COVID-19: Difference between revisions

From Citizendium
Jump to navigation Jump to search
No edit summary
mNo edit summary
 
(3 intermediate revisions by the same user not shown)
Line 1: Line 1:
{{subpages}}
{{subpages}}
{{TOC|left}}
{{TOC|right}}
{{Authors|Gareth Leng|Pat Palmer|others=y}}
{{Authors|Gareth Leng|Pat Palmer|others=y}}
{|
|
{| align=center style="width:70%; background-color: #f7f7a6; border: solid 3px #f2e0de; padding: 2px;" 
|- align=center
|style="background-color:#e8edd6;"|'''<span>This is a protected page.</span>'''
|-align=center
|'''<big>This topic is highly controversial. A public health expert, Gareth Leng, was invited to write this article, and it is not open for public editing.</big>'''<br/>
|}
{{Image|Novel-Coronavirus-SARS-CoV-2-49531042877 32d730487d o.jpg|right|350px|SARS-CoV-2 (in yellow), the [[virus (biology)|virus]] that causes COVID-19, revealed in an [[electron microscope]] image as it emerges from [[Cell (biology)|cell]] surfaces (blue/pink).}}
{{Image|Novel-Coronavirus-SARS-CoV-2-49531042877 32d730487d o.jpg|right|350px|SARS-CoV-2 (in yellow), the [[virus (biology)|virus]] that causes COVID-19, revealed in an [[electron microscope]] image as it emerges from [[Cell (biology)|cell]] surfaces (blue/pink).}}
The Coronavirus Disease ('''COVID-19''') is caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that caught the public attention by the end of 2019. <ref>[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it Naming the coronavirus disease (COVID-19) and the virus that causes it], World Health Organization.</ref> Albeit its publicly known outbreak in [[human]] hosts originated in [[Wuhan]] in the [[People's Republic of China]] (PRC) towards the end of 2019, during the Military World Games, its viral origins SARS-CoV were first known to the human society during the 2002 - 2003 outbreak in Guangdong Province in PRC. The human transmission of the virus in 2019 was first reported on the Chinese social media by the medical doctor Wenliang Li, noticing the SARS-structured virus in the local hospital from a patient's sample test. The whistle-blower, however, was brought to the local police station in Wuhan immediately for admonition, and later died from the virus. The Chinese authorities behind governmental power tried to obstruct the [[World Health Organization]] (WHO) from listing COVID-19 as Public Health Emergency of International Concern (PHEIC), and the global institutional signal on the pandemic was only issued in January 2020. <ref name="extrapolation">Pachankis, Y. I. (2022). Epistemological Extrapolation and Individually Targetable Mass Surveillance — The Issues of Democratic Formation and Knowledge Production by Dictatorial Controls. ''International Journal of Innovative Science and Research Technology, 7''(4): 72-84. DOI: [https://doi.org/10.5281/zenodo.6464858 10.5281/zenodo.6464858], Bibcode: [https://ui.adsabs.harvard.edu/abs/2022IJISR...7..472P/abstract 2022IJISR...7..472P].</ref> <ref>[https://www.who.int/europe/emergencies/situations/covid-19#:~:text=The%20first%20cases%20of%20novel%20coronavirus%20%28nCoV%29%20were,outbreak%20as%20a%20pandemic%20on%2011%20March%202020. Coronavirus disease (COVID-19) pandemic], World Health Organization.</ref>
'''COVID-19''', from the perspective of year 2021, is a [[disease]] that results from [[infection]] with SARS-CoV-2, a [[coronavirus]] that apparently first infected [[human]] populations in [[Wuhan]] in the [[People's Republic of China]] towards the end of 2019. The disease was first described as an atypical ‘[[virus (biology)|viral]] [[pneumonia]], and by January 2020, the infectious agent had been identified as a novel coronavirus. The origin of the infectious agent is uncertain: the current consensus is that it probably originated in [[bat (mammal)|bats]], and that a novel mutated form of the virus, in which a spontaneous mutation had enabled the virus to infect humans, may have infected humans through interactions between live bats and people at a wild food market in Wuhan.


By March 1<sup>st</sup> 2020, more than 3,000 deaths had been attributed to COVID-19, and on March 11<sup>th</sup> 2020, the WHO declared the coronavirus outbreak to be a [[pandemic]]. By the end of March, the global death toll reported had exceeded 45,000. By December 2020, more than 66 million cases of COVID-19 had been reported globally.
On 13 January 2020, the [[World Health Organisation]] (WHO) published protocols to diagnose infections using real time RT-PCR (reverse transcriptase polymerase chain reaction). <ref>[https://www.who.int/docs/default-source/coronaviruse/wuhan-virus-assay-v1991527e5122341d99287a1b17c111902.pdf World Health Organization (WHO): Berlin, 13.01.2020Diagnostic detection of Wuhan coronavirus 2019 by real-time RT-PCR]</ref>


== Virology ==
On January 22, 2020, The China National Health Commission reported the details of the first 17 deaths attributed to the new coronavirus: 13 males and 4 females, with a median age of 75 years.


