COVID-19: OUR FIGHTBACK OPTIONS

We know that COVID-19 is caused by a virus called SARS2, officially SARS-COV-2.  Each virus is so small it cannot be seen using standard microscopes, but can only be seen under an electron microscope, as shown to the right. 

Each virus consists of:

• A fatty coating
• RNA inside
• Protein ‘spikes’ that bind onto ACE2 receptors on human cells to inject the RNA, which then hijacks the cell’s mechanism to produces more viruses, thereby killing the cell

Viruses aren’t ‘alive’ as such, and can’t be ‘killed’.  But they can be rendered inactive.

WHAT DOESN’T WORK

Firstly it is important to realise viruses are not bacteria, and so:

• Anti-biotic drugs don’t work, though may be deployed to address a secondary bacterial infection
• Anti-bacterial hand wash and other products do not work, unless they contain at least 60% of an alcohol by volume (slightly less by weight)
• Disinfectants that are not based on bleach will not necessarily work
  

WHAT DOES WORK

There are fundamentally five ways to de-activate SARS2:

1. The body fights viruses such as SARS2 by using the proteins in anti-bodies, T-cells and cytokines to bind with the spike proteins, thereby rendering them inactive
2. Various ways to break up the fatty layer, thereby rendering the virus inactive
3. Destroying or modifying the RNA
4. Reducing the chance of transmission from one person to another
5. Medicines and medical techniques to reduce severity of the symptoms

USING PROTEINS AND VACCINES

Although the body uses proteins of various types to bind to bind to the spike proteins of the SARS2 virus, I am not aware of any artificial method that uses this approach.

Though vaccines work by stimulating the body to produce anti-bodies, T-cells and cytokines in advance of infection to either:

• Prevent infection
• Reduce the effects of infection

BREAKING THE FATTY LAYER

Someone can become infected by touching their mouth, nose or eyes with hands that have viruses on them.  They could have touched a contaminated surface. So we want to make viruses on surfaces inactive, one way being to break the fatty layer of SARS2 on surfaces:

• Hands
• Any surface that would be touched, be it worktop, door handle, cricket ball etc.

Like any other fatty substance, soap and water is universally regarded as the best way to clean hands, by breaking down the fat and flushing the viral remnants away.  Here is the NHS advice

Alcohols disrupt the fatty layer, and so hand sanitisers with at least 60% alcohol  can be effective.  But not other hand sanitisers.  "Which?" has produced a guide.

For other surfaces, disinfectants can be used. 

The World Health Organisation recommends simple bleach, to be applied by cloth rather than spray.

For businesses such as in food preparation, there is specialist guidance available:

• The British HSE page is gobbledegook, and seems best if you’re trying to get to sleep
  
• Companies such as OZO Innovations, here in Oxford, are producing new disinfectants that kill bacteria and de-activate viruses in a more efficient way
  

This research was published in  the Lancet in early April, showing which ddisinfectants work (soap working immeidately for 2 out of three samples). 

It also shows how long the virus survives on various surfaces.  Hard surfaces like steel and plastice lasting several days, whereas paper only a couple of hours. Bank notes look a risk at 2 or 3 days.

It is important to realise that alcohol and disinfectants should not be taken internally.

But it is disappointing that it is not safe enough to have a puffer with a soap solution that could be used after infection.  Sadly that would also be dangerous.

DESTROYING OR MODIFYING THE RNA

DNA and RNA, including viral RNA, can be affected by UV light.

For humans it is dangerous, and can for example lead to skin cancer or eye damage.  Hence sunglasses being marked as UV safe.

What about the RNA in the SARS2 virus?

The most powerful UV rays of shortest wavelength, known as UVC can work.  Typically a wavelength of 254 nanometres (UVC254) is used to disinfect surfaces  such as buses, as that avoids liquids and staff to apply it.

