I’m not a doctor and I don’t play one on TV but my father was a biochemist and he always said that infecting microorganisms are intolerant of an acid environment and that therefore one common-sense step people could take to reduce their susceptibility is to acidulate their system by increasing intake of acid foods (lemon juice, vinegar, etc.). I don’t know if that is a contributing factor, but he and I both have followed that practice and have largely avoided infectious diseases despite having systems that on their own are low-acid.
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@felixfelix Drinking lemon juice or some other acidic food doesn't alter the pH of your body, let along your lungs.
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@felixfelix I am a microbiologist and that is not good advice. I’m sure your father had good intentions but eating acidic food does not cause your system to be more acidic - nor would you want it to. Your body needs to stay at a very specific and controlled pH for many metabolic processes to work properly.
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@felixfelix My mother, in her old age now, has always believed in the benefit of inhaling heated vinegar vapor (she would put some vinegar in a small pot and heat over stove and then inhale the steam).
If what your father said has some validity, I wonder if this is something worth trying by the general population...
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People should better wear masks even though they are not sick in order to protect themselves against those infected spreading the virus which such persons do not know that they are carrying the virus, they can be anyone sitting next to you.
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@Tim Surgical masks do not protect you very well if you are healthy, especially since they may encourage you to put your fingers all over your face to adjust them, carrying virus to your face. They are important to keep coughs and sneezes IN. So sick people should wear them. And people caring for sick people should.
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@Carl Zimmer Will masks help to reduce transmission?
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@Tim 1. Masks saturate with moisture from our breath. They are not true barriers. 2. People often touch the mask to adjust it which means they keep touching their face defeating the purpose of the mask. 3. We need to leave the masks for those who need them, health workers, or there won't be anyone available to take care of those who are truly sick. Wash your hands all day long. Stay clear of groups and clean surfaces u use frequently including: ur cell phone, your car steering wheel and door handles.
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Though people open to this information already know it, a surprising portion of the public ignore, can't be bothered, or don't believe it. Young people in particular think it's not their problem. The problem of falsehood being equated with facts is another epidemic which has overflowed into our society's lifeblood.
I think this bears repeating, again and again. It's very simple, but apparently too many people dismiss the practice of normal hygiene:
"Infected people can avoid spreading the virus by wearing a mask, but healthy people do not need to wear a mask unless they are caring for a sick person."
"The best way to avoid getting infected with the coronavirus and other viruses is to wash your hands with soap, avoid touching your face, keep your distance from sick people and regularly clean frequently used surfaces."
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Hi Carl, can I get your sources in terms of publications? Nature and The Lancet are listed, but not the papers themselves. I'd like to read them.
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https://www.medrxiv.org/content/10.1101/2020.02.22.20025791v1.full.pdf A study by researchers in China has drawn a conclusion that “ The study found that, to certain extent, temperature could significant change COVID-19 transmission, and there might be a best temperature for the viral transmission, which may partly explain why it first broke out in Wuhan. It is suggested that countries and regions with a lower temperature in the world adopt the strictest control measures to prevent future reversal”.
The above conclusion seems to vindicate that the onset of summer and higher temperature in the Indian Sub continent may be the reason for the sluggish COVID-19 transmission.
I will appreciate your response.
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@N.G Krishnan The research on temperature's impact on SARS-CoV-2 is very preliminary and sometimes contradictory. The Yale scientist Nicholas Christakis pulled together some important aspects in this Twitter thread: https://twitter.com/NAChristakis/status/1235963915911286785
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The body makes a substance, alpha-1 antitrypsin which inhibits the enzymatic attachment of coronavirus to the bronchial epithelium. Smoking (anything) reduces alpha-1 antitrypsin and opens the door to the virus. If anyone was ever waiting for *the time* to quit smoking, it is now
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"Healthy people do not need to wear a mask unless they are caring for a sick person" Can you hear how ridiculous that sounds? How can you possibly know whether the person standing next to you, behind you, in front of you in line or on an elevator is infected???
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I'm sure even this comic book presentation is over Trump's head. His eyes will glaze over with boredom at the "Making Viral Proteins" stage.
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I have been working at this nursing home here in Norman Oklahoma for a few months now I have been sick for about a week not vomiting sick not nauseous per se but I feel real weak and my nose was runny for about two days and now it's like completely dry my head hurts all the time and I can't even walk up my stairs in my house without having to stop for like 5 minutes just to sit there and breathe and catch my breath it is kind of hard for me to breathe but then again I have been working 16 hour shifts and I'm just wondering maybe that there's a possibility I should go and be tested and how do I go about doing that just to be on the safe side?
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@Karrie Adkisson The main symptoms of coronavirus is a fever and a dry cough. You should contact your doctor to see if you should get tested. Here is CDC's advice page: https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html
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If the coronavirus binds to ACE 2, how do ACE inhibitors, like lisinopril affect the coronavirus infectious process?
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@Lauren I am not aware of any findings on that subject. That's not the sort of research that gets done in the first few urgent months of an emerging disease...
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@Lauren @ Carl Zimmer This Wikipedia article may be useful, but not encouraging: https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_2
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I'm 14 years old and I have three siblings. My parents came back from a trip from Seattle, Washington area. I'm scared that hey might have corona virus because my dad said he had chills and my mom was coughing a lot. I have had a stuffy nose and head aches ever since they came back and i'm scared. I don't know if I'm short of breath or any other symptoms, but my two sisters and one brother have been having the same symptoms as me. I'm only 14, so i'm probably not getting good information or understanding everything but I'm scared. I told my parents and they told me it's probably nothing. What should I do?
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@kinda scared Don't forget that we get lots of viruses every winter--cold viruses, flu viruses, and more. They cause some different symptoms and similar symptoms. The top symptoms of covid-19 are a dry cough and a fever. But I'm not a doctor--so talk with your parents and pediatrician about your health.
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If soap immediately destroys the oil outer layer that holds the protein, would using a simple soap+H2O mist spray help? How about a dishwashing detergent like Dawn, would that help destroy the virus. It is that oil base which protects the outter layer of the virus. How about salt and water?
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@indira There's no evidence that those techniques work. But there is lots of evidence that washing with soap for 20 seconds works.
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@indira @Carl Zimmer A dishwashing detergent like Dawn, which breaks down fats, should similarly break down the lipid envelope of the virus. Any soap you can use to clean a frying pan should be effective in breaking down the envelope of the virus. I have not seen any reports that the other techniques you ask about could be effective.
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Will 30 minutes in a sauna at high-enough temperature kill the virus?
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@Jamie hayes I have never seen anything about that, so please don't rely on that as a way to avoid infection. Wash your hands with soap, don't touch your face, regularly clean surfaces, keep your distance from sick people, don't shake hands--these are the recommendations from experts based on good science.
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@Jamie hayes @Carl Zimmer Washing your hands with soap works because soap breaks down the lipid envelope of the virus, similar to the way it breaks down the fats when you wash a frying pan. Like Carl, I have not seen any reports that heat that does not kill you will kill the virus.
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So, what is the decided nomenclature? Is COVID-19 the name of the virus, or is it the name of the illness caused by a SARS-COV-2 virus? Or vice versa?
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@Robin R. Covid-19 is the name of the disease. SARS-CoV-2 is the name of the virus that causes Covid-9. SARS-CoV-2 is a coronavirus--coronaviruses are a group of virus species that cause a variety of diseases such as SARS, MERS, and colds.
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@Carl Zimmer did you mean it causes Covid-19? Not covid-9?
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Carl Zimmer has done an excellent job managing this. There is a user-friendly Q&A from my colleague Todd Ellerin posted at the bottom of my comment that addresses some of the unanswered questions from this blog. I am a physician and microbiologist myself. A few small points:
1. While we are still learning about Covid 19 there is every reason to believe that the fundamentals of transmission, disease course and recovery be similar to other coronavirus infections, including the common cold (also a coronavirus). We have experience with thousands of people who have been infected with Covid 19 in December and January. From this experience we know that once a person recovers he/she is immune from reinfection. When enough people are infected and recover, "herd immunity" develops, which means that an infected person is no longer able to transmit the infection to others who have recovered. As long as the person does not transmit the infection to someone who has NOT been infected, the infection will be hit a "dead end" once the person recovers him/herself. This is how pandemics eventually typically resolve.
2. It will be difficult to develop a vaccine against Covid 19.
If it were easy to make a coronavirus vaccine there would have been a vaccine developed long ago against the common cold virus, one of the most common infections on earth.
https://www.health.harvard.edu/blog/as-coronavirus-spreads-many-questions-and-some-answers-2020022719004#q2
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I shopped at my local supermarket today and was stunned at the lack of adherence to cleanliness. If I hadn’t the need to buy essentials, I would have abandoned my order at the checkout counter. The woman scanning groceries never bothered to sanitize the surfaces or her hands before handling my food & goods. The guy bagging was just as bad. Yuck! I wiped everything down before putting things away at home.
Then I stopped in at the drugstore, a large chain. The same situation there at the pharmacy. No one using hand sanitizer, no wiping of surfaces, certainly not the checkout device with the community stylus used to respond on the electronic reader. I asked for a tissue in order to handle the stylus. It was provided but wasn’t readily handy.
