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On the Pandemic: A layman's view

 

On the Pandemic: A layman’s view

 

 

Aesop

April 05, 2020

 

A new (novel) pandemic (Greek for pan=all and demos=people) disease (COVID-19) is here. Thanks to the cheap and fast travel globalization gifted us, we’re now exposed to a pandemic. It is high time for everyone (mostly lay people like me) to meet our competitors. Here’s my (a layman’s) take.

When the savannah emerged because of the cooling planet 4-7 million years ago, our ancestors altered their behavior. They realized it was time to abandon their arboreal lifestyle and descend to the ground (Fluery 2011). That was the first time they came in close contact with their microbe (unseen) competitors. Today, we know there are about a million microbe species. Out of these, some 1,415 cause us (humans) disease (Bryson 2019).

The Australopithecus encountered most microbes on the soil when he started walking. He met microbes when he began hunting and gathering. Our ancestors encountered microbes but did not see them. They only felt something else is altering their homeostasis. But they survived because they were few and far apart. The total number of our ancestors during the Neolithic age was so small that microbes could not infect the entire population. Our species was estimated to have been 5 million during the Neolithic age. One tribe might perish because of (maybe) smallpox microbes but the next tribe will neither know nor catch it because it never had contact with it. Microbes caused epidemic, not pandemic. Besides, some of our ancestors started using fire around 300,000 years ago (Harari, 2014). They evaded lethal microbes by cooking their game before consumption. But this safety would change around 10,000 years ago due to agriculture.

The agricultural revolution started 10,000 years ago. Human beings retired from the uncertain livelihood of hunting and gathering. They domesticated edible crops plants and animals. We began storing grains for rainy days. The agricultural surplus boosted the population and brought trade. Agriculture created empires (governments) and cities. The increasing population growth, population density, and food surplus attracted competitors. Our oldest microbe competitors like smallpox, typhus, plague (bubonic/lymphatic system, pneumonic/lung, septicemic/blood), syphilis, scarlet fever, and others flourished in cities (Fluery 2011).

In his classic book Guns, Germs, and Steel, Jared Diamond (1997) came up with four strategies microbes employ to win natural selection. I like to sum them as: stalking, hitchhiking, influencing, and ambushing. Microbes stalk us by residing in dead animals we are about to eat raw, i.e., without frying or boiling. Others hitchhike on the saliva of mosquitoes, fleas, lice, or the tsetse fly to give us malaria, plague, typhus, and sleeping sickness in order. Other microbes modify our behavior. There are four examples. Smallpox blisters our skin to reach out (infect) others. Coronavirus, influenza, common cold and pertussis force us to cough and/or sneeze so clouds of them may be launched as projectiles to other victims. Cholera induces massive diarrhea hoping to catch people using similar sewage or water supply system. And, rabies forces its victims to engage in a biting frenzy to spread them. But not all microbes are so crafty. The hookworm and schistosomes physically ambush their victims in water or soil and burrow into their skin.       

Human beings might be (arguably) the most intelligent species on this planet. But intelligence is one factor in the struggle for survival. Some are too fast, others too strong. But microbes are invisible to us. Microbes are measured using microns. 1mm is 1000 microns. The COVID is so small that a bunch is said to travel in droplets that are 5 microns (0.0002 inches in diameter). That is why the N-95 mask is effective against it. Any mask whose pores are above 5 microns is less effective. In any case, microbes are invisible to our eyes. Beyond this, microbes have enormous ability to copy their cells (reproduce) in a short amount of time. A typical bacterium (length between 0.25-5 microns and weighing one trillionth of a dollar bill) replicates once before its lifespan is over in 20 minutes (Bryson 2019). E. coli reproduces 72 times in 1 day. Viruses (discovered in 1900) are much smaller than bacteria and replicate even faster. This thought experiment helps us understand how small a virus is. If one could scale up the virus to be as big as a tennis ball and applies the same scale to an average human being, that human being will be five hundred miles tall (Bryson 2019). The same goes for virus replication. The 1918 flu virus is said to have released 100,000 to 1 million new flu viruses in the infected body within 10 hours (Fluery 2011). However, viruses only replicate when they reside in living cells. This is what microbes bring to the stage: invisibility and replicability. They overwhelm us before we could detect them.

