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All the keys of coronavirus (SARS-CoV-2), the new invisible enemy

It has certainly disrupted our way of life. No one expected it. Its arrival has been too abrupt and we are still assimilating it. We often boast about them for being too small and too simple. Maybe, but that does not mean they should be taken lightly. They are capable of causing economic recessions and bankruptcies, mass deaths, the closure of an entire country and the collective hysteria of the whole of society. SARS-CoV-2 is calling into question the stability of our civilization, it is challenging our cohere ability, and moreover, it is challenging our species supremacy. The future of this new disease is uncertain: we do not know if it will become more endemic like seasonal influenza or if we will succeed in stopping it. The only thing that is crystal clear is that we will have to do our best if we want to get out of this…

The new severe acute respiratory syndrome coronavirus (nCoV-2019 or SARS-CoV-2, while COVID-19 is the name of the illness) is a virus that belongs to the family Coronaviridae. To date, six other viruses of this family are known to cause disease in humans, including the famous SARS and MERS (Middle East Respiratory Syndrome Virus). The first was the author of the 2002-2003 epidemic that started in China leaving behind 774 deaths and spreading to more than two dozen countries, and the second has been the cause of 2506 infections since its appearance in 2012 in Saudi Arabia until January 2020. Some coronaviruses are also the etiological agents of the common cold.

This family is further divided into two subfamilies: Letovirinae and Orthocoronavirinae. The latter hosts the coronaviruses strictly speaking, and among them SARS-CoV-2. This subfamily is in turn divided into four genera composed of 39 species so far. Of all of them, we will focus on the Betacoronavirus genus, which is the one to which our protagonist belongs.

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Phylogenetic tree of the coronaviruses genus. Betacoronaviruses hosts SARS-like viruses and MERS. Note the “Bat” prefix: it indicates that these viruses have been found in bats. Du et al. 2016

All Betacoronaviruses possess a single strand of ribonucleic acid (RNA, a molecule very similar to DNA where the genetic code is stored) of positive polarity. They are quite large in size, ranging from 80 to 130 nanometers. To visualize it better, 80 nanometers is equivalent to 0.00008 millimeters, that is to say they are almost 1000 times smaller than a red blood cell. SARS and MERS are also Betacoronaviruses.

They are enveloped viruses, that is, they have a lipid bilayer membrane. Precisely their name refers to their shape as it can be seen through an electronic microscope: they are icosahedral viruses of spherical appearance with a series of stick-shaped glycoproteins stuck in the envelope, which are the ones that give them the shape of a crown. These same glycoproteins are the ones that function as antigens, that is, they are the molecules recognized by the antibodies of our immune system, and they are the ones that the virus uses to detect the cells it is going to infect. Although we will develop this later, it is known that in humans, the cell receptor with which they have the most affinity is the ACE2 protein of the alveolar cells of the lung.

Within that lipid envelope we find another protective envelope, the nucleocapsid, which is a protein formed by subunits known as capsomers that surround a strand of helical RNA. This complex, formed by the nucleocapsid and RNA, is known as the virion because it is the fundamental particle capable of carrying out the infection. And little more, as simple as that would be these entities.

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General scheme of a coronavirus, formed by a double lipid envelope and a segmented protein nucleocapsid that protects the genetic material. They use their surface proteins, among other things, to bind to the target cells and start the infectious process. Animaciones Científicas

The enigmatic origin of the virus

Its origin is currently unknown, but keeping in mind that SARS-CoV-2 belongs to the coronavirus family and therefore it is capable of mediating zoonotic transmissions, i.e. diseases transmissible from animals to humans, its original reservoir is suspected to be an animal that is also frequently consumed in food or in traditional Chinese medicine. These suspicions are due to the fact that the epicenter of the current pandemic is found in the Wuhan market.

Wuhan is the capital of Hubei Province, China, with a population of 11 million people. It is the sixth largest city in China, the transport hub of the central region of the country and therefore one of the best interconnected cities. It is famous for its Huanan Seafood Wholesale Market, where not only seafood products are traded but also a great variety of wild animals often alive, including many forbidden and endangered species, which are commonly used in the country’s food or traditional medicine. These markets are known as wet markets. They are are known for their habit of wetting the floor to clean it relatively, but the truth is that hygiene and sanitary controls are often absent. Here, thousands of animals of different species are crammed together in uncomfortable cages, which is the ideal breeding ground for a virus or any other germ to swarm at will, making it easier for these microorganisms to jump between species.

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In the Huanan market, in the city of Wuhan, diverse wild species are crowded together in terrible conditions. A real hotbed of viruses and other potential pathogens for humans. The Sun

The virus was uncovered when severe pneumonia and atypical respiratory dysfunctions began to increase in Wuhan on December 8, 2019. Coincidentally, many of the affected patients either lived near the Huanan market or worked there, so it did not take long for the Chinese authorities to close it down. On 31 December, the outbreak in Hubei Province, the third in the last 20 years to be triggered by a coronavirus, was reported to WHO. Finally, almost a month later, on January 7, 2020, its identity was discovered at the Chinese Center for Disease Control and Prevention (CDC) from a throat sample of one of the patients. It was on February 11, 2020 that the World Health Organization named the new epidemic germ with the temporary designation nCoV-2019, i.e. new coronavirus 2019. On 11 March, in the face of the unstoppable advance of the coronavirus, the thousands of patients infected and deaths from the new pneumonia and the successive increases in the alert level, the WHO turned to an old taboo of humanity and raised the gravity of the situation to a pandemic.

As we were saying, it is not known who the original reservoir of coronavirus 2019 is so far. It’s been suggested that the origin could have been contaminated seafood, bats, snakes, pangolins, but nothing is clear. Of all of them, the most suspicious would be Rhinolophus affinis bats, since they are reservoirs of an important diversity of coronaviruses. In fact, in 2013 and after decoding the genome of one of these coronaviruses, it was discovered that it would have the ability to use human cell receptors, a fundamental premise for continuing intracellular replication. Genetic studies carried out on coronavirus 2019 have revealed that its genome is very similar to that of two SARS-like viruses present in bats: SL-CoVZC45 and SL-CoVZXC21. In addition, the genetic similarity between the bat coronavirus and the one that infects us is quite high, 96%, although not enough to confirm that our coronavirus is a successor.

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The horseshoe bat Rhinolophus affinis is the main suspect of being the original reservoir of coronavirus 2019. Lars Fehlandt

Scientists stress that it is very rare for a virus to jump directly from the original reservoir to us, that, more often than not, there are several intermediaries. This was in fact the case with SARS and MERS, which from the bats, the original reservoir, would have gone first to the civets and the dromedaries respectively and then to us. Therefore, animals carrying SARS-CoV-2-like coronaviruses are being sought. Among the various alternatives, the one that best fits this profile so far is the Malayan pangolin (Manis javanica), again because of the high genetic similarity of the coronaviruses it carries with those of bats and ours, although there could be more unknown intermediate hosts. Snakes and crustaceans were already ruled out. Both pangolins and horseshoe bats are traded in the Wuhan market (the pangolins’ scales are used to make medicinal remedies). The difficulty in tracing the original reservoir of the virus lies in its high rate of mutation, which we will discuss later.

This is the most accepted hypothesis at present, but we should take into consideration an information that emerged at the end of February and that went unnoticed. The team led by Dr. Yu Wen-Bin of the Xishuangbanna Tropical Botanical Garden dismissed the Wuhan market as the origin of the epidemic, or at least as the only cradle of the coronavirus, in a paper that is still pending review, a disturbing fact that makes it very difficult to trace the origin of the disease. They reach this conclusion after analysing 93 complete genomes of the coronavirus to reveal the evolution and the route followed by the virus during the first months of the epidemic and taking into account that a significant number of the first affected patients in Wuhan had no connection with the Huanan market. Therefore, SARS-CoV-2 would not have appeared in the famous market, but in another mysterious place. In fact, these experts suggest that the market would actually have functioned as a catalyst for the spread of the virus, like a bomb that caused an explosion of infections due to crowding and poor sanitary conditions. Logically, this information has led the most conspirative people to immediately think of the level 4 biosafety laboratory located a little more than 20 km from the market, which we will talk about later.

