October 2020 – San Francisco Examiner

From the orthopedist’s point of view, the story of COVID-19 is not over yet and is not well understood. Here are some points (some controversial) that may awaken you.

The virus SARS-CoV-2 behaves very differently from other viruses that infect humans. In some people it may seem harmless, but it lives in receptors commonly found in the nasopharynx (nasal cavity) and tongue, while in others it first invades through the lungs and then contains the brain. Invades most vascular tissue. The long-term effects on those who survive the infection are unknown and can be problematic.

For example, the herpesvirus often spreads through the mucous membranes, and many teens are afraid of seemingly random lesions on the lips. The virus hides in nerve tissue, pops out intermittently in life, and may even be associated with Alzheimer’s disease. We have never succeeded in developing a herpes vaccine.

HPV, the virus that causes cervical cancer, afflicts millions of sexually active teenage women and appears to have resolved afterwards, but years later, cervical cancer develops. To do. Hepatitis C infects millions of people and develops chronic liver failure or liver tumors in just a few decades. It took years to develop vaccines for these two viruses. HIV, the cause of AIDS, still does not have a vaccine 40 years later.

All viruses are malicious, but SARS-CoV-2 is not required. In the short term, athletes who get sick with this virus show varying amounts of lung damage. Severe inflammation of any tissue in the body results in scar tissue. The lungs of athletes exposed to this disease can suffer permanent performance degradation. At least two forms of the mutant coronavirus are known so far (and at least one person is infected with both forms), but more forms are likely to occur.

There is no cure right there. DNA and RNA vaccines under development are dangerous proposals. They rely on the harmless virus adenovirus to deliver the genetic components of the viral spike protein to muscle cells, causing your own cells to produce this spike protein. The hope is that your body’s immune system will see the protein as a foreign body and attack it. The memory of this attack is stored on T cells, so it will be defeated the next time a spike protein appears.

However, this is similar to the model for generating autoimmunity. In this model, the body produces an abnormal immune response against its cells (or products from those cells). No one yet knows if this will come from these vaccines. Years and thousands of people are vaccinated to find out. Other vaccines developed in a more traditional way use dead or attenuated viruses to introduce the immune system into foreign proteins and are more likely to be safe. But even these take years to properly develop and test. Still, a few people will have strange and / or sometimes fatal reactions.

There is also considerable confusion about the treatment exacerbated by the order received by the President of the United States. Viruses and bacteria stimulate the body’s immune system. It makes sense to enhance irritation with antiviral drugs such as remdesivir and monoclonal antibodies. Stopping the immune response by steroids is meaningless and is usually used only when a response called a cytokine storm is out of control.

Some false activities to fight SARS-CoV-2 are also tragic. The enormous amount of money wasted in deep cleaning schools and elsewhere should be spent on improved ventilation, masks, restrooms, and remote desks. Viruses float through particles and aerosols. No cases of surface-to-human transmission have been recorded. Overdue national programs for the production of large numbers of personal protective equipment, test materials and ventilators for schools and businesses solve most problems until effective treatments and vaccines are available.

Here are the steps I personally take: Wear a mask whenever you are near someone. I always wash my hands in our office and surgery center all day long. Do not go to indoor restaurants, bars or airports (except for health care trips). I wash my nose with saline every night, rub my tongue with a scraper, and use mouthwash on every occasion. Cleaning the nasopharynx where the virus is present at the ACE-2 receptor is an effective way to reduce the amount of virus and reduce the risk of getting sick or infecting others.

And just as important is the test. I’m missing out on the latest infections where the virus doesn’t have time to propagate yet, but it works pretty well. However, as soon as we test on the spot and get immediate results, most of us will be able to resume normal life. If logic is simply widespread, dealing with a pandemic is not too difficult.

Dr. Kevin R. Stone is an orthopedic surgeon at the Stone Clinic and chairman of the Stone Research Foundation in San Francisco.

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