As the COVID-19 continues to spread around the globe and claim thousands of people’s lives more or less every day you may wonder if it is the end of the world as we have all seen in numerous films before 2020.
What strikes me is the impact this particular coronavirus has already had on our daily lives and societies and what havoc it has wreaked. We now live in times when you open the front door and see bags with food left by your friends or relatives and parcels delivered by the postman but you have no social contact with either of these people. We now live in times when instead of saying goodbye in person to your relative dying of COVID-19 you only have the luxury of doing so “online”.
It is too early though to look at the aftermath of this disaster as we are nowhere near the end of it and we may never get there. Most scientists and researchers agree that it is highly likely that we will have to live with social distancing measures till a vaccine is invented which may take months and most probably years.
The lockdowns around the world were implemented to delay and reduce the human-to-human transmission of COVID-19 and ease the pressure off the healthcare systems around the world. Lockdowns themselves do not provide a magical treatment to COVID-19. We all understand by now that it is probably not the way out from this crisis. What we also understand is that the only way “to go back to normal” in our pre-COVID-19 understanding is to have a working and reliable vaccine.
Was COVID-19 already in Europe in the middle of December 2019?
When I got really sick at the end of December 2019 and came down with a high temperature and a cough, I thought it was the flu. I am usually fit and healthy and the last time I was so sick was in my teenage years when I had bronchitis.
This time though “the flu” hit me hard, the temperature was high and persistent for 4 days and the cough lasted approximately 3 weeks. As at that time there were no coronavirus cases reported and no alert issued in London, I was treating my ill health with meds as any flu in addition to hot soup, tea with cloves, cardamom, ginger and lemon. I was feeling really bad and weak those days. Then thanks God I got better and went back to work.
My colleagues were also sick at the same time as me and whole families of theirs too. So I guess we got it from someone infected who either came to our office or from one of the colleagues returning from the trip abroad-they were many of those too. Or maybe one of us picked it up from public transport or from anyone outside our office...we will never know now.
Anyway, at the end of January we were all back to work and were talking about how ill everyone was and how weird it was that we were all unwell at more or less the same time. Everyone was saying that there was a bug going around in London and everyone was unwell. Nobody thought that it was possibly that Chinese coronavirus that reached London already at the end of December 2019.
Has China been late in reporting the outbreak to the WHO?
China itself informed WHO about the coronavirus outbreak only at the end of December 2019. However, in London many people and we in my workplace already were ill by the third week of December 2019.
There is also evidence now that in certain regions of Russia pneumonia was on the rise as well as recorded cases of people with a high temperature and a cough that then recovered themselves by treating these symptoms as a flu. These reports go back to the middle of November 2019.
Across the social media platforms you can see people around the world raising the same concerns that potentially the virus was already in the UK, USA and other countries in Deecember 2019.
This makes one wonder if China informed the WHO at the end of December 2019 "on time" and if this pandemic could have been prevented and lives saved.
Unsolved Mysteries around SARS-CoV-2 causing COVID-19
There are many unanswered questions about the COVID-19 at present. A picture is blurred as the virus is acting in such numerous ways and has such devastating consequences that humanity has never seen.
From what species SARS-CoV-2 jumped to humans mystery
There is still uncertainty around what animals humans got SARS-CoV-2 from and among the suspected species are bats, pangolins, pigs and even poultry. This article goes into more detail regarding this debate: https://www.topimpactfactor.com/post/what-is-coronavirus-and-can-our-lives-ever-go-back-to-normal
Human-to-animal transmission mystery
It was previously thought that only human-to-human transmission of SARS-CoV-2 was possible. What is truly surprising and unclear at present is why and how human-to-animal transmission started taking place. It looks like the original strain of SARS-CoV-2 has mutated. There have been cases of household pets getting infected with COVID-19 from their owners who tested positive for COVID-19.
