Transcript as broadcast week of March 11, 2020 on Radio Eoshock, ecoshock.org.
Alex Smith: This is Radio Ecoshock with a feature on the coronavirus – what do you need to know, and what you can do. With his daily briefing on the novel coronavirus, Dr. John Campbell has become a YouTube teacher for the world. Recently, John has appeared on radio from Germany to Australia. He is a man made for the hour, I think.
John is a British retired nurse teacher. After teaching nurses in several countries, John got his doctorate on open learning for medical training. No wonder he draws it all out so professionally for hundreds of thousands of YouTube viewers. From Britain, Dr. John Campbell. Welcome to Radio Ecoshock.
John Campbell: Thank you very much, Alex.
Alex Smith: Now, speaking as we are in the first week of March in a rapidly evolving scene – and it’s changing every day – what do you see is the outlook for this new disease in Britain?
John: Well, I think the chief medical officer in my country is of the opinion, and the Prime Minister is of the opinion that it’s overwhelmingly likely we are going to see more cases. Now, the big concern is what will happen is we’ll follow patterns that have happened in China, Iran, South Korea, and Italy where the isolated cases became clusters, and the clusters went on from being isolated cases to clusters to community spread. This is the big concern.
Now, community spread means that the virus is going from person to person, and we can’t really follow that epidemiologically. We can’t relate that back to a particular epicenter of the infection. So, with the community spread, cases of the virus will just pop up, and we won’t probably be able to work out where they came from, and that means that we’re out of the containment stage into the delay stage where we try and delay it for as long as we can.
But that’s unfortunately what I fear is going to happen – that we’re going to see cases popping up as a result of community transmission, and this is likely to occur because of the fact that this virus is transmissible from people that are asymptomatic. That means without symptoms or people that are pre-symptomatic before they developed symptoms, or people that develop only a very mild illness, and even though they have a very mild illness themselves, they can still be infectious and spread the virus onto other people. You can subsequently develop a more severe illness.
WHY WE NEED TO SLOW INFECTIONS DOWN (WE CANNOT STOP IT)
Alex Smith: What’s the advantage to delaying it though, John? Maybe we just let it run its course and get it over with.
John: Well, what likely happens in epidemics is that quite a large proportion of the population will be infected. So, the chief medical officer in my country estimates about 80% as being the open number. The number of people that are likely to be infected in my country and indeed globally unfortunately is likely to be 60 to 80%.
Now, some of these will have very mild disease. Perhaps half of those will have very mild disease, but another half will have symptomatic disease, but bad enough to be off work, sick for a few days. But a proportion of these, perhaps around about 12%, will have more severe and serious diseases that requires some medical treatment such as giving intravenous antibiotics, supplementary oxygen or intravenous fluids.
Now, if it’s 12% of about 30% of the population, that’s actually an awful lot of people, and we would really struggle in terms of health care provision to treat all of those should they become ill all at the same time. So, what we want to do is we can’t really stop it from spreading, but we want the people that are getting severe illness to be spread out as much as possible, so that gives us a much better chance of being able to give them effective medical treatment.
If we can give them effective medical treatment, that is going to reduce the overall case fatality because effective medical treatment makes someone much more likely to survive a severe infection of the illness, a severe symptomatic illness than they would without medical support. We can’t actually treat the virus itself, but we can do an awful lot of things to support people while they’re critically ill. So, we need to spread that out as much as possible.
What we don’t want is a big peak of infection as it goes up quickly, and then it will go down quickly but most rather have a source lower gradual bump, so that we spread the infections out over a year rather than over just a few weeks, and then we’ll be able to manage the situation much more effectively, medically, and it would also mean that a much smaller proportion of the working population is off sick at any one time.
So, for example, if 50% of the people were going to get the virus got the infection in a three or four-week period, as some models predict, then an awful lot of the workforce would be off sick at any one time, and of course, that’s going to include health care professionals as well whereas if we can delay it and spread that, spread out the amounts of people that get the infection over a longer period of time, it will become much more manageable, so that’s what we need to aim for.
