Frequently seen statements about the ‘rona
Words by Maxim Buckley
The decision to write this article came about because I was growing pretty sick of all the misinformation out there with regard to how SARS-COV-19/COVID-19/Corona virus/the rona is being addressed medically by governments and health bodies. This is by no means a critique of the approaches made by the government nor a recommendation on what to do next since I am simply not qualified to do that. This article attempts to explain the medical reasoning as to why certain actions have been taken and why we are not even close to being out of this pandemic. The following are some statements I frequently see on social media that desperately need to be addressed.
- We need more testing
This is a fairly ambiguous statement so I will have to take some liberty with its meaning. Whilst there should be more testing, this testing should be reserved only for those in certain categories and there are some fairly simple reasons for this. The first is pretty boring and is that tests are a physical resource we only have so many of, almost everyone should be able to deduce this. The second does involve some maths. Firstly, no test is 100% accurate. Some initial research from China where 50 patients were tested by reverse transcription polymerase chain reaction (RT-PCR) and then had a CT scan completed found that the accuracy of the CT scan for detecting COVID-19 was 98% whereas the RT-PCR was only 70%, and that was on patients who were admitted to a Chinese hospital with symptoms of COVID-19. Now, these were initial results published in February, however the simple fact that no test is 100% accurate still stands. If we have a test with 70% accuracy and we test 100 people, we potentially have 30 people returning into the general population who are in actual fact positive for COVID-19. There are of course ways to artificially improve these test outcomes. Let’s say the 70% accuracy came from an indiscriminate sample of the population. To improve this accuracy, we test people with known risk factors e.g. overseas travel to countries with known outbreaks. Now our accuracy is slightly improved, but we can do more by testing those who have returned from overseas and have flu like symptoms. Because the likelihood of someone having the disease is significantly increased, we now have a more accurate test. If you would like to know more, this is all done by pre and post-test probability scores for positive and negative outcomes. So yes, we need more testing in populations of those who are at risk or are showing symptoms.
2. Why not let the recovered go back to work?
This one is an understandable assumption made by many people. The simple answer is we don’t know enough about the immune system and how it reacts to COVID-19 because, and I can’t stress this enough, the virus has existed in human circulation since about October-November of 2019. We do not know how strongly the immune system reacts to the disease, we do not know if sufficient immune memory is developed, we do not know if those who have been previously infected and who become reinfected are able to spread the disease the second time round. This of course is all being investigated but it does take time. We do have antibody tests, but like the tests for the existence of the disease, these are not 100% accurate. There are two types of tests concerned with immunity. The first is rather fast and simply tests for the presence of antibodies against the virus. The second takes slightly longer and checks for the quality of antibodies against the virus. Essentially, there are some antibodies that tag the virus for the immune system and there are some that neutralise the virus, the latter being more effective. It is not yet fully understood if a person who has recovered from being infected will have long lasting antibodies of either kind against COVID-19 since the disease has only been around for 6 months. To let those who have recovered to go back to work whilst a pandemic is still ongoing unnecessarily puts lives at risk.
3. If we had a vaccine against SARS we’d have one for COVID-19
Again, I will have to take some liberty as to the meaning of this statement. One interpretation is that because SARS and COVID-19 are both coronaviruses with an 82% genetic similarity then the immune system would recognise them as being the same and would mount the same response. This simply is not true. A good example of this is the seasonal flu virus. Viruses work in a “lock and key” type way where they are highly specific to certain cell receptors. Given the specificity, our immune system is also very specific to them and so requires the correct “key” to the “lock. By simply changing the receptor proteins on its surface, the flu virus is now totally unrecognisable by the immune system since it doesn’t have the right “key”. Whilst I won’t pretend to be an expert on the protein structure of SARS and COVID-19, I would bet that a SARS vaccine would confer no immunity to a COVID-19 infection.
The second interpretation is that we would have the vaccine infrastructure in place to create a viable vaccine more quickly. This is somewhat true but is quite presumptive. First of all, it assumes that COVID-19 can be vaccinated against, which is looking likely but is still being tested so we have no idea. Secondly, it assumes that the vaccines would be similar in their method of production. Very quickly with regard to vaccines there are ones containing dead viruses, ones containing alive viruses that are inactivated (attenuated viruses), and there are ones containing specific proteins from the virus that the immune system will create antibodies against. There are also vaccines that take control of host cell machinery, but these are still largely experimental. Given that two viruses, though related, can be totally different when the immune system is concerned, then two vaccines can be completely different in their development. Something that is very true of this statement is that vaccines do not make drug companies very much money and are extremely costly to develop. Medications that require daily administration such as metformin for diabetes control will always net a drug company more money than a vaccine. Take from that what you will.
4. We need to use (x) medication against COVID-19
This one is pretty dumb. Again, the one simple fact is that COVID-19 has been around 6 months. That is not long enough for any concerted effort to decide what medication is most effective against infection.
Most of you should know you can’t take antibiotics for viruses and this is pretty simply put up to the fact that bacteria are completely different from human cells in structure and can reproduce by themselves, they just need the resources to do so. Viruses however, hijack host cell machinery to reproduce. If you were to stop the virus from reproducing, you would then be stopping your cells from completing a necessary process. And that assumes we know by which process COVID-19 uses to reproduce and have a drug to stop or inhibit that cellular process. For the pharma bros, I know that antivirals do more than that, this is just a brief rundown.
Finally, drugs need to be effective against an infection. “The cure can’t be worse than the problem” blah blah blah. Scientists need time to test drugs, they need to make sure they are effective and do what they are meant to do, this requires many trials which take a fair bit of time.
5. Let the healthy get sick, create herd immunity
This is by far the worst of the lot. First and foremost, it commands a blatant lack of regard for human life. Excluding the fact that hospitals would be overrun, catching a disease is always worse than having a vaccine or else we wouldn’t have vaccines. I remember being so extremely jealous that my little brother was able to just get a vaccine for the chicken pox whereas I had to sit at home playing Age of Empires for a week (okay not that jealous but you get the point). I got the flu shot yesterday, I felt a little off in the afternoon but I’m now back to normal. If I were to have the flu I would be in bed for at minimum 3–5 days and would feel that effects for at least 2 weeks. Some reports have also noted that an infection from COVID-19 can leave you with fibrosis of the lungs and of course many people the world over have died from the disease, an outcome no one wants.
I also take issue with this argument because, like I have previously stated, the disease has only been around for about 6 months. We have no idea how long immunity will last for.
Finally, herd immunity depends on the amount of people a person with the disease will infect, known as the R0. Depending on where you look, the R0 of COVID-19 is anywhere between 2 and 3. So anyone who becomes infected with COVID-19 will infect between 2 and 3 other people. The mathematical equation to figure out the percentage of the population that needs to be vaccinated to create herd immunity is 1–1/R0. So, depending on where you get your numbers, you need 1–1/2=50% or 1–1/3=67% of the population to be infected to create herd immunity. Now infection doesn’t occur in a linear fashion through those who are most fit to survive it. We often hear that we need to create herd immunity to protect the vulnerable. Quite simply you cannot protect the vulnerable from a disease that infects a population indiscriminately. Any country who had this as part of their policy at any point in time should be ashamed.
That’s a quick little rundown. I learnt early on in this that it’s best not to make statements unless you know thoroughly what you’re talking about. Hopefully this has helped you learn a thing or two. Stay safe and stay well.
