When teaching anatomy/physiology, microbiology, and other life science courses, I explain that microorganisms (microbes) such as viruses and bacteria tend to congregate like clumps of very light glitter used in cosmetics, arts and crafts, etc. Tiny glitter-size particles are difficult to see individually, with only somewhat-large glitter clumps generally visible to the naked eye. Anyone near a "glitter-infected" surface (table, handrail, doorknob, store checkout counter, etc.) might unknowingly contact a few sticky glitter particles either directly by physical touch or indirectly via air movement from air conditioners, heaters, window drafts, and/or others breathing or walking by. Glitter-size particles easily adhere to light films of moisture on human skin, etc., requiring soap and water (not just water alone) to remove. Airborne glitter-size particles are easily inhaled and readily stick to fluid-lined inner membranes of lungs which then becomes very challenging for the pulmonary system to exhale.
Viruses (virus = Latin root for “poison”) are the smallest of all known microbes - the smaller the microbe, the more easily it often “sticks” and more difficult it often becomes to “unstick”. Particulate matter (PM) refers to tiny particles in ambient air measured in micrometers (one millionth of one meter = micron). Levels of PM2.5 (fine particles less than 2.5-micron diameter) and PM-10 (coarse particles less than 10-micron diameter) are commonly used to describe air quality by the Environmental Protection Agency (EPA). Particles larger than 10 microns generally get trapped in nasal hairs, mouth, and/or throat before they could be inhaled deeper into delicate gas exchange surfaces of lung capillaries. Nose breathing is common during rest, whereas mouth breathing is necessary during exercise thus increasing risk of airborne illnesses and their transmission when outdoor sporting events are held at times when air pollution exceeds EPA standards. COVID-19 particles are spherical with diameter of approximately 0.125 microns - similar size as particles used to test efficiency of High-Efficiency Particulate Air (HEPA) filters which remove pollen, pet dander, tobacco smoke, dust mites, etc. to improve air quality for sinus allergy sufferers. The average diameter of one human hair is about 100 microns (range of 17-181 microns) - so about 80 fine 0.125-micron COVID-19 particles can line up across width of one hair.
The human immune system has never in the history of mankind been exposed to this novel (new) strain of coronavirus and is thus unprepared for, and confused and overwhelmed by, its rapid replication within human cells. Humans have long been exposed to other coronavirus strains, with about 20% (estimated range of 10-30%) of viruses which cause the common cold being coronaviruses. Coronaviruses were first identified in the 1960s and named for their crown ("corona") of club-shaped spikes on their surface as viewed by electron microscope. Most types of respiratory infections from coronaviruses are relatively-harmless, but some virulent (destructive) coronavirus strains may travel deep into moist lung passages where they stick with their spikes and contribute to pneumonia, bronchitis, emphysema, etc. COVID-19 currently seems to behave differently than other coronavirus and influenza strains, thus making its transmission and fatality rate difficult to predict. In a few years, humans will hopefully have enough naturally-produced specifically-programmed antibodies cruising through their bloodstream who have not forgotten the previous COVID-19 grief they encountered and will hopefully immediately attack and defeat coronaviruses of all kinds. Unfortunately, natural production of antibodies which will always defeat COVID-19 is not yet happening as of March 2020 - especially not in susceptible persons. If you were formally diagnosed with COVID-19 and have since completely recovered (virus-free for 14 days), please donate your blood plasma to a local blood bank for medical trials using your valuable new antibodies. Promising new evidence suggests that immediate transfusion of antibodies sensitized to COVID-19 into intensive-care patients whose life is immediately threatened may one day become the miracle everyone is hoping for. It only takes a quick blood test to determine if your blood level of potentially life-saving antibodies is high enough, and nasal swab to prove you now test negative for COVID-19.
Parasitic microbes tend to mutate continually, with the mutation rate of a given virus or bacteria often varying considerably. Common examples include: 1) the relatively-high mutation rate for the family of RNA viruses that causes influenza necessitates a flu shot every year, 2) the relatively-low mutation rate for the bacteria that causes tetanus requires a tetanus shot ever 10 years, and 3) a vast majority of persons previously infected with the varicella-zoster (chickenpox) virus, or had the varicella (chickenpox) vaccine, are thereafter immune for life. Pox viruses, unfortunately, can remain dormant in nerve tissue for your entire life and possibly reactivate later to cause shingles (herpes zoster). It is hoped that COVID-19 exposure will not cause an illness later in life as unfortunately happens with shingles - but this is not yet known.
