Lessons From COVID-19
Public health preparedness is always a challenge, but we can learn a lot from what has transpired so far
Controlling the spread of infectious diseases relies heavily on extreme fidelity in sentinel systems. To remedy the poorly managed SARS outbreak in 2002, China implemented a robust system of reporting. However, a system is only as good as the integrity of the users. We learnt this from Li Wenliang. He was an ophthalmologist who alerted his medical school alumni group on WeChat, about a suspiciously large number of cases of a pneumonia that was reminiscent of SARS. These cases had been identified thanks to an early warning system for pneumonia, implemented by the Chinese CDC after the 2002 SARS outbreak. Wenliang’s message went viral on Chinese social media, and the hospital authorities who should have alerted the Chinese CDC of these cases in the first place, instead took him to task. Li Wenliang became infected with the COVID-19 virus and died on Feb 7, 2020, at the age of 33 years.
When governments obfuscate facts and try to control the narrative with nary a care for the citizenry, nothing good can come of it. The rate at which new COVID-19 cases are reported is matched only by articles about the virus and the disease, but outpaced by churlish chatter and theories about it.
The virus in question
On February 11, 2020, the International Committee on Taxonomy of Viruses (ICTV) named the new virus SARS-CoV-2 (other names used in the literature include 2019-nCoV), and the WHO announced the disease will be called COVID-19. To keep matters simple, WHO has advised that rather than confuse people with the prefix SARS used in the ICTV name, COVID-19 virus is an acceptable nomenclature.
The COVID-19 virus belongs to a family of viruses called Coronaviridae, subfamily Coronavirinae. Viruses, like plants and animals, have a hierarchical nomenclature system— family, subfamily, genus, and species. The Coronavirinae subfamily has four genera (plural of genus) — Alphacoronavirus, Betacoronavirus, Gammacoronavirus, and Deltacoronavirus; the COVID-19 virus, like the virus that caused the SARS outbreak in 2002, is a Betacoronavirus. The flu virus that one is more familiar with, belongs to an entirely different family — the Orthomyxoviridae family. Although both are RNA viruses (most viruses have either RNA or DNA as their genetic material), the flu virus is a negative strand virus; the COVID-19 virus is a positive strand virus. Unlike the COVID-19 virus, for the flu virus to multiply when it enters your cells, it must first co-opt the cellular machinery to make a positive strand of its RNA before getting the necessary viral proteins manufactured and assembled, after which the assembled multiple virus particles will now go out and infect other cells/people.
Coronaviruses are the largest known RNA viruses — their genetic material is almost three times larger than the influenza virus. Their name comes from the crown-like spikes on the surface. These spikes play a key role in how the virus particle enters the cells of your respiratory system creating havoc and even death in some cases.
Not all Coronaviruses infect humans, but they are generally zoonotic — meaning they can be transmitted to humans from animals. For example, the SARS outbreak was because the SARS-CoV virus spread from bats to civets to humans; the MERS-CoV virus spread to humans from dromedary camels. Until the SARS outbreak, Coronaviruses were assumed to be primarily responsible for up to a third of common colds.
In general, designing vaccines and other treatments for viruses is incredibly difficult and particularly so for RNA viruses because the mutation rates for RNA viruses can be more than 100 times that for DNA viruses. Imagine a LEGO setup where you had to find a red piece to complete the structure of mostly red blocks, but between the time you picked up the piece and brought it to the almost-finished piece of LEGO art, the neighboring blocks mutated to a yellow color rendering the red piece more or less useless for that particular piece of art. This analogy underlies the main reason why designing and manufacturing the “perfect” flu vaccine each year is not always possible, leading to some years having less effective vaccines.
