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The end of the crisis: Six ways to retard a virus

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Award-winning and multishortlisted novelist Steven Boykey Sidley has meandered through careers as an animator, chief technology officer for a Fortune 500 company, jazz musician, software developer, video game designer, private equity investor and hi-technology entrepreneur. He currently lives in Johannesburg with his wife and two children. Free Association is his fourth and latest novel.

The internet is awash with non-expert opinions about Covid-19. Mine included. My first post about it was in January when there were about 3,000 infections. I had seen the Chinese stats, had done a back-of-the-envelope calculation, and had duly freaked out, projecting millions dead by now. I was wrong. But since then I’ve learned a few things.

I won’t repeat the epidemiology stats – these are now easily available from the WHO website and others, and some are still fairly fluid – Case Fatality Rate, transmissibility, that sort of thing. Also a subject for another day is the not-enough-hospital-beds panic. Scary indeed.

But let’s talk about how this thing ends, some time, probably later rather than sooner.

There are only six ways to stop or retard this virus. Or any virus.

The first is vaccination. Smallpox killed over 500 million people (!) in the 20th century alone. It was eradicated from the face of the Earth by the miracle of vaccination (save for some vials in the basements of various governments, which in itself is worrying). Many other viruses have also been klapped by vaccination, although some of them have made a re-entry, partially due to the near-criminal idiocies of the anti-vaxxers (polio and whooping cough are examples).

So there are now many smart companies working on a vaccine for Covid-19 (Croesus-like riches await the winner). The problem lies in the testing (not all vaccines work well or at all) and then the long process of approval, given that appropriate agencies have to ensure both efficacy and safety, and this takes a while.

For instance, Israel’s research outfit, Magil, promises to have a testable vaccine by April, but even if it works well enough, there is still at least 12 months of further trials, testing and approvals ahead.

So figure 18 months, minimum, and try to ignore the fact that vaccination science is still somewhat of a dark art – they do not know with any certainty why some are successful and some are not.

The second way is via pharmacological treatment. Vaccinations are preventative by design but chemical treatments get into the fight after you are infected, either by boosting your natural immune system or attacking the virus directly or other biological mechanisms.

There are no treatments for Covid-19. But there are a lot of companies working on them, including a version of the anti-Ebola treatment Remdesivir, developed by Giliad Sciences in the US. This is now the top contender. Phase III trials are now under way, but optimism is tempered by the fact that Phase III is not the finish line (there are four phases), and many trials never get there.

The third way is by social intervention, specifically geographical containment and quarantine. This is best evidenced by the slightly belated but eventually aggressive/draconian Chinese response. They essentially put a lid on a population of 50 million across a wide region of China (Hubei).

It has worked. All curves, including rates of infection and death, have flattened or gone negative. It can be done there – the government has total control by autocratic dictat.

But Italy, one of our favourite bickering democracies, are also doing it – 16 million people are now under lockdown even with the probability of total economic wipeout for the country. And the US? UK? We shall see – it would require a combination of political will and logistical competence, both in short supply worldwide.

The fourth way is weather. The seasonal flu tends to spike in cold weather. But Covid-19 is novel (actually nCoV-19 is the official term for this virus – “n” stands for “novel”). It means they have no idea how it will spread in the summer, because it is, well, novel. And of course there is us, in the Southern Hemisphere, just about to go into winter. So even if it is seasonal, it won’t help us until September or so. Trouble is surely coming soon.

The fifth way is virus strength or weakness, over which we have no control. Too strong a virus kills its host so fast that it cannot be passed on. Too weak and it doesn’t spread (technically this means the metric “R0” – which measures transmissibility – is less than one. If this is the case the virus fades away. Covid-19 is not killing its hosts fast enough, and its R0 is greater than one. So it is here to stay.

There is one last way to mount a defence. It is massive non-pharmaceutical intervention at hospitals using intubation or machines like ventilators to keep the lungs working (and keeping the patient alive) while the body tries to recover. But there are just not enough ventilators in the world for this to be a rational strategy. It is the last-gasp tactic, quite literally.

And of course there are the outliers, viruses very unlike this one. These have been viruses throughout history which have simply arrived, ravaged and disappeared. Or popped up hundreds of years later and disappeared again. Bill Bryson’s book The Human Body covers these nasty events in pretty graphic detail. It is a long book, but the virus stuff is on page 319 and goes on for only about 15 pages. Read it if you do not frighten easily.

So. The end of this crisis lingers out there somewhere. Before it becomes visible there will be damage aplenty (both personal and economic), but viruses have always eventually been brought to heel, either by human ingenuity or the forces of nature.

That’s why we are still here. DM

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