Mask drastically reduces the virus load on our defences. Vaccination simulates the virus assault and stimulates our immune system. This response wanes in the absence of a profitable or unsuccessful virus assault or one other dose of vaccine.
UNITED WE STAND, DIVIDED WE FALL: 2020 was the yr of the Virus; 2021 was the yr of the fightback; 2022 may be the yr of the finish of the pandemic if we collectively will it. The virus is an inanimate piece of genetic materials which springs to life when it infects us. We domesticate it, multiply it, and assist it unfold by generously sharing it with our contacts like a pc virus on our contact record. The greatest technique to remove it’s for all of us to point out sufficient self-control to collectively boycott and quarantine the virus by getting ourselves and most of humanity vaccinated, utilizing properly fitted N95 masks in public areas, and avoiding nonessential journey and crowds particularly indoors. All our leaders, celebrities, influencers and industries, particularly the medical insurance coverage corporations ought to promote this message vigorously on all types of media.
QUARANTINE AND LOCK DOWN THE VIRUS: To keep away from quarantines and lockdowns we have to break the chain of transmission of the virus. To unfold, the virus wants its contaminated host to hold it close to different inclined hosts and assist it change into airborne. R, the replica variety of the virus is the common variety of people contaminated by one contaminated particular person. A worth of R above 1 means the variety of contaminated individuals is rising, whereas under 1 they’re reducing. Value of R for the coronavirus between 2 and 4 often results in a lockdown and disrupts our life and the economic system. Instead, we will interrupt the unfold of the virus by utilizing a number of defences now accessible to us in the type of masks with social distancing, vaccines, testing on the slightest doubt or contact with an contaminated particular person, self-quarantine when contaminated and searching for early medical assist.
VACCINES ELIMINATED SMALLPOX, BUT NOT COVID-19: Vaccines are efficient in offering lifelong or long-term safety and in some instances elimination of infectious viruses that don’t hold mutating, like smallpox, polio, measles, mumps, rubella (German measles), varicella (chickenpox) Hepatitis B vaccine, Japanese encephalitis, and rotavirus. Effective vaccines can be found towards rabies, however contaminated wild bats and stray canines present them a secure home. Virus infections for which we’ve not but developed vaccines embrace chikungunya, dengue, HIV/AIDS, respiratory syncytial virus, cytomegalovirus, herpes simplex virus, and so on. Influenza and SARS viruses mutate ceaselessly sufficient and simply sufficient to flee vaccine and an infection stimulated antibodies and artificial antibodies reminiscent of monoclonal antibodies. For influenza virus, fashions are used to foretell the probably prevalent variant every year and the vaccine is up to date. Too many mutations as in the Omicron variant can result in poor long-term survival because of elimination by pure choice. If such a variant could be very extremely transmissible, it might out-compete different variants after which get eradicated itself which is what number of epidemics in the previous have ended naturally. Vaccines and checks will have to be up to date to maintain up with the mutating virus.
PANDEMIC WAVES AND SURGES: Classically pandemics because of new pathogens have three waves (determine 1). The first wave is by a microbe which has jumped from another species to people and isn’t but totally tailored to people. The second is the largest and worst wave when a virus variant is totally tailored to people. The third wave is often gentle as additional mutations weaken the virus however enable it to flee the immune response together with cross and herd immunity, and finally the pandemic peters out. The virus then turns into endemic or extinct. Sometimes additional mutation can result in a extra harmful variant like the 2009 (H1N1) pdm09 variant throughout H1N1 Pandemic that precipitated a fourth wave a lot worse than the second wave (determine 2). The Omicron variant as per a Hong Kong examine multiplies 70 instances quicker in the airways however 10 instances slower in the lungs than different variants of concern. This explains why it’s spreading quicker, has a shorter incubation interval requiring a shorter interval of quarantine; and doesn’t appear to be inflicting respiratory issues and issues.
TRIPLE DEFENCE AGAINST AIRBORNE VIRUSES: Influenza and SARS viruses are distinctive in that they’re the solely viruses which have precipitated pandemics in the final hundred years. Both are airborne, mutate ceaselessly needing repeated jabs with up to date vaccines and have been the important focus of bioweapon analysis. We want a triple defence towards these viruses.
MASK AND VACCINES: Vaccination alone is insufficient as publicity to numerous viruses can overwhelm our immune system as has occurred in UK and Israel the place after profitable vaccination drive, masks and social distancing mandates have been withdrawn, which led to recent waves of an infection.
