Covid 19 Transmission
Viruses are not bacteria; so thinking of one in terms of the other means you will misunderstand the principles that needs to be understood. It’s a bit like following the lifecycle of whales and expecting it to apply to ants.
The key is the mechanisms of transfer. You do get the feeling that people are employing precautions against bacteria when dealing with this virus, and putting the rigourous procedures against minor risks of transfer while freely allowing major ones. One thing that is notable is the risk from proximity compared to the risk of contact surfaces. Infected people have passed through many airports contacting hundreds, possibly thousands of surfaces that other people subsequently contact, but there ae very few widespread outbreaks because of this, most of them being traceable to being in the presence of an infected person. The second thing is what constitutes ‘cleaning off’ or killing a virus. Does soap and water or using hand sanitiser kill or damage a virus? Most research done in this area seems to concentrate on the effects on bacteria, then saying this also applies to viruses and will work in exactly the same way. Soap and water seems to have a similar level effect as sanitisers, but what level of bacteria or viruses is present in the waste fluids that are removed? Is it more likely that soap and water is a surfactant that stops bacteria and viruses adhering the surfaces, so that they gets washed away and not killed or damaged? Levels of alcohol required in sanitisers ranges from 60-85% minimum to be effective, a figure that quite often doesn’t gel with gel ones, and I’ve seen as little as 30% or even claims of non-alcohol based ones. Again, were they tested on bost bacteria and viruses, or are they simply based on assumptions? The logic goes thus: We’ve made assumptions and programmed the computer to work out the required parameters. The computer we programmed says using these parameters will make the product effective. We used those parameters to produce the product, so it is effective. 1+1=3, 3=3, therefore 3=1+1 and 1,000 computers can work this out a billion times as fast, so this answer can be calculated for thousands of different compounds rather than just a few, replacing a million people doing the same job. Except just 1 person would say it’s wrong.
A bacteria is a strong entity that can easily survive and move from one place to another without outside intervention. They can multiply freely from one entity given the right environment. Viruses are fragile and need other cells to survive and transfer. They overcome by force of numbers and trickery, needing a statistical significant amount to overcome opposing defences.
The typical understanding of transmission is in the form of the diagrams below:
or
but the reality is more like:
A group of exposures from a number of infected people leading to an infection when it passes an accumulated threshold.
Viruses seem to go more on a statistical transmission by the number of exposures. One entity of a virus can infect, but it is quite unlikely, usually needing a number of exposures of a number of entities at various points.
The severity has a 1st factor of the number of times a person is exposed.
Its likely that there are a larger number of people who have been exposed to the disease, but haven’t actually gone on the develop the disease as they have not had the significant number of exposures for the bodies systems not to combat it. They are in the grey area of having the potential for developing it but not developing it through lack of entity numbers. Although this will give a small protection and possibly raise the threshold for infection, but they would not have immunity if exposed to larger numbers. All it needs is more people and transfers to do this.
The sign of this are in the potential contacts people have in their occupation, where people who meet quite a few other people generally in their work accumulate to push them over a dangerous threshold. This means that occupations such as Taxi and bus drivers, ticket collectors, shop assistants, security guards, on call police constables and nurses would have a significantly higher number of accumulative points of infection. The higher the number of attacks the more severe the consequences.
The disease utilises the ACE2 enzyme that is in balance with the ACE enzyme controlling levels of angiotensin I and II. These enzymes are part of the Renin-Angiotensin-Aldosterone system that controls most of our body’s energy and fluid transfers. Knocking out of kilter part of that system has notable effects, and people with certain conditions already have the system less well controlled or impaired, that shows up in weight accumulation, type II diabetes and autoimmune diseases. It isn’t odd that one of the drugs to control this, the ACE inhibitor Lisinopril has side effects of dry cough, dizziness, high potassium levels, diarrhoea, low blood pressure, chest pain and fatigue and in young children the disease has some of the effects similar to Kawasaki Disease.
The main attack seems to be on the squamous epithelial cells that surround most major organs in the body, interfering with their repair and renewal. The squamous epithelial cells are flat to allow for more efficient chemical transfers, but they offer an easier target for this same reason, and a lot of that transfer goes on in the lungs, that have a large area of these cells and a high expression of ACE2. Other areas of the body have a lot of these cells holding them together such as the intestines, heart, kidneys and liver.
This will give a risk of the form below:
Job: The number of people you come into contact with during the day that can raise your accumulative exposure. Force of numbers, contact and re-contact with infected people increasing them at an accumulated rate to pass a threshold of infection.