It took us over 196,000 years to detect microbes. The Homo sapiens (presumably, knowing things) emerged 200,000 years ago. But it was only in 1723AD (over 196,000 years later) that Antonie van Leeuwenhoek (a Dutch) introduced microorganisms (bacteria) to the world (Kruif 1926/1854). Harari (2015) summarized how human beings understood diseases before the 18th Century.

Until the modern era, humans blamed diseases on bad air, malicious demons and angry gods, and did not suspect the existence of bacteria and viruses. People readily believed in angels and fairies, but they could not imagine that a tiny flea or a single drop of water might contain an entire armada of deadly predators (Harari, 2015, p.7).

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Leeuwenhoek crafted a microscope that allowed him to see our species’ greatest competitors: micro-organisms. But Leeuwenhoek (father of microbiology) did not know how microbes behaved. There would be people like Pasteur (father of fermentation), Koch (father of detective microbiology), Semmelweis (father of germ theory) and others who would not only unveil them but also prove microbes are our fiercest competitors for survival in this world (Kruif 1926/1854). It would take almost 200 years before another Dutch botanist, Martinus Beijerinck, discovered viruses (which he named after toxic for Latin) in tobacco plants in 1900 (Bryson 2019).

At this point, it is important to see what microbes did to us until we recognized they existed and started fighting them. Microbes dictated the course of our history. They determined how many people died, which leaders fell sick, and which empires crumbled. Had the plague (from Ethiopia) not spread in Athens and killed Pericles, Athens would not have fallen (Fluery 2011). There would have been no Macedonia. The death of Marcus Aurelius (Rome’s emperor), Peter the Great (who died from gangrene bacteria), and Louis XV due to microbes altered the course of history (Oldston 2010). The Japanese and Chinese emperors also died when the Black Death washed out Europeans in the 15th Century. The conquest of North and South America was facilitated by germs. It is said that European germs wiped out 95 percent of the Native American population (Diamond 1997). Microbes also influenced American history (Oldston 2010). George Washington and Abraham Lincoln are said to have caught smallpox during tough times. Napoleon sold Middle America to Jefferson because he was alarmed watching his troops die from yellow fever in Haiti. The Louisiana purchase made America the superpower that it is today. In the mid-1860s, Lincoln was put on bed rest after delivering the famous Gettysburg speech amidst the American civil-war because he caught smallpox (Oldston 2010). F.D. Roosevelt was confined to a wheelchair because he caught polio, etc. Microbes don’t care about one’s status in life. We are prey, i.e., just food and shelter to them.   

The discovery of microbes, albeit too late, also buried superstition. People believed evil spirits, cosmic alignments, and imbalanced body fluids caused death before these little beasts came to light. That is why Pope Gregory declared all Christians must say “bless you!” when a person sneezes in the aftermath of the Black Death. People thought the devil is always waiting to pounce on people’s souls (Fluery 2011). They thought the soul leaves the body temporarily when people sneeze. If someone doesn’t catch the moment and say: “bless you!” the devil could overtake it and cause havoc. Another prejudice has to do with star alignments. Ancients thought the state of the moon, the sun, and other stars affected our fluids. That’s why they came up with the name: influenza (which means the influence of) (Fluery 2011). Other misbeliefs like Malaria (bad area) etc. spring from ancient prejudice. It was after Spalanzanni declared microbes don’t generate spontaneously (rejecting Aristotle) out of non-living objects (they procreate like us) and Pasteur (and others) showed some of them are quite dangerous (unless we fight them) that advanced countries created new fields of microbiology, virology, and others (Kruif 1926/1854). It was after mankind got rid of his prejudice that he started making vaccines.

