COVID-19, A Perspective

By Gerrit Van Wyk.

A cure worse than the condition.

In the middle of December 2019, cases of atypical pneumonia causing severe adult respiratory distress syndrome (SARS) started appearing in Wuhan in the Chinese province of Hubei. Dr Li Wenliang, who eventually succumbed to the disease, shared lab reports online, after which the Chinese government severely reprimanded him for spreading rumors.

By mid-January 2020 the disease popped up in Thailand and Japan, and then rapidly spread all over the world. By August 2021, 200 million people, or 2.6% of the world’s population had been infected, and more than 4.4 million, or 1 in 45 of those infected died.

We know a lot about viruses in general and even about coronaviruses, but the SARS-CoV-2 was different, so we had a lot of catching up to do. Viruses are everywhere and play an important role in transmitting genetic material between species, regulating many organisms, and affecting soil and water, and has been around for over 3 billion years. About 8% of human DNA consists of retrovirus fragments that became part of us millions of years ago, and we carry many unidentified viruses in and on us that don’t make us sick.

Viruses are not cells but particles, or virions, and must bind to other cells to hijack their metabolism for reproducing. The virus genome, particularly that of RNA viruses, mutate quicker than human cells, which helps them evade the immune system and survive. They evolved to create symptoms like sneezing, coughing, diarrhea, etc., to spread.

Coronaviruses cause about 15% cases of common cold cases, and two previous epidemics, SARS-CoV-1 and MERS-CoV, jumped from animals to humans, and research shows we can spread the virus back to animals. Coronaviruses have spikes on their surface which helps them bind to cells, and most mutations are of the spike protein which helps them evade immune systems.

We know a lot about the human immune system, but there’s also a lot we don’t know about it. When we encounter a foreign protein, the virus for example, we respond by making chemicals such as cytokine to attract more cells to fight it off. B-lymphocytes produce antibodies binding viruses to keep them from spreading, and some retain a memory to more easily respond if we encounter the same protein again. What makes us sick is not the virus but our body’s response to it. In some people their immune system goes into overdrive for unknown reasons and they become seriously ill or die.

Drugs need the metabolism of cells to work, and since viruses don’t metabolize, there are no drugs to treat them, we treat their effect on the immune system instead. Some drugs like for example Ivermectin work in laboratory tests, but to create similar conditions in humans requires toxic doses hence are of no use. What looks good in theory or in a laboratory often doesn’t work in practice.

Vaccination means giving a vaccine, and immunization creating immunity by giving a vaccine. Vaccines work by making people immune against the disease or reduce the immune response, and by preventing spread. Herd immunity is reached when enough people in a population is immune which prevents the disease from spreading. By presenting a disease-causing agent that’s been weakened, inactivated, or a fragment of it to the immune system, antibodies are created protecting against future infection.

Just like our immune systems respond differently to an infection, we respond differently to vaccination, which means not everyone make antibodies or the same amount. The efficacy of a vaccine means it reduces the risk of infection. For example an 80% efficacy means the risk of getting infected is reduced by 80%, not there’s a 20% chance of getting infected. One of my professors at medical school said drugs without side effects don’t work, hence no drugs are without side effects, which, usually, are so mild it doesn’t bother us. Some drugs can rarely have severe side effects and vaccines are the same. We can respond with no, mild, or rarely, serious side effects like we do to all drugs.

For the COVID-19 disease (SARS-CoV-2 is the virus) two types of vaccines were developed; four based on traditional inactivated viruses, and two of the new RNA technology, which uses an injection of messenger RNA to trick the body into producing the SARS-CoV-2 spike protein, which triggers an immune response to the part of the virus needed to bind to cells. The latter reduced the risk of getting infected by 95% early on.

Another way to prevent an infection from spreading is public health measures. Most infections require close contact, hence can be prevented from spreading to others by avoiding large gatherings, particularly indoors, wearing a mask, keeping your distance, handwashing, etc. The big issue is not getting infected, its keeping people from dying from the infection, which can be done by preventing them from getting infected through immunization or public health measures. Travel rapidly spreads infections widely.

Those are the facts, and we had them, but it didn’t prevent us from making a mess of managing the pandemic. We also had the lessons from 1918 influenza pandemic, 2003 SARS epidemic, and 2012 MERS outbreak, but chose to respond to them with rapid amnesia. Hence when the time came, we were woefully under prepared.

It critically depends on all or most of a population consenting to implementing policies, including vaccination, for them to work, which in turn depends on credible evidence-based measures and clear and consistent messaging, which is where the train derailed.

The initial fear was hospitals would be overrun, and in some cases, they were, but as time went on, the emphasis shifted to case numbers, which has no relationship to admissions. The media obsessively published case rates, or the number of people testing positive for the virus, which created anxiety despite not having any relationship to deaths. The only number that really mattered was the case rate amongst people at risk, which was ignored. We needed to target those at risk from getting seriously ill or dying, instead we targeted everyone which is a terrifically inefficient use of resources. When epidemiological predictions were published, it inevitably emphasized the worst case, and when actual experience turned out differently, people started doubting them. Ninety-seven percent of the world population weren’t infected by the virus and 44 of every 45 infected didn’t die of the disease.

The emphasis on keeping infection rates and deaths low and protect health care systems ignored multiple other issues. It had negative social, economic, educational, political, and environmental consequences which will remain with us for a long time because we didn’t think things through properly at the time.

We didn’t consider the complexity of the issues we were dealing with and acted as if it was a simple problem with simple solutions, there was a massive breakdown of communication and dialogue, of considering multiple viewpoints, cooperation, and sense-making, and learning our way out of the problem. There is a difference between being ignorant and stupid; you are ignorant if you lack intellectual ability and you can’t do anything about it, you are stupid if you have the intellectual ability but hang on to impractical or useless viewpoints and refuse to change them.  

The only way out of a complex mess like this is cooperation, the opposite of what we did. Federal systems like Germany, Switzerland, and Australia responded collectively, in Canada everyone did their own thing based on political opportunism. Our scientists, epidemiologists, and policy makers should have done the same thing and shared their knowledge and perspectives, but they didn’t. Instead, we acted stupidly.