Where we are today and what lies ahead
Across the globe there are more than 90,000 confirmed cases, and more than 3,000 deaths since the disease first came to light in December. Depending on your source of information, a vaccine for COVID-19 could be right around the corner, or could take months to become available. But we’ll probably see a treatment sooner than a vaccine, most likely from re-purposing drugs that were designed for other diseases. Continuing with the LEGO metaphor, since the red piece comes from a tried and tested set of LEGO blocks, it might fit and help to nicely complete an altogether different LEGO structure. Re-purposing drugs will most likely be the fastest path to a treatment, because safety studies will already be in place.
But until then, there are some simple steps that one can implement to reduce the possibility of contracting the virus. Since the incubation period is almost two weeks, and because there is now sufficient evidence of community transmission not unlike the flu, everyone should be careful so as to provide the equivalent of herd protection to those who are most susceptible to the COVID-19 virus — the elderly, and those with underlying health conditions.
Some of these suggestions might sound trivial, but without getting unduly panicked and paranoid, and simply being sensible so you can keep your life going, here are a few things to keep in mind: try not to touch your face — on average most people touch their faces more than 20 times per hour; cover your mouth and nose when you cough or sneeze — not with your hands, but with the inside of your elbow; wash your hands with soap and water especially after having touched communal spaces; if you use public transport, try not use the support straps and bars, and if you do use them, don’t forget to wash your hands later; avoid the traditional handshake — it’s unlikely people will be offended considering the current situation — how about a simple nod, or a namaste/aadaab/salaam/greeting-in-your-favourite-language! Check the CDC website for more detailed suggestions on how to keep yourself and your community healthy — if you have any symptoms outlined at the site, please contact your healthcare provider, don’t worry about being labelled a hypochondriac: it’s better to be safe than sorry. Implementing these simple changes is going to help everyone — those who are healthy will remain healthy, those who have sub-clinical infections will get better sooner.
COVID-19 is also a wake up call to those of us who are relatively sedentary — in general, maintaining a healthy level of exercise gives your immune system a head-start when it comes to fighting off many diseases.
A silver lining?
While crises tend to bring out the worst in many — witness price gouging on masks and other products, most crises also have a silver lining. The SARS outbreak in 2002 led to a more robust control system in China — of course, one can’t account for lack of adherence, but perhaps there is a silver lining that we can try to see in this COVID-19 emergency situation. Certainly, we’re seeing an enormous increase in scientific publications related to the coronavirus, with 364 papers published so far in 2020. There is also a wider sharing of scientific findings and increased collaborations, as well as free rather than paid access to these findings.
Global public health is a critical arm in any healthcare system because of how connected the planet is today. Responsible healthcare policies and healthcare systems of each country are just as important as a demand for responsible environmental policies by every country, yet there is little discussion of global healthcare. Without robust and accessible healthcare systems across the globe, who is going to be able to enjoy the clean environment that we are all fighting for? We’ve been derelict in pushing for access to equitable basic healthcare across our planet.
The current COVID-19 situation is also a call to science journalists to keep important scientific findings in the public’s eye so that governments sustain and enhance scientific efforts, rather than slash them — in the first year of Donald Trump’s presidency, science was a major casualty. Outside the scientific community, not too much press was given to a finding from China in 2017. Back in November 2017, scientists from the Wuhan Institute of Virology in China published a paper describing all the genetic building blocks of SARS in a single population of horseshoe bat. Accompanying their findings was a prescient remark: “This work provides new insights into the origin and evolution of SARS-CoV and highlights the necessity of preparedness for future emergence of SARS-like diseases.”
Perhaps we can hope that anti-vaxxers will also see the light, and overall public health will improve. But, here’s a million dollar question: will healthcare be available to all? That’s a question we’re going to have to weigh in a few months when we go to the polls — don’t underestimate your power.
Update: The World Health Organization has released a short video to help understand how you can reduce your risks of getting COVID-19
If a reader is interested in learning about the mechanism of cellular entry of the COVID-19 virus, please check the CDC website for relevant material. Information contained in this article is not a surrogate for clinical advice — please contact your healthcare provider for any concerns you have about the COVID-19 virus.
