Fighting the coronavirus
In the absence of a vaccine or definitive treatment, authorities are focusing on containment and mitigation while individuals should focus on their personal hygiene and staying healthy
By Duncan Levine
Prevention, as goes the well-known proverb, is better than cure. But, in the case of 2019 novel coronavirus (Covid-19) disease, the outbreak of which was officially upgraded to a pandemic by the World Health Organisation on 11 March, there is currently no cure or definitive treatment available. This means that the only options left to deal with the virus are prevention, mitigation and supportive treatment for infected patients. Most of the efforts of authorities globally to date have been focused on containment and mitigation, that is, reducing, as far as possible, the spread of the virus, and offering the best possible supportive treatment to those infected. As these efforts continue and while researchers work on a vaccine and finding the best treatment options, individuals would do well to focus on staying healthy so that, if they do become infected, they will increase their chances of recovering quickly.
Although scientists have learnt a great deal about Covid-19 in the months since the disease was first detected in Wuhan, they have yet to identify the cause and what treatments work best, while they still don’t know enough about transmissibility. This makes forecasting likely outcomes extremely difficult. According to Dr Chen Yee-chun, Professor of Medicine at National Taiwan University, speaking at an ECCT lunch on the coronavirus, it is impossible to know what will happen this early on as to how severe the pandemic will eventually turn out to be. The scope, morbidity and mortality, she said, will depend on the combination of severity and transmissibility. Chen’s advice is that is that we should pay attention but not panic.
A number of possible scenarios have been offered as to how the pandemic will develop. In the most extreme scenario, the disease might spread worldwide and affect as much as half the global population within a year, overwhelming health services and killing tens or even hundreds of millions of people. However, the WHO is still promoting an optimistic scenario in which determined action contains Covid-19 to specific regions and suppresses it.
In the meantime, authorities everywhere need to take action on multiple fronts. David Malpass, president of the World Bank Group, writing in the Financial Times, pointed out that the outbreak required urgent action to help countries respond to, prevent and reduce the contagion and loss of life. The response, he wrote, will be most effective if governments and the private sector take co-ordinated and rapid action, he said. He noted, based on experience with Ebola, SARS and Zika, that with the right measures, taken quickly, countries can stop the transmission of diseases such as Covid-19, and protect lives. He added that all governments should increase their health security and that strong primary health systems are the most effective way to do that. Moreover, the costs of upgrading defences against health security threats are just a fraction of the resulting costs of epidemics.
In the absence of a cure or effective treatments governments worldwide are focused on containing the spread as much as possible, and offering patients the best possible supportive treatment. While the governments of China and, most recently, Italy, have imposed complete shut-downs to contain the virus, other governments have imposed less draconian measures, some reasonably effective and others less so.
Taiwan’s authorities have received near universal praise for their coordinated and comprehensive approach to their handling of the outbreak and their open, frank and frequent communication with the public. In terms of response actions, besides implementing travel restrictions, quarantine for infected patients and other general preventative measures, the fact that the majority of patients that have been infected by the virus to date have either already recovered or are in the process of recovering fully, demonstrates that the quality of patient care in Taiwan is exceptionally good.
To catch Covid-19, you need to be physically close to someone shedding significant amounts of virus so, obviously, the best way to prevent infection is to avoid close contact with other people and, to prevent the virus from spreading to others and to protect one’s self, by keeping one’s hands clean and wearing protective gear, such as face masks. As to why only a few people become infected, the answer is not definitive but, according to Dr Chen, it is likely to depend on the balance between the pathogen, the environment and the host, that is, the amount of pathogen a person is exposed to, the health of the person exposed to it and the environment. For example, dirty environments with poor air flow are high risk areas for spreading the virus. Therefore, simple things like washing one’s hands (which kills the virus) and keeping rooms well ventilated are effective protective measures.
Taiwan’s CDC has also recommended a number of measures that companies should take to safeguard their employees, including implementing social distancing measures, restricting or cancelling travel, conducting frequent environmental cleaning and ventilation decontamination, adopting flexible working schedules for employees and using teleconferences for communication in order to reduce physical contact.
Diagnosing Covid-19 is crucial to tracking its spread and evaluating the measures necessary to stop it. Biomedical researchers are making rapid progress, particularly in genetics and data analysis. Scientists already know the virus’s full genome, the sequence of around 30,000 biochemical “letters” in its genetic code. Labs around the world are using this to diagnose Covid-19, through what is known as polymerase chain reaction (PCR) testing, which amplifies and identifies any genetic material from the virus in patient samples.
Both the public and private sectors are working urgently to improve the speed and accuracy of PCR kits and, because they are in short supply, scale up their production. For example, Academia Sinica, Taiwan’s national research academy, says it has synthesized monoclonal antibodies that are able to identify the protein of the virus that causes Covid-19. According to Academia Sinica, the potential reagent, if successfully mass produced, will shorten the rapid screening test for the coronavirus from about four hours to 15 to 20 minutes, which will significantly improve screening efficiency.
