When the first reports about the novel coronavirus SARS-CoV-2 in the Chinese city of Wuhan appeared back in January, few people were able to predict how it was going to affect our lives on all levels. Now, a few months later, we still know very little about this virus – but medical professionals across the globe had more than enough opportunities to form the first impressions of what it is, how it influences human health and what we are to do about it. A lot of the information one can find about it right now is doubtful, inconsistent and often contradictory – however, it is not always the sign of deliberate misinformation. Just like with any other novel issue, there are no established opinions or 100 percent certain facts. Doctors are still finding things out and do it in the conditions of a crisis and constant overtime. It is no wonder that they often come to different conclusions – the body of information on SARS-CoV-2 is still too small. However, some things we do know. In this essay, we will mostly cover them and pay some attention to what possibly awaits us in future.
First, let us get the nomenclature out of the way. Although both the pathogen and the disease it causes are both commonly referred to as ‘coronavirus’, it is not their official name – it is just a generic name of the virus type it belongs to. The official name of the virus is SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), with COVID-19 (coronavirus disease-19, pointing out the year of the first outbreak) being the name of the disease it causes.
Since the virus entered human population back in December 2019, we heard many rumors about its potential sources and behavior. Many of them turned out to be either fakes or premature conclusions (like the rumors about its potential artificial origins and gradually decreasing lethality). Now we can say with a huge degree of certainty that SARS-CoV-2 is similar to other coronaviruses and has zoonotic origins, most likely originating from a bat-borne virus, as it is very similar to other known bat coronaviruses.
One of the most characteristic features of the novel coronavirus is that its symptoms are highly varied. They differ greatly from person to person. Absolute majority of cases are asymptomatic or result in mild flu-like symptoms (fever, dry cough, joint pain, general fatigue). There are so many registered asymptomatic cases that many believe that the true number of infected with SARS-CoV-2 is much greater than what is known from official sources. Most people simply get infected, do not develop any symptoms and do not even know that they carry the disease (however, it is currently unclear if they transmit it). Much fewer cases result in more severe symptoms, such as the loss of smell and taste to having difficulty breathing, chest pain, nausea and diarrhea. Rare cases lead to complications like pneumonia and organ failure, resulting in death.
The severity of COVID-19 is very unevenly distributed among the people of different ages. The absolute majority of severe cases and fatalities accrue to the patients over 70 years of age. Fatality rates among people under 40 are generally about 0.4 percent but rapidly climb among older patients, up to and over 30 percent. Younger people dying of COVID-19 are almost uniformly reported to have been suffering from other serious conditions, most often heart disease, hypertension, diabetes, cancer and obesity.
Although the chances of surviving the disease are high, we have been dealing with it for too short a time to make any conclusions about its long-term effects on survivors. However, there is already some ground for alarm – severe cases of the disease were reported to cause heart, liver and kidney damage, and some of those who recovered from it showed signs of 20 to 30 percent drop in lung capacity.
One of the aspects of the new disease that is seemingly hard to explain is how different are its mortality rates in different countries. For example, in China, the first country hit by the virus, it is about 4 percent, while in Italy, a country widely considered to have one of the best healthcare systems in the world, it is staggering 11 percent.
However, the situation becomes clearer once we start considering that we live in a real world, not an idealized simulation. A person who gets sick with COVID-19 does not immediately find out about his/her condition. Data about this case does not magically appear in a database. The statistics only take into account the officially confirmed cases – people who tested positive for SARS-CoV-2. Testing policies and capabilities differ from country to country. China took considerable effort to contain the disease from its early days, and widespread testing was one of the main strategies. Italy, on the contrary, did not consider itself under severe risk. It still suffers from a severe shortage of COVID-19 test kits. As a result, most people who get infected but do not develop severe symptoms are advised to stay at home and are not tested at all. Most tests refer to the patients who were admitted to hospitals. In other words, one’s condition has to be already quite severe to be tested. It is no wonder that the official percentage of those who die from the disease is going to be high.
As a result, the real mortality rate can be much lower not just than the Italy’s 11 percent but even than China’s 4 percent. Considering the speed with which the new coronavirus spreads, it would not be surprising if hundreds of thousands have already been infected and got well without ever realizing they were sick in the first place.