The SARS-CoV viruses are enveloped and SARS-CoV-2 is described to be positive-sense and single-stranded RNA virus with a genome size of ∼30 kb. <ref>Xu, X., Li, G., Sun, B., and Zuo, Y. Y. (2022). S2 Subunit of SARS-CoV-2 Spike Protein Induces Domain Fusion in Natural Pulmonary Surfactant Monolayers. ''The Journal of Physical Chemistry Letters, 13''(35): 8359-8364. DOI: [https://doi.org/10.1021/acs.jpclett.2c01998 10.1021/acs.jpclett.2c01998]</ref> SARS-CoV and SARS-CoV-2 have the same components of Spike proteins, where Spike 1 (S1) protein binds to [[angiotensin converting enzyme]] (ACE) 2 in entering human host cells, and Spike 2 (S2) protein facilitates fusion between the viral and host cell membranes. <ref>Scialo, F., Daniele, A., Amato, F. ''et al.'' (2020). ACE2: The Major Cell Entry Receptor for SARS-CoV-2. ''Lung., 198''(6): 867–877. DOI: [https://doi.org/10.1007/s00408-020-00408-4 10.1007/s00408-020-00408-4], PMID: [https://pubmed.ncbi.nlm.nih.gov/33170317 33170317], PMCID: [http://www.ncbi.nlm.nih.gov/pmc/articles/pmc7653219/ PMC7653219]</ref> <ref>Kliger, Y. & Levanon, E. Y. (2003). Cloaked similarity between HIV-1 and SARS-CoV suggests an anti-SARS strategy. ''BMC Microbiology, 3'': 20. DOI: [https://doi.org/10.1186/1471-2180-3-20 10.1186/1471-2180-3-20]</ref> S2 protein is highly affined and structurally similar to the gp41 protein of [[human immunodeficiency virus]] (HIV) -1, therefore, it is also argued that SARS-CoV viruses, abnormally over-lengthed for single-strand virus, correspond better to the negative-sense paramyxovirus. <ref name="theostra">Pachanis, Y. I. (2023). [https://www.clinandmedimages.com/wp-content/uploads/2023/03/JCMI-v6-1633.pdf Theoretical Strategies in SARS-CoV-2 Human Host Treatment]. ''Journal of Clinical and Medical Images, 6''(28).</ref> <ref>Zhang, X. W.
By late January 2020, it was clear that the disease was being transmitted by person-to-person contact; the disease was rapidly spreading throughout [[Hubei]] Province, where Wuhan is located, and cases had been reported in several other countries, apparently attributable to travel from Wuhan. Accordingly, on January 30, the WHO declared the coronavirus outbreak a Global Public Health Emergency. <ref>[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 WHO: Coronavirus disease (COVID-19) pandemic]</ref>
& Yap, Y. L. (2004). Structural similarity between HIV-1 gp41 and SARS-CoV S2 proteins suggests an analogous membrane fusion mechanism. ''Journal of Molecular Structure: THEOCHEM, 677''(1): 73-76. DOI: [https://doi.org/10.1016/j.theochem.2004.02.018 10.1016/j.theochem.2004.02.018]</ref>


=== Pathogenesis & Symptoms ===
By March 1st 2020, more than 3,000 deaths had been attributed to it, mostly in China. But the disease had already spread to several other countries, and on March 11th 2020 the WHO declared the coronavirus outbreak to be a [[pandemic]]. Soon virtually every country in the world was experiencing cases of the disease. By the end of March, the global death toll had exceeded 45,000.
In China, strong measures were taken in early 2020 to control the outbreak. Movement in and out of Hubei Province was controlled very strictly, and severe restrictions were placed on social contacts within the Province. This containment policy was combined with a rigorous policy of contact tracing and isolation, and enforcement of mask wearing and other precautions. These measures effectively suppressed the outbreak in China.
 
By December 2020, more than 66 million cases of Covid-19 had been reported globally; it seems likely that this is a considerable underestimate as many cases are asymptomatic, and many others with symptoms were never tested. The reported death toll exceeded 1.8 million.
 
==Symptoms==
The median [[incubation]] period for COVID-19 is estimated to be 4-5 days after exposure, but incubation periods of up to 14 days have been reported in exceptional cases. The spectrum of [[illness]] ranges from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome and death. Of about 70,000 persons with COVID-19 in China, 81% cases were classed as mild, with no pneumonia or mild pneumonia, 14% as severe (defined as [[dyspnea]], respiratory frequency ≥30 breaths/min, saturation of [[oxygen]] ≤93%, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen <300 mm Hg, and/or lung infiltrates >50% within 24 to 48 hours), and 5% as critical (respiratory failure, septic shock, and/or multiorgan dysfunction or failure).
The median [[incubation]] period for COVID-19 is estimated to be 4-5 days after exposure, but incubation periods of up to 14 days have been reported in exceptional cases. The spectrum of [[illness]] ranges from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome and death. Of about 70,000 persons with COVID-19 in China, 81% cases were classed as mild, with no pneumonia or mild pneumonia, 14% as severe (defined as [[dyspnea]], respiratory frequency ≥30 breaths/min, saturation of [[oxygen]] ≤93%, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen <300 mm Hg, and/or lung infiltrates >50% within 24 to 48 hours), and 5% as critical (respiratory failure, septic shock, and/or multiorgan dysfunction or failure).


