2019-nCoV, a New Threat and Exemplary Action by the Chinese Authorities
IN two months, the novel coronavirus—or 2019-nCoV—has affected more people than the SARS virus had done in 2002-2003. While it is spreading faster, it is more infectious than SARS, the infections are less severe: the numbers of people becoming seriously ill or dying are less than with SARS. The Chinese authorities have reported 7,711 confirmed cases as of January 30th, of which 170 people have died of the disease. The bulk of the infections are from the Hubei province, with Wuhan as the epicentre of the outbreak.
While there are various doomsday predictions of this epidemic, the Chinese authorities have acted with exemplary speed and taken extreme measures to isolate and control the spread of the disease. Nowhere else in the world would it be possible to have a lockdown of the city of the size of Wuhan, with its 11 million populations; or genome sequence the virus which they have now made public; or reach diagnostic tests; and mobilise 6,000 medical personnel for Wuhan. That is why the WHO has also praised the Chinese authorities in their handling of the epidemic and the measures they have taken.
What is a coronavirus? Coronaviruses are a family of viruses that infect the respiratory tract. They include the familiar ones such as common cold and influenza, and also the more worrying ones that affect us from time to time, such as SARS, MERS, avian flu, swine flew, and now nCoV. They may cause mild body ache, sneezing, coughing, fever, and in severe cases complications such as pneumonia.
The earlier two similar viruses that have caused lung infections are SARS, Severe Acute Respiratory Syndrome, and MERS, the Middle East Respiratory Syndrome. Both these viruses originated from other species. SARS was a bat virus, and MERS was infections from camel to humans. Unlike MERS, both SARS and cCoV, while originating from other species, have the human to human transmission, making them much more infectious. The nCoV is infectious even when it is incubating in the body and no symptoms are visible. This means people who are completely unaware that they are carrying the infection, can also infect others. This makes controlling the spread difficult. With 7,711 confirmed cases, the Chinese authorities are also monitoring another 88,693 who have been in close contacts with the infected patients.
There have been various theories about the species from which the virus originated as well as the place where this specie jump occurred. Initially, as a cluster of cases had been reported from the sea food market in Wuhan, this was thought to be the place of origin. As this also where a lot of wild animals are sold, tt was theorised that this virus could be from a snake.
After the genome sequence has been made public, it is now clear that there are cases that did not originate from the Wuhan market, and the virus may have spread, but it did not originate from the market. While the first recorded case of the virus is December 2019, the likely date of earliest ancestral version as constructed from the 28 virus sequence the Chinese authorities have made public indicate, is in early November. This would be the date when the first mutated virus infected a human being, from which all infections can be traced. The virus is also now being recognised as closest to various bat viruses, and a bat virus is the most likely source of nCoV.
What kind of medicines do we have in our repertoire against the nCoV? How quickly can we identify or develop such medicines? Can we develop a vaccine against this virus?
Here is where the great advances we have made in the last few decades come in. First is the speed with which the virus has been sequenced. This was the first step in developing a diagnostic kit and making it widely available. The Chinese authorities are now supplying a large number of such kits for a quick identification of those infected, and isolating them as quickly as possible. The second is testing existing medicines that we have against similar diseases, hoping some of them will work against nCoV as well.
Chinese researchers have found that out of 30 odd antiviral and other drugs, three existing drugs—Remdesivir, Chloroquine and Ritonavir—have fairly good inhibitory effects. This research was jointly conducted by the Academy of Military Medical Sciences and the Wuhan Institute of Virology (WIV). Of course, moving from laboratory level to actual trials is still a big step, but the speed with which this has been done is unthinkable in a different era.
In addition, the Chinese medical authorities are also testing a number of traditional Chinese medicines for therapeutic effects, but no such candidate has yet emerged. This is not surprising, as traditional medicines would work against diseases that are stable, allowing traditional practitioners to gather sufficient empirical knowledge to treat such diseases. If the disease is novel, it would not have been seen by such practitioners, and therefore unlikely that a traditional medicine would be available against it.
The second line of defence, and in the long run the most important one, is a vaccine. Once the virus is isolated, a vaccine is of course a matter of time. Traditional vaccine development takes almost six months to develop, after which we can conduct clinical trials and decide on their effectiveness. This time, we have a much more powerful toolkit. As we know, traditional vaccines work as we use either a much milder form of the disease, or a small snippet of the virus DNA to trigger an immune response in the body. This works to protect us from future infections from the same virus. This time, we also have messenger RNA—or mRNA—that can induce a similar immune response of the body. These vaccines can be developed as fast as 30-40 days and can then be fast-tracked into clinical trials before they are mass produced and used to vaccinate the entire population.
A Chinese and three international companies are in the race to produce an mRNA based vaccine. In this case, it should not be viewed as competition, as more such candidates, more the chance of success of a vaccine that would work against nCoV.
A word on the other aspects of the infection, particularly on the West’s pathological hatred of China and Russia. A whole bunch of fabrications are now being advanced, of Chinese developing a biological weapon in Wuhan’s biological laboratories that simply got away. I would give them the same credence of stories that the US engineered the AIDS virus for weapon purposes, and it escaped while testing in Africa.
The second is the nonsense of homeopathy and traditional medicines having cures for nCoV. If a disease has not been seen, and a medicine has not been tested against it, to talk about a cure existing is foolish. None of the so-called medicines have been tested against nCoV, as it has yet to emerge in India. Ayush’s claim, without any testing or logic that traditional medicines can work against such disease is based on not knowledge, but on belief. Similarly homeopathic claims, which always emerge in times of epidemics, particularly viral epidemics, have always failed when tested.
What such claims do is to delay treatment, particularly for the old and others whose immune systems are weak. Most healthy people will recover from such virus infections; it is the older people who fall prey to serious illness, and also die from such viral diseases. Just so that we understand the scale of the flu virus infections, a part of the family of coronaviruses, an estimated one billion get infected by flu every year and the mortality rate is 300,000-700,000. The flu still remains our biggest killer in the coronavirus family, and every time a new outbreak of SARS, avian flu or now nCoV takes place, we are reminded of the influenza pandemic of 1918 that killed an estimated 50 million worldwide.
Claiming false cures will only delay the essential measures that need to be taken; what WHO has said: isolate the suspected patient, provide immediate support, and follow-up on the contacts to prevent further spread. Not hocus pocus medicine.