance and minimizing unsanitary hand-to-face contact.

The trick to taming this terrible threat is mass-cooperation between our fellow human beings. This is the time to stop all non-essential exposure. It’s a suck-back and reload situation. It might be a good time to just read a book while staying home.

So far, there’s been amazing interaction between health authorities and political personnel. This is a unique time in human history. What makes this different from other pandemics is that our experts have much better communication ability than in past outbreaks and have responded, for the most part, with speed.

So has cooperation among the public. There’s been some fear factor and some fake news. That goes on with every crisis, and that’s to be expected in this one, too. The Coronavirus-19 fight will be won. Unfortunately, there’ll be casualties along the way.

Casualties fall into two groups in our interconnected society. One is health care workers and pandemic victims. The other group is financial—business and personal. There’ll be few segments not taking a punch in the gut from this new kid’s viral viciousness. Yet, our societies will survive and so will you.

The key to surviving this viral outbreak and “flattening the curve” as the containment process is called, is knowledge and caution. Properly protected, you can minimize your exposure to viral transmission and respond quickly if you’re contaminated. Keeping your distance in social settings, washing/disinfecting your hands and shielding your face (eyes/nose/mouth) are the most important things you can do—they’re the three top tools to tackle the threat.

Post Publication Note (23Mar2020): This graph was supplied by a DyingWords follower:


Post Publication Note (24Mar2020): CalTech Interview with Virologist Dr, David Ho.