End the pandemic in the new year

Mask significantly reduces the viral load on our defenses. Vaccination simulates the attack of the virus and stimulates our immune system. This response decreases in the absence of a successful or unsuccessful viral attack or another dose of vaccine.

UNITED WE STAY, DIVIDED WE WILL FALL: 2020 was the year of the virus; 2021 was the year of the response; 2022 may be the year the pandemic ends if we collectively want it. The virus is a piece of inanimate genetic material that comes to life when it infects us. We cultivate it, breed it and help it to spread by sharing it generously with our contacts like a computer virus on our contact list. The best method to eliminate it is for all of us to exercise enough self-control to boycott and collectively quarantine the virus by having ourselves and most of humanity vaccinated, using N95 masks as well. adjusted in public spaces and avoiding unnecessary movement and crowds, especially indoors. All of our executives, celebrities, influencers, and industries, especially medical insurance companies, should vigorously promote this message across all forms of media.

QUARANTINE AND VIRUS LOCKOUT: To avoid quarantines and lockdowns, we need to break the chain of transmission of the virus. In order to spread, the virus needs its infected host to carry it close to other susceptible hosts and help it spread through the air. R, the virus reproduction number is the average number of individuals infected by an infected individual. An R-value greater than 1 means that the number of infected people increases, while below 1, they decrease. The value of R for the coronavirus between 2 and 4 usually leads to containment and disrupts our life and the economy. Instead, we can stop the spread of the virus by using several defenses now available to us in the form of masks with social distancing, vaccines, testing at the slightest doubt or contact with an infected person, self-quarantine in case of infection and early medical research help.

VACCINES KILLED THE COW, BUT NOT COVID-19: Vaccines are effective in providing lifelong or long-term protection and, in some cases, eliminating infectious viruses that do not continue to mutate, such as smallpox , polio, measles, mumps, rubella (German measles), Varicella vaccine (chickenpox) against hepatitis B, Japanese encephalitis and rotavirus. Effective rabies vaccines are available, but infected wild bats and stray dogs provide them with a safe haven. Viral infections for which we have not yet developed a vaccine include chikungunya, dengue, HIV / AIDS, respiratory syncytial virus, cytomegalovirus, herpes simplex virus, etc. The influenza and SARS viruses mutate frequently enough and just enough to escape the vaccine and infection. antibodies such as monoclonal antibodies. For the influenza virus, models are used to predict the likely prevalent variant each year and the vaccine is updated. Too many mutations as in the Omicron variant can result in poor long term survival due to elimination by natural selection. If such a variant is very highly transmissible, it can compete with other variants and then eliminate itself, which is how many epidemics in the past naturally ended. Vaccines and tests will need to be updated to keep up with the changing virus.

Figure 2: Chart 2006-10

PANDEMIC WAVES AND OVERVOLTAGES: Classically, pandemics due to new pathogens have three waves (Figure 1). The first wave is that of a microbe which has passed from another species to man and which is not yet fully adapted to man. The second is the biggest and worst wave when a virus variant is fully adapted to humans. The third wave is usually benign as new mutations weaken the virus but allow it to elude the immune response, including cross and herd immunity, and eventually the pandemic dies out. The virus then becomes endemic or extinct. Sometimes an additional mutation can lead to a more dangerous variant like the 2009 (H1N1) pdm09 variant during the H1N1 pandemic which caused a fourth wave much worse than the second wave (Figure 2). According to a study from Hong Kong, the Omicron variant multiplies 70 times faster in the airways but 10 times slower in the lungs than other variants of concern. This explains why it spreads faster, has a shorter incubation period requiring a shorter quarantine period; and does not appear to cause breathing problems or complications.

TRIPLE DEFENSE AGAINST AIR VIRUSES: The influenza and SARS viruses are unique in that they are the only viruses that have caused pandemics in the past hundred years. Both are airborne, mutate frequently, requiring repeated injections with updated vaccines, and have been the primary focus of biological weapons research. We need a triple defense against these viruses.

MASK AND VACCINES: Vaccination alone is inadequate as exposure to large numbers of viruses can overwhelm our immune system, as has happened in the UK and Israel where after a successful vaccination campaign, mask warrants and social distancing have been removed, leading to new waves of infection.
HEPA MASK AND FILTER: The first and most effective defense is to use a properly fitted N95 face mask that filters 95% of viral particles. Adjusting the nose clip is important because any mask that does not fit the face properly will be ineffective as air will bypass the mask around its side edges; therefore, children need smaller N95 masks. NIOSH N95 or N95 is the US standard for masks. Similar standards in other countries are FFP2 in Europe, KN95 in China, DS in Japan, KMOEL in South Korea, P2 in Australia and New Zealand. These also filter out other microbes, PM 2.5 dust, smoke and allergenic particles. HEPA air filters are required for air conditioning / ventilation in closed spaces such as buildings, airplanes, trains and other public transport.

