Corona Virus Cure?
Kinkajou: So Corona virus. CoVid 19.
The greatest threat to humankind this century?
Erasmus : Or just a mecca for mad lemmings! Can we discuss our containment strategies?
Kinkajou: The corona virus epidemic will cost humanity over $100 trillion within the next year. It will cause immense social and economic disruption. It will destroy human productivity, human families and human lives. Lack of income will devastate businesses their employees and their dependents. The next wave of damage will affect interlinked businesses – that is businesses dependent upon the productivity and activity of other businesses. For example if a tourism business collapses – restaurants may fail, fuel distribution points such as petrol stations may fail, hotels, motels, pubs, clubs, social groups, bus makers and boat makers and even food stores and clothing stores may all be hit.
Erasmus :But does it have to be this way?
Dr Xxxxx : We have chosen isolation and separation as our point of attack to control the spread of the virus. But I believe you may as well try to collect the particles in a puff of smoke. When it first appears in may be possible to encapsulate and isolate it. But once it begins to spread, spread is inevitable. In the same way you cannot catch all the particles present in a puff of smoke; neither can you contain the infective spread of a virus like the coronavirus.
Goo: But this has worked so well in West Africa for stopping the spread of Ebola Virus.
Dr Xxxxx : Yes. But there is a substantive difference between the nature of the Ebola virus and the nature of the coronavirus. Ebola virus leaves behind points of devastation – liquefying human beings infected with the virus. The virus spreads generally slowly, to close associates and especially by touch. Individuals become visibly infected, and in the long-term live or die. There are no hidden infections. There are no subclinical cases. There is only death or life. With a death rate of 30 to 90%, there’s not much that goes hidden either.
Goo: What will we Achieve?
Kinkajou: Yes. So what are we likely to achieve with our current disease control strategies?
Dr Xxxxx : Currently we are using public health strategies to control the spread of infection. We have seen this work extremely well for infections such as Ebola which spreads through contact predominately. We have seen very poor usefulness of these strategies for respiratory droplet spread infections.
The probability is we are spreading out the infection epidemic. Instead of one “short” burst of infection and then the virus dying away – we’re going to have a long ongoing infection epidemic going on for some months before the rise in herd immunity/ (other) makes the infection die off.
Erasmus : But coronavirus is a very different animal to most respiratory viruses.
Dr Xxxxx : When a group of people (let’s say 10 people) are infected with the coronavirus, a number of different outcomes is possible.
The person may be affected so badly that the require hospitalization and ventilation. The person may become seriously ill requiring substantial medical attention.
The person may develop significant symptoms which they bring to the attention of medical professionals. The person may develop significant symptoms they do not bring to the attention of medical professionals – being cognizant of the potential downside of being declared to be infected. (Notably the ostracism of one’s family and neighbours and perhaps even one’s fellow employees. Being forced to cease work. Being forced to isolate.)
The person may also develop very minor symptoms which may cause very few symptoms and never quite get to the point where the person seeks medical attention, assessment or investigation.
Dr Xxxxx : So summarizing, Of a group of 10 people infected with coronavirus one may be on a ventilator, two may see a doctor and even require hospitalization for some time, one or 2 may seek medical attention which may or may not be available (PCR testing has been limited only to air travellers, people returning from overseas or people exposed to a confirmed case).
5 or so people may not present any medical attention or care at all. Essentially, this creates a front line with all the medical weapons trained forward but with the enemy in every direction, and possibly in the trenches as well.
Erasmus : Yes I can see. It’s never going to work. Separation and isolation is a good policy where there is a definite line drawn between infected and well. Where this line is not well-defined such as in the case of a respiratory virus such as coronavirus, you may as well chase the particles in a puff of smoke as try to control the spread of disease.
Dr. PCR NAAT technology gives us Incidence Data but we need Prevalence Data
Erasmus : Explain !