God help us all. It’s no wonder infections are spreading.
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@Que Paso?
Even if retailers are scrupulous about cleaning every surface they can, no matter how scrupulous a person is about washing their hands, if they happen to touch one contaminated surface and then their phone ...
It seems to me a much more effective way to break the chain is to avoid touching one's face. I wear a red band on my right wrist to remind me not to.
What do the Co-V-2 test kits actually test: nasal mucous, blood, stool, etc.? If the virus passes into the throat and then to the GI tract, does it get into the bloodstream that route? How long does it take to go from eye, nose or throat to the lungs? How long does the virus have to been the body before the test kits can positively identify it? So many questions! Thanks.
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@Mrs. Cat Indeed, many many questions to be answered. My colleague Pam Belluck has done some excellent reporting to address some of those questions, in a new article: https://www.nytimes.com/article/coronavirus-body-symptoms.html
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Is someone who tests positive for covid19 then resistant to it after they recover from any symptoms?
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@sandra Scientists suspect that is the case. But it's only been a bit over a month or so since people have begun recovering from this virus, so we have to wait and see. Immunology is weird from one species of virus to the next.
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Thanks for all your help, Carl! I searched the PDF of the article on surface viability and I'm wondering if the virus can survive on hair. Hair isn't mentioned in the article. I just washed my hair and noticed that before shampooing, water ran down my face and some went into my mouth. Nothing about fabric either. Or is it only unporous surfaces? I didn't find the article clear on this stuff, but maybe it's me.
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@sim The researchers are focusing on the most common surfaces where the virus might survive. I'm not sure how viruses would get on your hair--it's far, far more likely for them to get on your hands, which are constantly touching surfaces.
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Given the ACE2 binding nature of this virus if I'm understanding correctly and given the number of diabetics (many undiagnosed) in our population, could we see much higher fatalities than China or Italy?
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@Sjones Diabetes is a risk factor for serious cases, based on the studies on Chinese patients.
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@Sjones : Not sure how you make the connection between ACE2 and diabetes?
ACE2 expression in diabetes is decreased. However it is increased in the heart and lung of patients with heart disease and pulmonary hypertension - and this may be one reason why people with heart disease are more susceptible.
One has however to distinguish between susceptibility (which contributes to spread in population) and lethality.
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Very clear article with excellent visuals. Thanks.
It would be interesting to know what percent of the people who are contracting Covid-19 did not get their flu shot this year.
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1. What percentage of the deaths are from autoimmune over-reaction, vs secondary bacterial infection
2. If overwhelmingly from over-reaction, what is the most likely basis for the age-correlated mortality statistics - i.e. does it actually correlate with age, or with other adult/elder behavior (e.g. smoking) or affliction (e.g. diabetes) or immune system suppression (e.g. organ transplant or chemotherapy)
3. With all the billions we're spending on face-masks and earmarks, would Trump ever consider doing what Kennedy did - i.e. an "Apollo moon shot" along the line of advancing clinical diagnostics so that any incoming virus can be sequenced (including hundreds of concurrent variants) and taxonomized within 30 minutes or so, and a corresponding detection test can be devised within 30 hours or so, and a trigger for corresponding optimal immune response can be developed for clinical use within 30 days or so
Incidentally, here's the current – and badly-underfunded – version of such an initiative, about where the US space program was, the day before Sputnik launched…
https://spectrum.ieee.org/the-human-os/biomedical/bionics/darpas-firebreak-treatment-for-the-coronavirus
Triggering such a response could serve as both early therapy and vaccine...
There is no fundamental reason such timetables couldn't be met...
Compare what we spend on this, to what's being proposed to sequester CO2, or to take another half-century run at fusion...
Is it possible to "design" such a virus as military weapon?
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@DM There's no recorded case of a military lab designing a virus as a weapon. Viruses and bacteria have been used as weapons from time to time in war, but those were existing pathogens. All the evidence about SARS-CoV-2 points to it coming from the same swarm of coronaviruses in bats that gave us SARS and MERS.
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Mr. Zimmer - Thank you for your informed replies. I just ordered a couple of your books and hope The Times will follow up with a similar article on the immune system...
This is terrific but....There is a great deal of difference in saying a mask is not helpful vs. we need the public to not buy masks.
I am of the opinion that if you have a good mask & are going in public, where unfortunately people may well be infected...it just might help. There is a reason why those in healthcare need them (& should already have them of course, the CDC & gov. generally is failing terribly - no tests, not enough PPG??) & want them. Masks don’t help, as a blanket statement, is incorrect. This virus is, among other things, airborne. Yes, it would helpful if your eyes are covered too, but covering 2 out of 3 (nose, mouth) is better than covering none. Let’s be factual & transparent these difficult days, and not, like too many, ignorant or full of propaganda. Don’t take the CDC at its word, they have proved themselves, so sadly, to be faulty (perhaps largely due to trump, not certain). Listen, but mix in your own common sense.
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Thanks for this. If you would re-do the illustrations using Bic Macs, french fries, and chicken fingers maybe our bloated POTUS will take a look at it.
How about shaking hands?
When someone extends his hand to me, I tend to grab it even though I am reluctant. I don't like to touch people's hand. So, I am wearing a thin pair of mechanic's gloves from Home Depot. With my gloved hand I can grab the door handle without first pulling my sleeve to cover my hand.
With my sticky mechanic's gloves I can push touch pads at ATM or gas station.
I wash my gloves every few days.
What annoys me is that people come to my table at a restaurant to shake my hand. Please people, don't do that to me.
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@hiker It's time to keep your distance and hope that people don't get offended. Better to be offended than to get sick.
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@hiker I recently attend a social event where I met several people new to me. We all had fun coming up with suggestions on ways to greet without shaking hands. Elbow bumps, double hand waves, high 5 in the air, slight bow as in the Japanese tradition. There are many ways we can greet without touching hands. Try it, with a big smile! 😁
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@Carl Zimmer I will extend my elbow instead of my hand. He can grab my elbow or return me with his elbow.
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Saw article today. China had 3,000 deaths with a population of over 1,000,000,000.
On other words, use common sense.
What are the prospects for a COVID-19 vaccine?
There are vaccines for some viruses, like HPV, hepatitis A and B, and Ebola, but not yet for others, like HIV and HCV, even after years of work.
Is a vaccine for a new coronavirus merely a hard problem, or is it a really hard problem?
According to this (2009) article, there are vaccines for coronaviruses in chickens, cattle, dogs, cats and swine, but not for humans.
https://www.medscape.com/viewarticle/706717_1
SARS vaccines: where are we?
Rachel L. Roper; Kristina E. Rehm
Expert Rev Vaccines. 2009;8(7):887-898.
According to this recent article in Wired, Peter Hotez was working on a virus for SARS, and overcame some interesting problems, but it was put on ice after SARS died out and the funding dried up.
https://www.wired.com/story/everything-you-need-to-know-about-coronavirus-vaccines/
Megan Molteni
Wired
03.04.2020
Everything You Need to Know About Coronavirus Vaccines
Of course, even if you had a vaccine, it might not be 100% effective.
(I won't even ask you about the prospects for an anti-viral drug for COVID-19. That's even more difficult to predict.)
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@Norman There are a number of vaccine projects in the works. Vaccine development is far more sophisticated today than 10 years ago. Now scientists can rapidly sequence pathogens, determine the structure of pathogen proteins, and design methods to get the immune system to recognize the proteins as a target. Unfortunately, then we have to wait for trials to run their course as they did before. And the immune system can always throw us a curve ball. Still, given the promising work on SARS, we should remain hopeful.
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Cool graphics.
Thanks for generating a lucid, terse, and dynamite summary. The illustrations in this piece are just cracker-jack, Grade A, and top shelf. Lay folks will easily follow along.
Excellent visual! Thank you. No politics. No opinion. Just facts!
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Very helpful.
That’s not how soap works. This article explains better.
https://virologydownunder.com/why-does-soap-work-so-well-on-sars-cov-2/
Alluring article, but poorly explained. Many important parts of the diagrams are unlabeled and not placed into context, leading to confusion.
Have they tried Accutane as a way to fight this virus? It would drastically reduce mucous and oils in the body (this virus has an oily covering). I had a horrible flu a few years ago for weeks and happened to start Accurate not long after. It kicked the flu’s butt in a matter of days.
I think it’s worth a try or a trial.
Are those of us with asthma or reactive airway disease at high risk for complications? I keep hearing to keep it under control, but if we get flare-ups when we are sick, necessitating us to use inhalers, could the body's reaction potentially (or likely) be fatal?
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@Laura Here's a post from the Asthma and Allergy Foundation of America https://community.aafa.org/blog/coronavirus-2019-ncov-flu-what-people-with-asthma-need-to-know
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Can the number of viral particles a person is initially exposed to affect how the body fights the infection? For example, if someone sneezes directly into my face vs. my transferring the virus from something I might have touched to my mucous membranes. It would seem to me that if the initial number of virions (virus particles) was very great as opposed to smaller, far more respiratory cells will be initially infected, making it harder for the body to fight, because it takes a certain number of days to produce antibodies. And if I have the virus and sneeze or cough, and then inhale some of those virus particles back into my own lungs, can previously uninfected cells now become infected?