However, this leads us to a worrying question: how long has the virus actually been infecting people? As time passes, it is becoming increasingly clear that the virus did not emerge in early December as claimed by Chinese authorities. The South China Morning Post assures that it would have accessed some documents from the Chinese administration that are still pending publication in which it is confirmed that the first cases of infection, among which could be patient zero, possibly a 55-year-old man, began in Hubei almost a month before, in November 17, the official date given at the beginning (December 8). This information was deliberately withheld, forcing even the doctors not to reveal anything about it. According to Dr. Ai Fen, one of the “whistleblowers” who allegedly broke with the censorship, by December 16 they already knew that the atypical pneumonias were caused by a new coronavirus never seen before, but because of bureaucratic obstacles they were unable to confirm their findings until December 31. In other words, time was lost that could have been used to learn more about SARS-CoV-2 and to alert the rest of the world sooner. But not only did they withhold information, they would also have blatantly lied. When in early January Chinese authorities reported only 41 cases in their country, the truth is that they were already close to half a thousand according to the newspaper, which would be logical if the epidemic started much earlier than we thought…

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The beautiful pangolins are critically endangered by indiscriminate hunting for their precious scales to make medicinal remedies in Asia. WWF Indonesia

Be that as it may, the truth is that there is no certainty. Now, there are two main scenarios being considered:

  1. That the virus already evolved in the intermediate host, let’s say in the pangolin, and acquired the appropriate receptors to invade human cells, so that when it jumped to a human host it was ready to replicate in it. This scenario is disturbing because it predicts the emergence of more epidemic outbreaks, as the infective strain continues to swarm among wild animals.

  2. That the virus would jump to the human being without being pathogenic yet, so that it would have evolved once in the human organism. This could explain why the virus camouflaged itself so well at first: since it had not undergone the mutation that gave it the necessary affinity to bind to human cells, it would not have had any obvious effects on those infected, which would have been those of a common cold or flu at most. Only after it had been transmitted from person to person for a certain time would it have evolved to fully adapt to its new host. From this, a plausible prediction can be made: that the virus was therefore already acting on humans long before Chinese authorities sounded the alarm.

Of course, there is the version that categorically assures that the coronavirus is a laboratory manufacture, a version that always appears in any epidemic or pandemic. Many doubt that the coronavirus originated in Wuhan. Among them are Zhao Lijian, spokesman for the Chinese Ministry of Foreign Affairs, Zhong Nanshan, an expert in infectious diseases, or Hua Chunying, director of the Information Department of the Chinese Ministry of Foreign Affairs, and other members of the Asian Politburo. All of them have stated that there is no conclusive evidence to say that the virus originated in China, although for the moment everything points in that direction. To make matters worse, Zhao has spread on his Twitter account his belief that the virus has actually been deliberately introduced into the country by the United States, probably to undermine the Asian giant’s economic growth and image, a conspiracy that is booming thanks also to youtubers, who have echoed this version quickly.

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Zhao Lijian, spokesman for the Chinese Ministry of Foreign Affairs, triggered the controversy on Twitter by claiming that the United States was hiding the true origin of the virus, which had actually been born on its territory. Twitter

Basing on a “cryptic” interview with Robert Redfield, director of the U.S. CDC, who reveals that some deaths believed to be caused by the seasonal flu in the United States were actually caused by the new coronavirus, Zhao wonders why he doesn’t give more data on when patient zero was infected in the United States and other basic epidemiological data. For Zhao, it’s clear that the U.S. is hiding information about the true origin of the coronavirus, which would have been born in the land of the stars and stripes and then brought to Wuhan in October 2019 by U.S. military athletes in the context of the World Military Games.

This theory has been widely publicized in the Chinese media. Nevertheless, it is suspicious that they are mainly Chinese political figures who are extolling this version, suggesting an attempt to clean up their country’s image through propaganda and a counter-offensive against the labels that the virus has received from other countries. Without going any further, POTUS Donald Trump calls the disease “the Wuhan virus” or the “Chinese virus” every time he has the chance. In other words, it seems like another episode in the geopolitical war between China and the United States. Be that as it may, the evidence given by the Chinese spokesman is very tentative and not very clarifying.

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It is almost a taboo, but every time new emerging diseases appear, many turn to the theory of their artificial origin. The objective according to these versions would always be the same: to destroy society and the eugenics of the population in order to establish a New World Order. SecureWeek

As is often the case, the United States is once again at the centre of yet another conspiracy. But there are several arguments for discarding the theory of artificial origin. First of all, if a country wants to create a biological weapon, the first thing to do is to keep it from getting out of hand and to control it at will in order to suppress it at the right time, for example, before it affects its population and economy. However, as we have seen over all these months, the virus has spread wherever it wants and without control.

Taking as a principle the logical reasoning that any biological weapon must be practically perfect in order to be controlled without problems, the truth is that this coronavirus does not comply with this premise. The virus is not perfect for several reasons. The first of these is found in the famous stick-like glycoproteins that they use to recognize target cells. There are two regions in these proteins: one that they use to recognize, for example, the ACE2 protein of the alveolar cells, and another that is responsible for breaking down the virus’ envelopes so that the RNA that will penetrate the cell be released. Well, the team headed by researcher Kristian G. Andersen predicted on the basis of computer models that the structure of these regions has a series of “flaws” that imply that the affinity of the virus with ACE2 proteins is quite good but far from ideal, evidence that points to natural selection as the author of the coronavirus and not a machiavellian biotechnologist. That is, if it had been an artificial creation it could only be considered somewhat sloppy.

Another reasoning that should be put forward is that if a power, either China or the United States, has manufactured a virus to economically destabilize its rivals and take over the supremacy of the world, it is logical that before releasing the weapon it would have manufactured an antidote to armor itself against it. Otherwise, it would suffer the same vicissitudes that it had intended exclusively for its enemies, which is precisely what is happening: the great powers are suffering from the pandemic outbreak of coronavirus to a greater or lesser extent, and their economies are clearly suffering as well.

However, we have to concede to conspiracy theorists that the laboratory virus hypothesis is not crazy. Since the polio virus was manufactured from scratch in 2002, biotechnology has come a long way and there have been several more cases of virus being manufactured artificially. One of the most prominent examples is that of researchers David Evans and Ryan Noyce, from the University of Alberta in Canada, who in 2017 succeeded in making from scratch a relative of the dreaded smallpox virus (officially and completely eradicated in 1980) with infectious capacity from viral genes bought over the Internet that they then assembled in the laboratory. Their work was highly controversial, mainly because it demonstrated how easily and cheaply the material needed to make a virus can be obtained, and because the accessibility of the method they followed allows unscrupulous countries and bioterrorists to replicate it.

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This picture has gone around the world. It shows a boy vaccinated against smallpox and an unvaccinated boy. The smallpox virus was one of mankind’s worst nightmares. The world’s first vaccine was extracted from it. Now, some have an interest in creating very similar viruses under a justification that convinces few people… Twitter

However, a very different and more plausible scenario is that there has been an accidental escape from a laboratory, a possibility proposed not without some scepticism by the already mentioned Kristian G. Andersen. In the scientific literature there are several examples of bioassays carried out in biocontainment laboratories with the aim of analysing the possibility that a SARS-like coronavirus present in bats could make an interspecific jump and colonise human cells. Well, Andersen questions whether the new coronavirus could have emerged after repeated in vitro testing with human cells in any of these laboratories.

Perhaps multiple experiments in transferring a bat SARS-like coronavirus into human cells have forced one of these viruses to mutate into a strain very similar to SARS-CoV-2. The hypothetical leak could have occurred if the virus had somehow accidentally infected any of the workers. Thus, it could begin to be transmitted from person to person camouflaged, not only because of the time it takes for symptoms to appear, but because in this case the symptoms would be attenuated because the virus does not yet have the affinity necessary to replicate en masse in human cells. With enough time, it could then evolve into the new coronavirus. As a curiosity, Andersen cites an article published in Nature in which, precisely, a SARS-like virus present in Rhinolophus sinicus (the same genus to which the bat suspected of being the original SARS-CoV-2 reservoir belongs) is characterized as being capable of using the ACE2 cell receptor, that is, the one that uses SARS-CoV-2 to infect the cells of the lung alveoli. Well, guess what institution most of the authors of this article work at? Those who thought of the Wuhan Virology Institute, the one about 20 km from Huanan market that has been pointed out as the real epicenter of the pandemic, are right.