Alex Smith: John, it seems this virus is more successful in a contained community where it can create clusters whether it’s a cruise ship or a nursing home. I wonder can a single virus infect us, in which case personal protection would be pretty unlikely, or does it take a certain load to enter our systems and cause this disease? What do you think?
John: That’s a very good question. Now, this is a novel virus. It was only first identified in December. So, normally, the likelihood of getting an infection depends on the number of viral particles someone’s exposed to or indeed the number of bacterial particles, but viral particles in this case. The virulence of that virus or bacteria, and the state of the host’s defenses. So, the infective dose of the virus is going to be different depending on the individual it’s infecting and their host defenses.
So, for example, someone with chronic obstructive pulmonary disease who is not able to clear sputum out of their lungs effectively, probably a relatively small number of viruses would be needed to infect those because those viruses would not be cleared from the lungs by the cilia and the mucus and the coughing the virus and the new sputum up whereas someone with a healthy respiratory tract, you’d probably need a larger number of viruses to cause the infection. Now, we don’t know what the number of viruses is. In theory, yes, one virus could cause the infection if it gets down into the lower parts of the airways.
In practice, I suspect we’re talking about a larger dose than that, but those figures just haven’t been quantified yet, and we don’t know that.
HOW IT KILLS
Alex Smith: Well, look, this sounds like a good opportunity. If you could explain to us where this virus goes in the lungs and how it damages our ability to live.
John Campbell: So, a virus is what you call an obligate intracellular parasite. That means a virus can only reproduce inside a living human cell, in this case, a living human cell. So, this virus is only transmitted from human cell to human cell. It cannot reproduce on its own like a bacteria, and a virus can only reproduce inside a human cell if it gets into the cell, if it has some way of getting into the cell, and the way a virus gets into the cell, this particular virus, is something called a spike protein, and that spike protein fits into a particular receptor on the surface of our cells. It’s the only way it can get in.
It’s a bit like putting a key in a lock. So, the virus would be the key, and the receptor would be the lock, and the particular receptor that the COVID-19 virus fits into is called an ACE2 receptor, an angiotensin converting enzyme receptor type 2, and these are found in the lower parts of the airways particularly. So, there’s not so many in the upper airways, but they’re in the lower airways. The virus will lock on to these receptor sites. That will facilitate the entrance of the virus into the cell. After the virus absorbs onto this receptor site, the virus will go into the cell, and the virus will then start reproducing inside the cell because the virus will take over the genetic apparatus of the cell.
That’s what the viruses do. They hijack the genetic apparatus of the cell to force the cell to make new viral particles. Instead of making new cell protein, it’s making new viral proteins, and then after a period of time, those viruses will start budding from the surface of the cell, and they will bud into the lumen, into the hole down the middle of the respiratory tract in the bronchioles, the small bronchial passages, and that will get into the mucus, and that will be [inaudible 00:08:37] up into the upper parts of the airway where the virus will be shared by coughing and sneezing and then to some extent, just breathing out is what we call a droplet infection. It’s certainly a droplet infection.
Now, the problem is that the virus, when the virus is reproducing inside the cell, eventually, the virus will take over so much of the cell’s protein-producing apparatus that it will kill the cell. So, the virus itself can kill the cell. That means you start killing cells in the lower part of the respiratory airways. As well as that, when the cell is infected with the virus, viral particles will go to the surface of the cell, and the body’s own immune system will actually kill the cells that are infected with the virus. Again, causing damage to the respiratory epithelium.
Now, that damage has two effects. The first effect is the damage of the respiratory epithelial surface provides an ideal place for bacteria to live, so we can get bacterial secondary infection, and that can lead to pneumonia. But as well as that, the presence of the virus and all the cell destroying that’s going on leads to a lot of inflammation, and the inflammation causes the capillaries in the area to become leaky, and the capillaries will leak, and fluids will start leaking into the tissue spaces in the lungs, and eventually fluid will collect in the alveolar air spaces, the small air spaces over which gaseous exchange takes place. They will gradually fill up with fluid.
