Mar 28 2020
Adopted from the lecture given in Russian on March 20th, 2020 by Prof. Michael Schelkanov, Chairman of the International Center for Molecular Technologies, Chairman of the Virology Laboratory, Chairman of the Laboratory for Microorganisms’ Ecology, School of Biomedicine, Far-Eastern Federal University of the Russian Federation, Vladivostok, Far-Eastern Chapter of the Russian Academy of Sciences. The lecture was given at the meeting of the Scientific Council of the Far-Eastern Federal University.
SARS-CoV-2 is the virus causing the COVID-19 disease: 'CO' stands for 'corona,' 'VI' for 'virus,' and 'D' for disease. The virus was named “Corona” because of peplomers - proteins known as “spikes” - found on the surface of the virus.
I disagree with classifying current situation as pandemic, because the wast areas of the world do not have epidemic, most notably Russia, Latin America and Africa. It was premature and generated hysterical frenzy amongst many politicians.
There are 4 (four) types of Coronaviruses (“CV”):
Alpha-coronaviruses
Beta-coronaviruses
Gamma-coronaviruses
Delta-coronaviruses
SARS-CoV-2 is a beta-coronavirus, along with SARS and MERS-CoV. They are the only ones known to cause severe illness in humans.
The primary hosts of the alpha- and beta-coronaviruses are bats. Bats carry up to 47 viruses. Coronaviruses are found in saliva, urine and feces of the bats.
Gamma- and delta coronaviruses are found in birds, pigs, etc. There is no known transmission of these to humans.
The secondary or intermediary hosts are dogs, raccoons etc. which are also delicacies in Asia).
All of the above are part of Asian, Chinese included, cuisine, but:
Fake #1
Snakes and fish (seafood) were the source of SARS-CoV-2
Fact #1
The transmission of SARS-CoV-2 via snakes or fish is not possible because coronaviruses are not found in fish and reptiles. The source of the confusion is the fact that Tobaniviridae – viruses of fish and snakes – were classified as coronaviruses until 2018.
The current outbreak most likely originated from pangolins (Dr. Why:- scaly anteaters, mammals, which are a delicacy in Asia, as well as a “panacea” for all maladies, including cancers). Pangolins are protected by international treaty, but they are trafficked by the thousands for their scales, which are boiled off their bodies for use in traditional medicine; for their meat, which is a high-end delicacy Asia (Dr. Why: not only China, but the whole South-East Asia - it’s official name is Malayan javanica, indicating its origins from Malaysia and Indonesia’s Java Island) and for their blood, which is seen as a healing tonic.
Pangolins are the Red Book endangered animals and therefore the target for poaching and contraband. (Dr. Why: the kilo of pangolin meat costs $350 to a restaurant in Vietnam. They're sometimes mixed with frozen fish or snakes as a cover, hence SARS-CoV-2 origins at a seafood market in Wuhan).
The article published in October of 2019 titled “Viral Metagenomics Revealed Sendai Virus and Coronavirus Infection of Malayan Pangolins (Manis javanica)” in Viruses Journal reports a study of 21 pangolins confiscated from poachers. Most of pangolins were very sick and died within 2-3 days from severe lung injury resulting in pulmonary edema and fibrosis. SARS-CoV was the most widely distributed coronavirus found in lungs and gastrointestinal tract of these pangolins.
Fake #2
SARS-CoV-2 is resistant to most disinfectants, hence one needs extra-strong, powerful disinfectants to kill it.
Fact #2
The morphology (structure) of SARS-CoV-19 is the same as other CVs making it sensitive to ALL approved disinfectants.
Fake #3
SARS-CoV-2 can retain its viability for a long time (“survive” is a misnomer, because virus “does not live” without a host cell).
Fact #3
SARS-CoV-2 does not retain its viability longer than a few hours. It lasts a bit longer on porous surfaces, like a cardboard, and much less on polished surfaces like glass and even less on metal. The worst-case scenario is 24 hours.
Fake #4
SARS-CoV-2 can be transmitted via parcels and other shipments.
Fact #4
Because SARS-CoV-2 cannot retain its viability for longer than 24-hours, all shipments are safe. At the very least, these are not epidemiologically significant, e.g. “drop-contact transmission”, even if theoretically possible, will not ignite a local outbreak.
(Dr. Why: On the same token, take-outs, deliveries from restaurants, etc. executed during <6-hour time frame are NOT safe)
Fake #5
SARS-CoV-2 is made in the lab.
Fact #5
SARS-CoV-2 is a zoonosis - an infection jumping from animals to humans, as confirmed by finding of SARS-CoV-2 in pangolins. Coronaviruses have high propensity for recombination - exchange of genomes between different viruses).
Fake #6
There are no medications to treat SARS-CoV-2.
Fact #6
Thanks to the fact the the first outbreak occurred in Wuhan - the home of one of the few BioSafety Level 4 - BSL-4 (the highest) laboratory - we had deciphered SARS-CoV-2 genome in early January. It was shared with us by our Chinese colleagues. This allowed Russia 2-3 additional months to prepare and contain the epidemic. We were the first one to develop test kits and worked closely with Chinese colleagues to find medications, which would be effective for treating SARS-CoV-2 (Dr. Why: Russia closed its land boarder with China BEFORE the USA closed its ports of entry for Chinese arrivals. Russia has >2,500 miles long land boarder with China).
Based on SARS-CoV-2 structure containing long polypeptides ORF1a and ORF1b, we knew that the following medications likely to have activity against it.
