– By Dr Hassina Kajee, Specialist Physician and Medical Director of the Nutrition Network
As the outbreak of 2019 novel coronavirus diseases (COVID-19) in Wuhan, Hubei Province, China spreads swiftly across the globe, we as a global nation are realising the potential and actual devastating effects of this infection.
Many of us, doctors and laypeople alike, are struggling to comprehend the enormity of this pandemic because few of us were alive in 1918 when Spanish flu brought the world to its knees. My great grandfather-in-law, sadly demised at that time, leaving behind a young pregnant wife and an 8 year old daughter. He was in his 40’s and it seems he had ‘weak’ lungs.
I am sure there are many people who remember a relative who was affected by Spanish Flu. Spanish flu had an estimated fatality rate greater than 2.5% and around 50-100 million people worldwide. The world has not seen anything like this since.
Education empowers. When we know what we’re dealing with, we can plan, prepare and avoid panic.
What is a virus?
Viruses are the smallest of all microbes. They consist of genetic material, either DNA or RNA. Viruses are obligate intracellular parasites: they must enter a cell to reproduce in order to make more copies of themselves. They then use the host cell’s machinery to replicate and use the host cell’s cell membrane to make a membrane around itself and effectively to go into ‘stealth mode’. In this way, they are able to infect more host cells while remaining relatively undetected by the host.
Coronavirus is an RNA virus similar to SARS virus and distantly related to MERS virus.
Thus far, from phylogenetic studies in China, two different types of COVID-19 have been identified, type L (accounted for 70% of cases and the one that predominated in the early days of infection in Wuhan), and type S (30% of cases.) The clinical implications of these findings are as yet uncertain.
How is coronavirus transmitted?
Coronavirus was transmitted to humans via an as yet unidentified animal source. It is transmitted from human to human via droplet spread.
It can be transmitted either from direct contact, as in when an infected person coughs. The saliva will contain viral particles.
“A typical cough starts with a deep breath, followed by a compression of air in the lungs and then a crackling burst as that air is forced out in a fraction of a second.
The average human cough would fill about three-quarters of a two-litre soda bottle with air — air that shoots out of the lungs in a jet several feet long. Coughs also force out thousands of tiny droplets of saliva. About 3,000 droplets are expelled in a single cough, and some of them fly out of the mouth at speeds of up to 50 miles per hour.”
Transmission can also occur when the particles expelled by the cough land on objects. This is referred to as transmission via fomites.
A new study has found that coronavirus can remain alive in the air for up to 3 hours, on copper for up to 4 hours, on cardboard up to 24 hours and on plastic and stainless steel up to 72 hours.
Therefore it is important to ensure social distancing and to wipe down objects with a solution of diluted bleach or alcohol before touching objects that may have been in contact with infected sputum.
It seems that pregnant women do not transmit the virus via the placenta (vertical transmission). In a small study of nine pregnant women in China, none passed the virus on to the newborn baby via the placenta. Also, all of the pregnant women in this study recovered despite having severe COVID-19 pneumonia. This is thought to be due to the protective effect of immuno-suppression during pregnancy,
How does it get into our bodies?
For a virus to be transmitted, it needs to get into the host cell. Viruses bind to the host receptor and are then internalised. These receptors have a role in normal cell function and are hijacked by viruses to gain entry into cells. The virus has been shown to use the same receptor as the SARS virus, the angiotensin-converting enzyme 2 (ACE2) for cell entry. This is interesting and thought to contribute as a risk factor for hypertensives who are on the drug class ACE-i or ARB’s as these drugs result in up regulation of ACE2 receptors in the lungs.
What does COVID-19 do once in the human body?
Once attached to the respiratory epithelium via receptors, the virus hijacks the cell’s machinery. It now takes over the machinery to produce copies of more Coronavirus. Once this happens, the cell is not able to continue its usual work. What’s worse is that once the virus is expelled from the cell, it will now:
- remain undetected because it is covered by the human host cell membrane
- infect many more of the same host cells
- result in the death of the cell it once infected
Symptoms of COVID-19 infection:
According to UpToDate, “The incubation period for COVID-19 is thought to be within 14 days following exposure, with most cases occurring approximately four to five days after exposure. In a study of 1099 patients with confirmed symptomatic COVID-19, the median incubation period was four days (interquartile range two to seven days). Using data from 181 publicly reported, confirmed cases in China with identifiable exposure, one modelling study estimated that symptoms would develop in 2.5 percent of infected individuals within 2.2 days and in 97.5 percent of infected individuals within 11.5 days. The median incubation period in this study was 5.1 days.”
What factors are associated with increased susceptibility to viral infection?
While the death rate in China of 2.3% has been thought to be an over-estimation because many young and asymptomatic patients are not being tested, it seems that the most susceptible are in the age group over 80 with people over the age of 60 also falling into the high-risk group.
