Covid-19 Talk

Disease and death has always been right at the centre of concerns for the humankind. First humans blamed God’s anger, later came the concept of environmental and dietary factors being responsible for diseases. As early as 1st century BC, the possibility of invisible living entities entering human body system to cause diseases was already proposed. But, we had to wait till the discovery of the microscope in the 19th century to identify the different microorganisms as definite causes of different diseases in human.
Rapidly, several disease causing bacteria, fungi and parasites were identified. We came to know almost all about them and learned to fight them off, quite successfully. So much so that the average human life expectancy nearly doubled over the last century.
However, there still remained a large number of diseases like Small Pox, Chicken Pox, Influenza, Measles and Common Cold…for which no definite bacterial, fungal or parasitic causative entities could be identified. There must be even smaller pathogens! It was also noted that this entity retained its ability to cause disease across all mechanical and chemical barriers so far known to stop pathogenic (disease causing) microorganisms. This entity was first called virus in the year 1898. The first human disease proved to have a viral aetiology was yellow fever in 1902. Next was poliomyelitis in 1909.
Study of viruses remained difficult, as they would not grow in culture media like the bacteria and were too small to be seen under even the best light microscope. Electron microscope was discovered in 1934 and we could finally see virus.
Viruses are very different from everything we knew so far as living organisms on the planet. Today, in the middle of the biggest viral crisis of modern human civilization, it is essential that people outside the community of doctors, microbiologists and scientists clearly understand what is going on. Understanding a problem is half solution.

1. What is a VIRUS?

To understand a virus, we have to start from the understanding of a cell. A simplification of the classic definition of cell would be, “the structural and functional unit of life”. All organisms from a moss to a human are just systematic, compact, organized assembly of large number of different kinds of cells. Essentially, a cell is a tiny packet of a unique biochemical jelly called cytoplasm strewn with tinier functional entities working in a coordinated manner as machine parts. One of these entities must be at least one string of proteins arranged in a genetic sequence. This is the nuclear substance, able to divide by itself under instructions inscribed in its own sequence of proteins! This nuclear division eventually leads to division of the whole cell itself, retaining all special characteristics and that is the central event of perpetuation of the life form.
Higher organisms have quite complex cells, but for today’s discussion, we need to look at a cell in its simplest possible form; the unicellular organism. The whole organism here is a single cell capable of performing everything necessary to survive and propagate. We humans, require about 37.2 trillion cells for that!
The unicellular organism under our scanner first is a bacterium. It is the last point where we find cellular organization as described before. It has a cell wall and the nuclear material with both essential types of nucleic acids (specific protein sequence) DNA and RNA in it.
NOW! Cannot go into details of DNA and RNA…not important. Just believe that these are the two chemical entities that must be available for the nucleus to be able to produce identical replicas as coded in the genetic sequence and this is the very essential first step of existence of a whole species as such. All functions of the cell and therefore of the organism is encrypted in codes as a protein sequence that is the DNA; and the decoding key sequence for interpretation of the codes and for applying into function are inscribed in the RNA. Therefore, one is completely useless and redundant without the other. Up to bacteria, each cell contain both DNA and RNA, but the poor virus has just one…either DNA or RNA.
Viruses do not have a cellular organization and contain only one type of nucleic acid and never both. Therefore, they are obligatory intracellular parasites for life, using the DNA or RNA of the host cell as applicable. Here lies the reason why viruses cannot be cultured in inert media like the bacteria can be...where will they get the counter nucleic acid required for division, in the non-living substrate? Therefore, independently a virus is not strictly a living organism; as metabolism, growth and reproduction are absent. DNA and RNA must be working together for functions that we recognise as LIFE. We cannot strictly kill something that is not living. That is why the antibiotics do not work on viruses. Don’t panic…. 1. We may not be able to kill but we can destroy non-living objects and 2. Virus acts as living inside live cells so…. We are still in the game.
Viruses occupy the twilight zone that separates living from the non-living. They are living chemicals. Viral nucleic acid can be kept crystalized in a vial at one time, denied of all provisions of life and once introduced into a living cell the crystals can unleash full function at another time! The extracellular infectious viral particle is called a virion. It is a virus only when it is in action inside a cell. A large number of human diseases are caused by viruses, common cold to Rabies or AIDS; Mumps, Hepatitis A, B and C, Dengue fever, Influenza, Herpes, Pox to some tumours and cancers! Yes you heard right, unlike any other group of microorganism viruses have been proven to be able to cause some cancers in some animals and in human.
A virion is essentially just a piece of a nucleic acid sequence, surrounded by a protein coat, the capsid. Some are enveloped by a further fatty overcoat derived out of the last host cell.