Currently, there is no treatment for this disease, and all that medical professionals can do is provide supportive therapy to those who develop severe symptoms. Generally, it turns out to be quite effective – however, the main danger lies in the limited throughput capabilities of healthcare systems across the world. A small percentage of coronavirus disease patients become unable to breathe on their own and need intensive care and mechanical ventilation. Ventilators are highly complex devices that only work in conjunction with other intensive care equipment and require attention of trained specialists. As a result, if a huge number of people get infected over a short period, the medical system of a country can simply be unable to cope with the spike in the number of patients requiring this treatment. During the outbreak in Italy, many hospitals did not have the necessary number of ventilators, and doctors literally had to decide whom they could help and whom they had to let die.
As healthcare systems of developed countries are optimized for an average number of patients with each specific disease they have to deal with, they are not ready for such spikes. While COVID-19 is much less lethal than many other diseases, humanity as a whole does not have an immunity against it, which means that it spreads rapidly and is very hard to contain. As a result, its main danger lies not in the severity of individual cases, but in their sheer number.
SARS-CoV-2 is genetically very similar to the viruses that caused two other recent coronavirus outbreaks: SARS (‘atypical pneumonia’) and MERS (Middle East Respiratory Syndrome). However, those were quickly contained and did not result in nearly the same number of infections and deaths. What makes the new coronavirus so different from its predecessors?
The important thing here is to understand the purpose pursued by the virus, just like any other living organism. This purpose is procreation – the virus is not ‘interested’ in killing its hosts, it simply strives to spread its generic material across as many of them as possible. When hosts die in the process, it is not the desired outcome but a side effect. From this point of view, SARS-CoV-2 is a much more successful virus than SARS or MERS. It has a much lower lethality rate (currently 5.6 percent of confirmed cases vs. about 10 percent of SARS and more than 35 percent of MERS) accompanied with a longer incubation period. Taken in conjunction with a projected huge number of asymptomatic cases, and we get a virus that spreads rapidly and stealthily, keeps most of its victims alive to continue the spread of the disease and is much easier to transmit. As the initial window of opportunity when the first few infected could have been isolated has passed, the spread of the disease can no longer be contained.
All this considered, it would be wrong to talk about the influence of coronavirus on health without mentioning its psychological effects. With its low lethality and normally mild symptoms, it would not be much of exaggeration to say that SARS-CoV-2 wreaks a much greater havoc with human minds than with their bodies. This is only further exacerbated by the extreme measures most countries take to contain the spread of the pandemic.
As soon as it became obvious that the disease would spread from China to other countries, it has been leading to growing anxiety, fear and panic among the populace. Even levelheaded individuals are susceptible to it when subjected to alarming news and rumors every minute of the day. This, in turn, leads to many different types of irrational behavior: people start buying medical masks in bulk, quickly exhausting their supply, stock up on food out of fear of possible shortages and become progressively nervous and stressed as the pandemic spreads further. Some individuals from the survivalist community go as far as leaving their homes and retreating to isolated locations, genuinely expecting the fall of civilization, universal famine and riots. Conspiracy theories about the artificial origins of the virus, its intentional spread by this or that enemy and concealment of the real fatality rates by the government become ever more abundant.
When you take into account what people can do under the influence of hysteria, it becomes obvious that psychological effects of COVID-19 can be far more dangerous for the society as a whole than its relatively mild physiological symptoms.
The important thing to understand about the novel disease is that it is no point in panicking about it or trying to sit it out. COVID-19 is not going anywhere – at the moment of writing, there are more than a million cases across the globe (and there can be just as many, if not more, unconfirmed and asymptomatic cases), there is no hope of isolating it and stopping its spread. According to the most optimistic prognoses, a vaccine will be created in a year or a year and a half at the very earliest, and there is no guarantee that it will be created at all – after all, medical science of the entire world has been looking for a vaccine against HIV for decades without any result. Considering how contagious COVID-19 is, we should resign ourselves to the fact that the majority of population (at least 60 to 70 percent) will have to be infected with it before the vaccine is ready, if it is created at all. Some of these people will inevitably die, and the only thing we can do is to try and control the spread of the virus by quarantine measures and social isolation. The new coronavirus infection has become a part of our reality, and we will have to learn to live with it. After the initial outbreak is over, there will be new ones, but they will gradually become less severe as the percentage of people with immunity grows. In the course of time, the dreaded SARS-CoV-2 will become just yet another among many other viral respiratory infections humanity has to coexist with.