I remember looking at the new epidemic in China earlier this year and thinking that while the numbers were worrisome, they were also far away from me. SARS-1 never got here. MERS never got here. Ebola never got here. It’s certainly easier to keep a purely academic interest when your loved ones are not at risk and your daily life isn’t impacted.
Having reliable sources of information always helped me to control my anxiety and fear of the unknown. So, I’ve been revisiting my virology lessons and exercising my critical thinking to help me make sense of this pandemic.
VIRUS STABILITY ON SURFACES
How long does a virus lasts outside a host? It depends on the virus. Coronaviruses are enveloped viruses and are more fragile because of that. Once you disrupt their outer lipid envelope—with soap, for example—you have inactivated them.
This paper provides data about SARS-CoV-2 stability on a variety of surfaces. After aerosolising the particles, they deposited them in various surfaces, like plastic, copper, and cardboard, to study how long the virus remained there.
They concluded that the virus could last three hours in aerosol form, less than 24 hours on cardboard, and up to72 hours on plastic. Just note that these are under experimental conditions. I doubt that an aerosol could last that long outdoors, but having this data is a good starting point. Also note that despite remaining quite some time in the surfaces, the quantity of virus diminished, and we still don’t know how much virus is needed to cause an infection.
COVID-19 IN PAEDIATRIC PATIENTS
Since the beginning of the pandemic that scientists and clinicians noted that the severity of the disease increased with age. Children seem to have less symptoms, if any at all. This is a relief to many people, but also poses some questions: why aren’t they affected? Do they act as asymptomatic transmitters? The answer to this last question is yes, and that is why we should restrict their contact with elderly people. Grandpas and grandmas all over the world are longing for their grandchildren.
As for the disease manifestations in children, there isn’t much data. This study considered seven Chinese children that were hospitalised with Covid-19. Note that one was admitted to the ICU. As far as we know, it’s very rare that this virus will cause serious disease in the younger population, but it’s not impossible. Apart from this, there is still no clue to why their alveoli lining cells do not react the same way as the adults’ when infected by SARS-CoV-2.
There is also a pre-print available from Pediatrics that provides an initial characterisation of Covid-19 in children and sums up the available data.
THE ANTI-INFLAMMATORY DISCUSSION
As a pharmacist, this one hit close to home. I saw the French health authority communicate about anti-inflammatories possibly increasing the severity of Covid-19, as well as multiple social media posts around the same issue and was intrigued. I followed the trail to the source, a letter to the editor of The Lancet. I read it and couldn’t discover why such a conclusion was taken from it. That letter forms the hypothesis that patients with diabetes and hypertension may show more severe symptoms of the disease caused by SARS-CoV-2 because they have more ACE-2 receptors, which serve as the entry point for the virus. In a single line they state that “ACE2 can also be increased by thiazolidinediones and ibuprofen”. This is a good letter, where the authors form hypotheses to be tested. They haven’t done any actual study, and haven’t produced any new data. Just a hypothesis. In my humble opinion, it’s a really long stretch from taking anti-inflammatories for an acute situation and ramping up your expression of ACE-2 receptors to such an extent that your cells would be suddenly flooded by viruses. I think that a more plausible hypothesis would be to say that people that take anti-inflammatories chronically (e. g., for arthritis) could have more ACE-2 receptors than people that do not. But once again, it’s a hypothesis, not backed up by any data. There was so much controversy about this letter that the corresponding author issued a statement on how to interpret the letter, emphasising that there is no evidence of adverse impact of ibuprofen on the infection by SARS-CoV-2 and that further research is needed in this area.
The European Medicines Agency (EMA) has released a statement to say that there is no data that supports the claim that anti-inflammatories increase the severity of Covid-19, and that they are still the second line treatment for fever (the first line being paracetamol), and that they are safe to use if you don’t have any contra-indication for it, namely asthma, hypertension or anti-coagulant usage.
These are by no means an exhaustive analysis, but I hope it’s enough to shed some light on the controversy around some scientific literature that has made its way to the news.
Do you have any thoughts or comments?
Leave a comment below and let me know.
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