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Several researchers of the Wuhan Virology Institute (highlighted in red), the complex where the biosafety level 4 laboratory is currently located, the site where some place the true origin of the pandemic, are involved in this study. Nature

It should be noted that the Wuhan biosafety level 4 laboratory was inaugurated at this institute in 2015, and from the beginning it was aimed at studying viruses such as SARS. The level of biosecurity containment is determined by the equipment that the laboratories possess, with the level 4 laboratories having the most sophisticated equipment and asepsis, so that they are authorized to work with the most dangerous pathogens, such as Ebola. During the development of this centre (which is part of a project to build a network of this type of facilities throughout China), critical voices raised, such as that of the prestigious molecular biologist Richard Ebright, who doubted that all the required safety measures would be followed, especially given certain precedents. Here, Ebright refers to several leaks that happened in high security biocontainment facilities in Beijing. Guess what? Yes, the SARS virus. Also reluctant was Tim Trevan, a biosecurity consultant, for whom security at these facilities can only be assured in societies where censorship does not predominate, implying that if any transgression occurs at such facilities, the administration would hide it by all means instead of publicizing it. Others, however, are skeptical that any kind of leak could occur in a level 4 laboratory.

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Professor Richard Ebright was sceptical about the safety at the Wuhan Institute of Virology. Prabook

A leak from such a place may be unlikely, but not impossible. In 2004, an article was published in The New England Journal of Medicine discussing how a 27-year-old microbiologist became infected with SARS (again, the virus) while working at the Institute A biosafety level 3 laboratory in Singapore. How he became infected is unknown, especially given all the individual protection measures taken at these sites. Interestingly, his job was not to work with coronavirus but with West Nile virus, but it appears that the cell culture he handled was not only contaminated with West Nile virus but also with SARS. Somehow that the study authors couldn’t resolve, that undesirable germ got into the culture.

However, Andersen himself rejects the possibility that the coronavirus has escaped from a laboratory strain. He argues that if this were the case, a progenitor strain with genetic characteristics very similar to those of SARS-CoV-2 would have been isolated, and so far nothing of the sort has been found. He also suggests that some mutations found in the current virus should have been produced in an immunological scenario and that in vitro cell cultures would not have been sufficient. In any case, much is still unknown about the virus and nothing rules out that in the future new data may appear suggesting negligence as the origin of the pandemic and refuting the theses of Andersen and company… Or maybe not.

Another side of this conspiracy is that of the independent journalists and videobloggers who mysteriously disappeared or were arrested in China after showing to the world that the magnitude of the new coronavirus was much greater than we’d been told. China, trying to hide as much as possible the true seriousness of the epidemic in Hubei province, as it did with the 2003 SARS epidemic, has branded as false news the information brought to light by Chen Qiushi, Xu Zhangrun, Xu Zhiyong, Li Qiaochu and Fang Bin among others, some of whom are also defenders of the artificial origin of the virus. Treated as mere dissidents, all they did was criticize the initial poor management of the government and reveal the lack of means available to Chinese hospitals and the deaths from viral pneumonia.

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Zu Zhangrun, a Chinese dissident, was an intellectual who strongly criticized the administration’s immoral handling of the epidemic. He was taken into house arrest after publishing his revealing essay Viral Alarm: When Fury Overcomes Fear. Yahoo

Symptoms and at-risk groups

The incubation period until the onset of symptoms is currently estimated at 1-24 days, although it is extended to 4-7 days on average, like SARS and MERS. This time period is longer than that for seasonal flu, which is usually 1-4 days. The vast majority of patients begin to show symptoms before 12 days, although it may be delayed up to 3 weeks according to the latest information, but these would be the most minority cases, approximately 101 out of every 10000 cases.

There is also a sexual bias: more men than women are hospitalized, but not much more, only 2%. This may be due to differences in the chromosomal profile and the type of hormones we have, as these are known to play a major role in immunity, among other factors.

Once the virus has managed to colonize our body, the patient most often shows several of the following symptoms according to the World Health Organization: fever (87.9% of cases), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), dyspnea or respiratory failure (18.6%), which in the worst cases can lead to bilateral pneumonia (affecting both lungs), sore throat (13.9%) and chest pain, myalgias (12.8%) and headache. Chest X-rays usually show spots in the lungs. Rare are the cases that manifest themselves with diarrheal episodes (3.7%, as opposed to SARS or MERS), nausea and vomiting (5%), or with symptoms characteristic of an upper respiratory tract infection, such as a runny or stuffy nose and sneezing. Especially in older people, confusion or dizziness may also occur. Recently there have been cases of sudden acute anosmia, i.e. abrupt loss of smell and loss of taste, conjunctivitis, heart damage (heart failure, acute myocardial damage) and skin diseases especially in children (chilblains, hives or rashes on the extremities, although studies are still needed) associated with coronavirus infection. Although the latter symptoms are less frequent, it is important to take them into account, because sometimes they are the first to appear, even before the cough or the fever.

This clinical profile is quite similar to those produced by other coronaviruses, such as SARS, MERS and those of the coronaviruses that trigger the common flu. However, dyspnea is not normal in a flu for example, and abundant nasal secretion is not characteristic of the new coronavirus. But as we see, the symptoms are similar, to the point that it is complicated to distinguish between both diseases in the initial stages, and do not allow a reliable identification of the disease from the signs and symptoms. In this regard, we must be cautious with the tables that compare the symptoms of SARS-CoV-2 with those of the cold or flu, because most of them present several incorrectness, mainly denying symptoms of COVID-19 that can really appear, even if in low proportion.

Some of the symptoms already suggest that the coronavirus is not only capable of invading the respiratory tract. Although it seems that its predilection is the lower respiratory tract, it has already been proven that it is capable of invading other regions of the body, not in vain, the ACE2 receptor, in addition to lung cells, we can also find it in the endothelium, a monolayer of cells whose function is to cover the interior of blood vessels and the heart. Only with the advance in the number of autopsies of bodies infected with coronavirus (which are still scarce) have these new conditions been discovered. We must take into account that blood vessels run through any organ and that a generalized damage in the endothelium of these structures due to the infection or to the consequent inflammatory reactions may lead to cardiac, hepatic, renal disorders, that have been precisely recorded in some autopsies.

The most reliable and frequently used methods to diagnose the presence of the new coronavirus are the molecular technique of real time PCR (polymerase chain reaction) using samples obtained from sputum or nasopharyngeal washings and the serological technique. The former aims to detect the virus in the body by identifying its genome, while serological tests look for the specific antibodies that our body generates to fight the microscopic invader. Both procedures provide results within a few hours.

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Age-related mortality rates of the first 44672 confirmed cases in mainland China. People over 60, especially those with previous pathologies, are most at risk. CNN

As with the flu, the population at risk is the immunosuppressed people and those over 60 with certain previous pathologies or comorbidities. For example, patients with diabetes, asthma, cardiorespiratory or cerebrovascular problems and hypertension may be at serious risk. Our bad habits, such as smoking, could worsen the evolution of the disease. In fact, the team led by Dr. Nanshan Chen, in one of the first clinical and epidemiological articles published about the coronavirus, recorded the deaths of two men, one aged 61 and one aged 69, who had no previous risk pathologies but smoked. In these cases, coronavirus 2019 can become fatal with severe pneumonia, pulmonary edema and/or acute respiratory distress syndrome.

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Mortality rate depending on the previous pathologies shown by the patients. Those with cardiovascular pathologies are most at risk. These data are based on the first 44672 confirmed cases in mainland China. CNN

However, we must be careful with this information. This does not mean that all elderly patients with these diseases will die from a coronavirus infection. We always speak from a statistical and percentage point of view… Children, on the other hand, are mostly asymptomatic and those who suffer from it do so as if it were a mild cold without major complications. It has been said that children cannot contract the disease, but this is false: they can be infected and also be a vector for the spread of the disease. On the other hand, is reassuring the positive diagnosis with mild symptoms or asymptomatic that the majority of the population shows, around 80% of those infected. Only 15% of those infected show a serious diagnosis and 5% a critical diagnosis. In addition, the Chinese authorities have confirmed that 87% of those infected in their country have recovered without major problems.

There are infected patients who are admitted to hospitals with a certainly depressed immune profile, with leukopenia and lymphopenia and diminished levels of T-lymphocytes. It is possible that the reserve of these cells is depleted because of the immune response triggered by the virus. This encourages other opportunistic diseases to infect the patient and the diagnosis aggravation.

Death usually occurs from collapsed lung or multiorgan failure, either caused by coronavirus per se or by co-infection of other pathogens that take advantage of the weak immune system. The mortality rate of SARS-CoV-2 is not too high, estimated to be about one tenth of that of SARS 2003. It is true that in a few weeks it has surpassed SARS in terms of victims, but not because it is more lethal, but because it spreads much more rapidly. Still, experts are asking for peace of mind and saying it’s too early to establish a foolproof death rate. This figure cannot be established until the pandemic is over. Fundamentally, because depending on the geographic context, it changes a lot: in Wuhan it is between 2 and 12% depending on the sources we consult. But, for example, in Spain, and more specifically in Madrid, with the recent multiple deaths of elderly people in nursing homes, this rate rises to 7%. In general, and at the time of writing this article, this value is estimated to be around 4%. This is a low mortality compared to other coronaviruses, that is, this virus will not eradicate any population. The real danger is, as we will see below, the speed of spread, which can render the health services of a region or a country obsolete.

