by Jose Sealtiel Cruz
A meme circulated just as 2020 has dropped, speculating that a pattern can be seen when we look at the past centuries: 1820 saw the cholera epidemic, then the Spanish flu in 1920, implying as if 2020 would see something as bad.
That was January. Things did get worse. I hope I did not laugh upon seeing that meme.
Spreading to all continents except Antarctica, the world ushered in a new decade with an unprecedented guest: the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infecting hundreds of thousands from more than a hundred countries around the globe (see this link for live updates) and mounting a death toll higher than the 2009 H1N1 pandemic, SARS-CoV-2 (which causes the coronavirus disease, COVID-19) is severe enough to sound the alarms of the World Health Organization (WHO) into declaring it as a pandemic on 11 March 2020.
People are driven to their homes as the world scrambles to weather the pandemic and try to live as normally as possible with increasing restrictions in place.
But what do we need to know?
What makes the coronavirus special
Tedros Adhanom, Director-General of the WHO, can be noted in saying “[w]e have never before seen a pandemic sparked by a coronavirus. This is the first pandemic caused by a coronavirus” as the organization declared the virus as a pandemic.
We must ask a fundamental question: what makes this coronavirus deadly?
A virus is simply genetic material (DNA or RNA) enclosed in a layer of proteins and lipids. It cannot self-replicate (which makes it technically a non-living thing) but does so by infiltrating the host organism’s cells and injecting it with its genetic material. This causes the invaded cell to produce more copies of the virus until the new viruses destroy the host cell, spreading to other uninfected cells to repeat the process.
According to John Hopkins Medicine, what sets a coronavirus apart from other viruses is it originates from animals which can sometimes be transmitted to humans. The coronavirus also gets its name from the pointy structures studded on its surface like a crown (thus corona). Its effect on humans can range from mild (such as colds) to severe, the latter being the case for three known diseases caused by coronaviruses: the severe acute respiratory syndrome (SARS); the Middle East respiratory syndrome (MERS); and the coronavirus disease (COVID-19).
SARS-CoV-2, or simply the virus that causes COVID-19 (to avoid unnecessary fear), underwent a few name changes. Raising alarm after its first outbreak in Wuhan, China in December 2019, the SARS-CoV-2 was first named as the 2019 novel coronavirus simply because it is a newly discovered coronavirus (reportedly starting in the wet markets of Wuhan, but disputed as experiments in now-retracted academic articles). It was renamed to what it currently is now, SARS-CoV-2, as it has similarities to the coronavirus that caused the SARS outbreak in 2003.
Symptoms of COVID-19 include fever, tiredness, and dry cough; among other less typical symptoms listed by the WHO including “aches and pains, nasal congestion, runny nose, sore throat or diarrhea.” However, the virus causing the disease may be inside a person’s body without showing symptoms of the disease (called asymptomatic); or may appear 1-14 days after the person is infected. When left unattended, COVID-19 can cause pneumonia that cannot be treated with antibiotics – the way doctors treat normal pneumonia.
SARS may be deadlier than COVID-19, according to the WHO, but COVID-19 is more infectious than SARS. Thus, from the words of the WHO Director-General, countries need to “test, test, test.”
The kit and the issues on testing
It is not only the rising count of COVID-19 patients in the Philippines that are making the headlines as issues on testing for COVID-19 also nabbed headlines, with politicians getting tested while breaking the Department of Health’s (DOH) protocols on testing stealing top spot and creating trending hashtags on Twitter. The slow progress has also made the rounds on the internet with the DOH running low on test kits (as with many countries) and the dismally low number of tests done per day, though the department has since made efforts to increase the country’s testing capacity.
Why is the Philippines struggling to churn in more tests?
There are two types of tests to determine if a person has COVID-19: the rRT-PCR test and the antibody test. The rRT-PCR, or the real-time reverse transcriptase-polymerase chain reaction, can test the presence of COVID-19 even if the person does not exhibit symptoms of COVID-19. This may be more effective in detecting the presence of COVID-19 as the procedure’s sensitivity allows to detect a virus from a sample, but it takes more time and is generally more expensive.
To give a sense of how technical this test is, let us see how it is done.
The rRT-PCR starts by taking swab samples from a patient’s nose or throat. The genetic material of the virus (RNA) is extracted from the sample and is mixed with an enzyme, reverse transcriptase (thus the prefix RT), to convert the collected genetic material to DNA. The DNA is then mixed with primers and enzymes while repeatedly cooling and heating it to produce copies of it (in the millions). As the DNA is copied, dyes bind to it. A test turns out positive if more light (fluorescence) is detected as copies of the virus DNA is created; negative if the detected light stays the same.
