The Covid-19 Chronicles: The truth of the matter

A file picture of healthcare workers using surgical masks.

HARUKI Murakami said, “Pain is inevitable. Suffering is optional.”

One of my favorite writers and an avid runner, Murakami was referring to the pain felt when running long distance, which is unavoidable because of biological reasons. He argued, however, that bearing the pain, to “suffer” or otherwise, is up to the runner.

They say ignorance is bliss, but when it comes to surviving Covid-19, ignorance is suffering. We suffer because we do not know, and what we do not know, we fear. But our advantage as a civilisation facing this pandemic is the fact that we live in an age of rapid access to information. Awareness is a way to bear the pain.

Searching “Covid-19”, we would find an amazing wealth and surge of knowledge accumulated within the span of months on what was a non-existent disease less than half a year ago.

But there is also a wealth of misinformation. Between the realms of fact and fiction, there also remain highly contentious discussions about the disease and how to protect ourselves.

So, what is actually the truth about Covid-19?

Among the first questions that circulated was the origin of the virus that causes Covid-19, the SARS-Coronavirus (CoV)-2. Some speculated it was a genetically modified virus escaped from a laboratory studying bat coronaviruses in Wuhan, China. A coincidental snippet from a 1981 novel by Dean Koontz mentioning a biological weapon called Wuhan-400 further fueled theories of man-made origins.

But several genetic studies refute this idea. Firstly, the key feature of this spherical virus, the spikes or “key” that allow it to bind, unlock and enter our cells, do not actually fit the ACE2 “lock” found on our cells the way it theoretically would, based on computational or logical predictions. The SARS-CoV-2 genetic makeup also does not match previous templates used to study similar coronaviruses.

Secondly, similar coronaviruses found in bats and Malayan pangolins provide clues that the virus may have arisen from these animals.

Thirdly, these animal viruses still do not match perfectly with the features of the SARS-CoV-2 spikes, suggesting it must have mutated and changed genetically before being able to infect humans.

So, although we still do not know exactly where SARS-CoV-2 came from, its genetic information provides strong evidence that it came from the wild courtesy of the world’s best engineer: natural selection.

A related contentious issue is how the virus spreads. The spread of infectious disease is a dynamic between the host (the origin), from where it came and the next host it can infect (the destination).

Early public health interventions focused on isolating infected individuals because we thought the virus spread via droplets, directly from one person to another. Then a study showed that aerosolised virus could remain in the air for three hours, and up to seven hours on materials like plastic.

Panic ensued, prompting the World Health Organisation (WHO) to emphatically state, “Covid-19 is not airborne”.

So, which is it?

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What the evidence suggests now based on the rate of spread in general and in specific super spreader events where many people are infected from one source (for example, the Diamond Princess cruise ship or the Sri Petaling Mosque tabligh event), is that the disease is mainly spread via droplets from direct contact with an infected person, but it may also in some situations spread through air and intermediate objects.

Indeed, there are many roads to Rome, and likely Covid-19 is so contagious because it can use multiple paths to reach a new host.

This then brings us to practical questions like, how do we protect ourselves?

Whether from infective droplets or aerosols, we know surfaces may carry viruses. Frequent handwashing with soap for at least 30 seconds, or if not possible, hand-sanitising with alcohol-based sanitisers (60-95% ethanol or isopropanol), effectively removes infectious viruses.

Some people question the permissibility of alcohol-based sanitisers for Muslims and the side effects of frequent handwashing/ sanitising like dryness. Non-alcohol based sanitisers exist, but there is less evidence on their effectiveness against viruses.

Religious authorities like the Federal Territories Mufti have also deemed alcohol-based sanitisers necessary and can be used in prayer, especially since they are not consumed, and hence, not intoxicating.

There are efforts locally to increase supply and improve formulations of alcohol-based sanitisers to make them gentler on skin, such as including moisturisers and kaffir lime, as being done in Universiti Sains Malaysia (USM).

A more controversial issue is wearing masks. Previously, face masks were recommended only for healthcare workers, infected persons and their carers. This was aimed to reserve supply for those who need it most, reduce the risk of people not practising social/ physical distancing due to mask-wearing, and reduce the risk of other infections from improper mask-wearing.

However, with more people infected and compelling evidence that up to 30% of people with Covid-19 are able to spread the virus without showing any symptoms, the public is now recommended to wear masks when outside homes.

Our precious frontliners should be prioritised for more protective surgical masks, but cloth masks with good moisture control covering our nose and mouths may be enough for the rest of us.

Finally, because we do not yet have a vaccine to prevent COVID-19 disease, there have been many discussions about potential treatments.

Here, it is important to remember what makes something a cure or a poison is its dose. An effective drug is one where the dose needed to kill the virus is much lower than the dose that is harmful to the human ingesting it – an indication of its “selective toxicity”.

Many home remedies suggested on social media such as rasam, garlic or warm water have little scientific basis to work. For even if they contained any substances that can kill the virus, the amount needed may not be sufficiently found even in the thickest, most garlic-infused cup of rasam. And water that is hot enough to kill the virus will first burn our throat.

There are repurposed drugs intended for other diseases like lopinavir for HIV/AIDS or chloroquine for malaria currently being evaluated, but we are still waiting for enough data to know if they are safe and effective for Covid-19.

In any case, drugs should only be consumed under advice from healthcare providers to avoid tragedies such as accidental poisoning from self-medication.

But we can find some comfort in candidate treatments on the horizon. On top of repurposed drugs, there are new approaches like using antibodies to bind and block the virus from entering our cells. There are also potential combinations of new drugs that directly inhibit the virus from replicating like remdesivir, together with anti-inflammatory drugs that reduce the overaggressive response from our immune system, preventing the self-inflicted damage seen in severe cases of Covid-19.

In saying all that, clearly the truth is, we do not know definite answers to many questions. What we can do in the meantime is reflect on what we do know.

We know with certainty that life pre-Covid-19 was full of underappreciated blessings and joy.

One of the things I miss the most is my morning run around the USM Penang campus. It is a beautiful (painfully) hilly campus. The old trees were familiar friends who patiently watched as I struggled up different inclines. The green mosque greeted me when I coasted to the foot of the hill.

We know that the pain that we all feel now to some degree, is perhaps an inevitable and necessary course, and a chance for us to rise above.

We know that besides our fallibility from threats like infectious disease, nothing else is certain.

But uncertainty is a familiar friend in science and the quest for truth.

And as the great physicist Richard Feynman said, “What is not surrounded by uncertainty cannot be the truth.”

Pain is inevitable, suffering is optional.

There is inevitably pain in uncertainty, and it is unsettling.

But instead of suffering, we can choose to view uncertainty with hope.

For as long as we acknowledge that we do not know for certain, we can try and find out. That is the scientific truth.

Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah is senior lecturer in Medical Microbiology at Universiti Sains Malaysia, and an affiliate of Young Scientists Network-Academy of Sciences Malaysia. She is active in science communication and infectious disease biomedical research. She was the first female Asian champion of FameLab, the world’s longest running science communication competition, in 2018. The writer’s views are her own. - Star