I submit that what’s missing in this crisis is a good song. Oh sure, there’s lots of sturm und drang out there, but nothing you can dance to. And we need a little dancing right now, if only in our socially limited spaces. Maybe we can resurrect my old high school principal, Hose-Nose Allen, who was adept at patrolling the gym and making sure no one was dancing too close. These days he’d be making sure masks and rubber gloves were in place. But I submit there’s already a song out there for all of us, and it only needs a tiny bit of tweaking to bring it 4 decades forward into total relevance to our perilous modern times https://www.youtube.com/watch?v=BR2JtsVumFA. It’s a high-energy tune, and Lord knows we could use more of that, even if we’re incubating COVID-19, for which a major symptom is fatigue (how can you tell?). It’s such a fire-you-up song, George W. Bush had it on his iPod. Probably still does. After writing all that, and I promise I’m not retracting a word, I found some who has constructed a cute parody around the song for our current crisis https://www.youtube.com/watch?v=jOf1FLxpAGM . But I say stick with the original and let your mind fill in the corrections. You may come up with better words than the youtube chika. And Jeffrey Fieger’s brother Doug, who led the one-hit wonder Knack, probably needs the money. Who knows how much he gets from a youtube hit? He’s probably gotten as much from George W. Bush as he’s going to get.
But I wanted to tell you a bit about coronavirus. I decided a few days back I should actually learn something about it rather that just make snide remarks like “when you wring your hands, wash them before and after”. Besides having a medical degree and 40 years of practice experience, I was once a virologist. My masters is in microbiology. From ’75-’84 I attempted to do research in 4 different virology labs. I sucked at bench research, but could usually grasp the basic concepts. So I dove in a few days ago to bone up on the basics of this latest peril to our existence. I am wearing my white coat, with stethoscope in pocket, as I write this. So you can trust me. I’m a doctor. I wear the white coat more often these days, even though I am retired and not seeing patients, as I want to reassure my dear wife she is living under the same roof as a licensed physician. With all the fear and trembling being disseminated on campus by Dr. Schlissel and his band of nervous nellies, I figure she needs all the comfort I can provide when she comes home. A beer, a fire, and a home cooked meal may no longer be enough.
But knowledge is, as they say, good. Do you care that that the family of our current nemesis got its name because the many protein spikes from its membrane made it look like it had a crown?
Like all viruses, it’s a pesky and clever little critter. It’s the largest RNA virus. Influenza, by comparison, is about the same size (50-120 nm vs 100 nm) but has a smaller genome, 14,000 vs 27-32,000 nucleotides. The human genome is 64,946,660,000 nucleotides. Measles, herpes, and chickenpox are DNA viruses. DNA is the stuff of our genes, and needs to be transcribed into RNA to be translated into the proteins that do all the work. DNA viruses have to follow that same path, sidling up to the enzymes in the cells they invade to do the work, but it’s a couple steps. The genome of coronavirus is positive strand RNA, so it just comes in, latches up to a few ribosomes (structures that negotiate the whole protein making process) and starts seeing things to its own ends. Over half the coronavirus genome is devoted to the protein it will use to replicate its own RNA. What plops out is a big protein molecule that contains within it the power to chop up the rest of itself into two pieces that assemble and become the machine to churn out more little coronaviruses. Most viruses bring their own nucleic acid replicating enzyme with them. But corona just asks the host to whip them up a fresh one. Coronas aren’t content to just penetrate a cell, they hone to the Golgi apparatus, a membrane bound transport system deep inside for shuffling proteins about the cell. There are 9 proteins in the coronavirus that do different things. The spike protein that makes up the “crown” has the property of looking to immune proteins like a nice place to settle their “Fc” portions. Immune proteins have an “Fv” portion that recognizes various foreigners and the “Fc” portions where it just settles in. So immune proteins coming to attack Mr. coronavirus just turn tail and settle in instead, and nothing happens. Its main purpose is to latch onto cells to invade, and it is the structure to be mimicked by any vaccine that’s being developed. Other proteins help it get in and out of the cell it’s infected. Transcription of the viral RNA proceeds willy nilly with none of the proof reading that usually accompanies nucleic acid synthesis. As a result, the error rate in reading coronavirus RNA is about 1/10,000 nucleotides. With an average 30K genome, that translates to 3 mutations per replication. So making new Mr. coronaviruses is a pretty shaky proposition, and why they can sometimes turn dangerous, from common colds to SARS.
Coronaviruses account for about a third of all common colds. Testing for coronavirus has been available on “respiratory panels” for years, but few doctors test as there’s nothing to do for these viral diseases. A couple of times this century, coronavirus has mutated to get out of hand and cause trouble. In 2002 Severe Acute Respiratory Syndrome (SARS) emerged from China and quickly spread to the US, South America, Europe and Asia before it was controlled. During the 2002-2003 outbreak, 8,096 people were confirmed as infected and 774 died. In 2012, people began dropping in the Arabian peninsula to Middle East Respiratory Syndrome (MERS). Of 2,494 laboratory confirmed cases, 858 died (34.4% fatality rate). Fortunately, MERS never travelled. When Chinese peasants began dropping in Wuhan province last December, the virologists at the conveniently located Wuhan Virology Institute were all over it. The unfortunate folks with severe respiratory disease not responding to usual measures who had all just been at a local fish market harbored a coronavirus, sharing 79% of its RNA with the nasty agent that had cause SARS. That was enough to make them the same species. The host animal was the local bat, who carried the same thing. They named their find ”2019-nCoVBetaCoV/Wuhan/WIVo4/2019” or 2019-nCoV for short. So those complaining that calling this the “Wuhan virus” is somehow disparaging to our Chinese friends should note that this is what their own scientists designated. Nowhere in this report can I find any red flags saying this virus is some sort of Andromeda strain. Maybe the similarity to the original SARS virus has been enough to trigger the sort of insane response we’ve seen to date. It is easily transmissible by human-to-human contact. Stats to date say the fatality rate (about 1%) is worse than the flu (0.1%) although way more people get the flu every year than are ever going to get this coronavirus. I had hoped that diving into the science would give me a better understanding of the panic. Alas, it has not.
But I have been encouraged by some recent developments. One of my favorite former nurses sent me this video about some new findings regarding possible treatment. It turns out that a drug I once prescribed by the barrel full – Plaquenil (hydroxychloroquine, a quinine extract from cinchona bark) – does a bang up job of inhibiting coronavirus replication in the test tube. The concentrations needed to achieve this effect are similar to those reached by standard dosing of the drug for other conditions (rheumatoid arthritis and lupus) https://www.youtube.com/watch?v=vE4_LsftNKM&feature=share. Other drug combinations are being tried, particularly using some of the anti-HIV drugs. Before AIDS, there wasn’t much attention to anti-viral therapies. So I have supreme confidence a treatment will emerge, and soon.
And as we seek to endure, the great CS Lewis provided words long ago which speak to our situation. Let us heed them. https://www.thegospelcoalition.org/article/cs-lewis-coronavirus/
Hunt R. Corona viruses, colds and SARS. in Microbiology and Immunology On-line, Hunt R, Editor. University of South Carolina School of Medicine. http://www.microbiologybook.org/virol/coronaviruses.htm
Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, Si HR, Zhu Y, Li B, Huang CL, Chen HD, Chen J, Luo Y, Guo H, Jiang RD, Liu MQ, Chen Y, Shen XR, Wang X, Zheng XS, Zhao K, Chen QJ, Deng F, Liu LL, Yan B, Zhan FX, Wang YY, Xiao G, Shi ZL. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 Mar;579(7798):270-273. doi: 10.1038/s41586-020-2012-7