Covid-19: Things we still do not know

It is more mysterious than any Sherlock Holmes adventure.

They thought it was a flu, they were wrong. The novel coronavirus or Covid-19 is much more than a flu.

The experts said that any person who contracted the virus would show symptoms of flu, fever and breathing problems. But, later many cases of coronavirus were reported with patients having no fever.

The world is at war - all the countries are fighting against one common enemy - a microscopic creature - invisible and tiny - but potentially fatal.

All big weapons are falling short of killing the enemy. It is winning with every death, and the world is losing sanity, slowly and gradually.  That is because: there is still a lot about the virus that we do not know.

In an April 13 article in the New York Times, Charlie Warzel lists 48 basic questions about the coronavirus, and while we may have partial answers to some of the questions he raised, the article is a stark reminder of everything we do not know about the deadly virus still.

Warzel's questions included: what must be done to protect ourselves against Covid-19? How deadly is it? How many people have really caught it and shrugged it off? How long does immunity to the disease last after infection?

While we have been trying out various options as answers to these questions, the reality is we do not have concrete answers to any of them.  

"Despite the relentless, heroic work of doctors and scientists around the world there's so much we don't know," wrote Warzel.

What medicines work on Covid-19?

In the weeks following Warzel's article, doctors in the US have got some clarity on at least a few of the queries about medicines he raised.

The US doctors started administering hydroxychloroquine on Covid-19 patients. This was a move backed by Donald Trump that eventually failed. People were dying. Subsequently, the US Food and Drug Administration, issued a statement warning coronavirus patients and their doctors from using the drug.

Then came remdesivir, an antiviral drug, which was used to treat SARS patients. The drug seems to have taken the world by storm. While world leaders and their laboratories are debating over its usefulness, Japan has already approved remdesivir for use against the novel coronavirus. Bangladesh has also started producing the drug.

However, there are conflicting reports to suggest that this drug may not be the magic cure we all are looking for.

Is herd immunity an option?

While scientists do their work in the laboratories, world leaders also thought about other ways of beating the virus. That is when talk of herd immunity came into play. That is another potential weapon against the virus.   

Herd immunity happens when so many people in a community become immune to an infectious disease that it stops the disease from spreading.

Some leaders — for example, Boris Johnson, the prime minister of the United Kingdom — suggested it might be a good way to stop or control the spread of the new coronavirus, which causes Covid-19.

This can happen in two ways, Firstly, many people contract the disease and in time build up an immune response to it (natural immunity), and secondly many people are vaccinated against the disease to achieve immunity.

Herd immunity can work for some diseases but not for Covid-19, at least not yet. Studies have found that only a tiny proportion of the global population – maybe as few as 2% or 3% – appear to have antibodies in the blood. But that percentage is way too low to work.

Unfortunately, we are some way from having a vaccine to Covid-19 although many are being trialed, meanwhile reports of Covid-19 reinfection in China and South Korea undermine hopes of achieving immunity through widespread contraction of the disease.

How is Covid-19 actually killing us?

We are now almost six months into this pandemic, which began in November in Wuhan, with over 78,000 Americans dead and 276,000 more around the world.

The major question which has still remained unanswered after almost six months is: how is the virus killing us?

The clinical shape of the disease, long presumed to be a relatively predictable respiratory infection, is getting less clear. A few common symptoms include fever, dry cough, and shortness of breath. But, the baffling news  according to the Journal of the American Medical Association, is that 70 percent of patients sick enough to be admitted to New York State's largest hospital system, till the end of April, did not have a fever.

The most bedeviling confusion has arisen around the relationship of the disease to breathing, lung function, and oxygenation levels in the blood — typically, for a respiratory illness, a quite predictable relationship. But front-line doctors have been expressing confusion that so many coronavirus patients were registering lethally low blood-oxygenation levels while still appearing, by almost any vernacular measure, pretty okay.

It is one reason they began rethinking the initial clinical focus on ventilators. But after a few weeks of unclear benefit to Covid-19 patients, doctors said these patients may have done better on lesser or different forms of oxygen support. Reports said 88 percent of New York patients put on ventilators, for whom an outcome is known, had died. In China, the figure was 86 percent.

In late April scientists reported that they had "vastly underestimated" the ability of the disease to mutate— investigating the disease as it appeared in just 11 patients, they said they found 30 mutations.

In a fantastic survey published on April 17, Science magazine took a thorough, detailed tour of the ever-evolving state of understanding of the disease. Science lists the following organs as being vulnerable to COVID-19: brain, eyes, nose, lungs, heart, blood vessels, livers, kidneys, intestines.
On April 15, the Washington Post reported that, in New York and Wuhan, between 14 and 30 percent of ICU patients had lost kidney function, requiring dialysis.

A few days later, the paper reported that "young and middle-aged people, barely sick with COVID-19, are dying from strokes."

In the space of a few months, we've gone from thinking there was no "asymptomatic transmission" to believing it accounts for perhaps half or more of all cases, from thinking the young were invulnerable to thinking they were just somewhat less vulnerable, from believing masks were unnecessary to requiring their use at all times outside the house, from panicking about ventilator shortages to deploying pregnancy massage pillows instead.

Six months since patient zero, we still have no drugs proven to even help treat the disease. Almost certainly, we are past the "Rare Cancer Seen in 41 Homosexuals" stage of this pandemic. But how far past?