Mitigating Covid-19 Infections

Just some information, a few observations and a paradox concerning the rates of Covid-19 (novel Coronavirus) infections in different countries and people of different ages. I have a degree in Microbiology and a PhD. in Medicine but I am no expert here - I am just asking questions on Saturday 28th March 2020. My last job was in a rich-country Immunology department but I have spent a few years travelling in poorer countries and The Brazilian President quipped that Covid-19 is a rich-person's disease. Today, The UK has announced over 1000 deaths whilst, by contrast, Vietnam's health ministry says that there have been zero deaths though a total of 174 confirmed cases there. I wonder if simple additional mitigation measures might already be available? Possible ideas might be: turning off air-conditioning, riding a bicycle to work, staying warm, exercising and living outside, catching a related less dangerous virus first, stopping smoking, getting a long sleep, eating more (or starving), and boosting old peoples immune systems with vitamins etc. but I have no data to test these ideas. Understanding why young people are not dying from this virus would be great and might be transferrable easily but learning that someone who is old and sick from many diseases already and might die soon is natural and not news. People who have had Covid-19 and recovered can work in hospitals and supermarkets protecting others. If we just had a cheap reliable test, everyone could take it on one day and then there would be nowhere for the virus to hide and everyone would stop panicking chasing ghosts that they cannot see.

Background knowledge of SARS-CoV-2 and the Covid-19 Pandemic

To see the paradox, one must first collect the data and understand or model the expected rates of infection, sickness, reporting biases and deaths. The BBC has some numbers for where we are with the pandemic today. Here is some background information that you have probably heard already:

As Douglas Adams and the UK Government might say: Don't panic, keep calm and carry on. We do not need just to sit indoors and wait for a vaccine, that might be the worst thing to do ! Sweden is not panicking. Sweden does not have a lockdown. Realise that this is natural, normal and we will all die anyway and it used to be much worse when half of all children would die under the age of five in the UK (in the late Victorian era) due to poor overcrowded housing so there is no need to destroy the global economy or buy a year's supply of toilet roll so wake up, smell the flowers and count your blessings but know this SARS-CoV-2 virus is not directly an economic threat to any country - even the weakest. The UK created the greatest empire that the World has ever known when those children were dying from those forgotten simple infections and, by contrast, sick retirees now losing a few years off their pensions and annuity payments actually only helps rich economies. Also, this is not an intelligent alien invasion, instead the virus is a dumb, stupid accident that does not want to kill you or anyone else: it is just a bunch of chemicals that can reproduce and spread if you give them a nice home to invade and trash. So, in perspective, the current novel Coronavirus is a mild cold or sub-clinical infection in most people and it is possible to avoid infection - this particular virus is full of weaknesses (others might be much worse). Only government reactions to the virus can cause any serious economic damage.

The dead and the nearly dead are the most vulnerable people in any society and deserve respect and love but not at the cost of the productive, creative, happy living people. Health care for young people is wonderful and a great investment. If six hundred thousand people normally die each year in the UK, I wonder why we are aiming to keep deaths amongst the sickest, nearest-to-death people in the UK below twenty thousand just so they can then later die from the even nastier diseases of dementia and or cancer which are currently the two commonest causes of death in the UK? The total overall cost of the cure must be less than the cost of the infection or why bother ? Histogram of Covid-19 death rates by age, sex, and prior disease

Avoiding the virus

From basic physics and chemistry, the novel Coronavirus, SARS-CoV-2, can be destroyed or rendered non-infective outside your body by:

It can also be mechanically filtered out of the air by full NBC gas masks or blown away by any breeze and normally needs to be directly transported into one's eyes, nose or mouth on a grubby finger. If you are outside exercising in sunshine in fresh air, you cannot catch the virus. British police can be stupid about this. Exercise will also increase production of mucus in your lungs and then your lungs and trachea will wash yourself from the inside as little whipping cilia will pump and push the cleaning mucus up and out of your lungs where you can spit it into a tissue. It may be that almost no one who cycles for a living ever catches the serious version of this disease ? It would be good to get the data? People who work, travel or live in crowded air-conditioned offices, trains, buses or homes are ripe for infection - especially in hospitals. However, even Singapore which almost worships the air-conditioner, has managed to suppress Covid-19. Indeed, we need a success to know what works and what is the minimum necessary for mitigation. Singapore has been a success but they usually only trace people who have been close with the infected person for over 10 minutes. In this BBC article, Coronavirus: The detectives racing to contain the virus in Singapore , it says: 'There was no interest in someone I had brushed shoulders with even if it was someone that I knew. They were looking for people I had spent some amount of time with.' Officials were looking for close contacts, typically someone who spent more than 30 minutes with the infected person, within a 2m space. Getting angry with a family walking in a park or sat on a sunny beach with a sea breeze is a crazy over-reaction or worse ? UK supermarkets certainly spread panic if they close or limit access but probably do nothing good relative to other risks or cause people to go to a few other specialised shops instead.

