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12th February 2020

Repeated warnings about mutant flu / other new viruses like SARS-CoV-2

At a time of panic in some communities, here is a common sense view. I am writing as a physician and trends analyst who has been involved in the fight against HIV (another mutant virus) for over three decades.

Since 1987 I have been predicting the great vulnerability of our world to new mutant viruses or mutations of existing ones like SARS-CoV-2, in my book The Truth about AIDS, in Futurewise published in 1998, and in The Future of Almost Everything published in 2015/2019.

The reason is that new virus types appear every year, and we lack antiviral drugs to combat them.  Only some of these are coronaviruses.

Indeed, the most effective antivirals today are less powerful than penicillin was against many types of bacteria when first discovered in the 1940s.

Vaccines can also take a very long time to develop against coronaviruses and other pathogenic viruses, and may only be partially effective.

For example, don't expect an effective, safe, widely available vaccine against this coronavirus SARS-CoV-2 for 15-18 months.

Some years ago I wrote this: "With around 7 billion people alive today, there is a small risk of viral mutation every time a single person is infected with any existing viral type, made easier by dense urbanisation in many countries, dramatic growth in international travel, and the lack of an antiviral equivalent to penicillin. Conditions have been perfectly set for some time for just such outbreaks as Swine Flu or Sars. We should therefore expect more to follow - less or more dangerous than Swine Flu."

This has also been the position of the World Health Organisation for over two decades.

Thirty years ago medical students were trained to diagnose specific virus infections by their typical symptoms and skin rashes, but today the range of low-grade viral infections is huge and rapidly growing.

Few are formally diagnosed.

Doctors just tell people they are suffering from a "self-limiting condition" which is another way of saying there's no treatment but it is unlikely to kill you.

Longer term global challenge from new viruses and new illnesses like COVID-19

The longer term global challenge therefore is that coronavirus 2019-nCoV is just one of a large number of totally new agents emerging each year, often in China, the vast majority of which are relatively harmless causing combinations of aches, pains, fevers, rashes, gut problems and other symptoms.

A small proportion of such new viruses are so lethal that they typically kill their victims before there is much opportunity for transmission, so infections tend to die out rapidly.

But the most dangerous potentially to the global community are new viruses which have longer incubation periods, and are less likely to kill. Coronavirus SARS-COV-2 is much less lethal to an average infected person than SARS was in 2003, but has already spread far more widely, and does appear to be more infectious.

Many of these new viruses typically emerge in South East Asia, in nations like China, having jumped from animals into humans, sometimes with a mutation at the same time.  

Just one such new virus was of course HIV, which to date has killed over 40 million with illnesses related to AIDS.

Fortunately we have effective antivirals now against that particular virus, after years of intensive research, but it remains a major global health risk, with just under 2 million new infections a years, and many deaths linked to AIDS.

How Coronavirus SARS-CoV-2 may mutate further

A huge uncertainty is how this new coronavirus will evolve. All flu-type viruses tend to go on mutating - they can become more or less dangerous and more or less infectious.  

The good news is that a very common trend is for new viruses like SARS-CoV-2 to become less lethal, as they pass through one person to another and across neighbourhoods.

But sometimes a new virus can infect someone who is also carrying ordinary flu, and their cells get muddled about which virus to make, so that a new combination of genes happens.  

Such an event could change the virus radically in behaviour, however SARS-CoV-2  does seem relatively stable compared to ordinary flu or the common cold.

We need to know how SARS-CoV-2 is transmitted

THere's a huge amount of research to do into how this particular coronavirus spreads.  It's really important in understanding what the real risks are.  In many other viral conditions, you can form a list of potential routes of infection, but the key is knowing which one or two cause 90-95% of all cases.

SARS-CoV-2 appears to spread mainly by coughing and sneezing to those within a metre or two, but SARS in 2003 did spread to some people by surface contamination, to hand contamination, to nose / mouth.  One research paper suggests that coronavirus may be excreted in faeces.  But it appears that most people catching SARS-CoV-2 have been in close proximity for some time to someone who is coughing or sneezing, or who is otherwise unwell.

Ordinary flu is also a major killer

We also need to remember that normal flu kills 50,000 a year in the US, and around 75,000 across the EU, mainly older people, particularly if frail with other serious conditions.  

Doctors are used to seeing death rates three or four times normal every deacade or two, so US death rates from 2019-nCoV of - say - 150,000 would not be that far from normal year on year variations.  

I am not saying that is what is going to happen, only that we need to see things in proportion.

