South Africa has endured the Covid-19 pandemic for 6 months and the journey is still not over. Briefly.co.za explores what is known about the virus after half a year has passed.
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By Dr Mark Holiday
After a full half-year of lockdown in South Africa, we’re still learning about the Coronavirus contagion that has sickened the world.
Some patients are battling to throw off the debilitating ME-like symptoms that linger for many months.
A trustworthy safe vaccine is still elusive. Our children are generally safe. The press tells us that immunity after contracting the disease is not a guarantee. Here’s an update on the current situation.
Can you get Covid-19 a second time?
Yes. A handful of cases have been confirmed around the world and the press typically has blown these extremely rare events into a front-page crisis.
Immunologists and virologists agree that the general human immune response to Covid-19 is ‘comfortingly normal’ and is as one would expect from most viral infections.
Scientists say that the patient’s response of antibody formation and subsequent cellular immunity to Covid-19 is as normally anticipated.
The normal decline in antibody levels after the infection is over does not imply that the memory part of your immune system has forgotten the virus.
A lot of immune memory resides in the B-Cells and T-Cells that have been stored away. Any further encounter with the virus will quickly reboot your immune mechanism to protect you quicker than your first encounter so that any infection after the first one should be a non-event or at least very mild.
How long it all lasts is a question that only time will answer, but if you have actually contracted the disease its likely to be permanent.
Vaccine manufacturers are aiming for this permanent state of affairs, but they are unlikely to attain the level of immunity that an infection will induce.
Big numbers: another way of looking at this is to hypothesize that a small number of people will indeed get it a second time- say 0.1% (=1 in 1000).
With actual world figures of 29 million people infected thus far it would mean 29 000 people would have been tested positive a second time and we surely would have heard of them by now instead of the handful that the press fearmongers us with. In this 0,1% scenario, 28 971 000 people would not get a second infection.
Do masks help?
Yes. Surveillance figures of communities that introduced masks all show a sharp decline in infection rates.
Furthermore, antibody tests in those communities have shown an increase in asymptomatic persons.
This implies that although masks may not protect you completely from getting the infection, what seems to happen is that you may get a diluted number of viruses entering your upper respiratory tract in low enough numbers to induce an immune response with no overt illness.
Good news regarding children:
Liverpool University looked at paediatric statistics from 260 hospitals in England, Scotland and Wales. Of the 69500 Covid-19 hospital patients, 651 were less than 19 years old and 225 were under the age of a year.
No children without serious comorbidities died, nor did any children between 1 month old and 15 years old.
Their symptoms were similar to those of adults, but critical care patients presented with confusion, altered consciousness and conjunctivitis. These critical care kids were more likely to have contracted the disease in hospital.
A new worrying feature of this illness is the number of people who suffer longstanding symptoms after they have overcome the initial viral disease.
This complication makes it no longer a simple case of getting the illness over and done with and this particular problem makes a strong incentive for the production of an effective vaccine.
Normal convalescence statistics report 20% of people having symptoms 30 days after the illness and 10% at 45 days. Long-Haulers typically may feel sick for many months.
The Long -Haulers exhibit many of the much-disparaged symptoms of ‘Yuppie Flu” that was first reported in the late 1980’s with no physical causation ever confirmed, relegating many patients to psychiatrists.
There has been an upsurge in interest in websites pertaining to ME (Myalgic encephalomyelitis, Yuppie Flu or CFS- Chronic Fatigue Syndrome) due to the similarity of symptoms. There are over 60 000 people in the UK reporting this complaint.
Symptoms are many and varied, but in the main are: extreme fatigue aggravated by even mild exercise, breathlessness, poor concentration and focus, headache, muscular and joint aches, insomnia, cough and chest pains, dizziness, memory loss and anxiety.
There may be a persistence of disease symptoms such as excessive sleepiness, taste and smell loss, thirstiness and painful fingers and toes.
The problems of these patients are compounded by them having no energy to work as well as concomitant income loss.
Discussion with medical academics has shed no light on the causation of this syndrome and there are no laboratory markers to confirm its presence. In ME/CFS employers are prone to be unsympathetic and may blame it on malingering.
Treatment at this stage is largely supportive with various supplements being suggested. I fear that this condition is going to feed a frenzy of unethical alternate practitioners who will extort desperate patients with ‘energy drips’, unproven supplements, ozone infusions and the likes thereof.
Perhaps serious scientists will now take a more focused look at this ME syndrome to explain its physiology.
Will we have a safe vaccine this year?
No, not until mid-2021. A group of competing vaccine development companies: Pfizer, Moderna, J&J, GSK and Sanofi recently signed a pledge amongst themselves to not release a vaccine unless rigorous standards are adhered to, now supported by the WHO.
I suspect that this was in order to prevent presidential pressure before the US election in November.
Last week the Oxford/Astra Zeneca group reported a case of Transverse Myelitis (Spinal inflammation) halting its trial. Investigation of this patient attributed the cause to underlying Multiple Sclerosis and the trial is back on track.
It’s instructive to remember the outcome of rushing the 2009 Swine-flu vaccines to market without adequate testing. This presidential decree backfired when over a 1000 cases of Guillain-Barre paralysis ensued.
Earlier, Briefly.co.za reported that the World Health Organization (WHO) asked countries to take part in the global agreement that countries that are unable to afford access to the Covid-19 vaccine will be able to distribute it to their population.
The COVAX global facility has been created to helped pool funds from richer countries and organisations to help develop a Covid-19 vaccine and distribute it across the globe.
The WHO hopes that a vaccine will be ready by the end of 2021. COVAX is part of a broader programme called the Access to COVID-19 Tools (ACT) Accelerator which aims to coordinate the rolling out of Covid-19 vaccines, including tests and treatments.
Currently, there are more than a dozen drug companies in a race against time to develop a safe and functioning Covid-19 vaccine.
A number of these companies are expected to reveal if their vaccines are safe and work by the end of 2020.
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