Nucleotid analogs - RNK polymerase inhibitors (RNA-dependent RNA polymerase - RdRp)
Ribavirin - approved in the USA. It was developed in 1972 in Soviet Union;
Triazavirin - approved in Russia. It has a novel triazolotriazine core, which represents a new structural class of non-nucleoside antiviral drugs;
Baloxavir marboxil, approved by FDA in 2018;
Remdesivir – investigational in the USA - and getting the most press currently.
Protease inhibitors
Kaletra: Lopinavir and Ritonavir - used to treat HIV, approved in the USA
Inductors of infected cell apoptosis
Ingavirin - approved in Russia;
Interferons
interferon beta 1b (Betaseron; Extavia) - approved in the USA
Interferon type III (λ) - investigational in Russia
Serum of the people recovered from the disease (Dr. Why: it contains antibodies to the virus. It is by no means novel and is being used to treat various infections for many decades). Chinese already brought serum to the EU and Russia. Serum can be collected and stored for a long time.
Fake #7
COVID-19 infection has a record high fatality rate.
Fact #7
COVID-19 has relatively low fatality rate. For instance, original SARS infection had fatality rate of 9.6%, while MERS had fatality rate of 34.4%.
COVID-19 fatality rate at the time WHO announced pandemic (March 11th of 2020) was 3.6%. (Dr. Why: it is approaching 1% as of today).
In comparison, influenza infection amongst non-vaccinated population has fatality rate of 1.5%.
Fake #8
There will be 100 million sick by the end of February.
Fact #8
We already know that these “dooms-day” projections did not materialize. Importantly, epidemiological situation in the epicenter of the epidemic has a positive trend, exactly as models predicted.
Questions and Answers
Q: Why Russia and China have seemingly less incidence of the infection and are able to contain it?
A: I do not want to sound like a hurrah-patriot, but Russia has the most well developed state system for biologic safety. It was inherited from the USSR. The healthcare is based on Semashko system (Dr. Why: Nikolai Semashko was appointed People's Commissar of Public Health of Russian Federation and then Soviet Union and served in that role from 1918 until 1930) - centralized, integrated, and hierarchically organised with the government providing state-funded health care to all citizens. China built its system based on this model. (Dr. Why: Some of the formed Soviet Republics and other countries, most notably Cuba, follow the same model demonstrating the efficiency and universal reach).
CDC (Dr. Why and the US healthcare system) is less efficient because of the lack of central command vertical and the lack of universal coverage. For instance, influenza monitoring rules differ from state to state and mostly based on hospital monitoring. The system failed, leaving politicians hysterical and disoriented. Of note, Iran’s system was modeled after CDC in shah’s times and remains within the same confines.
Q: How is SARS-CoV-2 virulence and pathogenicity compares with flu?
A: There is no scientific data to support exact values for virulence, pathogenicity, or lethality. There is a high rate of complications, respiratory failure in particular, which put enormous stress on ICU. It can also affect GI tract and liver.
This virus should be also studied from a standpoint of societal psychology (Dr. Why: due to obviously inadequate and disproportional reaction of politicians and the societies as whole). The note from a Council member - let’s also add anthropology to the epidemiologists training.
Q: What about immunity to SARS-CoV-2?
A: Immunity against CVs does not last more than 2-3 years, but it is unlikely to infect more than once per year. The same rule applied for all upper respiratory infections (URI) – immunity should work on mucosal surfaces, which is not easy to accomplish.
Q: Is this virus going to stay?
A: Yes, it is possible, just as other viruses stick around, for instance various influenza viruses.
Q: How stable is the virus?
A: It is well preserved in feces (hence, one can get infected in a toilet), and in biologic fluids – saliva, nasal secretions, sputum - for longer, at least for 24-hours, but in aerosol - 6-8 hours max, a few hours on polished surface like glass and even less on metal. Remember to clean your workplace regardless of the time of the year and current epidemics. It is always a good practice.
Q: When to expect epidemic’s slow-down?
A: In several weeks, as temperatures go up and humidity goes down. Also, viruses are very efficiently killed by ultraviolet light, so the transmission in the summer will go down regardless.
Q: Can ultraviolet lamp be used to disinfect?
A: Yes, it is very efficient against all viruses. 20 min is enough to kill it. One can use an ultraviolet lamp or an air-recycler. The latter sucks in air into an encased ultraviolet lamp and sterilizes it. One does not need to leave the room while using air-recycler. Please read the instructions for a specific model to determine settings and time needed based on the space size.
Q: What about vaccines? Why are we told vaccine will be available only in 1-1.5 years?
A: There are multiple vaccine clinical trials. Can we shorten the time to market? 1-1.5 years, as per WHO, means the time frame it can be available for the entire world. In developed countries, starting with Russia, I expect the vaccine to be available by summer.
In fact, once we know virus’s genome, vaccine preparation takes 2-3 weeks. There are currently over 100 vaccine preparations against this virus, but certification requires approximately 6 months. It has to be tested in vitro, then for safety in animals and humans, and efficacy in animals and humans. Also, vaccine efficacy should be tested in the epicenter. This is impossible, because Russia only has a limited number of cases. But, we have experience with influenza vaccine, which must be made anew every year, which takes 6 months.
Q: What about masks?
A: One must remember three rules when it comes to masks:
It is better to have the mask than not, but it is not a panacea;
Mask must be worn correctly and it has to be changed as often as once an hour;
Mask is more effective on a sick than on a healthy.