It’s probably some kind of virus” is a common statement, not only in everyday life when someone feels ill, but not infrequently in the doctor’s office.
We hear them in the patients’ conversation with the practice assistant, but we also use them in the consultation. I find this “saying” very meaningful. In the collective consciousness, it implies that it is something common, even normal; something that needs no additional diagnostic intervention, but also no causal therapy, because “there is nothing you can do anyway” and it “passes by itself.”
And what sounds like a nihilistic excuse is often true: Viral illnesses with respiratory or gastrointestinal symptoms along with (sub)febrile temperatures and some headache and limb pain are common, almost always self-limiting, and harmless. After a brief history and physical examination to rule out danger signs of a more serious illness, “some virus” leads the family physician to the useful medicine of accompanying in the natural healing process and the patient to reassurance and confidence in his healing powers. By not using molecular biological amplification methods for the specific diagnosis of the virus and by not using unnecessary antibiotic therapies, we remain cost-conscious and do not contribute to the rapidly developing problem of bacterial resistance.
However, not all viral infections are self-limiting and harmless, and for a long time conventional medicine had hardly any effective antiviral therapies available against them. Vaccination against many of these diseases became established as a preventive measure. Herd immunity with population vaccination coverage of over 95% has the potential to eradicate viral diseases whose only host is humans (e.g., smallpox, polio, measles) or at least cause them to disappear in a geographic region (see articles by Niederer-Loher, Schöbi). Against other life-threatening diseases with an animal reservoir, such as yellow fever, early summer meningoencephalitis or rabies, vaccinations exist that guarantee practically 100% protection for persons at risk (cf. article by Beck).
The search for effective vaccines against chronic viral diseases such as HIV and hepatitis C has so far been unsuccessful. Highly effective antiviral chemotherapeutics have been and are being developed against these viruses, which can cure these deadly diseases (hepatitis C) or suppress their activity to such an extent that an almost normal life expectancy results and the infected people can no longer pass on this infection (HIV, cf. article by Staehelin, Hauser, Furrer).
In order for our population to benefit optimally from our prophylactic and therapeutic means, we must explain to our patients, but also already to our children, that not all diseases are “some virus”.
Prof. Dr. med. Hansjakob Furrer
