Dr. Leda Raptis

Leda Raptis, PhD, is a member of the Division of Cancer Biology and Genetics, Queens University School of Medicine, Cancer Research Institute.

 

Dr. Raptis hosts a website for breast cancer patients and survivors.  Her website is full of informative articles that are ever changing.   Read about the journey, advocacy, diagnosis, treatment and survivorship.  

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Hello dear friends,

 

            As we all know, this new coronavirus (covid for short) has hit the world with a vengeance that is unknown to any of us living today.  As of May 2, over 3 million people have been infected and over 241,000 have died from it. In the US alone, the numbers are 1.1 million infections and 67,000 deaths, in Canada 55,000 cases with 3,400 deaths.  We-breast cancer survivors know all too well that we have to be extra careful because our immune system may be compromised to differing degrees, even after chemotherapy is over [1].  We cannot fight infections from this covid as well as before we got cancer.  That’s why it is important to know how to fight it differently.

            Covid attacks the lungs and respiratory system, but it was shown recently that it can attack the heart, digestive system, skin and other organs too, while some people lose their sense of smell.  Although a relatively small proportion of infected people die compared to, for example, the SARS coronavirus that hit in 2003, it spreads very effectively and is killing a larger number of people than SARS ever did, and all over the globe.  This is for several reasons that are explained below, together with strategies to cope.

 

How to kill the virus

            Unlike viruses like influenza or AIDS, covid is quite stable in the environment, that is it can survive for several days as it waits to attack somebody who will become its new “customer”… and knowing how stable it is on different surfaces is key to getting rid of it.

            Since the virus appeared in earnest last January, scientists in China have isolated it and sequenced its RNA genome.  A technique called “RT-PCR” is very sensitive but it detects the presence of viral RNA only, not active, infectious and nasty virus and it is used in diagnosis. In early papers only viral RNA was examined.  More recently though a paper came out where they looked for live and active virus on different surfaces [2].

            The results showed that liquid soap does not kill the virus effectively, it just washes it off.  Washing with soap is useful but not enough.  Besides, you can’t wash your hands for 20 seconds when e.g. you are out shopping, when you need protection the most.  covid is not flimsy like the AIDS or flu viruses, but it does die by itself in the environment. 

            In short, the virus is infectious on the following surfaces, at 20oC:

paper: 3 hrs (I wonder if it is because it gets absorbed into the fiber and hard to elute, not really killed?)

wood, cloth: 2 days (same question as paper)

glass: 4 days

steel, plastic, eg cell phones: 7 days (or even more in some cases)

 

That is, if you leave groceries outside on the porch for ~4-7 days that should be enough to inactivate the covid, but be careful:  If the temperature is low, less than 4 oC, then the virus is still alive. In the freezer (-20 oC) the virus is alive for very long time.

 

The virus can be killed by:

Bleach 1:100, ethanol 70%, rubbing alcohol (isopropanol) 70%, Benzalconium chloride (BAC)-containing disinfectants.  With any of these solutions in 5 min it’s gone.

Soap is not very effective at killing covid, although it does wash the virus off.

Stable at 4oC for >14 days, killed at 70oC in 30 minutes.

 

Covid is spread by asymptomatics, and through the air

Another issue is, how do you catch it? Of course, if someone is infected, they usually cough and have a fever. Then a test can show the presence of the virus high up in the nostrils, or more recently in saliva [3].  The problem is that lots of people do not show symptoms right away, but after several (1-14) days. During this time the virus is replicating in them slowly and they can spread it by simply breathing or talking, even if they are not yet coughing.  Some people have very light symptoms or even none at all. As a result, as shown by recent papers, 50-80% of transmission is from asymptomatic people [4]… In a study from Boston, they tested random people walking in the street, no symptoms at all, and almost a third were positive! In another study with women about to give birth in New York, out of 215 women 4 had symptoms and were positive but another 29 had no symptoms and were positive too.  That is, 87.7% of transmissions were from asymptomatic people…