Age As you get older things start working less efficiently, which usually starts at about 50 and increases with age.
Weight: The heavier you are and the higher the fat accumulation, the more you’re system is out of kilter and the higher levels of ACE2 and ACE to balance it, so the more there is for the disease to utilise and destabilise.
Diabetes II If you have diabetes type I, especially if it is not closely controlled, the higher the level of inflammation is possible from an infection to raise it above the threshold.
Poor autoimmune response The poorer your autoimmune system the less facility is available to fight off the disease, so the more likely it is to take hold.
Lung Impairment Its likely that people with lung problems through things like smoking have a higher level of infection in them. Asthma being an inflammative illness.
Blood group It’s likely that certain blood groups from around the world have been exposed to similar viruses in the past. With a mixtures of races from different areas, some populations will have had less exposure than others overall and do worst for a new exposure. The likelihood is that this isn’t the first time that such a disease has ventured into the world, but its likely that only populations that are local to the area of emergence would have a complete advantage, other areas being such a mixture, some not being exposed at all, especially in higher latitudes on the other side of the planet. Those with a higher number of people with O rhesus positive and B rhesus positive seem to do the best. Countries with a higher number of rarer blood groups seem to fare worse than those with more common ones. A groups seem to do worse than B groups. Rhesus negative seem to do much worse than rhesus positive.
Sex Females have a greater tolerance to disease than males, shown by longevities in areas that have low attrition, but with changing roles this is slowly decreasing. In areas of high attrition the gaps are larger.
This would mean that the highest risk factor would be something like a 55 year old north European male security guard who also does part time work as a taxi driver or care assistant, is a heavy smoker and very overweight, with type II diabetes, having come recently out of hospital after heart problems and AB- blood would have a very high risk of developing serious conditions from Covid-19, whereas a 25 year old slim female in good state of health from China working as office clerk and her own transport, who has never smoked, with blood type O+ would have a very low chance.
The big problem is that the numbers are now out of control, there being 200,000 new cases in the world yesterday, so sooner or later, unless you basically stop your country trading for a very long period, with the potential for far even more dire economic consequences, everybody will be exposed to it in suitable numbers to infect substantially. If an effective vaccine is found, due to the number of cases and therefore possible mutations that it may only be partially effective, we may also find that as it is a new virus to the world it may only be effective for years or even only months.
We have influenza vaccines that have been around for about 85 years, in general use for maybe 30, and really effective for 20, but there has never been a coronavirus vaccine, and influenza vaccines need to be updated each year given around 25 million cases producing a set number of new mutations. Covid-19 has almost reached this number already, with the likelihood of many times that number to produce potential new versions, possibly resulting in needing a new version of the vaccine each month or week.
We have treatments that are better than in previous months, but things like remdesivir take 6 months to produce, needing precise and something like 25 stages and interactions at temperatures like -78°C. Get it wrong and you need to throw away the whole batch.
A lot is made of possibly up to 1/6th of the population of the UK having has exposure to the disease, but as there have been 300,000 cases out of a population of 67 million and all the contacts that happened, its likely that virtually everybody has been exposed at some time, some producing a small amount of antibodies or antigens, but given an exceeded threshold would still develop the full level with the defences producing little effect above not being previously exposed.
World Situation
We have a few countries that seem to have concentrations of cases that give some indication of the potential infection rates that may happen. Qatar has a recorded level of 4.26% of the population having been infected, Bahrain 3.16%. Other large countries have recorded about 2% and the UK is currently 0.5%. Unless the figures are based on different strains it suggests that the minimum known to unknown cases is 1:23
Conducting a thought exercise in the mechanics of transmission I thought of something like a car boot sale and how the participants can be affected. Touch transmission is probably negligible compared to proximity transmission, especially if you were out in the open where viruses would have a very bad time on surfaces. Take a typical car boot sale with 200 cars and 2000 visitors. Each stall would be pretty separate to transfer between each one would be small, but each table would probably experience at least one visit on average for each visitor. So we would have say 2 people in each car totalling 400 with 2000 contacts against 2000 people with up to 400 contacts. The numbers would be the same of course, but each of the stalls would have 5 times as many different contacts and possible contaminants or risks as the visitors. It also goes on intention, but most unless things are poorly presented most people will take away that which they touch and out in the open transmission by touch will probably be small due to the number of people who are interested in the same things and touching such. The problem would be for touch is the money that would change hands at least a few times.
