Native Answers Coronavirus Related Basic Science Questions

[Native]

I had a request a few days ago to do this, and now since everything is quarantined I might have time to try to explain the nitty gritty. To start this thread off. I in no way believe that I am the authority on the subject, but I am on the "critical list" and can still go to work regardless of what else happens around here.

Credentials: PhD level microbiologist who teaches 2nd year med students. Molecular Bacteriology is my true expertise, but I have a lot of overlap in the viral world and am competent enough to teach it. My training provides strong overlap into, molecular testing, anti-virals, epidemiology, vaccinology, immunology, etc. to varying degrees. Critical respiratory care isn't my thing and won't be of any help for those questions, other than most viral lung infections have standard treatment protocols, which I again, don't know. Example, there are currently reports out of France that NSAIDS are proving worse. I've got no comment on that.

I am not going to name drop, but I am connected to people who do know things, from high levels to low levels across various academic medical centers, national and state organizations. If a question is good enough and I can't answer it, then... I will use my phone a friend.


Potential Idea, @BigRedMax. I could start another thread with Questions for Native and the discussion can go there. Things that I am able to answer or write up explanations about can go here. I don't really want the whole thread to be a back and forth discussion and the information gets lost. I will also post links to articles/tweets/blogs that are good as I also believe I can vet sources and am more connected to appropriate sources than most. Really I don't know what is best format, we shall see. My time is somewhat limited and I don't know what kinda interest this is gonna get.


-Native


Some starting reading: Note the dates things are published, cause that often changes perspective a bit.

click through and read thread.

How Bad Is the Coronavirus? Let’s Run the Numbers

The risks posed by Covid-19 — and the possibilities for getting it under control — become clearer with some simple math.

www.bloomberg.com

What scares you?

A blog about hospital infection prevention.

haicontroversies.blogspot.com

 

[Deleted member 3889]

Basically Native is the smartest ****** on the board.

 

[Deleted member 3889]

Basically Native is the smartest ****** on the board.

And @Huskerthom will still argue with him.

 

[RedStones]

@Native

A few Questions:

1. Does the body built antibodies to the virus or can you catch it again after you recover?

2. Is this virus is expected to mutate like the seasonal flu?

3. Will this become an annual epidemic like the flu?

Probably more to come.

 

[Native]

Basically Native is the smartest ****** on the board.

And @Huskerthom will still argue with him.

Not the smartest, by far. Very narrow range of focus for a long time.

 

[Native]

@Native

A few Questions:

1. Does the body built antibodies to the virus or can you catch it again after you recover?

2. Is this virus is expected to mutate like the seasonal flu?

3. Will this become an annual epidemic like the flu?

Probably more to come.

I will get to all of these. I picked a poor time of day to start the tread as I have to go home to children. But expect these things to at least be discussed to an unsatisfactory level.

 

[Native]

If you could get Covid19 in any country on earth, where would your dream place be?

Can't sleep so I'll start with the hard ones. Somewhere warmer with snorkels and beaches etc. On the assumption I am young enough and likely to fall into the mild to no complications, otherwise, I want to be at the front of the curve and at a good hospital where Docs aren't worn out yet. So send me to Omaha, Iowa City, Mayo...

 

[Native]

@Native

A few Questions:

1. Does the body built antibodies to the virus or can you catch it again after you recover?

2. Is this virus is expected to mutate like the seasonal flu?

3. Will this become an annual epidemic like the flu?

Probably more to come.

I’ll take a stab.

1. Yes, and maybe yes. I read that there is a small % of people in China that have been cleared and then were symptomatic with active infection later.

Can You Get Coronavirus Twice? How Long Are You Immune After COVID-19?

Are you immune to the SARS-CoV2 virus after you get infected? If so, how long does this last?

www.forbes.com

2. Already has mutated several times based on sequencing. It’s possible that a mutated strain could be undetected, depending on how the test is designed and/or chance. Also possible that a mutated strain could be infectious to someone who has had a different strain, which is how other viruses work-see link above.

3. Possible. Not enough known about how this novel virus is going to behave, but it looks like it. This article discusses...