2. What are the different types of viruses then…?

The different viruses are different protein codes, either DNA or RNA. The capsids also vary and so do the fatty envelops. That is why the different viruses act differently and are identified as unique entities by the host immunity radars.
Most animal viruses are roughly spherical, though there are many other interesting shapes, like the bullet shape of Rabies and the brick shaped Pox virus. Coronavirus is an enveloped, spherical, RNA virus. It has unique club shaped projections on the envelop that resemble the solar CORONA.
Viruses are generally classified as DNA or RNA viruses based on which type of nucleic acid they sport. Some DNA Viruses: Poxviridae family, Herpesviridae family, Adenoviridae Family Some RNA Viruses: Rhabdoviridae family, Retroviridae family, Coronaviridae family. Only one genus has been recognised in the Coronaviridae family, it is the Corona Virus. All corona virus tend to cause respiratory tract diseases. In the recent past, SARS and MERS outbreaks were due to Corona virus only.
COVID 19 is an infectious disease caused by a new mutated species of Corona virus. With few exceptions viruses are very heat labile and are inactivated within seconds at 56°C and within few minutes at 37°C (average normal human body temperature)! They are stable at low temperatures…and that is the reason for us getting the common cold when it is cold commonly.
COVID 19 Corona virus is an exception. It takes about 15 minutes to get significantly deactivated at 56°C and can stand temperatures of 38°C reasonably well. Low temperatures and low humidity nevertheless keeps the virus happier. But, the crux is that COVID 19 Corona virus do not get affected very much in the range of regional and seasonal variations of temperature and humidity. Therefore, a hot and humid summer won’t be the simple answer to the Corona crisis.
Almost all viruses are disrupted under alkaline conditions and that is why soap and water wash is helpful. This holds good for COVID 19 Corona as well. Alcohol, Peroxide, Hypochlorite, and Iodine are also very effective on this virus, but only when it is out in the open (no role on the intracellular virus). Antibiotics active against bacteria are completely useless against viruses.