But microbes fought these vaccines through adaptation and even destruction. Penicillin (kills and maims bacteria) and, later Tetracycline were deemed miracle drugs until microbes developed resistance in the 1980s (Fluery 2011). The most effective solution to this problem turned out to be microbes themselves. Pioneers like Pasteur began to notice that injecting a weak and small number of microbes into a healthy system trains the immune system to devise an effective strategy to destroy them (Kruif 1926/1854). Once the immune system learns how to defeat the microbes stronger and numerous microbes will have no fighting chance. The other discovery pioneers made instigating civil war among microbes themselves. The microbe world is a brutal place of endless civil war. Different species of microbes destroy each other as they compete for resources to survive. This turned out to be helpful for us. It is said 90 percent (90 trillion) of the cells in our bodies are microbe cells (Fluery 2011). Some give us 10% of our calories and extract vitamin B2 and B12 from foods we can’t digest (Bryson 2019). Human cells constitute only 10 percent (10 trillion). We, human beings, are, after all, big caves hosting 40,000 species of microbes (including 174 species of the virus) in our body (Bryson 2019). So, when invader microbes enter our body, microbes residing in our body based on positive symbiotic relation (mutual or a neutral rather than parasitic) fight them tooth and nail. There are 900 species of microbes in our nostrils alone. This outcome has been successful or devastating depending on the strength of the invading microbes and our combined effort (immune system, internal microbe effectiveness, and ability to create vaccines) to fight them. But one certain thing is this: our species is in a tough struggle for survival against microbes. Whoever adapts quickly wins.

The COVID-19 is a new edition of the Coronavirus family. They are called “corona” because they are surrounded by spikey protein shields that make them look like crowns (WHO, 2020). The COVID is hardly a living organism. Bryson’s (2019) vivid description of virus (from a layman’s vantage) is worth quoting:

A VIRUS, IN the immortal words of the British Nobel laureate Peter Medawar, is “a piece of bad news wrapped up in a protein.” Actually, a lot of viruses are not bad news at all, at least not to humans. Viruses are a little weird, not quite living but by no means dead. Outside living cells, they are just inert things. They don’t eat or breathe or do much of anything. They have no means of locomotion. We must go out and collect them—off door handles or handshakes or drawn in with the air we breathe. They do not propel themselves; they hitchhike. Most of the time, they are as lifeless as a mote of dust but put them into a living cell, and they will burst into animate existence and reproduce as furiously as any living thing (Bryson, 2019, p. 31-32).

 

That is why washing hands using soap for over 20 seconds helps. When we rub our hands, we are peeling off the “protein wrapping” the virus uses as a shield to hide its “bad news”. In 1989 British researchers experimented by making a volunteer secret an artificial fluid from his nostrils. But this fluid was only visible via ultraviolet lights. The volunteer socialized in a cocktail party with other volunteers. When the party ended and the ultraviolet light was on, the dye was everywhere. “The average adult is said to touch her/his face 16 times an hour, and each of those touches transferred the pretend pathogen from nose to snack…to doorknob...and so on until pretty much everyone and everything bore a festive glow of imaginary snot” (Bryson, 2019, p. 34). This experiment shows why washing hands regularly and social distancing is critical to prevent the spread of COVID-19. When a person already infected with COVID-19 sneezes, these spiky microbes use the droplets as a fast jet to fly and land on another person’s nose, eye, or hand. A sneeze or cough droplets are said to travel up to 1 meter (WHO, 2020) before falling to the ground only to be picked by someone touching that floor etc., etc., (see figure below).

Source: Xu, Luo, Yu, and Cao (2020, p. 3)

Once COVID-19 finds its way to a person’s mouth or nose, it goes straight to his lung, stomach, or spleen (Watch NMN, 2020; Kurzgesagt, 2020). Once it encounters the lung tissue, it uses the spike to pinch the cell and transfer a DNA code that alters the cells normal function. In other words, COVID-19 tells our cells to replicate the virus abundantly. When this happens the body panics. The immune system declares war. One of the tactics our body uses is to raise our temperature by a few degrees. This is meant to annihilate the microbes while making our body vulnerable to organ/tissue damage, delirium, or even death. That is why the fever is one symptom of COVID-19 (body trying to fight). Some immune system forces specialize in killing the infected cells. Others force infected cells to execute suicide. But the chaos disables our immune system’s ability to make a surgical attack. They start killing everything, including our healthy cells. As a result, our organs, especially our lung, becomes a graveyard filled with fluid. A person at this stage needs a ventilator to inhale oxygen and exhale CO2 because his alveoli are flooded. If our body continues to submit, COVID-19 enters the bloodstream. This is the final stage. Once COVID-19 enters the bloodstream it kills the patient (Watch NMM, 2020; Kurzgesagt, 2020).

