Wuhan has unending supply of virus variants, supervision must

Right-toknow, published many February 2020 emails of a biosafety expert, Professor Le Duc to his close associate WIV Professor Yuan Zhiming, urging him to investigate the lab origin of Covid-19 virus. His questions including “Is anyone on your team conducting gain of function studies, recombination studies or any other studies that may have resulted in the creation of the ncov?” drew no response. In April 2020, he emailed Phillip Russell, former president of the American Society of Tropical Medicine and Hygiene, that it was “certainly possible a lab accident was the source of the epidemic and I also agree that we can’t trust the Chinese government.” Russell, who died later in 2021, replied, “The extraordinary measures taken by the Chinese government, including persecution and probable killing of two brave physicians, to cover up the outbreak, the steps taken to silence the laboratory personnel, the change in leadership of the lab, all point to the lab as the source of the outbreak.” Russell continued, “This reminds me of the efforts by Matt Messelson and many colleagues to cover up the Sverdlovsk anthrax outbreak. They succeeded for many years aided and abetted by many in academia until Ken Alibek defected and the truth came out.” UNENDING SUPPLY OF VIRUS VARIANTS: WIV has collected wild viruses from all over China and other parts of the world including Nagaland in India. Data of Covid-19 virus genomic sequences deposited in a US government database by WIV researchers were later withdrawn and suppressed by them, leading to doubts and suspicion. Four unique insertions in the RNA of the Covid-19 virus with a human specific furin cleavage site is clear evidence of genetic engineering, as no member of the coronavirus family has these features. The Covid-19 virus variants of grave concern have “game changer” cluster mutations and enable the virus to be more transmissible, highly contagious and also evade our antibodies generated through previous infection and vaccination. There have been numerous accidental leaks reported from many biosafety laboratories. With the largest collection of coronaviruses in the world and published history of years of genetic manipulations, an unending supply of virus variants can be expected in the absence of international supervision.

WHERE DID OMICRON ARISE? The Omicron variant has about 50 mutations of which about 30 are in the spike protein. So many mutations in less than 2 years of this pandemic raise many doubts. Emma Hodcroft, a University of Bern virologist says the Omicron variant diverged early from other strains, back in mid-2020. Various possibilities have been considered by experts about how this variant or its predecessors remained undetected for so long. Kai Kupferschmidt says in an article in the journal Science, “mutations could have accumulated in a chronically infected patient, an overlooked human population, or an animal reservoir”. There is a distinct possibility that Omicron is another strain out of the five strains reported in the journal Nature on 20 January 2020, by Shi Zhengli, the “Bat Lady” of WIV.

THE NATURAL COURSE OF A RESPIRATORY VIRUS PANDEMIC: The SARS outbreak lasted from November 2002 till May 2004. MERS outbreaks occurred from June 2012 to 2014, with further outbreaks in South Korea in 2015 and in Saudi Arabia in 2018. Influenza epidemics or pandemics have lasted 2 to 3 years each, Asiatic flu (18891890); Spanish flu (19181920); Asian flu (1957-1958); Hong Kong flu (1968-1969);

Russian flu (1977-1979); H1N1/09 Bird flu (20092010). The virus keeps mutating till herd immunity develops by repeated infection or vaccination. Evolutionary selection ensures that mutant strains that are more infectious and transmissible and do not kill their host eventually dominate, because more host deaths means fewer hosts available for the virus. Eventually, over 2 to 3 years, the mortality rates of these respiratory virus infections decrease, and the virus becomes endemic and persists in small pockets of the vulnerable population with occasional small outbreaks. The influenza virus vaccine is updated yearly, for the northern hemisphere in June before the wet season and similarly in the south in January. With a major part of humanity not vaccinated, Covid-19 will continue to spread, mutate and re-infect like the abovementioned outbreaks for at least 2 to 3 years.

