SARS-COV-2 – Whither Our World?

Jayanta Bhattacharya

IT must be a tautology to begin with Virchow’s famous quotation – “Medicine is a social science and politics is nothing else but medicine on a large scale. Medicine as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution; the politician, the practical anthropologist, must find the means for their actual solution.” Every pandemic since at least 200 years seems to bolster this aphorism. During the years 1867-69 quarantine in the Suez Canal was stringent. For its obvious trade and economic interests, England manoeuvred quarantine laws for cholera epidemic – a pandemic of the period. Cholera deaths were represented as deaths from diarrheal diseases. And, as a sequel, cholera research and other basic science researches as well came to a halt.

One might feel uncanny when one comes to know that “Trump reportedly offered $1 B to poach coronavirus vax (developed by a German biotech pharma CureVac) for US use only” on March 16, 2020, and the German response was “A vaccine made in Germany would be "for the whole world," health minister said”. New York Times (15.03.2020) reported, “U.S. Offered ‘Large Sum’ to German Company for Access to Coronavirus Vaccine Research, German Officials Say”.

Impact of politics on medicine is more evident from a Nature editorial (7.04.2020) – Stop the coronavirus stigma now. The editorial reminds us that the pandemic is fuelling deplorable racism and discrimination, especially against Asian people. Education and research will also pay the price. It is candid and explicit to admit its wrongs – “When the World Health Organization (WHO) announced in February that the disease caused by the new coronavirus would be called COVID‑19, the name was quickly adopted by organizations involved in communicating public-health information. As well as naming the illness, the WHO was implicitly sending a reminder to those who had erroneously been associating the virus with Wuhan and with China in their news coverage— including Nature. That we did so was an error on our part, for which we take responsibility and apologize.” Moreover, failing to do so has consequences. It’s clear that since the outbreak was first reported, people of Asian descent around the world have been subjected to racist attacks, with untold human costs — for example, on their health and livelihoods. Law-enforcement agencies say they are making investigation of hate crimes a high priority, but such inquiries might come too late for some, including many of the more than 700,000 Chinese undergraduate, master’s and PhD students studying at universities outside China. The majority are in Australia, the United Kingdom and the United States. Many have returned home while their institutions are closed owing to lockdowns, and many might not return. Students are hesitating to come back, in part because of fears of continuing racism, along with uncertainty over the future of their courses and not knowing when international travel will resume.

These young people will experience disruption and the loss of new connections and opportunities. But the loss of students from China and other countries in Asia has wide-ranging -and worrying implications for the scholarly enterprise, too. It means that universities in the affected countries will become less diverse — something that has not happened for generations.

Finally, the editorial concludes – “Many leaders want to listen to and act on expert scientific advice to deal with this pandemic and save lives. On terminology, the advice is clear: we must all do everything we can to avoid and reduce stigma; not associate COVID-19 with particular groups of people or places; and emphasize that viruses do not discriminate — we are all at risk.

It would be tragic if stigma, fuelled by the coronavirus, led Asia’s young people to retreat from international campuses, curtailing their own education, reducing their own and others’ opportunities and leaving research worse off — just when the world is relying on it to find a way out.”

Regarding biology and treatment of the virus we are at the moment still groping. How the virus causes damage inside our body and produces so many symptoms – ranging from losing smell, haematological disorder, normal breathing despite severe lack of oxygen in blood to severe respiratory distress, disordered bowels, pre-symptomatic and asymptomatic carriers (around 60% of affected people) and more – is not much clear to us. In the field of traetment we are more disarrayed and consistently searching for an effective therapy, including vaccine – the most plausible answer to the virus attack. In an editorial of the New England Journal of Medicine (NEJM, 26.03.2020) it was noted – “A robust research effort is currently under way to develop a vaccine against Covid-19. We anticipate that the first candidates will enter phase 1 trials by early spring. Therapy currently consists of supportive care while a variety of investigational approaches are being explored. Among these are the antiviral medication lopinavir–ritonavir, interferon-1β, the RNA polymerase inhibitor remdesivir, chloroquine, and a variety of traditional Chinese medicine products. Once available, intravenous hyperimmune globulin from recovered persons and monoclonal antibodies may be attractive candidates to study in early intervention ... Critical to moving the field forward, even in the context of an outbreak, is ensuring that investigational products are evaluated in scientifically and ethically sound studies.” To add, there comes up a report in JAMA (27.03.2020) – “Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma”.

WHO has opened a new site – Solidarity Trial – to upload all available treatments (small, large, randomized controlled trials or non-randomized ones) with all available medications for extending and sifting our knowledge of the virus. There are also recent reports of not only human-to-human transmission but also interspecies (tigers and dogs) transmission, to add more worry.

The NEJM (26.02.2020) paper (“Escaping Pandora’s Box – Another Novel Coronavirus”) clearly enunciated, “We have created a global, human-dominated ecosystem that serves as a playground for the emergence and host-switching of animal viruses, especially genetically error-prone RNA viruses, whose high mutation rates have, for millions of years, provided opportunities to switch to new hosts in new ecosystems. It took the genome of the human species 8 million years to evolve by 1%. Many animal RNA viruses can evolve by more than 1% in a matter of days. It is not difficult to understand why we increasingly see the emergence of zoonotic viruses ... a combination of altered human behaviors, environmental changes, and inadequate global public health mechanisms now easily turn obscure animal viruses into existential human threats.”

Evidently, it is corporate greed and capital which has made everything and everyone commoditized. Our mastery over nature has devastated normal ecological balance and harmony. We have become prey to zoonotic viruses, which should not be. The world after COVID-19 will never be the same.

The author is a Medical practitioner, independent scholar and public health activist

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Apr 12, 2020