If the alveoli are full of fluid, that means the oxygen can’t get in, and it also means the carbon dioxide can’t get out. So, the levels of oxygen in the blood would start to drop. That’s a condition called hypoxemia, and the low levels of oxygen in the blood means there’ll be low levels of oxygen to all the tissues of the body such as the heart, the kidneys, the liver, the brain. That’s called hypoxia, and the hypoxia will start damaging essential organs.
When these inflammatory changes cause the fluid to start accumulating in the tissue fluid, in the lungs, and in the alveolar air spaces in the lungs, that’s called acute respiratory distress syndrome, ARDS. So, the mechanism of death will be or severe illness will be ARDS with the lungs filling with inflammatory fluid. Bacterial secondary infection, which we can treat, and the other mechanism is viral pneumonia. So, the presence of the virus in the lungs again will cause inflammatory changes due to the infection this time rather than due to the information.
And again, the alveoli will fill up with inflammatory fluid, and that will stop the exchange of gases. So, basically, if you want to be… To put it fairly melodramatically, people will be drowning because the alveolar air spaces in the lungs are full of fluid. And the other thing that can happen is because the virus stimulates the immune system, the cells in the immune system can release particular chemicals called cytokines, and that can cause what’s called a cytokine storm, and that presents a sepsis with a high respiratory rate, a high pulse rate, high fever, high blood sugar levels, altered mental status, and alterations in the amount of white cells in the blood, and increasing the amount of lactic acid in the blood.
So that’s another possible complication. There’s quite a few ways that this virus can get you if there is a severe infection especially if it’s causing these inflammatory changes in the lower tissues of the lungs and the lower airways.
Alex Smith: Now, in Western countries, most of the people who have died are seniors, many with pre-existing conditions as you mentioned, but are there cases where healthy people, even young people, can die from this disease?
John Campbell: There are. Now, the death rate increases greatly with increasing age. So, the death rate is going to be higher in people in their… It starts going up in about the 50s. So, people 50 to 60 are going to die more than younger. People 60 to 70 are going to die more than younger people, and it goes up with increasing age until the death rate over the age of 80 is really quite high. Now, this is partly because as people age, the immune system becomes less efficient and less able to combat the virus.
But as well as that, as people age, the probability that they will have other diseases as well increases. These are called comorbidities. So, people in their 70s and 80s are much more likely to have heart failure, diabetes mellitus type 2, chronic obstructive pulmonary disease, chronic renal failure, hypertension, and all these other diseases that are commonly associated with older age, and these comorbidities are also going to reduce the level of immunity that people have making infection more likely.
But as well as that, they’re going to make serious disease more likely to occur with complications. So, it’s partly age, and it’s partly comorbidities, and there haven’t been any studies so far that have dissected this apart. So, whether it’s primarily the increased case fatality rate is primarily as a result of increasing age or primarily as a result of the comorbidities isn’t clear, but both are probably relevant.
Now, your question about younger people being affected is… so far, the data that we have is from China. Now, the Chinese have done quite large epidemiological studies on this now. It shows the death rates in children seems to be much lower. Now, we’re not quite sure whether the infection rate in children is lower, but the children are less likely to get infected, but whether it’s children get a less severe form of the disease or a combination of those two things, but we’re certainly very grateful for the fact that this doesn’t seem to be affecting children particularly.
Now, this is actually in contrast to previous epidemics such as the 1918-1919 pandemic of influenza where young people were disproportionately affected. This doesn’t seem to be like that, so that’s good. Now, you’re right in saying that young adults have caught this disease. Perhaps the most famous case is Dr. Lee in China who was the original whistleblower who was suppressed by the local Chinese authorities and tragically went on to die from the disease when I think he was 33.
