Presented by the COVID-19 Task Force

What Is the Coronavirus?

Right now, there are a lot of questions about the current COVID-19 epidemic. As a former molecular immunologist who used to engineer viruses, I am seeing a lot of confusion and misinformation out there as people try to grapple with the public health measures being instituted. In an effort to try to be helpful, I have crafted the following article on the coronavirus to give some background and information.

I will try to give practical thoughts on all of this. Of course, I am also an attorney, so I have to add that in no way am I providing medical advice—only information.

On a personal level, it is gratifying to see so many people pull together. I am fortunate to work with a tremendous group of people doing what they can. I know this extends out to you, as we do what we can for our friends, family and other loved ones.

Finally, for the vast majority of us, this will be but a brief disruption of the normal day-to-day routine. Like all epidemics, it will end. 


The Difference Between Bacteria and Viruses

Here are some interesting details about why COVID-19 is infectious. Bottom line, this is an infectious pathogen which is causing our current epidemic.

A. Bacteria or Microscopic Organisms Treated with Antibiotics

Scientist finds link between antibiotics, bacterial ...Very generally speaking, there are two classes of things that make you sick. One is bacteria. These are microscopic organisms that are ubiquitous. They grow and divide all on their own. There are lots of kinds that live inside of us. When they misbehave, we can treat them with antibiotics. Antibiotics are drugs that typically impair or stop their ability to grow and divide.

B. Viruses Are Infectious Particles Treated with Vaccines

Bacteria are different than viruses. A virus is a packaged piece of genetic material that highjacks the cells’ normal functions to make more of itself. To make an analogy, you have your computer and want to print out a report. A virus would come in and use your equipment to print out more copies of itself. A typical treatment is a vaccine. A vaccine is usually an inactive piece of the virus that our immune system can learn to identify. This way, when the real virus comes around, it is ready and can rapidly clear it out.

There are many different types of viruses. The flu is a virus. HIV is a virus. Coronaviruses are also a class of viruses. They are very similar to SARS or MERS, which you may or may not have heard about.

C. Some Technical Detail About SARS-CoV-2 (COVID-19)

The official name for the COVID-19 virus is SARS-CoV-2. It causes COVID-19 disease. However, because everyone is calling the virus and infection COVID-19, I will just call it that as well. However, if you see “SARS-CoV-2” floating out there; it is just the official designation for this virus.

SARS-CoV-2 without background.png

We already know a lot about the molecular structure of this virus. To the right I have pasted a picture that is used a lot in news stories. This is a typical representation of the virus. The gray stuff is the lipid bilayer or shell. This is the outer wrapping paper that keeps the genetic material safe. The genetic material is what is known as a single-stranded, positive RNA molecule.

COVID-19 is also studded with the red colored things in the picture. These are called spike structural proteins. It is these red areas that help the virus grab onto cells in the body to infect them. Some preliminary data shows that the COVID-19 has a special component referred to as a “furin-like” protease area. [1] This is what may make this virus so infectious to people. It also would be a good target for future medications to combat this virus. Bottom line, this virus is very infectious to people.

Corona Virus Testing

There is a lot of confusion about testing for COVID-19. Usually, when we want to know if we have the flu, we give a sample, and in five minutes, we can have an answer. This is because we already have an antibody test. COVID-19 is still too new to have a test like this, so we are using what is known as polymerase chain reaction or PCR. I will try to briefly explain how each test works so, hopefully, you can understand some of the issues being discussed by the medical professionals.

A. What Is an Antibody Test and Why Don’t We Have It for COVID-19?

What is Monoclonal Antibody Therapy for Cancer? | Dana-FarberThe human immune system works by developing antibodies to specific pieces of pathogens. Antibodies actually look like the letter “Y.” I include a cool picture of a cartoon depicting antibodies starting to bind to something.

Antibodies are like puzzle pieces in that they only fit into a very specific complementary shape. When we get a vaccine, our immune system will take a piece of the virus and design specific antibodies that will bind to it. This way, when the real virus comes around, the antibodies will stick to it and act like turning on a bright neon sign for the rest of the immune system to see.

