SARS-CoV-2

First of all, we are all made of stardust! And by ‘we’, I mean everything; stars, planets, animals, birds, tress, every element, DNA, even the tiny atoms came from the death of a star or one could say as cosmic explosion! This does not go different for the micro-organisms; microbes are also included. I have always thought that huge things from outer space or natural calamities may be a huge menaces to our planet. Like the one that happened approximately 66 million years ago, an asteroid destroyed three quarters of the plant and animal species on Earth or Tsunami in the year 2004. But it seems that we have evolved so much that we humans itself will be the threat to other species in this world and also a huge threat to our own Planet Earth. We have seen how tiny our Earth is when compared in large-scale. But it is encountered that even a microbe which is of size 60 – 140 nano-meter can give quite a tough time to human and animals.

Yes, I am talking about the Coronavirus (COVID19 or SARS-CoV-2). This isn’t the first pandemic our people on Earth are facing. Our ancestors have faced Plague in 1720, Cholera attack in 1820, Spanish flu in 1920 and in this century, we are facing Corona Outbreak. Well, I wonder whether it’s just a coincidence or humans are cursed to face the pandemic once in every century!

(Here lies the initial stages of coronavirus)

On December 31 last year, China alerted the WHO to several cases of unusual pneumonia in Wuhan, a city of 11 million people. The virus was unknown. Within 24 hours, the number of infections exceeded 40.

On January 7, according to WHO, officials announced they had identified a new virus. The novel virus was name 2019-nCoV and has identified as belonging to the coronavirus family, which includes SARS (severe acute respiratory syndrome) and common cold.

On January 11, China announced its first death from the virus, a 61-year-old man. On January 13, WHO reported a case in Thailand, the first outside of China, in a woman who had arrived from Wuhan. Health authorities in the US, Nepal, France, Australia, Malaysia, Singapore, South Korea, Vietnam and Taiwan confirmed cases over the following days.

On January 23, the city of Wuhan, Xiantao and Chibi in Hubei province were placed under effective quarantine. The rail and air departures were suspended. By the end of the week, more areas were placed under lockdown affecting a total of 56 million people.

On January 30, the WHO declared the coronavirus as a global emergency as the death toll in China jumped to 170, with 7711 cases reported in the country. By the end of the week, China reported 304 deaths with 14,380 infections.

Within a few days, new cases were confirmed in India, Philippines, Russia, Spain, Sweden and the United Kingdom, Australia, Canada, Germany, Japan, Singapore, the US, the UAE and Vietnam.

On February 2, Philippines reported the first death outside China, the Victim being a Chinese man from Wuhan.

On February 10, China had confirmed 908 deaths and a total of 40,171 infections. On February 11, WHO announced that the disease caused by new coronavirus would be called as “COVID-19” or “SARS-CoV-2”

In a long-anticipated move, the WHO on March 11, declared on the coronavirus outbreak a pandemic. There were no new domestic cases reported in China from March 18 for the first time since the start of the outbreak. On March 20, coronavirus-related deaths surged past 10,000 globally.

Currently there are 2,626,467 confirmed cases; 183,404 deaths, 703,923 recovered globally due to COVID19. (Till April 22′ 2020)

(Check out the video for the statistics of various countries confirmed, recovered and death cases)

This pandemic is so real and serious that it affected the entire world. It is so bizarre that the whole world got affected in a very such short span of 4 months and this isn’t over yet!

Coronavirus – The Latin word ‘Corona’ means Crown. The virus got its name because of its spiky appearance seen in Electron microscope, its proteins sticking out from the surface. There are pathogens like bacteria and viruses cannot be considered as harmful until they find a living host and start replicating inside the host. Then it can be considered as a huge threat. But the antibiotic drugs that kill bacteria are not affect against viruses!

This virus is most likely originated from bats. In general, bats carry a lot of infection that does not cause major harmful diseases for the bats itself. But it can be dangerous for humans and animals. The virus might have come directly from the host or there might have been an intermediate host which passed on to humans. The intermediate host could be any animal.