I just read that Gov. Jay Inslee (WA State) is considering limiting all public gatherings in his State to 250 people. Can you explain the number selected and what this could mean specifically to Florida (also with a high number of Covid-19 cases) where theme parks abound? Could you also extrapolate what this could mean generally, to all States that have multiple public places where people congregate regularly for example, places of worship, schools and universities, nursing homes and of course, sporting, arts/theatre, and music events? And lest we forget all transportation that carries more than 250 persons (or the terminals where persons congregate), malls and shopping centers, etc.
If HIV meds (like the one being tested from Gilead) do prove to be effective would people already on them be less apt to be infected? If they are infected would their symptoms be lessened?
I am sure there are people in the hotspots (Milan for example) on antiviral therapy and wonder if that angle would give us more information. Perhaps those on the therapy have faired better?
On another note, the guidelines for wearing masks are not logically sound. First, many who have the virus do not know it so if everyone was wearing one, it is hard to believe that infections would not be reduced.
Second, If healthcare workers are told to wear them with infected patients the implication is that there is protection from the virus. If the issue is improperly wearing them or wearing the wrong masks then education is needed.
Thank you for the very informative article.
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@jeff If everyone hoards masks, there will not be enough for health care workers to do their job. If they get sick, the system collapses.
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In one of the earlier articles from NYT on the coronavirus, a Chinese researcher reported that they have found a version of the corona virus in bat Caves in Yunnan, and about 15-20% of the local population had antibodies against the virus. More recently, Chinese researchers have reported that transfusion of blood from individuals who recovered from the Corona virus has speed up recovery of others. Would that be a direction drug companies and physicians might be able to follow to develop a vaccine for the corona virus,
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@Elizabeth There are many coronavirus strains and species in bats, so protection against one doesn't necessarily provide protection against covid-19. We need a way to make antibodies that can latch on precisely to the molecular structure of sars-cov-2.
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I'm coincidentally in a (soon-to-be-cancelled) Microbiology lab class in school and it's interesting learning about this in the midst of a pandemic. People don't need to be microbiologists, but it's important to understand some of these fundamental characteristics about the virus in order to be educated. I think the government(s) need to do a better job of doing that. There's a lot of false information out there that's either misleading or should only be understood from an official source.
Does fever help in the battle against this virus or, like with bacteria, it may contribute to virus propagation?
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@Sandra As I understand the latest studies, pretty much everybody who develops covid-19 gets a fever, regardless of whether they survive or not. So I'm not aware of any evidence that fever helps. (There are indeed examples of diseases where high temperature does help, and others where it doesn't.)
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Is it ok to use our shirt sleeves to scratch our faces? Can the virus also stick to our clothes somehow?
Any idea how this may impact summer sleepaway camps? I would think it'll be under control enough by then that there will be protocols allowing camps to be open if they follow sanitary measures. But I'm curious to hear from an expert. It's still 3+ months away. Thank you for your time!
How contagious is someone who has been exposed, but not exhibiting any symptoms yet?
This is an excellent presentation. I wish you also commented that this particular virus has hardly mutated since that initial copy in Wuhan. Generally most viruses mutate by now. It is almost that we have a "perfect virus". It is in a sweet spot. It can spread expeditiously, rarely(assuming it infected millions and not 120,000 tested positive) kills the host and it is under no real pressure to be killed by an antiviral agent nor can be inactivated by vaccine initiated antibody. Come fall it could become a beast that kills or dies meekly.
I am wondering if people who get infected then go through 14 days of isolation (whether they get sick or not) are immune from getting infected and thereby being carriers again. I haven't found an answer in my queries.
I keep reading the advice to get a flu shot, which for complicated reasons I haven't yet.
Hypothetically, if a person is asymptomatically infected or incubating COVID-19, but thinks she is healthy, what happens if she gets the flu shot? Is there a particular risk involved there?
Hoping the Times experts will answer this.
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I read in another Times report that there was a SARS vaccine which was created and vetted for population use. It was never mass produced because SARS faded away. Another Times story said that SARS and Covid-19 were 81% genetically identical.
When looking for a possible defense against C-19 why not start with the SARS vaccine? It seems a lot more logical than looking to an HIV drug or Tamiflu. Probably this was considered by researchers but no one ever publicly mentioned it. Remdesivir might be a good candidate, though, because it has had some success in the past against coronaviruses.
An immunization specialist at the local health clinic explained the regular flu shot to me. The regular flu shot creates antibodies that target specific viruses. If the antibodies don't recognize the virus, they remain inactive. Understood. Regular flu shots won't work even in heavy doses.
However, he also explained a different flu vaccine that operates differently. This was long before coronavirus was a threat. The clinic specialized in travel immunizations.
This vaccine supposedly changed your cellular structure such that a virus, flu or otherwise, was less likely to latch onto your cellular proteins in the first place. I have no idea if the vaccine is applicable to ACE2. However, the idea is the protein becomes to slippery for the spikes to latch.
I'm wondering if anyone can offer insight or even explain what the vaccine immunization specialist was talking about.
ABSOLUTE BRILLIANCE ! Even if you or I don't completely understand it, its a tremendous piece of information - well done NYT!
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There are lots of little details about hand washing and transmission that I think many people would find helpful - or is it just me going crazy? You come in from outside, turn each faucet spigot on, wash your hands. Do you really have to change that towel each time, now that your hands are clean? What do you do about the faucet you touched with those dirty hands? I won't have enough wipes or paper towels to last if that is what is recommended. Should I be washing my clothes after each wear, in case I have brushed up against someone on the subway who has the virus on their clothes? And I can't believe a little tissue is going to prevent a sneeze from spreading the virus. What else should we be doing?
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I found the article useful and interesting, but the graphics aren't labeled very well. I guess I'm looking for more details. Colors change and cell walls get big or small - it's hard to tell. Other layers appear without any label. Please, label parts of diagrams and when using graphs clearly label all axes etc. (another issue with other articles). Thanks!
To the authors:
You would do everyone a big favor, and reduce the panic, if you were to do an exact parallel explanation for this year’s flu.
I had symptoms very similar to this at the end of January after a cruise. Fever, deep lung congestion, fatigue, but no nasal anything and no muscle aches. My doctor had no idea what I had and the cough took forever to go away. My question is, is the test for COVID-19 an antibody test? Can it tell if someone has already had it and recovered, or do you need an active infection?
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The first symptoms are dry cough and fever which appear on average 5 days after an initial infection. You start manufacturing and dispersing virus on day one, not knowing you are infectious and not wearing a mask or seeking medical help. Is this how community spread is propagated?
Will social isolation (maintaining at least 3 feet from another person) stop the potential spread of inhaling virus in the air?
Side note... I’m an Instructional Designer. This is an excellent learning piece! Great visuals, great explanation! 2 thumbs up!
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This is an interesting article. I am trying to figure out if I test positive for ANA (anti nuclear antibodies) does that improve my chances of recovery and make it worse. What positive ANA means is that I produce T cells that can attack body parts. Will those same T cells attack the virus?
"In severe cases, the immune system can overreact and start attacking lung cells. The lungs become obstructed with fluid and dying cells, making it difficult to breathe. A small percentage of infections can lead to acute respiratory distress syndrome, and possibly death."
So does this mean that my strong T cells could be more able to attack my lungs?
Will social distancing and handwashing PREVENT the spread of the virus or only slow it down? Is there ever a point where, barring a vaccine, we can say that the virus is “gone”...or will that only come if so many people have gotten sick and either recovered or died? In which case the answer to my first question would seem to be “slow it down”.
I understand by the way that slowing it down allows for better treatments and the development of potential effective anti virals etc. and is therefore urgent.
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@Karen We have only managed to eradicate two viruses in all of history--smallpox and rinderpest. Smallpox was eradicated thanks to it only infecting humans, an effective vaccine, and careful tracking of cases around the world. SARS is gone, but perhaps lurking still in some animal reservoir. Barring a vaccine, it's hard to imagine covid-19 being "gone." But slowing down covid-19 with social distancing, good hygiene, etc., can reduce the number who get sick, while also "flattening the curve" so that hospitals won't be so badly slammed with serious cases--allowing more people to get good care.
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Since we wil know how many tests are positive for COVID-19 in each city so why isnt the number for those tested positive for flu published for each city?
I was wondering if the virus can live on surfaces and if so, for how long? Also can it be transmitted through food?
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@Michele P. The article says, "Coughing and sneezing can expel virus-laden droplets onto nearby people and surfaces, where the virus can remain infectious for several hours to several days."
I'd like to know if it can be transmitted through food, too.
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@Michele P. Here is a new preprint from NIH researchers on surface survival (it has yet to be peer reviewed by a journal): https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v1 I have no information on food.
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@Carl Zimmer Thank you!