MASK AND HEPA FILTER: The first and simplest defence is utilizing a properly fitted N95 face masks that filters out 95% of the virus particles. Adjusting the nostril clip is essential as any masks not becoming the face tightly shall be ineffective as air will bypass the masks round its aspect edges; therefore kids want smaller N95 masks. NIOSH N95 or N95 is the US commonplace for masks. Similar requirements in different nations are FFP2 in Europe, KN95 in China, DS in Japan, KMOEL in South Korea, P2 in Australia & New Zealand. These additionally filter out different microbes, PM 2.5 mud, smoke, allergen particles. HEPA air filters are required for air con/ air flow in closed areas like buildings, plane, trains and different public transport.
VACCINES: Vaccination simulates the virus assault and stimulates our immune system to supply antibodies and killer cells towards the virus. This response wanes in the absence of a profitable or unsuccessful virus assault or one other dose of vaccine. For Covid-19 various kinds of vaccines have been developed a lot quicker than ever earlier than. These present totally different targets to our immune system:
1. Only the receptor binding area (RBD) of the spike protein by the RBD subunit protein vaccines like the Corbevax and Covovax;
2. The total spike protein by the mRNA vaccines from Pfizer, Moderna, J&J or DNA plasmid vaccine like ZyCovD or viral vector vaccines like Covishield, Sputnik V.
3. The total useless virus by the attenuated virus vaccines like Covaxin. Each sort of vaccine has its benefits and drawbacks. There are massive variations in the antibody and mobile immune responses to those vaccines. Vaccine combine and match research are exhibiting higher outcomes than booster doses with the identical vaccine. Vaccine by nasal route will additional cut back infections and transmission by offering native immunity at web site of virus entry. Larger the variety of unvaccinated or in any other case weak populations accessible, the extra infections and mutations will happen.
CONTACT TRACING, TESTING AND SELF-ISOLATION HALT VIRAL TRANSMISSION: Effective early detection of viral an infection kinds the second line of defence by stopping additional transmission of the virus to different weak individuals. This wants fast early testing of all with early signs of the illness, tracing and testing of all their contacts and likewise numerous random testing of the inhabitants. Social distancing, restrictions on journey and crowding are different essential measures to interrupt the chain of transmission. Laxity in these measures makes lockdowns inevitable. RT-PCR checks are a molecular take a look at achieved in costly Thermal cycle machines in massive batches and examine for genetic materials of the virus and are the most correct checks until now. Separate checks can be found for every particular gene goal of the virus reminiscent of E (Envelope), S (Spike), RdRp, N (Nucleic acid) and ORF genes. Antigen checks detect sure proteins of the virus that set off an immune response. A brand new fast cheap take a look at RT-LAMP has been developed by ICMR-NIV Pune and launched for manufacturing just lately. Nucleic acid amplification checks (NAATs) detect even low ranges of viral nucleic acid, are quick however costlier. Genome sequencing is dear and achieved in specialised laboratories for epidemiological research and never for administration of Covid-19. Ideally virus samples of 10% of contaminated people are despatched for genome sequencing to establish the variant and mutations current, however in observe 5% or much less are examined relying on the case load. Neutralising antibody checks are to not be confused with antigen checks as they estimate an individual’s antibody response to vaccine or an infection.
EFFECTIVELY TREAT THE INFECTED, TO AVOID DEATH AND PANIC: Early detection and applicable therapy is essential to try to stop issues and demise. Triaging of sufferers into these appropriate for house quarantine, symptomatic remedy and monitoring, these needing admission to hospital or ICU is critical to keep away from useless over burdening of well being services. Initially many medication together with present antivirals have been repurposed for therapy. Recently particular antivirals like Molnupiravir, Ritonavir and Monoclonal antibody therapies like Sotrovimab, Ronoprave and Evusheld have change into accessible. Steroids, blood thinners, Oxygen, ventilators proceed to be wanted the place related.
NEW WORLD AND WORK ORDER: The pandemic has accelerated adjustments in the work order to work at home and anyplace; on-line schooling and leisure; digital conferences and conferences. Home supply of necessities, services and products, together with tele well being companies has been attainable via advances in telecommunication, transport, drone, ecommerce, digital fee, automation, synthetic intelligence and plenty of different applied sciences. Many nations are adapting quick and prospering whereas different nations are lagging and deteriorating. This is quickly altering the world order with many developed economies already affected by stagnation, now hit by lockdowns. China, which was anticipated to quickly change into the world’s largest economic system now finds itself in a downward spiral of debt, lockdowns and world lack of belief. India could be very depending on China for medical and different critically essential provides. Chip scarcity is affecting availability of many life-saving medical units. India ought to begin manufacturing semiconductors and different essential parts and strategically essential tools. This is India’s greatest likelihood to change into a world well being and companies, agricultural and manufacturing, sustainable dwelling and financial chief.
Dr P.S. Venkatesh Rao is Consultant Endocrine, Breast & Laparoscopic Surgeon.