Line 21: Line 34:
There is also evidence that Covid-19 can lead to cardiac, dermatologic, hematological, hepatic,neurological, renal and other complications. The long-term consequences for survivors of Covid-19  are currently unknown. Persistent symptoms after recovery from acute Covid-19 have been described, and  infection has been associated with a potentially severe inflammatory syndrome in children (multisystem inflammatory syndrome in children).<ref>[https://www.covid19treatmentguidelines.nih.gov/overview/ NIH: Overview of Covid-19 updated December 17 2020]</ref>
There is also evidence that Covid-19 can lead to cardiac, dermatologic, hematological, hepatic,neurological, renal and other complications. The long-term consequences for survivors of Covid-19  are currently unknown. Persistent symptoms after recovery from acute Covid-19 have been described, and  infection has been associated with a potentially severe inflammatory syndrome in children (multisystem inflammatory syndrome in children).<ref>[https://www.covid19treatmentguidelines.nih.gov/overview/ NIH: Overview of Covid-19 updated December 17 2020]</ref>


== Epidemiology ==


Currently, the first known human infection of SARS-CoV viruses dates back to November 2002 in in Foshan municipality, Guangdong Province, PRC. Although highly implausible, as of the latter half of 2004, only 1,454 cases were clinically confirmed with 55 deaths, reported by the relevant Chinese authorities and WHO affiliates. <ref>Xu, R.-H., He, J.-F., Evans, M. R. ''et al.'' (2004). Epidemiologic Clues to SARS Origin in China. ''Emerging Infectious Diseases, 10''(6): 1030-1037. DOI: [https://doi.org/10.3201/eid1006.030852 10.3201/eid1006.030852]</ref> Substantially the same conduct in data fabrication and destruction has continued in COVID-19 by the PRC government, including with The China National Health Commission's report on January 22, 2020, with 17 deaths (13 males and 4 females) in a median age of 75 years. <ref>Lonas, L. (2021). [https://thehill.com/policy/healthcare/538726-who-investigator-says-china-refused-to-hand-over-key-data-on-early-covid-19/ WHO investigator says China refused to hand over key data on early COVID-19 cases]. The Hill, Health Care.</ref> <ref>Mu, F. (2022). [https://www.voachinese.com/a/world-health-organization-needs-more-information-on-china-covid-situation-20221230/6897850.html Director-General of the WHO Dr. Tedros Adhanom Ghebreyesus Demands Beijing in Providing Authentic Epidemic Data]. Voice of America.</ref> Even though the Chinese authorities hold tight to the narrative of the zoonotic origins of SARS-CoV and its 2019 outbreak from a wild-life food market in Wuhan, theories on laboratory leak based on nuclear structural analysis still emerged. <ref>Constantino, A. K. (2023). [https://www.cnbc.com/2023/03/17/covid-origins-who-urges-china-to-release-data-on-wuhan-market.html WHO calls on China to release data linking Covid origin to raccoon dogs at Wuhan market]. CNBC, Health and Science.</ref> <ref>Mole, B. (2023). [https://arstechnica.com/science/2023/02/energy-dept-reignites-bitter-covid-origin-debate-with-shaky-lab-leak-stance/ Energy Dept. leans toward lab leak as COVID origin, at odds with other agencies]. Ars Technica.</ref>
==Mortality==
 
More than 1.8 million deaths had been attributed to Covid-19 by December 2020. There is considerable uncertainty about this number. [[Mortality]] from Covid-19 increases sharply with age, and is exacerbated by a range of [[comorbidity|comorbidities]] including [[obesity]] and [[diabetes]]. Accordingly some have noted that dying ''with'' Covid-19 does not always mean the same as dying ''from'' Covid-19. This factor might overestimate the rate of death due to Covid-19, conversely, in some settings there is considerable underdiagnosis of Covid-19 related death. There has also been concern that the measures taken to contain outbreaks of Covid-19 may have affected the rate of deaths from other causes. On the one hand, measures taken to limit transmission of Covid-19 are also likely, for example, to have been effective in limiting transmission of [[influenza]], reducing the death rate from this disease. Conversely, effects on [[mental health]] of social isolation, and reduced access to [[health care]] may have increased deaths from diversity of other causes. Given these uncertainties, some believe that the most reliable estimate of deaths caused by Covid-19 come from measures of ‘excess deaths’ – the total number of recorded deaths in a region compared to historical data on the expected number of deaths.  
=== Public Responses ===
 