VACCINES: Vaccination simulates the attack of the virus and stimulates our immune system to produce antibodies and killer cells against the virus. This response decreases in the absence of a successful or unsuccessful viral attack or another dose of vaccine. For Covid-19, different types of vaccines have been developed much faster than ever. These provide different targets for our immune system:
1. Only the receptor binding domain (RBD) of the spike protein by RBD subunit protein vaccines such as Corbevax and Covovax;
2. The whole spike protein by mRNA vaccines from Pfizer, Moderna, J&J or DNA plasmid vaccine like ZyCovD or viral vector vaccines like Covishield, Sputnik V.
3. The entire virus died from attenuated virus vaccines such as Covaxin. Each type of vaccine has its advantages and disadvantages. There are wide variations in the antibodies and cellular immune responses to these vaccines. Vaccine mixing and pairing studies show better results than booster doses with the same vaccine. The nasal vaccine will further reduce infections and transmission by providing local immunity at the site of entry of the virus. The greater the number of unvaccinated or vulnerable populations available, the more infections and mutations there will be.

CONTACT FINDING, TESTING AND SELF-ISOLATION STOP VIRAL TRANSMISSION: Effective early detection of viral infection is the second line of defense by preventing further transmission of the virus to other vulnerable people. This requires rapid early testing of all with early symptoms of the disease, tracing and testing of all of their contacts, and also a large number of random population tests. Social distancing, travel restrictions and overcrowding are other important measures to break the chain of transmission. Laxity in these measures makes confinements inevitable. RT-PCR tests are a molecular test performed in expensive thermal cycling machines in large batches and verify the genetic material of the virus and are the most accurate tests to date. Separate tests are available for each virus specific target gene, such as the E (envelope), S (tip), RdRp, N (nucleic acid) and ORF genes. Antigen tests detect certain proteins in the virus that trigger an immune response. A new, rapid and inexpensive RT-LAMP test has been developed by ICMR-NIV Pune and put into production recently. Nucleic Acid Amplification (NAAT) tests detect even low levels of viral nucleic acid, are quick but more expensive. Genome sequencing is expensive and is done in specialized laboratories for epidemiological studies and not for the management of Covid-19. Ideally, virus samples from 10% of infected individuals are sent for genome sequencing to identify the variant and mutations present, but in practice 5% or less are tested depending on the number of cases. Neutralizing antibody tests should not be confused with antigen tests because they estimate a person’s antibody response to the vaccine or infection.

TREAT THE INFECTED EFFECTIVELY TO AVOID DEATH AND PANIC: Early detection and appropriate treatment are important in trying to prevent complications and death. Sorting patients into those suitable for home quarantine, symptomatic medication and monitoring, those who need hospital admission or intensive care is necessary to avoid unnecessary overloading of healthcare facilities. Initially, many drugs, including existing antivirals, were reused for treatment. Recently, specific antivirals like Molnupiravir, Ritonavir and monoclonal antibody therapies like Sotrovimab, Ronoprave and Evusheld have become available. Steroids, blood thinners, oxygen, and ventilators continue to be needed as needed.

NEW WORLD AND WORK ORDER: The pandemic has accelerated changes in the work order for working from home and anywhere; online education and entertainment; virtual meetings and conferences. Home delivery of essential items, products and services, including telehealth services, has been made possible by advancements in telecommunications, transportation, drones, e-commerce, digital payment, automation, artificial intelligence and many other technologies. Many countries are adapting quickly and prospering while others are lagging behind and deteriorating. This is rapidly changing the world order with many developed economies already affected by stagnation, now hit by lockdowns. China, soon to become the world’s largest economy, now finds itself in a downward spiral of debt, lockdowns and loss of global confidence. India is heavily dependent on China for its medical and other critical supplies. The shortage of chips is affecting the availability of many vital medical devices. India is expected to start manufacturing semiconductors and other important components and strategically important equipment. It is the best chance for India to become a world leader in health and services, agriculture and manufacturing, sustainable lifestyles and economy.
Dr PS Venkatesh Rao is a consultant in endocrine, breast and laparoscopic surgery.

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