Uniting against our common enemy

The basics of COVID-19: An unprecedented global health crisis | Column by Moon Jae Pak (Spring 2020 issue)

The worldwide pandemic spread of coronavirus has caused infection of a half-million people in the U.S.  at this writing, and caused the death of about four percent of that population.  As this virus has been spreading its destruction globally, scientists from many countries have been working very hard to analyze how the contagion spreads, why it reacts differently in different people, how to treat it, and how to find a vaccine to stop it.

The highly contagious virus is called SARS-CoV-2, and its origin was the city of Wuhan, Hubei Province, China. It was named “severe acute respiratory syndrome coronavirus 2” (the origin of the long acronym) by the International Committee on Taxonomy of Viruses.  It was later named COVID-19 by the World Health Organization. 

It is believed to have emerged from animals in the Wuhan area including bats and snakes. In humans, the virus lives in the upper respiratory tract, mainly in nasopharyngeal area. Despite its being fatal for some people, the majority of those who test positive remain either asymptomatic or minimally symptomatic.

The test to detect the presence of the coronavirus in people is called Reverse Traction-Polymerase Chain Reaction (RT-PCR) and it involves obtaining a swab from the patient’s nasal mucosa.  It usually takes 24 to 48 hours to culture and obtain the result of the test, as it involves waiting for a biochemical reaction.  Aside from recently-developed coronavirus antibody test, the RT-PCR is the only objective measure by which the entire population can be divided into two categories: Positive (infected or suspected infected); and negative —- the lucky population.

Therefore given the pandemic nature of the COVID-19, this RT-PCR has rapidly become a singularly important test, used worldwide on millions of people since the pandemic started. 

It is however very important to remember that the positive RT-PCR does not necessarily prove the person is infected.  Only about 10 percent of those testing positive become symptomatic, and even then, only half of those develop severe pneumonia requiring oxygen and even intubation and help with breathing from a ventilator. 

The rest of the positive population stay asymptomatic, and after about two weeks, some even become RT-PCR negative!  The viral incubation period is known to be about two weeks.  However, positive people, even asymptomatic ones, could become the source of viral spread; this is the crucial importance of quarantine, isolation, separation and home-stay.

Not infecting other people is critically important because there is currently no effective treatment for COVID-19.  In addition, the infectivity of this virus is so high, that geographic separation between the positive and negative people is a crucial matter. Presently, this passive measure of avoiding the spread of infection is the only way to stabilize the coronavirus epidemic which is growing so rapidly.

For mildly symptomatic cases, the treatment options are limited.  These patients should rest, have adequate nutritional support and hydration, use over-the-counter medicines to relieve pain, coughing, and fever.

Severely ill patients who are going into respiratory failure, pneumonia, and hypoxemia, must be hospitalized in an intensive care unit (ICU) where (theoretically) there is quick access to intubation and ventilatory support.  Usually the CT scan of the chest in such cases shows extensively destroyed lung tissue, meaning a poor prognosis for recovery.

So far, none of the proposed treatment measures have been proven effective; one of them is hydroxychlroquine (Plaquenil), a malaria medicine.  Also, there has been some experimentation with the antiviral agent Remdesivir, used in the past in Africa as a treatment for Ebola, and also  Avigan (Favipiravir), used in Japan without proven antiviral efficacy. These are sometimes referred to as drugs used for compassionate treatment, meaning a treatment of last resort.

For COVID-19 or any other viral disease, the most reliable way to eliminate the disease would be the development of a vaccine.  An impressive list of viral diseases have been controlled through a vaccine: Measles, mumps, diphtheria, chicken pox, and malaria are a few of these.  The effort to come up with anti-coronavirus vaccine began early on when the epidemic emerged in late 2019 both in Wuhan, China and in the U.S. Research for a virus has been going on intensively ever since.  One of the products of this research is an experimental vaccine called PittCoVacc, administered by a microneedle prick.  The effectiveness of this vaccine is under study and it is too early to tell if the vaccine will be effective against COVID-19.

Approaches to treat or vaccinate against COVID-19 are proceeding quickly.  The disease is non-discriminatory, knowing no national boundaries, races or political persuasions. It is the enemy of all of us.  Ultimately, for the successful control of this fast-spreading and hitherto unknown disease, it is essential to have full support and participation of everyone on earth.