Bacteria are "alive" because they can replicate by themselves, which makes them often effectively treatable with antibiotics. Viruses are technically "not alive" and "not dead" but occur in a "zombie-like" state which can be considered a "missing link" between chemistry and biology. Zombies sometimes move (albeit very slowly) which enable them to invade human lungs somewhat easily while also being difficult for your immune system to destroy. Viruses require fluid-filled host cells such within human to replicate, and at present are treated mostly with antiviral medications (which often do not work well) or possibly the aforementioned injection of antibodies from plasma of recovered patients to hopefully provide specific protection (either partially or completely) from subsequent challenges by same virus. How prolifically a microbe replicates and/or mutates, in addition to how virulent it is to certain human demographics, are important considerations in medical management, and public health social prevention and vaccination strategies.
It is possible that COVID-19 may have already mutated from its original “S” strain into a more aggressive “L” strain - but there is simply not enough data as of March 2020 to know for sure. Seasonal flu shots in years past contained 3-4 strains of influenza - but even the world's top scientists at the Centers for Disease Control and Prevention (CDC) headquartered at Atlanta Georgia, despite their very sincere efforts, sometimes guess wrong as to which specific strains to include in flu shots in anticipation of an upcoming flu season. As with the learning curve for vaccine development and dissemination following the January 1918 to December 1920 influenza (Spanish flu) pandemic which infected 500 million people (about 25% of world population at the time) and 2009 H1N1 (swine flu) pandemic which infected an estimated 11-21% of the global population, there is much to yet understand about COVID-19. Unlike most influenza strains, H1N1 did not disproportionately infect and kill older adults as COVID-19 is now sometimes appearing to. Case fatality rate (reported deaths / reported cases) during the H1N1 pandemic was only 0.02%, but is estimated to be 3-4% during the current COVID-19 pandemic. An epidemic broadly describes any problem that is actively spreading, often to the point where it is quickly growing out of control. The term epidemic is commonly used in the context of contagious microbes and also spreading of non-contagious societal threats such as obesity, diabetes, and the opioid crisis. Epidemic outbreaks occur over a specific geographic community and affect an unexpectedly high percentage of the population within that community - such as with seasonal influenza viruses, the malaria parasite, and the severe acute respiratory syndrome (SARS) virus. A pandemic is a large-scale epidemic, disrupting a much wider geographic region across multiple countries and continents, and possibly the entire world. Once a contagious microbe has spread across boundaries to different continents, a global pandemic is almost always imminent - such as with previous smallpox virus, tuberculosis bacteria, and HIV/AIDS virus pandemics. On March 11, 2020, the World Health Organization (WHO) headquartered at Geneva Switzerland alerted the world that the COVID-19 epidemic had upgraded to a pandemic.
Literally days after the April 15, 2009, identification of the first H1N1 strain of influenza in the US in a ten-year-old in California, the CDC began developing a vaccine with clinical trials in July, followed by four different vaccines approved by the Food and Drug Administration (FDA) in September, and first doses available in October. By December 2009, well over 100 million vaccine doses were deployed, with the H1N1 strain now included in seasonal flu shots. Vaccine effectiveness is hampered by ongoing mutations which occur within nearly all natural virus cycles. Despite intense efforts, it will probably take over one year for an effective COVID-19 vaccine to become widely available - still much much better than the 5-7 years generally required for most previous vaccine candidates. RNA viruses have RNA genomes as their main genetic material which replicate in the cytoplasm of host cells, whereas DNA viruses have larger DNA genomes which must travel further into the nucleus of host cells to replicate. RNA viruses unfortunately do not have genetic mechanisms to effectively fix their own “copying errors” which sometimes results in more virulent strains - in contrast to human cell DNA which is fortunately often able to fix replication mutations to defend against cancer, etc. RNA viruses such as COVID-19, H1N1, and Ebola are more unstable and tend to mutate more rapidly. DNA viruses such as pox viruses, herpes viruses, and hepatitis B are more stable, thus replicating less often. H1N1 killed about 12,500 Americans in the 12 months following April 2009, far fewer than the current highest estimate of 62,000 Americans killed annually by influenza, and far far fewer than estimated upcoming deaths by COVID-19.
