A lot of what we do is what I call ‘Science in the Middle.’ You want to know something about a big population so you take a sample of the population, study it, and then extrapolate to the population. 250,000 women (the population) get breast cancer each year so to get a new drug approved you test a sample, say 1,000, and then, if it works, extrapolate to the population.
But sometimes it is a new disease, what I call ‘Science at the Beginning.’ Here you are seeing something new, never seen before, but you think it is important and so you put out a description of everything you can about it with the hope it helps people look for more cases. Sometimes it grows into a population and you can do ‘Science in the Middle’ experiments and sometimes it stays small. Some of the findings in the first few patients will become universal findings and some will be ‘red herrings,’ unique to that patient. At the time you don’t know which is which, of course. This kind of science is called ‘Case Reports.’
The first case report of HIV on Jun 5th, 1981, involved five patients in LA over eight months, with a rare infection, usually only seen in end-stage cancer patients; but they didn’t have cancer. We now have 38 million cases worldwide.
In March of that year, 1981, I wrote a case report on the third case of an unusual kind of prostate cancer. 39 years later we now have exactly 21 cases in the world! So a tiny contribution to medicine.
The first patient in the US with coronavirus is charted below. Three notable findings:
1. Cough was the first symptom not fever. In fact he had a fever only after he was hospitalized. If common, this makes spread easier as the temperature screening method used everywhere won’t find early cases and stop contact.
2. He declined very quickly, only 72 hours from being at work to being in a hospital. So if you’ve been sick for a week at home it is not like this first case and so it may be just a cold or the flu..
3. The nausea and vomiting really throughout it, is unusual for respiratory viruses. My bet is this will end up being a great science clue, this ability to infect cells in the gut and the lung by the same virus at the same time, will become some new, important science understanding. Minority Report: this patient had TWO infections at the same time and this will be the exception. Time will tell…