I really appreciate this article that easily illustrates this issue from a scientific point of view. This is a simplified version of what medical researchers are dealing with, but for people that maybe haven't realized the complexity they face this opens a window into it. This also sheds light on how much better off we could've been if we had proper funding for this medical research that would've let us tackle this pandemic from the jump. Lack of focus on medicine and science is harmful and has unfortunately has fatally impacted our nation and the world.
2
If lethality is attributed to a massive immune response, which explains why children with relatively underdeveloped immune systems are spared, and why Chloroquine may be an effective therapeutic then:
1. How are immunosuppressed individuals doing with the infection, e.g., folks on any number of medications for auto-immune illnesses?
2. Following #1, have steroids been helpful? I know they're NOT recommended in SARS/MERS.
@Carl Zimmer - thank you for answering questions directly in the comments. The lack of clear information on this has been incredibly frustrating and I'm finding most of my questions asked and answered here.
I'm a NYT comments fan, but this is by far and away the best and most helpful comment section I've encountered - thank you for taking the time to answer everyone's questions!
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Great article on how COVID-19 takes over the cell's machinery and causes the virus.
This national health crisis should wake up the US to finally realize why we should be making reagents, drugs, medical products etc in the US.
We now can't test for the COVID-19 virus because we don't have the RNA needed which is made in Germany as well as other countries. This will allow the virus to explode.
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@Jacquie : It didn't help that Trump turned down the WHO's offer of test kits, which 60+ other countries had taken them up on!
For Carl Zimmer (co-author):
The article is quite good, and your responses via "NYTimes Replies" is even better, delving into complex topics that require research knowledge (yes, I know you're not a doctor).
I've been tracking the development of Covid-19 (and, yes, my PhD is in another field), and in my opinion, your answers do a solid job of providing useful information without straying into harmful speculation or underplaying the risk.
Thank you for reading these questions carefully and doing what you can to shed light on them.
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@C. Whiting I'm glad to do what I can during this troubling time.
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@C. Whiting.
Thank You for the logical article.
Why are people hoarding water? It is almost like hoarding electricity. My husband is in public utilities. Water, sewer and electricity are almost automated, meaning very few humans involved.
Perhaps you could do an article on overreaction caused by fear. We are fighting that battle too. Thanks
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Wouldn't people want to be in trials of possible vaccines right now instead of just dying or ending up with permanent lung damage? Trials of cancer drugs given for compassionate reasons have been the only way to save some people's lives and same for HIV drug trials. Why isn't this allowed or considered? If an ebola drug is really effective let people who want to try it have it. The structure of the SARS-CoV-2 virus is known and researchers in Australia are testing 100 variations on this structure for a vaccine. They have invented a method to more quickly stimulate the immune system to recognize the virus. Why not let people have some of this now vs. just dying?
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@freyda Vaccines have to be tested on people who are not yet infected. Cancer drugs can be tested on people with advanced stages of the disease to see if it can shrink the tumors. Different problems.
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@Carl Zimmer On Feb. 2 the following article appeared saying Thai doctors had found success treating the corona virus with available drugs and then this possible method was not mentioned again. Why? And in the Australian work the vaccine is helping the body's immune system to better recognize and fight the virus so wouldn't an infected person benefit? https://www.yahoo.com/news/cocktail-flu-hiv-drugs-appears-124753996.html
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Could an expert explain how these responses are different from a common viral infection?
This explanation seems similar to textbook summaries of viral infections, in my non-expert memory. Highlighting the differences would help the reader understand how, specifically, this virus is exceptional or what it shares with the common cold or flu.
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@Alex K What makes this virus of great concern is the combination of transmissibility, fatality, and our lack of immunity to it. It works a lot like other viruses, especially related viruses that cause SARS and MERS. But there's some evidence that it binds tighter to the ACE2 protein, which may make it more contagious than SARS.
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Young people seem to have a higher resistance to the coronavirus. There is a theory that they are exposed to more colds, which gives them higher immunity. If that is true, maybe researchers can find a cold strain that would confer some immunity and deliberately infect people with it.
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In all seriousness of the situation, I've learned a whole lot about the viruses a lot more than I did in schools and college. I was surprised to learn that a virus is a non living thing (a complex molecule) that can be activated inside a host. Perhaps more research on viruses might shed some light on life itself.
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The following statement in the article begs the question of how a person knows that they are “healthy” and therefore need not wear a mask:
“Infected people can avoid spreading the virus by wearing a mask, but healthy people do not need to wear a mask unless they are caring for a sick person.”
I understand that discouraging wearing masks by people who are not infected or caring for the infected may be the right thing to do, as a matter of public policy, to help ensure sufficient supply for healthcare workers, the infected and those caring for he infected.
But for the current mask shortage, however, it makes sense that almost everyone should be wearing masks. Although most surgical masks might only be marginally effective to prevent contracting the virus, those who do contract the virus would be less likely to spread the virus if they are wearing masks before they become aware of their infection.
Local, state and federal governments should consider stockpiling masks in anticipation of the next epidemic, which could then be widely distributed at the early stages of an outbreak. Assuming there were a critical mass of mask wearers in any given population early-on, the R-naught value would likely be significantly lower than would otherwise be the case.
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@Nedly My colleague Roni Rabin wrote an article on this issue in January: https://www.nytimes.com/2020/01/23/health/coronavirus-surgical-masks.html
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I'm with Nedly on this. I can't tell you how many people I encounter daily who never cover their mouth when they cough. I would like to wear a mask & use it properly. But because of the shortage I won't be wearing one. I do have a neck gaiter which I plan to deploy in crowded areas.
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We need to proactively practice social distancing to try and flatten the curve of cases of Covid-19. This will help reduce the chance of our health care system being overwhelmed with the sick. Though we all may contract SARS-CoV-2 we will stand a better chance at recovery if we can get timely care.
This is a good article to help educate the public about viruses. The lipid molecules covering viruses break apart when we wash with soap. Any soap that breaks through lipids is effective. The empty shelves that once stocked Purell demonstrates the herd mentality of the public. Nice squeeze bottle on the go, but not really necessary to protect against spread of virus.
Please wear mask even if you think you are healthy. This coronavirus is known to be asymptomatic, and with prolong latent period when is still able to be spread.
Hence, in practice you can't be certain if you are "healthy" or not. If you manage to get one, wearing mask is an effective precaution to reduce infection from mouth droplets!
Of course, the other suggestion in this article should be adopted too.
If you look at the data that is available on resolved cases for China and all other countries as a group you can see that China has the lower mortality rate (about 5% vs. about 15%) It might be worthwhile to write an article on how the Chinese are treating their citizens for this disease. For example, I have read in the Chinese press that a vast majority of victims are starting care with traditional Chinese medicine techniques. I have also read that severe cases are being given plasma transfusions donated by recovered patients that had milder disease. This is a technique that medicine refers to as convalescent plasma therapy and it essentially takes the newly developed antibodies from a recovered person and uses them to help a patient with more severe disease recover. I suspect there is more we can do for ourselves than just wait for a vaccine which may be a long time in coming.
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@Ericka D There are lots of clinical trials underway right now, and we'll need to wait to see their results. If one person takes one medicine and gets better, we have no way to know that the medicine did the trick. Most people get better on their own, so this kind of false positive result could be dangerously misleading for the small fraction of people who become seriously ill. Fatality rates are complex to calculate, and they vary within countries and between countries. They even change over time in one place--see this preprint about fatality rates in China: https://www.medrxiv.org/content/10.1101/2020.02.17.20023630v5
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@Carl Zimmer Carl thanks for your note. I am confused by your assumption that there is no existing medical evidence for TCM and convalescent plasma therapy as evidence-based approaches with coronavirus. Of course the Chinese medical establishment has published papers on TCM and coronavirus and the papers show clear advantages to some TCM therapies. Convalescent plasma therapy has been in use for close to a century around the world and it is also supported by published research. if, in the face of a serious public health crisis, we close our minds to the evidence that already exists and is working in China, we are doing a disservice to ourselves and the readers who depend on us to enlighten them.
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@Ericka D , I agree with you 100%. I also read that the Chinese were using high dose intravenous Vit C. with great success.
If it worked in China it may work here why not try it , it will not likely cause harm if given by a Doctor of Oriental medicine who knows there medicine.
I have also wondered why the media is not giving more information about how to build ones immune system, since weakened immune systems seem to be the cause of most deaths.
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A very good and needed explanation. One thing that could use more explanation is that a virus is not really alive. So it cannot be "killed". What would be the best way to describe the effect of damaging the virus -- soap, alcohol, desiccation, etc. -- so it could not achieve its innate task of hijacking our cells for reproduction?
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@Bruce Michel The debate about whether viruses are alive is more philosophy than science--but incredibly fascinating nonetheless. (I'm writing a book about the general topic.) "Inactivated" is fine to use instead. The point is that once the lipid membrane of the virus gets disrupted, the virus is so damaged that it can't infect any more.
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@Carl Zimmer So, is there any way a person can contribute to that 'disruption of the lipid membrane'? with their diet for example?