Viruses can be likened to burglars who sneak into your house, consume your food, make millions of babies on your couch - with these babies then spreading rapidly to your other furniture to make more babies, and eventually destroy almost everything inside. The term "cat burglar" is somewhat ironic as one theory proposes that COVID-19 spread from bats to cats to humans in a public market selling wildlife in Wuhan, China. Some viruses can travel from animal to man, and vice versa from man to animal - but the threat of COVID-19 transmission to humans from pets or livestock is currently unclear. A good clinician is really worth their money if they can prescribe the absolute minimum dose of a medication to get the job done - thus preventing side effects. Too high of an antiviral dose can cause considerable collateral damage - analogous to a large SWAT team complete with tanks and AK-47 automatic assault weapons shooting up your house to apprehend one burglar, when just one squad car with a couple officers would have been sufficient. Viruses have differing replication rates within different humans and also once they enter different cells - with many having the potential to make tens of thousand of copies of themselves within just a few hours. In certain conditions, it only takes a few days for an infected person to get loaded with millions of viral particles - within each teaspoon of blood! Because viral proteins come from human proteins, antiviral medications must be very specific to prevent them from doing as much, or more, damage to body cells than the virus itself - potentially making unproven "cures" worse than the disease itself. Many patients are given a "cocktail" of antiviral medications because they are more difficult for a given family of rapidly-mutating viruses to resist - but unfortunately some virus families mutate too quickly for even a large cocktail to defeat. Viruses have the potential to mutate faster than bacteria and are also less likely to mutate into versions of themselves that are so riddled with copying errors that they can no longer continue replicating.
I tell my kids, and youth I have influence with, that responsible parents and grandparents have always done everything in their power to protect vulnerable children from infectious microbes. Now these same parents and grandparents, who took great care of you when you were younger, would appreciate your taking COVID-19 pandemic warnings responsibly and do everything in your power to help protect us vulnerable adults by:
- social distancing of at least six feet
- obeying local stay-at-home (station-in-place) orders, and curfews
- avoiding crowds
- regularly washing hands with soap and water (preferred) or sanitizer
- regularly disinfecting all "high-touch" surfaces such as telephones and keyboards
- avoiding touching your face (especially eyes, nose, and mouth)
- avoiding close contact with sick people
- self-quarantining for minimum of two weeks if you are sick yourself or might have been exposed
- not over-purchasing items such as toilet paper to leave some for others
- wearing a mask and disposable gloves where required and also when appropriate
- avoiding touching "public pens" at stores when signing for your charge card
- awareness that carriers of COVID-19 can be asymptomatic (not have symptoms currently and maybe never will) but can still infect others
Signs and symptoms often describe the same condition, but these terms differ from a biomedical perspective. Signs are numerically measurable indicators of illness (often verified by formal diagnosis from a health care provider), whereas symptoms are what a potentially soon-to-be-diagnosed patient is personally feeling. Signs can be felt, heard, or seen - measurement of body temperature in degrees Fahrenheit/Celsius, heart rate in beats per minute, blood pressure in millimeters of mercury, size of a bruise or open wound in inches/centimeters, abnormal heart rhythms measured in millimeters by an ECG, etc. Symptoms are subjective (often not outwardly visible to others) such as personal feelings of chills, nausea, and dizziness - not objective measurable signs that can be documented independently. Signs and symptoms for influenza often happen suddenly with no prior warning, whereas COVID-19 often causes a "slow burn" after which the infected person briefly feels better before "crashing". Most COVID-19 patients with mild to moderate signs and symptoms recover in about two weeks, whereas patients with severe symptoms generally recover in about six weeks.
A carrier is by definition an infected person who currently has no signs or symptoms and are thus probably not aware they are shedding COVID-19 and potentially spreading it to others. You wearing a mask provides protection to others, whereas others wearing a mask provides protection to you. "Self-quarantine” means voluntarily staying within a well-ventilated residence after potential exposure while monitoring yourself for potential signs and symptoms of infection for the duration of the 14-day COVID-19 incubation period - checking your temperature in morning and evening, reporting symptoms to your healthcare provider, etc. The COVID-19 incubation period (time between exposure until the microbe has replicated to the threshold when signs and symptoms are apparent in the host) ranges from 1-14 days, with most cases occurring 5-12 days after exposure. “Patient-isolation” refers to separation of persons who have been formally diagnosed as carrying a transmittable microbe by preventing their movement in society until clinically determined to no longer be contagious.