This new microbe is novel (new). We found out about it some four months ago when it started killing people in Wuhan, China. So, researchers are still learning about it. The best-case scenario for creating vaccines will be after 18 months. Even after the vaccine is made, there will be challenges of priority (who gets treated first), finance (who can afford it), and logistics (who can get it fast). That is why Korean researchers are trying to see if vaccines used to treat other diseases could probably be used against COVID-19 (Park, 2020). Repurposing drugs is not new. Viagra, for example, is used to treat erectile dysfunction. But it was created to treat blood pressure. But repurposing is also a long shot. Therefore, the only option left is behavior. People must alter their behavior lest they infect others or be infected by the virus. That is where the government meets science.

Effective governments, namely, those experienced in planning big projects, deploying resources, and mobilizing their people have a better fighting chance than those who can’t. Of course, demography helps at this stage. Governments that have an aging population face bigger obstacles than governments managing a youth bulge. Until recently, youth bulge used to be a threat to political stability. But today it means more people will probably catch mild COVID-19 infection and recover quickly because young people have resilient immune system. That is what happened in China. 2.8% of confirmed COVID-19 cases died in China. The majority (14.8%) were over 80 and the minority 0.2% percent were between 10 and 39 years old (Begley, 2020). African countries (including Ethiopia) have a better fighting chance in this aspect. However, the government’s ability to alter social behavior and put in place the logistical support needed to detect and treat people is the determinant factor. That is why governments that played a central role in economic affairs are recovering quickly that governments that applied hands-off policies.

Governments that played an active role in mobilizing their people for development gained invaluable experience in crafting strategies, deploying resources, and make adaptations by assessing the feedback from real-world experience. That is why certain East Asian countries have controlled the pandemic swiftly. Legido-Quigley et. al. (2020) outline nine concerns and responses Hong Kong, Singapore and Japan health systems applied to contain COVID-19.

·       Surveillance: Identification, testing, travel restrictions of people from China, EU

·       Intragovernmental coordination: drawing on experience with epidemics

·       Financing measures: direct cost (treating patients): healthcare is free in Singapore, the government provides routine financing in Hong Kong, Japan.

·       Planning: to sustain routine health care-services: Japan had a shortage of hospitals; Singapore had difficulty reaching the private sector. In all countries intensive care unit bed capacity was limited.

·       Supply: There were critical care treatment and medicines for COVID patients. But there were concerns over personal protective equipment (PPE) in hospitals, facemask in community. 

·       Training: infection prevention and control measures. Health care staff was stretched in all countries.

·       Management of Information Systems: Timely, accurate and transparent communication. Daily meetings between Regional Health System Managers, hospital leaders, and the Ministry of health. Doctors have WhatsApp and Telegram groups to share logistics and clinical information. Authorities use websites to debunk misinformation.

·       Political environment: Dictates public trust (a problem for Hong Kong). Rumors trigger panic purchasing.

By contrast, governments that delegate everything to the private sector have no option but to rely on the private sector to shoulder the social burden. But private sectors are designed to profit. They rarely prioritize corporate social responsibility. That is why countries not having free health care systems are finding it difficult to treat patients during the pandemic. As Ceukelarie and Bodini (2020) put it:

In many countries across the globe, public state-funded and government-run health systems have been gradually dismantled. Privatization has affected their ability to coordinate large-scale preventive campaigns, limited their capacity to expand curative services in crisis situations while eroding the broad public’s confidence in the health system as a whole.

For example, in order to apply effective contact tracing, a fine-grained health system with an expanded first line is imperative. China has been able to mobilize thousands of health workers in the efforts to track down the contacts of infected individuals. In the US, where primary health care is weak and the health system is highly dependent on secondary and tertiary care, large-scale contact tracing is almost impossible (2020, p.2).