REDUCING THE CHANCES OF TRANSMISSION

The key problem with COVID-19 is that people are infectious without realising it:

• Either before they develop any symptoms, for a few days or longer (pre-symptomatic)
• Without developing symptoms for a longer period (asymptomatic)

There are various ways to reduce the chances of transmission:

• It is believed that transmission is principally through viruses on water droplets in the air, so:
• Best to be outdoors or in well ventilated indoor areas
• Social distancing.  Most water droplets drop to the ground within  about 1 metre, unless someone is laughing, breathing hard exercising, coughing or sneezing.  Risk is significantly lower at 2 metres:
  
• Transparent barriers, such as being used in supermarkets between checkout staff and customers
• Wearing a mask (see separate posting, to follow):
• PPE grade, often called N95, that protects the wearer
• Simpler masks and face coverings for “Source Control” that stop most droplets on leaving the mouth, and therefore stops them reaching anybody else.  “My mask protects you. Your mask protects me”.  The better masks provide some limited protection for the wearer
• Visors to provide protection for the wearer and those being breathed upon, such as worn by hairdressers.  Visors should always be used with a mask, as droplets can escape around the sides of visors
  
• Reducing the times someone touches their mouth, nose and eyes.  People unwittingly do so over 20 times per hour ordinarily
  
• Washing hands, as above
• Cleaning potentially contaminated surfaces, as above
• Lockdowns, as below

LOCKDOWNS

A “lockdown” is a ‘blunt instrument’ that reduces transmission by stopping people from meeting, principally by getting people to stay at home and restricting how they can meet people from other households.  This can be:

• A formal hard lockdown, as used in Spain.  People weren’t allowed out, involving severe restrictions even on food shopping
• A formal less hard lockdown, as used in UK.  We were allowed daily exercise and food shopping
• A voluntary lockdown as used in Sweden, where schools and most businesses stayed open.  If properly explained to the public, that can be nearly as effective as a formal lockdown, with Sweden finding travel dropped as much as in neighbouring countries that had a formal lockdown

Lockdowns can be national or local.  The UK has had its first major local lockdown in Leicester, having had smaller lockdowns in individual factories, hospitals etc.

Lockdowns can be used in two ways:

• As last resort, when other measures are not working and infections are rising.  This was the case in the UK.
• As first resort, to prevent infections taking hold, as used by New Zealand

Which way is dependent on each countries’ circumstances.  Islands with little external interaction, such as New Zealand, have benefited from the ‘first resort’ approach.

Whereas the UK is more open to international travel. and so followed a ‘last resort’ approach, given the substantial ‘side-effects’ of a lockdown:

• Restrictions on people’s lives
• Adverse impact on mental health
• Adverse impact on the economy, affecting jobs
• Adverse impact on the national debt, with need for increased borrowing or other fiscal measures

Lockdowns are very much a matter of ‘horses for courses’ and a matter of judgement.

MEDICINES AND MEDICAL TECHNIQUES

Whilst reducing transmission is clearly the best way to reduce the level of illness, at least until a vaccine is available, how about those people who have contracted the disease?

Looking at the basic process for how an infection affects someone [link], the obvious thing to do is to reduce the chances of them either:

1.  Needing hospitalisation
2. Being affected by LongCOVID, where there are prolonged symptoms, often due to organ damage

Sadly the treatments that are available are almost exclusively in hospital.  That’s medicines, for example to stop microclotting or the use of equipment to help breathing such as CPAP machines (air pumps) and mechanical ventilators. 

There’s virtually nothing available today for the two objectives of helping people at home.  Certainly no medications, now hydroxychloroquine has been debunked as ineffective yet can kill.

There is the usual advice for flu-type infections, such as bed rest, plenty pf water and paracetamol .  There is only one other technique for home use, to my knowledge.  That is deep breathing

IN CONCLUSION

The main hope against COVID-19  is that vaccines will be produced that are both safe and effective.  But that will take months, into 2021 at least, especially to ensure they are safe enough for mass vaccination.

Should medicines come along that could be taken at home to prevent serious illness, we could potentially be more relaxed about contracting COVID-19. 

But in the meantime, as death and LongCOVID makes COVID-19 such a dangerous disease, we need to adopt a mix of anti-transmission techniques:

• Social distancing, preferably 2 metres
• Face masks where 2 metres is not practicable
• Other physical barriers, such as visors and transparent screens
• Avoiding touching one’s mouth, nose or eyes as much as possible
• Hand washing using soap or high-alcohol sanitisers
• Treatment of touchable surfaces using soap, alcohols, disinfectants and UV light (none of which should be used internally)
• National and local lockdowns as last resort if infections are rising, or to get infection rates much lower (see separate posting)