THE CORONA VIRUS – BASIC FACTS
By Allan Maynard March, 2020
Updated – March 29th, 2020.
I have made some updates to my article that was initially posted on March 14, 2020. The new information is in blue font. So much has changed over the past 2 weeks. It is very difficult to keep up. In many cases – do we really want to focus on such dire news? But we must.
There is a great deal of concern and even hysteria about the spread of the corona virus. I have done a lot of research on the topic and decided to collect the information for those interested. I have a strong personal interest in this topic given that my wife is in a care home and I am currently not allowed to visit. Should we worry? Yes – to the point that we take precautions and listen to the advice coming from medical authorities. Should we panic? No – it will be temporary and the disease does seem to be peaking in China and South Korea. Moreover, the majority of those infected do not need hospitalization.
There’s no doubt though that this outbreak is upending our lives in ways that we could not have guessed even 1 month ago. There has never been a better of example of why we need evidence based decision-making. The following is the evidence taken from reputable sites such as the WHO (World Health Organization) and others.
What is a corona virus?
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases. The current crisis is due to a new strain that has not been previously identified in humans.
Researchers first isolated human coronaviruses in the 1960s, and for a long time they were considered generally mild. Mostly, it resulted in a cold. But the most famous coronaviruses (SARS, MERS and this one – CoVid19) are the ones that jumped from animals to humans.
NOTE – SARS – Sever Acute Respiratory Syndrome – outbreak in 2003
MERS – Middle East Respiratory Syndrome – outbreak in 2012
The name comes from the ‘studded spikes’ within the virus. It looks like a ring when viewed under an electron microscope – like a crown (corona is Latin for crown). The current corona virus outbreak – the virus was initially called novel corona virus because it is new (novel). It was more recently recently given the name CoVid 19.
Names of outbreaks matter! This is why there has been a significant outcry when a number of politicians and media personalities have been referring to this outbreak as the “Chinese Virus” of the “Wuhan Virus”. In 2015, the World Health Organization issued guidelines on how to name diseases. These guidelines stipulated that the names should NOT single out particular human populations, places, animals or food. Names that commit those sins often wind up being wrong but by then the damage can be done.
Consider for example the so-called “Spanish” Flu. That name came from a major misunderstanding. Spain was one of only a few major European countries to remain neutral during World War I. Unlike in the Allied and Central Powers nations, where wartime censors suppressed news of the flu to avoid affecting morale, the Spanish media was free to report on it in gory detail. Since nations undergoing a media blackout could only read in-depth accounts from Spanish news sources, they naturally assumed that the country was the pandemic’s ground zero. The Spanish, meanwhile, believed the virus had spread to them from France, so they took to calling it the “French Flu.” But there is also evidence that it started in the United States since the first known case was reported on March 11, 1918 – in an army base in Kansas and spread into other army bases before being transported to Europe.
It is vital that science based factors drive discussions on disease outbreaks. Global cooperation is needed as opposed to useless finger pointing. As an example – we are seeing unprecedented speed in CoVid research thanks in large part to early Chinese efforts to sequence the genetic material of the virus that causes Covid-19. China shared that sequence in early January, allowing research groups around the world to grow the live virus and study how it invades human cells and makes people sick.
Origins of COVID 19
Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.
CoVid 19 is thought to have originated in bats that in turn infected animals held for human consumption. It has also been suggested that pangolins (ant eating mammals) could be carriers.
The virus first emerged in the Chinese city of Wuhan in December, and is thought to have leapt to humans at a seafood and wild-animal market (Huanan Market), where many of the first people to become infected, worked. Pangolins were not listed on an inventory of items sold at the market — although the illegality of trading pangolins could explain this omission. These kinds of markets are referred to as wet markets and there is growing concern that they will continue to be the source of other virus outbreaks. After the SARS outbreak in 2003, the Chinese government closed wet markets and banned the ‘farming’ of wildlife. But this ban was later reversed. After the recent outbreak of the CoVid 19 – a large number of wet markets have again been closed – hopefully for good.
More information has been published of late about the role of bats. A new University of California study finds that bats’ have a fierce immune response to viral infections which likely causes the viruses to replicate more rapidly. The bats carry huge viral loads which can be easily shed and thus transfer to other animals – including humans. A research team in China is headed by a well-known virologist (Dr. Shi Zhengi) who is now known as the ‘bat lady’. Her team has identified hundreds of corona viruses – most harmless but dozens belong to the same group as SARS and CoVid 19.