New Coronavirus May Circulate Forever As A Seasonal, Endemic Pathogen, Experts Fear

The new coronavirus is likely here to stay.

www.sciencealert.com

My additions to FLAS.
1). There is that chance. The people who have developed a second infection also fall into a group of people that haven't necessarily been thoroughly vetted and are likely to have never actually cleared the infection the first time. As further antibody testing is developed people will have a lot better understanding of the likelihood of reinfection and if the population is developing "durable immunity".

2). Mutations are going to happen. There are a lot of factors in play here. The influenza virus (orthomyxoviruses) is made up of 8 segments of RNA. When an infection occurs where multiple strains of influenza are around there is the possibility of segment swapping, this leads to wholesale changes taking place. This is a major reason for the pandemic potential of the flu. This is a pretty neat thing to happen. Birds have one version of the influenza, Humans have another. Pretty hard for the mixtures of segments to occur. However, pigs have both versions. So in the event the bird flu and human flu are active in the same region and with swine confinement facilities you have the perfect storm and the potential for these large changes. This is referred to as "genetic shift"

Covid-19 on the other hand is a single strand positive sense RNA virus. It like the flu and most all other viruses is going to incorporate mutations through its replication process. As FLAS pointed out, changes are already taking place and modeling predicts that a virus often moves towards selection of increased passage, less virulence over time. We shall see if this plays out, but intuitively this makes sense, a strain that gets optimized for infecting the next person is unlikely to maintain attributes that maintain it's full virulence(ability to cause disease). These changes are referred to as "genetic drift" as the are subtle small changes that move the infection to less recognizable.

3) A lot of what I described above frames my answer to the seasonal aspect of this. There may be seasonality, which I can explain more later, but the potential for large changes isn't there in the same manner that exist for influenza. A lot of this will be determined by how durable the immune response is. We are currently a naive population, with none to very little background immunity so it is hitting us hard. If we have a strong, protective immune response than the mutations that we are challenged with on a seasonal experience will be lesser.

 

[Native]

How does a virus develop in a bat? What causes it to jump to different species or what mutations have to happen to jump species?
Why does China seem to be a breeding ground for viruses (SARS, H1N1, etc)?

Fun question. I have been reading and seeing things that the bat for sure is most likely, but people always want to make sure it isn't that wacky pangolin. A lot of this has to do with what is known as tropism. Tropism refers the the cells, tissues, etc that support the growth of the virus. But the term tropism is also used at the species level, to help describe the range of species that can get the infection. I have yet to see any concern for puppies and COVID.

When this is tissue specific, such as rabies, you end up with a virus only effecting the nervous system. It is why COVID-19 effects trachea and upper lung. The virus needs a port of entry and coronavirus of the SARS family bind and have entry facilitated through angiotensin converting enzyme 2. ACE2. So if a cell express ACE2 then COVID-19 can enter. Presumably, in this case a bat has ACE2 counterpart that helps it infect. This could require a mutation to allow binding of the bat to human variety of the virus or could be similar enough to cross over.

A fellow virologist I worked with would say there is a herpes for everyone. That virus was varied enough that there was species level tropism for about every species on earth was his guess. Basically 180+ different versions have been identified and more would be if anyone cared to figure out the herpes of their favorite odd species.

Why China? Well, increased population growth, humans ranging to different areas, and willingness to eat a larger variety of things likely all play a role. There are tons of zoonotic (animal to human) diseases that already exist. Farmers more at risk for them than city folks. Go spelunking and you increase your chances of a fungal infection. Any time you increase your proximity with other species the chances for a crossover event go up.

 

[Native]

@Native when will they have a test available to ascertain if someone has already had the virus and have developed anti bodies?

Biomedomics has an IgM/IgG test that was CE-IVD marked recently.

COVID-19 IgM/IgG Rapid Test – BioMedomics Inc.

BioMedomics is a point-of-care diagnostics company that aims to provide novel, rapid point-of-care tests to aid in the diagnosis of critical diseases.

www.biomedomics.com

And this is why I don't necessarily want it to be Native's thread. I was unaware of this test, though not surprised at all that it exists. These types of tests are going to be crucial for our understanding of the seasonality and durable immunity. IF we only get at IgM response, then its not going away.