When competing in fall team sports, we went to outdoor practices and games knowing there was always a possibility of extreme rain or lightning. Even though we individually prepared as best we could, sometimes our entire team had to temporarily retreat to the locker room. We returned to the playing field as quickly as possible, often with more enthusiasm than we had before the weather delay. When coaching, I told athletes that our team goal is to win every game, and our coaching staff has worked together to develop a progressive plan for victory in the postseason championships. Coaches are always be ready to adapt their game-plans as a sports season progresses due to unforeseen internal and external adversities - but will never change their goal of continually improving teammate relationships to overcome collective weak links-in-the-chain to eventually win big at the end. I personally feel promoting this attitude is very important in the context of stay-at-home "flatten the curve" requests by public health "coaches" in the front line battle against COVID-19.
I personally test positive for faith (that as a functioning "village" we can work together to overcome seemingly insurmountable obstacles), hope (for a better tomorrow as we learn from mistakes which all teammates are prone to make), and love (for my fellow humans). This can only be accomplished by socially distancing from unbelief and fear, and imposing self-quarantines against grief and despair. Contrary to popular thinking, Charles Darwin wrote very little about natural selection of those who are the strongest or most intelligent - but believed almost exclusively in the survival of population groups who found ways to adapt to changing environmental stressors. If you are fortunate enough to have an immune system which adapted (and thereafter super-compensated) following infection by COVID-19 , please immediately donate your antibody-rich plasma to your local blood bank. Research by the National COVID-19 Convalescent Plasma Project (now being fast-tracked for FDA approval) will hopefully soon lead to therapies for critically-ill patients now kept alive by ventilators in hospital intensive care units - https://ccpp19.org/. Success of these novel therapies in battling this novel disease can be greatly enhanced by the quick altruism of COVID-19 survivors. The specific antibodies that you could only have developed through your personal victory over COVID-19 can now hopefully assist biomedical researchers to alleviate the suffering of others whose life now hangs in the balance from the same COVID-19 infection from which you were fortunate enough to overcome just a few short weeks ago.
The world of science is by nature a very competitive field and thus often attracts fiercely competitive people. However - if scientists could put aside their egos and often-contentious ambitions to come together to build atomic bombs to kill their fellow humans, surely they can now unite their knowledge and skills to alleviate suffering and death by their fellow humans from infectious microbes such as COVID-19.
When battling life-threatening infections, the human immune system desperately needs a continual daily intake of protein to make life-saving antibodies. Essential amino acids cannot be manufactured within the liver from non-protein sources and thus must be consumed regularly via food or supplements. Forget the myth of “feed a cold and starve a fever” – You should be “feeding your cold and feeding your fever” by drinking lots of chicken soup which contains lots of protein from which your body can make lots of antibodies. Daily protein intake is particularly important during the critical days when you are actively fighting an infection because humans cannot store previously-consumed amino acids to later make antibodies to battle future illnesses. The liver quickly converts excess protein into fat (triglycerides) which is then stored in adipose tissue, and cannot be reconverted back into amino acids (at least under normal conditions). The importance of daily protein intake is evident via mothers and children being sick much more often in underdeveloped countries as even a marginally low protein intake can severely compromise immune function. Furthermore, many living in underdeveloped areas do not have access to toilet paper thus making fecal-oral transmission of disease extremely prevalent.
All public health crises of our current COVID-19 magnitude are followed quickly by food insecurity crises so please consider a cash or food donation to your local food bank. Food insecurity is defined by the US Department of Agriculture as “the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways”. When an emergent public health crisis begins impacting a community, many consumers quickly stock their home pantries and hoard household items such as toilet paper. Local food banks who rely on daily donations of unsold grocery items from grocery outlets then end up with far less product to give to those in need, and often also receive fewer food donations from benevolent local farmers and ranchers. Social distancing has necessitated that food banks adjust their supply chains to low-contact distribution via food box deliveries to front doors of senior citizens and families with children now staying home from school (whose the most nutritious meal of the day might previously have been school lunch in many low socioeconomic areas).
All Hidden Manna Food Bank administrators, board members, and workers are volunteers thus enabling 100% of all cash donations to fund food delivery expenses (gasoline for vehicles, refrigerators, coolers to transport food in trailers, etc.) to serve the needy in the greater Seattle metropolitan area - https://www.hiddenmanna-washington.org/donations
"Stay apart today so you can get together tomorrow"
Daniel G. Graetzer, PhD
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