@Ken " One thing that could use more explanation is that a virus is not really alive. " -- It's just semantics. The virus takes control of living cells, so there's no useful distinction. Killing it means causing it to no longer function. "is there any way a person can contribute to that 'disruption of the lipid membrane'? " -- certainly ... wash your hands with soap. "with their diet for example?" -- No ... you have to destroy it *before* it gets into your airways.
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Here's what I don't understand. An infected person should wear a mask to protect those nearby BUT it is not recommended that one wear a mask to protect oneself against folks who have the virus and don't know it and aren't wearing a mask but casually sneezing into the environment. There are people sneezing everywhere who aren't adequately capturing the spray. Wouldn't wearing a mask in congested areas like airports be a good protection???
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I am concerned about this recommendation that healthy people do not need to wear a mask. I understand that we do not have enough masks if everyone goes out to get them. But there is no incentive for all infected people to wear masks all the time. The chance to encounter the virus in a public space is thus very high. Would it be more helpful to suggest that people going out to public spaces wear a mask during the epidemic?
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@Pense Here is the CDC guidance--healthy people should not wear masks. Health care workers and sick people should. https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html
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@Carl Zimmer The only reason CDC stated is the shortage of masks. Should we then urge the government and businesses to rapidly increase the supply and make them available to the potential caregivers as well as the public? Anyway, there are not any masks in stores these days for potential caregivers to purchase.
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@Carl Zimmer I'm not sure why the recommendation for healthy people is not to wear a mask. I think it would help me not to touch my face which all admit is very difficult to do. We all touch our face unconsciously and a physical barrier can help break the habit.
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From looking at the infection numbers, it's clear that the coronavirus is MUCH more prevalent in countries that are currently having colder weather, compared to say Southeast Asia where the infection numbers are much lower. What effect does hot weather (greater than 37 celsius) have on killing the virus in terms of helping the lipid envelope to breakdown or 'melt'?
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@kntbkk That is an important question. Some respiratory viruses, like influenza, are seasonal. In part, that's because people are outside more in the warmer seasons. In part, it may be because the temperature and humidity change the physics of droplets. But in the case of seasonal flu, the immunity some people already have to the virus also helps to break the transmission chain. This is an entirely new virus, to which it seems none of us has pre-existing immunity through antibodies, etc. And even if it does prove seasonal, it could just come roaring back in the fall. Harvard epidemiologist Marc Lipsitch addressed this at length here: https://ccdd.hsph.harvard.edu/will-covid-19-go-away-on-its-own-in-warmer-weather/
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@kntbkk
How do you explain the outbreak in Iran then?? Pretty hot there.
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Best article on COVID-19 with great illustration - easy understand. Thank you for giving us a better understanding of this "creature."
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Tamiflu and Relenza could reduce the multiplication of the SARS-COV-19 virus.
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@Steven of the Rockies There is no evidence yet that Tamiflu or Relenza is effective against SARS-CoV-2. Clinical trials on a number of possible antivirals are underway.
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@Steven of the Rockies
What evidence or scholarly peer reviewed source can you offer ?
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@Steven of the Rockies Apparently, sadly, they don't. Other antivirals are being tested, including an antiviral that was used against Ebola and others that have been used against AIDS
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Typo correction:
Since those already infected with Covid19 do not wear name tags, it is probably a good ides for high-risk targets (immune-compromised, elderly and those with co-morbid conditions (diabetes, etc.)) to wear protective face masks when in crowds or gatherings. They are the most severely-affected statistically. Here is where an ounce of prevention may save your life. It is a logical extension of protective protocol. I am a Doctor in my 70s and I do, particularly when grocery shopping. I do not like limiting my restaurant visits and travel but I do not yet have enough data in this country to assess my risk effectively - we did not test early enough to see what's actually going on here, and we still do not have enough testing data. I feel things will be more wide-spread than we are being led to believe by this administration.
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Coronavirus is focused on evolutionary fit survival by fruitful multiplying among it's primate African ape animal mammal hosts.
Without any viral regard for their gender, color aka race, ethnicity, national origin, faith, education, economics and politics.
Coronavirus appears to discriminate on the basis of age and health.
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Would someone please read this to the president?
He would be incapable of doing it by himself.
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@MIMA There are lots of pictures, but they needed his name multiple times. I recommend we rename the virus as tRumpVirus19. This way it is more likely he will also look at the associated words.
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@MIMA
That eliminates his cabinet. Next?
In all the misery caused by Coronavirus there may be a glimmer of hope: people will develop a healthy respect for science and- hopefully- an interest in it. The forces of backwardness may yet be defeated.
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Hmmmmmmm!
Thank you for the enlightening article. One question I'm curious about that is not addressed is why it is reportedly not adversely affecting children and young people, and attacking only aged or those with pre-existing respiratory or other problems.
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@Robby You are not the only one curious about that question. Scientists are trying to figure that one out too. Possible explanations include that kids are exposed to other coronaviruses that merely cause common colds, offering cross protection. Or that kids have better regulated immune systems. Or that pollution over a lifetime makes lungs more vulnerable. No one can say for sure--but the research to find out is underway.
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Pretty much the same as HIV in design. the points are for mechanical attachment and it defeats the immuno response by hampering some aspect like the Tcells. Depending on the DNA code in the virus...the methodology fo infection and damage to be done is all [rogrammed. Also how much it will replicate and what defenses it will disable.
I think the image showing the virus entering a cell is not correct: the virus RNS is released inside the cell. In the image it seems that the RNA is released outside the cell.
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@Mauspino This illustration shows the route in which the virus is swallowed up in a vesicle, which moves down into the cell, and then the virus fuses with the vesicle membrane and opens up a passageway for the RNA to go into the cystosol.
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@Carl Zimmer Is there a more detailed illustration to which you can point us or a link you can post? If found the Viral protein entry confusing. If I understand the pale green shape is a vesicle that is allowing the protein to slip through the cell wall, is that correct?
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@Carl Zimmer I too am finding that illustration very confusing and I came to these comments in search of clarification. Based on your note here, it seems that perhaps the illustrations skipped the step where a vesicle forms at the cell boundary, and instead shows the next step where RNA is released from the vesicle into the cell interior. Do I have that right?
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Fantastic article and great comments!! I always read the comments which always seem to add to the discusion.
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Are alcohol based sanitizers as effective as soap in destroying the virus?
@Susan Otte soap and water are the best defense. Hand sanitizers are second and can can be used when soap and water is not available. I keep it in my car and handbag.
It's frustrating once again a virus is blamed on bats. We really don't know this and shouldn't be included when really its speculation.
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@Matt Bats shouldn't be "blamed"--after all, they're just living their lives, and are ecologically crucial. But the evidence from evolutionary trees is overwhelmingly clear that this virus ultimately evolved from a bat coronavirus, as did SARS and MERS. It's possibly it passed through some intermediate host first, but no one has found compelling evidence yet.
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@Matt -- The comprehensive report from the World Health Organization said that the corona virus found in bats is 96% identical to the corona virus now found in humans. It's the closest match that could be found.
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@Carl Zimmer in Honduras, near the Miskito Coast, bats attack (suck and bite) the nipples of nursing pigs who are not brought in at night. This causes infections and loss of the ability to nurse the piglets. Most piglets die and the mothers are butchered. Could the coronavirus be in the pig from the bat attacks?
Y'all talking about "The Trump Flu" ?
Let's give him what he wants, recognition and his name on things.
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The virus is a useless entity whose only function is replicate inside of the individual host (human beings!). Wreaking havoc by rendering our immune system defenseless.
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So why won’t the masks protect be helpful here
If it can stop it from spreading it sure can be helpfull when inhaling
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@Nihal You can effectively protect yourself from infection by washing your hands, not touching your face, and staying away from sick people. Using masks properly requires training--otherwise, you can end up infecting yourself as you adjust it on your face.
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@Carl Zimmer Most surgical masks will not filter the virus and are therefore useless. Medical workers have very special masks when interfacing with patients.
@Carl Zimmer So I think this advice assumes we are all too stupid to adjust a mask. This is ridiculous. It also assumes we will be unable to resist the subliminal message that the mask has made us impervious so will reduce hand sanitation. While there always people in the population who pop their statins and still eat junk, I'm not one of them. The only reason we can't have masks is that there are not enough to go around.
This is an excellent, concise and simple to understand piece. Thank you. Through the hysteria driving markets and runs on staples at the big boxes, facts are what matter most. "Wash your hands with soap... keep your distance from sick people and regularly clean frequently used surfaces." Still sound advice.
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Thank you NYT, for putting together this simple and easy to understand graphic. If everyone would just look at the part titled "Covered With Spikes," I think they would then understand just why soap is the key to stopping the spread of this virus.
This is the part I don't get: "Infected people can avoid spreading the virus by wearing a mask, but healthy people do not need to wear a mask unless they are caring for a sick person."
Does a mask help if you are not infected? If not, why wear one when caring for a sick person?