3. How does virus infect? How does viral infection spread?

We must realise that every cubic inch of space that we live in are shared with microorganisms, a good number of which are viruses! Skin provides a simple general first line of defence and most microorganisms are quite harmless for us. A pathogenic virus, under favourable circumstances can enter human body system through the respiratory tract, the alimentary tract, Breached skin, conjunctiva and the genital tracts. Some viruses are transmitted from parents to progeny.
Not all viruses follow same route and nor are all routes suitable for all viruses. The respiratory tract offers a most important route for virus entry and we need to understand that in depth now; and so we shall come to that route last. The alimentary tract, mouth to anus is a common viral route of entry. However only few viruses are able to infect through the intestinal walls. All enveloped viruses are destroyed by bile in our intestine. Corona virus is an enveloped virus. Of the common viruses only Enteroviruses, Adenoviruses and Hepatitis viruses enter through the intestine. Poliovirus can stay and proliferate in the intestine but infects only at the next level.
Skin entry is through abrasions and stings and bites. Needle stick injury or contaminated injection induces Hepatitis B, C and AIDS fall under this type of infection. Rabies virus enters through animal bites. Many viruses including the Corona virus can permeate through the delicate conjunctival membrane if it is present in a splash of aerosol to the eye.
HIV is notorious for invasion through genitourinary tract. Congenital viral infection can occur at any stage in the foetal period from the carrying mother. This is vertical transmission. HIV, Rubella, Cytomegalovirus and some tumour viruses are known to spread this way. A very large number of viruses are able to infect the cells of the respiratory tract, the nose, throat and lungs.
Fluid droplets containing virus can jump from one respiratory tract to another spreading the infection. As this discussion is raised in the backdrop of the Corona pandemic, let us elaborate the respiratory infections in more detail.
Sneezing and coughing produce fluid droplets of both large and small dimensions. The large droplets fly short distance, about 3 ft. (1m) but hold large concentration of infective material. However, this is also the mode of spread that can be restricted easily by practicing sneeze/cough etiquette and by the use of suitable barrier devices like masks and visors. Larger the virus, less is the likelihood of it escaping the filtration system of masks. The Corona virus responsible for COVID 19 is a reasonably large sized virus. This droplet/aerosol spread has been proven to be the primary mode of spread of the specific Corona virus of the present pandemic.

Use of masks is in random practice, but the recommendations are not being followed. Recommendations:
• If you are healthy, you only need to wear a mask if you are taking care of a person with suspected COVID 19 infection.
• Wear a mask if you are coughing or sneezing.
• Masks are only effective when used in combination with meticulous hand hygiene techniques.
• If you wear a mask, then you must know how to use it and dispose of it properly.
• The mask must fit the contours of face to create a real seal, the ones with gaps at mask-face interphase are no good.
• Avoid touching the mask while it is in use. If you have to, wash hands as recommended. Same you do when you put on the mask.
• Take the mask off from behind, without touching the front and wash hand as recommended.
• Do not reuse single use masks.
• Don’t use the mask to give yourself and others a false sense of security….
it IS SO if ALL OF the above guidelines are not being followed. Understanding this is extremely important. We are seeing people wearing whatever masks in whatever way and going out even when it is not absolutely essential thinking that they have an armour against COVID 19. Be assured that is not the case.
Some poorly informed people have made mask wearing a stupid ritual. Some supermarket owners are forcing people to wear masks if they had to enter their shop for buying essential provisions. This is wrong. At this moment anything outside the guidelines is wrong if not criminal. There are people in the ques who are supporting the views of the inadequately educated super market owners. Their argument “how do I know, you are not infected with COVID 19?”
…If I am, mine and your improper masks worn and handled in improper ways won’t save you. False sense of security is detrimental…it makes people casual and relaxed and therefore easier targets. People need to come down from the masked paradise of the fool and protest against any draconian dictums unsupported by solid science. If one coughs and sneezes, he/she must have proper mask and use it according to set guidelines.
In spite of several announcements by appropriate authorities that masks is not essential for everyone and unnecessary use deprives those who really need (the carers), some people are making a mockery of it. The supermarket owners have no authority to dictate guidelines on public health. Please protest wherever you can. Have printouts of WHO guidelines in your pocket when you go there.
Small droplets on the other hand, can travel further and under suitable environmental conditions of supporting temperature and humidity, can retain infectivity for longer time over longer distance. This is airborne spread. Fortunately the virus load in the travelling small droplet is low, but still infectivity may be intact. And, to get infected, one needs just one. Personal measures are not enough to prevent airborne infection and this is where Community lock down becomes vital. The spread as well as the pickup of the airborne aerosol becomes significantly obstructed by the walls if all are indoors.
The droplets small or big, may travel whatever distance but eventually have to settle on an available surface under the effect of gravity. The infectivity is still preserved. Thus, touching that surface would allow the virus to be picked up by the casual hand and passed on to the respiratory tract through the nostrils in no time. Here lies the importance of the OCD of handwashing associated to COVID 19. Not only the droplets, the hands can welcome major downloads of the bug in another way. Almost inevitably a runny nose is wiped with the back of the hand several times a day by even the most sophisticated individual….and you know what can follow…touching door knobs, handle bars, currency, a handshake…. Now imagine the runny nose was due to a mild COVID 19 flu.

