Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS-CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• Personal Protective Equipment (PPE)- PPE are any item that covers any part of the body with the design and intent of keeping viruses in the environment from infecting the wearer of the PPE. PPE’s include all masks (which includes respirators), face shields, eye shields, gloves, gowns.
• Ventilator- a ventilator is a machine that can force a person unable to breathe to inhale and exhale and control both effectively.  They are sometimes called respirators, but during this pandemic the word respirator is now reserved for reference to a tightly fit mask.

The Origin of this SARS-CoV-2 Virus, the pandemic coronavirus

As readers of Real Answers have read many times, this new coronavirus, the SARS-CoV-2 virus, is still very new to humanity.  It never infected a human until November of 2020, only a few months ago.

This claim raises many questions, including:

1. How do we really know humans didn’t get this infection before November, 2020?  and
2. If the first human infection with the SARS-CoV-2 virus started all of a sudden a few months ago, where did the SARS-CoV-2 virus come from?

But the essential question is this:  If you have a virus in hand, how do you analyze it to find out where it came from?  Viruses are very tiny, and there is not much to them.  They have two components, one is a string of a few genes, the other is a small number of proteins that forms a coat around the genes, that’s it.  How does one look at the little string of genes and the handful of proteins and figure out where it came from?

The answer is so intriguing.  It turns out that there are people who spend their lives sleuthing the path of how viruses evolve.  And that only works because every stretch of genes contains stories.  Every sequence of DNA or RNA, the stuff genes are made of, came from some prior sequence.   If you know that range of sequences, you can trace how the genes you have in hand came to be.

One of the most fascinating examples of this is told in the book by the great genetics sleuth, Dr. Cavalli-Sforza, Genes, People, and Languages.  In this book he traces his work looking at the DNA sequences from groups of humans around the world, which allowed him to begin to really answer, where did humanity come from?   Did we evolve all over the planet, or in one place and then by wandering cover the globe?  If the latter, when were the waves and what were the paths of the great migrations?  Dr. Cavalli-Sforza’s work and other like him have come up with solid proof that all 7 billion of us came from a small group, as few as 10,000 people (the nightly population of Beachwood!) in East Africa.   This book is especially amazing because linguists can trace the same paths of change, because as we migrate, we bring our languages and dialects with us.  It turns out the pace and ways in which our DNA has varied over time and place precisely copies to the pace and ways in which our languages have changed, quite a confirmation of these observations.

The same approach to analysis can find out the path of origin and change of any life form that has changing genes, and that includes viruses.  We cannot confirm their findings by tracing viral languages of course, but the fact that language changes and genetic changes in humans match, confirms the accuracy of the technique of tracing changes in genes to chart paths of origins of any life form.

So here is what the coronavirus gene detectives have found.   They have established that the gene sequences in the pandemic SARS-CoV-2 virus traces to a set of coronaviruses found only in one species of bat, the horseshoe bat found in the Yunnan province of China. Yunnan is a province on the southern border of China, just west of Guanxi province which is the province just north of Hong Kong.  The capital of Yunnan is about 1000 miles from Wuhan.   Now the coronavirus from which the SARS-CoV-2 virus originated is not the same coronavirus as that in the horseshoe bat anymore, if it was, it could not infect us.   So what the coronavirus gene detectives have found are the intermediate steps the horseshoe bat coronavirus took to become the pandemic SARS-CoV-2 virus.

There are several steps and they include:

1. Changes in the original horseshoe bat coronavirus, this led to this virus being able to infect not just horseshoe bats, but some other animal.
2. A jump by the changed (mutated) horseshoe bat coronavirus from the bat to the next animal.  Evidence is increasingly pointing to that hapless new victim being the pangolin.  Pangolins are scaly small Asian anteaters.  But the changed horseshoe bat coronavirus now able to infect other animals, may have also jumped to other animals too.  Some researchers find it can grow in cats and ferrets, but it should be emphasized there are no known instances of such viruses going from cats and ferrets to humans.
3. The protein coat of the coronavirus in question in horseshoe bats has 19 spikes, that changed version which now can infect pangolins has 5 spikes and attacks mainly the lungs in the pangolin.
4. Now, in the pangolin, this coronavirus changed yet again, and it is believed it is this change, a change documented by the coronavirus gene detectives, that created a new coronavirus able to infect humans.

Each of these steps is now described by specific changes in the genes that now trace the SARS-CoV-2 virus, step-by-step, with solid genetic proof, from horseshoe bats in Yunnan to pangolins in Wuhan, to all of humanity.