In addition, a few species of wild animals in the zoos have tested positive for COVID-19. They could potentially catch SARS-CoV-2 from their feeders who were asymptomatic at the time of feeding. But this is only a guess.
It appears to be unclear why some people infected with COVID-19 do not develop any symptoms while they test positive for SARS-CoV-2. They are called asymptomatics and it is believed the rate of asymptomatic coronavirus infections to be around 40%.
On the other hand, it is unclear why some people test negative despite being in close contact with a member of their household who has tested positive. A 14-month-old COVID-19 toddler passed away at the beginning of April 2020 in Gujarat, India. His parents, however, tested negative and did not display any symptoms of COVID-19.
SARS-CoV-2 related inflammatory syndrome in children mystery
There has been a notable rise in children with “multisystem inflammatory state requiring intensive care” over the last 3 weeks in London and other UK regions.
On 25th April 2020 Paediatric Intensive Care Society has issued a high priority alert over a possible SARS-CoV-2 related inflammatory syndrome in children to all GPs across the country. The advice to GPs read 'the prevalent presenting symptoms are abdominal pain and diarrhoea and rapid progress to a shock-like picture'. Cases seem to be rare at present and “Our understanding of pathophysiology is currently incomplete. Whether this is COVID-associated or something else is not clear at the moment.”
Symptoms displayed by children included a high temperature, abdominal pain as well as cardiac inflammation. The cases have features of toxic shock syndrome and atypical Kawasaki disease. This has been observed in children who tested SARS-CoV-2 negative and in those who tested SARS-CoV-2 positive. At least 12 children needed intensive care.
Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, said “We already know that a very small number of children can become severely ill with COVID-19 but this is very rare – evidence from throughout the world shows us that children appear to be the part of the population least affected by this infection".
Antibody tests and immunity to SARS-CoV-2 causing COVID-19 mystery
Researchers, scientists and doctors are learning more about SARS-CoV-2 virus as the COVID-19 progresses around the globe and more people are getting infected. Doctors admit that they are still at the beginning and it is not clear who is vulnerable and why some of us get affected so severely.
Nevertheless, each country has to reach “herd immunity” meaning that a high proportion of the population becomes immune to COVID-19 (not all though). This immune response will protect those who develop it from getting COVID-19. However, it is unclear at present if there is a lifelong immunity to SARS-CoV2 virus causing COVID-19.
Antibody tests that were briefly mentioned in this article aimed to inform us if one has developed immunity to COVID-19. One would then not be at risk of catching COVID-19 and can safely go back to work. Unfortunately, antibody tests developed so far have not been reliable.
In addition, there have been cases reported around the globe of reinfection with COVID-19 although such cases are very few. It is unclear though why some people get infected with COVID-19 again. It might suggest that some do not develop antibodies after having contracted COVID-19 or do not develop enough of these antibodies and therefore have no immunity to SARS-CoV2 causing COVID-19.
Drug development against SARS-CoV-2 causing COVID-19
In response to the urgency of the situation, many already existing drugs are being tested for their suitability to treat COVID-19 patients.
A malaria medication, hydroxychloroquine, that was hoped to be used in treatment of COVID-19 patients unfortunately was found not fit for its purpose. It has been found that it actually caused more deaths among those treated with it than those treated with standard care.
Remdesivir, an antiviral drug, has been shown to have no benefit for COVID-19 patients at the time of writing this article (28th April 2020). However, on 29th April 2020 the National Institute of Allergy and Infectious Diseases stated that preliminary data show that patients who received Remdesivir recovered faster than those receiving placebo. However, the study design did not include a group of patients who were untreated and therefore it does not indicate how well Remdesivir is working.
SARS-CoV2 vaccines development against SARS-CoV-2 causing COVID-19
At the time of writing there are at least eight types of vaccines being tested against SARS-CoV-2 and over 90 vaccines are being developed by research teams across the globe.
It is hoped that one of them will provoke an immune response that will block SARS-CoV-2 upon exposure to it or kill SARS-CoV-2 if the person becomes infected.
