When Stephen Colbert, a late night TV show host in America asked American astrophysicist Neil deGrasse Tyson, his thoughts on coronavirus, Neil replied, “we are in the middle of a massive experiment worldwide. Maybe the experiment is, will people listen to scientists.” In India, we have what are known as the Fundamental Duties. These are not legally enforceable, but are crucial in the development of citizens. There are eleven Fundamental Duties, and one such Fundamental Duty states that, “it shall be the duty of every citizen of India to develop a scientific temper, humanism, and the spirit of inquiry and reform.” With these thoughts in mind, i would like to discuss many questions one may have in his/her mind during these times. I personally have many.
So let us start with the first question. What is a coronavirus ? Viruses that falls under the category or family of coronaviridae, are called coronavirus. Members of this family, coronaviridae, are known to cause respiratory or intestinal infections in humans and other animals. Leo L. M. Poon and J. S. Malik Peiris in “Detection of Group 1 Coronaviruses in Bats using Universal Coronavirus Reverse Transcription Polymerase Chain Reaction” writes, “coronaviruses are a group of enveloped positive strand, single stranded RNA viruses with a corona like morphology. These viruses have genome sizes ranging from 28 to 32 kb, which makes them the biggest among the RNA viruses. They further add, “based on antigenic and generic analyses, coronaviruses can be categorized into three groups. Group 1 and 2 are found to infect mammals, where as avian species are known to be the natural hosts for Group 3 viruses.”
My second question is, is COVID 19 the first and the only coronavirus in the history of mankind ? Leen Vijgen, Elien Moes, Els Keyaerts, Sandra Li, and Marc Van Ranst, in “A Pancoronavirus RT PCR Assay for detection of all known Coronaviruses” writes, “the recent discoveries of novel human coronaviruses, including the coronavirus causing SARs and the previously unrecognized human coronaviruses HCov-HKUI, indicate that the family coronaviridae harbors more members, than was previously assumed.” They further add, “all human coronaviruses characterized at present are associated with respiratory illnesses, ranging from mild common colds to more severe lower respiratory tract infections.”
Third question, what is the possibility of COVID 19 being a bio weapon ? Can it be artificially created ? How is it transmitted ? Leo L. M. Poon and J. S. Malik Peiris in “Detection of Group 1 Coronaviruses in bats using Universal Coronavirus Reverse Transcription Polymerase Chain Reaction” writes, “the zoonotic transmission of SARs coronavirus from animals to humans revealed the potential impact of coronaviruses on mankind. The incident also triggered several surveillance programs to hunt for novel (new) coronaviruses in human and wildlife populations. Using classical RT-PCR (Reverse Transcription Polymerase Chain Reaction) assays that targets a highly conserved sequence among coronaviruses, we identified the first coronavirus in bats. Using the same approach in our subsequent studies, we further detected several novel coronaviruses in bats. These findings highlighted the fact that bats are important reservoirs for coronavirus. The recognition of SARs like coronaviruses in palm civets, and other small mammals in live game animal markets, prompted intensive surveillance for coronavirus in wild animals. Following upon this interesting discovery, several coronaviruses were identified in the mammalian and avian species. In particular, our initial studies first revealed that bats are an important reservoirs for coronavirus.”
Fourth, can we compare COVID 19 with the great pandemic of 1918 ? The pandemic of 1918 killed at least 50 million people worldwide, of which 6,75,000 was in the United States of America. It is considered by many as the most serious plague to hit mankind, more serious than the Black Death in Europe. The pandemic of 1918 is also called as the Spanish Flu. The World Health Organization makes it clear that while naming, one needs to make sure that the terminology remains sensitive to the sentiments of a community in general. So, many avoid calling it the Spanish Flu and generally stick to the much neutral terminology, i.e, the pandemic of 1918. But, why call it Spanish Flu ? Writer Laura Spinney writes, “the story of misnaming of the 1918 pandemics is well known. World War 1 was in 1918, and the belligerent nation censored their press, not wanting to damage their population’s morale. Spain however was neutral in that war, and when the first cases of flu occurred there, they were widely reported. The disease had already been in the United States for two months and in France for several weeks. That information was however kept out of their newspapers. So the world came to see the disease as coming out of Spain.” In a month alone (May 1918), the flu killed 8 million people worldwide. Most of the death occurred among the young people between the ages of 18 and 40. The 1918 influenza pandemic charged across America in 7 days and across the world in 3 months. But how did the virus spread ? There are many theories that supports the spread of the virus, but the most important one is the troop transportation. Initial phase of the spread began in the spring of 1918. By May of 1918, the influenza had reached France, where American troops were fighting the Germans. From there, it spread to Spain, Egypt, Palestine, and the Far East. By the summer of 1918 (July), the pandemic became very serious in France, Germany, Spain, Portugal, and parts of South America. This was the first wave.
