You can have COVID 19 virus and show no symptoms —Expert
The biggest challenge in COVID 19 is that not much about the virus is known. Dr Adeola Fowotade, a consultant virologist at the University College Hospital (UCH), Ibadan, in this interview by SADE OGUNTOLA speaks on myths and other efforts at cutting down the transmission of the virus in Nigeria. Excerpts:
Can drinking of alcohol protect against coronavirus? Reports say some people resort to it as a form of protection because of the alcoholic content of hand sanitizers?
There was a report that some people from Iran consumed alcohol because they heard that alcohol helps to kill the virus, but they died. People commit errors that sometimes might eventually lead to loss of lives. Such fake news makes people not to take appropriate preventive measures because they de-emphasise important things. They look at hand-washing as something very basic and simple and not effective against coronavirus. So, they want to do something that they feel is more effective, like drinking of alcohol to kill the virus that they have along the respiratory tract and some other funny things like that. Again, a large number of people getting misinformed through the social media at the same time, carrying out the wrong actions, refusing to perform the necessary actions and ultimately, this leads to the spread of the disease, increase the number of people that have put their lives at risk and eventually makes nonsense of all the control efforts. So there is need to put in a lot of efforts into debunking all these myths and wrong information on coronavirus and to ensure that people are given the right information so they can take the right action and ultimately, this will help us with the control effort.
NCDC is testing blood samples collected through the National Influenza Sentinel Surveillance system for coronavirus as its surveillance for the virus. It also developed a tool to track and monitor health care workers for the infection. Of what significance is this in NCDC’s preparedness for curtailing the spread of the virus in Nigeria?
The National Influenza Sentinel Surveillance is an ongoing process that is on the lookout for cases of influenza within the community. They are collecting respiratory samples and since COVID 19 is a virus that is transmitted through the respiratory pathway, NCDC is seizing this opportunity to test these samples for COVID 19 as a form of active surveillance for the virus in the community. The other too to track health workers is something that is still rudimentary at the moment. But the whole idea is to look at how, when and why health workers had contacted coronavirus and the necessary steps to make ensure that they upgrade infection protection practices in those areas. It is to show where there are failures in the infection prevention and control at the hospital level and where there may be a potential failure even for upcoming disease outbreaks.
How advisable is the use of Chloroquine daily as prophylaxis against coronavirus?
Studies done in places like China on cell lines using different concentrations of chloroquine found that it helped to reduce the multiplication of the COVID 19. They also found that chloroquine helped to improve the recovery in some patients with COVID 19 as well as to reduce the number of deaths from the disease. But such clinical trials are meant to go through a number of phases, in cell lines, animals and more humans infected with COVID19 to see whether chloroquine will have any effect and if it is safe because a much larger dose than is used for malaria treatment is probably needed. However, in this instance, they have simply moved from cells to humans and so the results they have generated from the test is not sufficient for NCDC to say that they want to adopt the use of chloroquine for treating persons with coronavirus. In any case, viral infections are self-limiting in immunocompetent persons; the immune system is sufficient to clear the virus overtime. Ideally, for persons that have a good immune response that come down with COVID 19 infection, all that is required is good supportive care; the symptoms are treated as they occur and so you probably will not need anything to specifically inhibit the virus.
Is that why NCDC is not adopting chloroquine as a prophylaxis?
There is no basis whatsoever for taking chloroquine as prophylaxis; this just happening like when we had the Ebola virus scare that people started to take table salt and all sort of things. It is a wrong thing to do; we do not have sufficient evidence to say that it is protective against coronavirus at the dose of chloroquine many people who do so take.
How advisable is the use of homemade hand sanitizers made from menthylated spirit, especially now that prices of hand sanitizers have doubled in the market and scarce?
The efficacy and safety of homemade hand sanitizers, promoted in social media, have not been checked in the laboratory. Also, we are not sure if it is safe to the skin. So I will not recommend home-made hand sanitizers for now.
How is wearing facemasks doing more harm than good, especially by healthcare providers who are free of coronavirus?
If you are not coughing and you are not the one directly taking care of somebody that is coughing or that is infected, you have no business using face mask to prevent this virus. The drawback of using face masks in healthy people is that it gives you a false sense of protection, and so you completely ignore all the other safety measures; you don’t even bother to wash your hands or do any other thing that could help to protect you. Again, most people who are not used to wearing facemasks start to touch their face in other to try to adjust it. But we do not want people to be touching their face with unwashed hands, an act we are trying to discourage people from doing. Also, we found that most people using facemasks don’t use it appropriately as we expect. The green part should be outside and the white one should be on the inside. It is also meant to fit well over the nose and cover the mouth. But this is what we find and so the purpose of the mask is defeated because droplet flying in the environment can still enter the nose.
Are there many candidate vaccines for coronavirus because reports have it that the one from Israel would be available in the next eight months, while more and more people are getting infected and dying?
There are so many vaccines for the infection at different stages of development. For instance, a candidate COVID-19 vaccine is currently being developed by the Migal Galilee Research Institute in Israel. The vaccine by NIH and Moderna Inc has passed the first stage trial in mice and they have recruited 45 healthy volunteers for the next phase. Also, there is the Inovio, a vaccine that is unlike many types of vaccines, it may not need refrigeration. Regeneron Pharmaceuticals is exploring a different approach: simply injecting people with coronavirus-fighting antibodies instead of teaching the body to make its own antibodies. This method could provide temporary protection against infection or work as a treatment for someone already infected. However, it is like in clinical trial for drugs, it must pass though a lot of phase trial, too to see if it would invoke sufficient antibody production that can protect an individual, safe and so on. All these things don’t happen in a month and because you are also limited by participants that are ready to participate in these trials, especially if you want to do a good job and get an appropriate license for you to use the vaccine. They have gotten 45 healthy volunteers that are ready to participate in one of the clinical trial of the vaccine. Even then, you cannot judge based on these few people, you still want to try on other people, possibly other ethnic groups that reside in other places that differ from those contact. This is why it is not something that we are expecting anytime soon.
What are the challenges scientists are facing with COVID 19
Some patients will carry the virus, but without any symptoms and so there is no way to tell that they are carrying the virus. However, the fact that they do not have symptoms does not mean that they cannot infect other people. That is really challenging. The fact that these people will not be able to be picked out at the point of entry, because the infrared thermometer is going to say that they are fine meanwhile they are incubating the virus and they are potentially infectious, is also a challenge. Again the fact that we don’t have a vaccine that is ready and we do not know when it is going to be ready is also a problem. A vaccine might not be ready until about eight to 10 months at least. Even up until this moment we do not know what the animal source of this virus is and so there is a possibility that we might be having contact with the animal source and we do not know and this does not help even with prevention essentially. There is still a lot of information on the virus that is still largely unknown, so scientists are still trying to find out why so many things are happening. That is also a challenge.
Why is it dovetailing in some countries and increasing in some others
The fact is the more the virus continues to circulate, the higher the chances of recombination and mutation. So the virus you probably started out with at the onset of an outbreak continues to differ as the outbreak continue to progress. This is why for most outbreaks, WHO always put in efforts to ensure that it does not go on for too long a time. Also, China at the moment is getting to a phase of their epidemic curve, where have been able to mount all the necessary things they are supposed to do and so, the number of people that are transmitting the virus have reduced. We are talking about a virus that if one person is infected there is a chance of that person infecting 4 to 5 other people. So if you have a large number of cases that means you have a large number of people that will be potentially infected. In a place like China, the number of cases is reducing because they are also putting in a lot of containment measures. So there is a limited transmission from one person to another. But for those of us outside China, we are learning by the day.