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"Any American can be tested for coronavirus," Pastor Pence recently declared. The fundamental premise of the entire public health response is an accurate diagnostic test. By unleashing a rushed-to-market, unproven "test"--and now multiple, country- or NYSE-traded laboratories variants thereof--whose characteristics (sensitivity and specificity) are unknown, the scientific illiteracy of the populace and our imbecile-in-chief will soon be exposed. The expected mass of false positives among the worried well --including asymptomatic people and those with the common cold (another type of coronavirus)-- will soon overwhelm our dysfunctional disease care system. Meanwhile, the false negatives will be reassured as they unwittingly spread the infection to others. Expect little objective or consistent advice from the nurse practitioner or physician's assistant, if they return your calls (since the medical system is largely afraid of email, and there are no more doctors who actually provide direct access). How will we know when it's safe to come out from hiding? Keep a close eye on Pastor Pence's prayer group.
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Of course the problem is that our number of reported cases is clearly false due to the unavailability of testing. If they fully tested the population of people with reason to believe they've had exposure plus the number of people who have symptoms but don't fit the narrow testing profile -- the numbers would skyrocket. We're living in an idiot's paradise right now, existing in a bubble of what you don't know can't hurt you. Actually it can and we need to know the truth. Testing is the key.
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Thank you for keeping me informed!
As I talk with acquaintances, colleagues and friends about the Covid-18 and the virus causing it, I am horrified how in fact little people know, how unconcerned they are about taking basic precausions (hand hygiene), how they believe it is not coming to Los Angeles City (!), how their travels (flights to Washington DC with family to see museums in 3 weeks or taking a cruise to Mexico in 2 weeks) are OK.
YEs I understand and always admired American optimism - but this is not helping with slowing/curtailing the spread of Covid!. Hence I appreciate your informative coverage even more especially at times like and while White House does not help educate and really downplays the seriousness of this situation.
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Thank you!
I will share it with my boys.
This whole episode brings up the really scary scenario of some rogue individual or government creating a biological weapon, where only they have a vaccine that works. That didn't happen in this case, but the thought of such a thing happening is quite sobering. It's the stuff of a James Bond movie, but the reality really isn't entertaining, or funny.
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@Carl Zimmer Thank you for addressing readers' questions and misperceptions about Covid-19. With an administration that is anti-science and cloaks the truth on a daily basis, the public needs as much access to accurate, scientific information as possible. Thank you for playing a role in helping dispel rumors and misinformation. And while I'm at it, I, too, have a question I have not seen addressed in all the reading I've done on the topic: As a lap swimmer, I'm wondering if Covid-19 is easily transmissible in water?
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I do hope you're right. I recall reading some weeks ago that scientists thought it might be possible to be reinfected. Someone apparently went from testing positive to negative to positive once again.. It could be that no one is certain yet about this virus. I'm hoping the coronavirus can be mitigated before any more widespread infections takes place.
My doctor gave me a pneumonia shot and I'm hoping it might help allay some of the general nastiness. Will it does anyone know?
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@annberkeley2008 You may want to ask your doctor (I'm not a doctor!). But this question does come up often, and here's what I can say in general: Pneumonia is a lung disease that can be caused by many different kinds of pathogens, both viruses and bacteria. It's possible that you received a vaccine for Pneumococcus, one species of bacteria that can cause pneumonia. Which is great, because it works and saves a lot of lives. But it doesn't protect against SARS-CoV-2. More on the pneumococcal vaccine here: https://www.cdc.gov/vaccines/vpd/pneumo/index.html
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@annberkeley2008 No scientific evidence to suggest it would. The vaccine protects against the bacteria known as streptococcus pneumoniae, which has completely different make up than the COV-19.
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@annberkeley2008 : There are two pneumonia vaccines, typically given a year apart, and they protect against bacterial pneumonia, not viral pneumonia. So, no, the pneumonia vaccine you received won't protect you from a viral pneumonia directly caused by coronavirus. However, it could provide some protection against an opportunistic bacterial infection, that is, a secondary bacterial pneumonia that develops following a coronavirus infection.
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RE: "The virus is enveloped in a bubble of oily lipid molecules, which falls apart on contact with soap."
Q: I thought the soap was physically helping to wash it away, down the drain. Do all soaps have this oily lipid molecules that breaks it apart or just some? Is there an active ingredient to look for? Are natural soaps as good as non- natural soaps? Does any soap work as long as it bubbles? Soaps for the most part don't have active ingredients (I think the ones surgeons use do).
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@Bonnie Soap is good for all viruses and bacteria because it can help push them off your hands. Soap is EVEN BETTER against so-called "enveloped viruses." Ordinary soap will do the trick. Just make sure to wash for 20 seconds. Here is the WHO guidelines for effective hand washing. https://www.who.int/gpsc/clean_hands_protection/en/
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@Bonnie
Soap IS the active ingredient. Simply put, it comes from an oil or a fat that has an alkali (opposite of an acid) added and some heat.
When you wash your hands one end of the soap molecule will attach to the dirt/grease or in this case, the fatty outside of the virus. This causes the outside of the virus to fall to bits.
The other end attaches to the water you are washing with and this does the "physical washing down the drain" as you put it
Just a plain bar of soap and water will be fine - you don't need anything fancy
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@Bonnie Soap is a detergent and detergents generally "lyse" (to cause dissolution or destruction of cells). Viruses are too small and can easily be stuck in the folds of the skin. The 20 second wash is recommended so that there is a greater chance of the soap reaching all the nooks and crannies.
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Recommendations for prevention must stress more the fact that it is most important that people not touch their eyes/nose/face. Noone can wash their hands often enough to protect them from being "germ-free" (this is a misnomer since it is physiologically not possible; I'm just using it to make a point).
As soon as you open a door, touch other surfaces or your hands are near someone coughing/sneezing/breathing, your hands are full of germs again. That is ONLY a problem ONCE they come into contact with respiratory mucous membranes (concerning germs affecting the upper airways); this is the crucial moment of transferrence and NOT having the germs on your hands.
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It's interesting about the progression into the lungs. I am surprised I have not read anything about physicians recommending the use of rescue inhalers (albuterol) or percussive therapy to keep the airway open at the onset of disease. Any pulmonologists on this thread want to address that?
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Educational article, but I wish it had made this clear: "hijacking the cell" is the way viruses in general replicate, not just Coronavirus. A virus inserts its DNA into the host cell, and tricks the cell into making more viruses. From that point, there are two different pathways viruses use for reproduction - the lytic cycle and the lysogenic cycle. The lytic cycle is what is described in this article, in which the cell gets destroyed and the new viruses are expelled. However, important to remember: viruses have been doing this since the dawn of time. Coronavirus didn't invent it.
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Two weeks ago everyone in my girlfriend's family came down with the most severe sickness. All eight members of her household were affected. Her elderly mother was the most sick, but her extremely healthy son-in-law suffered complications that led to hospitalization.
The son-in-law was tested for the most common strains of flu, A and B, and it was found that he didn't have antibodies that would prove infection. Testing for COVID-19 is non-existent, so he wasn't tested.
My girlfriend lives in semi-rural Oregon, and both she and her daughter work for school districts. They come in contact with and are usually sickened by several forms of flu each season.
She now believes that this may have been COVID-19, because of the severity of the sickness and the way it infected and affected her family.
Oregon currently reports 14 cases of the virus infection, and this hasn't changed much in the last few days —despite being bordered by two states reporting among the highest rates of infection in the country, CA and WA.
Her community doesn't plan on closing schools as a precaution. No tests have been administered, and there doesn't seem to be any effort to track community infection or research recent deaths and hospitalizations.
This lack of response may be due to a host of different factors —the lack of support from the federal government among them. It may also mean that the coronavirus is already in the wild, widespread and running its course, unreported.
To me, this is terrifying.
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It is important to mention that nearly all people will mount an immune response to the virus that will effectively neutralize/clear the virus after a week or two and thereafter be "immune" to the virus. That is, after recovery, these people will not get sick if they encounter the virus again in the future. In fact, it would be good if the authors would add this as another panel late in the presentation (perhaps before "A Possible Vaccine" to emphasize that this is a self-limiting infection in nearly all people. It would also be good if the Times and other media outlets would let people know how to take care of themselves if they DO get sick, with rest, good nutrition and especially good hydration (lots of water and other fluids).
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@John Scientists know very little about post-infection immunity to this virus--how well and how long it protects a person who gets sick, and how it helps create "herd immunity." So it wouldn't be appropriate for journalists to jump ahead of the evidence.
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@Carl Zimmer excellent point and this will be a very complex issue in vaccine development, which is to say how long will the immunity last.
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@Carl Zimmer: While the nuances of the type(s) of immunity important for recovery and resistance may not be thoroughly understood, the basic idea that this is a self-limiting illness is something that could be emphasized. This is obviously well undersood from the 96-99% of people who have already recovered from this infection. In this regard it is basically the same as recovery from other viral respiratory infections like the common cold and flu, even if the actual symptoms and course of disease may differ?
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Thank you for explaining this. We need more articles like this on the science of this disease.
The illustrations on this article are top notch.
(I didn’t see a credit for them - I may have missed them.)