The virus needs a living chain of fresh uninfected hosts and does not persist on most surfaces for long. Any time social distancing or self-isolation breaks the chain, the virus spread is halted forever and the same is true with herd immunity once most people have antibodies and cannot be infected so there are reasons for optimism. The virus naturally fades away when people are resistant or isolated. Germany and The Netherlands recommend keeping 1.5 metres apart when meeting people but the UK recommends even further: 2 metres. Both distances are just guides. Infectious diseases on aircraft are typically found to carry a few seats forward, back or to the side but that is a sealed pressurised tube without much fresh air where people sit as close together as possible for over 10 hours - the opposite of being on a beach or even passing in a supermarket! Apparently, when the ventilation was turned off for four hours on an stationary airliner carrying an influenza patient, 72% of the passengers became infected by the end of the delayed flight ! Ships are also notorious for lack of fresh air: especially warships without windows. One French warship quickly had over 1000 infections but no one died because the patients were not sick and old. It seems that being a woman helps not catch the virus and even two people living very close or intimate lives does not always allow it to spread - there might be a simple reason for the protection and it would be nice to know how? Men do have larger lungs both in absolute and relative to body mass and score higher in almost all risk-taking behaviours except cigarette smoking so it might be that simple or to do with immune gene expression from the X chromosome. Another issue is that someone might be infected but not actually contagious for most of the infection period and children might be infected but show fewer symptoms. Simple physics explains how the virus concentration would be thousands of times higher close to someone's face and breath. Government advice is trying to prevent community spreading too rapidly. However, the home might be the place where most of us catch this virus because of the lockdown, the proximity, the length of time together and the recycled indoor air. Changing from public transport to electric bicycle transport is simple and healthy.

Avoiding serious infection

Each of us normally has an awesome immune system better than all pharmaceutical companies put together with both a standard constant immune response and also an adaptive immune system that can identify and optimise antibodies to recognise and fight invading pathogens in less than two weeks normally. However, the best advice that you will always hear for everyone who is sick is take a rest and get your sleep. Sleep is almost free and getting over 7 hours (or even 10 when sick) will help reduce the seriousness of many infections. Apparently, our bodies have very strong daily cycles and even a simple skin cut is healed three times faster if it occurs during the daytime (when manual labour makes scratches common) whilst, by contrast, antibody production and many body repairs take place during sleep. The point is that, even after infection, everyone is absolutely fine normally but if one is old (going to die soon anyway), immunocomprised or recently was infected by an influenza virus, then, in those special cases, the person becomes vulnerable. Even older people are not normally killed by the virus but some people with pre-existing heart conditions or diabetes are especially vulnerable. In the north-eastern Italian city of Rimini a man aged 101, identified publicly as only "Mr P", was released from hospital on Thursday after being admitted last week and testing positive for Covid-19. Spain and Italy are rich countries with good pensions, weather, family structures and healthcare so they kept many old people alive, healthy and happy longer than most countries ever could but nature still cares more about genes and DNA more than individuals who are supposed to die so this virus is having a shocking effect there.

I would guess that the location of the original site of infection matters and the dose definitely matters. Covid-19 seems to be two different diseases: a mild upper respiratory tract infection for most people and a deadly pneumonia for old people with pre-existing medical conditions. In one Italian study, 99% of those who died had at least one pre-existing medical condition, half had three diseases already before Covid-19. Infective doses matter - especially with gut infections - so getting a faceful of virus deep into ones lungs like a certain heroic Chinese ophthalmologist probably got from a patient, is probably the worst thing, the one to avoid. We should protect medical staff from heavy infections deep into the lungs but maybe, by contrast, small infection doses with less virulent strains in the most active immune system protected tissues actively protects patients ? The old original bat coronavirus is 96% identical with SARS-CoV-2 at the protein level but may never have infected or spread between humans despite: thousands of years of bats and humans sharing caves, getting eaten and, even today, and sweeping up bat poo regularly for transport to market and sale as fertiliser. I would imagine that just like Jenner published how infection with Cowpox virus protects against Smallpox infections, other Coronavirus infections might protect against Covid-19. Were there any people in Wuhan who really were exposed to bat poo etc. regularly ? It would be fascinating to know if they became sick at the same rates as those less exposed to bat guano ? Some people will always be genetically resistant to infection but they might be in a minority. Bill Gates wrote a column to try to help people understand the virus but his real help was a few years earlier.

