South Florida Sun-Sentinel Palm Beach (Sunday)
Scientists at crossroads to unravel coronavirus
NEW YORK — What is this enemy?
Seven months after the first patients were hospitalized in China battling an infection doctors had never seen before, the world’s scientists and citizens have reached an unsettling crossroads.
Countless hours of treatment and research, trial and error now make it possible to take much closer measure of the new coronavirus and the lethal disease it has unleashed. But to take advantage of that intelligence, we must confront our persistent vulnerability: The virus leaves no choice.
“It’s like we’re in a battle with something that we can’t see, that we don’t know, and we don’t know where it’s coming from,” said Vivian Castro, a nurse supervisor at St. Joseph’s Medical Center in Yonkers, just north of New York City, which struggled with its caseload this spring.
Castro had treated scores of infected patients before she, too, was hospitalized for the virus in April, then spent two weeks in home quarantine.
The coronavirus is invisible, but seemingly everywhere. It requires close contact to spread, but it has reached around the globe faster than any pandemic in history.
COVID-19 has caused economic upheaval echoing the Great Depression, while claiming more than 593,000 lives. In the U.S. alone, the virus has already killed more Americans than died fighting in World War I.
Even those figures don’t capture the pandemic’s full sweep. Nine of every 10 students worldwide shut out of their schools at one point. More than 7 million flights grounded. Countless moments of celebration and sorrow — weddings and graduations, baby showers and funerals — put off, reconfigured or abandoned because of worries about safety.
In short, the coronavirus has rescripted nearly every moment of daily life. And fighting it — whether by searching for a vaccine or seeking to protect family — takes knowing the enemy. It’s the essential first step in what could be an extended quest for some version of normalcy.
“There’s light at the end of tunnel, but it’s a very, very long tunnel,” said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University.
The new coronavirus is roughly 1,000 times narrower than a human hair. But scrutinized through an electron scope, it is clear this enemy is well-armed.
Coronaviruses, including the newest one, are named for the spikes that cover their outer surface like a crown, or corona in Latin. Using those club-shaped spikes, the virus latches on to the outer wall of a human cell, invades it and replicates, creating viruses to hijack more cells.
Find a way to block or bind the spikes and you can stop the virus.
But the coronavirus has a weakness: an outer membrane that can be destroyed by ordinary soap. That neutralizes the virus, which is why health experts emphasize the need to wash hands.
There are hundreds of coronaviruses, but just seven known to infect people. Four are responsible for some common colds. But in 2002, a virus called SARS, for severe acute respiratory syndrome, spread from China to sicken about 8,000 people worldwide, killing more than 700. Another coronavirus called Middle Eastern respiratory syndrome, or MERS — identified in 2012 — spread to humans through camels.
The new coronavirus, though, has captivated scientists’ attention unlike any in decades.
Even early on it was clear this virus posed a major threat, said Thomas Friedrich, a researcher at University of Wisconsin-Madison. Human immune systems had never encountered it. And unlike Zika, whose spread can be controlled by targeting mosquitoes, or AIDS, which most often requires sexual contact, the new virus is readily transmitted through droplets in the air.
“Basically, everyone in the world is susceptible,” Friedrich said.
Scientists are fairly certain the disease originated in bats, which harbor many coronaviruses. To get to humans, it may have been passed through another animal, possibly consumed for meat. By late January, when Chinese authorities walled off the city of Wuhan, where the disease was first diagnosed, it was too late to stop the spread.
Soon after the first case in Wuhan, Chinese tourists with the virus traveled to France. But doctors there reported recently that a fishmonger contracted the disease even earlier than that, from an unknown source. On Jan. 21, the first confirmed U.S. case was reported in Washington state, in a man who had traveled to Asia.
“It’s one person coming in from China and we have it under control. It’s going to be just fine,” President Donald Trump said at the time. Ten days later, he blocked entry to most travelers from China.
But genetic analysis of samples taken from New York patients showed most of the virus present arrived from Europe instead, and took root in February — well before anyone thought about quarantining after a trip to Madrid, London or Paris.
Since February, when Dr. Daniel Griffin began treating patients suspected of having COVID-19, he has cared for more than 1,000 people with the disease, first noted for attacking the lungs. But the infection certainly does not stop there.
“I am actually shocked,” said Griffin, a specialist in infectious diseases at New York’s Columbia University Medical Center. “This virus seems to leave nothing untouched.”
The lungs are, indeed, ground zero. Many patients find themselves gasping for breath, unable to say more than a word or two.
The reason why becomes clear in autopsies of those who have died, some with lungs that weigh far more than usual.
When Dr. Sanjay Mukhopadhyay examined autopsy samples from a 77-year-old Oklahoma man, he noted changes to the microscopic sacs in the patient’s lungs. In a healthy lung, oxygen passes through the thin walls of those sacs into the bloodstream. But in the Oklahoma patient, the virus had turned the sac walls so thick with debris that oxygen was blocked.
The thickened walls “were everywhere,” preventing the lungs from sustaining the rest of the body, said Mukhopadhyay, of Ohio’s Cleveland Clinic.
Autopsies reveal “what the virus is actually doing” inside patient’s bodies, said Dr. Desiree Marshall, a pathologist at the University of Washington who recently examined the heart of a Seattle man who died from disease.
“Each autopsy has the chance to tell us something new,” she said.
The coronavirus, though, keeps raising fresh questions. It left the hearts of two men in their 40s, recently treated by Griffin, flaccid and unable to pump enough blood. Some younger people have arrived in emergency rooms suffering strokes caused by blood clotting, another calling card.
Kidneys and livers fail in some patients and blood clots put limbs at risk of amputation. Some patients hallucinate or have trouble maintaining balance. Some get a treatable paralysis in arms or legs. Many have diarrhea, but often don’t mention it until Griffin asks.
Initially, doctors put patients on ventilators if their blood oxygen levels dropped. But death rates were so high they now try other strategies first, like turning patients on their stomachs, which can help them breathe. The truth is that hospital workers are learning as they go, sometimes painfully.
With states and countries reopening in the face of an ongoing pandemic, it’s even more crucial to find solutions. At least the last few months have spotlighted the most critical questions.
Can people who have been infected with the disease get it again?
Dr. Anthony Fauci, the U.S. government’s top infectious disease expert, has said that having the disease once should confer some degree of immunity. But it’s not clear how much or for how long, or what levels or types of antibodies people must have to protect them against future illness.
If some people harbor the virus without symptoms, how can we block transmission?
The reality is that many infected people will never feel symptoms or get sick. That means temperature checks and other strategies based on symptoms won’t be enough to stop it. Instead, many experts believe, widespread testing is needed to find silent carriers, isolate them until they are no longer contagious, and track down those they may have infected. Masks and distancing can help prevent infection and slow the spread of the virus.
Will researchers find medicines that can be used to treat the disease?
Hundreds of studies are under way, testing existing medicines and experimental ones. So far, only one — a common steroid called dexamethasone — has been shown to increase survival. An antiviral medicine, remdesivir, has been shown to shorten recovery time. Two others — the malaria drugs chloroquine and hydroxychloroquine — have not proven safe or effective in large-scale trials.
How long will it take to find a vaccine?
Scientists in more than 150 labs around the world are pursuing a vaccine and nearly two dozen candidates are in various stages of testing. But there’s no guarantee any will pan out. . Some huge studies are expected to begin this month.
“It’s almost the Manhattan Project of today, where an enormous amount of resources are being devoted to this,” said Rene Najera, an epidemiologist at Johns Hopkins University and the editor of a vaccine history website.