MASKS: You never know which new virus is coming your way, so an N95 mask is our best protection. N95 mask with an exit valve is inappropriate as it is designed for protection against dust. A three-layer surgical or cloth mask is inadequate as it can block only large droplets from a sneeze but is inadequate to block the virus in fine droplets exhaled by an infected person. The mask should fit the face well and prevent air flow through gaps on the sides bypassing the mask. A major study, “Safe traveling in public transport amid Covid-19” in South Korea found “Mandatory wearing of masks and practicing social distancing with masks during peak hours reduced infection rates by 93.5% and 98.1%, respectively”. VACCINE OPTIONS: Human ACE2 receptor does not mutate, hence an ideal vaccine would protect us from the limited set of mutations of a virus spike protein that can fit our ACE2 receptor. Since such an ideal vaccine does not exist, vaccines are updated for each new mutant strain that lowers vaccine efficacy. Diagnostic tests and vaccine efficacy antibody tests also need updating. Virus carrier vaccines have a segment of DNA inside a non-infective adenovirus and MRNA vaccines have MRNA inside an outer lipid capsule. Both instruct our cells to produce virus spike protein to trigger an immune response. As only the spike protein is exposed to our immune system, spike protein mutations reduce the efficacy of these vaccines. The MRNA technology was developed to kill cancer cells, but as a vaccine for an infectious disease, there is a risk of our immune system attacking our cells if they keep producing virus spike protein, leading to inflammation and autoimmune disease. Steven R. Gundry in an article in the journal Circulation dated 8 November 2021 stated, “We conclude that the MRNA vaccines dramatically increase inflammation on the endothelium and T cell infiltration of cardiac muscle and may account for the observations of increased thrombosis, cardiomyopathy, and other vascular events.” These complications are rare and need long-term follow up to allay doubts. The virus carrier vaccine, if injected into a blood vessel instead of a muscle, can rarely cause platelets and antibodies clumping, leading to the formation of dangerous blood clots. Inactivated virus vaccines expose our immune system to the entire virus and not just the spike protein and hence produce a broad-based immune response which is effective even if the virus undergoes mutations in its spike protein. When needed they are easier to update. Specific adjuvants increase the efficacy of the vaccine. The Icmr-bharat Biotech Covaxin has better and safer adjuvants than other similar Chinese vaccines. It is based on a time-tested safe technology used for polio and other vaccines and has been found safe even in children. Its production involves multiplying the Covid-19 virus obtained from clinical samples, in Vero CCL-81 cells. Very high safety precautions are required to prevent any live virus leak. Strict regulations and multiple quality control measures ensure that the virus in the vaccine is inactive and cannot infect.

THIRD DOSE BOOSTER: Dr Eric Topol, director of Scripps Research Translational Institute had tweeted, “The problem with vaccine waning 4-6 months later was first recognized in Israel in July, confirmed by more than 10 reports, and occurs with all vaccines. Protection is fully restored (or even exceeded) by 3rd (booster) shots. If a person doesn’t get infected, they can’t transmit.” Most virus vaccines involve primarily three doses. Since immunity can develop to the virus used as carrier in a vaccine, the Russian Sputnik vaccine uses two different virus carriers for its two doses. Hence if the first two doses were of a virus carrier vaccine, a third dose should ideally be a different vaccine. An intranasal vaccine stimulates both local and systemic immune responses and blocks both infection and transmission at site of infection in the upper respiratory tract. It is acceptable to those frightened of injections. Costs of production and vaccination are lower and syringes and needles are not needed. THE OMICRON VARIANT: Early observation suggests that Omicron causes severe fatigue, body ache, headache but no loss of smell and taste or breathing difficulty, complications and death. It is more infective as it is infecting even fully vaccinated international flyers. Its speed of spread worldwide suggests that it is more transmissible. Rapid change in the Covid-19 test results from negative to positive, during a flight, suggests it has a shorter incubation period. The virus needs humans to spread it and provide opportunities to mutate. There is no need to panic. Instead we should use vaccines and masks, follow Covid appropriate behaviour and avoid crowds. Proper use of N95 mask blocks all airborne microbes, dust and allergens and is a good breathing exercise. Healthy lifestyle, nutritious food, exercises and adequate sleep help stay fit and cheerful.

Dr P.S. Venkatesh Rao, MBBS (Vellore), MS (Vellore), DNB, FRCS (Glasgow), FACS, FICS, FMAS, FAES is Consultant Endocrine, Breast & Laparoscopic Surgeon.