Prevalence Vs Incidence
To understand the problem of COVID / Corona Virus, you need to understand these two critical concepts.
Dr Xxxxx : The problem is exacerbated by the way we test for the coronavirus disease. We are using PCR (polymerase chain reaction) technology, a.k.a. NAAT (nucleic acid amplification testing). These test protocols look for unique or distinctive chains of nucleotides.
A sample is collected, the sample is broken into fragments, DNA (or RNA) is amplified and testing reveals the presence or absence of fingerprint DNA fragments. It is an excellent test for the presence of an organism – be it a virus, bacteria, fungus or a cell from any animal or human being.
- used in Corona Virus Diagnosis.
This sort of testing is extremely useful in the epidemic. We can work out who is carrying the virus and who is not.
Erasmus : But if the virus can be sneaky or invisible (asymptomatic), don’t we also want to know who may have HAD the disease, but no longer has the disease – now being immune to the disease.
Dr Xxxxx : Yes indeed. PCR testing tells us the incidence of an infection. Who has the infection right now? What it is not good at telling us is the prevalence of infection.
This is because there are 2 reasons why a PCR test can be negative. Firstly the person may not have the disease and may never have had the disease.
Secondly the person may not have the disease, because they have already recovered from the disease and their immunity has removed every trace of the organism by exterminating the organism e.g. the corona virus in this case.
What is useful in this circumstance is as serology testing. If the antibodies are present, the person has been exposed to this disease or to a very similar disease. They have developed immunity. There are some special cases in looking at this. In the case of the HIV virus, developing immunity does control the virus and reduces the number of viral particles in the bloodstream, but it does not succeed in totally exterminating the virus. For most viral illnesses, once immunity arrives (as defined by positive serology), the virus is cleared and becomes essentially undetectable.
Erasmus : So why aren’t we using both tests?
Dr AXxxxx : Too many politicians might be embarrassed by all the economic devastation they have unleashed, with negligible benefits. If you hide the serology results, no one can say you did the wrong thing. In act you can pat yourself on the back for doing a great job, because there’s no evidence to the contrary.
And can you imagine if you did backtrack and stop the CoVid containment strategy and someone’s 85 year old granny dies. Woe beholds anyone doing anything to make that happen.
Goo: At 85 years old, she was doomed to go soon, I think. Something would definitely knock off granny and soon. If not CoVid then the flu or pneumonia. Or maybe granny just falls over and breaks a hip, develops complications and exits stage left from that.
Erasmus :Yes no one wants to admit how many suicides will result from the economic disaster and how much misery and death may result from the “containment” strategy. Countries like India are full of now unemployed migrant workers, sleeping in the streets and unable to feed themselves. Often also not that country’s problem as they are not citizens.
Dr AXxxxx : But I’m sure there’s more to this puzzle.
Dr Xxxxx : I think so. PCR tests are unfortunately very profitable. Most companies would prefer to develop a PCR test because the protocol is much standardized and a premium can be charged (due to the complexity of the technology involved), for doing the test. Serology tests require the isolation of “specific” antibodies. These are unique to every infection.
They can involve a range of antibodies – not just a single unique marker as in PCR DNA fragment markers. These need to be isolated, purified and then combined with a test indicator such as an enzyme giving colour changes/cells such as red cells giving a cell lysis reaction with antibody antigen interaction et cetera.
Erasmus: So PCR is complex but easy and profitable. While serology is finicky, requiring purification, standardization and detection systems to be incorporated into the test protocol to give result. Because serology is an old technology, it is remunerated poorly in many of our pathology testing systems. New tests are expensive to produce but old tests such as measles mumps rubella serology have been around so long that they set the benchmark for remuneration.
Dr Xxxxx : Exactly!