This may be due to a suppressed or weaker immune system as a person ages, also because as a person ages, his/her response to infection may be less dramatic, often mounting no fever or systemic response. Thus the illness is often picked up much later than it would be in a younger person.
Certain people can be more susceptible to a virus due to polymorphisms in cell receptors. At the same time, for this reason, some people can be less susceptible to a virus.
Various factors contribute to immune suppression including being on immunosuppressive agents for medical reasons, being infected with an illness that causes suppression of your immune system (as in untreated HIV infection), being co-infected with another infective organism, bone marrow ablation as in those being treated for some type of haematological cancers, genetic immune diseases. Poor nutrition and chronic stress may also suppress the immune system.
- Nutrition factors
In this study, it was found that “Micronutrients such as zinc, selenium, iron, copper, b-carotene, vitamins A, C, and E, and folic acid can influence several components of innate immunity. Deficiencies in zinc and vitamins A and D may reduce natural killer cell function, whereas supplemental zinc or vitamin C may enhance their activity.”
Natural killer cells are a vital part of the immune system especially in the role against coronavirus.
- Chronic diseases
Another study included 1099 patients with confirmed COVID-19, of whom 173 had severe disease with comorbidities of hypertension (23·7%), diabetes mellitus (16·2%), coronary heart diseases (5·8%), and cerebrovascular disease (2·3%).
Other chronic diseases mentioned as high risk for severe disease was chronic renal failure, cancer, cardiovascular disease, cerebrovascular disease and of course, chronic obstructive airways disease (COPD)
While there is nothing we can do about our age or our genetics, we can have an effect on our epi-genetics’… the factors that cause genes to switch on and off. We can do this by making sure we get enough sleep, modulate our stress levels, eat a nutritious diet high in whole unprocessed foods and low in refined carbohydrates and preservatives; get enough sunshine to activate vitamin D and get a good balance of rest and exercise.
What we also know:
In studies looking at health care workers who had contracted the illness, it was found that:
Most came from one particular region and were thought to have been contracted from a home contact.
For those who contracted COVID-19 nosocomially (in hospital), through extremely thorough contact tracing, it was found that in many cases, COVID-19 was contracted in the very early days of the epidemic when people were not as aware of contact precautions.
Once better precautions were taken, it was found in one study that infection rates in healthcare workers had minimised drastically.
Young children and adults also seem to either get a mild form of the illness or are completely asymptomatic. However, it is important to note that asymptomatic carriers can pass this disease on to those more vulnerable with devastating results.
How should we handle this pandemic:
If you are in the ‘at-risk group’
It is best to practice social distancing while eating healthy food, resting and relaxing, knowing that you are doing your best to prevent illness. Disinfect hands or surfaces with 70% alcohol spray if you come into contact with a surface that you’re unsure of.
Enhance your immune system by taking extra vitamin C containing foods as well as Vitamin A containing foods like liver. In my patient group I suggest supplementation with Vitamin D3, Vitamin C, Vitamin A and iodine (in those without thyroid disease).
If you think you have had contact with someone who has COVID-19, call your central hotline for more information. If you start to feel slightly unwell (fever, cough, sore throat, myalgia, breathless), within 2 days of contact with an infected person or you suspect infection via fomites, call your hotline or seek medical assistance as soon as possible.
If you are not in the high-risk group
Do you best to limit the spread of this virus by preventing transmission. Clean hands with soap and water washing for at least 20 seconds.
Don’t visit grandma or grandpa unless it is to drop off their grocery shopping. Disinfect the food you’ve bought before delivery. Keep your distance (no hugging sadly).
To make social distancing easier on grandparents and families they may be missing, use Skype or send videos to remain in contact.
Keep fit by running or walking in nature. Keep mentally fit by being in nature while still practising social distancing.
Rest, sleep, play and eat nutritious food, specifically unprocessed food that is nutrient-dense.
It is wonderful to note that China has managed to dramatically reduce the number of new cases of Coronavirus infection by implementing good hygiene practices and quarantine. Today their new case infection rate stands at 39 with their daily case rate steadily dropping.
It is also important for us to note the economic impact that an uncontrolled outbreak would have. Many people are now forced to work from home, investors have pulled out of unstable economies and the downstream effect on that could be disastrous to the economy and make this period of quarantine longer and more difficult to recover from. By doing our best to limit spread and protect our vulnerable population, we will be doing our best not only for ourselves but also for the economy.
Overall, we can use this period to reflect and improve the way we live.
Eat more nutritious foods. Choose whole, unprocessed and low sugar foods.
Spend more time outdoors in nature.
‘Do’ less and ‘be’ more to be more grounded and better able to deal with stressful circumstances as they arrive.
Exercise for a healthy body and mind.
SLEEP soundly and enough to keep your immune system as healthy as possible.
PREVENT illness by implementing a healthier lifestyle before you are already diagnosed, especially if you are genetically predisposed to chronic disease.