 

[Native]

Btw, I’m not trying to steal Native’s thunder...i let him know I might throw a few answers in somewhere...especially when it comes to testing.

I do have not problem with the answer "I don't know". You are way more versed in test specifics than I am. I just mainly wanted a thread I can screen a bit of the content so that we can avoid a bit of the side bars and drivel that are an integral part and help us develop that love HM.

 

[Native]

I've read a lot recently about the potential that Covid 19 was burning it's way through China in November of last year and was likely already in the US before January. If that was the case, we're likely not seeing anywhere near accurate numbers of infected and the virus has likely spread to a much larger portion of the population than was previously expected. If that's the case, the symptoms are much more limited in a healthy individual than influenza. This is all theory at this point, but it seems to have some legs.

IF this is accurate, are we drastically overreacting to the threat? It sure looks to me that outside of a small, already compromised slice of the population, the potential for this to be terminal is limited.

Thoughts?

This seems to have potential to me as well. Can't test for what you don't know exists. The article below address quite a bit of this. A lot is yet to be learned on transmission, viral load, what asymptomatic actually looks like. Will definitely be interesting what epidemiologists conclude about family spread and the prevalence and spread from kids.

We’re learning a lot about the coronavirus. It will help us assess risk

We need to learn a lot more about the coronavirus. But we're already learned a lot — and it will help us assess risk.

www.statnews.com

 

[Native]

Native, maybe go into detail about social distancing. People hear "flatten the curve", but may not understand that. I like this link:

These coronavirus simulations show how to flatten the growth curve — The Washington Post

The early trickle of new coronavirus infections has turned into a steady current. By creating simple simulations, we can see how to slow it down.

apple.news

Also, can you detail the timeline process of finding a vaccine, clinical trials, and commercial release?

To me the simplest way to explain flatten the curve..... There are only so many ventilators to go around, we can't have everybody need them at once.

And that is what it is all gonna come down to IMO.

Vaccine, trials, commercial release... those are big unknowns. The veterinary world already gives your pets a coronavirus vaccine (I have no idea as to what strains(likely not SARS version) or how effective etc), so not unreasonable to think that one could be developed rather quickly.

First trial started this week:

First US clinical human trial of potential coronavirus vaccine set to start Monday | TechCrunch

A human clinical trial of a potential vaccine for the new coronavirus will begin on Monday, the AP reports. The trial, which will test the effects of an

techcrunch.com

When people get scared stuff gets green lighted faster. As far as timelines, all I would know is what articles like this suggest.

 

[Native]

I think I am pretty caught up at the moment. If something needs better clarification ask again in the questions thread or shoot me a PM. If you don't understand me then there is a really good chance @huskernut doesn't either and it is our group responsibility to help him out.

 

[Native]

1. I read yesterday that we do not really know what the mortality rate is because most people who are tested exhibit symptoms and many who are carriers have such mild symptoms that they do not realize they have it.
2. Through social distancing at the current rate are we preventing the larger population from developing anti bodies necessary for future outbreaks?
3. Are there any theories as to why this strain has almost no effect on the younger population?

Received these questions via PM.

1. Think this is very true. Impossible to know actual rates without the data. Kids are getting this coronavirus and shedding virus, but not being tested. Often times when you see a mortality rate, you don't know what assumptions they are making as far as kids, rates of testing etc. What we do know is that people are getting extreme events and people are dying.

2. No, we are just delaying everyone from developing their response. If you look at the two curves, the idea is basically the same amount of sickness, just spread out over a long period of time. People do not share ventilators well.

3. It is interesting for sure. The prevailing theory on a lot of this is degree of the immune response. Kids are exposed to a ton of things and the amount of inflammation induced is a huge variable. Basically, a kid is healthy and growing well and is willing to let the virus hang out and do its thing without the body freaking out. By freaking out, I mean the production of various cytokines and immune molecules that generate the fever, fluid influx, airway tightening etc. So as we get older, we have our immune system "where we want it" but the response is more aggressive and that is where a lot damage self inflicted by the immune response being ramped up which least to the respiratory failure/shock etc.