THIS evidence completely demolishes all claims that people concocted the SARS-CoV-2 virus.

THEREFORE, the wild accusation that someone in a nefarious lab in China created the pandemic is completely ludicrous.  This idea can only be circulated now for some purpose other than explanation.

Now, if the SARS-CoV-2 virus came from an animal in China, does that make it the fault of any people in China?  No.

Keep in mind, the evidence for the origin of the extremely catastrophic H1N1 influenza virus pandemic of 1918 points its origins to ducks in Kansas, and no one thinks the people of Kansas had anything to do with creating that super-calamity.

Spreadability

Just How Contagious is COVID-19?

If you have been reading Real Answers, you will know the key property that can define how rapidly a germ spreads is it R0 number, its reproducibility number.  The R0 tells us if someone gets infected with a germ, on average, how many people will I infect.

The R0 for the seasonal influenza virus that shows up in the US every December and disappears every April is about 1.4.  That means each person with it infects, on average about 1.4 people.  AN R0 of less than one means a virus will not spread well or at all.  At 1.4, the influenza virus spans the globe every winter, infecting about 1 billion people every year.  So 1.4 is plenty high enough.   An extreme R0 is for TB which has an R0 of 10 and measles which has an R0 of 12.  At such super R0’s, one infected person could infect a continent in no time, which is exactly what happened to native Americans and TB and measles.

Initial estimates of the R0 for the pandemic SARS-CoV-2 virus put it at 2.5 or so, which makes it wickedly more contagious than plain old influenza.

But more recent analysis puts the R0 much higher.  One article from the CDC, due to be published in July 2020, but early released last week, https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article, calculate the R0 for the pandemic SARS-CoV-2 virus to be 5.7!

This is bad news.

If this virus really spreads, on average, to 5.7 people from each person infected, here is what that means.  Start with one person, on average they will infect 5.7 people.  So after one round of contacts we go from 1 person infected to 5.7 people infected.  Now do this 10 times, and you go from one person with COVID-19, to 36 million people infected!  Go 20 rounds of 5.7 people infected for every 1 person infected, and you reach a number about 200,000 times the total population of the planet.

These numbers are, sadly, plausible.  A recent study of 200 pregnant women was done in an obstetric hospital service, where very pregnant women was tested for COVID-19.  They found about 1 in 8 of the total population was infected, and most had no symptoms.   It is wildly unreliable to extrapolate from 200 pregnant women to all of America, but just if about 1 in 8 of us have been or are infected with this virus, that would mean about 40 million Americans have been infected with the pandemic SARS-CoV-2 virus.

Further, we think the first case occurred on January 24, that was 83 days ago.  A cycle of COVID-19, getting infected and then becoming contagious takes about 5-7 days or so.  That would mean if we say 83 days have passed since patient #1 happened here in the US, that we have had about 11 cycles of infection.  An R0 of 5.7 would yield about 40 million infected people, which fits the rough estimate from the total testing of a couple of hundred people.

And, as we have reported in earlier posts here, a large number of people infected with the pandemic SARS-CoV-2 virus have no symptoms at all.

If a virus spreads wildly, and at least half of those infected and contagious have no idea they are infected, that virus will spread like wildfire.  At this point in time, evidence is substantial to say that the virus causing COVID-19 will spread like wildfire if allowed to.   One quick proof of that concept is that the virus did not exist in humanity until 5 months ago, and now has already infected people in every nation on the planet.

Getting Back to Work AND Limiting the Spread

We present the most recent information on how contagious this virus is because the world is interested in coming out of hiding soon.

As we have noted in earlier posts, there are many, many, many examples in countries around the world, and in states across the United States, that when people gather, this virus spreads, quickly and widely.

So, if people start gathering where they work or play, there will be more COVID-19 infections.  The only question is, can we somehow tamp down eruptions of infection well enough to avoid a major conflagration of infection?

We know this from the world’s experience, if we identify most cases, isolate them when identified, early on, then spread can be controlled.  Social distancing is necessary when these two steps are not in complete use.