Besides the asymptomatic transmissions, and the stability of virus on different surfaces, another important issue is, is it transmitted through the air and how effectively?  A paper came out in Nature from Wuhan, and showed that covid RNA can be found in tiny droplets (aerosols) that remain aloft in the air and can be inhaled by others for at least two hours. That is, despite earlier findings, that covid is transmitted through larger droplets that fall to the ground and do not stay in the air for long, or through touching contaminated surfaces, covid is transmitted through the air also, and carried around in air currents. In hospitals, in areas where the ventilation was good, very little viral RNA was detected, but it was found again in areas where staff members were taking off their protective equipment, indicating that it settles on clothing and it is knocked off back into the air. Luckily, the amounts of covid RNA found were greatly reduced when hospitals implemented more rigorous cleaning procedures [5].  I would think that as virus can attach to dust particles, it may be lifted to the air by walking on the floor too. This study examined RNA only, they did not try to culture the virus to see if it was active when recovered from the air or not, but the presence of RNA showed that covid can be in the air.

That is, clean and clean and clean and decontaminate with alcohol or BAC-containing disinfectants…

 

How to deal with the virus

When a virus starts to spread, at first few people are infected but as you don’t know who is shedding virus, and as the virus can even spread through the air, the number of cases goes up fast.  The only way to know is by testing, but this is now woefully inadequate.

This is why we are told to stay home to avoid getting sick and infecting others.  However, we are not productive if we stay home.  Even if we get paid by the government while under quarantine, we cannot eat money, someone has to produce food.  And people involved in all stages of food production, farmers, factory workers, cooks, etc must be tested and be negative, because otherwise lots of people will get sick.

The only way to get out of under this is to test everybody so that positive people are quarantined.  Just avoiding everybody in essence, by staying home we are over a hundred times more careful than we need to be, based on the best estimate of total infected people at the beginning of the pandemic. Then productivity grinds to a halt!  But, this is not necessary, as shown from Korea, New Zealand and Taiwan.  In Korea, by extensive testing and tracing all contacts and quarantining the positives for two weeks they reduced the new infections from 900 to 10-20 a day in two weeks, without closing down schools or stores! 

Testing asymptomatic people is something that is not being done yet. I just read in the news that massive testing of asymptomatic people, ie everybody, started in Los Angeles and in Boston.  When we do this, negative people can go back to work. With masks perhaps but they can work.  

Testing is now performed in public health labs mostly, but hospital labs or University research labs will have to pitch in soon.  Research labs do not have the capacity to do hundreds of tests a day but they have the knowledge in spades.   

 

Use a mask?

 

 

Other covid transmitters

Bats are the only mammal that flies, apart from pigs. For several reasons bats can be infected by several viruses for a long time without showing symptoms, ie they are good “reservoirs” of viruses such as rabies, SARS, Ebola and now covid. All indications point to a bat or also a pangolin coronavirus mutating enough as to infect humans too, and very effectively. These animals can multiply the virus and keep it for ever, so that getting rid of the virus completely as was done for smallpox is not possible. Luckily, we do not keep bats as pets.

Many of us love cats. I do. But, cats can be infected with covid by their human owners, according to a recent paper.  Then the cats can infect other cats and amplify the virus, but whether an infected cat can pass on the virus to people is not yet clear, because we don’t screen cats to know.  In any case, in the Bronx zoo tigers and lions started coughing and sneezing after coming into contact with an asymptomatic keeper that tested positive (no, they did not eat him…).  Zoo vets anesthetised one tiger to stick a thin brush up her nose to get a sample to test, and lo and behold she was infected!. This means that the virus does grow in felines. Most of us do not keep tigers at home, but I do not let my cat out since I found out that he could catch the virus.  He loved being outside and when I told him he can’t get out he was most upset!   

 

Drugs being developed

            Covid is a virus which has RNA as genetic material, rather than DNA as any organism does. This RNA must be copied millions of times and this is something that only enzymes of certain viruses can ever do, not cellular enzymes.  This is why inhibiting such enzymes was thought to be the way to go.  It is easier said than done however, because the drugs must be specific for these enzymes to avoid side effects.

            One such drug (Remdesivir) had been developed for the Ebola virus, but unfortunately it was not effective.  Now this drug was trialed for covid and showed promising results. 

