“If you would be
a real seeker after truth, it is necessary that at least once in your life you
doubt, as far as possible, all things.” - Rene Descartes
Today, I am
interviewing a medical expert, researcher, published author of many scientific,
peer-reviewed articles and medical textbooks, a well-known professional, and an
academic of many years, who currently works for a government agency that
supervises medical care in Australia, ensuring that the public are protected
and that they enjoy safe, effective and evidence-based treatment and care. I
shall refer to this person as Dr X.
Jammy: Dr X, thank you for
agreeing to this interview on the COVID-19
pandemic. Your expertise is valued and your time is appreciated.
Dr X: you’re welcome, I am
happy to provide as much up-to-date and accurate information as I can in a language
that an average lay person can understand.
Jammy: Please explain to
me, what are viruses?
Dr X: Viruses are
interesting aggregates of organic matter,
that technically are not able to be classified as “living”. They don’t respire,
they don’t respond to stimuli, they cannot reproduce themselves and many of
them, if purified, can be crystallised like sugar or salt and stored in a jar
on a shelf, unchanging for many years. They are of two major types, depending
on whether they possess their genetic material in the form of RNA or in the
form of DNA – not both like our cells have.
Jammy: So are they cells?
Dr X: No, they are not cellular. They are very
simple compared to cells possessing in most cases only a little genetic
material in their core and a surrounding, protecting shell of protein, with or
without an external envelope of lipid, depending on the virus type. They are
exceedingly small. A red blood cell of a human is 7,500 nanometres (a nanometre
is a billionth of a metre), a typical bacterium is around 1,000 to 2,000
nanometres, and a large, complex virus is only around 400 nanometres, while a
small one is about 25 nanometres.
Jammy: So if they cannot
reproduce themselves, how do viruses multiply?
Dr X. They are expert fraudsters
and master deceivers. When viruses come into the body, their external proteins
latch onto cell receptor molecules and thus they enter into living cells.
Inside these, they take over the metabolism of the cell and they force the cell to make more and more
viruses instead of more cell. As the cell fills up with viruses, it bursts,
is destroyed and thousands of new viruses emerge, to infect more body cells, or
come out of the body to infect other people.
Jammy: Hmmm, seems like a
pretty pointless existence…
Dr X. Well, no more
pointless than many living organisms, or even some people!
Jammy: When viruses come
into the body, can’t we take antibiotics
to destroy the viruses? Just like we do with bacterial infections?
Dr X. Bacteria, fungi and
protozoa can be relatively easily managed with antibiotics and other drugs
because they are living organisms with their own metabolism, which in many
cases is quite different to human cells. Antibiotics interfere with the
metabolism of these microorganisms, killing them or suspending their growth so
the body’s immune cells can destroy them. Viruses, as we said, are not alive
and do not metabolise. Thus they are not susceptible to antibiotics and most
antimicrobial drugs.
Jammy: But AIDS is caused
by a virus and HIV infection can be
treated effectively nowadays with drugs, can’t it?
Dr X: Yes, HIV infection
can be effectively managed nowadays with a cocktail of specific drugs because
HIV is a rather special virus. It is a virus which can only make the cell
manufacture more virus by getting the cell it infects to first make a special
enzyme that doesn’t exist in human cells (the enzyme is called reverse
transcriptase). Many of the anti-HIV
drugs interfere with this special enzyme’s activity in cells, hence preventing
viral replication in cells.
Jammy: So, theoretically, it’s possible to have a drug that
interferes with COVID-19 replication in cells? That would get rid of virus
from the body, and hence infection?
Dr X: This is much more
difficult. COVID-19 is a more or less quite ordinary virus, which comes into
cells and takes over cell metabolism easily, utilising all of the cell’s own
enzymes and nutrients to make more virus. If
we interfere with these cellular metabolic pathways with a drug, we would be
interfering with the metabolic process of all cells in our body, which could
effectively kill us. A rather drastic way of overcoming a viral infection.
Jammy: What about hydroxychloroquine? Doesn’t that help with overcoming COVID-19 infection?
Dr X: For a while, some
initial studies with it showed promise. Unfortunately, examination of these
initial trials with this drug, indicated that they were conducted in a rather
haphazard manner and the results of the studies were not interpreted in a
scientific manner. More trials were conducted, and at this time, there are very
limited data to support the use of hydroxychloroquine for the treatment or
prevention of COVID-19. Clinical evidence is emerging, but results are
inconclusive. Besides, prolonged use of hydroxychloroquinone (especially in
compromised patients or together with other drugs) has numerous side effects,
some of which are life-threatening. Hydroxychloroquine
is definitely not the wondrous cure for COVID-19 as some very vocal people
are vehemently suggesting – I wonder if these people have shares in drug
companies manufacturing hydroxychloroquine?