Kinkajou: So it sounds like that by us using PCR testing, we’re almost flying blind. We are making huge assumptions as to the size of the potential pool of humans able to be infected. We have no idea how many people may have actually recovered from the infection and may be immune. It leads us to assume the worst. If PCR detects 10 cases and one of them dies, it leads us to think that 10% of the infected population will die. But if serology reveals that 100 people have had an recovered from infection and PCR identifies that 10 of these people have the virus and one of these people dies, it becomes obvious that the mortality is only 1%.
Erasmus : There is a massive difference between a death rate of 10% and a death rate of 1% .It 10% of the population is doomed to die – we should all run home and hide under the table. If 1% of the population is going to die though – should we be worried?
Kinkajou: 1% of the population dies every year. Actually it is a bit more than this. It is called old age. If everyone were able to live to 100 years of age, it becomes obvious that 1% of the population must die every year to make this a self-sustaining cycle. So a death rate of 1% in the case of a virus such as the coronavirus implies that perhaps more people will die a bit quicker, and then perhaps things will slow down afterwards as we resume usual “mortality”. People live and people die. 1% a year is average. There is almost no point changing anything we do in our lives, for a mortality of 1%. From what you said before, the mortality could be even lower than 1%.
Dr Xxxxx : So the key issue is the development of serology testing to supplement PCR testing. You cannot plan if you don’t know what you are dealing with.
Erasmus : This brings us to the crux of the dilemma of the coronavirus epidemic. Are we dealing with a 10% death rate? Are we dealing with a 1% death rate? Are we dealing with a 0.3% death rate? The actions we take as a result of each of the circumstances are likely to be very different. Our current paranoiac panic and mayhem reaction to the corona virus epidemic is appropriate if we are facing a 10% death rate. It is however extremely inappropriate, creating social and economic devastation far in excess of what the virus could do it self, if the death rate were to be .3% or even up to 1%.
Dr Xxxxx : Exactly. Our actions must be predicated upon knowledge of the incidence and prevalence of the disease. PCR testing gives us excellent knowledge of the incidence of the disease. Serology testing will supply us with information of the prevalence of the disease.
Kinkajou: So what is the future of our attack against the corona virus?
Erasmus : I don’t think many of our politicians and decision-makers realise the consequences of their actions. Most people are caught by the image that self – isolation will control and eventually extinguish the Infection. This is not what the containment/isolation process we are following is all about.
All our concern derives from the death/severe illness statistics that have eventuated from Italy. In Italy 50 to 80 people per thousand have died. Our planners in Australia in anticipating the impact of an illness such as this here have projected that if we can slow the infection rate down, more people will have access to high level care such as intensive care and ventilation machines. (There is more than just machinery involved here. You need trained staff capable of operating and supervising the technology as well).
However this is not eventuating in Australia. Prior to the weekend of 4th April, Australia was experiencing .4 per thousand deaths from the coronavirus. On the latest statistics as of 4 April, we have seen approximately 5 per thousand deaths from the virus. You need to put these numbers in perspective. Approximate one per thousand people die every month from whatever cause – in our society namely old age and old age related illnesses.
What are the main risk factors for dying from coronavirus? Currently the chosen variable most associated with illness and death is age.
Dr Xxxxx : I would however propose that it is immune dysfunction that is the critical factor. This is very hard to measure though of course there are a number of surrogate variables from which conclusions can be drawn. Some of our routine testing has also drifted away from some of the main determinants of immune dysfunction that are critical – in my opinion. Namely, the de-amidation of the gliaden antibody test is significant. Unfortunately, many doctors have some disagreement over the importance of these medical issues.
Dr AXxxxx : Some people only learn what they are taught.
Dr Xxxxx : Their work may not have exposed them to medical issues which have caused them to question the training and knowledge.
Dr AXxxxx : But some of these fellows are absolutely crazy. I saw a fellow in TV recently criticising the medical system’s response to the infection. He was a surgeon. He was packing folded up paper in the cracks around his doors.
Another nasty virus with no cure.
Kinkajou: Though if there is a Zombie Virus epidemic following the coronavirus epidemic, maybe we will end up thinking he is the clever one.