However, there is currently no vaccine and no existing drugs are designed to treat coronaviruses, although some antiviral medicines may alleviate the symptoms. Chinese doctors are prescribing drugs normally prescribed for HIV, and another antiviral called remdesivir that was developed to treat Ebola. However, it is not yet clear whether these drugs help against Covid-19.
Programmes to develop vaccines quickly to prevent Covid-19 infection are underway in dozens of academic and private labs around the world, some under the auspices of the Oslo-based Coalition for Epidemic Preparedness Innovations (Cepi), a US$750m partnership set up in 2017 by governments, industry and charities to prevent future pandemics. According to Dr Chen, at least two research institutions in Taiwan are working on a vaccine. However, she said that the process is technically very complicated and will take time.
Last month, Moderna, a US biotechnology company, produced the first samples of its vaccine to the National Institutes of Health (NIH) for testing in healthy human volunteers. The NIH expects a clinical trial with about 20 to 25 volunteers to start in April, with initial results available this summer. But even if the first trial is successful, no vaccine is likely to be available for widespread use for some time because further clinical trials have to be conducted for long enough to ensure that they immunise safely. That will take a year or more.
To rush out a vaccine that is later found to be unsafe would have disastrous consequences, not only for the fight against the coronavirus but for future public faith in vaccines more generally, which has been undermined in recent years, albeit usually by opponents based on unsubstantiated claims lacking scientific evidence.
Since, even with drastic measures in place, containment is never likely to be completely effective, and it is therefore impossible to stop people from becoming infected, the next best option is to focus efforts on taking the best possible care of infected patients. And, as has become clear in the case of Covid-19, the best defence against the virus is a healthy patient.
Although the fatality rate of any pandemic can only be calculated after the fact, based on statistics so far, the estimated overall fatality rate is likely to be lower than 1% of patients that become infected, although the rate is as high as 10% for elderly patients or those with pre-existing chronic illnesses.
So, obviously, the greatest attention and degree of care should be focused on patients most at risk while treatment for other patients as well as the general population not yet infected, but at risk of getting infected, is to keep them as healthy as possible.
Keeping the body’s immune system healthy is the best defence against disease. This can only be done by maintaining a healthy diet, getting plenty of exercise, minimising stress and getting good quality sleep.
Well-known Taiwan commentator and medical doctor, Shen Fu-hsiung, wrote on his Facebook page that, in the absence of a cure and specific treatment for Covid-19, patients can only be given supportive treatment. For this reason, he wrote, a patient’s ability to recover depends much less on the treatment than on the patient’s overall physical health and immune system, which, stripping out genetically-inherited weaknesses, is mostly determined by their diet and living habits.
Our bodies contain more cells belonging to microbes, such as bacteria and yeasts, than human ones, which means that keeping a healthy microbiome is key to maintaining a healthy immune system. Not only do our microbes form protective barriers, they also programme our immune systems. Animals bred with no microbiome have less well developed immune responses. Older people, and those with diseases that are characterised by inflammation, such as allergies, asthma, rheumatoid arthritis and diabetes, tend to have less varied gut microbiomes. To get the right microbes, requires a varied diet with lots of high-fibre and fermented foods and pulses.
Tina Chiu, Associate Professor from the Department of Nutritional Sciences at Fu Jen Catholic University remarked for this article that while not enough research has been done on Covid-19 to say anything definitive about the best diet for Covid-19 patients at the moment, since those with chronic diseases, such as diabetes, are at a higher risk when infected, a balanced healthy diet that keeps glucose, cholesterol and blood pressures at healthy levels would be a sensible place to start.
Taipei Beitou Health Management Hospital nutritionist Pan Fu-zi was quoted in a United Daily News online article as saying that the best kinds of food to boost one’s immune system are garlic, red quinoa, Brassicaceae vegetables (also called Cruciferae), such as cauliflower, cabbage, kale, garden cress, bok choy, broccoli, Brussels sprouts and similar green leafy vegetables, citrus fruit and blueberries.
Exercise is also very important to keeping a healthy immune system. Exercise mobilises white blood cells by increasing a person’s blood flow, so they can perform their vital function of helping to fight infections by attacking bacteria, viruses, and germs that invade the body. It is therefore recommended that adults do at least 150 minutes per week of moderate aerobic activity (such as hiking or cycling) or 75 minutes of vigorous activity (running, swimming fast or aerobics).
The best advice for older people, who are more vulnerable to infection, is to do whatever exercise is possible. But those who develop a habit of regular exercise over the course of their lifetimes have been shown to be able to slow down the decline of their immune systems that happens naturally with advancing age.
Exercise has the added benefit of reducing stress, something that is very important to the immune system. Stress hormones, such as cortisol, can compromise immune function. Drinking too much alcohol also harms the immune system.
Exercising and eating well will have the likely knock-on effect of helping people sleep better, which is very important because a fatigued body is more susceptible to viruses.
As containment and mitigation efforts continue and while we wait for a Covid-19 vaccine and more effective treatment options for infected patients, healthcare authorities would do well to extend their public education programmes beyond what people should do to protect themselves and others from contracting the virus to how they should keep themselves as healthy as possible. The message that should be promoted to the general public is that a healthy body and immune system is the best defence to fight the coronavirus and other diseases.