The [[People's Liberation Army]] affiliated medical schools in Chongqing first responded to the Wuhan epidemic when the public discontent and outrage on PRC's initial response and the whistle-blower's admonition. <ref name="extrapolation" /> Later news outlets in PRC attributed all credits to Xi Jinping who "commanded personally and deployed personally". <ref>[http://www.qstheory.cn/zdwz/2020-01/31/c_1125515503.htm Deploying Personally! Xi Jinping: Firmly Winning the Sniping Battle Controlling the Epidemic], QSTheory.</ref> Yet contrary to the narrative, it is believed that the response was bottom-up, which caught the attention of WHO in requesting to issue PHEIC in the first place. It is analyzed that crediting the first responses to Xi Jinping were out of military power control, and led to the military lockdowns from the top-down, which is against the fundamental human rights in the autonomy in the right to health. <ref name="extrapolation" />
 
With the PRC's obstructions on WHO's PHEIC, the then head of the U.S. National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci had to spend the prime response time proving COVID-19 being human-to-human transmissible. <ref>Gore, D. (2022). [https://www.factcheck.org/2022/08/correcting-misinformation-about-dr-fauci/ Correcting Misinformation About Dr. Fauci], [http://FactCheck.org FactCheck.org]</ref> <ref>Pachankis, Y. I. (2023). Public health equity in information asymmetry – phenomenological studies upon SARS-CoV-2 supervirus mutation. ''International Physical Medicine & Rehabilitation Journal, 8''(1): 14-18. DOI:  [https://doi.org/10.15406/ipmrj.2023.08.00326 10.15406/ipmrj.2023.08.00326]</ref> It was not until late January 2020, scientific proofs on person-to-person transmissibility via respiratory fluids pinned WHO's declaration of the coronavirus outbreak a Global Public Health Emergency on January 30. <ref>[https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations WHO: Scientific Brief: SARS-CoV-2 and Potential Airborne Transmission]</ref> <ref>[https://www.who.int/emergencies/diseases/novel-coronavirus-2019 WHO: Coronavirus disease (COVID-19) pandemic]</ref> <ref>[https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html Scientific Brief: SARS-CoV-2 Transmission], Centers for Disease Control and Prevention.</ref>
 
=== Origins & Transmissibility ===


The UK is one of the countries that has been hardest hit by the Covid-19 pandemic. In 2020 there were nearly 85,000 more deaths recorded in the UK than would be expected based on the average in the previous five years. By comparison, about 72,000 deaths were attributed to Covid (by mentions on death certificates), so it seems that there may have been some under-reporting of deaths due to Covid-19.
<ref>[https://www.bbc.co.uk/news/uk-55631693 BBC News: Covid: 2020 saw most excess deaths since World War Two]</ref> In some countries, a very much more extemsive under-reporting is apparent - and it has now been acknowledged that  in Russia the true death toll of Covid-19 is at least three times higher than the reported number of deaths due to the infection. <ref>[https://www.bmj.com/content/371/bmj.m4975 The BMJ. Covid-19: Russia admits to understating deaths by more than two thirds.]</ref>
{|align="right" cellpadding="10" style="background-color:#FFFFCC; width:50%; border: 1px solid #aaa; margin:20px; font-size: 92%;"
{|align="right" cellpadding="10" style="background-color:#FFFFCC; width:50%; border: 1px solid #aaa; margin:20px; font-size: 92%;"
|'''CDC guidance'''
|'''CDC guidance'''
Line 45: Line 52:
|}
|}


The zoonotic origin narratives of SARS-CoV viruses have been maintained by the low infection and mortality rates reported and circulated globally since 2002. Zheng-Li Shi, the Chinese scientist at the spotlight of lab leak theory, published extensively in globally reputable scientific journals such as Nature for the zoonotic predictions of COVID-19, i.e., SARS-CoV-2. <ref>Menachery, V. D., Yount, B. L. Jr, Debbink, K. ''et al.'' (2015). A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence. ''Nature Medicine, 21'': 1508–1513. DOI: [https://doi.org/10.1038/nm.3985 10.1038/nm.3985]</ref>
==Transmission==
 
COVID-19 is mainly transmitted through respiratory droplets ("when an infected person coughs, sneezes or talks") from person to person between people who are in close contact with one another (i.e., within about 6 feet)
<ref>[https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations WHO: Scientific Brief: SARS-CoV-2 and Potential Airborne Transmission]</ref>.