From the beginning we have been bombarded by the media with the fact that the new coronavirus is little more than a common flu, especially in terms of its mortality. Who knows if it has been due to negligence, to avoid social alarm or to ignorance, but this is false. This coronavirus kills between 30 and 40 people for every thousand patients diagnosed, while the seasonal flu only kills approximately one person for every thousand patients diagnosed, and it is also more contagious. In other words, nCoV-2019 is 30-40 times more lethal than seasonal flu. However, its mortality is significantly lower than that of MERS (35%) or SARS. The problem of downplaying SARS-CoV-2 is that it may have led to neglect and lack of concern and, consequently, to further spread.

The WHO has already warned young people to follow the rules of prevention and social distancing, because they are not immune to the virus, in addition to being important vectors of the disease, and there have already been several cases of young people without previous illnesses with a serious diagnosis of coronavirus that have sometimes ended with their death. One of the explanations would be in the viral load that colonizes the organism, that is, the amount of viral particles present in the body fluids. The higher it is, the more difficult it is for the immune system to fight the infection, and therefore a more serious clinical profile is expected. How can this viral load be increased? Precisely if we do not follow the rules of social distancing. The more exposed we are to infected people, the more likely it is that each of these individuals will transfer part of their viral load to us, i.e. we will gradually accumulate more and more viruses which makes the situation within our body untenable.

There has also been intense discussion about the possibility that our pets may catch or suffer from the disease. It should be made clear that there is no evidence of this so far. It is true that in this pandemic there have been two reported cases in Hong Kong of dogs testing positive for coronavirus. One of these is a 17-year-old Pomeranian dog gave weak positive results for coronavirus. He lived with his owner, who was infected. He was quarantined and returned home after testing negative. At no time did it show any symptoms. The animal died shortly afterwards, on Monday 16 March, of unknown causes, as the owner refused an autopsy. We might think that it was due to age. It is not known how the virus got into its organism, perhaps because he sniffed or licked some infected surface.

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So far, two cases of dogs testing positive for coronavirus have been found, both in Hong Kong. It’s still too early to draw any conclusions. El Español

The other case is that of a two-year old German shepherd who has been quarantined after testing positive for a number of tests and who was also living with an infected person. As with Pomeranian dog, the animal has also shown no symptoms. According to Malik Peiris, a virologist at the University of Hong Kong, these could be the first cases of human-animal infection, but studies are still needed to confirm this. Be that as it may, such situations were to be expected according to veterinarians

According to the latest information, a four-year-old Malaysian tiger named Nadia, who lives in the Bronx Zoo of New York, is also reportedly infected, as are her sister Azul and two other tigers and three lions from the same zoo. Nadia developed dry cough, so she was tested and confirmed its infection. It is suspected that an asymptomatic caretaker transmitted the virus to them. Fortunately, no animal has evolved into a more serious condition. Two positive cases have also been identified in cats so far: one in Belgium showing symptoms of a digestive and respiratory infection and one in Hong Kong. Both animals were living with infected people.

The tiger Nadia from the Bronx Zoo of New York has tested positive for coronavirus. It seems her asymptomatic caretaker was the one who passed it on. Yahoo Noticias

As for the cats, a pre-print study signed by Jianzhong Shi and his team confirms that cats along with ferrets are the most vulnerable groups to the virus. No adult cat or ferret inoculated with the virus developed serious pathologies such as pneumonia, but the virus was able to replicate in the upper respiratory tract of these animals, including the nasal turbinates, the tonsils, the soft palate and, in the case of cats, also in the trachea. Viral samples were also recovered from the faeces of some of the felines, suggesting that the intestine of these animals is an attractive niche for the coronavirus. Another interesting result is that two healthy cats ended up being infected after being exposed to the sick individuals, that is, that transmission by respiratory air droplets would be possible between cats. These experiments were repeated with a pair of young cats, and positive results were obtained in both transmission and viral replication. In these cases, it seems that the juveniles suffer the consequences of the infection to a worse extent, as researchers recorded massive lesions in the tracheal and nasal epithelium and in the lungs. In contrast, this same experiment replicated in dogs, chickens, pigs and ducks showed that these species are little or not at all susceptible to the virus, i.e. the germ has little or no success in reproducing in them.

Who knows, there is still much that is unknown about this virus and it may still have many surprises. Nor would it be the first case of a parasite reaching an unusual host accidentally… What must be made clear is that there is still no evidence that our four-legged friends can infect us and that, be that as it may, nothing justifies abandoning pets because we are seized by hysteria and neurosis.

Another major concern is whether an infected pregnant mother can pass the new coronavirus to her child, either during the period when the fetus is in the womb or later during breastfeeding. As usual, the excess of information makes it very difficult to distinguish false from true information or speculation from fully proven facts.

Not long ago, a couple of suspected cases of newborns infected with coronavirus appeared in the media. Logically, these news became viral. For example, SARS and MERS never caused intrauterine infection in any fetus. Also, a preliminary study recently published in The Lancet and signed by Dr. Huijun Chen dismissed this after analyzing this possibility in 9 pregnant women infected with the new coronavirus. All the pregnancies were successful and the babies were born healthy and without problems, therefore, surely this new virus behaves like its relatives. In any case, if newborns are infected it is most likely due to their exposure in the hospital to an infected person or object. However, as with so many other facets of this new virus, it is best not to anticipate events.

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There is still no cases of intrauterine infection. On the contrary, newborns of infected mothers have been born healthy and without the presence of the coronavirus in their bodies. Hospital San Joan de Déu

Uncertainties don’t end here. There are already several recorded cases of patients who continue to test positive after discharge. Are possible relapses or, worse, reinfections? Again, little is known. In general, experts say there is no danger of becoming infected again after acquiring immunity and that contagion from already healed patients is very unlikely. For this reason, the quarantine period for an infected person is 14 days from the onset of symptoms. It is possible that genetic traces of the virus remain in the blood after infection, little more than residues, and therefore tests continue to be positive. However, there have been isolated cases of relapses, for example in China, where an additional 14 days of isolation has been recommended. The good news is that no infections have yet been reported from patients who have relapsed.

We do not want to leave out the psychological damage that the current situation is causing, which is often worse than the physical damage of the coronavirus. Uncertainty, the stress of homebound for a long time, the fear that anyone of us can catch the disease at any time or lose their jobs, the fear imbued by fake news or the mental saturation caused by overexposure to excessive information (which, moreover, is usually pessimistic) can cause significant emotional instability in the population, a shock translated into irrationality, anxiety, hysteria and collective psychosis. And we have already seen the results in various countries: people crowding into supermarkets to take basic foodstuffs, masks, gloves and disinfectants, even weapons, before anyone else for fear of being out of supplies, others abandoning their pets for fear of catching the coronavirus, the typical look of suspicion directed at those who cough or sneeze, the increase in family fights and even divorces. It is clear that the other epidemic, that of fear, is spreading at a not inconsiderable rate.

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These kind of images have served as a vector of fear. The vision of empty supermarkets has had a psychological feedback effect that has led some irresponsible people to empty the shelves of the establishments. The lack of solidarity and immaturity has temporarily destroyed even the stocks of food that are essential for certain groups of the population, such as coeliacs. Most of these provisions will end up expiring in the homes of these individuals and finally in the garbage. Nothing justifies it… Última hora

Routes of transmission

In order to fight any pathogen, it is essential to know how it is transmitted in order to establish preventive health measures and to cut or reduce the chain of infection and know its pandemic potential.

The transmission rate of any infectious disease is often measured by one parameter: the basic reproductive number, represented as R0. Basically what it tells is the number of infections caused by an infected person. For example, if one person can infect three people, each of those three can infect three others, and so on. To calculate this, the total size of the susceptible population, the transmission rate and the recovery rate among other variables are taken into account. There are different methods of approximation, which must also be taken into account because different results are obtained. The value 1 is taken as a reference, so that if the R0 obtained is less than one, the pathogen has a weak capacity to spread and the number of infections will end up being extinguished, and vice versa if this parameter is greater than one. Logically, this value varies throughout an epidemic episode, since it depends on the number of infected, susceptible and immunized people, and it is something that we ourselves with appropriate health measures and policies can modify. For example, the daily reproductive number in Wuhan, a similar parameter to the previous one, was reduced from 2.35 to 1.05 in just one week after the government travel restrictions were introduced.