I believe, NOW the COVID 19 recommendations make ample sense: 1. Stay indoors avoiding external exposures and contacts as much as possible (to the true sense of the terms).
2. Practice impeccable sneeze/cough etiquette.
3. Avoid touching outside objects, surfaces and people.
4. Wash (with soap and water) or sanitize hands after every venture outside…and when out, every time you touch something or someone.

Here comes the obvious question, how long after starting from the infected source does a droplet still remain infective?
The answer is not so simple. It is, a few hours to several days, depending on factors like temperature, humidity, surface texture etc. Therefore, do not count the possible time lapse factor at all. COVID 19 Corona virus has a big range of survival parameters, more than most flu viruses. If there is a possibility of a surface being contaminated anytime in the past or, if you are just not sure…do not touch. If however you have to, simply clean it with soap and water or an alcohol containing disinfectant wipe GENEROUSLY. When you are not sure whether your hand did touch some surface of the above category that you haven’t cleaned….simply wash your hand instead, likewise.
Remember, not only nostrils, eyes and mouth could also be entry points.
We must understand here that COVID 19 Corona virus is a new entity on earth, born out of a natural mutation (yes, scientists belonging to the opposite lobby unhappily confirmed that it was not born in any laboratory in China) and the world knowledge regarding it is still limited. I am therefore solely talking about the points where there are no confusions and following a “safety first” principle. Fortunately that covers the whole gamut of anxious questions that have any relevance to the wellbeing of individuals. We do not need to ponder over fancy thoughts and fairy tales at this juncture.

4. What happens in viral infections? What happens in COVID 19?

Virus - host interaction has to be understood in three different levels; Viral infection of the cell…proceeding to effects on individual…proceeding to effects on the community.
As I mentioned before, a virus is an obligatory intracellular parasite. Viral infection is therefore entry of the virus into a suitable cell in one of the many ways discussed before. The common way of entry of a virus into a respiratory epithelial cell would be by surface adhesion. The viral envelop adheres to the target cell membrane and initiate a complex dynamic surface chemistry that will dissolve the barriers of either side. The inside of the host cell and the inside of the virus are now freely mixing and the genetically active viral substance (RNA in the case of COVID 19) swims smoothly into the host cell. With almost immediate effect the control of the metabolic machinery of the host cell is hijacked. The host cell now is a slave machine producing body parts of the virus, instead of performing the originally genetically designated works for the host. Extensive coding, decoding, miscoding activities take place in the nucleic acid elements inside the live pool of host cell cytoplasm under instructions of the viral genome. All necessary raw materials for viral genesis are sponged out of the host cell and all energy rich elements are rerouted to supply the new-born army of invaders. As there is no tomorrow for this factory, production runs at hyper drive and eventually millions of viruses burst open, leaving back the wasted destroyed cell and each of them move on to recruit a fresh cell in the same way. This continues exponentially to the powers of millions!! The invasion thus moves on to the level of the individual from the cell level.
The system of the host gets alarmed soon and the defence response kicks in. the clinical expression of the viral infection is the net result of the virulence of the invading virus strain and the impact of the resistance offered by the host defence.
The resistance unleashed by host immune system is through the deployment of a vast array of physical and chemical weaponry (immunoglobulins, cytokines, interferons and some killer cells) into the system that can deactivate and destroy the viruses. This counter attack in an otherwise healthy individual gets proportionately more and more as the viral attack gets more and more offensive due to massive reproductive yield. Virus specific antibodies are the best weapons. But, we do not have reserved specific antibodies in the ammunitions hold if we do not know the virus from earlier exposures. That is the major hitch when a new virus makes debut.