Mysteries around the impact of SARS-CoV-2 causing COVID-19 inside the body
Much of the effects of coronavirus on our bodies is poorly understood and it is not clear what lasting disabilities the virus will cause. Although lungs are ground zero for damage caused by SARS-CoV-2, it has been observed that COVID-19, or the body’s response to it, can devastate the heart, blood vessels, kidneys, liver, eyes, gut and brain. Scientists are just starting to unravel the nature and scope of the harm in the body caused by COVID-19.
Heart and cardiovascular damage due to SARS-CoV-2 causing COVID-19 and possible pathways of attack
How the virus attacks the heart and causes cardiovascular damage is still a mystery.
It might be that a lack of oxygen damages blood vessels or the SARS-CoV-2 directly attacks the heart and blood vessels the lining of which is rich in ACE2 receptors like the nose and alveoli.
It could be that the out of proportion inflammatory response to COVID-19 is the reason for a high death toll across the globe. The “cytokine storm” which is the disastrous overreaction of the immune system might also be the reason why so many patients’ condition deteriorates. Cytokines guide a healthy immune response, however, in “cytokine storm” cytokine levels are over the top and immune cells start to attack healthy tissues. What follows as a result is a leakage of blood vessels, drop of blood pressure, formation of clots and organ failure.
Brain affected by SARS-CoV-2 causing COVID-19
Looking back at the outbreak of SARS(the coronavirus behind the 2003 severe acute respiratory syndrome epidemic) which I briefly mentioned in this article, we can see that SARS sometimes caused encephalitis/brain inflammation.
COVID-19 patients have also been reported to have encephalitis/brain inflammation, seizures and brain injury. ACE2 receptors are present in the brain stem and therefore SARS-CoV-2 has a way to get there, however, at present it is not clear under what circumstances it happens.
It is also unclear why some patients are not gasping for breath when their oxygen levels are extremely low. It looks like SARS-CoV-2 virus somehow depresses the brain stem reflex to sense oxygen starvation in COVID-19 patients.
Gut affected by SARS-CoV-2 causing COVID-19
There is now a growing body of evidence suggesting the SARS-CoV-2 virus can infect the lining of the digestive tract(GI) which is abundant in ACE2 receptors. Many patients that experience diarrhea have also tested positive for COVID-19.
The WHO organisation already lists on its website information that “very few people will report diarrhoea, nausea or a runny nose”.
Kidneys and liver affected by SARS-CoV-2 causing COVID-19
Kidneys are abundant in ACE2 receptors and present another target for SARS-CoV2.
People with some chronic kidney disease and diabetes are at a higher risk of having acute kidney injury and consequences associated with it. “Cytokine storm” mentioned before along with Remdesivir, an antiviral drug, used in treatment of COVID-19 patients and ventilators, boost the risk of kidney damage.
More than 50% of patients diagnosed with COVID-19 and hospitalised had liver and bile duct injury. However this might be linked to drugs being administered as part of treatment or a response to the body’s own immune overreaction.
Eyes affected by SARS-CoV-2 causing COVID-19
Approximately one third of hospitalized patients with COVID-19 develop inflamed eyes with a sticky discharge-conjunctivitis.
Learning the hard way
While we are still learning and trying to unravel the mysteries around SARS-CoV-2 causing COVID-19 to better equip ourselves for the current pandemic and any future outbreaks, the precious weeks in January, February and March 2020 were wasted by many countries. Despite a rise in cases of SARS-CoV-2 reported across the globe, many nations were in denial as to the potential threat of SARS-CoV-2. It seems like SARS-CoV-2 has tricked even the most respected experts in public health and infectious diseases let alone others including politicians.
When Italy was hit the hardest, the UK was still not in lockdown believing that COVID-19 will not reach here or at least that it will not have such devastating consequences on people’s health, work and lives. Sadly it has happened and we are now learning the hard way.