Now, there was different factors there. He was certainly exhausted in extreme tiredness, and we know that lack of sleep can reduce the efficiency of the immune system, so that might have been a factor. It may well have been because he was working clinically, he was exposed to a lot of other organisms as well. So, he may well have been exposed to influenza as well as COVID-19 for example. If you get the two viral infections at the same time, then that’s going to reduce the ability of the immune system to fight both of those to some extent.
So, it may be that he had multiple infections at the same time. For example, there was a case of a 35-year-old Thai taxi driver, I think it was. No, Thai retail worker, I think it was. 35-year-old Thai retail worker, and he was previously fitted well, but then he contracted dengue fever, which is a common virus in that part of the world. So, he was already here with dengue fever, but then he caught the COVID-19 as well, and it killed him. So, it was probably the combination of the dengue and the COVID-19 that killed him.
Generally speaking, younger people have a much lower case fatality rate, but it may be that if someone has multiple infections at the same time, that’s going to increase the risk of fatality. Again, the precise research data on this has not yet been done to be able to pick apart exactly what are the risk factors in younger people, but if we take the whole younger age group, some studies in China for example have shown that people in roughly the 20 to 40 age group, their case fatality rate is about 0.2% whereas that goes up progressively with increasing age.
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INSTITUTIONAL SPREAD – including prisons, nursing homes, etc.
Alex Smith: You are tuned to Radio Ecoshock. We are exploring the medical aspects of the novel coronavirus with Britain’s Dr. John Campbell, and we have talked about clusters and this virus, and America has the world’s largest prison system with about 2.2 million people in jails, and if the prisons get infected, the choices look bleak as far as I can see. The guards and support people will be reduced by their own illness and quarantines and workers staying home.
I noticed Iran, temporarily, they say, freed 54,000 prisoners, and that we have army barracks and nursing homes and mental hospitals and more. Shouldn’t we be trying to empty these places out? What do you think, John?
Dr. John Campbell: This has been a concern since the start of this epidemic that there’s going to be institutional spread. So, such places as students, halls of residence, as you rightly say, prisons. Now, there was a case in Seattle recently where there was quite a large outbreak in a nursing facility for people with chronic conditions, and that resulted in high fatality because again, you’ve got a lot of people living quite closely together, and there’s been prison outbreaks in China and, as you correctly say, in Iran.
So, anywhere where people are living especially indoors and a lot of people in a confined area, there’s going to be a greatly increased risk. Prisoners in the United States are certainly at significant risk. If you get one or two cases in a prison, then it’s likely to spread through the entire prison and infect maybe 60 to 80% of the people in that prison.
So, I think what we need to do is… I mean, certainly, if you can reduce the density of people in the prisons, that would be a very expedient move, but if that’s not possible, if the people have to stay in the prisons, then we certainly need very good regulation of people going in and out, so that people who are potentially infected and not coming into contact with the people in the prison.
But of course that’s very difficult to do because people can have a fever that then you might recognize that they’re symptomatic and might be infected, but of course as where I said, many people get a very mild version of the disease, and people can be infectious before they are symptomatic. Before they’re feeling unwell, they’re still spreading the disease.
One of the problems in the United States has been that testing has not been quite as on the ball as we would like it to have been. Now, I did notice there was a political declaration today to introduce huge numbers of tests that can be carried out locally in the United States. But up until this point, testing in the United States as I understand it has been done entirely by the Center for Disease Control in Atlanta, and there hasn’t been a huge amount of testing done.
For example, the Chinese are currently carrying out one-and-a-half-million tests per week. The South Koreans have carried out 100,000 tests. The Italians have carried out 20,000 tests. I think the total number in America is dramatically less than that. So, cases have been missed in the States. It’s quite possible that this virus could already be in prisons. I don’t know that yet, but it’s certainly a very high-risk environment, and we’re going to need it to work out some way to maintain order, and it is going to be a problem.
As you rightly say, staff are going to be involved as well as inmates. It is quite a big concern. I think some political decisions may have to be taken.