While there has been ongoing concern about the extent to which COVID-19 is transmitted by people who are infected with COVID-19 but who are unaware of that because of the absence of any obvious symptoms, its global spread might predate the Wuhan outbreak. <ref>Menachery, V. D., Yount, B. L. Jr, Debbink, K. ''et al.'' (2015). A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence. ''Nature Medicine, 21'': 1508–1513. DOI: [https://doi.org/10.1038/nm.3985 10.1038/nm.3985]</ref> <ref>Jones, W. (2022). [https://dailysceptic.org/2022/12/30/the-evidence-covid-19-was-spreading-silently-around-the-world-in-late-2019/?highlight=The%20Evidence%20COVID-19%20Was%20Spreading%20Silently%20Around%20the%20World%20in%20Late%202019%2C The Evidence COVID-19 Was Spreading Silently Around the World in Late 2019], The Daily Skeptic.</ref> <ref>Pachankis, Y. I. (2023). Questions of COVID-19: Institutional Derogations of Global Health. Lambert Academic Publishing. Bibcode: [https://ui.adsabs.harvard.edu/abs/2023qcid.book.....P/abstract 2023qcid.book.....P]</ref> Under the umbrella of COVID-19 without public tracing from SARS-CoV-2 to SARS-CoV, early estimates were that as many as 80% of infections are asymptomatic, but these estimates later appeared to be excessive, and have since been revised down to between 17% and 20% of people with infections. It remains unclear to what extent infected people with no symptoms can infect others, but theories emerge that S1 and S2 proteins can assert pathogenesis independent of each other in human hosts. <ref>[https://www.bmj.com/content/371/bmj.m4851 Pollock AM, James Lancaster J (2020) Asymptomatic transmission of covid-19. BMJ 2020;371:m4851]</ref> <ref name="theostra" />
The idea that droplets of virus-laden mucus are the primary mode of transmission guides the US CDC's advice to maintain at least a 6-foot distance. <ref>[https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html Centers for Disease Control and Prevention (CDC): Scientific Brief: SARS-CoV-2 and Potential Airborne Transmission]</ref>


There has been ongoing concern about the extent to which covid-19 is transmitted by people who are infected with covid-19 but who are unaware of that because of the absence of any obvious symptoms. Early estimates were that as many as 80% of infections are asymptomatic, but these estimates now appear to be excessive, and have since been revised down to between 17% and 20% of people with infections. It remains unclear to what extent infected people with no symptoms can infect others. From viral culture studies, it seems that people can become infectious one to two days before the onset of symptoms and continue to be infectious up to seven days thereafter. It seems likely that symptomatic and pre-symptomatic transmission have a greater role in the spread of infection than transmission from truly asymptomatic
people. However, asymptomatic and presymptomatic people make more social contacts than symptomatic people (most of whom are isolating). Hence to limit transmission of the disease, it is important that everyone, regardless of whether they are exhibiting symptoms, follows social distancing measures strictly and takes reasonable measures (mask wearing and hand washing). <ref>[https://www.bmj.com/content/371/bmj.m4851 Pollock AM, James Lancaster J (2020) Asymptomatic transmission of covid-19. BMJ 2020;371:m4851]</ref>
==Myths==
{|align="right" cellpadding="10" style="background-color:#FFFFCC; width:50%; border: 1px solid #aaa; margin:20px; font-size: 92%;"
{|align="right" cellpadding="10" style="background-color:#FFFFCC; width:50%; border: 1px solid #aaa; margin:20px; font-size: 92%;"
|'''Facts about Covid-19 as reported by the WHO to correct widely circulated misinformation.'''
|'''Facts about Covid-19 as reported by the WHO to correct widely circulated misinformation.'''
Line 73: Line 87:
|}
|}


=== Vaccine Development ===
A great many myths have been propagated about Covid-19. Many of these have circulated on [[social media]], including [[conspiracy theory|conspiracy theories]] about the origin of the virus, and claims that the pandemic is a [[hoax]]. Others have been circulated recklessly by various politicians, celebrities, and broadcasters. The WHO maintains a 'Mythbusters' site in an attempt to counter this misinformation with facts. <ref>[https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters WHO: Coronavirus disease (COVID-19) advice for the public: Mythbusters]</ref>
 
The first proposition on SARS-CoV viruses is traced back to 2007 on [[ClinicalTrials.gov]] with the identifier NCT00533741. It did not have any participant according to the record, and SARS-CoV was categorized into the Global Initiative on Sharing All Influenza Data (GISAID) in 2008. <ref>[https://www.clinicaltrials.gov/study/NCT00533741 SARS Coronavirus Vaccine (SARS-CoV)], [http://ClinicalTrials.gov ClinicalTrials.gov]</ref> <ref>[https://gisaid.org/about-us/history/ About Us - History], GISAID.</ref> Meanwhile, up until 2021, numerous HIV-1 vaccine developments have failed with only one phase 3 vaccine reporting 31.2% efficacy against HIV-1 acquisition. <ref>Hargrave, A., Mustafa, A. S., Hanif, A., ''et al.'' (2021). Current Status of HIV- Vaccines. ''Vaccines, 9''(9): 1026. DOI: [https://doi.org/10.3390/vaccines9091026 10.3390/vaccines9091026]</ref>
 