The flow of people around generally would mean that shuffling would incur an additional chance for each person of contact, most people keeping separate except to view, but the end result would probably be a risk of 4 times having a stall as passing. This also applies to other areas as shops and transport in close proximity so it would be an interesting exercise especially for occupational accumulation rather than the view of one contact producing an infection, more of the view of accumulative thresholds.
Conducting a thought exercise in the mechanics of transmission I thought of something like a car boot sale and how the participants can be affected. Touch transmission is probably negligible compared to proximity transmission, especially if you were out in the open where viruses would have a very bad time on surfaces. Take a typical car boot sale with 200 cars and 2000 visitors. Each stall would be pretty separate to transfer between each one would be small, but each table would probably experience at least one visit on average for each visitor. So we would have say 2 people in each car totalling 400 with 2000 contacts against 2000 people with up to 400 contacts. The numbers would be the same of course, but each of the stalls would have 5 times as many different contacts and possible contaminants or risks as the visitors. It also goes on intention, but most unless things are poorly presented most people will take away that which they touch and out in the open transmission by touch will probably be small due to the number of people who are interested in the same things and touching such. The problem would be for touch is the money that would change hands at least a few times.
The flow of people around generally would mean that shuffling would incur an additional chance for each person of contact, most people keeping separate except to view, but the end result would probably be a risk of 4 times having a stall as passing. This also applies to other areas as shops and transport in close proximity so it would be an interesting exercise especially for occupational accumulation rather than the view of one contact producing an infection, more of the view of accumulative thresholds.
It has been obvious there is an upturn in cases since the start of August by anyone following the numbers. It is also obvious that it will return time and time again as there has been a consistent increase in the world, and we can’t keep ourselves isolated forever and survive economically.
Because nothing has been done in the world as a whole, dealing with it locally and piecemeal, it is now academic about catching the disease. Sooner or later everybody probably will. The numbers also give that unusual mutations will probably occur. We may be lucky that the main strains become more benign, but it’s a 50/50 chance they won’t and may become worse.
An effective or long-term vaccine may or may not appear, infections may or may not give little more than short term immunities, and it is pretty sure such things as obesity, serious medical conditions, blood grouping, occupation, social habits and advancing age leave you more susceptible if exposed to it time and time again. All give a risk factor, and the more you have, and the larger the factor, the bigger the risk. It’s a numbers game with thresholds that are advisable not to exceed.
For people under 50 years old the risk is generally quite small, being very small under 30, but the risk is still there. And the risk will increase as they get older, depending on how it plays out.
We have had a lock down of everybody, but we are still in a level of restriction, and the people who are still being very cautious are the older groups, so with the young going on seemingly as if nothing has happened, they will show the highest rise in cases and depress the mortality figures as there is little risk to them. If you go out an about and observe how people are currently interacting or restricting, being conscientious about wearing masks, and being slightly more cautious, there is a definite difference between age groups and personality types. Some are very cautious, some just cautious, some indifferent, some merely going through the motions and some blaze and arrogant, as if they are daring the virus to come near them. If you go out you see lots of groups of younger people associating with other groups, and schools and colleges are back. It’s true for them the risk is very small, but they might incur passive infection for other people they care about.
So, the numbers in the young will rise and mortality will decrease as its not filtering to the older people yet. The risk to school level pupils is tiny.
We mustn’t go on as though nothing was there, but we must also realise that it is only a matter of time before we get it. Everybody is waiting for a ‘get out of jail free card’ with the vaccines that may become available. And getting the disease may or may not give longer term advantages and certain levels of short-term immunity.
It still up in the air what will happen, with being infected early having advantages, and being infected late having advantages, depending on the type of mutations.
On a level of probability its better to be infected as late as possible, as there is more time to pick and choose, and multiple vaccines and ones modified for new strains hopefully should become available.
We have passed the time of containment, all we can hope for is management. So our economy has to be tailored as such. A more restricted life for those at risk, work for those not. But those at risk will need to appreciate more solitary pursuits, getting out in the open air more, but not with large groups around them or busy places. Associations will need to be more within age groups with younger people testing more often. I can envisage such things as younger and older coffee shops, below 50’s and above 50’s taking off. Nursing and residential homes will need to change to older staff, not having so many younger ones, or ones that do not have a busy social life.
Cheap and quick testing is a must and vital. Tests are still expensive, but economies of scale should bring them down. We don’t need complete accuracy and therefore expense, but we need to appreciate their limitations, and even a 75% accurate one would be adequate if uses regularly. As I said previously, everybody will probably catch it at some time and it’s a numbers game. But those who decide to take the risk anyway must be allowed to do so, but not necessarily associate with those that don’t. If you’re young then it doesn’t really matter how many of your own age group you mix with as long as you don’t mix with people a lot older or at risk.