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I have read that the antimalarial drug Hydroxychloroquine (Plaquenil), also commonly used as an anti inflammatory drug for certain autoimmune diseases, is being studied as a disrupter of corona virus. Is there any reality to this rumor?
@Louisa M. It's being studied, yes, but there are dozens of compounds in clinical trials. We'll have to wait to see how the results turn out. Here is a preprint review of clinical trials in China: https://www.medrxiv.org/content/10.1101/2020.03.01.20029611v1
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@Louisa M.
In India studies have shown that colloidal silver kills the malaria virus within 24 hours. We use it in our family to keep colds at bay, basically stopping the cold before it develops, and it works! I’m taking regular doses everyday as a preventative. My mother had malaria and she lives in the Miskito Coast. Now that she takes silver shield everyday she has not had a single outbreak of the virus.
@Carl Zimmer In India studies have shown that colloidal silver kills the malaria virus within 24 hours. We use it in our family to keep colds at bay, basically stopping the cold before it develops, and it works! I’m taking regular doses everyday as a preventative. My mother had malaria and she lives in the Miskito Coast. Now that she takes silver shield everyday she has not had a single outbreak of the virus.
Wouldn't it be possible to develop a soapy rinse for our noses that's simply break apart a majority of the viruses that enter thereby minimizing the risk of a large hijacking? I can understand antibodies blocking the virus from attaching to cells but what about just killing the virus cells to begin with? I am not opposed to putting a couple of drops of Dawn dishwashing liquid into a bottle and spraying out my nasal cavity every once in awhile especially after being in public. Would that work or am I way off base?
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@Dan Stone Once the virus is in your nose, it can get into the mucous membranes, where soap will won't be able to get to it effectively. Focus on washing your hands and not touching your face.
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@Dan Stone I agree with Mr. Zimmer - putting soap in your nose will be unlikely to help, and is more likely to actually dry out the sensitive membrane, removing the protective mucus layer. I would actually guess that doing this could actually increase your susceptibility to many different pathogens.
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@Dan Stone
Please don't put Dawn dishwashing liquid in your nose. That could cause a sinus infection Also, rinsing the nasal cavities with tap water is NOT safe. Only rinse with distilled or sterile water. The over-the-counter saline solutions sold in pharmacies are safe because they are made with sterile water. Here's a link to the federal government's directions for nasal lavage, a treatment that some people use to prevent or decrease sinus infections. This is NOT a treatment for the COVID virus. The article just underscores why dishwashing liquid and tap water could be very harmful.
https://www.fda.gov/consumers/consumer-updates/rinsing-your-sinuses-neti-pots-safe
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Fantastic article i feel like i learned a lot! What I'm currently questioning, however, is the "Pre-Infection" level.
That is to say - they human body has a defense mechanism that prevents a virus from taking hold (not 100% of people who have the virus enter their bodies will get sick).
What/how does the body set up defenses "pre" infection?
My mind has it pictured like a wall around a castle...and once the wall falls - the immune system (men-at-arms) take hold.
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@Ben There can be lots of reasons that viruses don't establish a successful infection. They may have mutations that make them bad at invading cells. Or the immune system may quickly recognize them and wipe them out before they have a chance to get out ahead of our defenses in terms of their population.
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Excellent explanation for the need for protective measures like social distancing and frequent antisepsis. Thank you for your cogent analysis.
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@Janet Kennedy You're very welcome.
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EXCELLENT GRAPHICS & clear, concise explanation.
Thank you.
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This article raises a couple of questions in my mind that I really haven’t thought about before. First, it seems that the coronavirus itself doesn’t cause sickness and death, but it’s the body’s immune reaction to it that causes the problem. The article points out that the immune system not only attacks the invading coronavirus, but also the body’s own lung cells, which results in harm to the lungs. That raises the question of why the immune response can’t distinguish between invading cells and its own cells. Sounds like what happens with autoimmune diseases.
A second question is why the body’s cells “allow” the invading coronavirus RNA to hijack the workings of the cell. Why don’t the cells recognize the invading coronavirus RNA as foreign and ignore it?
Maybe an even more basic question: why do viruses exist at all? Why hasn’t evolution selected them out? Do viruses exist just to cause mayhem, or do they confer some kind of benefit somewhere? It seems like only the virus itself “benefits” in that it gets to replicate and reproduce itself, to the detriment of its host. But maybe that’s just how biology works.
I could probably spend the next couple of hours researching these questions myself, but I hope that knowledgeable NYT readers will have the answers.
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@N Those are all awesome questions. -->Viruses don't exist to do anything in particular. They're just very successful at escaping immune systems and replicating inside of host cells. Evolution keeps producing new strains of viruses with new adaptations, some of which let them jump to new hosts (like us). -->The viruses have evolved the ability to infect our cells and take over their machinery, just like other viruses. Cells actually have lots of anti-viral proteins, but the viruses have evolved counter-measures against them, too. -->The coronavirus contributes to death by killing the cells lining the lungs, which adds to the overall disruption, along with the damaging inflammation from the immune system. The immune system is very impressive, but unfortunately not perfect.
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@N
I don't think it's accurate to say that the virus itself is not causing sickness/death/harm. In one of the early papers from China they noted that 85% of all patients (survivors and fatalities) had Lymphocytopenia (deficient level of Lymphocytes - basically the brains of the adaptive immune system.) In some viruses (and this was also apparently true of MERS) the virus is infecting CD8 T-cells, the cells that normally would eliminate viruses, and killing the T-cells.
So it appears that the Covid virus is one of those that is actively killing off an essential part of the immune system.
Ironically, the virus is "successful" at invading the T-cell but ultimately "fails" by killing the individual host cell. The net result for the human being, however, is that the immune system is being degraded and ultimately may lose the overall fight for survival because the body loses the ability to eliminate the virus.
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@N
Great thoughts.... please work on this, you can get a Nobel prize! Viruses are not “alive” which is an amazing thing to realize. Perhaps we are the anomaly and viruses are the norm. If you are old enough to remember the Apollo 11 moon mission, the returning astronauts were put in quarantine upon their return in case they brought back “moon germs” (there were none.) And if you never read the original “War of the Worlds” the ending may surprise you!
I would gladly stop spending trillions of dollars on wars and start spending trillions of dollars on scientific research on combating viral contagion. Maybe it’s not too late.
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Our society needs to remove the stigma of wearing medical masks by encouraging those who are sick and must be out in the public, to wear them - children too, along with good hygiene ie washing hands. We could see a decrease in colds and influenza which in some cases lead to more serious illnesses for anyone one immunocompromised.
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This administration starting at the top treated this extremely serious problem with light abandonment. Climate change has taken a back seat, albeit it's also a very serious issue.
How is it that so many countries are able to test thousands of people a day and the supposedly greatest country in the world are only testing a few hundred here and there. We have hit a new low thanks to trump because he only thinks of himself and his ratings. He can contemplate his ratings when he's out of office comes Election Day.
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@Sari When I read that they've only just now tested some, not all, of the workers at the Life Care Center in Kirkland, WA and the emergency rescue personnel and firefighters who have removed patients from that facility have YET to be tested, I couldn't believe it! We are in deep trouble.
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@Sari a trump owned company needed to have the sole rights https://www.wsj.com/articles/PR-CO-20200310-906710
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I do not understand this statement: "Infected people can avoid spreading the virus by wearing a mask, but healthy people do not need to wear a mask unless they are caring for a sick person."
So if I'm on a packed subway, and someone who is unknowingly infected, coughs right near me, wearing a mask won't help? In order to be infected I have to have prolonged exposure to the virus? A few coughs from an infected passenger next to me won't be a problem if I don't wear a mask?
Or is this statement meant to assuage us in order to maintain an inadequate mask supply for healthcare professionals? What is the real reason for this statement?
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@doug... I agree. It seems obvious that if some or most of the danger is initiated by droplets expelled by infected individuals, that a mask will dramatically reduce those droplets, and thus the danger. Thus everyone should be wearing a mask where people are in close proximity with each other.
I agree that healthcare workers must have priority over the general public in keeping healthy, but it seems like the "experts" are misleading the public about masks because of the lack of adequate supply. Doing so, just exaggerates the lack of trust and feeds panic among the general public.
It seems our government was and still is ill prepared to help us in this crisis.
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@doug Here are WHO guidelines about masks: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks
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@doug
Not all Medical masks are the same, the mask that is form-fitting and tight to the face with no gaps and has a filter, N95, works best and is in short supply and only works for a few hours.
The virus is a teeny tiny particle.
I bough carpenter’s dust masks. Not ideal, but like you were thinking, hey, it’s something!
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I wonder to what extent the actions that people are taking to avoid Covid-19 are also reducing other infectious illnesses. Every year during flu season, we are advised to wash our hands, stay home if sick, etc. but many people ignore that advice. Not anymore.
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@Ken I was thinking the same thing. Overall there might be a drop in flu and other illnesses due to people using proper hygiene
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@Ken Hand washing is a good way to avoid getting the flu and other diseases. It would be great if this greater burden could also be reduced if everyone washes their hands.