One run of rRT-PCR takes about 3-6 hours, with results ideally furnished within 1-2 days.
The rapid testing kits developed by the UP-NIH is basically the essential ingredients to run an RT-PCR test good for one (or a batch of) test(s).
Antibody tests, meanwhile, detects for antibodies present in a patient that has COVID-19, using blood samples from the patient. However, the antibodies may only be present at least five days after a patient catches the virus – the test may turn out negative even if the patient did contract the virus: a false negative.
It is clear that the rRT-PCR tests are more superior, but it poses more constraints beyond its long run time: the equipment required to run the tests costs millions, laboratories should at least be biosafety level 2 (BSL-2) certified, and individual tests cost P5,000 to P8,000 (though the UP-NIH test kits cost P1,320 plus other required procedures). The slow response of DOH in accrediting laboratories has also posed a problem as it drew the ire of Marikina Mayor Marcy Teodoro.
Currently, COVID-19 tests are done mainly in the Research Institute for Tropical Medicine (RITM), along with DOH-approved laboratories across the country currently totaling to 17 and performing at least 3,000 tests a day.
No wonder medical professionals are telling everyone to stay home. But why stay home?
Flatten what curve?
The buzzword for the pandemic is the call of medical professionals to flatten the curve – but what curve do they speak of?
The DOH tracks the number of active cases since January 28, which can be represented as a graph of the days since the first confirmed case of COVID-19 in the country against the total number of confirmed cases. This creates a curve that, as of writing, tends to increase.
The data can also be presented as a graph of the days since the first confirmed case in the country against the new number of cases across the country. This also creates a curve whose behavior depends on how many new cases are recorded daily.
If mitigation measures are not put into place, it is projected that the daily increase of cases would be steep; if they are put into place, chances are that the daily increase of cases would be lower. Reducing the new daily cases matter because of one crucial factor: hospital capacity.
BusinessWorld reports that there are currently only 106,000 hospital beds throughout the archipelago, 29,000 of which is in Metro Manila. Some estimates provide a lower number: around 70,000 to 80,000. The ideal situation is that a hospital bed is available for 800 people in a country – for the Philippine population (around 105 million and counting), that accounts for around 130,000 beds.
Not all hospital beds can be used for COVID-19 patients, thus the workable number of hospitable beds would be lower than the given estimate. DOH records show that there are about 5,500 beds, 1,281 of which are intensive care unit (ICU) beds, allotted by hospitals across the country exclusively for COVID-19 patients as of April 14; alongside a total of 12,413 community isolation beds as of April 12.
The Philippines has exceeded 5,000 cases in April 14, where 3,151 patients are currently admitted.
Couple this with the lack of necessary equipment such as ventilators (756 in hospitals as of April 14 where 644 are available; and 1,474 in total) and, in general, personnel; and the grim possibility that medical personnel succumb to the sickness; the healthcare sector, public or private, can only accommodate a limited number of patients.
In fact, some private hospitals have already reached maximum occupancy considering the current number of cases. Metro Manila alone can record 140,000 to 550,000 cases over the course of the pandemic, according to the initial report of UP COVID-19 Pandemic Response Team.
The healthcare sector can only work around a limited number of patients (those infected with COVID-19 or otherwise) – any number of cases beyond the capacity of the healthcare sector can be left unattended and lead to their death. Thus, the need to decrease the spread of the virus is critical even if only 20% of COVID-19 cases – 1 out of 5 – require hospitalization. This limit is usually represented by a horizontal line in graphs projecting the daily recorded cases.
Healthcare experts want to prevent the curve from being steep – having more cases than what can be accommodated by hospitals – for it will bring about service deterioration and inevitable deaths in a shorter timeframe.
To lessen the load of hospitals and health workers, experts and policymakers are backing measures in flattening (or cattening for the cat lovers) the curve even if it means dealing with COVID-19 for a longer timeframe. The curve also flattens when we graph the cumulative number of cases, as seen in this article by Vox. How do these measures help in weathering a pandemic?
Soap, distance, and disinfectants
The rules are somehow set in stone already for most of us, which are (set by WHO) as follows: keep a distance of at least one meter (ideally two meters) from the people around us, avoid touching our faces, cover the mouth and nose when sneezing or coughing, and stay at home when possible (more so as places in the Philippines are placed under community quarantine). These seemingly simple measures are effective due to the way the virus spreads.