To get an idea, estimates made by the WHO agree that the basic reproductive number of SARS-CoV-2 varies between 1.4-2.5, but there are studies that speak of 3.28 on average, which is indicating that it has a dissemination capacity that is not bad. It is slightly higher than that of seasonal flu and very similar to that of SARS, which varies between 2 and 5 (at the end of the 2003 SARS epidemic this parameter was reduced to 0.67-1.23).

The reproductive number must always be taken with caution, because what it really represents is the potential for transmission of a disease. For example, the common flu has an R0 of approximately 1.3, and yet millions of people suffer from this disease annually.

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The new coronavirus is transmitted by direct contact and by the infectious droplets expelled in sneezes and coughs. Wikipedia

How is it transmitted? Basically by contact and through respiratory droplets with infectious capacity that are emitted when coughing, sneezing or merely speaking. Therefore, this is already giving us a clue, that is, that we have to be relatively close to the infected person for those secretions to reach us, less than 1.5-2 meters approximately.

In addition, the virus cannot enter the body from anywhere. Fortunately, our largest body organ, the skin, functions as an impregnable barrier to microbes. Therefore, entities such as the coronavirus 2019 can only enter though those places where there is no skin, such as the nasal and oral mucous membranes or the eyes, places where the virus undoubtedly and frequently reaches with our help when we do not follow the appropriate hygiene measures, such as simply washing our hands regularly. Because of these issues, transmission was previously considered to occur from mainly symptomatic patients, who are those who present with cough and spread the virus most easily, not only because of the symptoms but also because of the high viral load they carry in their bodies during this phase. But just as the role of asymptomatic and undiagnosed people in the spread of the disease was previously doubted, recent research has made it clear that these epidemiological groups have played a major role in the rapid spread of the virus and, consequently, that the reported numbers of infected people are extremely underestimated (some authors estimate that there are actually 10 times more infected patients in the world than are reported).

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Undiagnosed and asymptomatic people have played a key role in the spread of the coronavirus. Prensa Libre

As time goes by, this germ becomes better known. The latest information suggests that SARS-CoV-2 can survive up to three hours suspended in the air inside the micro-droplets, as an aerosol. But not only this, because it seems that this virus resists everything. It has also been shown that it can survive up to two or three days on plastic or stainless steel surfaces and about 24 hours on cardboard. Curiously, it can last up to four hours on copper surfaces. These viability data are very reminiscent of the stability of SARS, as the authors of the study published in The New England Journal of Medicine point out. The scientists also call for caution, because their study was conducted under laboratory conditions, with controlled temperature and humidity. But outside, these times can be modified. At 22ºC and 60% humidity, the virus can persist for 3 hours on paper (both print and tissue) and for 1 to 2 days on clothing, wood or glass. For all these reasons, it is essential to wash your hands repeatedly, because you can touch a contaminated object at any time.

The few cases that have been diagnosed with diarrhea, vomiting, and abdominal pain raise the suspicion that the new coronavirus, like its congeners, SARS and MERS, may infect the cells of the intestinal epithelium and enter the body by that route. This would imply that the virus could be transmitted through the faeces, a danger mainly for those developing countries that lack adequate health and hygiene infrastructure and organization. However, it is still too early to confirm anything about this.

Below is a table summarizing the key epidemiological data on SARS-CoV-2 (on a temporary basis) and some of its relatives. The data for the new coronavirus are very relative and unstable, as they depend on the statistical method used, the area affected and how the cases evolve. Also, until the pandemic is over, no accurate estimate can be made. Even so, this serves to demonstrate once again that putting SARS-CoV-2 and seasonal influenza on the same level is absurd. 

 

SARS-CoV-2

SARS-CoV-1

MERS

Influenza

Incubation period (days)

4 – 7 on average (1-24 in general)

2 – 7 on average (2 – 14 in general)

5 on average (2-14 in general)

4 on average

Reproductive number (R0)

1.24 – 3.28 (6.49 according to some estimates)

2 – 5

0.3-0.8

1.3

Mortality rate (%)

4 in general (15 in people over 80 years)

14 – 15 in general (50 in people over 64 years)

35-40

<1 (0.1 according to WHO)

The key to stopping the pandemic lies not only in the health services and strategies of each country. The most important role is played by the ordinary citizen. It is essential to follow the recommendations of scientists and the obligations of the authorities. It is essential to maintain hygiene, to disinfect our hands repeatedly whether we go out on the streets or not. The minimum safety distance of one metre must be maintained. Health services must not be collapsed: if we show slight symptoms, we must inform the appropriate authorities through the telephone and online media they provide us with and follow their recommendations before going to any hospital. If we are ill keeping the quarantine at home, we must avoid as much as possible the contact with the rest of the members of the household and disinfect everything we touch that can be accessible to the rest. And if we are living a period of regional quarantine, we must comply with it categorically. Go out to the street as little as possible, at most to buy food, take the dog out or go to our workplace and, above all, avoid all that can be close contact with others. We are not on holiday, but in the middle of a battle. These are not extreme or restrictive measures, they are necessary measures. Sport and leisure can be done perfectly at home with a minimum of imagination. From Periérgeia we want to make it clear: STAY AT HOME!

flatten-the-curve-sanitary-system-colapse-reproductive-number-r0-sars-cov-2020-flu-seasonal-influenza
“To flatten the curve” is a metaphor that refers to a mathematical and statistical prediction that contemplates two scenarios: one uncontrolled and one under control. Basically what these predictions represent is the evolution over time of the number of coronavirus infections in a scenario with measures that try to stop the spread and in another without them. A certain number of infected cases is taken as a reference from which the health systems can collapse. This is a totally catastrophic scenario for any nation in which is expected a traumatic number of deaths, an economy broken and the majority of the population becomes infected. It is up to us to respect the safety measures to prevent that threshold from being breached. Medium

The more times we leave our homes, the more likely we are to spread the disease and become infected, so we have to be responsible and civilized. If we do not flatten the curve as soon as possible (which is the aim of all these measures) and let the health system collapse, that is going to be the real chaos. If we think the current situation is crazy, it is nothing compared to what can happen if we do not take action. If we believe this isolation period lasts too long, it can be perfectly doubled in a collapsing scenario, and that is when we will truly regret it and suffer the unspeakable. We must not be overconfident when the infection curve begins to shrink. That reduction must be maintained over time. If during that period we relax and forget about the measures, we are subject to an upsurge in the infection. All the effort put in until then will have been in vain and we will have to restart it. Avoiding all this is in our hands. So, again: STAY AT HOME!

The attack strategy

Viruses are forced intracellular parasites, that is to say, outside the cells they have nothing to do, they have no type of activity, they remain latent, practically dead, in a state of suspension, that is why it is discussed whether to consider them living beings or not. The truth is that they are strange beings. They do not feed or breathe, they only exist to reproduce and proliferate, and for that they basically use the cells they infect.

Positive-strand RNA viruses, like our protagonist, follow a general pattern to enter cells, and although the infective strategy used by SARS-CoV-2 is not fully defined, everything suggests that it is very similar to the rest of their relatives. Viruses may be many things, but they are undoubtedly the masters of deception. Because that’s basically what they do, they trick the cells and use the machinery that makes them work in their favor.

First, coronaviruses use their surface glycoproteins as sensors to detect the target cell. Our organisms have an impressive cell diversity, and viruses cannot infect the cell type they want (although some viruses are more generalists than others), but the one with the right receptors, which the virus can detect with its surface proteins. Remember that in the case of the new coronavirus (like other SARS-like viruses), one of the surface proteins with which it has the greatest affinity is the ACE2 of the cells of the pulmonary alveoli.

The virus will know when it has found its victim when it detects the right protein receptor with its stick-like glycoproteins. It will then receive the signal to enter the cell with its full consent. This step is called adsorption, adhesion or endocytosis: the lipid membrane of the virus merges with that of the cell and the virion, made up of the nucleocapsid and the genetic material which, let us remember, is a positive-sense single-stranded RNA, will be released into the cytoplasm. Said this way it seems easy, but the truth is that the virus is perfectly camouflaged. We will understand it better later. Let’s focus now on the genetic material of the virus.

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First, the virus has to find the target cell it’s going to infect. To do this, it looks for the cell’s surface receptors. If the affinity between these and its “stick-like” glycoproteins is accurate, the infectious process begins. The New York Times

This RNA strand is simple because it is only made up of a single strand, unlike the DNA strand that we all quickly remember, which is double.  Okay, but what is the meaning of “positive sense strand”?