In order to get some actual biological information about COVID19 apart from various articles I read, I approached a very good friend of mine who has studied biotechnology. Here are some Q & A with Srikanth, about the testing method, trail method and so on…

1. What does the virus affects first when it enters the human body

It is predominantly lungs. But there are reports of people with non-respiratory symptoms. The SARS-Cov-2 has been reported to affect even digestive tract, brain, liver etc.

Viruses need to enter the host cell to replicate. SARS-CoV-2 enters the human cells by interacting with a receptor called ACE2 on the surface of the cells. ACE2 is abundant in lungs, alveoli to be specific. This is the reason for predominant respiratory symptoms. However, ACE2 is present even in other organs too.

In people with weak immune system, there is a risk of multiple organ failure as the virus starts infecting other tissues apart from lungs. It is unwise to disobey the quarantine or lockdown, as even if they recover easily, the lives of our dear ones are at risk.

2. I noticed that there are two types of testing the virus are there: Rapid antibody testing and Real time PCR (Polymerase chain reaction) testing. Which one is effective and why?

Both are different and have their own importance. As ICMR has noted, antibody test is for surveillance while PCR is for diagnosis. Antibody test detects the body’s reaction to virus while PCR detects the presence of virus itself.

As the name suggests rapid antibody testing is for immediate results. This test detects the presence of specific antibodies that are produced by our immune system in response to the infection. However, antibodies usually become detectable few days after initial infection. The point of this test is to know if someone has had or is having the infection and if they are immune after recovery.

On the other hand, RT-PCR takes time and lab work. The RT-PCR detects the presence of viral genetic material in the samples. RT-PCR is considered the ultimate test.

There is another type of test called as antigen testing. In this, we test for the presence of viral proteins. This is under development.

3. There are clinical trial, solidarity trial and vaccine trails right. What exactly are those? What are the aims of these trails?

Drugs need to be tested before the patient is treated with them. This is done through several stages of testing. This process is called as clinical trial.

Vaccine testing is a clinical trial where the safety and efficacy of the vaccine are tested. Vaccine trials like any other clinical trial take time.

Solidarity trial is a novel international initiative where different treatment methods are tried and compared. As different hospitals in different countries try different drugs and drug combinations, lot of data is generated which can be analysed for further issuing treatment recommendations. We are innovatively repurposing the drugs already proved to be safe to treat a new disease. This approach is for combating the current emergency and significantly reducing the time taken for clinical trials. Hydroxychloroquine is one such drug being tested.

It is highly dangerous to self-medicate oneself with compounds being discussed in the media. If you feel you are at risk, contact your doctor or coronavirus helpline.

4. After the infection of COVID19, how much time will it take for the body to generate antibodies to get detected by the test kit? (This question came up when rapid antibody testing method is used to detect the virus)

The antibody levels are detectable few days after the infection. Earlier tests are not much reliable as the concentration of antibodies would be too low to detect. Antibody IgM can be detected after around 5-10 days while IgG can be detected after around 10-14 days. IgM is the first line of defense in our body while IgG is the main defense that kicks in later.

5. Once the vaccine has been discovered, obviously there will be a shortage to reach every person in this world. So, in order to stop the spread, how much percentage of people at least must be vaccinated?

It depends on two factors – herd immunity and reproduction number R_o. R_o is the number of people infected by one infected person. When an infected person contacts two other people, even if one of them is immune the spread of infection is greatly reduced. If the R_o is high, a greater number of people tend to get infected and so there needs be higher number of people with immunity (herd immunity) to slow down its spread. The people with immunity against the infection are in a way protecting the vulnerable population from getting infected.

Those who have recovered from the infection are already immune. Those who were not infected need to be vaccinated. For Measles with a high R_o of 12-18 about 93% of the population needs to be vaccinated.

The R_o of SARS-CoV-2 has been estimated to be around 1.5-3.5. So, about 75% of the population may be need to be vaccinated.

