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1. CAN THE VIRUS MUTATE?

 

Yes! The SARS-COV-2 can mutate and has been mutating. It has mutated several times. The mutation changes the genetic code of the virus but not how the virus functions. Viruses (and SARS-COV-2 is not an exception) take over the host’s cells and tricks it into making copies of the viruses’ cells. Vaccines work by stimulating the production of host antibodies. The antibodies neutralize the virus cells by binding to them. Over time, mutations can make vaccines less effective. When a virus mutates, the antibodies can no longer bind to the surface antigen of the virus. There is only one strain of COV-SARS-2 but about 11 mutations. Another paper that was not peer-reviewed identified about 30 mutations. Presently, there are many trials under way to develop a vaccine for the SARS-COV-2. However, a virus can mutate in such a way that the antibodies stimulated by the vaccine is not binding to the virus. Let’s hope it doesn’t happen with SARS-COV-2.

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2. IS CHLOROQUINE EFFECTIVE IN THE TREATMENT OF COVID-19?

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No drug has been approved by the World Health Organization (WHO) for the treatment of COVID-19.However, chloroquine has been successfully used in the treatment. Yes! There are known side effects like prolonged QT interval but it is contra-indicated in people with G6PD Deficiency and pregnant or breastfeeding mothers. Quinine was first recognized as an antimalarial centuries ago. It was isolated in the late 19th century from the bark of cinchona tree. Chloroquine is a synthetic form of quinine.It is an antimalarial and has antiviral properties on the RNA virus. Coronaviruses are large, enveloped, single-stranded, positive-sense RNA viruses with a genome that is about 30 kb in length.

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In Nigeria, anyone more than 20 years old must have used chloroquine. Chloroquine modulates the immune response during a virus infection. It causes alkalization in the endosomes which affects several steps in virus replication. Endosomes are vesicles used in intracellular transport. Chloroquine inhibits the replication of the virus. The dose is 500mg twice daily but can be modulated according to the viral load. The patients’ vital signs and viral load should be monitored. It has been used successfully in China and some private practitioners in USA have used it during this pandemic. It is also being used in Nigeria and in some North African countries.

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3a. WHAT IS THE ROLE OF VITAMINS C, D AND ZINC IN TREATMENT OF COVID-19?

 

I would refer you to the audio slides. These vitamins do not destroy the virus but interfere in its replication thereby boosting the host’s immunity to fight the virus. Prophylactically taking vitamins C, D and zinc would boost the immunity but not prevent infection.

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3b.  WHAT IS THE ROLE OF VITAMIN E IN TREATMENT OF COVID-19?

 

Vitamin E is an antioxidant but I have not seen any documented evidence on the role of vitamin E in the treatment of COVID-19.

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4. SHOULD RECOVERED PATIENTS BE STIGMATIZED?

 

No! Recovered patients should not be stigmatized. Please go over the article I wrote on Ebola virus disease stigmatization. Stigmatization will only drive those suffering from symptoms into hiding thereby spreading the disease. We should enlighten people through intensive and sustainable mass health education that COVID-19 can be prevented and that it can be successfully treated if symptoms are reported on time.

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5. WHY DOES SARS-COV-2 CAUSE AN ORGAN DAMAGE?

 

The human body has white blood cells that defend the body against enemy (antigen) attack. The white blood cells are also called leucocytes. There are different types of white blood cells. They have different functions. The lymphocytes are specialized white blood cells that target viruses. There are different types of lymphocytes with varying functions; These are natural killer cells (or Killer cells), B and T cells. When the virus is inside the lung tissue, the white blood cells produce cytokines. Interferon and Interleukin are both cytokines that respond to virus invasion. These cytokines recruit more cells to attack the antigen (virus). It activates the response of the killer cells. The killer cells destroy any cell it does not recognize as the host cell. Unfortunately, it over reacts (cytokine storm) and begins to attack the hosts’ cells causing multi organ failure. Autopsies performed on patients that died from COVID-19 have also shown that they suffered from disseminated intravascular coagulopathy.

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6. IS THERE A STANDARD TREATMENT FOR COVID-19?

 

I would refer you to the slides on COVID-19. There is no World Health Organization (WHO) approved treatment for COVID-19 but different countries are using a variety of drugs including chloroquine, vitamins, C, D, zinc and Azithromycin. Some countries like Madagascar are going through the prophylaxis route and using a herbal elixir made from Artemisinin an anti-malarial. Presidents of Tanzania, Guinea Bissau, Senegal, the Congos (Democratic Republic of the Congo and Republic of the Congo) and Chad  have sent their aeroplanes to collect boxes of the elixir for their citizens. The elixir has not been approved by WHO.

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7. WAS COVID-19 ONCE KNOWN AS THE SPANISH FLU?

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No. While the two are pandemics affecting the respiratory system, they are not the same. The Spanish flu took away 50 million lives and infected about a third of the world population.It infected 500 million people. They are both caused by viruses. The Spanish Flu was caused by H1N1 influenza virus while COVID-19 is caused by the coronavirus. At the time of the Spanish Flu, vaccines and antibiotics had not been developed. The main stay was crowd control, social distancing and good personal hygiene. Although it was called the Spanish Flu, it did not originate from Spain. However, Spain was the first country to report it in its newspapers.