If you’re older, especially over 50, then mixing with people who do not restrict makes associating with you a risky proposition.
Our current situation is probably going to now be the norm for the next decade, so we need to tailor the economy to match. But we need to lose our anxiety and not let it run rife and out of proportion, thinking anybody who comes close as a serial killer with an axe.
Enlarge our personal space, but realise that people go through it. Just try to reduce that number where possible, not eliminate it, as that way lies anxiety and conflict. If you project everybody as an enemy, they become an enemy, and aggressive action promotes aggressive responses, you being the problem, not them.
Sir John Bell’s was is the first really sensible appraisal of what is happening. The battle against not catching the current Covid-19 or a mutation of it is very likely over. The numbers are increasing in the world too much and reoccurring in every country. There is still the problem that because there haven’t been massive instant deaths, the people who claimed that there was no problem and still claiming it’s just a bad cold, still think it’s a conspiracy. Nearly a million dead in six months, and still continuing is just a myth to them. Every doctor is also in on this conspiracy.
Comparing seasonal flu, flu its estimated kills up to about 600,000 in a full year, so at a very minimum Covid-19 is about 4 times as bad. But that is based on about a billion people suspected as getting it. Not a tenth of that number. The number who have caught the disease so far could be as low as 50 million, a long way to go. Estimates of 10-100 times that number are opinions, and not backed up by events, numbers or the stats.
Despite the small setback with the Oxford Vaccine the vaccine isn’t off the cards, and developers need to be extra cautious, hence the delay if there are any problems. Rushing things to be the first, or bringing out one without going through all the processes, at best it may be ineffective. At worst it will be worse than not having one, with people thinking they are immune and aren’t, so not being as careful, or having a possibility of making people more ill than they would be without it, and actually increasing mortality. While this may seem like pandering to the ‘anti-vaxxers,’ apart from a few badly checked ones, in nearly every case the odds are in favour of vaccines. People who have them doing better on average in every case by a factor of 50:1. One death from an adverse reaction for every 50 who would die if they had the disease.
We live in a blame-orientated society where things still happen, and people don’t like the idea that nobody is to blame, things just conspire to make them happen. Medical people are gods and infallible, so it shouldn’t happen.
AstraZeneca has one of its biggest packing sites at Macclesfield, but there seem to be a lot of signs that its moving most of its production to France, so I’m not sure how it will affect the 30 million doses of an unknown vaccine quantity and formula, but its likely that even if a vaccine proved ready tomorrow it would take 6 months at least to supply it. At best I would think that my original estimate of 18 months I made in march is still in the ballpark.
With the Russian vaccine, it worries me. Too fast, too soon springs to mind. If the best can probably only manage 18 months, the Russian researchers must be 3 times as efficient and good as the best in the rest of the world. Or willing to take short cuts, you decide.
As Sir John says the priority is testing with an aim to reducing the stats, 100% or 99% accuracy being pretty meaningless in this situation. Accuracy costs a lot of money, with private testing costing as much as £300 to be 99% accurate, of what?
A £30 70-80% accuracy test that will suggest the likely result is what is required. Even at 70%, two tests two weeks apart would produce a 80-90% result if similar.
With the numbers currently happening, and the possibility that either there is a lessening of immune response or blood based antibody sensitivity, an antibody test to tell if you’ve had it becomes irrelevant. A quick cheap swab test that anybody can apply and get at least some accuracy, even at 70%, is what is required to personally isolate, or at least take more care. If we had that, with some restriction on distancing and mask wear, we would stand a chance of weathering it until some form of scientific method is found. Without it we are open to just letting it take its course and hoping for the best.
Somebody asked why there is this difference between people who are seriously ill and people dying from the disease? Its a question of process flow. About 10% of people will suffer a more severe reaction to the current main mutation. Of those 10% will become so severe that the person dies. This means that at any one time you will have about 1% of people who are in real danger of dying. The whole infection seems to take about 28 days with about 5 days before realising you have the disease and going to severe then death within about a week. So you will have people coming into that area and people leaving it because they have died over a period of about 2 weeks. So a rough estimate would be about 14 times the current serious/critical levels plus possibly 10% for long term deaths. So if you had on average 100 people who were serious enough then you would probably get 1,400 plus 140 totalling 1540 people dying long term.