COVID-19
A World War 2 Trilogy - By FRED NATH (Novelist and Neurosurgeon)
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COVID-19

A nineteenth century traveler called Charles Kinglake published his travelogue of a journey across the Mediterranean and Middle east (Eothen). I had to study it for ‘O’ levels. At the time I couldn’t understand why there were frequent references to plague and weird superstitions about things like: if you have a cold you can’t catch plague. He thought he was lucky to get a bad head-cold on his journey. Maybe I understand him a little better now.
It seems to me that even when confronted by facts and scientific truths we still cling to foolish superstitions in the hope that hope will save us. It won’t. Get used to disappointment folks. In the current pandemic, we should all accept the few facts that are available:

1.       The virus spreads like any upper respiratory tract virus – droplets that emanate from your mouth and physical contact of virus particles on hands with your eyes, nose or mouth. When you cough, micro-droplets of moisture emanate from your mouth. In a still atmosphere, they have a range of up to 2 meters. Sneezing is even more powerful. Speaking results in droplet spread as well but not as distant as coughing or sneezing. So – keep your distance from others – it’s not offensive to do so, only sensible. Don’t shake hands. No peck on the cheek. Wash your hands every time you come home. Wipe all communal surfaces with an ant-septic agent – that means door handles and your computer mouse and keyboard. Do it frequently or at the very least when anyone else has used them. Wipe your smartphone, door keys and car keys. If you go shopping, wipe the handle of the supermarket trolley before you start pushing it round and when you go to your car, sanitize your hands before you get in. Wipe the car door handle, steering wheel and gear stick with an antiseptic wipe before you set off.
  
2.      Whether or not you get an infection depends on three things (Koch’s postulates):
a.      Host susceptibility and resistance
b.      Virulence of the organism
c.      Dose of the infecting organism.
You need to think about this because the people most at risk are those who fit the above criteria. Living with and being in intimate contact with someone who has the virus means that you have a pretty good chance of catching it and your outlook isn’t good if you have an illness that compromises your immune system. Stay away from old and sick people – if you care about them.

3.      As far as I can see reading stuff, 75% of people will get a ‘flu-like illness. 15% will be seriously ill and between 1% and 2% will die of respiratory or multi-organ failure. Mortality is highest in old people especially those who have an underlying illness. Over the age of 80 the mortality may be as high as 20%. So why are younger people less affected? I have a feeling it’s partly because they are never still – they are fitter to start with i.e. they have a better respiratory reserve. They also have a higher metabolic rate and burn off calories faster. That readiness of the body to raise core temperatures from metabolism may be a reason for their relative resistance. Most respiratory viruses take hold best at slightly below core body temperature – that’s why they get into you through the upper airways, since your nasal temperature is a little below core temperature. The cell turnover of the ciliated mucous membranes in the airways is probably better in younger people too, so recovery may also be better in young people. We can’t get younger, but maybe we should all exercise more on a regular basis to try to increase over all fitness and metabolic rate. OK that isn’t fact but there is some logic in there somehow.

4.      If you have had the virus and no longer have symptoms, you probably won’t get it again for a long time – like resistance to influenza. That doesn’t mean the virus won’t mutate and change its characteristics in the future, just that this virus will gradually peter out with time. But… and there is always a ‘but’. It is known that as a virus passes from person to person, it attenuates, that is, it gets weaker. A new infection is very virulent but by the time that virus has infected a number of individuals, it produces less of an illness – the later in the epidemic you get the virus, the more likely it is that it won’t make you as ill as it made the first person with it.

5.      Herd immunity is necessary. It’s all about who’s got it and who hasn’t. If you are in a room with ten people who are not resistant and one of them has the virus, potentially they all get infected. If you are in a room with nine immune people and one person is infected, the odds are you won’t be infected. If you then look at a population of people, eventually as immunity increases, the virus can’t reach enough people to continue in a big way. The immune people form a kind of resistance wall, since they can’t pass on the virus to you if they don’t have it.

6.      Dog shit. Yes, that’s it! The way to think about contagion is, in your mind, to picture the virus as dog shit. Each time you touch something potentially infected, think how it would be if you could actually see and smell it. You would never put your hand in dog poo and then touch your face or shake hands or fail to wash your hands (regularly). If you want to avoid this virus, think dog shit.

7.      The probability is that we will all be exposed to this virus. Once you accept that it is easier to come to terms with the future. Some of us will die – hope it’s not me and I hope it’s not you.

There’s more but I’m getting bored.

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