Kinkajou: So what do you think of the isolation/containment scheme?
Dr Xxxxx : In a nuclear fission reaction, such as in the atomic bomb, an atomic nucleus impacted by a neutron can generate 2 to 3 output neutrons from the disintegrating atomic nucleus. This results in an out-of-control nuclear explosion. The process of viral spread is faster than this (Not in actual time- but in terms of the kinetics of the mechanism). A single infected person can infect 2 to 200 other people in the right situation. E.g. imagine a food handler, coughing on take- away food, because he/ she is not wearing a face shield.
So if we don’t damp down the infection cascade (epidemic), the moment we start easing restrictions, that is the moment that the infection literally goes viral (out-of-control and exponential). Essentially society becomes caught in a “control by isolation” trap. The only thing that will stop the epidemic re-flaring to exponential growth is the presence of herd immunity. That is, a good proportion of the population say 30%-50%, becomes immune to the virus and this damps down the spread of the virus.
Dr AXxxxx : Seems like a dubious strategy for success. Makes sense to monkeys I am sure.
Kinkajou: But this is our chosen plan of action.
Erasmus : There are 2 groups of people who have a vote on what we do. The diehards for whom “all life is sacred” – at any price and the pragmatists looking at their own economic realities. Our management of this disaster may well cost us economically one hundred trillion dollars worldwide. And the more successful our isolation containment is, the more the economic cost. You could plot the cost as about 3 trillion dollars a week on a world-wide basis.
Is a death rate of one per thousand acceptable? Is a death rate of 5 per thousand acceptable? As I have said, one per thousand per month dies under normal circumstances in any case. This is called old age/illnesses of old age.
Goo: Yes all life is sacred. However many people may well accept that the economic damage is so substantial that it is acceptable to them to allow some people to die. In short, it is not life at any price. It becomes life – at a price that is acceptable to them.
Kinkajou: So is there a way out of this dilemma?
Erasmus : Yes. I like the good doctor’s idea: IIPI. Firstly we have to accept that the only way out of the situation is through the development of herd immunity. We need to accept that we are undertaking isolation for/containment strategies to slow exponential growth of the coronavirus infection – to a point where more intensive care and ventilation resources are available to more people.
And then critically I think we need to accept that a management strategy such as IPII can change the odds. Even if all we can do with current technology is to cut the death rate from 5 per thousand to 2 ½ per thousand, this statistic can completely change the balances of risk and cost which we used to make a decision. There is probably 3 trillion dollars per week at stake in this decision.
Finally, maybe we need to identify and maximise the immune status of the unrealised “immunocompromised”.
(Censored by Order of the Commandant /
Security staff :
Frobisher & Beethoven :)
A death rate of 2.5 per thousand means that the number of people dying is the number of people that would normally have died in 2 and half months. This may well be socially acceptable and minimise economic damage substantially. Currently the damage were doing to world economy is greater than that what a world war would inflict. We would not willingly launch a world war due to the potential consequences. But currently we are thoughtlessly launching an economic tsunami far in excess of anything that a world war may trigger.
Dr Xxxxx : The key statistics are the death rate per thousand and the severe illness/intensive care usage per thousand people infected. Another key statistic is prevalence date (gained from serology) as opposed to the incidence data gained from PCR coronavirus testing. And we need to quickly look at to what extent an IIPI process can change the odds.
Hard to believe that with 3 trillion dollars per week at stake, we expect companies to develop technology at their own costs, using possible “profit” as a carrot. The system has much deeper pockets and a much more significant stake in not only the outcome, but the rate of progress to an outcome.
Only then can we choose a path midway between human devastation and economic devastation. And remember the people who are suffering the most from economic devastation, are likely not to experience the human devastation resulting in hospitalization and death – 95% of the time, (serious infections occurring somewhere between 1 to 5%).
Dr AXxxxx :The choice is yours.