Recent estimates of what that really means across the US have been calculated and give us all a good sense of what we are up against if we want to go back to work and play AND keep this pandemic from roaring again:

1.  You simply cannot limit the spread of the virus with people gathering without knowing where the initial cases are appearing, and that cannot be done unless enough people are tested regularly to find those early cases of COVID-19.
   1. People who need regular testing, let’s say health care workers, grocery workers, police, fire, should be tested every week it is estimated, to find new infections that sprout up and isolate them before they spread.  There are about 3 million health care workers (docs, nurses, maintenance crew, etc.) and about 3 million other front-line workers. That means to monitor this group that is under heavy exposure, we would need about 6 million tests done every week.  The nation has done a total of 3.4 million tests over the last 2 months!
   2. Testing is designed to let us know who has an infection, and since at least 50% of people infected have no symptoms, if you want to find those infected one must test the asymptomatic well-appearing.  This can be done in a surveillance manner, using statistics to create a random sample of a number far smaller than the total number of all Americans, but it would require a system in which a number smaller than everyone still represents everyone.
2. Contact tracing- This involves contacting, personally, every person who has spent more than 15 minutes closer than 6 feet to a proven infected person (whether or not that proven case has symptoms
3. Isolation- so far, isolation has taken place at the infected person’s home.  That made some sense during the time everyone was isolated at home, but if people are going back to work and play, placing an infected person back in their home is a great recipe to spread this very contagious (see above) virus across wide regions.  Think about it, let’s say I get infected, and am sent home, I infect my family, who then goes out to work or school or play and spreads it, on average, to 5.7 people each.  The whole project of identifying infected people rests on this step, taking steps so that the infected person does not spread it to anyone else, this will require isolation outside the home.
4. Social distancing- To the degree that testing, contact tracing, and isolation are able to find every case and keep each infected person from spreading it to anyone, to that degree social distancing will become less important.  But, given that the US is not in a position, at this time, to do steps 1, 2, or 3 to a scale sufficient to stop the spread of the virus, social distancing for here and for now will remain our best hope.

Some Countries Have Done These Steps and Succeeded in Stopping the Spread of COVID-19

The East Asian success stories are well known.  In each instance these nations have adopted the 4 point program listed above, they have excelled at screening their entire populations, every day, and having those with any hint of infection, by symptom or exposure, for testing.  Identified cases are isolated outside the home.  Various levels of social distancing have been used, showing steps 1-3 are more helpful than social distancing.

An interesting emerging story is in Iceland where a national project to test everyone is coming along well, they are now up to 10% of everyone tested, and a quick look at their trend lines shows that they have essentially stopped the spread of the virus as of April 9th or so, https://www.worldometers.info/coronavirus/country/iceland/   Recently a senior official in Iceland shared that all their testing and public health techniques were taught to them by America.  If we had practiced what we taught Iceland, our numbers of death would have been around 10,000 rather than 34,000 now.

Germany is a nation that has also benefited from widespread testing,

The point is these steps are very doable, they work, and nations that do them best suffer the least.  The question remains, why don’t we?

Severity

One brief note on severity of COVID-19, and it is upsetting news.  We had noted that beyond attacking the lungs, COVID-19 now is known to cause clots to form in some, and in others to actually infect the heart causing the heart to weaken its pumping power.  Now it is reported that the virus also infects the kidneys.

https://www.kidney-international.org/article/S0085-2538(20)30251-9/fulltext

The most upsetting news on the issue of severity has to do with the unknown deaths.  Recent reports find that the number of deaths occurring at home has sharply increased in NYC and some of that is attributable to COVID-19, which is plausible given observations of people succumbing suddenly while being treated in the hospital.  The other rise in unknown deaths that is very alarming is that in nursing homes.

BOTTOM LINES

1. The virus that is causing this pandemic, all of COVID-19, the SARS-CoV-2 evolved naturally from bats to infect another animal perhaps pangolin, then humans.  Proof is in hand that no human created this virus, IT WAS NOT CREATED BY CHINESE OR AMERICAN PEOPLE IN A LAB.
2. This virus spreads very, very well, it is highly contagious, and much of it is spread by people with no symptoms.
3. Because it is highly contagious, and now present all over the world, coming out of lockdown will CERTAINLY put anyone in a close group of people at risk for exposure.
4. As the world comes back to work and play:  Testing, Contact Tracing, and Isolation are the only reliable hope to avoid another explosion of cases and deaths.  Other countries have done these three steps, and succeeded dramatically, we can too, all we need to do is decide to do so.
5. The SARS-CoV-2 virus is known to attack our lungs, and now also the heart and increases chance of clots in the legs, pulmonary emboli, and strokes, but now kidney damage can be added to the list.

The virus evolved and came upon an approach to attack humanity.  Now humanity must find a path forward to protect all we care for from real harm.

We again hope all do stay well, stay safe.

To your health,
Dr. Arthur Lavin