Merck Manual

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Commentary—Straightforward Solutions for COVID-19

Commentary
2020-04-15 Robert S. Porter, MD, Editor-in-Chief, The Merck Manuals

Go to the COVID-19 Resources Home Page

All serious problems have details and complexities. But too often these complexities distract us from what’s straightforward about the problem. Here’s what’s straightforward about the COVID-19 pandemic:

  • A pandemic spreads when infected people come into contact with susceptible people
  • A pandemic won’t spread if you PREVENT infected people from coming into contact with susceptible people

When it’s obvious who’s infected, this is straightforward, though not always easy from a practical standpoint.

But with COVID-19, it’s NOT obvious who’s infected (actually INFECTIOUS, able to transmit infection) because of the well-known asymptomatic and minimally symptomatic carriers, who are infectious without obvious signs of being infected.

Thus, we have been isolating EVERYONE from everyone elseour current general lockdown. Because if everyone is isolated, then we’re sure those who need to be isolated are in fact isolated—along with large numbers who don’t. This is the same principle as when the police arrest everyone in a bar after a fight breaks out; they know they’ve got the guilty parties but at the cost of inconveniencing a lot of innocents in the interest of maintaining law and order.

If only there was a way to distinguish infectious people from susceptible people. Some sort of TEST we could apply so we could isolate only infectious people and let everyone else go about their business. What a boon that would be!

Of course, as we all know, there ARE tests to identify people infectious with the SARS CoV2 coronavirus. Even without new technical or scientific breakthroughs, our tests are generally quite adequate to identify infectious people.

So why are we still on lockdown? What is keeping us from finding and isolating only infectious people? Since adequate tests exist, it’s obvious that we could find and isolate the majority of infectious people if we had more

  • Test materials and equipment
  • Testers to run the equipment
  • Sites to locate testers and equipment
  • People to identify and contact the people who should be tested
  • People to properly collect and transport samples
  • People and technology to follow up test results and ensure cases are isolated

Some of these things have been started on an ad hoc basis by local authorities. But since the pandemic cannot be controlled only locally, success requires organization at the national level to coordinate, streamline and manage this process.

None of these things require scientific or technological breakthroughs. 

Straightforward.

Go to the COVID-19 Resources Home Page

Dr Robert S Porter

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Tongue Discoloration
The tongue may become discolored for a variety of reasons, some of which are harmless and others more problematic. Which of the following is capable of causing black discoloration on the top of the tongue?