Seven months have passed since the epidemic struck: Scientists struggle against the ‘smarter’ virus  

COVID-19 is now more than seven months old. If we consider the first officially reported case to have occurred on Dec 31, 2019, we entered the eighth month of the pandemic on the last day of July.

The marauder continues its deadly march across all parts of the globe. For sure, mortality from the disease seems to have come down in Europe, China and several Asian countries. But no country or WHO has begun to breathe easy. Lockdowns remain a popular method to keep the virus at bay, and yet, they seem to do little to stem the tide. In spite of concerted efforts of the collective scientific community, little is certain of which way the virus would behave.

There is a lively debate in scientific journals of the effect of lockdowns in checking the spread of the virus. A dominant view is that lockdowns have been successful only in wounding the economy of nations. Poorer countries, India included, have had to bear the brunt of this assault on economy. Attempts to resuscitate the economies of nations have not borne much fruit. Even China, the country of origin of the pandemic, reels under an economy rapidly heading downhill. Chinese citizens are confused and their attempts to withdraw their savings from banks have met with resistance from their government.

There was a belief in a section of the scientific community that the advent of a northern summer would slow the virus down. This hope, rather than belief, has been belied. Even Siberia is in the grip of an unprecedented summer and yet, Russia remains high in the list of countries with ever increasing new infections.

The other big hope was that herd immunity would kick in after a certain percentage of population has been infected and has subsequently recovered. But a recent Spanish study with a fairly large number of patients tested for antibodies against the virus shows that persons with detectable antibodies numbered just about 5% of those tested.

Humoral immunity through antibodies is an important and essential defence mechanism against infectious diseases. In fact, we vaccinate the population hoping to raise antibodies that would defend against future infections by the virus. That is how mankind managed to eliminate the scourge of Small Pox and check Polio. But in spite of more than 150 candidate vaccines in various stages of development, we are not sure any more if a vaccine will be the answer against future spread of infection. That is another hope which no more appears as bright as it did three months ago.

There is talk now that the other arm of immune defence, namely cell-mediated immunity, may be more important in combating the infection. But scientists and immunologists have not been able to quantitate the cellular immunity in any reasonable manner. Cell-mediated immunity is known to result in rejection of solid organs after transplantation, and a transplant recipient needs to be given immune-suppressive drugs lifelong to prevent such a rejection.

The doses of immune-suppressive drugs need to be modified all the time because we do not know how much is enough. Too little may result in rejection and too much may result in new, life-threatening infections. So, we have no clear answers if cell-mediated immunity following exposure to the virus would suffice to prevent infection. Clearly, we do not have all the answers regarding herd immunity.

Even the mechanism by which the virus causes disease is less than clear. It was initially believed to be a respiratory pathogen that causes a devastating pneumonia, like SARS and MERS viruses, which are also Corona viruses. However, the disease caused by this virus has shown protean manifestations affecting not just the lungs but kidneys, heart, liver, gastrointestinal tract, skin et cetera.

Numerous small clots have been found in small blood vessels of different organs and systems on autopsy studies, the causation of which has been poorly understood. One thing is certain- these small clots deprive the cells of organs and systems, oxygen that is carried by blood, resulting in their dysfunction and failure.

The drugs that have been tried against the virus are a legion. In their haste to inform the world of the efficacy of a particular drug, scientists have rushed to medical journals with their research without peer review. The efficacy of these agents could not be reproduced or confirmed in larger, randomised and placebo-controlled trials subsequently.

Hydroxychloroquine and certain antiviral agents like lopinavir-retonavir combination are good examples. The initial success with these agents could not be replicated by larger trials and these drugs have now been abandoned.

Immunity boosters have been recommended by practitioners of alternative systems of Medicine. However, it has also been shown that some patients die as a consequence of an uncontrolled immune response resulting in a ‘cytokine storm’. More and more immune cells get activated within the body, resulting in a catastrophic process of cell destruction. Clearly, the response of different patients to an infection with the virus is different and unpredictable. All treatments need to be individualised to a patient to help them overcome the deadly virus.

The spread of the infection has also been a topic of many controversies. Initially believed to be spreading only through large droplets that are released following a cough or a sneeze, the recommended physical distancing was 3 feet or one metre. This has been changed to a minimum of six feet or two metres because it is now believed that micro-droplets get aerosolized and can travel a fair distance and even hang in the air to infect other unsuspecting victims merely present in the same space. The acts of talking and laughing can generate such aerosols.

Persons who are asymptomatic and entirely unaware that they have the virus can also spread the infection! Fomites like door handles, cardboard boxes and utensils were considered highly infectious. This has also been since discounted.

Lastly, we come to a very special area of virological studies called ‘Gain of Function Research’ or GOFR. Virologists have been tinkering with the virus in the lab to render it more infectious, ostensibly to find cures against a future epidemic, or even a vaccine, for last many years.

This kind of research has been questioned for its ethicality in various scientific forums. Laboratory accidents are known to happen. The virus may escape the controlled bio-safety conditions of the lab and infect humans. The risk is real and has been the subject of numerous scientific publications, science fiction and even popular mainstream movies.

The possibility of one such escape from a Virology Lab located at Wuhan in China has been the subject of many publications. That China was less than transparent in reporting the initial infections and WHO was less than honest in warning the rest of the world is also well-known.

In this regard, the reader is referred to an article by Milton Leitenberg published in Bulletin of Atomic Scientists on 04 Jun 2020. Titled ‘Did the SARS-CoV-2 virus arise from a bat Coronavirus research program in a Chinese laboratory? Very possibly’, the author makes a strong argument with plenty of circumstantial evidence in support. The Chinese subsequently admitted that they have destroyed the viral specimens held in the Wuhan Institute of Virology. The entire pandemic has bedeviled mankind about its origin, its spread and its management.

The truth is somewhere out there. The virus continues to pose more questions than humankind can answer at present even as the war against the virus continues.

The author is Former Commandant and Director, Army Hospital (Referral & Research)