Coronavirus – What can we do?
CORONAVIRUS

Coronavirus – What can we do?

Responding to this Pandemic

Coronavirus, one of handful of pandemics in the last 100 years, might spread through droplets but the fear it invokes spreads in ways beyond containment. It has brought about a sense of uneasiness and uncertainty in equal measure, taking siege within our cognitive space. In this case, some fear is not only important but necessitates a shift in how we go about our lives. An encounter such as this serves to reset our moral fabric and obligation to society. It comes as a ‘not so gentle’ reminder that preservation of life takes precedence over our intrinsic desire to propagate self. While there seems to be a long journey ahead for the sick to recover, and for the families of those who succumbed to the virus, our prayers alone will not do. With over 120 countries and 137,000 people positive for the disease, and counting, we are from the end, though many aren’t around to see it through.

 

HCoVs (Human Corona Viruses) are responsible for Common cold in about 10-35% of the cases and generally occur in late fall, winter and early spring. SARS and MERS that wreaked havoc in the past belong to the same family of virus. Historically, SARS (Severe Acute Respiratory Syndrome) in 2002-2003 took the lives of around 800 people with a 10% mortality with a 90% burden clustered in Hong Kong and China. In contrast,  MERS (Middle Eastern Respiratory Syndrome) inflicted significant burden to Saudi Arabia between 2012-2017 with a mortality rate, close to 34%. The H1N1 or swine flu that affected more than a billion people in 2009 had a mortality rate of 0.02%. Though mortality rate for COVID-19 is much lower, the number of documented cases of corona virus is 15 TIMES MORE than SARS, at this time. Hence, COVID-19 is unique in its ability to transmit with ease and severe enough to cause significant mortality.

 

Coronaviruses (CoVs) are ENVELOPED viruses with an unusually large single stranded RNA genome with a UNIQUE REPLICATION STRATEGY. Well, this may mean very little to many. Putting it simply, they are viruses with spikes in their surface that helps attach to a host, and in this case, a human lung tissue. Once it attaches to the lung tissue, it replicates making copies of itself and damaging the lung tissue, making oxygen exchange very difficult. This is also the reason for early respiratory symptoms with COVID-19. This continues till the host’s immune system fights the intruder, like in a war scene, sans a Hans Zimmer sound track. So, WHAT CAN you do? The singular goal of the virus is to reach the LUNGS, and all that one can has to do is ‘STOP THAT’ from happening. Well, easier said than done. This is also the reason to stay away from people who can transmit droplets through sneezing or coughing. This is referred as social distancing. Regarding masks, conventional masks can be porous and drippy facilitating this transfer while the better N95 masks (incredibly uncomfortable to wear) are reserved for health care professionals and those with infection, so they DO NOT transmit to others. Epidemiologists and social scientists argue that wearing masks in the absence of any risk or signs of infection might make people touch their face more often than usual, further exacerbating risk. Moreover, piling up those masks at home, anticipating a doomsday will only prevent the ones who actually need it from procuring one. Remember, we are not any safer if the community around us is less safe, no matter how many masks we buy. Keeping the hands clean (a 120 second wash) is in line with this idea to kill the virus before it reaches the LUNGS. So, what will ACTUALLY help is to use common-sense and follow safety instructions put forth by local health departments, assuming there is one. In the very young and the very old, the immune system is more likely to be compromised and therefore, we see greater risk. Coronavirus affects every individual equally. This includes the self-righteously health conscious with an impeccable waist line, so do not take it lightly for no one is spared.  However, it unequally and adversely impacts the elderly and those with a compromised immune system. More importantly, the healthy ones who are more likely to recover, can still transmit the disease to someone, older and sicker, who may not be as lucky. It is therefore imperative for the young and healthy to be obligated to protect the elderly. Remember, we will all get there, or at least we hope we do. 

 

The idea of quarantine is the most critical in fighting this intruder. The longest incubation period for the virus to survive before it attaches to a host (in this case a person) is 14 days which is a lot longer than for common flu which is 3 days. During this period, if the exposed quarantine themselves, while the sick diligently and carefully seek care through proper channels, and the healthy remain personally and socially responsible, we have what it takes to put a lid on this one. Yet, we struggle to do ALL of that. As testing becomes more easily available, the numbers will explode adding to the social media hysteria surrounding the illness, which is more tragic than the illness itself. Most data sources based on rates of infection point to a 2% fatality rate. Data on fatality rate comes from the entire world and could be significantly less depending on the country of residency. China, which is at the epicenter of this pandemic is home to much of these numbers. Even in China, only those who show signs of severe symptoms were tested, further exaggerating the fatality rate. While morbidity is also related to overall burden, MOST WILL RECOVER with traditional recovery numbers largely under reported as well as they come from those discharged from hospitals. So, quarantine will become a new normal in the coming weeks, and this means a significant disruption to the lifestyle we are used to. It is better to accept these as necessary for mitigating risk, which includes every one of us.

 

A single virus that originated from a single animal source transmitting an infection to one person has brought such a frenzy around the world beyond geographic borders, religion, socio-economic differences, education and political ideologies. It should invoke a personal reminder of the fragility of the human constitution and the importance of collective social responsibility. It is profoundly important in not just fighting and mitigating this imminent risk, but also prevent the next one from attaching to us, quite literally. Today, we witness empty playgrounds, schools, churches, temples and mosques, as we are encompassed by an alarming state of hypervigilance, which may be necessary to control this pandemic. Our pre-occupation to protect ourselves should equal our obligation to keep the community healthy.  When this is all over, it will rest on all of civilized society to exclude practices that put scores of people far and wide at risk. Let this be a gentle reminder to not take life for granted and nothing lasts forever, not you, not me, not even the virus.  Remember, everything is in YOUR HANDS, literally. 

Ravikumar Chockalingam MD MPH#

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