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@Ken Yes, this is happening in Hong Kong right now. They are seeing a large drop in other infectious diseases because of the measures taken for Covid-19.
https://www.ft.com/content/ad7ae6b4-5eab-11ea-b0ab-339c2307bcd4
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I've asked myself a question that I cannot find any answer for although I think it is quite an obvious question to ask: How does the manner of infection affect the likely progression of the disease and its severeness?
Case A: I touch a contaminated surface in the subway and then touch my face, bringing a small amount of viral material into my body, and becoming infected.
Case B: I'm locked into a room with a person who is already severely ill with Covid-19 and is spreading huge amounts of the virus everywhere. So a huge amount of coronaviruses enters my body.
It does not appear plausible to me that it wouldn't make any difference. If there are only few copies of the virus initially in my body, shouldn't that improve my chances to experience only mild disease and not become critically ill? While the virus multiplies until there are enough copies of it to cause disease, the immune system has already had some time to start mounting a response.
Whereas if the first contact with the virus is already a massive onslaught, wouldn't it be much more likely that the immune system is completely overwhelmed before it has a chance to even start making antibodies, leading to severe illness or death?
I'd really like to read expert opinions on this.
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@GS Hi, this is Carl. I'm a columnist for the Times and helped Jonathan Corum put this together. In answer to your question, when it comes to pathogens, the dose you get can make a difference to whether you develop the disease or not, and how bad it gets. Different pathogens have different minimum infectious doses. Here is an example of a study on mice about the dose required of the MES virus (related to the coronavirus that causes covid-19). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869108/ In my role as a journalist, I have not come across an estimate of the effect of dose when it comes to covid-19.
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@GS
First, this is a NOVEL Corona Virus: we have no innate immunity since we have not had previous exposure. No antibodies mean a much higher risk of infection. also, some viruses (common cold for instance) which are also Corona Viruses can cause infection multiple times. We don't know about this one yet.
The RNA enters through mucous membranes or open wounds. That's when contact with your nose or airways is most dangerous and skin contact with them transfers it. Sneezes will spread them just like colds - fluid particles making contact with everything thy in the spray path. The more contact, the greater the risk.
The health and response of your immune system are factors in severity of disease. That is why those with co-morbid conditions like Diabetes or who are immune-suppressed (chemo for cancer, TNF inhibitors like Humira, Enbrel and the like and those with pre-exiting lung/airway disease (COPD, etc.) are more susceptible. AGE also seems to be major factor based on available data - the older you are, the more susceptible to higher mortality.
All it takes is one attack in theory, so be careful. You can become very contagious well before you exhibit symptoms, as can others.
Diagnoses are subjective and depend upon the individual and your Doctor's experience.
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@Carl Zimmer
EXCELLENT article. As you may have guessed, I am a Doctor. The simpler we make the WHOLE TRUTH, the better we arm our citizens.
Thank you for explaining infinitely better than this dangerous administration.
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Perhaps this virus is mother nature's way of fighting back to reduce the number of humans on the planet. We are aggressively destroying Earth's life support systems of air, water, and soil. Perhaps if our collective behavior improved, which would also include not invading spaces we shouldn't get into and eating every kind of animal, this would not be happening.
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@Shann : I agree completely. I wish this new virus had a higher death-to-case ratio. And yes, I'd be perfectly happy to be one of those who dies from it. I suspect I already had it, though, a few weeks ago, and it didn't send me to the other realm.
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A large portion of the United States citizenry is rejecting science, avoiding vaccinations and reverting to a kind of new dark age. The government has partially taken this stance and hence the shortage of testing kits among other things. We'll soon know how the consequences of these actions work out as the virus spreads.
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@Goat2
Will Trump start talking about Fake Funerals instead of Fake News!?
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All of the awfulness aside, what a wonderful way to learn that our world is shared by other organisms looking to survive like we are. We have to understand that based on sheer numbers, we live in their world.
Also, our bodies are made to survive by fighting off all of these pathogens. How many of us have been invaded by these microbes and didn't know it because we are healthy with beautifully engineered immune systems?
I can't wait to share with my students!
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@Ed C Having written a book about viruses, I have to agree. Scientists estimate that there are 10000000000000000000000000000000 viruses on Earth (10^31)!
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@Ed C Viruses are not technically alive nor organisms. Bacteria that cause many disease are alive but Viruses are not considered to be alive.
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@Ed C
"For so it had come about, as indeed I and many men might have foreseen had not terror and disaster blinded our minds. These germs of disease have taken toll of humanity since the beginning of things--taken toll of our prehuman ancestors since life began here. But by virtue of this natural selection of our kind we have developed resisting power; to no germs do we succumb without a struggle, and to many--those that cause putrefaction in dead matter, for instance--our living frames are altogether immune. But there are no bacteria in Mars, and directly these invaders arrived, directly they drank and fed, our microscopic allies began to work their overthrow. Already when I watched them they were irrevocably doomed, dying and rotting even as they went to and fro. It was inevitable. By the toll of a billion deaths man has bought his birthright of the earth, and it is his against all comers; it would still be his were the Martians ten times as mighty as they are. For neither do men live nor die in vain."
The War of the Worlds
H.G.Wells
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I know it is obvious, but if we invested more in medical research we would be much further along in medical knowledge. Compare our spending on military weapons to our spending on weapons against viruses.
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@Nick Point taken.
However, with the explosion of information available today to savvy users, people like myself are more educated about these things than my ancestors. Because of this, in my opinion, we live in a golden age of science and scientific inquiry.
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@Ed C and this golden age of science would be much better if we invested more on scientific research. We are not investing in science as much as we could. We need research to help us better deal with pandemics like this one. And while it’s true that there’s a lot of information out there, that information didn’t come out of nowhere. Researchers need funding to do experiments, publish data, and move scientific inquiry forward.
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I think I've heard the answer is yes, but can asymptomatic people infect others? Or is it truly only a cough or sneeze--evidence someone is sick--that sends the droplets into the environment?
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@Ella Individuals can transmit the viral particles even if they are not showing symptoms, however it is much more infectious if you're actively coughing and sneezing since you are sending particles out into the world further and more frequently.
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@Ella
There is some evidence that the virus can appear in fecal matter which is aersolized when you flush the toilet. This is in the top story out the New England Journal of Medicine’s web page dedicated to this virus. I always close the lid when flushing to help mitigate this.
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It is worth pointing out that the number of ACE2 receptors is increased in the alveolar cells of smokers. Good idea to avoid smoking as it may increase susceptibility and worsen outcomes.
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@Jeff
Something that seems to have been missed is that 4000 people a day die of air pollution in China, and the percentage of smokers is very high, leading to a higher death rate there. I believe the rate is over 3.5% in Wuhan where there is excessive air pollution, less than 1% in rest of China, rural areas.
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@Jeff Doesn't pot (canibonoids) attach to the same receptors as this virus?
Interesting article, but not that easy to understand.
Writing from Italy, here are some other things to do to avoid getting infected:
- Keep a distance from all other people - here the recommendation is one meter (about three feet); I realize this is difficult for people taking mass transit;
- Do not touch the handles of supermarket carts or screens at supermarket checkouts; if you have to touch these surfaces, wash hands immediately after;
- Do not share mobile phone with others;
- Be careful handling money (coins and notes given as change); wash hands immediately after.
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@Ann P
I'm a biologist and while I'm generally interested in such things as the viral life cycle, I don't think it's really an important thing for people to understand right now. More important are the things you list. And social distancing...which everyone in the US should be practicing right now as much as possible.
Take care over there in Italy. We are thinking of you and are right behind you.
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@VH
I agree that there are important basics to communicate to people. There are many articles readily available on this subject currently. I don't think I'm the only one that appreciates the reminder of the science of how it spreads. It calms me and makes me more certain of the actions that I am taking to stay healthy and reduce my contribution to any spread. All the best, everyone.
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@Ann P I am glad for fuller explanations that put the guidelines in context. Those of us with noncompliant personalities need the explanation. I am not very good with "do this, not that" guidelines. Tell me how soap dissolves the viruses protective coating and you have me washing my hands, advising others to do the same and happy to explain.
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Best of luck to the scientists and others working on the issue and the doctors and nurses caring for the infected.
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While antibodies against the flu virus may not be helpful against the SARS-CoV-2 virus, taking your flu vaccine helps prevent or ameliorate a flu case and stimulates other viral immune defenses in your body. In addition, taking the flu vaccine reduces the numb er of flu cases in the healthcare system, leaving doctors and other staff available to deal with severe coronavirus cases.
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@Monica most importantly, a patient who has been vaccinated against the seasonal flu will be able to receive a faster and more accurate diagnosis if they present symptoms of the COVID-19, as it is unlikely these symptoms would arise from the normal flu thanks to their immunization.
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@Nicolas
While I agree that getting the flu vaccine is very important, I don’t agree with your overall comment. The effectiveness of the flu vaccine varies every year due to the virus mutating . This year my son and I came down with influenza A despite having gotten the vaccine. It was not a “lighter” version unfortunately.
A swab by the dr confirmed the flu.
I’m in complete agreement that we should all do what we can in terms of preventing illness and overwhelming the healthcare system.
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