One of the criteria used to classify animal RNA viruses is the polarity or direction of their RNA strand, which can be positive (represented as 5′ > 3′) or negative (3′ > 5′). If it is positive, this RNA acts directly as messenger RNA (mRNA): this is the RNA that serves as a template for synthesizing proteins by a process called translation, since it is still a translation from one language (the genetic code) to another (the sequence of amino acids that make up the protein). Thus, the RNA genetic code of our virus can be read directly once it has entered the cellular cytoplasm and be translated into proteins, the same proteins that will make up the basic structure of the viral offspring, i.e. the nucleocapsid and the surface proteins. This is done by the ribosomes, cellular organelles whose function is to translate the genetic code of the cell to synthesize proteins. Ribosomes travel along the virus’ messenger RNA strand to make a protein by adding the amino acids corresponding to the genetic sequence they are reading, as if they were translating a language.

Well, if the strand has negative polarity it means that it is complementary to the messenger RNA, i.e. it will serve as a template to synthesize a mRNA strand and therefore cannot act directly as such. Thus, in these cases, the infection process consists of one more intermediate step in which an mRNA must be synthesized. The fact is that coronaviruses directly carry a messenger RNA ready to start the synthesis of their proteins.

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Once the affinity is established, the virus releases the virion into the cell’s cytoplasm. The New York Times

Once the virion has entered, a fascinating process starts: the virus begins to sabotage and control the cellular machinery to replicate itself. First, it uses the cell’s ribosomes to produce a protein: the polymerase. This protein will serve to make a negative-sense RNA molecule from the positive-sense RNA originally carried by the virus. From this mould, the polymerase will make several different messenger RNAs (or positive-sense RNAs) that will be used later to produce the different proteins that make up the coronavirus. Here is a very important factor to take into account.

This polymerase works against the clock and at impressive speeds encoding new RNA, mainly because it has to produce as much as possible before the host cell activates its alarm system to the virus that is damaging it. The faster the protein works, the more it is neglected and the more likely it is to introduce some random error into the genomes it makes. These mistakes are the mutations, and they can generate new more or less virulent strains of the virus, although most tend to make dysfunctional virions. They are also responsible that the virus acquires the necessary elements to jump between species. It is also true that because a large number of slightly different RNAs are generated, there is a possibility that these individual molecules will recombine with each other to form new RNA molecules that will serve to form new viruses or strains and thus increase their genetic diversity. This is very advantageous, not only for viruses but for all living beings, because the greater the genetic diversity, the greater the probability that the species will survive, since genetic diversity allows different individuals to face an adverse event in different ways: some will survive and others will not through natural selection.

polymerase-pulmonary-alveoli-infection-infectious-process-glycoproteins-membrane-receptors-rna-genes-genetics-coronavirus-covid19-sars-cov-2020-virus
Once the viral polymerase has manufactured the mRNAs (the spiked lines), these are directed to the rough endoplasmic reticulum where the ribosomes (the blue body) begin to translate the RNA into proteins (the bead necklace) that will make up the viral offspring. The New York Times

The mRNAs are then directed to another cell organelle, the rough endoplasmic  reticulum, which occupies virtually the entire cytoplasm of the cell. It is a large, highly folded membranous complex to which a huge number of ribosomes are attached, giving it a rough appearance that can be seen with a microscope. Therefore, this organelle is constituted as a great factory of protein production. It is here, therefore, that the viral proteins will be manufactured and assembled.

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In the rough endoplasmic reticulum (the folded mass surrounding the nucleus), ribosomes synthesize and assemble the proteins of new viruses. The New York Times

The virus would already be almost complete, it just needs to pass through another organelle: the Golgi apparatus, the one in charge of packing the freshly made viruses into membranes. Once it is completely formed, the virus is ready to leave its host and continue its infection in other cells. The expulsion is very simple: the membrane that it has obtained in Golgi apparatus melts with the plasma membrane of the cell and the virus is expelled… In this way, viruses leave the cells surrounded by an envelope with the same composition as the membrane of those cells. And here is the key to why the cells allow the endocytosis of the virus: because it is camouflaged by the outer envelope coming from the cell it has parasitized, and whose composition is considered as something known by the cells it wants to infect. That is why it is allowed to pass. At least, it’s mind-boggling. It is not a matter of frivolity, but it is undeniable that viruses, by “their great cunning”, have earned their existence.

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When the viruses have formed, they are expeled by the cell to continue their colonisation. The New York Times

Viruses work very fast and exploit the cellular machinery to the fullest. Such is the amount of virus that can accumulate in the cytoplasm of an infected cell that it ends up dying (we are talking about millions of viral particles). It simply explodes and dies. This is the real damage of viruses, this is how they kill the cells and, in the worst cases, they even kill the whole organism. When a cell dies, its contents are dumped into the extracellular space, including various molecules such as cytokines, which are responsible for triggering the immune response.

The effects of the virus on the body

SARS-CoV-2 has an advantage over SARS-CoV-1 of 2003: that it can be dispersed very effectively during the prodromal period, the time when initial symptoms (such as the dry cough) develop, which may explain its enormous spread. This already informs us of its high reproducibility in the upper respiratory tract. However, the virus tends to descend through the respiratory tract towards lower areas, causing pneumonia in the worst situations. Here it can also replicate, which is why the X-rays show lung spots as a consequence of the presence of the coronavirus. If colonization is not stopped, the risk population groups develop a very serious diagnosis at an alarming rate, already suffering from acute respiratory distress syndrome and rapid deterioration.

SARS-like viruses tend to trigger cytokine bursts in the human body, so the coronavirus 2019 is suspected of doing so as well. Cytokines are a large family of molecules, many of which are pro-inflammatory, that are secreted by cells in the face of infection. The ultimate goal is to trigger the immune system to attack the invader and the cells it has infected through a variety of procedures. But there is a problem: in the face of an excessive siege, this system can get out of control and attack all over the place with little distinction between healthy and infected cells. In other words, it practically becomes an autoimmune reaction.

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The lungs of some patients who have been infected with the new coronavirus look like this. These spots or opacities in the lungs are the organic damage caused by the virus. Yahoo

This cellular massacre results in the accumulation of a huge amount of detritus and cellular debris in the organs, which can affect healthy cells in a harmful way. In the case of SARS-CoV-2, the organs most affected will be the lungs. In this context, the problems do not cease to occur: if this is not reversed, the alveolar cells of the lungs will continue to die and, consequently, the lungs will progressively lose capacity. This is why scientists are detecting patients who, after recovering from the disease, have 20% to 30% less lung capacity, since part of their lungs have been destroyed during the infection (they have pulmonary fibrosis or hardening), losing functional surface and elasticity. In this phase of the disease, patients need to be connected to a respirator.

All of this physiological damage to the lungs can lead to the permeation of the membranes that connect the alveoli to the blood vessels, which allow the exchange of CO2 and O2. Blood plasma can leak out and flood the lungs. Lung capacity is thus virtually incapacitated, the lungs can no longer perform their function and the patient dies. This filtration also has a side effect: the other organs begin to notice a lack of blood perfusion and oxygen and become impaired. Because of this and because of the already mentioned derangements of the vascular endothelium in some regions of the circulatory system, deaths can occur due to multi-organ failure (usually linked to previous pathologies that had already weakened these organs).

Another cause of death associated with coronavirus infection may be a weakened immune system. We have already mentioned that leukopenia have been recorded in some infected patients. The reasoning therefore is as follows: the virus consumes part of the body’s immune reserves. Consequently, these other previous diseases that some patients have find fewer obstacles to develop. To top it off, a weakened immune system facilitates invasion by opportunistic pathogens that can grow with fewer problems in the body. Even the microorganisms that live naturally in us, which are normally beneficial to us and whose abundance is normally regulated by the immune system, are unleashed and become pathogens. There are known as opportunistic diseases.

Coronavirus in the world

Case identification is problematic. The numbers of infected people are greatly underestimated, especially since many asymptomatic patients are not taken into account. However, as the WHO has already warned, mass testing is one of the best ways of tackling this problem. The more health certificates are available, the easier it is to know where new outbreaks may occur and to follow the chains of infection, as well as to prevent all those who have been in contact with someone who is infected.