            There have been several trials for other drugs but used “on compassionate grounds”, just for a few desperate cases without matched controls. A previous trial was done for remdesivir too and published in Lancet but it showed that there was no significant effect. However, the latest study involved over 1,000 patients in the US and other countries and especially it had matched controls ie people with the same level of sickness and any other characteristics with placebos ie people who got no treatment. All were very sick, and neither the patients nor the doctors knew who got what till the end of the study. The results showed that patients treated with remdesivir were ready to be discharged from the hospital within 11 days, on average, compared with an average of 15 days for patients who had received a placebo. 

            While not a “knockout,” the head of US National Institutes of Health, Antony Fauci said that the results show an important and promising avenue for further study. “What it has proven is that a drug can block this virus,” Fauci said. That is, any other drug will be compared to that one from now on. In any case, the results are not published yet so that scientists can examine their validity, but based on the information at hand Remdesivir got FDA approval to do more trials. There is hope for the millions of covid victims.

            Remdesivir can have serious side effects, including loss of kidney function and declining blood pressure. Those symptoms are caused by severe cases of covid-19 as well, making it difficult to determine which problems were caused by the drug and which by the illness.

The drug must be given intravenously over five to 10 days, and the NIAID trial results apply only to hospitalized patients. Remdesivir is not intended for use in the majority of patients, estimated to be 80 percent or more, who are infected with the novel coronavirus but do not require hospitalization.

The covid virus uses a protease to multiply, ie an enzyme that cleaves proteins. There are several drugs that inhibit the protease of the AIDS virus and they are being used in clinical trials for covid but no results yet. Stay tuned.

Lots of noise has been made about chloroquine and hydroxychloroquine, drugs used against malaria, but also against Lupus and arthritis. President Trump was touting them as panaceas, but he has shares in Sanofi, the company making them. Unfortunately, neither did well in clinical trials. He also said that laundry Bleach and Lysol kill the virus, why not use them in a clinical trial, and several people tried them and got poisoned. Regarding chloroquine, a couple in the US took it to prevent catching covid (!) and died!  Please do not try.

 

Vaccines

            What is a vaccine? It is either a virus that is similar to a nasty one, but not pathogenic (live, attenuated virus vaccine), or killed usually with formaldehyde, or more recently just parts of the outside of the virus. In all cases the vaccine makes you produce proteins in the blood, called anti-bodies, that can bind on the nasty virus and do not let the virus infect you, so that disease is prevented. There are many different ways to produce a vaccine, each trying to overcome specific challenges. Many companies are trying to make a vaccine for covid but it will take some time because it has to be tested first to make sure it works.

            Not all viruses can be inhibited with a vaccine. Eg there is no vaccine for the AIDS virus, in spite of many attempts, likely for the simple reason that the AIDS virus destroys the person’s ability to produce antibodies. In that case, if someone catches covid and recovers, they could catch it again, and there are some reports of this kind, although not well documented. If confirmed, making a vaccine will be hard. Another potential problem is, if the virus itself is able to change frequently, like the influenza virus does. Covid is more stable than influenza, but if it does change then we will need to make new vaccines every year or so, like the flu.

            The first vaccine, consisting of RNA was by a company called Moderna. There are many others in trial now in the US, England and other countries. Some are claiming having results by September and they are already making large quantities of vaccine even before the trial is done. 

 

 

Here is President Trump’s corona-anthem:
https://www.youtube.com/watch?v=TSU0NtaPRDE

 

 

 

References

 

1].  Coronavirus: Cancer patients nearly three times more likely to die of Covid-19, study says.  The Independent, April 28, 2020.  https://www.independent.co.uk/news/health/coronavirus-cancer-patient-death-rate-study-china-hubei-us-a9488481.html

 

2]. Stability of SARS-CoV-2 in different environmental conditions. Alex Chin et al.

Lancet Microbe 2020 Published Online April 2, 2020 https://doi.org/10.1016/ S2666-5247(20)30003-3

Correspondence:  llmpoon@hku.hk

https://www.thelancet.com/action/showPdf?pii=S2666-5247%2820%2930003-3

 

3].  https://www.medrxiv.org/content/10.1101/2020.04.16.20067835v1

 

4].   Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). R. Li et al., Science 10.1126/science.abb3221 (2020). https://science.sciencemag.org/content/early/2020/03/24/science.abb3221

 

5].  Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Liu et al. Nature, April 27, 2020.

                           

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