The coronavirus spreads through droplets – it cannot travel through the air as it is relatively large and heavy for airborne transmission – from an infected person’s saliva or mucus. Droplets can travel up to a meter, explaining the recommended physical distancing of at least a meter and why new patients are infected by coming in close contact with a COVID-19 positive patient. An article by the Washington Post simulates how physical distancing measures are effective in flattening the curve.
Droplets containing the virus can also survive on surfaces for some amount of time, depending on the material (see this article for more information), bringing the need to disinfect surfaces whenever possible. When it is unavoidable to touch surfaces, such as doorknobs, tables, or guide rails; avoid touching the face for it would be easier for the virus to enter the body once it goes on the face.
Frequent cleaning of the hands is also recommended due to the way soaps and disinfectants interact with the virus. Soaps are particularly effective against viruses (of any kind, and bacteria) given the structure of its molecules, consisting of a head that attracts to water and a tail that attracts to fats and oils.
In handwashing, the tails of these molecules would want to escape the water while also wanting to attract the layer of lipids in the virus. Once the tails attract the lipids around the virus, it would try to get away from the water – opening the virus in the process. Removing one component of a virus destroys its entirety; its remnants washed away with the water. It is recommended to handwash thoroughly for at least 20 seconds, (apparently) the length of two Happy Birthday songs (or these songs for a change).
Using alcohol is also effective against the coronavirus as it denatures the protein layer of the virus. Research shows that alcohol of at least 30% concentration should be used to kill the coronavirus and most optimal at 85%. Commercially available rubbing alcohol is perfectly fine, but alcoholic beverages such as vodkas or whiskeys can do the trick so long as it goes on the hands and not in the stomach.
It can also be remembered that places are set under community quarantine, for instance, Luzon (under enhanced community quarantine) from 17 March until 13 April (and eventually extended until the end of April) – essentially a month. Lockdown durations can vary but is usually is a minimum of two weeks to make way for the incubation time of the virus (which can manifest from 1-14 days). The quarantine imposed on Luzon and other provinces is done, possibly, to be able to detect, confine, and treat cases up to the second generation – that is, those infected by COVID-19 positive patients.
South Korea has not imposed a lockdown of any kind, a feat the world is watching; instead, they worked on testing as many potentially COVID-19 positive people as possible and intense contact tracing. However, these big decisions require reliable data.
These measures are only preventive and allows researchers more time in finding the solution to ending the pandemic: a cure.
Working towards an elusive cure
The medical world is scrambling not only to test people for COVID-19 and treat COVID-19 positive patients, but also to find the cure to end the coronavirus storm.
Thanks to technology and massive cooperation within the research community, cure research efforts have started as early as January 2020 with Chinese researchers publishing the genetic sequence of the SARS-CoV-2 online – the key to understanding the virus and, ultimately, how to defeat it.
Though the virus is discovered to have mutated a new strain and setting back research a bit, its (80-90%) similarity to the virus that brought the 2003 SARS outbreak and the shelved vaccine efforts on the last coronavirus outbreaks (SARS and MERS) provided researchers a head start by repurposing the vaccines to work against the virus causing COVID-19. Some companies are already on clinical trials, with some on the taxing human testing phase.
Supercomputers are also brought to the party, with IBM supercomputer “Summit” identifying 77 treatments that can potentially stop COVID-19 using known coronavirus models to find compounds that can bind and render the coronavirus’ corona (protein spikes) ineffective in a research published in ChemRxiv. The United States’ White House also partnered with IBM in allowing researchers to use the latter’s pooled computing power to run models that would help sift through possible treatment methods.
The WHO has also started a global clinical drug trial of four existing drugs that hold the most potential as a treatment for SARS-CoV-2, including two drugs used against HIV (lopinavir and ritonavir), malaria treatment drugs (chloroquine and hydroxychloroquine), and experimental remdesivir; the trial called SOLIDARITY. Eligible patients need only to have their data listed on the WHO website by their doctor and sign an informed consent form to be sent to the WHO.
It is to say that, though cure research is progressing in an unprecedentedly swift pace, no effective cure has been approved by any drug boards or the WHO. It is said that the vaccine against the virus causing COVID-19 may take at least a year to be available. No drug has been approved as a treatment against COVID-19, and self-medication is heavily discouraged as it can cause potential harm (as is the case for an Arizona couple).
But far as we are from discovering the cure for COVID-19, there is some (grim) hope: the world has weathered the last coronavirus outbreaks, SARS and MERS, well before vaccines are made readily available.