Economic Dangers

Many people worry about the cost of fighting the disease being too high - especially the debt to be paid by the children. Michael Burry gave a strong case to Bloomberg about the economic damage being caused by the government responses, not the virus.

Open air hospital photograph treating 1918 influenza patients in sunshine and fresh air

Treatments after infection

Most people do not need any medicine or treatments of any kind but there are some being developed and the UK death rate is estimated to be 0.5% and should fall as treatments are discovered but testing has been unclear so far. Each recovered patient can donate their blood plasma which should contain antibodies to fight infections in the plasma recipient. Each recovered patient can have their immune system memory cells read to discover which antibodies were being made and these can be copied and manufactured. BAT have already started with human antibodies being made in tobacco plants.

Everyone expects that the virus will not be important next year so all the direct economic effects of government responses should be finished by then. The journal Nature is providing a virus research update showing possible targets..

Paradox of the Poor Countries

World map showing a green band over Europe and North America show where easiest for Covid-19 to spread

From meteorological data, it appears that the virus spreads most easily in cool temperate humid climates like those shown in the green band in the map above which cover Europe and North America. The large wide red band covers areas which are too hot or dry to favour the spread of the virus. Maybe there is something about the climate or the relative poverty of people in Cambodia, Thailand, Vietnam and even the Philippines which helps protect the locals despite strong connections to both China and The USA which were the two most badly affected countries at different times ? Vietnam had many early infections but the disease has not spread much. Vietnamese people are smart, disciplined and their government controls everything but the people are still poor with basic healthcare. Cambodia even allowed a cruise ship to dock when it had been refused by every other country out of fear of infection and the president himself even went down to the dock area to wave as the passengers disembarked. Only a single passenger was ever found to be infected and then only after they had already left Cambodia and travelled through Kuala Lumpur in Malaysia?

These poorer countries are generally not well run but when looking at the rates of death from Covid-19, they appear to be doing astonishingly well. However, Vietnam is trying a full lockdown now as a single infected airline pilot in a bar was unlucky enough to give the disease to 13 others in District 2 in the biggest city Saigon which is full of air-conditioners. Is it just warm sunny weather enouraging an outdoor life in the fresh air? Are they not testing or actively hiding results - maybe slightly but I think it is also a real effect - the virus is not spreading so well there ? An official Vietnamese government teacher friend in Vietnam is sure that it was the tight government control that was effective and important for the virus control. Thailand is a well-run middle-income country that also has low levels of death from Covid-19. It certainly seems that Indians can be infected easily and it is just relative isolation that protected them initially. The UK has been slow to get both antigen and antibody testing scaled up and health workers are very worried about ineffective protective clothing but we do have good researchers and the virus is a static target.

The Philippines is a remarkably beautiful country made up of over 7000 islands with many surrounded by calm turquoise waters, beautiful corals, iridescent giant clams, tropical fish and brightly coloured sponges and even lavender and pink starfish! The local people are unusually friendly, kind, sociable, fun-loving and speak English so it is a great country to visit as a tourist and the Chinese and Americans visit in the millions. I also recently spent a few months there exploring the natural beauty and trying to let people know how cheap solar power has become recently: cheaper than any other electricity in the Philippines.

Unfortunately, The Philippines is definitely not all Paradise because there are problems with corruption, pollution, congestion, poverty, poor town planning, electricity production and reliability, and also with healthcare. Vaccination is a wonderful cheap safe way to protect people against infectious diseases but, in The Philippines, the live attenuated Polio vaccine can pass through a vaccinated child and emerge as live infectious Polio virus into polluted rivers and water sources which then infect other vulnerable Philippinos with a full Polio disease. Better, normal standard sewage treatment should prevent this completely. So the Philippines should be both rich and beautiful but is not currently and it is facing a special threat from the novel Coronavirus that causes the Covid-19 disease. It might appear surprising and paradoxical that The Philippines which struggles to prevent diseases that almost every other country on the Earth can manage is now apparently not yet being swamped by Covid-19 cases when it has millions of potentially infected Chinese visitors, relatively poor health infrastructure, cronyism and coruption ?

Chinese in The Philippines Links

The Covid-19 epidemic started in Wuhan, China, a country of 1.4 billion people. China has become a middle-income country and they generate huge numbers of tourists and business emmigration with tens of millions flying to neighbouring countries or farther. It is sad that the authorities in China, especially Wuhan were slow responding to this novel disease. China has global responsibilities now but the Chinese people cannot control their own government. Many recent diseases have started in China and maybe they will trade less in wild virus-infested animals in future. One kind Chinese friend of mine sent me a free care package of hundreds of surgical face masks to help protect me and my sisters family.
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