IS THE COVID19 VIRUS REALLY WEAKENING ?

What follows is the perspective of a doctor practicing on the front-lines in the health capital of the world…

It's natural to want to hear good news at a time like this, but one needs to be wary about the potential implications of the same, especially if it is not verified. One of these so-called "good" news that has surfaced recently is that "the virus has begun to weaken". So, let's break it down - what was the source of such news; what was the expert's consensus; how does it relate to the current scenario; and what are its potential implications.

It all started, when Alberto Zangrillo, the head of the San Raffaele Hospital in Milan, made the following statement "In reality, the virus clinically no longer exists in Italy". This outrageously confident statement was based on a study that was done with a very small and skewed sample. His exact words on the findings - "The swabs that were performed over the last 10 days showed a viral load in quantitative terms that was absolutely infinitesimal compared to the ones carried out a month or two months ago".

The statements prompted a sharp rebuke within no time, not only from experts all over the globe, but also from Italy's top health advisor to the supreme health council, Mr. Franco Locatelli. He was quick to respond on national media that such a view is neither shared by experts nor by governments at large - "I can only express great surprise and absolute bewilderment for the statements made by Professor Zangrillo. Just look at the number of new cases confirmed every day to have evidence of the persistent circulation of the virus in Italy”.

 But let's take a step back and analyse on the basis of historical facts, evolutionary design, ground experience, and above all - just out right logic. As an emergency & primary care physician practising on the frontlines in a city like Chennai (Tamil Nadu, India) which is reporting some of the highest number of new cases per day in the country, my opinion on the topic is quite split. I am definitely seeing a lot more cases than I used to a couple of months back, but the amount of critical cases in our vicinity of our care still remains the same. I have heard similar opinions from more than 20 medical colleagues from across the city. so I have decided to offer two unique points of view to try and explain the paradox of the exponential increase in cases on one side and a not so "proportionate" increase in fatalities on the other.

 THEORY 1 - SURVIVAL OF THE FITTEST (In this case, the Smartest)

One of the golden rules in virology, quite emphasized at the beginning of nearly any chapter on genetics and microbiology, is that "Viruses that circulate in a community, tend to change and mutate over time". The reason is quite fascinating, yet again one of those concepts in science that drew me to medicine. The virus is technically not a living being, It needs a host to survive. Having said that, do not confuse it to be a symbiote, one which exists in harmony with its host. A virus is parasite through and through - Once it comes into contact with a host cell, it enters inside like an imposter dressed as an acquaintance, then forcefully inserts its genetic material into its host as if at gunpoint, literally taking over the host's functions and finally gets rid of the host once the heist is done.

 So if such a deviant creature goes around killing all its hosts, it can only live as long as the last infected person lives. Like you and me, the virus is interested in it's own survival. That is why from an evolutionary standpoint, it makes perfect sense for the virus to adapt into a form which doesn’t make people quite as sick but still gets to hop countries like a travel blogger. What blows my mind is that such tiny particulate viruses are capable of adopting such survival maneuvers that our multi-celluar brains are still not able to comprehend.

But here is the catch! (Naïve of you to think there wouldn't be any) - Viruses of the corona family such as the SARS viruses and their other mischievous cousins like MERS viruses, have historically been known to be far more stable than say a virus like the Influenza. Another factor refuting this theory is that coronavirus has shown compatibility with numerous other host species. Such stability in pathogenic potential has remained a cornerstone for the deadliest viruses in any generation. Let’s not forget that the 2nd wave of the spanish flu was a massacre not because the virus got weaker, but because we got complacent. The same goes to HIV, first discovered in the 1980s and no expert in the right sense of mind would say that the virus has gotten even a bit weakened over the span of nearly 4 decades. So as interesting as it may sound, the above concept, at least for the time being, would remain a theory.

However, This is not to say that the virus isn't changing at all. When researchers at Arizona State University analysed coronavirus samples collected from nasal swabs, they found one individual sample that had a major genetic difference from other samples. But it's unknown whether this particular variation of the virus results in more or less severe illness or any difference in symptoms at all. Confirming such a theory would require far more research collaboration across multiple demographics. 

Yes, it really was a question I was asked and thankfully so, otherwise I wouldn’t have gotten inspired to write this post.

THEORY 2 - LET'S NOT GIVE THE VIRUS ALL THE CREDIT, SAVE SOME FOR US

If the virus isn’t getting weaker, what could be the reason for the pandemic to be not so bad in so many places? The truth of the matter is, many dynamic factors could be at work. The virus may seem apparently less lethal in areas of the globe that are on the other side of the peak because extensive contact tracing, testing and monitoring are catching people far earlier in the course of their illness, as opposed to a couple of months ago when patients were only tested if they got sick enough to brave a packed hospital.

Around the world, healthcare professionals, public health officers, security personnel, government officials and philanthropists have been working tirelessly to flatten the curve. The list of people coming forward to contribute is just heart-warming. And those who aren’t authorized to work on the frontlines have shown their support in every other manner possible, right from providing shelter, supplies, moral support, to fighting the even more dangerous Info-demic of hazardous fake news.

 From an epidemiological standpoint, there are three major determinants for spread of a pandemic like this one - Dose, frequency & duration of exposure, along with health seeking behaviour. By wearing masks and sanitizing contact surfaces we have done a tremendous job at reducing the infective dose at source, but still a long way to go in terms of availability of PPE. With regards to frequency  & duration of exposure - home quarantine &  social distancing has done the magic in all places where it was practised well, regarding other places you know the real story. Finally moving on to health seeking behaviour, I am genuinely delighted that more and more patients are reaching out to doctors like me online & offline, rather than harmfully self-medicating themselves with the wrong treatment for the wrong duration or ignoring symptoms altogether. And from a treatment perspective, clinicians are now better equipped with dynamic protocols entailing the right drugs to target specific demographics.

Don’t even bother figuring out which finger is being used, you know which one.

 THE CONCLUSION

Having explored both view-points thoroughly - I urge you to analyse why only one of them could be true, because if both were to be simultaneously present or absent, the world would be a far better/worse place than it is today. Try to foresee the real world complications of both cases, because they are polar to say the least. There’s a huge difference between a change in pathogenicity caused by a substantial shift in the viral genome vs one caused by dynamic & mostly intangible public health measures. The first one would mean that we are nearing the end of the biggest financial cum health crisis of our time. The second case however, if true, is far more scary because it means that the virus has a solid chance of returning with vengeance if countries and individuals let their guard down.

Let's face the reality for what it is, the war is not over yet, the wounds are still fresh and the enemy is still lurking in the trenches waiting for us to get complacent. So let’s put our best foot forward, one which is backed by science rather than by fiction and make sure we extend our support to those who need us the most. 

Like it or not, there is only one way out of this crisis, and that’s the “positive” way out. So stay safe, stay happy and stay healthy. Cheers!

Graphic credits - Fusion_Medical & Ashkan