Hold
On for a Minute
I
am going to be blunt in expressing my views here some based on
empirical, some scientific and some gut feelings.
There
is a lot
we do not know about this pandemic and the herd immunity
is well below the potential for containment and my guess work is that
once it enters, India and Africa, just like AIDS it becomes a global
phenomenon which the W.H.O. won’t be able to predict its final outcome
(in developing countries in particular) in the near future.
What
we Know
1.
Its size is 120 nanometers.
2.
Its a RNA dependent RNA polymerase.
3. It
behaves like an enteric virus (that is why the delay of 10 days as
opposed to 3 to 5 days of Flu virus).
4. It
is a large protein with a protective coat hijacked from the host
cells.
5.
The primary host cell is unknown and my guess is the hepatocyte or
perhaps macrophage (provided the macrophage has a receptor protein to
engulf it).
6. It
hijacks the ribosomal protein factory of the host cell (most likely
the hepatocyte where most of body proteins are manufactured).
7. It
can mutate on its own will.
Why?
It
does not need DNA mechanism of the host cell.
8. It
can mimic (mimicry) the host cell’s proteins for its own survival
and may bypass the host immune reaction to its own advantage and
perhaps may even cause autoimmunity problem in some individuals.
9. It
has its own protease enzyme to dissect the host protein and may even
use the host cell protease for its own advantage.
10.
Viral pneumonia is a process when antigen excess over antibody may
cause an excess of inflammatory response (macrophage pushed to second
place -leukocte response is enhanced- to clear the debries) and an
alarming exudate into the lung alveoli.
This
is where the ventilators come handy to push the negative pressure
created (usually higher pressure created by the surfactant in the
alveoli lining mitigates the exudation of fluids) in the alveoli back
to manageable proportion by artificial means and allow macrophages to
clean up the mess in the lung.
The
premature babies lacks the surfactant and adults with chronic
cardio-pulmonary disease have more devastating outcome.
What
can be done?
1.
Treat it like an enerovirus with vigorous hand washing and no touch
technique (do not touch possible contaminated surfaces in public
places).
2.
Self discipline and home isolation over long period of time and
physical distancing.
3.
Social interaction with a land phone.
4.
Cellphone (do not share) is a carrier and there are now UV light
disinfectant cases already in the market.
5.
Stop all contact sports (close gymnasiums) and use not towels but
disposable paper towels.
6.
Avoid all unnecessary travel especially by airlines.
7.
Wearing a mask is optional (to hand washing) for normal uninfected
but mandatory for sick individuals and health care personnel (save
the masks for them).
8.
Home gardening including vegetables is an option we have neglected
(why visit the market for ginger and turmeric).
9.
Coriander, Perumkayam and Khohoma are vital local remedies.
10.
Hang a Khohomba (an old tradition) leave branch on the front and the
back door if someone incubating the disease is domesticated.
Reproduction
from New England Journal of Medicine
At
the beginning of the epidemic, the estimated basic reproductive
number (R0) was 2.38 and the percentage of undocumented
infections was 86.0%. Undocumented infections were estimated to cause
86.2% of all infections. Later in the epidemic and with augmented
testing, the proportion of undocumented infections fell to 35%, and
the R0 dropped to 1.36 and then to 0.99 as restrictions on
geographic movement tightened.
Comment
To
end an epidemic, R0
must be kept below 1.0 in a sustained fashion. Mathematical modeling
of epidemics is fraught with uncertainty given its reliance on
numerous assumptions that sometimes turn out to be faulty. However,
this study's rigorous modeling data underscore that drastic,
prolonged geographic mobility restrictions are needed to contain the
SARS-CoV-2 pandemic.
Many
countries are currently paying this high societal cost while awaiting
the advent of an effective vaccine.
