Hi, Orf. Your training in public health must make you an expert during this pandemic.

My training wasnt epidemiology, the study of disease in populations.

Thats a pretty academic distinction.

I suppose, but I did learn that prevention is easier and cheaper than treatment. Its the difference between saddling a horse in a stable and trying to saddle it in the field.

What does prevention entail for this virus?

Weve learned a great deal about prevention over the past centuries. In 1854, John Snow identified the Broad Street pump as the source for a cholera epidemic. He used careful mapping to identify the source of the contagion. Today, widespread testing allows us to find likely hotspots to isolate and investigate in detail. This was done in Korea leading to early control of the epidemic. The method is known as surveillance and contact tracing.

That might work in a smaller and more compact population, but how would it work in the United States with this virus?

No question that it will be harder. Especially since people can be infected and spreading the virus before they have symptoms. Moreover, it appears some people will carry the disease and infect others yet never show symptoms. Typhoid Mary was such a carrier in the early 20th century. Until we can test people at random, we will not be able to get a good handle on the extent of infection.

So, testing and social distancing will help control the epidemic. What about a vaccine?

That would make prevention much easier, but its not likely for years. Currently, we have several coronavirus diseases that need a vaccine but none has been found. Examples include MERS, SARS and Ebola. Developing a vaccine requires hard science and careful testing.

The alternative to prevention is treatment.

Like saddling that horse, its much more difficult in the field. Modern medicine can alleviate symptoms and stabilize patients, but it cannot guarantee a cure. Moreover, because this virus has clever ways hiding its infection, it becomes extraordinarily expensive and time consuming to treat.

Could there be a magic bullet to kill the infection?

Possibly, but finding one may take years. The usual sequence involves a series of clinical trials conducted in phases with careful protocols to insure the medication is working. The biggest risk is when the proposed treatment is worse than the disease. Remember, most people recover spontaneously or with mild treatment.

What are the trial phases?

The first phase tests carefully selected small groups to assess safety. This is particularly delicate in vulnerable populations, such as nursing home residents. In phase two, efficacy is tested by comparing at least two treatment groups, one of which may get a placebo or sugar pill. Confirmation occurs in phase three with a larger sample. A recent study with 333 patients tested tPA for the treatment of ischemic stroke.

Wow thats amazing.

Its far better than giving people an untested treatment that may kill them.

Dan Freeman lives in Galveston.

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The alternative to prevention is treatment | Guest Columns - Galveston County Daily News