Stemming the immune havoc of COVID-19

NEWS reports and the social media are alive these days with images of individuals receiving the much-needed COVID-19 vaccines. But in Nigeria, vaccination is still far off, and navigating through the pandemic hazards is more important now than ever—especially as infections spike around the country.

Unfortunately, many people have been exposed to the virus: perhaps a colleague at the office developed symptoms after the Xmas break, perhaps one of your children’s friends who had visited got sick through an acquaintance at a party or end of the year get-together.

In the last few months, exposure to someone with COVID-19 is one of the criteria for testing, and especially when there are such symptoms as fever, cough or generally feeling unwell. What does it mean to be “exposed” to a virus?

Dr Pelumi Adebiyi, a public health expert at the College of Medicine, University of Ibadan, said for purposes of contact tracing, an “exposure” to COVID-19 involves having spent more than 15 minutes at less than six feet from someone who is infected, especially in a closed setting, while wearing no personal protection.

He stated that some are also household contacts; these are those living with people who have been confirmed as positive covid-19 cases. Being exposed to a virus does not mean an individual will become infected or become sick with it. And the likelihood of that happening is directly linked to how far the individual is from the infected individual and whether protective measures were taken.

However, individuals exposed to the virus need to be sure they have not become infected or become sick with it. But time to go for the test is dependent on if it is an infinite contact, household contact or a one-off thing.

According to Dr Adebiyi, “Usually, for a household contact or those who have had infinite contact like those in close settings, who work in the same office and they have been having contact for more than two hours every day, we wait till about seven days before testing. But if you are not a household contact, we will wait until you develop signs and symptoms of COVID-19 before testing.”

A test could potentially pick up the presence of a virus about four to seven days after exposure. Before this stage, the number of viruses in a person’s system is likely too low to be detected by a test. Once those numbers or “viral load” shoot up, that patient will also start “shedding” the virus.

Shedding a virus means that there is a sufficient amount of virus circulating in the system—in the case of SARS-CoV-2, the virus that causes the COVID-19 disease, in your mucus and saliva—that it might escape the body and go elsewhere. SARS-CoV-2 is far severe acute respiratory syndrome coronavirus.

Aerosols can contain both entire infected cells and even those loose viruses, flung out into the air when we breathe, cough, or sneeze, or talk. Just talking, humans generate thousands of aerosols.

SARS-CoV-2 results in wildly different degrees of illness. The CDC estimates that 40% of coronavirus infections do not cause symptoms; others develop a cough or a fever. Some patients suffer life-threatening pneumonia and a condition called acute respiratory distress syndrome (ARDS).

In a certain number of COVID patients, an unbridled immune response causes damage throughout the body, producing blood clots, heart damage and even organ failure. The most severe cases require hospitalisation in intensive care units.

Professor David Olaleye a virologist, told the Nigerian Tribune that most available COVID-19 tests are PCR or “polymerase chain reaction” tests. The tests work by using the polymerase enzyme to replicate the viral RNA present in a sample (without actually copying the virus itself) to the point where it can be detected.

For the test, a swab from the back of the nose or throat is required as a sample.  The sample is sent to a lab where it is tested. This process can take hours, requires sophisticated lab equipment and technicians, and is typically done one sample at a time, although there are machines that can process multiple samples. The results are almost 100% accurate in spotting infected people when there is a virus on the swab.

Howbeit, there is a lot still unknown about COVID-19, but the answer is: probably not. Although many infected people experience symptoms for two weeks or more, that does not mean they are contagious the entire time they feel sick. And even if they still have symptoms and continue to test positive for the virus, that does not necessarily mean they are contagious.

Meanwhile, the new variants of the virus rapidly spreading which first caught scientists’ attention last month may be the harbinger of a new, particularly perilous phase of the pandemic. The concern that the new variant makes people sicker has led some countries to speed up vaccine authorisations or discuss dosing regimens that may protect more people rapidly.

But as the new variant surfaces in multiple countries, many scientists are calling on governments to strengthen existing control measures as well. U.K. Prime Minister Boris Johnson announced tough, new restrictions on 4 January, including closing schools and asking people not to leave their homes unless strictly necessary. But other countries have hesitated.

But researchers have been careful to point out uncertainties. Cases have soared in different parts of the globe over the past month while many other countries had different levels of restrictions and amid changes in people’s behaviour and regional infection rates, making it hard to pinpoint the effect of the new variant.

Isolating patients and tracing, quarantining, and testing their contacts are part of attempts at curtailing the effect of the new variant, too. Curtailing infections sharply has the added benefit of reducing the chances for the virus to evolve even further. The more the virus gets circulated, the more chances the mutants have to appear. In the long term, mutations could arise that threaten the efficacy of vaccines.

In addition, the transmissibility of some variants of the virus which appears to be increasing can drive a surge of cases and hospitalisations, which is highly problematic for health workers and hospitals already close to breaking point. This is especially true where public health and social measures have already broken down. This can have a knock-on effect on other essential health services.

Following the public health basics is now more important than ever. One must keep as much physical distance as possible from other people. Rooms should be well-ventilated. Wearing a mask is a must. Keeping one’s hands clean is an imperative. And coughing into the elbow should always be observed.

The virus is not fed up with infecting people. So, limiting transmission indeed is imperative to limit the chances of getting exposed to new variants.

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