The second wave began in August of 1918. It appeared to have begun both in France and India, possibly by the movement of troops. It quickly spread through all of Western Europe, most of the United States and Southern America, Canada, India, and China. The highest death toll was in India, about 50 per 1000 inhabitants, and in many of these cases, there was a correlation between poverty and high death rate. The second wave arrived in Boston, U.S.A, in September of 1918, through the ports, busy with war shipments of machinery and supplies. The war also enabled the virus to spread and diffuse through the mobilization of civilians into the army. On Nov 11, 1918, when Armistice Day was celebrated at the end of the war with parades and large gatherings, a rebirth of the epidemic occurred in some cities. The flu that winter was beyond one’s imagination, with a million infected, and a 1000 deaths.
The incubation period of the flu and the onset of symptoms were so short that apparently healthy people in the prime of their lives (ages 15 – 35) were suddenly overcome and within an hour, would become delirious, helpless with fever, and chills. A unique viral pneumonia, a patient could be recovering one day and dead the next. The body temperature ranged from 101 – 105 F (38 C). Those who did not die of the viral infection, often died of second bacterial pneumonia. One physician observed, it is simply a struggle for air until they suffocate. Sir Martin Gilbert, a British historian writes, “that October, 225 Londoners died of Spanish Flu. This was more than all the deaths from 4 years of Zeppelin and Bomber raids over Britain.” In South Africa, 20 percent of the population of Kimberly died. In Mumbai, a 1000 Indians were reported to have died of influenza in one month, and with each month, the epidemic intensified throughout the subcontinent. ANZAC (the Australian and the New Zealand Army Corps) soldiers, returning from Europe carried the epidemic to Australia and New Zealand. More than 12,000 Australians died of influenza, despite two compulsory preventative measures, the wearing of face masks, and the closing of theaters and cinemas. Six million died in India, the country where plague had killed a similar number at the turn of the century.
In the year 2014, Milton W Taylor in the book “Virus and Man : A History of Interactions” discusses about emerging viruses. On emerging viruses, Milton W Taylor writes, “emerging viruses are viruses that appear suddenly in the human population. There are viruses to which man has no history of exposure, and thus no or limited immunity. They are not new evolutionary creations, but are viruses man meets due to environmental changes, such as deforestation, entering into new habitat, or viruses that are transmitted from one species of animals to humans. Most of these viruses are terrifying and cause hemorrhagic fever, a complete destruction of the circulation system. These include the Lassa Fever, Nipah Virus, Ebola, HIV, SARs, and recently MERs, which is the latest in a series of new respiratory viruses infecting man.” So let us undertake a comparative analysis of the emerging viruses, through the years.
During the Korean War between 1951 – 1953, Hanta Virus caused an outbreak of hemorrhagic fever among American and Korean troops. Hanta Virus, is not a coronavirus, but a bunyavirus, but like many coronaviruses, is also a single stranded RNA virus. It causes sever respiratory infections, and is transmitted by a variety of rodents, mostly mice. The name ‘Hanta’ comes from the Hantan river in South Korea. The disease was first recognized in the U.S.A in 1993. It was referred to as the Four Corners Disease. An unexplained pulmonary (lung) illness occurred in an area shared by Arizona, New Mexico, Colorado, and Utah. The outbreak was related to an increase in crop yield, with a concomitant increase in the deer mouse population. In 1993, unlike the previous years, there was plenty of rain and snow, and thus the plant yield was greater than usual. It was estimated that the deer mouse population grew tenfold during this period, and thus had more contacts with human. In U.S.A, it is also remembered as “Sin Nombre Virus”.
Ebola Virus first emerged in 1976 in Zaire and Sudan. With a mortality rate that varies between 25 percent to 90 percent, it is the most lethal human viral infection known. Ebola, categorized under Filo Viruses, is a negative stranded RNA Virus, and causes hemorrhagic fever (internal bleeding). The first recorded outbreak killed 280 out of 318 cases in Zaire, and 151 out of 284 cases in Sudan. The disease spread rapidly among the hospital personnel, treating the sick, and among the general population, through contact with ill persons, handling the dead, and reuse of needles. In 1990’s, there were fatal outbreaks in Congo. In one case, 16 people became sick from eating a Chimpanzee, found dead in the jungle. Between 2000 – 2001, there were outbreaks in Uganda. About 425 cases were recorded, with mortality rate of 53 percent. Three most important risks associated with Ebola Virus infection were, first, attending funerals of Ebola patients. Second, having contact with the sick in one’s family, and third, providing medical care to Ebola patients, without using adequate personal protective measures. In 2014, there were Ebola outbreaks in Congo and Uganda. According to the Center for Disease Control, and World Health Organization, the origin of Ebola Virus is still unknown, although bats are suspect in this case, and also in similar diseases.
