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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 Vietnam's health ministry says there have been a total of 174 confirmed cases and no deaths 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 outside, catching a related less dangerous virus first, stop smoking, boosting old peoples immune systems etc.

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. 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 to just sit indoors and wait for a vaccine, that might be the worst thing to do ! 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 with 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 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 retirees losing a few years off their pensions and annuity payments 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 it a home to trash. So, in perspective, the current novel Coronavirus is a mild, sub-clinical infection in most people and it is possible to avoid infection - this 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. 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 die from the even nastier dementia and or cancer which are the two commonest causes of death in the UK? The cost of the cure must be less than the cost of the infection or why bother ?

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 and normally needs to be taken to one's eyes, nose or mouth on a grubby finger. If you are outside exercising alone in sunshine in fresh air, you cannot catch the virus. Exercise will also increase production of mucus in your lungs and then your lungs and trachea will wash yourself and little whipping cilia will 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 in crowded air-conditioned offices or homes are asking for infection. 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 '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. 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.

Avoiding serious infection

Each of us normally has an awesome immune system better than all pharmaceutical companies put together with standard constant immune responses and an adaptive immune system that can identify and optimise antibodies in less than two weeks normally. The point is that 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. 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. 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. 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 or years or bats and humans sharing caves, getting eaten and, even today, 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.

Treatments after infection

Most people do not need any medicine or treatments of any kind but there are some being developed. Everyone expects that the virus will not be important next year so all the direct economic effects of government responses will be finished by then.

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 are 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 countries are generally not well run but looking at the rates of death from Covid-19, they appear to be doing astonishingly well. 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 ? 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 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 being swamped by Covid-19 cases when it has millions of potentially infected Chinese visitors, relatively poor health infrastructure and 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 father.
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