Vital to know %  infected with no illness or very mild symptoms

Common signs of SARS-CoV-2 infection are fever, cough, sneezing, shortness of breath and breathing difficulties - all of course extremely common with other viruses, but are the classic pattern seen in COVID-19 illness.

Testing is complicated, time-consuming, costly and requires highly trained people in specialist centres - which can easily be overwhelmed. That is why doctors shifted in China to making a presumptive diagnosis of COVID-19 in any patient  with the above symptoms + classic chest X-Ray appearances, which can include multiple shadows on the lung, ground glass appearance and many other factors.  It's not a perfect diagnostic system, but it's rapid, gives the right answer a lot of the time in people with cough and fever who are suspected of having SARS-CoV-2 infection, and enables much faster contact tracing / control / treatment.

However, it seems that a significant number of people are becoming infected, but don't get anything more than very mild symptoms, maybe none at all.  

On the one hand, if true, this will make spread far harder to track.

But on the other hand, it means that reported death rates may be far too high, because we are missing most of these other milder cases.

Every person who recovers is of course carrying antibodies against SARS-CoV-2, and unravelling how the body responds will lead to all kinds of treatments.

To be certain of all this, we need to be testing large numbers of people who are completely well, to see if they have any evidence of previous mild infection.

And that can be harder than testing someone who is acutely sick.

Strict quarantine and contact tracing is vital

Some may argue that draconian measures to limit spread of SARS-CoV-2 may not be enough to prevent, ultimately, a global pandemic.

But even if that is the case (which is currently unknown), it is critically important to slow down spread as much as practically possible in early stages for several reasons.  

Firstly, to give time for experts to study the first cases, learn more about how it spreads, how dangerous it really is, risk factors for getting ill, and the best methods of treatment.

Secondly, it gives time to prepare potentially very large scale responses, ramp up testing facilities, manufacture supplies, train health care workers, mobilise communities and create additional treatment facilities.  

Thirdly, it delays potentially much wider spread until late warmer weather in Spring or Summer, when such viruses don't spread as well, at a time when hopefully winter pressures from other illnesses like flu are falling.

And that also means wealthy nations giving major support to emerging nations to help with health messaging, community mobilisation, testing, quarantine, treatment.

Most people in the world live close to the equator or in the Northern Hemisphere.

For all these reasons, we should commend and learn from China's gigantic health care response to SARS-CoV-2, as a national emergency. While other nations have had more time to prepare, this coronavirus was spreading rapidly in China before many realised what was happening, because the symptoms are those of many other viruses.

The truth is that very few other nations of the world have government powers and strength of organisation to respond in such rapid and comprehensive ways. 

Lessons from SARS chaos in 2003

The first SARS virus spread rapidly in 2003 but there were only 862 deaths and only around 8600 cases. 

Yet China faced a national crisis with thousands fleeing cities like Beijing, possibly carrying infection with them across many SARS-free areas. Normal life in some places ceased.

After much delay the government introduce with draconian measures including quarantine for entire buildings, thousands of workers, entire hospitals, severe limitations on travel, cancellation of public holidays, huge fines for spreading false rumours and so on.  

We have seen major disruptions since with other new viruses, for example in Mexico.  This time, with SARS-CoV-2, the Chinese government have acted at great speed and with huge responses.

Our world was very fortunate with SARS in 2003 that there were no cases in nations such as DR Congo or Zimbabwe, nations with very few health care resources, and weak government structures, compared to China, which is highly organised, efficient and centrally controlled.  

A single superspreader on one plane in such a low-income nation, would have been enough to ensure that Sars became a semi-permanent health care problem across the world.

Expect more mutant viruses - urgent need for better antivirals 

As I have often said in the past, all this underlines the urgent need to develop effective antiviral medication.

It is shocking that 60 years after the discovery of penicillin we still do not have a single antiviral that is as effective as the earliest antibiotics.

When we do, we will have a cure for common cold, flu, polio, smallpox, viral meningitis and viral pneumonia - amongst many other conditions. Genetic engineering may be a key weapon in vaccine development.

Reducing personal risk

In the meantime, all those potentially at risk can take simple steps to stay well - helping protect you from a host of other flu-like viruses, as well as ordinary coughs and colds at the same time. 

The virus cannot cross your intact skin - but moist membranes are vulnerable eg nose, mouth, eyes (probably).

That means washing hands regularly, not touching your face, using disinfectant hand gel in addition if you wish.  

And to state the obvious, don't spend time close up to someone who might be a carrier, particularly if they have a fever, are coughing or sneezing.

World Health Organsation Coronavirus 2019-nCoV update and infection control guidelines


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