Jammy: What about a vaccine against COVID-19?
Dr X: Vaccines are the
standard, safe, cheap and effective way to prevent a whole variety of different
viral diseases, for example: Polio, measles, hepatitis B, rubella. Will a
vaccine be developed as easily for COVID-19 as for the diseases I just
mentioned? The answer is maybe yes,
maybe not. The “maybe yes” comes from the observation that in animal
studies, coronaviruses stimulate strong immune responses, which seem capable of
knocking out the virus. Recovery from COVID-19 may be in large part due to
effective immune response. The “maybe not” comes from evidence just as strong,
at least with earlier SARS and MERS viruses, that natural immunity to these
viruses is short-lived. In fact, some animals can be reinfected with the very
same strain that caused infection in the first place.
Jammy: Some people suggest
that we should not bother with restrictions and precautions and just rely on herd immunity to get us over the
pandemic.
Dr X: Herd immunity occurs when a large portion of a
community (the herd) becomes immune to a disease, making the spread of disease
from person to person unlikely. As a result, the whole
community becomes protected not just those who are immune. Often, a percentage
of the population must be capable of getting a disease in order for it to
spread. This is called a threshold proportion. If the proportion of the population
that is immune to the disease is greater than this threshold, the spread of the
disease will decline. This is known as the herd immunity threshold. What
percentage of a community needs to be immune in order to achieve herd immunity?
It varies from disease to disease. The more contagious a disease is, the
greater the proportion of the population that needs to be immune to the disease
to stop its spread. For example, measles is a highly contagious illness. It is
estimated that 94% of the population must be immune to interrupt the chain of
transmission.
There are some
major problems with relying on community infection to create herd immunity to
the virus that causes COVID-19. First, it isn’t yet clear if infection with the
COVID-19 virus makes a person immune to future infection (as we said, that is
one of the problems with making a protective vaccine against this virus).
Even if
infection with the COVID-19 virus creates long-lasting immunity, a large number
of people would have to become infected to reach the herd immunity threshold.
Experts estimate that in the USA, 70% of the population (i.e., more than 200
million people!) would have to recover
from COVID-19 to halt the epidemic. If many people become sick with COVID-19 at
once, the health care system could quickly become overwhelmed. This amount of
infection could also lead to serious
complications and millions of deaths, especially among older people and
those who have chronic conditions.
Jammy: Oh dear! We are in
a bind… So what can we do?
Dr X: We must slow the spread of the COVID-19 virus
and protect individuals at increased risk of severe illness, including older
adults and people of any age with underlying health conditions. To reduce the
risk of infection we must all:
- Avoid large
events and mass gatherings.
- Avoid close
contact (within about 6 feet, or 2 meters) with anyone who is sick or has
symptoms.
- Stay home as
much as possible and keep distance between yourself and others (within about 6
feet, or 2 meters) if COVID-19 is spreading in your community, especially if
you have a higher risk of serious illness. Keep in mind some people may have
the COVID-19 virus and spread it to others, even if they don’t have symptoms or
don’t know they have COVID-19.
- Wash your hands
often with soap and water for at least 20 seconds, or use an alcohol-based hand
sanitiser that contains at least 60% alcohol.
- Wear a cloth
face covering or face mask in public spaces, such as in shops, where it’s
difficult to avoid close contact with others, especially if you’re in an area
with ongoing community spread. Dispose of the face mask safely in a rubbish
bin.
- Cover your mouth
and nose with your elbow or a tissue when you cough or sneeze. Throw away the
used tissue in a rubbish bin.
- Avoid touching
your eyes, nose and mouth.
- Avoid sharing
dishes, glasses, bedding and other household items if you’re sick.
- Clean and
disinfect high-touch surfaces, such as doorknobs, light switches, electronics
and counters, daily.
- Stay home from
work, school and public areas if you’re sick, unless you’re going to get
medical care. Avoid public transportation, taxis and ride-sharing if you’re
sick.
- Get tested for
COVID-19 if you have symptoms and self-isolate at home until you get the
results.
Jammy: Thank you Dr X,
sound advice indeed!
Dr X: My pleasure. Stay
safe and take care.