We use antibodies all the time in our medical tests. However, it takes time to develop and ramp up production of antibodies. Eventually, we will have an antibody test for COVID-19 that will let us know if we had the infection or not, just like the flu.

B. PCR Testing Is What We Are Doing Now.

Imagine you are in a library and you want to see if there is a single page in a book with COVID-19 on it. Just trying to page through all the material would take forever. Instead, what if you had a special copy machine, which would be able to grab onto the word “COVID” and start making copies of it. Let the machine run for a bit of time, and you would know pretty soon if the page was there or not. This is what PCR testing does. If there is a copy of COVID-19 in a sample, it will make trillions of copies of the RNA.[2]

PCR takes time. It is extremely, extremely powerful. It will tell you if there is a single page in the entire library. However, it can only test if the particular sequence is present or not. For example, if there is any crossover with other coronaviruses out there, it could detect that.[3] It also does not say if someone is infected or not, just if it is present. Now, if it is present, it is a likely safe assumption. However, it is an assumption.

C. Implications

Right now, labs are ramping up to do PCR testing. People with clinical symptoms who test positive are likely infected. Thus, it is important to understand that it is impossible to know what the case fatality rate (CFR) is for this virus at this point. CFR is the number of patients who died over the total number infected. We are trying to limit testing only to those individuals who have a clinical suspicion of infection. If 80% of the people are asymptomatic, then most infected people are not being counted.[4] Eventually, when we develop an antibody test, we could obtain a sample of the general population and see how many people had the infection. Bottom line, whatever you are seeing about the CFR or death rate, the actual number is going to be much smaller.

What We Kind of Know

The CDC has published the following data from the USA regarding CFR.[5]

Age

CFR

≥ 85

10-27%

65-84

3-11%

55-64

1-3%

20-54

<1%

≤ 19

0

As I mentioned before, this is likely much higher since we are only testing the sick. However, this data seems to be in line with what is coming out of China, Italy and France. However, by the time you are reading this, there is likely updated data, and all this information falls under general rule of thumb.

As mentioned, some people have no symptoms. Others only a headache and some fatigue. More serious clinical symptoms are cough, fever and fatigue. Some children were also reported to have vomiting.[6]

While the CDC broke out the CFR by age, there are also likely correlations between certain co-morbidities and increased severity. Any chronic problems in the lungs (asthma, COPD, history of smoking, diabetes) seems to increase morbidity and mortality.[7] Thus, there are subpopulations who have greater susceptibility.

We know from MERS (a related coronavirus) that once you are infected, you will develop an immunity to the virus. There are other viruses, like influenza, that can mutate to get around our immune system. Therefore, it becomes a seasonal problem. The question then becomes, do we have to worry about COVID-19 coming around year after year? Thankfully, it looks like the answer will be no. In a recent study in rhesus macaques, reinfection was found not to occur.[8] Thus, this virus is likely a one-and-done type of infection.

There was a letter to the Lancet noting that ACE inhibitors tend to upregulate production of ACE2 (I will not cite this). They hypothesized that this might increase susceptibility to COVID-19 and why those with cardiac disease are developing more disease. The line in the article getting attention is that ibuprofen increases ACE2, and people have been using this “information” to say not to take ibuprofen. This was only a proposed model, which has not been tested. This is no more than an educated guess at a potential mechanism. AHA released a statement stating that you can continue to take ACE inhibitors.[9] The WHO has, at the time of my typing this, reversed their earlier recommendation to not take it. Bottom line, check with your physician before changing medications.

Survival Characteristics of This Virus

One of the questions is how long will the virus survive on surfaces. Depending on the virus, they can persist from only a few hours to a week.[10] However, there are many things that go into this. The strain of the virus. The type of surface. Mode and concentration of deposition. Temperature and humidity. The important point is that SARS-CoV and MERS-CoV have been found to survive like influenza on surfaces.[11] Another coronavirus was found to remain infectious on common surface materials for five days.[12] A recent study shows that SARS-Cov-2 (COVID-19) was similar with SARS-CoV-1[13]

Thus, we can expect the virus to survive on surfaces. Given this, wiping things down would be a good precaution. Frequent handwashing. Avoid touching mucus membranes or the eyes with your hands.