However, in the current scenario, due to lack of complete understanding of the virus, it is ideal to vaccinate everyone. This is my opinion and I am not an expert. Anyway, there will be people who will prefer not to get vaccinated.

6. This is more like an what if question. What if the virus gets mutated? What kind of mutation do you think will occur in this virus?

A study in Iceland has shown that there were about 40 mutants of the virus in the country with just 218 patients. Please note that generally not all viral mutants are dangerous.

Mutations can help the viruses evade immune system. This is why we get cold and flu frequently. This is the reason new flu vaccines are created every season. The virus may mutate to resist the effect of vaccine before it’s ready. Even if the vaccine is successful, the virus may mutate to cause a second wave. The virus may even shift hosts rapidly. When two viruses infect the same person simultaneously, it can even lead to a new virus. Anything is possible! However, mutating into a deadlier virus is only going to decrease the number of hosts. So, the virus might become more infective but less dangerous. Let’s hope for the best. Luckily the easiest measures can effectively prevent this disaster.

This is not to create panic but to inform that these tiny critters are much more capable than what many people seem to think. Viruses are not stopped by noises or dung! There is a reason why scientists are emphasizing on saving our environment. We need to be much more responsible!

Basic reproduction number R₀(R-nought):

The most important mathematical entity for an epidemic is its basic reproduction number R₀. It is a measure of the epidemic rate (i.e. how fast the people are getting affected) in exponential terms. When R₀ > 1, the infection will be able to start spreading among people. When R₀ < 1, it does not spread. Generally, the larger the value of R₀, the harder it is to control the epidemic and it is more contagious. Till March 18^th R₀ as 1.7  0.07. The below table shows the rate of R₀ during various pandemic we came across.

Pandemic	R0
Hepatitis C	2
Ebola	2
HIV	4
SARS	4
Mumps	10
Measles	18

The entire world is dealing with the COVID19 virus. Scientists, doctors, nurses all over the world are going through a lot of stress than we all can imagine. Especially doctors and nurses, they deal with the affected patients everyday. At first, I thought that it won’t be a big deal. Because they are covered in a suit so that they won’t get affected from the patients. But is that the case in India? I wondered whether they get proper protection like other countries in the world.

So, to have a better idea on what is really happening with our doctors in hospitals. I had some Q & A session with Dr. Khishan, MD (Russia) regarding the awareness that has to reach the people who are still not serious about this situation.

1. Is the virus air-borne or it only gets transmitted by a person to person?

Viruses stay alive in the outside environment. But they require a host to grow and replicate. So, they get transmitted from person to person, in a ready infective state. But fair amount of chance to get infected from the environment also.

2. Is it prone only to humans? If so, why is it?

Animals are at risks too. But not as serious as homo sapiens. Unlike us, they present with multiple different groups of symptoms like loose stools (digestive tract.), etc

3. Does the count rate given and taken by the government is similar? Or to avoid panic among people, the government is showing less count-rate? (What do you think about it?)

Personally-speaking, the pandemic is true. The numbers are more or less unaltered. But there are lot of undiagnosed cases also. Do consider the fact that some information has been hyped by media and political parties for their best interests.

4. There are rumors about the virus that it cannot survive the temperature which exceeds 40 degree Celsius. Is it true?

Not true at all. This is not the first time there’s an outbreak. It’s happening for the third time. Just the first pandemic. The first was in fact in SA, which is hot by the way.

5. What if the person shows only one of the symptoms, let’s say coughing but no other symptoms? Is it ok not to be tested? Or its important to consult a doctor?

Consult, 200% consult. No other options! For instance, think radically. You have any one symptom go to the hospital, get tested.

Scenario 1: You are tested negative means you are safe, so is your family and anyone you come in contact with. You are not going to lose money also. The tests are done in Rajeev Gandhi Government Hospital.

Scenario 2: You are infected and haven’t been screened just because you are scared or negligent. In that case, you are infecting everyone who crosses your path. Your family, friends, relatives, neighbours, everyone. It ends up in a disaster that can be avoided with one small test.

