As he mourns the loss of a colleague, Johannesburg GP Dr Mark Holliday answers some some pertinent and thought-provoking questions about our battle against Covid-19

Spring witnesses legions of humans emerging from the grey trenches of an enduring isolation. The colourful season has brought with it a much-needed change in socialization and commercial regulations- aa well as a welcome lift in human spirit. Together, these are driving a burst in people connections.
But the Covid snipers are still everywhere- threatening to exploit the human need to touch at any turn. Lessons from the world’s war encourage us to keep our heads down to avoid becoming a casualty in a second wave barrage that typically follows the easing of restrictions.
Recent months have taught us much about the contagion nemesis.

Today, we have an advance on Covid’s tactics, know how to defend ourselves from the attacks and fear the enemy less. But Covid may have made a pact with a new and dangerous ally. Will the vaccines that are being rushed to the front lines at a chaotic and unsafe pace turn out to be a future foe in sheep’s clothing?

Here’ what we’re battling now:

Would you volunteer to receive a trial vaccine?
A big concern with vaccines is that they can enhance disease. A shortcut requires the intentional infection of people who have been vaccinated not only to see if the vaccine works, but to check that it doesn’t make the disease more severe.

Any volunteers for an injection of a toxic dose of Covid-19?
Two types of vaccine in the late stages of development involve RNA and DNA technologies never used in humans before.
They will use your cell to print copies of the vaccine… what else can they print?
One of the vaccines attaches the spike protein to a disabled cold virus. 10 trillion virus particles are used per injection into test-monkeys! You will get two of these injections!
All proposed vaccines require an injection and subsequent booster injection.

The world will thus need 16 billion injections.

Pharmaceutical companies are targeting an immune response of 50% which is well short of the herd immunity requirements of 60-70%. All current candidates are focused on blood antibody formation which may protect against lung disease, but won’t protect the nose and throat. This means that despite a milder illness you can still spread the virus – again not good for herd immunity.
There are now three vaccines in public use in Russia and China. Western scientists believe that these have been recklessly released too early, for responsible scientists traditionally take 15 years to develop a safe vaccine. These vaccines are inactivated virus vaccines that usually don’t develop a strong level of immunity.

An interesting problem may arise from those pharmaceutical houses that are using living viruses to carry the spike protein to our immune system. This technique has been used because it makes several shortcuts, but what if we have already had the carrying virus? We would then kill the carrier and neutralise the vaccine. Booster injections may also inactivate the first injection leaving the patient unaware that he has no immunity.

A new spanner in the works for those hoping for an early vaccine is the prohibition the FDA has imposed on the general release of any vaccine until two months after trial completion. This means there will be no vaccine before Xmas.

Variolation is the new buzzword in vaccination. It means that you can become immune by being exposed to small doses of virus through wearing a mask. This has been demonstrated by a higher prevalence of antibodies in populations that have been wearing masks, implying that they contracted the virus very mildly with no symptoms and yet became immune.

When will the second wave happen?
Most countries that have downgraded their lockdown levels have experienced a second wave, which was anticipated. The severity of the second wave is related to increased socialization. Reckless socialization such as at university parties in the USA and UK were not predicted, aggravating the big surges that they are experiencing. Curfews may even worsen the problem by people drinking faster and earlier, leading to more disinhibition and less social distancing.

In South Africa we are seeing a decline in new reported cases, but the festive season with recklessness is pending… The average time for a surge in Europe after reducing lockdown level is 55 days. Extrapolating from this predicts that South Africa will see an increase in cases around October 12 i.e. today!! (Lockdown to level two was 18 August). I predict that it will be later and milder because, to our advantage, our mild climate doesn’t require us to spend summer indoors using air-conditioners, unlike sultry Brazil and Florida.

There is a curious observation noted in countries with a second wave – the numbers of new cases are high, but hospital admissions and death statistics are initially low. Statisticians are claiming that this isn’t a true second wave because we are only identifying positive tests and not sick people (a casedemic). This may be due to the inadequacy of the PCR as a screening which gives false positives. Additionally, extra testing will inevitably identify more cases. The decreased severity may also be because all the vulnerable people have already succumbed or possibly that masks, distancing and variolation are working.

History reminds us, however, that in 1919 the second wave of the Spanish flu in South Africa killed 5% of our population in just six weeks. Current WHO estimates are that 10% of people have been exposed to Covid-19. This means that 90% have not!

Why do some people get it worse than others?
Our innate immune system prevents us from getting disease by not allowing viruses to penetrate our skin for example. In our respiratory tract we have tiny sweepers called cilia that move minute virus particles into the saliva that you swallow and kill with the acid in your stomach.

There are two main ways for coronavirus to enter our body: through the throat or through our lungs. If you can limit it to your throat you will only get a mild illness, however if it is inhaled in enough numbers to reach your lungs then you can expect a more torrid course. What also seems to matter here is the initial viral load: if you walk through the invisible cloud of virus particles left behind by someone who coughed recently, you may inhale enough virus to overwhelm the ciliary sweeping system. Part of the problem here is also that you have inhaled millions of viruses that put your immune’s recognition system a few days behind where it would have been had you only inhaled a few particles. The case for masks in crowded environments is high in this scenario.

Surfaces are not as infectious as previously thought:
Initial laboratory research showed the viability of virus on surfaces, leading to a new industry of deep cleaning and overly fastidious hand washing. Reviewing the evidence suggests that the virus on most surfaces is not strong enough to make people ill.

In a letter to The Lancet, an Italian group reported that transmission through inanimate surfaces is less frequent than hitherto recognized, confirming microbiological research in the USA. It is becoming clear that the most important factor in transmission is through breathing in contaminated air. Nonetheless, hand washing is an important part of self-hygiene and is still encouraged.

Donald’s Daiquiri:
The US president was treated with a large cocktail of remedies: Remdesivir is normally reserved for ICU cases, but logic does imply a better result if taken early. Artificial antibodies cultured in embryo cells were infused which also would have been significantly beneficial. Zinc, Vit C and Vit D were part of his cocktail as well as Famotidine, a surprise drug that is usually used to treat stomach ulcers but has shown some evidence in slowing Corona virus replication. Dexamethasone usually given late in the disease to prevent immune overreaction was probably unnecessary and its side effects may account for his post discharge euphoria. Omissions included Hydroxychloroquine and bleach (although it might have been applied to his hair).

Sadly, Covid has claimed its first life in our practice. Terry, an elderly male with diabetes who otherwise enjoyed excellent health and a zest for life, died three weeks ago. His passing was yet another warning shot, starkly reminding me that this war is far from over. Terry my friend, we all miss you.