It is crucial that we keep following public health instructions rigorously
We must try to understand the special characteristics of coronavirus, in a way we all may appreciate. We should make ourselves familiar with public health awareness in regard to the incidence of the illness, the illness itself, and the methods of its prevention.
We must also be prepared to accept that health instructions are to be rigorously followed, if we contemplate reducing the impact of the virulence of the present pandemic and its devastating consequences on our health, economy, and socio-political arena.
An old foe
Coronaviruses have rocked human health from the very start of the present millennium. The latest of the coronaviruses were able to infect human and animals, and until recent times, usually have been known for causing mild flus in human and a number of pathological conditions in animals; in chicks “infective bronchitis,” canine “respiratory disease,” and “hepatitis” in mice.
Spill-over from humans to animals and vice versa are rare. However, there have only been three known spill-overs of coronavirus of animal origin to humans, ever documented, causing a major epidemic -- SARS (CoV-1, 2002), MERS (Middle East Respiratory Syndrome, 2012), and the present pandemic causing severe acute respiratory syndrome named Coronavirus Disease-19 (Covid-19).
This indicates that the disease was discovered in humans in the year 2019. SARS-CoV-1 and SARS-CoV-2 belong to a viral subgenus, Sarbecoviruses, to the family of “coronaviridae,” and are believed to undergo frequent recombination heralding genetic mutation.
It is important to realize that SARS-CoV-2, itself is not a recombinant (a new combination of structural components) of any Sarbecoviruses detected to date. Its receptor-binding component important -- for specificity for binding to human receptors to gain access to human cells in order to infect -- appears to be an ancestral trait, shared (Clade) with bat viruses, and not one acquired recently via recombination.
Bats are mammals, capable of flying. Genetic analysis indicates that the virus has been circulating unnoticed in bats for many decades, and it has been a blessing for humanity that the natural barrier between bats and humans has not been transgressed prior to the beginning of the current millennium.
The SARS-CoV-2 is an RNA virus. Initial diagnostic tests in December 2019 failed to demonstrate the offending organism, and as such, the pneumonia clusters noticed in Wuhan, China were regarded as “pneumonia of unknown cause.” However, by January 10, 2020, analysis of the fluid extracted from infected lungs (broncho-alveolar area) demonstrated a 50% similarity to the MERS-CoV, an 80% similarity to SARS-CoV-1, and a 96% similarity to a specific bat coronavirus (RaTG13). The novel coronavirus became known as SARS-CoV-2.
The virus is of a spherical shape -- enveloped, non-segmented, RNA virus, only seen by electron microscopy (diameter 65-125 nano-meter), containing spike-shaped glyco-proteins giving the virus a crown-like appearance. Hence it was named ”coronavirus.”
The SARS-CoV-2 consists of an envelope, encircling the viral moiety -- the RNA (genetic), and a number of antigenic components (antigens) make up of four structural proteins: The spike (S) glycoprotein, the envelope (E) glycoprotein, the membrane (M) glycoprotein, and the nucleocapsid (N) protein. The genetic and antigenic components are important for diagnostic tests (RT-PCR and Antigen tests).
The present issue
However, the present pandemic that started in December at the end of last year in Wuhan, Hubei Province, China, caused a cluster of severe pneumonia, and spread rapidly. On March 11, the World Health Organization, WHO, declared the disease as a pandemic. The total number of recorded infections stands past the 20 million mark and the confirmed reported deaths surpassed 734,000. Spread from human to human happens with direct contact and droplet infection.
Covid-19 is not a rapid illness and develops in different stages consisting of a pre-symptomatic/symptomless phase after exposure, gaining access through the mouth, nose, and eyes. Even if they are not symptomatic, the sufferer is infectious from very early on and capable of infecting other individuals. Patients may then develop non-specific symptoms, often starting gently or insidiously, persistent coughs being the hallmark, continuing for a week or so.
Once symptoms develop, patients may either recover or patients’ conditions may progressively worsen, and then may herald the onset of inflammation of the lung, resulting in the progressive and unabated viral pneumonia. Peculiar to the Covid-19 illness, the virus is capable of inhibiting Interferon B, a protein inherent to the physiological mechanisms of the human body, that announces the presence of the virus on its arrival to human cells and triggers our bodily response to destroy and eliminate the offending enemy.
