Monday, 23 March 2020

Outbreak Diary - Day 001

The Facts in the Case of Australia's Coronavirus Outbreak

I write a lot of fiction on this blog - I even attempted some unfiction/nosleepypasta at one point, which was fiction but pretended otherwise. But, let me be clear, this is not fiction, this is the truth about what is happening in Australia - and in cases where I don't know the truth, I will do my best to be fully open about that. A lot is happening, but it feels like a lot of people are out of the loop on this one. So, I wanted to write this to try to inform people about some of the stuff that they don't currently know, and try to explain this virus, as well as disperse some of the misinformation which is being circulated during these times of confusion.

My name is Matthew Aaron John Anderson, I live in Queensland in the Greater Brisbane Area - the date is the 23rd of March 2020 (a Monday), and the time is 4:32 am, as I begin writing this.

I don't know too much about the beginning, but here's what I can piece together from the very start of this pandemic, based on what I've seen in the news, and the research I've done. Most people have heard of the SARS - Severe Acute Respiratory Syndrome, it's a pretty nasty disease, which caused thousands of deaths of South Chinese people between November 2002 and July 2003.
It's a disease which has flu-like symptoms - fever, muscle pain, coughing, sore throat and lethargy. This can lead to shortness of breath, pneumonia and other nonspecific symptoms.
But, the important fact in this case is that this Syndrome is a disease which is caused by a virus, specifically the SARS-CoV, which is to say the SARS Coronavirus.

What is a "Coronavirus"?

See, a coronavirus is a kind of virus which, under the microscope looks kind of like a children's "soft thorn ball" [Author's Note: I always called them nipple balls (they look like nipples to me), but you know, these things: link], basically, a sphere covered in evenly spaced studs.
Now, the difference between a virus and most other living things, like cells, amoeba or bacteria is that viruses can't self-replicate - they can't recreate themselves on their own, by sexual reproduction, parthenogenesis, or just splitting in half like some cells do. The way that they can continue to survive and spread is by finding a living cell which has DNA, and injecting it with their own RNA, so that it basically tricks the host cell into replicating the virus for it.
That's why the coronavirus looks the way it does - a ball covered in little studs - actually, let's get technical, they're actually called peplomers, or viral glycoprotein spikes. These viral spikes have developed to attach or fuse to host cell membranes, and then inject their genome payload.
It's not a perfect analogy, but it works kind of like a cuckoo bird - which lays its giant egg in the nest of another bird, and pushes the mother bird's own eggs out of the nest in the process. Except instead of a nest, it's the cells of your body, and instead of an egg, it's a coronavirus.
Or, if you're a geek, think of it like a vampire. Since the virus is undead (using that term loosely), it can't reproduce, so it reproduces by biting "mortal" cells, and making them into vampires as well, so they can then go on and bite more.

The reason this makes us sick is because when a cell is busy being a virus, or helping to replicate and perpetuate a virus, it can't continue to be the healthy cell it was. So, if a virus managed to infect your eyes, then it would break down the biology of your eye, and you'd go blind. If a virus managed to infect your brain, then you'd have neurological issues as your brain lost functioning parts. Or, in this case of SARS, as this affects your lung tissue most readily, it means that you would struggle to breath as your lungs become less "lung" and more "coronavirus".

But, why am I talking about SARS? Well, because viruses work by seizing healthy cells to replicate, it means that like everything else in the world, as those cells replicate, they can mutate and evolve. SARS virus, whilst being very effectively managed in human populations, it was still around in other animals, such as bats - in fact specifically bats, as virologists have determined that a mutation of the SARS virus, known as the "2019 novel coronavirus", or "SARS-CoV-2" is genetically similar to SARS viruses found in bats. As this disease mutated, it became much more virulent - now, the exact details of this aren't certain, but it is believed that this virulent form found in bats was spread to pangolins in Wuhan, China.
A pangolin is a mammal closely related to armadillos and sloths, it's also known as a "scaly anteater", and it looks kind of cute, but the important thing is, it's endemic to China, which is where SARS-CoV-2 first managed to transfer from bats, and into the human population, in late 2019. Which is what is causing the Coronavirus Disease of 2019, which is why we're calling this disease COVID-19.