Two days after the genome sequence of SARS-CoV-2 was published, on 13 January 2020, the WHO published protocols to diagnose infections using real time reverse transcriptase polymerase chain reaction (RT-PCR), which is the key technological procedure in mRNA vaccine production. <ref name="vaccine">Kyriakidis, N. C., López-Cortés, A., González, E. V., ''et al.'' (2021). SARS-CoV-2 vaccines strategies: a comprehensive review of phase 3 candidates. ''npj Vaccines, 6'': 28. DOI: [https://doi.org/10.1038/s41541-021-00292-w 10.1038/s41541-021-00292-w]</ref> <ref>Corman, V., Bleicker, T., Brünink, S. ''et al.'' (2020). [https://www.who.int/docs/default-source/coronaviruse/wuhan-virus-assay-v1991527e5122341d99287a1b17c111902.pdf Diagnostic detection of Wuhan coronavirus 2019 by real-time RT-PCR]. Berlin: World Health Organization.</ref>
 
All SARS-CoV-2 vaccines have been designed in targeting S1 protein for immune sterilization without regarding S2 protein's potential for autoimmune disease infection. <ref name="vaccine" /> Eliminating the S1 protein targeting on human ACE2 sterilized immunity against the typical pneumonia symptoms critical in SARS-CoV and COVID-19 severity, but post hoc studies suggest it does not sterilize immunity against COVID-19. <ref>Yonker, L. M., Swank, Z., Bartsch, Y. C. ''et al.'' (2023). Circulating Spike Protein Detected in Post–COVID-19 mRNA Vaccine Myocarditis. ''Circulation, 147''(11): 867-876. DOI: [https://doi.org/10.1161/circulationaha.122.061025 10.1161/circulationaha.122.061025]</ref> <ref>Bradley, B. T., Bryan, A., Fink, S. L. ''et al.'' (2021). Anti-SARS-CoV-2 Antibody Levels Measured by the AdviseDx SARS-CoV-2 Assay Are Concordant with Previously Available Serologic Assays but Are Not Fully Predictive of Sterilizing Immunity. ''Journal of Clinical Microbiology, 59''(9). DOI: [https://doi.org/10.1128/jcm.00989-21 10.1128/jcm.00989-21]</ref> Moreover, false-positive test results on HIV-1 have been reported on COVID-19 patients. <ref>Robinson, M. A., Nagurla, S. R., Noblitt, T. R., ''et al.'' (2020). Falsely positive fourth generation ADVIA Centaur® HIV Antigen/Antibody Combo assay in the presence of autoimmune hepatitis type I (AIH). ''IDCases, 21'': e00886. DOI: [https://doi.org/10.1016/j.idcr.2020.e00886 10.1016/j.idcr.2020.e00886]</ref> <ref>Salih, R. Q., Salih, G. A., Abdulla, B. A. ''et al.'' (2021). False-positive HIV in a patient with SARS-CoV-2 infection; a case report. ''Annals of Medicine and Surgery, 71'': 103027. DOI: [https://doi.org/10.1016/j.amsu.2021.103027 10.1016/j.amsu.2021.103027]</ref>
 
=== Morbidity & Mortality ===
 
More than 1.8 million deaths had been attributed to COVID-19 by December 2020. There is considerable uncertainty about this number. [[Mortality]] from COVID-19 increases sharply with age, and is exacerbated by a range of [[comorbidity|comorbidities]] including [[obesity]] and [[diabetes]]. Accordingly some have noted that dying ''with'' COVID-19 does not always mean the same as dying ''from'' COVID-19. This factor might overestimate the rate of death due to COVID-19, conversely, in some settings there is considerable underdiagnosis of COVID-19 related death. There has also been concern that the measures taken to contain outbreaks of COVID-19 may have affected the rate of deaths from other causes. On the one hand, measures taken to limit transmission of COVID-19 are also likely, for example, to have been effective in limiting transmission of [[influenza]], reducing the death rate from this disease. Conversely, effects on [[mental health]] of social isolation, and reduced access to [[health care]] may have increased deaths from diversity of other causes. Given these uncertainties, some believe that the most reliable estimate of deaths caused by COVID-19 come from measures of ‘excess deaths’ – the total number of recorded deaths in a region compared to historical data on the expected number of deaths.
 
The UK is one of the countries that has been hardest hit by the COVID-19 pandemic. In 2020 there were nearly 85,000 more deaths recorded in the [[United Kingdom|UK]] than would be expected based on the average in the previous five years. By comparison, about 72,000 deaths were attributed to COVID-19 (by mentions on death certificates), so it seems that there may have been some under-reporting of deaths due to COVID-19.
<ref>[https://www.bbc.co.uk/news/uk-55631693 Covid: 2020 saw most excess deaths since World War Two], BBC News.</ref> In some countries, a very much more extensive under-reporting is apparent - and it has now been acknowledged that  in Russia the true death toll of COVID-19 is at least three times higher than the reported number of deaths due to the infection. <ref>Dyer, O. (2020). [https://www.bmj.com/content/371/bmj.m4975 Covid-19: Russia admits to understating deaths by more than two thirds]. BMJ, 371: m4975.</ref>
 
