Pandemic Phase, Peak Phase, What Happens Now?

This Blue Heron Chiropractic post is about expanding the discussion on where we are – and what is next – in this Pandemic.  There are three parts to it. While we are trying to figure out how to make the right next moves, it’s important to all be on the same page. While I work up my responses, I intend to to share it with you – if you have a few moments. We are all in this together.

First, a couple of re-definitions. This is not a “Flu” pandemic, and so that comparisons to the Spanish Flu, etc, are not going to be completely accurate or predictable. SARS-CoV-2 is “perhaps”  more virulent; opinions do vary and are changing daily, but it definitely impacts the vulnerable quite dramatically.   Before I go there, let’s re-define a couple of other terms. The virus itself – as you know – is called “SARS-CoV-2”. The  vaccine, when it is developed, will be for that specific “germ”. The disease syndrome we are trying to prevent, caused by that virus, is “COVID-19”.  COVID-19 stands or “Coronavirus Disease 2019”. It is a Severe Acute Respiratory Distress Syndrome, and it apparently permits comorbidities (other simultaneous health conditions) to piggyback and overwhelm the victim.

A key word above is “Syndrome”. A syndrome is essentially a cluster of things that can show up in various combinations – one, all, or a varied assortment – in a disease or problem. A lot of what is seen in COVID-19 is an atypical pneumonia, a severe acute respiratory distress syndrome, or a Cytokine storm – or all of the above and more.  That latter, the Cytokine reactions, leaves to heart attacks, organ failures, etc.

But here is the thing about the Pandemic we are in. Part 1. Pandemics are a phase of an epidemiologic process; we are well into this situation and the pandemic phase is Phase 6. So what happens now?

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

Previous pandemics have been characterized by waves of activity spread over many months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature.

In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

https://www.ncbi.nlm.nih.gov/books/NBK143061/

[[ Dr. Dana commentary: Now again, the above dealt with “influenza” – the “flu”, and this is not exactly that – maybe more severe. During and after the Post Peak phase, there will still be prevalent contagion, requiring continued strategies and protocols. Essentially, the Pandemic is never “over”, while there are community-level “waves” occurring in more than one country. We will just be “Post-peak”, and the “post-peaks” are essentially regional. I am sure there will be a battle about this concept.  Countries that are “behind” the US on the curve, will develop contagion – they simply have to. So that will extend the “Pandemic”.

Part 2 of this post deals with Herd Immunity, a frequently misused and misunderstood concept. The reason it is misunderstood is “it’s complicated” and complicated things with a lot of factors hard to  pin down and understand. It’s more like you have to “operate” with them rather than “understand” them.  Herd immunity is community or group protection that happens when a critical number of the population is immune to a certain disease. It can help stop or slow the spread of an infectious disease like measles or swine flu. Depending on how you deep you want to go into this, it takes at least 40% of a “herd” to be immune to discourage the spread of a disease, and realistically more like 80-90% in the case of a vaccinated population, since not all vaccine applications “work”.   So, Herd Immunity will not work for COVID-19, “this time”. It might work further down the road. With all due respect, anybody you hear right now saying “I am going to let herd immunity take care of it” – despite the fact that we would really like it to be so – they are really not correct.

https://www.healthline.com/health/herd-immunity#how-it-works

Most projections do not show that we will reach “Peak” in Portland. for example, until the end of this month; that peak may then extend or take a while, “hanging” at the top of the curve. Plans about things remotely getting back on their feet should probably exclude May and consider looking cautiously at June.

Last, Part 3. Re-Infection. Viruses can mutate; their genetic fingerprint can change, preventing a (previously introduced) immune system from recognizing them. SARS-CoV-2 is not yet known to have mutated; it is being watched. “Waves” of infection numbers coming back up are probably not “re-infections of people who have been infected and thus developed antibodies. People who are talking about you getting “COVID-19” twice, as in getting it again after you have already gotten it, are just more of those blustering crowd-talkers, mushing things together. If people start getting a SARS twice, that means it’s more like a SARS-CoV-2a or SARS-CoV-2b has developed – it hasn’t been identified formally yet. That would be bad but let’s cross that bridge when and if we come to it.

Let’s all just be careful about what we are proposing and about our expectations. My expectation is we need to be “extendedly” careful.

This is all very exciting as well as terrible, and maybe think about opportunities to do good work, and what learning and opportunities might arise out of this. Let’s reform our systems and grow as a community and as a people and as a species. 

At Blue Heron Chiropractic, we are currently seeing only “Urgent Care” or truly acute care patients that cannot be managed by distance video. If you would otherwise need to go to an emergency room or urgent care, identify yourself to us and we will try to get you in. Once here, you will be masked and screened for fever, and we will discuss you and your family’s social distancing – and then we will get you treated. All others, contact us and request a video session. We can get quite a bit done during a 30 minute session.  Request an appointment here.