6. Everyone must be cautious about this. But especially the people with respiratory problems or heart conditions or diabetes, is there any other body condition which one already has must be even more careful?

Children and aged people must be careful. See, the point is simple. Anyone with an impaired immunity must be extra careful. Say it is with the respiratory system or cardiovascular or people with any cancer or autoimmune disease on immunosuppression. And people with arthritis and other disorders on steroids.

7. Is it true that when an affected person got cured from the virus, that person cannot be affected again? If that’s true, why are we not using their blood as a cure? Is there any complication doing this procedure?

A person recovers because of the immune system which has effectively fought the virus for which our body produces an antibody. That can be theoretically used against the antigen (virus) itself. But it’s not that simple. It’s a pretty hard process. First, we need to isolate it. And by simple transfusion of blood, you are also transmitting the dormant virus to a healthy individual which in turn will affect him first! Always remember that a virus can stay dormant in the system and in the environment for years before its virulence increases and start infecting.

8. What do you think about this out-break? From Lab? Or the reason they gave? Or a bio-war? (Just your thoughts or if you know the actual reason!)

That’s a very difficult question to answer, but speaking of which since you bought if up, if it’s a bio-war it can’t be done by any individual organisations without government support. Which brings us to the conclusion that if any government is involved then they would spread it on their enemy or targeted country and be well prepared to prevent itself from the virus. But I don’t see any big countries free from pathogen

Or especially those with that big of technical expertise. Cause all big fishes are affected now. So, what more could be the chances!

An experiment that has gone wrong can be a possibility. But nothing can be done about it. The outcome and the response will be the same. So, there is known point in discussing about lab outbreaks, because government perform experiments always. And they go wrong sometimes. Remember the nuclear fission experiments during world war 2.

Just out of curiosity…

9. Have you experienced with any of the affected person? If so, how was your experience? Also did any of your patients came to you so worried that they have the virus but they did not! 

I have come across few suspected cases. But not any diagnosed cases. As they’ll be quarantined immediately. And yes of course, a lot of patients come and they get really anxious about this. Thanks to the media for that!

10. Is our gov. Well-equipped to fight with the pandemic. What improvements do they currently need? What do we need in future?

Our government is not equipped at all. We need to improve everything! Hopefully, someone realise something and next time start putting money into health care systems than any religious or political organisation.

11. Will there be a risk of second wave after the lockdown ends because of asymptomatic carriers?

Definitely there’s going to be. Second wave, is already on! We need to do rapid screening for all individuals to isolate and prevent.

12. If the govt announced lockdown and other measures earlier, could we have prevented these ~500 deaths?

 There’s a good possibility that we could have prevented. But the problem here is Lock down is not that easy at it sounds! There are many issues to solve prior.

People find it hard even after precautions have been taken. I mean, the economy is going to take a major setback. Government must pile up adequate stock of medicines and grocery, or people would die of starvation. It’s hard for daily waged workers now. We need to take into account of all minor factors before the major lock down.

13. Do doctors and nurses in gov l hospitals take proper precautions while dealing with the affected patients? Are the suits like in other countries available in India?

We do take proper precautions with whatever we have. What else can be done? What has to be done has to be done. No suits like the other countries for your information.

Yet, here I am, right back to work after being sick for 2 days!!

Preventive measures

It is always important for us to be safe at all cause. Especially during this period, one has to take an extra care of themselves i.e. washing your hands or wearing a mask while stepping out. Like Dr. Khishan’s words, never hesitate to get yourself tested if you feel the symptoms. Ensure that you maintain social distancing with other people. Let’s consider this seriously and take care of ourselves and others too. Have a happy yet safe quarantine to all my readers!!

I personally thank Dr. Khishan and Srikanth to be a part of my article and clearing every questions not just to me but to my readers also 🙂

Source:

https://www.aljazeera.com/news/2020/01/timeline-china-coronavirus-spread-200126061554884.html (Follow this page for daily updates regarding COVID19 news)