=== Human Rights in Public Health ===
 
In [[People's Republic of China|China]], draconian measures were taken in early 2020 to control the outbreak with the martial law instruments. The effectiveness of the measures is not scientifically proven, and the following nationwide lockdown brought on tremendous loss with the human rights transgressions, including the substantial use of human trafficking technologies under the disguise of public health. <ref>Pachankis, Y. I. (2023). Jeopardies in human security and politicization of COVID-19. ''Ethics Med. Public Health, 27''(C): 100871. DOI: [https://doi.org/10.1016/j.jemep.2023.100871 10.1016/j.jemep.2023.100871], PMID: [https://www.ncbi.nlm.nih.gov/pubmed/36743192 36743192], PMCID: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9889251/ PMC9889251]</ref> With growing figures of post-COVID-19-vaccination sudden deaths after the global coercive mandates leveraged by civil freedom, medical doctors led demonstration rally broke out in [[Washington, D.C.|Washington D.C.]] in 2022. <ref>[https://thehighwire.com/videos/defeat-the-mandates-in-d-c-an-american-homecoming/ Defeat the Mandates in D.C.: An American Homecoming], The High Wire.</ref>


==Footnotes==
==Footnotes==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 10:15, 31 July 2023

This article is developing and not approved.
Main Article
Discussion
Related Articles  [?]
Bibliography  [?]
External Links  [?]
Citable Version  [?]
 
This editable Main Article is under development and subject to a disclaimer.
Authors [about]:
Gareth Leng | Pat Palmer and others.
CZ is an open collaboration. Please
join in to develop this article!
This is a protected page.
This topic is highly controversial. A public health expert, Gareth Leng, was invited to write this article, and it is not open for public editing.
(CC) Image: NIAID
SARS-CoV-2 (in yellow), the virus that causes COVID-19, revealed in an electron microscope image as it emerges from cell surfaces (blue/pink).

COVID-19, from the perspective of year 2021, is a disease that results from infection with SARS-CoV-2, a coronavirus that apparently first infected human populations in Wuhan in the People's Republic of China towards the end of 2019. The disease was first described as an atypical ‘viral pneumonia’, and by January 2020, the infectious agent had been identified as a novel coronavirus. The origin of the infectious agent is uncertain: the current consensus is that it probably originated in bats, and that a novel mutated form of the virus, in which a spontaneous mutation had enabled the virus to infect humans, may have infected humans through interactions between live bats and people at a wild food market in Wuhan.

On 13 January 2020, the World Health Organisation (WHO) published protocols to diagnose infections using real time RT-PCR (reverse transcriptase polymerase chain reaction). [1]

On January 22, 2020, The China National Health Commission reported the details of the first 17 deaths attributed to the new coronavirus: 13 males and 4 females, with a median age of 75 years.

By late January 2020, it was clear that the disease was being transmitted by person-to-person contact; the disease was rapidly spreading throughout Hubei Province, where Wuhan is located, and cases had been reported in several other countries, apparently attributable to travel from Wuhan. Accordingly, on January 30, the WHO declared the coronavirus outbreak a Global Public Health Emergency. [2]

By March 1st 2020, more than 3,000 deaths had been attributed to it, mostly in China. But the disease had already spread to several other countries, and on March 11th 2020 the WHO declared the coronavirus outbreak to be a pandemic. Soon virtually every country in the world was experiencing cases of the disease. By the end of March, the global death toll had exceeded 45,000.

In China, strong measures were taken in early 2020 to control the outbreak. Movement in and out of Hubei Province was controlled very strictly, and severe restrictions were placed on social contacts within the Province. This containment policy was combined with a rigorous policy of contact tracing and isolation, and enforcement of mask wearing and other precautions. These measures effectively suppressed the outbreak in China.

By December 2020, more than 66 million cases of Covid-19 had been reported globally; it seems likely that this is a considerable underestimate as many cases are asymptomatic, and many others with symptoms were never tested. The reported death toll exceeded 1.8 million.

Symptoms

The median incubation period for COVID-19 is estimated to be 4-5 days after exposure, but incubation periods of up to 14 days have been reported in exceptional cases. The spectrum of illness ranges from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome and death. Of about 70,000 persons with COVID-19 in China, 81% cases were classed as mild, with no pneumonia or mild pneumonia, 14% as severe (defined as dyspnea, respiratory frequency ≥30 breaths/min, saturation of oxygen ≤93%, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen <300 mm Hg, and/or lung infiltrates >50% within 24 to 48 hours), and 5% as critical (respiratory failure, septic shock, and/or multiorgan dysfunction or failure).

Among more than 370,000 confirmed COVID-19 cases with reported symptoms in the USA, 70% of patients experienced fever, cough, or shortness of breath, 36% had muscle aches, and 34% reported headaches. Other reported symptoms included diarrhoea, dizziness, rhinorrhea, anosmia, dysgeusia, sore throat, abdominal pain, anorexia, and vomiting.

Most patients who die with covid-19 show notable signs of damage to the small blood vessels in the lung. There are extensive ‘microthrombi’ – clumps of red blood cells and platelets that may block the vessels. There are also extensive deposits of complement – proteins that contribute to the immune response to infection. In short, the lungs show the scars of a battle in which the defenders have caused as much damage as the invaders; the consequences of this appear to be that the lungs are left unable to provide enough oxygen to maintain life. It appears that those who die with covid-19 often do so because of ‘collateral damage’ caused by a hyper-aggressive response of their own immune systems to the infection.