As of 24 March 2020, 398107 infected people in 169 countries (87% of the world’s sovereign countries) have been counted since the beginning of the pandemic, of whom 17454 have died and 103334 have been healed. These are cumulative values, i.e. all cases since the beginning of the pandemic in December 2019 are taken into account. If the numbers of infected people are frightening, it is better not to imagine the level they would reach if we added the asymptomatic people… But it’s not all bad news. The number of healed people is a bright light of hope. Taking into account these data, 25% of the sick have already been healed, and “only” 4.4% have died (which coincides with the mortality rate we have mentioned in the table).

The top 10 countries with the highest number of cases as of March 24th are: China (81591 cases), most of them concentrated in Hubei province, Italy (63927), United States (46805), Spain (39676), Germany (31370), Iran (24811), France (20149), Switzerland (9117), South Korea (9037) and United Kingdom (8160). On the other hand, these data are very interesting because of the other information they give, that is, the effectiveness and speed with which the different countries have introduced the measures they have considered appropriate to stop the number of infections and the seriousness and discipline with which the population is taking the crisis. Ultimately, this is what determines the classification.

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The map produced by John Hopkins University, which is constantly being updated, shows the cumulative cases from the start of the pandemic to 24 March 2020. The graph in the lower right corner shows the exponential growth in the number of infections. John Hopkins University

There is a truly interesting project of international cooperation which, by studying the slight genetic differences that the virus has developed in patients from different parts of the world, has been able to establish the travel route of the coronavirus. In this way, its tracks can be followed to the initial points of infection. As can be seen in the map below (to explore the interactive version, click HERE), the infections in Europe and the United States originated mainly in China, where the pandemic started, as well as in several countries surrounding China, Southeast Asia, India and Australia. The Old Europe has also become a major export site for the virus, not only within the boundaries of the European Union, but also to other continents, such as the Americas (especially South America) and Africa, in which case all cases reported there so far have originated in Europe. It should be noted that the data in Africa are biased, as cases have been reported in many more countries.

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Global situation reported as of March 20. Nextstrain

There is another important issue to be addressed in this section. A few weeks ago (although it can still be seen swarming the Net), the media gave a boost to a study signed by Chinese researchers which concluded that there were two strains of SARS-CoV-2, L and S. The more aggressive, L, would fortunately hardly have expanded, remaining confined to China. The one that is currently running around the world would be the milder one, S.

Well, this is the perfect example that shows the strong criteria that we must have in situations like this with all kinds of information. It is necessary to read as many sources as possible to contrast the avalanche of data that reaches us. The urgent need to find answers to something completely unknown can lead to hasty conclusions, which is what has happened here. This study has been intensely criticized by other scientists for the precocity of its conclusions. So the most recent results (which can be seen represented in the map above), after analyzing 529 viral genomes present in patients around the world, have dismissed the existence of two strains. On the contrary, SARS-CoV-2 has really changed little since it appeared, and no more aggressive strain has emerged so far.

Mediatization and misinformation

Many still wonder today if we’ve been told all the truth about the coronavirus or key information is been hiding from us as seems to be deduced from the South China Morning Post‘s statements about the real date the epidemic started. Especially at the beginning there was a feeling that the problem was more serious than it seemed at first glance. A suspicion that was accentuated by the unexpected death of Chinese ophthalmologist Li Wengliang by coronavirus infection, one of eight doctors who reported on social networks in late 2019, shortly before the Chinese government made the epidemic official, the appearance of a new SARS-like coronavirus in Hubei Province. His government censured him and arrested him for “spreading rumors” that, in the end, were not. The doctor was young and had no previous known pathologies. It seemed then that the virus was more dangerous than it seemed. However, even so, for most of January, rulers, spokespersons and journalists were determined to reduce its importance in the face of the seasonal influenza, “clearly more critical”. While we were being told this, China was confining people to their homes, quarantining tens of millions of people, running out of masks and gloves, building hospitals in little more than a week to accommodate the growing number of sick people who were collapsing the health system, and all because of a germ that was kinder than the flu? Now, as we know, we are experiencing the consequences of that carefree…

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The brave doctor Li Wenglian challenged the Chinese government by revealing information about the mysterious virus that was turning his country upside down. He ended up being arrested by the authorities. The image shows him intubated in one of the last photos taken of him alive. Weibo

There are many conspiracies around the coronavirus, and we have already discussed some of them. The most successful are those that advocate the existence of an obscure pre-established plan that the elites are managing to carry out.

In this context, there is an enigmatic novel in which the current pandemic is supposedly predicted in such detail that the author would even have been right about the origin of the virus that causes it. The dystopian book is called The Eyes of Darkness, and was published in 1981 by American writer Dean Koontz. One chapter discusses the Wuhan-400 virus, which was allegedly manufactured in laboratories outside Wuhan from 400 strains of artificially created microorganisms. It is described as the perfect biological weapon, since it would allow the destruction of a city and even a nation in a few days. However, several nuances need to be added: first, this part of the novel was not originally set in China but in the Soviet Union, and the virus was called Gorki-400. It is not known why, but at the end of the 1980s some parts of the work were modified, including the part that talks about the pandemic. On the other hand, the characteristics of the deadly man-made virus differ substantially from SARS-CoV-2: the fictitious virus kills its host within 24 hours without exception, it can barely survive for one minute outside the human body, and so on. Be that as it may, it is a somewhat lurid coincidence, like the one in the novel that predicted the Titanic disaster…

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Dean Koontz’s best-selling science fiction novel speaks in editions published from the late 1980s onwards of a highly destructive virus nicknamed Wuhan-400. If you have a copy, it wouldn’t be a bad time to sell it. On the Internet, people is asking for astronomical figures for it after this coincidence became known. Espacio Misterio

Another issue that has been highlighted is the disturbing simulation in which the Davos Economic Forum took part in October 2019, two months before it all began. The hosts of the simulation, known as Event 201 and held on October 18 in New York for 4 hours, were the John Hopkins Center for Health Security, the Davos Economic Forum and the Bill and Melinda Gates Foundation (as a curiosity, Bill Gates himself also predicted in 2015 that the next catastrophic event that humanity will face will be nothing but a virus). As we can read on his website, it was carried out:

“A high-level exercise in pandemic preparedness and response. […] The exercise will bring together business, government, security and public health leaders to address a hypothetical global pandemic scenario.”

The aim was basically to reproduce an exercise in intergovernmental and private-public cooperation to cushion the economic impacts associated with a hypothetical pandemic, which they called “event 201”, bearing in mind that humanity is faced with nearly 200 epidemics every year.

For their scenario, event 201, they envisioned a pandemic caused by a new coronavirus that at the end of 18 months would leave a trail of 65 million deaths before an effective vaccine was found or after 80 to 90% of the world’s population was infected. At this point, the virus would have become an endemic disease like influenza. It would be born in Brazil, jumping from bats to pigs and from pigs to us. It would be able to spread from person to person easily and people with mild symptoms would be the main cause of the rapid spread of the germ.

The similarity it bears in several details to the pandemic we are suffering from is certainly disturbing. These similarities caused many people to demand explanations from the John Hopkins Center, which quickly issued a statement denying any connection between its simulation and the current pandemic. What is clear is that this type of exercise does not seem to be very effective: each country acts in its own way and without following common guidelines. And the scenario that was being considered here was infinitely worse than the real one…

And of course, another successful conspiracy that quickly goes viral is the one that advocates the existence of a cure that powers are not interested in bringing to light in order to do business with it. However, here we have to be categorical, mainly to not play with people’s hope: there is no effective remedy against coronavirus 2019 so far. Right now, scientists and laboratories around the world are in the middle of a medical and scientific race to find the vaccine or antiviral that will end the coronavirus. All the charlatans who claim to have found the cure miraculously are frauds. Neither the lemon nor the baby’s urine are going to prevent us from getting the virus. If it were that easy, no country would have had to close its borders and the virus would not have spread so far. Let’s not encourage viral informations that run through messaging services and social networks, the vast majority of them are fake. Let’s not encourage the scoundrels who want to profit from other people’s anguish; on the contrary, let’s cut those chains of messages by not sharing them, contrasting the information and alerting our acquaintances to ignore them.

We have to be very careful, because misinformation carries fear. Likewise, and as we said before, we must be very critical with all the information that reaches us now, even that which comes from the media. Caution and judgment are the best vaccines against misinformation.

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The industrial stagnation of the world does not bode well. Several economic analysts have long warned that we are approaching a severe economic recession, equal or worse than that of 2008. The pandemic may be the missing event to blow everything up… Nueva Revolución

Another important facet of this pandemic that deserves to be treated briefly is the geopolitical strategy carried out mainly by China and the United States, which is really the continuation of a succinct war based on the use of economic instruments and toxic propaganda that has been going on for a long time. The Asian giant’s rivals have benefited relatively well from this crisis. China’s rapid expansion in all areas (although especially in technology) to meet the objectives of the “China 2049” plan and become the world’s leading economic power threatens the hegemony of the Western World, and more specifically that of the United States. All these cross accusations about who is really to blame for the pandemic fall within this context.