Which, on a bit of a lighter note, is a shame. With just the slightest of tweaks, we could have been calling this "Bat Flu", which I think sounds cooler and rolls off the tongue better, but when people started calling this disease "Wuhan Coronavirus" or "The Chinese Virus", the health officials in charge decided to nip the racist connotations of that in the bud, and stick to the official designation "COVID-19"
- this is why we can't have nice things.
[Author's Note: Whilst I personally blame xenophobia on the spread of "Chinese Virus" as a term, apparently the World Health Organization has guidelines and regulations for this - in fact they have a report titled "World Health Organization best practices for the naming of new human infectious diseases" (2015) - which discourages the use of location names, as well as encourages attempts to avoid confusion with prior viruses. This is why it's not called "SARS 2", even though that's basically the virus's name (SARS-CoV-2) - so that people can differentiate between the two more easily.]

Why is this virus different from Influenza/SARS/Common Cold/etc?

I'm going to go into more detail, but long-story short: it can kill more people.

Now, whilst this disease is not going to wipe out the whole world, and all things told, the death toll appears to be about 4% of infected - so if 100 random people were infected, approximately four should die - that's not too bad all told.
However, as I mentioned above, this virus mutated from the SARS found in bats, and two of those mutations are very relevant. I'm not a biologist or virologist, so I can't explain the mechanism, but in layman's terms:

  1. This disease has an incubation period of 2-14 days, from the time of infection, to the onset of physical symptoms.
    • This means infected persons felt healthy, despite coming into contact with the virus, so they wouldn't realize they were carrying and spreading the disease until 2 weeks later. Initial carriers were effectively "viral sleeper agents", heading home and socializing as normal, spreading the disease.
      This is how the disease managed to spread internationally - people who felt fine were travelling around the world before realizing they were spreading the disease.
  2. There are no known effective antiviral medications or vaccines available for the disease at this time, as it didn't exist until recently.
    • This is to say, because this new subspecies of SARS virus mutated only recently, November 2019 at the very earliest (but maybe December 2019) this species of virus is at most, only 4 months old (at time of writing). That is why this was called a "novel virus", essentially this is a newborn, we don't know how it behaves, we don't know what it's strengths and weaknesses are. It's only in the last month that we seemed to confirm that the main form of transmission was respiratory droplets, so we're scrambling to learn as much as we can.
At the moment, if you contract coronavirus, the treatment is symptomatic not etiological - that is to say, we can only treat the side-effects of the disease, not the cause. We can only effectively manage your symptoms (such as fever, joint aches, sore throat & coughing), to make you comfortable and healthy, so that your immune system can do the rest.
If we use that vampire metaphor - we can't actually kill the vampires, so instead we're trying to make the rest of the town strong enough to withstand the attack, and stop more people getting bitten, until the vampires all die of thirst.

This is why this disease is as deadly as it is. If your immune system isn't strong enough to do the rest - to fight off the virus - then you will die. This is why you may have heard about people who are "high risk" of this disease - which is to say that you have a higher risk of death, debilitation or severe illness, if you contract this disease. So, you are considered to face increased risk if you have:
  • Advanced Age (especially 60 years or older)
  • Breathing Difficulty
  • Diabetes
  • Heart Disease
  • Hypertension
  • Respiratory Disease (i.e. Asthma)
  • A Compromised Immune System
This should not be confused with people who are "at risk" of contracting the disease. In Australia, this includes people who have travelled to an area with high community transmission, such as the areas in China, Italy, the Phillipines; and those caring for sufferers of this virus (including nurses and those assisting people in self-isolation).