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8. WHEN WILL COVID-19 END?

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I will lay out the factors that would be responsible for the demise of COVID-19 and perhaps at the end of my treatise, you will be able to see the answer. I will use malaria as an example because malaria is endemic in Nigeria and we know the vector that carries the parasite.

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Malaria has been around before the time of Mungo Park and although we know the life cycle and the treatment for malaria it has not been eradicated. I believe your question on when will COVID-19 end is a way of asking when will the disease be eradicated?

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Eradication is a complete annihilation of the disease-causing agent in the region as in the case of malaria in Argentina and Algeria; in the world as in the case of small pox. Small pox once ravaged the world but is now only present in two laboratories. The last known case was in 1977. In 1980, WHO declared small pox eradicated. Vaccination was the panacea for small pox. There was and there is still no drug for small pox. The only viable small pox in the world can be found in laboratories in Georgia, USA and in Russia. Small pox is the only human disease agent that has ever been successfully eradicated.

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To be able to eradicate a disease, there must be an operable intervention. i.e something can be done and the action is humanly possible. It becomes an eradication when the elimination of the disease is achieved globally. It is an elimination when it occurs only in a geographical area. Algeria and Argentina have actually eliminated malaria not eradicated it.

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Eradication is also possible when the life cycle or replication (as in the case of a virus) of the disease agent is known and can be interrupted.It must inhabit the human host as the only vertebrate host and not have reservoir in an animal or other organism in the environment. If it did, then you’ll have to destroy the entire animal host.  The diagnostic tools must be available, sensitive and specific to detect the levels of transmission.

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Secondly, we consider the hidden and overt cost of eliminating the disease as opposed to controlling the disease. You control the disease when the health care system is not overwhelmed and the people that are infected can get treated.

Thirdly, we consider the possibility or feasibility of eradicating the virus. Fourthly, the disease must be of importance and must generate enough political and global will power to have it eradicated. You can’t eradicate a disease when not all the countries are on board with the same idea. The president of Brazil does not believe in the seriousness of the SARS-COV-2.

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A disease is under control when the number of new cases, old cases, morbidity and mortality are reduced to a manageable level that is acceptable to the community.  The interventions used to keep the disease under control must be sustained. E.g. use of mosquito nets, repellants, insecticide spray and environmental sanitation reduces the incidence of malaria.

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To answer the question when will COVID-19 end? The ending has you have asked might be when it becomes endemic. You can refer to the slides on COVID-19. It becomes endemic when even though it is present in a geographic region, it is not overwhelming the health system.

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However, it can be eliminated when a vaccine is developed and the incidence becomes zero in a region. If the vaccine is applied globally and there are no more new cases for a period of two to three years, it can be declared eradicated.

At most, what we can hope to achieve in the now, is a control because developing a vaccine takes months and even years. There are many vaccine trials under way in different parts of the world. Control can be by social distancing, quick identification of symptoms and diagnosis (through massive testing), isolation, intensive contact tracing, respiratory and personal hygiene. Recent reports show that being infected once does not prevent a re-infection which questions the relevance of herd immunity.

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9. DOES WEATHER AFFECT THE CORONAVIRUS?

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Please go over the COVID-19 slides.

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10. WHEN DO I THINK THE APEX OF THE DISEASE WILL BE REACHED GLOBALLY AND IN NIGERIA?

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You will be able to answer this question after understanding the following terms; herd immunity, reproduction number,

exponential increase and flattening the curve. I would revisit the question after explaining those terms in the forum.

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11. WHAT DO I THINK THE NIGERIAN GOVERNMENT SHOULD DO TO SECURE ITS CITIZENS?

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 The answer to this question is in an article I wrote titled COVID-19-; The inequalities in our

  healthcare system.

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12.  DO I THINK THE PHARMACEUTICAL COMPANIES ARE USING THIS OPPORTUNITY TO MAKE MONEY AND NOT ACTUALLY FIND A CURE AS SOON AS POSSIBLE?

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The pharmaceutical companies are using the opportunity to make money because if they develop a drug that cures the disease, naturally they should make profit because resources were used in the development. They should not make profits that would make the drug too expensive.However, it would be unethical if the cure is available and they are deliberately withholding it.

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To forestall such pre-emptive moves, global leaders have contributed up to the tune of seven billion dollars as of yesterday (5th May 2020) to find a vaccine that would work. One of the caveats of the agreement was that the vaccine will not be the property of any country or government but will belong to all. Remdesvir an antiviral drug used in Ebola virus disease, has been found to reduce hospital stay in COV-SARS-2 infection from 15 days to 11 days but not many countries have been impressed with it.

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To curtail costs, India has been given a task apart from other countries to find a vaccine because India has the biggest lab in the world dedicated to testing vaccines and it is hoped that if found from India, it would be cheap.

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