|Year : 2020 | Volume
| Issue : 1 | Page : 1-3
nCOVID-19 – Pralaya raised by mother nature to punish erring Homo Sapiens or the low-cost biological warfare by humans to conquer world?
Nimain C Mohanty
Professor Emeritus Pediatrics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
|Date of Submission||14-Sep-2020|
|Date of Decision||15-Sep-2020|
|Date of Acceptance||15-Sep-2020|
|Date of Web Publication||06-Nov-2020|
Dr. Nimain C Mohanty
Professor Emeritus Pediatrics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mohanty NC. nCOVID-19 – Pralaya raised by mother nature to punish erring Homo Sapiens or the low-cost biological warfare by humans to conquer world?. J Pediatr Assoc India 2020;9:1-3
|How to cite this URL:|
Mohanty NC. nCOVID-19 – Pralaya raised by mother nature to punish erring Homo Sapiens or the low-cost biological warfare by humans to conquer world?. J Pediatr Assoc India [serial online] 2020 [cited 2021 Feb 26];9:1-3. Available from: http://www.indjpai.com/text.asp?2020/9/1/1/300095
| Introduction|| |
Emergence and re-emergence of micro-organisms with vengeance is nothing new to the medical world that has been constantly in warpath against them to protect the humanity. What caught us all off guard was the surprising propensity with which the novel COVID-19 announced its arrival as a bolt from the blue in the form of a pandemic spreading globally within a month, inflicting mass casualties in developed countries in Europe and US, spreading from China. Unlike its six other cousins in the past two decades; from severe acute respiratory syndrome (SARS) (2002), Bird Flu (2005), Swine Flu (2009), Middle East respiratory syndrome (2012), Ebola (2014), Nipah (2018), the present SARS nCOVID (2019) caused havoc with massive human misery and mass casualties, posing more than a world war like situation. No one knows the exact medical management. There is colossal economic slowdown, scarce logistics, resources crunch, and confusion all around. The new disease is highly infectious, scary and deadly infecting over 10 lakh and killing 50,000 people worldwide till date.
| Background|| |
Most of us know about disease causing bacteria infects animals and humans. These are unicellular living organisms, so small that they are not to naked eye but through a microscope only. On the other hand, virus can invade a microscopic cell or bacteria, visible only by the electron microscope. Virus is not necessarily a living entity and hence not susceptible to antibiotics like bacteria is. Rather it happens to be a chemical particle of RNA or DNA, having lipid as its outer coat. On entry through droplets sneezed or coughed out of an infected individual, the spike like glycoprotein structures projecting from nCOVID-19 virus attaches itself to receptor sites on the surface of host mucosal cells in respiratory passage such as nose, throat, and eyes of healthy hosts where it gets trapped or settles first, before finally invading the lungs and other systems. Through these projections, the genomic RNA from the virus enters the host cells, integrates itself with host genome, change host genetic code, and synthesize abnormal proteins for its own survival as well as multiplication, thereby causing and spreading the disease.
| Prevention is Better Than Cure|| |
- The lipid coat of nCOVID-19 is resistant to most chemicals except soap which is lipophilic. On one side, the soap molecule attaches itself to the water molecule and at the other arm to the lipid on surface coat of virus, ultimately rupturing and exposing its core RNA to disintegrate. However, the saponification process with the production of adequate froth is required which takes at least 20 s
- Alternatively, any chemical sanitizer with minimum 65% alcohol content can kill the virus but not in the presence of any dirt on hands as alcohol dissolves fat
- As heat melts fat, drinking warm water above 25°C frequently and washing with hot water helps cleansing the virus attached to hands, mouth, and throat
- One should maintain safe distance from others to prevent the entry of virus particles through droplets brought out in millions while sneezing, coughing, or breathing out by infected individuals, mostly asymptomatic (17.9%) during first 5–14 days of infection, but unknowingly spread the disease. In fact, 46.5% of passengers in the luxury ship diamond prince who tested positive for nCOVID-19 were showing no symptom of disease at all, a deceiving profile of the notorious virus. On being symptomatic, the patient continues to be infectious for another one to 2 weeks until recovery or death
- In a pandemic scenario, strangers may be presumed infectious unless proved otherwise, maintaining social distancing to prevent community transmission
- Personal protective measures include good quality face masks (Ideally N95 or N99 which blocks 95% of particles), eye shields, gloves, and gowns. These are essential primarily for covid-19 patients or their caregivers, health-care staff from whom there is a risk of spread to others. Normal healthy individuals need not use masks at home or outside if proper social distancing is maintained
- nCOVID-19 settles and thrives on surfaces for as long as 4 days on plastic, glass, wood; 4–5 days on paper and fibers; 2 days on metals; 4 h on copper, and for 8 h on gloves – being its auto-disintegration time on these surfaces. If forms the core of tiny droplets of size less than 5 μ, it may remain suspended in air as long 2–3 h, as becomes lighter as outer layer of the droplet dries up; a rare risk of transmission by air. The virus remains resistant to cold exposure outside or air conditioning
- A mixture of beech and water (1:5) dissolve viral protein to break it from within. It is sprayed or used for mopping surface area; treat equipment, fomites such as books, paper, pen, cell phone, and television remote. Moisture facilitates virus survival. Proper ventilation dilutes viral concentration and reduce infection.