There is also evidence that Covid-19 can lead to cardiac, dermatologic, hematological, hepatic,neurological, renal and other complications. The long-term consequences for survivors of Covid-19 are currently unknown. Persistent symptoms after recovery from acute Covid-19 have been described, and infection has been associated with a potentially severe inflammatory syndrome in children (multisystem inflammatory syndrome in children).[3]


Mortality

More than 1.8 million deaths had been attributed to Covid-19 by December 2020. There is considerable uncertainty about this number. Mortality from Covid-19 increases sharply with age, and is exacerbated by a range of comorbidities including obesity and diabetes. Accordingly some have noted that dying with Covid-19 does not always mean the same as dying from Covid-19. This factor might overestimate the rate of death due to Covid-19, conversely, in some settings there is considerable underdiagnosis of Covid-19 related death. There has also been concern that the measures taken to contain outbreaks of Covid-19 may have affected the rate of deaths from other causes. On the one hand, measures taken to limit transmission of Covid-19 are also likely, for example, to have been effective in limiting transmission of influenza, reducing the death rate from this disease. Conversely, effects on mental health of social isolation, and reduced access to health care may have increased deaths from diversity of other causes. Given these uncertainties, some believe that the most reliable estimate of deaths caused by Covid-19 come from measures of ‘excess deaths’ – the total number of recorded deaths in a region compared to historical data on the expected number of deaths.

The UK is one of the countries that has been hardest hit by the Covid-19 pandemic. In 2020 there were nearly 85,000 more deaths recorded in the UK than would be expected based on the average in the previous five years. By comparison, about 72,000 deaths were attributed to Covid (by mentions on death certificates), so it seems that there may have been some under-reporting of deaths due to Covid-19. [4] In some countries, a very much more extemsive under-reporting is apparent - and it has now been acknowledged that in Russia the true death toll of Covid-19 is at least three times higher than the reported number of deaths due to the infection. [5]

CDC guidance

People who are physically near (within 6 feet) a person with COVID-19 or have direct contact with that person are at greatest risk of infection.

When people with COVID-19 cough, sneeze, sing, talk, or breathe they produce respiratory droplets. These droplets can range in size from larger droplets (some of which are visible) to smaller droplets. Small droplets can also form particles when they dry very quickly in the airstream.

Infections occur mainly through exposure to respiratory droplets when a person is in close contact with someone who has COVID-19.

Respiratory droplets cause infection when they are inhaled or deposited on mucous membranes, such as those that line the inside of the nose and mouth.

Transmission

COVID-19 is mainly transmitted through respiratory droplets ("when an infected person coughs, sneezes or talks") from person to person between people who are in close contact with one another (i.e., within about 6 feet) [6].

The idea that droplets of virus-laden mucus are the primary mode of transmission guides the US CDC's advice to maintain at least a 6-foot distance. [7]

There has been ongoing concern about the extent to which covid-19 is transmitted by people who are infected with covid-19 but who are unaware of that because of the absence of any obvious symptoms. Early estimates were that as many as 80% of infections are asymptomatic, but these estimates now appear to be excessive, and have since been revised down to between 17% and 20% of people with infections. It remains unclear to what extent infected people with no symptoms can infect others. From viral culture studies, it seems that people can become infectious one to two days before the onset of symptoms and continue to be infectious up to seven days thereafter. It seems likely that symptomatic and pre-symptomatic transmission have a greater role in the spread of infection than transmission from truly asymptomatic people. However, asymptomatic and presymptomatic people make more social contacts than symptomatic people (most of whom are isolating). Hence to limit transmission of the disease, it is important that everyone, regardless of whether they are exhibiting symptoms, follows social distancing measures strictly and takes reasonable measures (mask wearing and hand washing). [8]

Myths

Facts about Covid-19 as reported by the WHO to correct widely circulated misinformation.

Studies show that hydroxychloroquine has no clinical benefits in treating Covid-19

Vitamin and mineral supplements cannot cure Covid-19

Prolonged use of medical masks* when properly worn, does not cause CO2 intoxication nor oxygen deficiency

Spraying and introducing bleach or another disinfectant into your body will not protect you against Covid-19 and can be dangerous

Drinking methanol, ethanol or bleach does not prevent or cure Covid-19 and can be extremely dangerous

5G mobile networks do not spread Covid-19

The Covid-19 virus can spread in hot and humid climates

Cold weather and snow cannot kill the Covid-19 virus

Rinsing your nose with saline does NOT prevent Covid-19

People of all ages can be infected by the Covid-19 virus

A great many myths have been propagated about Covid-19. Many of these have circulated on social media, including conspiracy theories about the origin of the virus, and claims that the pandemic is a hoax. Others have been circulated recklessly by various politicians, celebrities, and broadcasters. The WHO maintains a 'Mythbusters' site in an attempt to counter this misinformation with facts. [9]

Footnotes