Alex Smith: The UK government just recently released a 27-page plan to deal with the virus, and I think they said there that one in five police may not be able to work being either sick or in quarantine, and they’re planning on calling in the army if need be. But as we just discussed, the army themselves have to defend their own people.
John: Yes, indeed. My government have estimated that at the peak of the outbreak, 20% of the workforce could be off sick at any one time. So, if 20% of the workforce are off sick, that’s 20% of nurses off sick, 20% of doctors off sick, 20% of prison officers off sick, 20% of police off sick. So, in the UK, we’ve said that the military will be available to backfill security issues and provide logistical support, and the government have said that the police would have to switch their focus from dealing with low-level crimes, only dealing with serious crime and maintaining public order. But the military may well be necessary to maintain law and order. That is a possibility.
Now, when there’s difficult situations, this can bring out the best and the worst in people, so I think we really have to hope this is going to bring out more altruism than it brings out depravity in people, but of course, we do always have to account for people. That will take advantage of difficult situations, and the military is certainly a possibility in my country, and I would suspect in the United States as well.
THE OUTBREAK IN IRAN
Alex Smith: The Iranian medical system was already weakened by punishing sanctions and now, the BBC is reporting Iranian hospitals and morgues have been overwhelmed. What have you heard about Iran, John?
John: Yeah, I’ve actually had some emails from clinicians in Iran who’ve written to me at some risk to themselves. Well, a couple of weeks before the government was admitting this, they did say there’s a lot of cases in Iran and that a lot of people were dying in Iran, and that it had been covered up because in Iran, there was particular problems. There was the 40th anniversary of the Islamic Revolution. I can’t remember this guy’s name. The guy that was killed in a drone attack, the end period for his mourning period, the 40 days Islamic mourning period coincided at the same time, and people were coming and going and traveling quite a lot for the elections as well.
So, there was three things all happening at the same time, which all resulted in public festivals, all resulted in people traveling. My understanding is the government didn’t want anything to interfere with these processes and interfere with the election. So, there was an initial denial and cover-up rather analogous to the Chinese situation. Now, my understanding is this has been rectified now.
The government have realized now that this is a serious problem. Not least because at least 20 deputies in the Iranian parliament had become ill themselves as indeed has the health minister. There was that famous video of the health minister mopping his brow when he was trying to give an interview, and it turned he tested positive himself the next day, and one of the vice presidents in Iran has also been tested positive, and he’s his ill with the condition. So, Iran does seem to be improving now, and I was very encouraged to hear that there is a World Health Organization team on the ground now in Iran, and I understand they’ve taken 100,000 tests into Iran with them as well as other medical equipment.
But as you rightly say that the medical systems in Iran were already challenged, and some Iranians had difficulty accessing good quality health care as it is, and this has greatly exacerbated the situation, and this is going to be the case in many less developed countries. Another concern I’ve had from the start of this is that the pandemic, as I would now call it, spreads to areas with weaker health systems where we don’t have the surveillance. We don’t have the screening. We don’t have the isolation facilities, and we don’t have the treatment facilities especially in poorer areas where a lot of people are crowded together in relatively confined spaces such as in a city slum areas.
The virus could spread very quickly in those circumstances, developing large clusters, which could facilitate further spread to other areas. So, it’s a major concern in many poorer countries, and Iran is certainly a major concern. As you rightly say that the services in Iran were already stretched due to external sanctions. I really hope that political differences can be put aside for the time being, and we can really help the people of Iran because even if you don’t want to help the people of Iran, which of course we do, but if there’s a large cluster in Iran, that’s going to spread to other places as well. This virus respects no borders. Helping one person is helping everyone.
AFRICA AND MIGRANTS
Alex Smith: Right. Well, you have worried on YouTube about the fate of Africa with the poor medical system there, and people in the West may say, “Well, that’s Africa. This is here,” but we have millions of African migrants already on the move, and some of them are poorly fed in migrant camps right now, waiting to come in. It’s everybody’s problem when this disease is on the loose.