Though the majority of immune responses are aimed at the virus, the seriously ill Covid-19 patients would demonstrate that their own immune mechanisms, instead of combating the virus, attack their own tissues and worsen the inflammation of their own respiratory mechanism and other vital organs.
A high proportion of the seriously affected patients would require intensive care management and a substantial proportion of them progressing to fatality. Elderly patients, in particular, with underlying conditions of heart and/or lung, diabetes, or the immunocompromised are vulnerable to fatality due to the novel coronavirus SARS- CoV-2.
Specific characteristics of the virus allow us to understand how our day to day activities may either help spread or prevent acquiring the illness. Coronavirus is a virus and is not a bacterium. It is a contagious entity, more contagious than the seasonal flu. It easily spreads from one person to another by direct contact or being in close proximity by droplet infection carried in the air following coughing, spitting, sneezing.
Hence, the importance of maintaining a distance of at least 3 to 6 feet, never spitting in public, covering mouths and noses with tissues or bent elbows when coughing or sneezing, and immediately discarding the tissue safely and cleaning hands thoroughly. The virus can survive on surfaces for up to 72 hours, depending on the surface.
Proper hygiene remains integral
Adequate washing of hands with soap and water destroys the virus -- washing hands with soap and water at least 10-12 times a day, for at least 20 seconds each time and avoiding touching faces with unwashed hands. If you are looking after ill patients, wash hands at regular intervals, and before and after caring for patients meticulously. Wash hands after coughing or sneezing; before, during, and after food preparation; before and after eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste.
Though not as effective as soap and water, the use of a hand sanitizer that contains 40-60% alcohol is an acceptable alternative; make sure not to use fake sanitizers. Adulterated sanitizers are positively harmful as they give a false sense of security while continuing to infect individuals using the sanitizer, as well as the persons they come in contact with. The chemicals or ingredients used to make fake sanitizers cause other illnesses, act as fire hazards, and often end in fatal consequences.
Since the virus can survive on surfaces it is important to clean surfaces regularly. Thoroughly clean door handles, desks, mobile phones, bathroom, and kitchen with disinfectant.
Avoid close contact with others if you have any symptoms and stay at home if you feel unwell, even with mild symptoms such as headaches and runny noses, to avoid the potential spread of the disease to medical facilities and other people. If anyone develops serious symptoms (fever, cough, difficulty breathing) it is mandatory to seek medical care early and contact local health authorities in advance.
It is a civic duty to note any recent contact with others and travel details to provide to the authorities who can trace and prevent spread of the disease.
Healthy individuals need to wear a mask if taking care of a sick person. An individual should wear a mask continuously if they are coughing or sneezing frequently. We must not forget that masks are effective when used in combination with frequent hand cleaning.
Masks should not be touched while they are worn. If the mask is touched inadvertently, wash hands with soap and water, or with sanitizer. It is vitally important how to properly put on, remove, and dispose of masks. Again, hands are to be cleaned after disposing of the mask. Single-use masks should never be re-used.
Regularly washing bare hands is more effective against catching Covid-19 than wearing rubber gloves. The SARS-CoV-2 virus can still be picked up on rubber gloves and transmitted by touching faces.
In order to boost the immune system, try to eat a wide variety of fresh foods and lots of fruit and vegetables, probiotics such as yoghurt and foods high in dietary fibre, such as bran and isabgol.
Highly processed foods are to be avoided, including sweeteners that can harm gut health. It is vital to get enough good-quality sleep at night, between six and eight hours, as is keeping yourself hydrated by drinking a minimum of two litres of water a day (about eight glasses). For smokers, it is a good time to give up smoking.
Every endeavour should be directed towards understanding the heinous biological enemy humanity has been exposed to and trying to follow public health advice and instructions as rigorously as possible.
Dr Raqibul Mohammad Anwar is Specialist Surgeon & Global Health Policy and Planning Expert, and Retired Colonel, Royal Army Medical Corps, UK Armed Forces.