‘Wet markets’ where wild and domestic animals are kept alive in cages for purchase are prevalent in warmer climates (Africa, China, SE Asia, etc) where refrigeration is scarce. There’s no doubt that wet markets were the source of SARS and CoVid 19. As such there will be an intense pressure to close these markets down. But it will not be easy as millions of poorer people rely on them for food. However, a good start would be to disallow the inclusion of wildlife in these markets. It should also be noted that factory farming of domestic animals (eg. highly crowded chicken farms in North America) could also easily become a source of viral outbreaks.
The pathogen can travel through the air, enveloped in tiny respiratory droplets that are produced when a sick person breathes, talks, coughs or sneezes. These droplets fall to surfaces within a few feet (6 to 10 feet or 2 to 3.5 meters). That makes the virus harder to get than pathogens like measles, chickenpox and tuberculosis, which can travel 100 feet through the air. The droplets land on surfaces where the viruses can remain infections for a number of hours. When people touch these surfaces, the viruses are transferred to hands and then eventually to the face near the mouth, nose and eyes. The virus can also be inhaled from the air if close to a person who sneezes or coughs. In both cases the virus then lodges in the trachea and lungs and the infection takes hold. The incubation period is likely around 5 days. Hand washing and keeping distance from others are two of the most effective ways to prevent this route of infection.
There has been some recent reports concerning how long the virus lasts on certain surfaces. The New England Journal of Medicine just published a study that tested how long the virus can remain stable on different kinds of surfaces within a controlled laboratory setting. They found that it was still detectable on copper for up to four hours, on cardboard for up to 24 hours, and on plastic and steel for up to 72 hours. But it’s important to note that the amount of virus decreased rapidly over time on each of those surfaces and so the risk of infection from touching them would probably decrease over time as well.
Degree of contagion
Research is still in its early stages, but some estimates now suggest that the CoVid virus is 20 times more contagious than the seasonal flu. That is enough to sustain and accelerate an outbreak, if nothing is done to reduce it. Projections as to how widespread this will become vary widely. In some locations the rate of infection is increasing around 30% each day. Italy and Iran provide worst-case examples of a rapid spread. Projections for the United States vary widely with some estimates showing 1/3 to ½ of the population eventually becoming infected.
The ease by which people can become infected is the worrisome piece. In fact – 2 studies have shown that people not displaying symptoms can nonetheless spread the virus. An analysis of infections in Singapore and Tianjin in China revealed that two-thirds and three-quarters of people respectively, appear to have caught it from others who were incubating the virus but still symptom-free. It should be cautioned that these were 2 relatively small studies but it is nonetheless a note of concern.
Despite some of these more dire warnings, it is encouraging to note that when global health authorities methodically tracked and isolated people infected with SARS in 2003, they were able to bring the average number each sick person infected down to 0.4, enough to stop the outbreak. Also note – frequent hand washing can reduce the chances of infection by 50% or more.
The current growth of CoVid 19 infections is in most countries is considered to be exponential. Something is said to increase or decrease exponentially if its rate of change must be expressed using exponents. A graph of such a rate would appear not as a straight line, but as a curve that continually becomes steeper or shallower. Perhaps a better way to consider the growth is the number of days it takes for the infections to double. According to “Our World in Data” – associated with a number of prestigious universities, the rates of infections doubling are: World (number of infections doubled in 6 days), Italy (7 days), Spain (4 days), USA (3 days), Canada (4 days), China (45 days). It is clear that China’s rate of infections are levelling while most other locations are still in the exponential growth phase.
The coronavirus outbreak hit amid flu season in the northern hemisphere and even doctors can struggle to distinguish between the two The overlap in symptoms probably contributed to slow detection of community infections in some countries, including Italy. Typical flu symptoms, which normally come on quickly, include a high fever, sore throat, muscle aches, headaches, shivers, runny or stuffy nose, fatigue and, more occasionally, vomiting and diarrhea.
Doctors are still working to understand the full scope of symptoms and severity for Covid-19, but early studies of patients taken to hospital found nearly all of them developed a fever and dry cough, and many had fatigue and muscle aches. Pneumonia (lung infection) is common in coronavirus patients, even outside the most severe cases, and this can lead to breathing difficulties. A runny nose and sore throat are far less common, reported by just 5% of patients. The only real confirmation of having Covid-19 is taking a test though.
Early research indicates the virus may be significantly more deadly than the seasonal flu, which kills roughly one in 1,000 people. An analysis of outcomes for more than 44,000 confirmed patients in China found that roughly one in 50 died (2% mortality rate). Eighty-one percent of patients infected with the new coronavirus had mild illness, 14 percent had severe illness and 5 percent had critical illness, according to the study.