This is war. The chemicals used by both parties are vile and toxic. They are often the main reason behind the clinical signs and symptoms of viral infection as presented by an individual.
Fever: An immunological beneficial effort. Most viruses are deactivated by temperature.
Cough: A response to noxious stimuli of viral damage and immune chemical irritation of the delicate respiratory mucosa of the upper airway.
Aches and pains: Effect of toxic chemicals on nervous system. Sore throat: Same as cough.
Stuffy or Runny nose: Surface oedema and thin emolliating mucus secretion in response to viral damage of respiratory mucosa of nose. Diarrhoea: GI effect of viral infection.

-------------------------------------------------------------------------------------------- Difficulty breathing: Advanced noxious stimulation of the whole of respiratory system, upper as well as lower. There is oedema as well as secretions that the body generates to emolliate. These reactions flood and occlude the air spaces of lungs progressively. -------------------------------------------------------------------------------------------- Multisystem failure: Shock: Carditis: Death
… These are the final eventualities of all infections that overwhelm the body system.
Incubation Period means the time between catching the virus and beginning to have symptoms of the disease. This is the time needed for the virus population to cross a threshold volume and for the immune system reactions to reach a threshold level.
Just like a single grain of sugar won’t make your tea sweet, but a spoonful will… the pathophysiological expressions also start showing only after reaching a certain volume.
For COVID 19 it is 1-14 days, most commonly around 5 days. Here lies the scientific basis of the government declarations of 14 day lock downs…It is not an arbitrary figure.
Like any war, there are three possible results, winning, losing and mutual temporary peace agreement. The last happens in some cases like infection by some Herpesvirus that can reside quietly in nerve ganglions for years following the initial attack; waiting to spring back into action when the host immunity is significantly lowered due to some other reason.
But mostly the war is decisive. If the host immunity is capable of mounting bigger and bigger counterattacks on the waves of fresh virus populations, the virus will succumb after a finite period and the individual is cured. Fortunately, even with COVID 19 Coronavirus, this is essentially the outcome for most immunocompetent individuals. The other end point is that of the virus winning. If the infected individual is at the extremes of age, is diabetic, is suffering from other chronic diseases, is under chemotherapy or somehow otherwise immunocompromised…the host defence army simply cannot match the viral offensive. They run out of ammunitions and succumb. The invading viral army is now free to proliferate and damage the vital organs one by one. Some remaining local guards at the organ outposts put up weak fights and the toxic by-products of these struggles add to tissue damage. Multi organ failure heralds death. In some cases, if the heart is an organ involved early, death is more sudden, of carditis.
Modern medicine and technology can support to some extent in the face of falling defence, providing some external chemical ammunitions and some mechanical support to the failing organs, like ventilator for the lungs and dialysis for the kidneys. However, if the host system doesn’t kick back within a reasonable period of time, the table cannot be turned.
Thus, the efforts to prevent the infection in the first place remains the best option always and every time. The elderly and the weak has to be protected by the healthy by fetching provisions of life during this period. They should not have to go out in the open.

5. How do we diagnose a viral infection like COVID 19?

Virus isolation being much more difficult than bacteria, the diagnostic tests are complex.
Tests are meant for confirmation of specific infective agent, for individuals with clinical symptoms and signs only. The signs and symptoms I repeat, are fever, cough and cold, malaise or breathing discomfort. In specific scenarios like the present COVID 19 outbreak, travel history is important. However, the latter alone is not an indication for testing in absence of symptoms and signs.

