THE PANDEMIC AND US, PART 2

WHY DO PEOPLE RESPOND DIFFERENTLY TO THE COVID- 19 INFECTION?

I was asked this question frequently by some of my readers. Indeed, this novel virus is very infectious and deadly. So far it infected over 100 million people worldwide and killed 2 million of them. But why people respond so differently to this viral infection? Why some remain asymptomatic when infected, why do some get very sick, hospitalized and recover, but some die?

I am not an infectious disease specialist but, as I see it, when a person is infected with Covid-19, many factors about that particular person ultimately affects the outcome of the disease. These factors could be summarized as follows:

1 – The unique genetic makeup of the person who contracted the virus. Our genetic makeup dictates how we respond to diseases and medications. We are all different. One size does not fit all, as far as genetic is concerned. In the future, medical care and treatments will be tailored according to the genetic makeup of people. This is called “personalized medical care.”

2 – Viral load of infection, meaning how many viruses a person is infected with. Contracting few viruses from a passerby would not make a person very sick. But, if a person sits or stands by an infected person for hours, his/her the viral load would be very high and this person most likely will become critically ill.

3 - Immune response to the virus, which is dictated by the genetics and immune modulation of the person. It could be no significant immune response, mild response or an overwhelming response (cytokine storm) which could be more dangerous than the viral infection itself, by causing many bodily organs to fail. 

4 – Existing underlying medical conditions of the infected person, such as a compromised immune system, advanced age, diabetes, heart disease, lung disease, obesity or cancer. This makes the person very vulnerable and a high-risk patient.

5 – Absence of effective medications for the treatment of the virus and, lack of experience as to how best to take care of these patients - which varies from hospitals to hospitals; absence of enough ICU beds, expert personal, necessary O2 supplies and even respirators. 

So, until we are able to vaccinate the population of the entire country, as well as the majority of world population, we are not safe. Covid-19 is a coronavirus, just like flu viruses all single- stranded RNA coronaviruses, they mutate spontaneously by creating genetically different variants. These variations in the genetic makeup of the virus (genome) gives it an advantage upon which a natural selection (survival of the fittest) to occur, to create a new dominant variety.

Our newly discovered vaccines may or may not be effective against these new variants. The more we wait to vaccinate the entire population, the more variants will occur, spread everywhere and possibly cause new pandemics. As the World Health Organization suggests, rich countries vaccinating only their own population (vaccine nationalism) would not solve the problem we are all facing. Pandemics involve the whole world. We don’t even know how long the vaccine immunity will last. It maybe, like flu- vaccines, that we would need yearly Covid-19 shots as well.

It appears that, in the meantime, our best bet is to strictly follow our proven public health protective measures: Face mask + Social distancing + Hand washing.

A good quality face mask should cover the nose, not just mouth. Because Covid-19 is a respiratory virus, it enters the body through the nose, by breathing virus droplets in the air. As a matter fact, 80 percent of infected people with the virus first complaint of sudden onset of loss of sense of smell, even before they developed a fever. This is because the virus has entered the nose and started to destroy the smell receptor in the nasal cavity. The sense of smell gradually returns to normal after recovery. It is not due to brain injury, as previously thought.

Social distancing reduces the viral load and hand washing / sanitizing reduces surface contact with virus. These measures should be followed even after vaccination, until the pandemic is totally under control. This is because a vaccinated and immune person still could get infected with the virus, but they would remain well and asymptomatic.