The current (as of March 12, 2020) number of cases worldwide is about 135,000 resulting in 5000 deaths. That equates to a 3.7% mortality rate. In Italy there are just over 15,000 cases with 1000 deaths (6.6 % mortality rate). In the USA – 1600 cases with 41 deaths (4.1 % fatality rate). Note – the numbers are changing daily. NOTE – see new number below.
It is assumed, however that there are many more mild cases that do not get to hospital and are not being counted, which would bring the mortality rate significantly down. Most researchers feel the true mortality will calculate to about 1 to 2 % making the CoVid 19 ten to 20 times more fatal than the flu. The mortality rate for the H1N1 (swine flu) of 2009 was 0.02%.
Deaths are highest in the elderly, with very low rates among younger people, although medical staff who treat patients and get exposed to a lot of virus are thought to be more at risk. But even among the over-80s, 90% will recover.
Some current numbers as of March 29, 2020 – 17:29 GMT
World 707,738 cases 33,526 deaths (4.74% mortality rate)
Italy 97,689 10,779 (11%)
Germany 60,659 482 (0.79%)
USA 133,146 2363 (1.7%)
Canada 6213 63 (1.0%)
China 81,439 3300 (4.0%)
One of the most notable points is the difference in mortality rate between Italy and Germany but there are considerations as to why. Firstly, Italy has one of the highest ratios of elderly residents. Secondly, it cannot be fully confirmed that each recorded death over the past month or so is directly due to the corona virus. In one study that involved a re-evaluation by the National Institute of Health, demonstrated that only 12 per cent of death certificates showed a direct causality from coronavirus, while 88 per cent of patients who died had other factors that could have contributed. A third factor is a suggested higher rate of lung issues due to air pollution and a high percentage of smoking within the population.
Is it seasonal?
Regular flu outbreaks are generally seasonal in the Northern Hemisphere. People are outside more and a degree of immunity can set in. For the CoVid 19 however, no one can say if this will be the case.
Cures and Vaccines
Efforts to develop an effective vaccine for Covid-19 have been quick compared with historical epidemics, such as Ebola. A number of teams are already testing vaccine candidates in animals and preparing to carry out small trials in people. However, the second and third phases of development will involve thousands of volunteers and will look more closely at efficacy. It is currently felt that a vaccine to protect people from the coronavirus would require a timeframe of a year or 18 months.
There is also work being done on antiviral drugs. The most hopeful at present are Kaletra, which is a combination of two anti-HIV drugs, and remdesivir, which was tried but failed in Ebola patients in west Africa in 2013 and 2016. Some Chinese doctors are also trying chloroquine, an antimalarial drug, which is off patent, therefore cheap and highly available, and would be very useful in low-income countries. The first results are expected in mid-March and should indicate if the drugs will at least help those who are most severely ill. A miracle cure is not expected.
Vaccination development is being undertaken on many fronts as is drug therapies. See upcoming article on my blog.
It is very difficult to predict what will happen over the coming months and year. We need to be concerned but also act in a rational way. The medical community is extremely knowledgeable with monumental efforts underway to decrease the risks we face. Life must to go on. It is crucial though that science based decisions are made.
The 3 largest impact measures will be –
- TESTING – South Korea is demonstrating that testing on a massive scale is very effective. That country is testing people at a rate of 10,000 people per day. The USA is very far behind having only tested 11,000 people to date. This is a worry. Fortunately, in Canada – testing is about where it should be. It is becoming more and more clear that testing is absolutely critical in fighting this pandemic. In Canada we have so far carried out 66,000 tests (as of March 20th). This is not enough. The main reason is a shortage of supplies and a back-log in labs. In the US – the situation is more dire as the country lost about 6 weeks due to a deficient test protocol and a slow federal undertaking. As of March 20th – the US had conducted 313 tests per million people as opposed to over 6000 tests per million people in South Korea. This is changing as some new test protocols are being developed. I will write about testing in a new blog.
- READYING HOSPITALS – Most hospitals are already at maximum capacity so it is important that emergency measures are considered to expand available beds and ventilators.
- FULL SOCIETAL COOPERATION – it is critical that all citizens follow the advice of the medical experts – hand washing, social distancing, staying home if sick, restricting travel, avoiding large groups and getting tested if needed.
I could political here but I might get carried away. In closing – we need to pay attention to health experts — NOT politicians and nonsense flying around on social media.