Our best weapons against disease don't work on COVID-19

by Jason Crawford · March 10, 2020 · 2 min read

To understand why the new coronavirus, COVID-19, is such a threat, it helps to understand our full arsenal of weapons against infectious disease—and why most of them aren’t going to help right now.

I summarized the main techniques/strategies here a few months ago.

1. Antibiotics: Don’t work here because SARS-CoV-2 is a virus, not a bacterium.

   In the 1918 flu pandemic, antibiotics would have helped (they weren’t invented yet) because many deaths were due to secondary bacterial infections. But that’s not what’s happening with COVID-19: it kills by attacking the respiratory system directly.

   Our technology for antiviral drugs, unfortunately, is not nearly as advanced as that for antibiotics. There’s no such thing as a broad-spectrum antiviral. (A paper last year pointed out how useful this would be in a pandemic.)

2. Vaccines: Could work against COVID-19, but unfortunately they take time to develop. I have heard 12–18 months for a coronavirus vaccine, and that’s fast. Vaccines are a long-term solution but can’t fight an emerging pandemic.

   And again, there’s no such thing as a broad-spectrum vaccine—the whole way a vaccine works is by stimulating production of specific antibodies by your immune system.

3. Sanitation and other environmental control: COVID-19 spreads directly person-to-person through respiratory droplets. This makes it one of the more difficult types of diseases to control.

   Contrast with cholera and typhoid fever, which are waterborne. Filtration and chlorination help a lot here. Or malaria and yellow fever, which can be attacked by reducing insect populations. In those cases, there’s something in between the people that can be controlled. But direct person-to-person spread is the hardest to control, because people don’t like to be controlled, and social contact is too valuable.

To summarize the challenge:

• Antibiotics don’t work because it’s a virus
• It’s too new for us to have a vaccine
• It doesn’t spread through any intermediary we can control (like water or insects)

It spreads directly person to person, with no immunity or cure. This is why, despite all the amazing medical advances of the last 100 years, we still lack effective tools against it. And why our best tools right now are hygiene (especially hand-washing) and minimizing contact (“social distancing”)—and why these things are so important.

Someday, maybe we will have:

• broad-spectrum antivirals
• much faster vaccine development
• or some other way to stimulate the immune system to produce antibodies

It’s a good reminder that we still need lots more progress.

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