An assessment of COVID-19’s progress from a doctor working in Japan

An assessment of COVID-19's progress from a doctor working in Japan

My area of expertise is mostly metabolic diseases, a little bit of immunology and cancer, so I’m not a virology / infection specialist or public health professional. I believe it is really important to be informed properly. As far as I watched from YouTube, there is a lot of false information lying around.

As of now, we can categorize countries’ approach to this disease in 3 ways.

Full isolation: I think the best examples of this are New Zealand and Israel. Some countries, such as these countries, whose borders are well controlled, have gone to very harsh and robust practices such as a very serious border closure, a mandatory curfew of up to 8 weeks in some cases, full enrollment and registration of everyone. If you have a geographical advantage, there is a strategy that can be applied, but this event has a disadvantage as follows. You need to keep your country under these conditions until a complete and effective rebel has been developed (I’ll come back to this topic later). So, you can return to normal life after a stage, but you will have to keep your limits closed.

Controlled release: now you can cite this category in countries where perhaps 20 percent of the population is infected, 30 are infected, the number of infections is high, but the number of positive cases is low. The best representative of this group is South Korea. It’s not bad in Germany. They quickly tested and circled the disease wherever it appeared, trying to prevent the spread of clusters. As the disease is spreading slowly, hospital, intensive care, doctor, bed etc. Before going into their crisis, they made the necessary interventions to the patients and kept the number of positive cases low. We haven’t seen much change in this strategy of South Korea for months, most likely, 70 percent of the population will not give up this policy until 80 of them are infected. They follow the spread of the virus in a controlled way, saving the lives of people as much as they can (I think this is the most advantageous strategy, I will explain later). These countries will not return to normal life as fast as the countries in the first group.

Herd immunity: now what the 2nd and 3rd groups are aiming for is the same thing, this so-called “herd immunity” … but their approach to this is another … South Korea is slowly trying to reach this point in a digestive way. and Japan played an important medical gamble in my eyes, radically targeting herd immunity. Great Britain looked at it, there could be 300,000 deaths in a few months, they changed their policies. There is no evidence that Japan has undergone a serious change in this policy yet.

Let’s talk about Japan

Yesterday, perhaps Japan’s most important comedian has died from covid-19. Ken Shimura was 70 years old (a young age for Japanese). The information I have gathered from the Japanese media is as follows:

March 17, Ken shows the first symptoms and does not go to work, stays at home (since the first day, Japanese officials advised that you should stay at home unless you get very sick, that is, if you reflect in the fever).

March 19, Ken’s condition is getting worse.
March 20, Ken is hospitalized.
March 23, Ken’s new coronavirus tests are positive.
March 29, Ken is dying.

If 70-year-old Ken started to show the first symptoms, he would have died today if he was accepted by a hospital and tested. Again, it would not spread the disease until March 20 due to the March 17 (and possibly earlier) infection, but even though I personally do not want to accept it, it seems that the events happened within the framework that the Japanese government wanted. In other words, if you have a fever, shortness of breath and cough that have not passed for 3-4 days, according to the Japanese government, they will test you “maybe” after that. As a matter of fact, a friend who showed these symptoms was x-rayed, but the test was not performed. In such an environment, the total number of people tested in Japan since January has not reached 20,000. However, they test for dying patients. Also, the curfew did not come, and so on. For the previous day, a fight competition with 6000 people was organized. This means that you are infected by the virus, wait for it to go home, but if it does not, endure as much as you can (the “gama” event in Japanese philosophy), if you are about to die, come to the hospital and try to treat you. In the meantime, I will talk about why x-ray was taken to my friend but there is still no test.

Now we do not know the dynamics of the virus very well. If the virus spreads very quickly, its killing is also high (number of hospitals, intensive care, doctor / number of beds, etc.). Well, if the speed of virus spread is low but effective, you can keep the number of positive cases somewhat lower this time, but this time the effect of the virus on the economy will be very bad because it means that the economy of a country has stopped for weeks or even months. I think that Japan, which is not in a very good economic situation, could not take this risk and decided to gamble. The Olympics were also very effective in this, but now they have seen that because of its lining, we have started to get more advice from the government over the ban for the past 48 hours. It is very likely that they will begin to take sound precautions in the next few weeks, like the UK.

There is another group besides the 3 groups I mentioned above, let’s call it 3.5 groups

These are the countries that could not understand the dynamics of the epidemic and were caught off guard. Of course, Italy, Spain, somehow France, USA can be shown as examples. These countries necessarily went to the implementation of the countries in the third group for a while, but they did it uncontrollably! Since their personal disciplines and hygiene are not at the top level like the Japanese, the rate of infection spread was much faster than in Japan and their health systems were paralyzed. So, they started losing most of the patients they could save.

Now let’s come to an important point: Where are we going? How will this disease end?

We can evaluate 3 things under this title:

Immune development against the virus
Vaccine studies
Drug studies

Obviously, my personal opinion, drug studies are the least important in my opinion, I will touch upon the causes of the virus and its infection characteristics.

Let’s talk a little immune. Let’s consider the 1st and 2nd topics under this section.