| Who Needs Testing?|| |
- Fever, cough, breathing difficulty within 14 days of foreign travel or had an exposure to any confirmed casein last 5–14 days, even if asymptomatic
- All health-care personnel who are or become symptomatic or between 5 and 14 days of coming in contact with any confirmed case without proper personal protective equipment
- All hospitalized patients having fever, cough, and/or shortness of breath.
Common Symptoms Some-what common Rare
1. Fever (98%) 3. Sore-throat 8. Runny nose
2. Cough (75%) 9. Diarrhoea
4. Aches and pains 10.O2 saturation
(Bone, muscle) < 94% or Cyanosis
7. Shortness of breath
| Morbidity and Mortality|| |
Although the infectivity of this virus is very high, the mortality is around 1.5%, seen from the trend world over. However, mortality among senior citizens remains very high as seen Europe. Ninety-five percent who died from this virus infection are in the age group above 60 years. Younger population has milder disease, manageable at home with symptomatic treatment such as paracetamol, plenty of fluids, health food, exercise, and self-quarantine in the separate room for 3 weeks. Patients with respiratory distress, recurrent vomiting, hypotension, altered sensorium would only need hospitalization on selective basis. Only few of them might need ventilation.
| Social Distancing|| |
- Must stay at home if one is sick or has underlying health condition (s) or any house hold tested positive for nCOVID-19. With mild or without symptoms, such patient can be self-quarantined in a separate room in own residence
- No gathering beyond 10 people at one place. Maintain at least 6 feet distance
- Avoid travel, shopping, social visits
- A must for high risk groups: Senior citizen beyond 60 years, pregnancy, newborns, underlying medical problems such as – immune compromised states, including co-infection with HIV, cancer cases under chemotherapy, diabetes, and heart diseases.
| Rationale of Lock Down|| |
The Chinese experience has shown that the maximum period of infectivity of nCOVID-19 is 3 weeks. That is why it is presumed that if all people remain indoors and maintain social distancing, the virus is bound to get auto-disintegrated and unlikely to spread from one individual to the other on at community level (Phase-2). If people fail to comply such guideline risking further spread, the lock down period may have to be extended on selective basis. Before lock down the cases in India doubled every 3 days but after lock down occurring every 5 days, everyone to see.
| How Long it is Likely to Take|| |
During an epidemic, the disease spreads to the whole population, rendering them natural immunity as and when they acquire the infection. If the organism happens to be very virulent with high infectivity, the disease spreads faster, peaking within a shorter period of time. A higher number of people suffer from the acute form of the disease, with higher mortality and serious adverse events or complications. This causes a significant public health problem in the absence of any immunity to the new virus. We do not possess any vaccine against the new virus as of now. If the infection rate is somehow slowed down, say by strict social distancing, the incidence curve is likely to plateau. People are bound to acquire immunity over time, without causing any public health problem or mass casualty. From the US experience, India is almost 1 month behind the Corona peak, apprehended there by the April end. Epidemiological and mathematical models suggest that if we continue strict social distancing until May end, we may get rid of the menace successfully; not withstanding our peculiar social fabric, infrastructure, economic condition, and free for all attitude. Some scientists have predicted early resolution, considering possible immunological superiority of Asians over the Westerners, applying the hygiene hypothesis, difference in microbiota, better armed natural killer cells, exposure to tuberculosis, anti-malarial drugs in the past but nothing established.