1. Respiratory tract materials have the highest positive yield for Corona virus. These are nasopharyngeal and oropharyngeal swabs and/or wash; Sputum; Broncho-alveolar lavage if there is not enough of the other materials.
2. Blood.
3. Sometimes urine and stool.
The specimen has to stay cold 2-8°C and may have to be frozen if testing is delayed.
At this moment, the only test considered to be dependably confirmatory is NAAT (Nucleic Acid Amplification Test for COVID 19 virus). The unique sequence of specific virus RNA is isolated and identified in NAAT. It is a Real Time / Reverse Transcriptase Polymerase Chain Reaction. In this test, very little amount of viral nucleic acid is amplified into millions of copies in a temperature mediated enzymatic reaction. Respiratory secretions, blood (serum) as well as urine/stool specimen can be used in this test and can test positive if there is a trace of the specific viral nucleic acid. This test has excellent specificity and sensitivity. Serological tests of blood (serum) are also available, but are presently approved for screening only. Precise results in these tests require paired serum samples of acute and convalescent phases. Therefore, application in the crisis period is limited to the understanding of disease activity in a sample population and formulating strategies for the community.
Viral Culture is possible but not recommended as a routine diagnostic procedure. Time and infrastructural factors are unfavourable.
COVID 19 is a new disease and optimal timing of testing and the best material to sample have not been confirmed. Therefore the practice is to test as soon as possible after signs show in a suspect and all possible material collected. Repeat sampling is done if the possibility of COVID 19 is strong on clinical and history grounds, but test results are negative. It is also done to confirm clearance after the patient is considered cured on clinical grounds.
Serological tests are being pushed as many commercially available validated serum samples have reached the market in face of the crisis. But there are large caveats and serology alone would not be considered confirmatory for presence or absence of COVID 19 Corona virus at this given point of time. If it indicates a positive possibility, NAAT will have to be done for confirmation. Serological tests will be positive for both present and past infections.

6. How is a COVID 19 patient treated? Treatment of viral infection:

Modern Medicine achieved ample success over most infective bacteria with the discovery of an endless range of antibiotics targeting different weak points of bacterial cellular structures or of their life cycle. The simplicity of viral structure and life cycle left us with too little choice. Simply, they have too few loose ends. As viruses are strict intracellular parasites, little damage can be done to them without actually damaging the host cell itself….how good is that?! Also, there is too little that is common to the different viral protein sequences and therefore a broad spectrum antiviral is not an option.
Also the viral generation flux is so fast that quick mutations to become resistant to a certain medicine in the next and successive generations is a simple reality for the virus.
Thus the onus to fight viral infections rest primarily on the immunity front.
We know, vaccines are dead, attenuated or synthetic viral antigens that are introduced into healthy individuals so that the immune systems get sensitized. Immunity now has specific antibody missiles to deal with it, should the real virus ever enter the system of vaccinated individuals. Sometimes a first, nonfatal infection by a virus does the same job of sensitizing the immune army with even better efficacy. An example of the latter is Chicken Pox.
However, unfortunately vaccines won’t work well for virus families that have vast number of strains and are constantly mutating as well. The reason is obvious, a system of identifying forms would be useless if the forms keep changing. The Coronaviridae family falls in this category.
Chemoprophylaxis and chemotherapy constitute the next line of defence. In spite of the challenges, medical science developed several antivirals since 1960s. Some are very useful against some specific viruses and some provide partial benefit.
Interferons are kind of broad spectrum viricidals but can help within limits.

Now, what about the specific definitive treatment of COVID 19?