In the medical sciences, transmission is evaluated in 4 groups:

By air (sneezing, coughing, etc.)
Direct contact
Indirect contact (plastic, PVC, steel, cardboard surfaces),
Through the feces / mouth (there is such a thing as the f diagram, those interested)

Now, when you take this pathogen, the virus, somehow, an immune system reaction has not occurred in your body yet. So, for example, if you test your virus at one stage, you will be positive, but if you do an antibody test, you will not be positive. Now, to understand how many people became infected during an epidemic, the main thing to look for is an antibody conversion rate, called seroconversion. In other words, it can be called antibody conversion rate. If seroconversion has occurred, this disease can be easily observed in the blood. This is because the body has too many viruses in the early stages of infection, while there are few antibodies. Therefore, the antibodies that are attached to viruses and we cannot find free antibodies. However, free virus can be found. In the advanced stage of the infection, since more antibodies are produced, this time the antibodies are high in number, and although they are attached to all viruses, we still encounter free antibodies in the blood. At the stages of these processes, the chances of getting false negative results are high. Often, someone with negative results is therefore retested.

Now, once you get over this seroconversion step, your immunological memory protects you from re-infection with this virus, because your body now stores that virus and the antibodies to be produced. The countries in groups 2 and 3 that I mentioned above are the countries that try to survive this seroconversion phase with minimum damage. That is why the first group is addicted to vaccination. New Zealand people who do not come in contact with the virus, therefore, cannot develop a seroconversion and cannot be immune to the virus. Once a vaccine has been developed, they will do it artificially, but until then they must protect themselves from this virus.

Another reason for me to explain this now is as follows; If we have a serological test in which we can test various antibodies, regardless of whether the virus is still in the middle or not, those who test positive can easily get into the human because they have antibodies in their blood that can stop this virus. Frankly, in my opinion, when we develop this serological test one day, people who have positive antibody tests can be given an identity card, and they can continue their lives freely.

Now, at this stage, there is a problem: As seen in influenza or norovirus samples, viruses are changing so rapidly that we cannot develop a final immune reaction to these virus infections. This is a matter of frequency and functionality of the mutation of the virus genome; Virus expert friends can explain this issue better. Now there is a topic called “genotype-specific herd immunity” against viruses that are constantly mutated. In other words, the herd immunity that develops based on the virus genome … that is, we can develop different antibodies against different forms of a virus. However, this also means that the virus is infected by antibodies that you develop through seroconversion may not work against another mutated version of the virus. Obviously, this is the issue that worries me the most. Another disadvantage of this issue is as follows: just as the virus develops triggers against your immune system, it can show the same triggers against rebellious studies. So, we can develop a nice vaccine and produce antibodies artificially to the body, especially as we see in the flu vacs, but the virus can change form over time and make this ace insufficient. Look, I’m not saying it overrides. The vaccine you receive will always be effective against that form of the virus but will not provide a similar defense against its new form.

In other words, you were positive serologically, you were given an identity card, now you continue your normal life … at this stage, you can face a problem as mentioned above. Unfortunately, it is too early to comment. In a few months this issue can be better understood.

Now, unlike the reason I told you, there is another reason why the tests are false-negative. I mentioned above that my friend was asked for x-ray, but no virus test was required. In some cases, symptoms similar to covid-19 disease appear in the lungs, while the test results are negative. The reason for this is that it is not an easy matter to take a sample to test this new coronavirus. In one of my previous writings, I mentioned how deep the types of cells infected by the virus. This poses a challenge for the healthcare professional who will take the sample, and it is very likely that the disease will be negative when a good sample is not taken. Again, this event reveals how blood tests should become widespread.

Now there is another issue that needs to be mentioned at this stage. Let’s say the virus is a virus that does not change form quickly, such as influenza, so once you experience seroconversion and you are serologically antibody positive, you can now call yourself a “covid-19 disaster victim”. You have been given an ID card, you have returned to life. The so-called “community transmission” was 80 percent. This still means that 20 percent of the community is sensitive and somewhat vulnerable to this disease. In order to protect this 20% segment, vaccines must be developed as soon as possible. The fact that people over the age of 65, which is also applied in our country at the moment, does not go out onto the streets is actually logical to be implemented at a later stage, but perhaps it is not so logical at this stage. Since the people who are serologically positive between the ages of 20 and 40 will no longer be ill and cannot transmit this disease, the number of positive cases can be reduced if people over 65 are still taking action until a vaccine is developed.

So, to put it together

A significant part of us will be able to return to our normal lives for up to several months.
Companies and universities will develop effective, serial and inexpensive serological tests.
People who have positive serology will be protected against the disease.
It is very complicated for an infected person to become infected again. Obviously, I think that it is a form change of the virus rather than an antibody produced in the immune system, but I can be wrong.

Elderly people with low immunity will be less at risk in the future, when a significant part of the population is serologically positive, but they will not give up strict control.

When we develop a vaccine against the virus, people who are more susceptible to the effects of this virus will be able to continue their normal lives.

Source: eksisozluk.com