First and upfront, let’s call this virus WARS*, which stands for Wuhan Associated Respiratory Syndrome. President Xi Jingping called for a war against the new virus, and a war it is. Therefore our acronym makes intuitive sense.
The naming of new viruses is getting politized and silly: yes, we need a catchy name to replace the unpronounceable ‘#2019-nCoV’ moniker. There was an outcry about the naming of the New Delhi (NDM) metallo-beta-lactamase but the name stuck. There are so many other infectious pathogens that are named after locations, and Lyme, Coxsackie and St. Louis are just examples without stigma. And of course, there is MERS touting its Middle Eastern origin. Sorry, the newly proposed name “NCV” (for Novel Corona Virus) is poorly chosen. So, WARS it is for us.
We are now approx. 2 months into an outbreak of WARS. As the epidemic is still unfolding nobody – really nobody! – can predict its course except for making ‘educated guesses’. SARS could be stopped with quarantine, MERS never developed into a large outbreak but is still around. Who knows how effective control measures against WARS will prove to be. It may be more difficult to stop a virus on earth than to colonize Mars.
Listening to the commentaries of experts from WHO, from regional and country ID experts, it is hard to separate fact from assumption. It is clear, however, that most of what is reported, falls in the category of ‘extrapolated biased opinion’. What is presented in the lay press, in news channels and talk shows often amounts to little more than scary fairy tales.
Let me summarize what we (seem to) know:
This is a respiratory virus with the potential to kill. It is hitting a population without prior immunity. It is being spread by droplets. It survives on surfaces and on the inanimate objects (fomites). It can (possibly) spread before a recently infected person feels ill and can be put into isolation. As a coronavirus, it is fairly resistant to inactivation. It is an airborne pathogen, but can be directly transmitted by contact too. It has already spread globally and we are at a point of exponential growth regarding #s of newly infected and #s of deaths. There is no specific antiviral treatment yet. It struck China at a most opportune time (for the virus): just as people started travelling all over the country for Spring Festival. It spreads like wildfire on cruise ships. It can kill immunocompetent people but mortality is higher in the elderly.
There is some progress to report in our knowledge base: WHO is providing some more solid data on this pandemic, the viral genome has been sequenced, and small VC companies are working on a vaccine. Drugs that show activity in-vitro are being re-evaluated, and chloroquine and TCM and remdesovir are making the news.
Are face masks helpful? WHO says no but I am not sure they are right. Even if the virus can penetrate surgical masks it may be good to wear them, if only to reduce the viral load on exposure. Yes, keeping a distance is probably good advice but that is not easily done on planes, trains or subways where we are dealing with very crowded conditions. A distance of 3-5 feet is impossible to keep on any metro, be it Shanghai, Tokyo or NYC.
In a normal, ie., poorly ventilated room, infectious droplets can persist in the air for hours before they settle down or disappear by evaporation. It is no surprise that cruise ships and hospitals are great distributors of the virus as they use recirculated air, esp. during winter months. This makes plane rides so dangerous: if somebody sneezes in row 83, you get to breath in coronavirus even in seat 1A.
Hospital water supplies and problems with heat sterilization were the cause of Legionnaire’s disease. Using a shower connected with a contaminated water tank provided an inhalation mist of legionellae. The COPD lungs of veterans, often former smokers, were unable to handle these high densities of infecting organisms delivered by aerosol.
So why are we keeping travelers locked up on cruise ships? Chances are that few were initially sick but with recirculated air everyone will get exposed to the virus. So, each ship becomes an island of infected, a leper colony of sorts as most will get infected eventually, the longer the stay. There is no ‘isolation’ room, no quarantine station on the huge cruise ships currently stranded offshore in several locales.
Next week, the extended Spring Festival is over in China. Many people will work from home, many will return to work, presumably using public transportation which is so efficient in this populous country. We can assume that just about all commuters will wear face masks and that’s a good thing. But will it provide enough protection from the few infected but asymptomatic patients riding along on the public transit system?
There is risk with everything we do. We accept the risk of getting run over in a traffic accident or being hit by a falling shingle when we go outside. SARS and the plague could be stopped by quarantine or by seeking distance from the epicenter. We still cannot control influenza, despite the advent of some drugs of dubious efficacy and a vaccine which is only reliable in those who need it least.
Ideally, we would like to stay home, or go into a state of hibernation only to wake up when all is over and the epidemic has run its course, rejuvenated and a few pounds lighter. We would like to go to a far-away island with only few inhabitants and no airport. We would like to stockpile food and masks and just stay in touch with the outside world with a phone connection. Last time people thought of running away from the real world was during the atomic scare and some chose ironically to go to Bikini Island. Well, we know what happened there, don’t we?
* now officially renamed COVID-19.
(Credits: Written by our contributing science writer who prefers to stay anonymous. The opinions expressed are not necessarily those of AllphasePharma Consulting LLC)