Also the smear campaign that has been launched against China, which furiously highlights all the mistakes it has made and its dictatorial way of managing global crises, and which the United States took advantage of to be the first country to close its companies on Chinese soil.

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The geopolitical war between the United States and China is more alive than ever, and the viral pandemic is yet another throwing weapon to determine who will achieve world hegemony. In the picture, the General Secretary of the Communist Party of China, Xi Jinping, and the always controversial president of the United States, Donald Trump. THOMAS PETER-POOL/GETTY

China has taken a serious setback that has significantly crippled its future plans. For example, all the investments it had intended for the American continent, many prepared for countries in South America that are diametrically opposed to North American neoliberalism, have been slowed down. However, the manufacturing and service sectors, which together account for more than half of the country’s Gross Domestic Product (GDP), have been the most damaged. This is obviously taking its toll on the rest of the world, especially as China is an active player that is fully integrated into the global economy, and on whose production chain, tourism and exports a large number of regions, including the European Union, depend. The situation is really serious: it is estimated that 5% of world GDP will be lost. That does not sound like much, but let us bear in mind that this 5% is equivalent to three billion dollars. Such has been the industrial standstill, that pollution has been substantially reduced in Chinese territory. However, the benefits that the United States will obtain in the short term will be very relative. The country of stars and stripes is currently facing the coronavirus on its own territory, while China has already begun to recover. In fact, it has reached third place as the country with the most cases of infection in a very short time. On the contrary, these potential benefits must be analyzed from another perspective: that of debt.

The World Bank and the International Monetary Fund already have credits ready to rescue countries in need after the pandemic ends, which does not bode well. The dominance that Washington has in these entities is well known. Therefore, the compensation that the indebted countries will have to give will clearly respond to US interests in order to improve their situation on the world’s game board.

Final thoughts

In situations like the present one, it is when the best and the worst of the human being is manifested in its maximum expression. The indiscriminate looting of masks and disinfectant gels and then of supermarkets and the lack of maturity on the part of all those who do not comply with the rules of isolation by travelling or joking about the pandemic is contrasted with the solidarity of those who offer to help others in the best way and with those who comply strictly with the isolation that, fortunately, are the majority, as shown by the images of empty towns and cities in countries that are in a regime of confinement.

True heroes deserve a special mention. Those who are on the front line sacrificing everything: sleep time, their energies and, of course, their physical and psychological health. It is not easy the work in which, especially now, they are surrounded by people who have expired their last breath or are about to do so, of patients anguished by their unpredictable becoming. Nor is it easy to be behind a cash register watching hundreds of people pass by every day putting their healths at risk, for other reasons because the looters we spoke of before have ended up with the basic individual security elements that are now essential for these groups and that the administrations are unable to replace.

For many of them it is the battle of their lives, which they do not abandon even if they have the enemy inside or if they are neglected by the administration. Because many of them are being mistreated: if not because of economic cuts in the public sectors, it is because of the lack of means of individual protection, which leaves them completely exposed to the disease. Putting up with the incompetence of those at the top is very complicated, elemental culprits in the chaotic situation that their respective countries are now experiencing because they have taken logical decisions late and wrongly.

They don’t wear cloaks, shields or metal suits. They don’t need them either. Heroism is more abstract than that. It emanates from their health suits, from their police and military uniforms, from their fatigue and sweat. You can see it in the gleam in their eyes, which translates into a personality that does not know surrender, in the tired smile, that of the brave, that of the warrior who will never kneel on the ground and who stands firm in the face of the opponent’s blows.

We all know who they are. And that’s why, because we know them, we have to thank them by helping them. We have to offer them that hand on the shoulder that they all need. Let’s listen to the authorities, let’s reason and let’s not be overcome by fear and anxiety. Let us not be foolish and let us remain isolated, restricting interpersonal contact as much as possible, so that this tragic episode becomes history as soon as possible. Let us put our ego aside and think about the sacrificed heroes, those who are in the hospitals, driving the ambulances, guarding the streets, maintaining the supply chains, those who are exposed daily while they go to their works, those who are working on the upcoming vaccines, those who are teaching from their homes, those who are strictly complying with the isolation measures, those who are manufacturing, out of pure solidarity homemade means of individual protection for the people that need them, because they also have limits. Let’s not give them more work, they don’t need it. They are the ones who will ultimately erase the nightmare, the ones who will restore normality again, so we must support them.

From Periérgeia, we give heartfelt thanks to the heroes. Redacción médica, Gorodenkoff, Larioja.com, Efe, ABC, Diario Información

The population is not only facing a virus. There is another equally or more damaging pandemic that was born alongside the viral one: that of misinformation and fear, in which not only unscrupulous individuals have played a fundamental role by generating and facilitating viral chains of fake news on social networks, but also the official media. The latter, through the occasional dissemination of hoaxes (i.e. that the coronavirus is little more than the seasonal influenza) and the information bias (how many times are we informed of the number of sick and dead people and how few we have been informed of the healed people, which are the majority), have broken all the rules of journalistic honesty and civility. This role, that of fear ambassadors, has been repeatedly denounced by several expert epidemiologists and virologists in vain. Because fear has already spread among the population, as shown by television, that extremely repetitive, tedious and obsessively pessimistic instrument that never tires of stressing on the negative. Did you know that psychologists recommend reducing daily exposure to the news in order to reduce the despair and negativity already produced by home confinement?

The coronavirus pandemic is a test. We need to pay attention to its oracular nature, for it is warning us of what may come and what we are doing wrong. There are much worse pathogens than SARS-CoV-2, not to mention climate change, which is closely linked to these health emergencies (much is said about the unpredictable consequences of those dormant viruses living frozen in the permafrost of Arctic regions that are melting due to global warming). The current situation is worrying, but what may come is terrifying. If we are being overwhelmed by this pathogen, in part because there is a worrying lack of global coordination, what will happen when more lethal diseases come? What would have happened if Event 201 had become a reality?

Many people think Gaia can’t take it anymore. She is running out of patience. We are poisoning her, extinguishing her children, exhausting her. We, Cainite traitors, show our gratitude to her for giving us food and shelter for millions of years in that way. Her immune system has already detected the threat, and it has been activated to teach us a lesson, either in the form of natural disasters or in the form of epidemics and pandemics. It is time for reflection. We are approaching the tipping point, and when we cross it there will surely be no turning back.

Humans, those innate irresponsible beings who blames others for his own mistakes, have already looked for a culprit. We have already mentioned the possible candidates for being the original reservoir of the virus: bats (which have always been blamed for all sorts of evils in a superstitious and obsessive way), pangolins… But who is the real and ultimate culprit of the latest epidemics? Who has been the one who has massively deforested and urbanized ecosystems? Have we not been the ones who have broken and modified the relative isolation of these zoonotic germs by opening up paths that bring them closer to our societies?

This new pandemic is yet another repetition of an episode that has occurred many times since the Neolithic. HIV, cholera, West Nile virus, avian flu, MERS, SARS-CoV-1. These are all cases of zoonoses transmitted from wild animals to humans and whose ultimate cause has been the increased interaction with them, either because we have destroyed their homes and forced them to move to urban environments or because we have based our economic and consumer activities on them. It is estimated that 60% of human infectious diseases are zoonotic, but if we add emerging infectious diseases such as SARS-CoV-2, that value increases to 73%. Let us be clear: global anthropogenic change is behind the vast majority of them, including the current one.

We needed the coronavirus to realize how fragile are the pillars on which our civilization is based. How the global market suffers from a tiny being. How we lose our humanity and how quickly we unleash chaos in response to something that really  hasn’t been the worst thing that ever happened to us. We laughed at ancient civilizations. We saw them as weak and unstable compared to ours, the global civilization, the wisest and most unwavering. Well, an extremely simple being is proving us wrong. Our civilization is in potential danger of being wrecked, like those that preceded us, those that were supposedly worse.

Let’s be smart. When this storm passes, let’s not forget it, let’s not let it go down in the annals of history as just another episode in human history. Let’s learn from it, because the ultimate cause is us. It is forcing us to look at ourselves in the mirror and to strip away our true personality, that shadow that hides behind appearances and propaganda with which we convince ourselves. However, the question is forced… will we ever learn?

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