Coronavirus NIH

Coronavirus shown in a image from the National Institutes of Health.

How many cases are there as of March 23?

• Globally: 334,981 cases, and 14,652 deaths in 190 countries around the globe. For World Health Organization map and data dashboard, click here.

• In the U.S: 31,573 cases and 201 deaths.

• In Oregon: 161 confirmed cases, with 43 people hospitalized. But only 3,025 people have been tested.

• In Wallowa County: No confirmed cases, but only five (5) people have been tested according to Oregon Health Authority and Wallowa Memorial Hospital figures. Only one test has been completed and its results were negative for coronavirus.

What is a virus, and what is the novel coronavirus?

A virus is a single RNA or DNA molecule encased in a shell of proteins, looking for a host so that it can reproduce. It is technically not a living organism. It is instead considered “parasitic” molecule that has to enter a living cell to reproduce. Once inside a host cell, a virus can reproduce hundreds or thousands of new virus particles, causing the normal cell to die and sometimes burst, thereby releasing the new viruses to start the cycle all over again.

The novel coronavirus causes the respiratory disease known as  COVID-19. It  is one of a family of coronaviruses—so-named because all exhibit a relatively round (spherical in 3-D) shape, with what appear to be appendages radiating from their sides, giving them the appearance of a crown when seen in two dimensions. Coronavirus-related diseases include many varieties of the common cold, as well as the more threatening SARS, and MERS, which have death rates of about 10% and 35% respectively. Coronaviruses are not related to the virus that causes “the flu” or influenza. Hence flu vaccines do not impart immunity to coronavirus.

How and where did it start?

COVID 19 was first recognized in December, 2019 in Wuhan, China. Research published in the journal Nature attributes the origin of COVID-19 to the jump or transmission of the virus from bats to people. The virus is, the authors say, 96% “identical to a bat coronavirus.”  Separate genomic studies have shown conclusively that the novel coronavirus originated naturally, and not in a laboratory or engineered setting.

How does it make us sick?

This particular virus is best equipped to attack the cells that line our airways, especially the lungs. “Dying cells slough away, filling the airways with junk and carrying the virus deeper into the body, down toward the lungs. As the infection progresses, the lungs clog with dead cells and fluid, making breathing more difficult,” notes science writer Ed Yong in The Atlantic. But COVID-19 brings some extra talents to the party, according to a paper published in Science March 6. The virus’ spiky projections, which contain a compound called furin, can also lock onto non-respiratory cells—especially those of the liver and small intestines. It has the potential to attack multiple organs in the body.

How and why does it spread so quickly?

The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes. It’s important that you practice respiratory etiquette (for example, by coughing into a flexed elbow). The virus structure and the content of furin in its outer shell also allows it to be more transmissible than other coronavirus’ including SARS and MERS, according to Scripps Institute research. You can carry and transmit the novel coronovirus without having any symptoms yourself. And you can catch the disease from people who appear to be completely healthy.

Furthermore, the time between cases in a chain of transmission is less than a week and more than 10 percent of patients are infected by somebody who has the virus but does not yet have symptoms.

Once out of its host, the life  of the virus varies by where it lands. A just-released NIH/CDC research paper has found that the protective shell around the COVID-19 virus breaks down in about 20 seconds when subjected to soap and water; hence the 20-second hand-washing rule. (Hint for timing your hand washing: It takes 18—20 seconds to recited the Pledge of Allegiance slowly, as you might at a basketball game.) The researchers also determined the virus can survive for about 2 hours in the air after a cough, for about four hours on copper, a day on paper or cardboard, and about two or three days on stainless steel, and plastic. Therefore, cleaning surfaces with soap and water or an alcohol or chlorine-based cleaner is helpful in stopping the spread of the virus. Frequent hand-washing for the "Pledge of Allegiance 20 seconds" is also very important. 

Who is susceptible?:

According to CDC statistics  the most severe disease and highest death rate occurs in adults age 65 years and older. To date, they account for only 31% of cases, but  80% of deaths associated with COVID-19.

However, COVID-19 is dangerous in for younger people as well. Nearly half of all confirmed cases were in people aged under 54, and almost 40 percent of all hospitalizations occurred in that age bracket. Children appear much less likely than adults to develop the disease, but can transmit it to others.

Who can get tested in Wallowa County? Why are tests so hard to come by?

Local and state rules for testing are designed to test only for the most certain of cases to conserve limited supply of test kits.  Oregon rules allow testing only of those who have a high fever of above 104, and a significant dry cough. 

Is there a medicine or vaccine?

Not yet.

In a quest for a vaccine, NIH, in collaboration with biotechnology company Moderna has begun trials at Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle. The open-label trial will enroll 45 healthy adult volunteers ages 18 to 55 years over approximately 6 weeks. The first participant received the investigational vaccine March 19.

 A randomized, controlled clinical trial to evaluate the safety and efficacy of the investigational antiviral remdesivir in hospitalized adults diagnosed with coronavirus disease 2019 (COVID-19) has begun at the University of Nebraska Medical Center (UNMC) in Omaha.This is the first clinical trial in the United States to evaluate an experimental treatment for COVID-19,

 According to the journal Science, WHO  is planning to launch extensive trials of four potential treatments. However these are essentially large scale experiments, not true clinical trials. WHO is focusing on four  therapies: an experimental antiviral compound called remdesivir; the malaria medications chloroquine and hydroxychloroquine; a combination of two HIV drugs, lopinavir and ritonavir; and that same combination plus interferon-beta, an immune system messenger that can help cripple viruses. The malaria drug chloroquine's  effectiveness for COVID-19 in humans is anecdotal and unproven according Dr. Anthony Fauci of the NIH. Presently, the NIH has funded 155 research projects, ranging in budget from less than $30,000 to more than $1 million to understand the novel coronavirus and produce a vaccine and a cure.

For an up-to-the minute update on the global spread of COVID-19, go to the World Health Organization's online map.

Sources for this story:

Oregon Health Authority (OHA), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), World Health Organization (WHO), Merck & Company, Science, Nature, The Atlantic, The Wall Street Journal, and the New York Times.

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