In 1998 in Malaysia, there was an outbreak of Nipah Virus. The origin of the virus was traced to pigs. The disease spread to other parts of Malaysia, with the movement of pigs for commercial reasons. The outbreak had been associated with land clearing for agricultural purposes. The affected area of Malaysia had been cleared of jungle, and fruit trees were planted. These fruit trees were attractive to a particular species of bats known as Flying Foxes. They in turn sprinkled the areas with their droppings into areas foraged by pigs. These droppings contained the virus, and thus the pigs and other mammals were infected. The Nipah Virus is associated with encephalitis (inflammation of the brain), fever, drowsiness, serious central nervous system symptoms, such as coma, seizures, and inability to breathe. In 2004, there was an outbreak of Nipah Virus in Bangladesh and India. This outbreak was not associated with pigs, but with the consumption of date palm sap, that had been contaminated with fruit bat droppings. In 2012, there was another Nipah Virus outbreak in Bangladesh, and human to human transmission was detected. In all the cases, the virus had a mortality rate of 75 percent.
Severe Acute Respiratory Syndrome (SARS) (hereinafter “SARS”) Virus appeared in 2002. Between November 2002 to July 2003, there were approximately 800 cases in Southern China, with a death toll of 10 percent. The major hot spot was Hongkong, with 9 percent fatality, but within a few months, SARS spread worldwide, carried by unsuspecting travelers. The infectious virus was identified as a coronavirus in 2003. The symptoms were fever, chills, muscle aches, and occasional diarrhea. After about a week (after infection), signs and symptoms included fever of 100.4 F (38 degree C) or higher, dry cough and shortness of breath. The SARS epidemic showed how quickly infection can spread in a highly mobile and interconnected world, but also showed how international cooperation among healthcare experts can effectively contain the spread of the disease. The virus spread from South China to Singapore, Taiwan, U.S.A, and Canada. Milton W Taylor writes, “to date there is no vaccine against SARS, however the passage of antibodies inhibits the Virus.” The first case of SARS appeared to have been a farmer from the Guangdong area of China (bordering Hongkong). The Chinese authorities reported the outbreak to the World Health Organization, with 305 cases and five deaths. However, it was later found that due to a tight restriction on the Chinese press, the details regarding the Virus was suppressed. Many suspected the data to be false. This may have led the World Health Organization to underestimate the severity of the outbreak. It took about 5 months from the initial outbreak for the Chinese authorities to allow physicians from the World Health Organization to visit the Guangdong province and to admit to the seriousness of the epidemic. This was followed by mass quarantine of hospital wards, under armed guards, and threat of execution to anyone, knowingly having SARS, and avoiding quarantine. However, these measures and international cooperation stopped the epidemic from spreading. Civets (a member of the cat family) was suspected of having the virus. Civets are also a food delicacy in China, and are also found in the wet markets. Later findings indicated that civets do not have the virus. In 2005, two teams of researchers reported the presence of similar coronaviruses in Chinese horseshoe bats, and also found that the virus was probably passed on through an intermediate host on the market. A phylogenic tree shows that civet and human SARS viruses are very similar. The ancestor of the civet and human strains seems to have been a bat virus. Based on this evidence, biologists have come up with a plausible path of transmission, i.e, infected bats and uninfected civets came into contact at a market. The virus was transmitted to civets and then multiplied and evolved in civets (or other animals) in the public market until eventually, the virus hopped over to humans.
In 2012, there was an outbreak of Middle East Respiratory Syndrome (hereinafter MERS) in Saudi Arabia, Qatar, and nearby countries, including some European countries. MERS, a coronavirus, causes severe pneumonia and kidney failure. Virus originated in bats and spread to humans, either directly or through an intermediate host. The Virus appears in clusters and there is human to human transmission. Recent evidence suggested that dromedary camels found in Southern Oman may also have been infected in the past with MERS, but there is no evidence that this is the source of the current epidemic.
Being aware of history solves many queries, as in the case of a pandemic. Information has always been a necessity, and being informed, a skill. Nothing that happens today is new, because at some point of time, it has already happened. The above information can be summarized into following points. First, there needs to be a cooperation and a transparent flow of information between countries, organizations, institutions, and people, in our multilateral world. For example : SARS was suppressed due to international cooperation. The Great Pandemic of 1918 also taught us how information sharing becomes vital in a new globalized world. The Press, being a fourth pillar in a democracy should keep it’s citizens informed, without any external pressures. Second, if we observe the data for the last 20 years, we can expect more outbreaks in the future, as we enter into unfamiliar territories, and as a result we encounter unfamiliar organisms, and they us. For example : as we move deeper into the amazon forests or other unsurveyed land, we need to be prepared to hear about more viruses.
The total impact of COVID 19 is yet to be known, with 17,00,000 plus positive cases worldwide and about 3,00,000 recovered. It is still less than the 50 million cases worldwide, during the Great Pandemic of 1918. Going forward, it becomes essential to learn from the past, and strive towards creating a more connected and a transparent world, where information flows seamlessly.
By,
S. K. Ghising
References
- Milton W Taylor, Viruses and Man : A History of Interactions, pg no 379 – 391
- Dave Cavanagh (eds), SARS and other coronaviruses : Laboratory protocols, pg no 3 – 73
- Laura Spinney, Indian Express article.