Governments unable or unwilling to monitor their economy don’t have the clout to ensure enough ventilators, ambulances, and other medical supply needs to get to those who need them the most. A pandemic, like poverty, needs a strong government.

In sum, it is ripe time for all of us to revisit our cognitive biases and realize what we see is not all there is (Kahneman 2011). They need to forge solidarity against their greatest enemy: bad microbes. There are little beasts that want to wipe our species out of existence. The little beasts have devised a better technique to evade us, enter our system, spread fast and wreck-havoc before we could create vaccines. The forecasted death toll in advanced countries is too dark to convey. One can only imagine the implications for less advanced countries. The only solution to this pandemic is an effective government. Governments that have experience in the fight against poverty and other problems (like previous pandemics of SARS in East Asia) have a better fighting chance than those who prefer to delegate everything to the private sector. The hope in climate, vaccines, and other magic bullets is far-fetched to ponder at this stage. The only option is altering social behavior. Effective governments play a decisive role in shaping social behavior and contain the spread of COVID-19.  

NB: Not a formal research paper. Not claiming any expertise. Just using reference in case anyone wonders where the numbers came from or wants to read further!

 

Works Cited

 

Begley, Sharon. 2020. "Who is getting sick, and how sick? A breakdown of coronavirus risk by demographic factors." STAT. March 3. Accessed April 4, 2020. https://www.statnews.com/2020/03/03/who-is-getting-sick-and-how-sick-a-breakdown-of-coronavirus-risk-by-demographic-factors/.

Bryson, Bill. 2019. The Body: A Guide For Occupants. New York: Penguin Random House LLC.

Ceukelaire, Wim De, and Chiara Bodini. 2020. "We Need Strong Public Health Care to Contain the Global Corona Pandemic." International Journal of Health Services 1-2.

Diamond, Jared. 1997. Guns, Germs, and Steel. New York: W.W. Norton & Company.

Fluery, Bruce E. 2011. Mysteries of the Microscopic World. Virginia: The Great Courses.

Harari, Yuval Noah. 2015. Homo Deus: A Brief History of Tommorow . New York: Harper Collins.

—. 2014. Sapiens: A Brief History of Humankind. New York: Harper Collins.

Kahneman, Daniel. 2011. Thinking Fast And Slow. New York: Farrar, Straus, and Giroux.

Kruif, Paul de. 1926/1854. Micobe Hunters. New York: A Harvest/HBJ Book.

Kurzgesagt. 2020. "The Coronavirus Explained & What You Should Do." You Tube. March 19. Accessed April 4, 2020. https://www.youtube.com/watch?v=BtN-goy9VOY.

Legido-Quigley, Helena, Nima Asgari, Yik Ying Teo, Gabriel M Leung, Hitoshi Oshitani, Keiji Fukunda, Alex R Cook, Li Yang Hsu, Kenji Shibuya, and David Heyman. 2020. "Are high-performing health systems resilient against the COVID-19 epidemic?" The Lancet. March 6. Accessed March 29, 2020. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30551-1/fulltext.

NMM. 2020. "COVID-19 Animation: What Happens If You Get Coronavirus? Nucleus Medical Media." You Tube. March 28. Accessed April 3, 2020. https://www.youtube.com/watch?v=5DGwOJXSxqg.

Oldston, Michael B. 2010. Viruses, plagues, and history: Past, present and future. Oxford: Oxford University Press.

Park, Steven. 2020. "You Need To Listen To This Leading COVID-19 Expert From South Korea | ASIAN BOSS." You Tube. March 27. Accessed April 3, 2020. https://www.youtube.com/watch?v=gAk7aX5hksU.

WHO. 2020. "WHO Novel coronavirus (2019-nCoV) ." You Tube. January 31. Accessed April 4, 2020. https://www.youtube.com/watch?time_continue=39&v=mOV1aBVYKGA&feature=emb_logo.

Xu, Chunwen, Xilian Luo, Chuck Lu, and Shi-Jie Cao. 2020. "The 2019-nCoV epidemic control strategies and future challenges of building healthy smart cities." Indoor and Built Environment 1-6.

 

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