A quick digression about handwashing. I have observed (you know who you are) the brief splashing of water onto the hands. This is not handwashing. Handwashing is about 20 seconds of rubbing the hands together followed by rinsing with water. It is the mechanical friction, along with the soap, that does the trick. When I was working with viruses, the rule of thumb was to hum the alphabet song while washing.[14]

There have also been studies about how long influenza can stay in the air when you cough. In a normal setting, it is believed to be three feet. Thus, standing six feet minimizes the chance of exposure to the viral particle. While it is unknown what the data is yet for COVID-19, this is the rule of thumb I am going to try to employ until I see other data to the contrary. Social Distancing is staying six feet away from each other.

Understanding Public Health Measures

COVID-19 appears to be very infectious. Normal people, going about their day, will tend to spread it. This will especially be so for younger people who don’t have symptoms, who only employ a ritual water splash and who constantly touch mouth, eyes and everything else. Thus, the current strategy is to try and slow the spread of the disease. This is what “flattening the curve” is about. I found a diagram and pasted it below:

The goal is to make sure we do not run out of hospital capacity for those who need it. I also add that there is some indication that the warmer months will also inhibit infectivity, so bring on Spring.

What Can You Do?

There are some practical things you can do to help yourself and loved ones.

  • Listen and follow the advice of medical professionals and the CDC. If you feel my other points contradict their advice, listen to them, not me.
  • Wash your hands frequently. Whenever I enter my house, I now wash my hands. Institute ritual times to make sure you are doing it more.
  • Clean surfaces you are commonly in contact with. Alcohol and bleach are your friends.
  • Avoid touching your face. Especially when you are out and about.
  • Have a thermometer, because it would be nice to know if someone in your house gets a fever.
  • Consider obtaining a pulse oximeter. I got one from Amazon for $20. This will measure the functioning of your lungs. I will seek medical attention for anyone in my family who drops to 90%.

I sincerely hope you have found this article informative and helpful. New information is coming out all the time. From what the data shows, this virus will run its course (hopefully, a flatter one).

 

 


[1] Coutard, et al., The spike glycoprotein of the new coronavirus 2019-nCov contains a furin-like cleavage site absent in CoV of the same clade, Antiviral Research, Vol. 176, April 2020, 104742.

[2] Normally, RNA is first converted into DNA, designated cDNA. Primers are then designed to bind to complementary regions of the viral genome so that a certain region is copied (amplicon).

[3] To torture my analogy further, if we test for “COV,” we could find COVID-19, COVID-20, COVID-21. Therefore, one issue could be specificity or false-positive results.

[4] We know there are asymptomatic cases. Wu, et al., Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China, Intensive Care Med, (2020).

[6] Liu, et al., Detection of COVID-19 in children in early January 2020 in Wuhan, China, NEJM March, 2020.

[7] Wu, supra.

[8] Bao, et al., Reinfection could not occur in SARS-CoV-2 infected rhesus macaques, biorxiv at https://www.biorxiv.org/content/10.1101/2020.03.13.990226v1

[10] Kramer, et al., How long do nosocomical pathogens persist on inanimate surfaces? A systematic review. BMC Infect. Dis. 2006, Aug. 16;6:130;

[11] Otter, et al., Transmission of SARS and MERS coronaviruses and influenze virus in healthcare settings: the possible role of dry surface contamination, J. Hosp. Infect. 2016 Mar;92(3):235-50.

[12] Warnes, et al., Human Coronavirus 229E remains infectious on common touch surface materials, mBio. 2015 Nov. 10;6(6).

[13] Doremalen, et al., Aerosol and surface stability of SARS-CoV-2 as compared with SARS-Co-V-1, NEJM March 17, 2020.

[14] By the way, use liquid soap for extra-credit points. Brook, et al., Contamination of bar soaps in a household setting, Micobios 1993;76(306):55-7. This is because bar soap can have bacteria living on it!

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