| Was the Bolt from the Blue or Strategized?|| |
We can't compare ourselves with the military might, secretive, communist China. It is an open secret that whenever any Chinese scholars or scientists are sent abroad for higher studies or research, they are expected to bring back some new technology with them by hook or by crook for their country. No state grant encouraged if they do not comply. No one is clear as to where from the current nCOVID-19 emerged from nowhere; primarily being a zoonotic descent, affecting bats and vampires, usually consumed by people in China. Possibly, the virus mutated over time to virulent human forms. Some say 2 Chinese research scientists working in Canada stole the mother virus to further develop at Wuhan for possible use in biological warfare. Despite UNO ban in 1975, China continued biological warfare research, maintaining a dedicated facility at Wuhan. Others say that a CIA secret agent while trying to smuggle out the genetically mutated virus from Wuhan came under skirmishes with Chinese army but escaped. In the process, the virus container got broken in the meat market area, exposing people around, spreading the virus fast. This served almost as a human trial for China to understand its potency for human-to-human spread, for which it was otherwise planning.
| Economic Implications|| |
The disease behavior was kept as a closely guarded secret. China conveniently closed eyes as the virus spread across continents, allowing foreign tourism, and at the same time, ruthlessly containing spread beyond Wuhan with iron hand. Perhaps, China was prepared in advance with experience in the treatment and prevention. China now assumes the position to export new-found drugs, vaccines, equipment such as ventilators, masks, gloves in mass scale to all over world; while purchasing panic selling of blue chip shares at throw-away prices from overseas investors in own companies, now rocketing sky high. China is now poised to emerge as a super power, rendering rest of the world as paupers without fighting an overt war against powerful Western world and rival countries. How come corona selectively spares other parts of China, Soviet Russia, North Korea, the entire communist bloc only? Self-discipline and strict enforcement of policy is required in public and national interest.
| Research Priorities|| |
Had the disease started in the developing world, it would not have received so much attention with usual blame game by the West, now so eager for a respite with dire urgency. None have been willing to invest in research on tuberculosis, leprosy, malaria, diarrhea or rabies, thinking never beyond their narrow borders and myopic vision. Perhaps, the success of vaccines against small pox and polio has made every one complacent, including all of us.
| Management|| |
Besides preventive measures, medical scientists world over are eager to find a definitive remedy, having tried several molecules in permutation and combinations. The speed, at which nCOVID19 genome got decoded, is noteworthy. Several medicines known useful in other conditions are under trial alone or in combinations. Among them, hydroxychloroquine 200 mg twice daily with azithromycin 500 mg once daily for 5 days or ritonavir 100 mg plus lopinavir 200 mg and hydroxychloroquine 200 mg twice daily for 7 day sunderclose medical supervision shown promise in Phase-II clinical trial in adults. Necessity is the mother of invention. Definitive treatment regime is likely to emerge sooner than later.
| Continued Medical Education|| |
Doctors and health-care personnel always strive hard to get always updated on advances occurring at any part of the world. It is high time to change the conventional modalities, so far dependent on resource intensive mega-conferences, courtesy pharmaceutical giants, not always without conflicts of interest. It is time to turn towards online education platforms, which beam up-to-date scientific contents on relevant topics globally. Massive open online courses platforms are viable and workable, with a slew of advantages. It does away with the hassles involved in organizing events, demanding hassles of coordination and man-hours. “It is not only economical but also makes learning at one's own convenience, within comfort zone, while maintaining social distancing, unlike conventional meetings and conferences.”
| Beginning of the End?|| |
Not merely the aforesaid six viruses creating havoc in the past two decades, scientists have identified about 6.3–8.3 lakh candidate viruses out of over 16 lakh on earth surface which are lurking in the wings to invade human beings turning as pathogens. In addition, hundreds and thousands are constantly mutating for survival and renewed pathogenicity. What if one by one or few of them together find their way as adversaries for the human race, having not found their natural habitat or usual host to live in? Are we not inviting the so-called Pralay? Hence, our strategy must be futuristic, investing our resources in the broad outlook of “Vasudhaiva Kutumbakam” in advanced research; while protecting Nature by calling immediate halt to our selfish destruction of flora, fauna and senseless killing of animals while taking all possible measures to reduce carbon foot print and prevent climate change. Our investments are indeed warranted in talentism than materialism, in case we care to learn any lesion. Those who fail to learn from history are condemned to repeat it. Better wake up to the warning signal by the Mother Nature. Save the nature, save universe, lest we shall have no time to repent for our greed!