The answer is brash. There is no substantive evidence that any currently available medicine can prevent or cure this disease.
There are several ongoing clinical trials. Antiretrovirals and Hydroxychloroquine with or without Azithromycin showed some promise. However, study sizes are small and no peer group consensus has been reached.
The line of management of acute illness due to COVI 19 primarily remains symptomatic and supportive. These include Oxygen administration where required…all the way up to artificial ventilation; control of fever and aches with simple Paracetamol; Antibiotics to prevent secondary opportunistic bacterial infections (opportunistic infections are very common when the full immune army is fighting a bigger battle and is suffering from exhaustion); Sometimes steroids to suppress acute lung oedema; Management of shock with suitable intravenous fluids and vasoconstricting agents…if needed; Convalescent Plasma Transfusion is being tried in some parts of the world (this is instant passive immunity).
There is no room for self-medication with hydroxychloroquine +/- Azithromycin for prophylaxis. This can cause cardiac arrhythmias. In some local protocols such has been tried for frontline care givers only under strict controlled conditions. Outcomes have not yet been worth publishing. As on today’s date, trying this at home would be falling prey to rumours.
Listen to your Government. Governments are accountable bodies. All standard Governments are working today in liaison with the WHO, the best equipped, best experienced and most hard working, well-meaning health advisory right now on this planet.
I am not particularly a “God and the Government” person and I am well aware of the misery that some governments are inflicting on poor migratory labourers due to callous sporadic spot dictums without back up plans…But, I believe, under the present crisis scenario, a single guideline is the only way forward. That, Global evidence based wisdom is being pipelined into the mass through the official authority, the Government….has to be believed.
All governments in multi-party democratic system unfortunately place their political interest first, but a pandemic is one special situation where no government would take a chance of letting their illiterate leaders advocate remedies, as a backfire may not be manageable in any whatsoever way. Precisely in their own interest will all government listen to the world scientific pool spearheaded by WHO now. So, you are safe believing them for once. If you are observant you will note that there would be carbon copy similarity in the health advice of different governments in spite of strong political differences. Some novel national medicinal animal products suddenly loosing popularity is a giveaway sign of the fact that everyone is now running for the cover of science.
So, safely trust your Government and comply with the policies laid down in COVID 19 defence. If you love to stay informed …go to the WHO site/s. Believe you me, you cannot structure a single question that is not already answered over there. They are updating the sites and the FAQs on almost hourly basis in simple language. And they stand by what they say. Do not trust anyone else…and that includes me…if I mention one word that cannot be backed up by WHO document cross check. If you are getting WhatsApp and Face Book advices from naïve friends …that travel in a different direction to the mainstream of this war against COVID 19; politely ask them to provide WHO evidence or delete such posts. That would be your service to the nation. Finally don’t panic. Homo sapiens were not born with the best modern medical gears, but they survived millenniums. Today they are only far better equipped. Remember more than 80% of the individuals contracting COVID 19 Coronavirus will have only mild symptoms like another common flu. They will recover by the strength of own immunity and develop some resistance to further infection. The remaining percentage will mostly pull through with modern medical systems support with better immune strength (worse hit - better active immunity). Yes, a very small percentage will succumb and that is the inevitability of being mortal and the world community of medical sciences are working relentless to reduce that percentage to as low as possible. The final answer to any viral outbreak is herd immunity which is being acquired by the population as we explained above…all the survivors in the equation. History tells us, this is in no way the first time that the world faced a pandemic. Only this time we are putting up a more organized scientific resistance. With easy travel across borders recruitment has been very widespread. The same science and technology that made this unbound locomotion possible, has also provided mankind with superior ability to combat the pandemic more comprehensively.
Revising the chain of events... RNA virus Coronaviridae family was present always with us. They are a group of viruses that cause flu in human (as well as in some animals). Our immune system learned to cope with them as with so many other viruses. But, viruses mutate fast. Through such mutations Corona viruses unleashed surprise attacks on human before. Two such major attacks were SARS and MERS outbreaks in the recent times. We eventually contained them both. Now they have done it again with another strategic mutation. The human immunity is going through a stunned stage due to the surprise factor. Immunity works strictly on a “identify first” principle to exclude damage to good cells of the body.
This phase is temporary and we are only hiding from the enemy in our bunkers till the biggest reserved force…HERD IMMUNITY marches into the battlefield and takes over. There is another interesting point. Viral mutation continues in the meanwhile as well… Understand that a dead victim is a dead end for the virus as well. Being obligatory parasite the virus actually wants the host to live …and thus shall try to mutate to a more compatible form (less virulent). That is what has happened to all the viruses that succeeded to exist on this planet after initial outbreak. So we see it is only a matter of time till we get to the end of this tunnel together.