Now, a regular influenza isn't fun, in fact people do die every Cold & Flu Season, but the difference is that your average flu has an incubation of about 2-4 days which means it burns through you pretty quickly, and you'll feel the symptoms pretty quickly meaning you can call a sick day (effectively self-isolating), and you'll get over it quick and harmlessly, since medications are available. Also, people who are high risk cam simply get vaccinated. So, it's unlikely that one person can spread this to hundreds of people in a short amount of time - but it does spread slowly enough that the Common Cold never dies out (which is why it's so common). So, you may infect two or three people, but if any of you take care not to spread it, then you limit the spread significantly, from little to none.
But, the way this virus works, because there's no medications and it incubates for so long, if we just ignore it then literally everyone will get sick, and everyone will get sick very quickly - it's a concept known as exponential growth. I don't know the exact numbers for this virus, so let's use an example:
Let's say we have a hypothetical disease called "Two Flu", (because one person will infect 1 other person in a day, meaning it doubles)
Let's see how this would play out:
Day 01: Patient Zero is infected - 1 person is infected with Two Flu
Day 02: Patient Zero infects his friend - 2 people have Two Flu.
Day 03: Patient Zero and friend both infect a person each - 4 people are infected.
It would start off small, but as it effectively doubles each time. it grows quickly...
Day 10: Just over a week has passed - 512 people are now infected with Two Flu.
     . . .
Day 20: Almost 3 weeks have gone by - 524,288 people are infected.
     . . .
Day 30: Approximately 1 month passes - 536,870,912 people are infected.
And that's not all - according to the best numbers we have, there are approximately seven and a half billion people on earth, 7,500,000,000 - meaning...
Day 34, Two Flu has spread across the globe - Every single person is infected.
Thankfully, "Two Flu" is harmless, because it's fictional... but Coronavirus isn't harmless, and it is virulent enough that it can reach exponential growth - and already has in some countries. Now, whilst COVID-19 isn't as fast as the fictional "Two Flu", we've seen cases of it double (from 500 to 1,000, in one case) in as little as 3 days, and in some cases increasing by thousands in as much as a week. That's not as fast as doubling daily, but that's still alarmingly fast. At this rate, the entire world could be infected before Christmas. That's why it's such a concern.

And while the average death rate is 4% now, that's based on the whole numbers, but if you break it down by demographics:
people aged 80 or older who become infected have a 14.8%-21.9% chance of dying
infected people aged 70-79 have an 8% chance of dying
infected people aged 60-69 have a 3.6% chance.
infected people aged 50-59 have a 1.3% chance of dying
anyone younger than 50 has less than a 1% chance (0.2%-0,4%)
Except 0-9 year olds, which thus far have had zero fatalities*

*note that at time of writing, there have been less than 10 cases of people aged 9 years old or less contracting the COVID-19 virus. So, although they currently have a 0% chance of death, the sample size for that group is too low for useful data. This doesn't mean they're at risk, simply that we don't have enough information to say whether they are or not.


How am I supposed to deal with COVID-19?

Well, step one is to remain informed, and act reasonably and rationally. I had a read through some of the common misconceptions, and deliberate misinformation, regarding this virus, and it is ridiculous. Unfortunately, politicians and even major news outlets have occasionally posted misinformation, or presented it in the form of scaremongering. Some of it is excusable, but most of it is not.
In a later post, I may discuss some of the misconceptions, but for now rather than confronting falsehoods, I want to simply present you with some truth. So, if you want to prevent the spread of this disease:

