By Ryan Bose-Roy
The Italian government closed nearly all commercial activity. Newly-dug mass burial sites in Iran are now visible by satellite. On Friday, March 13, the President of the United States declared a state of national emergency. As doctors, researchers, analysts, and policymakers work across the globe to address the current coronavirus crisis, it becomes harder and harder to piece together the disease’s impact on our daily lives.
Where I live, in New York, over 3000 public events have been cancelled. The typically packed, 100-year old subway train cars lie barren at rush hour. With parents keeping children at home, attendance to public schools has dropped by 30% in just two days and this morning, my class of 26 students was down to just 2.
In states like Pennsylvania, school districts and all nonessential businesses, including movie theaters, restaurants, and even government buildings, have been shut down for at least two weeks.
The coronavirus epidemic is something the world hasn't faced in decades. It’s worth learning about it.
Photos we took of New York City subway stations during rush hour!
The basics: what is a coronavirus?
A “Coronavirus” is any sphere-shaped pathogen with bulbous bumps called “virions” that surround the virus’s surface. These virions are made from “peplomers” - spiky proteins that help the coronavirus attach to its target. After the virus enters the body, these virions grab onto proteins coating the surfaces of cells and force the virus’s genetic codes into the cell’s reproductive program. This “biological-hacking” turns the cell into a virus-producing factory, killing it in the process.
Coronavirus disease 2019, or COVID-19, is an infectious disease caused by a particular type of coronavirus called “severe acute respiratory syndrome coronavirus 2,” or SARS-CoV-2. This virus enters human cells by attaching to the angiotensin converting enzyme 2 (ACE2) receptor, which is typically found on the surface of cells lining the heart, lungs, and kidneys. Once it enters the cell, SARS-CoV-2 also produces molecules that produce more virions and stop the body’s immune system from responding.
Since SARS-CoV-2 primarily interacts with cells in the heart and lungs, it produces a range of respiratory problems including coughing, shortness of breath, sneezing, runny nose, sore throat, fever, and sometimes pneumonia. However, the severity of these symptoms vary. Those who are older, have weaker respiratory organs, or are immunocompromised, are more likely to have worse symptoms after contracting COVID-19. In those older than 70, the risk of death is greater than 8%.
Artist's rendition of SARS-CoV-2 (credit: CDC)
Why should we care?
We’ve actually lived with coronaviruses for thousands of years. In fact, the Human Coronaviruses OC43 (HCoV-OC43) and 229E (HCoV-229E) are one of several viruses responsible for the common cold. Odds are, millions of people around the world have already had a coronavirus at some point during their lifetimes. What makes this coronavirus so different?
First, SARS-CoV-2 has spread faster than any other known coronavirus. The first Severe Acute Respiratory Syndrome (SARS) emerged from China in 2002 and spread primarily through air travel, affecting more than 8000 people over two years; COVID-19 broke those numbers in two months.
Second, COVID-19 is far more deadly. SARS and Middle East Respiratory Syndrome (MERS) each killed fewer than 1,000 people over several years. COVID-19’s death count is over 5,000 in two months.
Third, it takes as many as two weeks for people with COVID-19 to develop symptoms. As a result, people are more likely to spread the illness asymptomatically before they know that they are sick.
The problem with the numbers
A major issue in understanding the coronavirus is that there’s plenty more information yet to be gleaned. Researchers don’t have a complete theory about the full pathology of the virus - how it infects and destroys cells from start to finish. There is no agreed-upon reason for why older people are far more susceptible. And we don’t know how many people really have COVID-19.
This last problem is particularly pressing. In the United States, the Center for Disease Control has estimated that between 160 and 214 million people could be infected over the course of the pandemic. However, because the distribution of diagnostic tool kits for hospitals to use has been rapidly out-paced by the virus’s spread, the true number of coronavirus cases would grow faster than people would be able to recognize them. Furthermore, a recent study found that the SARS-CoV-2 can survive up to four hours on copper, 24 hours on cardboard, and three days on plastic and stainless steel. The virus can also linger in droplets in the air for up to three hours
Treatments
Currently, there is no active vaccine nor antiviral drug for coronavirus on the market. After a person is infected, doctors can only offer care to support the patient and treat the disease’s symptoms. This supportive care includes making sure the patient receives enough oxygen, managing fever, and using a ventilator to supply the lungs with air.
However, that is not to say that researchers are lagging in their efforts to develop a solution to the COVID-19 crisis. There are a number of vaccine candidates that currently exist.
The Coalition for Epidemic Preparedness Innovations (CEPI) -- a group designed to address crises exactly like the one in the status quo -- awarded a $9 million grant to Inovio Pharmaceuticals Inc. to develop a COVID-19 vaccine. This group was previously awarded a $56 million grant for the development of a highly promising vaccine against MERS, another coronavirus. The COVID-19 vaccine they developed, called INO-4800, administers synthetic genes into a person’s cells to boost immune response to the virus. Furthermore, a similar vaccine against COVID-19 called mRNA-1273 developed in the National Institute of Allergy and Infectious Diseases (NIAID) will enter phase one trials in humans during the next few months.
However, developing drugs and vaccines is an extremely difficult process. Finding the triggers in humans’ immune systems to find and take apart a virus can often take years, and clinical trials for viruses raise exceedingly important ethical concerns regarding a patient’s potential risk of death.
What’s Next?
Although the COVID-19 pandemic has justifiably caused a great deal of public concern, hope rings bright. I’m a glass-half-full kind of person.
Remember that most people with COVID-19 recover. The death rate for coronavirus is 11 times less than that of SARS, 34 times less than that of MERS, and 90 times less than that of Ebola. 99% of people infected with the SARS-CoV-2 will recuperate. Although the severity of the disease has been shown to be higher for older people, the oldest person to make a full recovery from COVID-19 is 103.
Second, due to the efforts of numerous countries -- including South Korea and China -- around the world to keep citizens in safer areas, the number of recoveries from coronavirus is starting to overtake the number of new infections. Companies such as Apple and Starbucks are also beginning to reopen their stores in these countries.
And finally, remember that with the proper hygiene measures, the global impact of this disease can be significantly reduced.
Stay healthy!