7. What about younger people dying?

Exceptions only prove the rule. Also, it is not only age that decides one’s immune status. People with heart and chest conditions, diabetes, cancer and under treatment for cancer are vulnerable at any age.

8. What about animals? ….about pets and about meat?

It is known that the original pool of COVID 19 was in bats. It must have got transmitted to humans through one or two intermediate animal vectors. These vectors have not been confirmed (pangolin is one possible vector), Though as explained before that the GI tract is unlikely to be a principal port of entry of Corona virus, WHO recommends full caution in handling of unprocessed meat products and animal blood. As a general rule ill animals and dead animals where the cause of death is unknown must not be consumed. Well cooked meat of hygienically slaughtered animals are safe.
It is possible that all pets are not as likely to get infected by Corona virus as humans. But, WHO has not cleared any pets as completely safe. However, no substantive document of a pet contracting Corona virus has been recorded. The advice is to treat a pet as one of us and that will answer all dos and don’ts.

9. So, most people will have mild flu, some will require treatment and very few old and ailing will succumb….So why is there so much commotion, this happens with every seasonal flu…isn’t it?!!

The big difference is in the speed and the vast extent of involvement. As we are passing through the vulnerable phase of immunity gap due to the surprise advantage of the virus we step into critical numbers. If the virus can infect huge numbers fast, in spite of 80% being cool and about 15% only requiring basic to moderate help, the remaining 5% will constitute a significantly big number for any geographical location on the planet. They will require advanced medical infrastructural and skilled manpower support altogether. There is only a finite number of such machines and such men/women available at this time at any place. Once this critical number is crossed, we shall have no option other than to stand and watch people dying whose deaths could have been prevented. Human race is not willing to take this hands down defeat in 2020. All the drastic drills are imposed to steer away from that point and get better equipped in the meanwhile.
Ventilators, Monitors and syringe pumps are three pieces of equipment we majorly need for the crisis situation. Out of these the ventilator, which is basically a sophisticated system of bellow that can push in oxygen through a tube in trachea from outside…is in short supply. Some major automobile companies have come forward to make ventilators on an emergency basis…and there is already a concern that ventilators are too sophisticated an equipment to be manufactured this way! Ventilator is not rocket science. The companies that make them produce based on need to hold the price in the market. They are expensive. Now on the face of the present crisis it is very much possible for different machine tool companies to produce different parts and assemble under the guidance of ventilator companies as long as they are not sceptical about opening the knowhow technicalities and drop the thought of business disadvantages once the crisis is over and there are too many ventilators out there in the market. The other important thing is to train big groups of junior doctors and nurses in manning the ventilators. Most do not know how to. This can also be done quite easily on an emergency basis by senior consultants on Respiratory Medicine.

10. Will a survivor of COVID 19 be then protected for life like one who had Chicken Pox as a child?

We do not have data to confirm that “for life” part of this statement. There is no “always” and no “never” in the art and science of Medicine. However, peer reviewed journals published official data that people who survived SARS and MERS …the two previous Corona virus outbreaks still show immune response to the virus two years down the line. There is no reason why that should not be the case with COVID 19 as well.

11. How are we going to celebrate day 22?!

WFor Heaven’s sake…NO PARTY on day 22. We’ll have to handle it very carefully. Instant complete normalcy and excitement to make up for the lost days brought back a second tide of H1N1 in 2009.
The Corona virus is not going to vanish at the end of the lock down. It will only get down to a manageable level. We must continue to act very responsibly to consolidate our control.
The normalcy should come in periodic stages…like essential services first; followed by most normal business of importance; Transportation should be opened gradually, sector wise; and finally luxury and entertainment sector lights light-up one by one….

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