1. Wash Your Hands often, with Soap and Water, for 20 seconds, especially after visiting a public place, going to the toilet, blowing your nose, coughing or sneezing; and before eating or touching on or around your eyes, mouth and nose.
See, this virus, although it's hard to see, it's still a physical organism, and the membrane that makes up its skin (also called the viral envelope) is composed of protein and fat. This is how it travels through respiratory droplets, the surface tension of the oil allows it to float in water, and that oily surface can also stick to skin until the viral spikes can find a cell to penetrate. However, soap has amphiphilic molecules - which means molecules which stick to both oil and water, allowing them to mix rather than separate. So, if soap comes into contact with the membrane of a COVID-19 coronavirus, it literally breaks apart, just like wet tissue paper. Of course, this process isn't immediate, it takes about 20 seconds (so a simple rinse and wipe isn't good enough). Also, once you break apart the virus, the water helps to wash its eviscerated corpse down the sink. And most hand sanitizers work, since ethanol is also amphiphilic, and that tends to be the active ingredient in hand sanitizers. But, just to be safe, you should read the ingredients and make sure that the sanitizer is at least 60% ethyl alcohol.
Since I'm having fun with my virus metaphor, think of these like sunlight to the vampires, breaking them down to ashes... but unable to reach them once they get inside.
Oh, and before you ask - although soap can kill the virus, the reason why we can't use soap to heal people who are already infected is that soap is safe on your skin, but it's deadly if it gets into your body. If you want to know more, look up "soap poisoning", but I warn you, it can get pretty grisly.
2. Maintain Good Personal Hygiene in General, including cleaning and disinfecting objects and surfaces which you touch regularly.
This matters because this virus can survive for some time outside of the body and disinfecting places that people touch prevents it from spreading. But, even if you don't have any infected persons around your house, it's useful to keep clean and healthy, because a compromised immune system puts you at greater risk - and having a pre-existing illness such as the common cold, food poisoning or the flu is one way to compromise your immune system.
3. Practice Social Distancing (of approximately 150cm), from those who have contracted, are at risk of contracting the virus; as well as those whose health you cannot guarantee, or those who are in the high risk category.
I've seen a lot of people joking about "social distance", since it's a funny concept, and refering to "no touching" rules as social distancing sounds like the same kind of unintuitive backwards-brained political correctness that leads to calling lies "alternative facts". Now, I can't speak for the person who came up with the term, but I think part of the issue is that people are inferring "social distance" to mean "a distance which is considered social", as opposed to what it is meant to imply which is "distancing during social activities".
Another issue is that people aren't sure when this rule should apply, as (for instance) a car rarely has enough space to sit a metre and a half apart. Are there times when social distance is okay to ignore? Can we hug our parents and children? Can we kiss our loved ones? Am I really going to get sick if I stand too close to a stranger?
The fact is, this rule exists for people whom we know have the virus, and so the rule isn't necessary, and can be ignored, when we know that both we and the person in question don't have the virus. However, because these are still early days, there is a huge grey area of "people who we don't know if they have the virus or not". And for those people you should still keep your distance, just in case, because that way it ensures nobody is at risk of sharing the virus.
So, are you sick? is your child sick? Has your partner contracted this illness? Has anyone in your family gone overseas, particularly to the epicenters of this virus? If not, then please, I implore you to hug and kiss your loved ones - with consent, of course.
In fact, my mother has a theory that with everyone being cooped up inside, there's a good chance we'll have a second baby boom, and I am conditionally in consensus with that hypothesis, but we will see...
4. If You are Infected with Coronavirus, Isolate Yourself, avoiding all physical contact with other people, staying home if possible. This includes staying away from hospitals and doctors, contacting them by phone when necessary, and if you require further care and need to visit a doctor, call them ahead of time.
This is one of the most important guidelines. You must avoid coming into close contact with anyone and everyone. This may not be possible in all cases, but it is necessary to avoid the spread of this disease. Of course, this isn't easy or fun, but that's why it's better to avoid getting sick than it is to isolate yourself after getting sick.

Wow, it's taken a long time to write this... several hours have passed as I've written and researched this, so now it's after midday, which means that here in Australia, we've now officially locked down several places where large groups of people would gather:
  • All Social Venues (i.e. Nightclubs, Casinos, Cinemas, etc.)
  • Some Sports Venues (i.e. Gyms & Stadiums)
  • Most Licensed Venues (i.e. Hotels, Clubs, Pubs; but excluding retail bottle shops and accommodation within hotels, motels, etc.)
  • All Places of Worship (i.e. Churches, Temples, Mosques, etc.)
  • All Dine-in & Table Service Hospitality Venues (i.e. Restaurants, Cafés, Bistros; but only for dining in, and such businesses are permitted to still serve food in the form of delivery, drive-thru or take-away)

Keep in mind, based on what The Prime Minister said last night, all these places are going to stay locked down for the next 6 months.

That being the case, it means I still haven't really answered the question - how is everyone supposed to deal with such strict regulations in place, and all these rules to follow, for six whole months?
Well, easy - do what I'm doing. I write as a kind of hobby, do you have a hobby? I figured keeping a diary of these times would be interesting. I won't write every day, but I thought this could help keep me busy. If you can't work from home, you can also watch TV, do chores around the house or relax, so long as you make sure to exercise - whether that means an exercise routine, or just going for a walk, you need to stay active (so long as you keep a social distance, you can exercise outside). And, most importantly, make sure that you call people and stay in touch. We're a social species, so we need to socialize a little for our mental health, and although you shouldn't visit friends and family, you can still contact them with all kinds of telephonic technology and social media.
I don't know about you, but I have a whole bookshelf of books that need reading, so I'm going to read a book, and of course do some writing. Oh, and try to stop touching your face. I don't know about you, but I rub my eyes all the time. Not only is it a bad habit, but it's risky in these viral times...

I'm the Absurd Word Nerd, trying to keep everyone, including myself, as informed as I can during this pandemic. Until Next Time, be careful out there, don't panic & stay informed.