John: Absolutely. I mean, if you think about refugee situations where people are living in difficult circumstances, they’re going to be more prone to infection because they’re living close together in temporary accommodation. It’s going to increase their vulnerability. Now, that’s bad for those individuals, and of course, as a civilized world now, we should aim to help all the individuals we can.
But even interested self-interest would indicate that we have to help these people because once the virus becomes established, the more people that have it, the more difficult it’s going to stop. That means the more likely it is that I’ll get it that my children will get it that your family will get it. So, we have to try and curtail this epidemic anywhere we can to contain it and to delay it and to mitigate it.
WILL COVID-19 DIE OFF IN WARMER WEATHER?
Alex Smith: Several authorities and pundits suggest this COVID-19 infection will just die down naturally as the weather warms up in the northern hemisphere. I think President Trump said that. Can we count on that, John?
John: We certainly can’t count on it. As we’ve said before, this is a novel virus. Now, it’s true the influenza viruses are much more prevalent in winter. Different reasons for that. Sometimes in winter people tend to socialize more inside, so they’re closer together because it’s cold outside. Sometimes, when it’s cold, the blood supply to the nose is reduced. That can mean that infection gets in easier. A little thing that’s interesting is in winter, we produce less vitamin D, and we know that vitamin D is now involved in the immune response.
So, we know there’s this big seasonality effect with influenza, both influenza A and B. The A type is the infectious type that comes from animals. Now, the seasonality of this virus is not known. Studies have been done on relative humidities on similar viruses that are analogous to the old SARS virus, and they actually showed that the virus survives quite well in low humidities and high humidities. We know from previous viral studies on viruses that were used to study the size.
One epidemic in 2002-2003, but the virus survived best at five degrees centigrade. But on surfaces, but didn’t survive for as long as 20 degrees centigrade, and probably only survived for a few hours at 40 degrees centigrade, but the seasonality of this particular virus is not known, and the reason I’m somewhat pessimistic about that is the virus has spread in places like Hong Kong, Singapore, which are warm. Thailand, there’s also been cases which of course are very warm places.
So, to answer your question, can we count on the spread of this virus going down in the warmer weather? Absolutely, we cannot count on that. Definitely not. We don’t know what the seasonality of the virus is. We are hoping that it’s going to spread less, but there’s no particular evidence for that at the moment. It still seems likely that the virus can last for several hours to several days on surfaces, and that we can pick it up and contaminate our facial mucous membranes like the nose, the mouth, and the eyes with that virus even after it’s been on a surface for a few days.
In my country, it doesn’t get that warm in summer anyway usually. It might go into the 20s, but I don’t think that’s going to be enough to have a massive effect on the virus. So, no. Unfortunately, I don’t think that’s going to help us too much. We need to contain and delay to spread out the severe cases, and of course, we need to give the scientists more time. The thing that’s ultimately going to stop this virus is vaccination. We need these vaccines, but unfortunately, there isn’t a vaccination is going to be possible in 2020. It’s probably going to be in 2021 before we get a vaccine.
Alex Smith: I’m Alex Smith. Get it all at our website, ecoshock.org.
Alex Smith: This is Radio Ecoshock. My guest is Dr. John Campbell, the retired nurse trainer from Britain, now, reporting medical news on the novel coronavirus. If we get a reprieve in the northern hemisphere this summer, if that happens, could the same disease pop up again with new waves and new quarantine next fall?
John Campbell: Pandemics often do have different waves. So, for example, in the influenza pandemic in 1918-19, there was a wave in 1918, and then a further wave in 1919. So, that can happen. Now, I’ve just recently learned that this COVID-19 virus is actually mutated. There’s an S form, and now I think there’s an L form as well of this virus. What we don’t know yet is if you’ve been infected with the S form, can you then be infected with the L form as well? So, it is possible. There are some anecdotal cases at the moment of reinfection, so it may be that people could be reinfected as the virus mutates, but for epidemics to pandemics to follow waves would be quite a normal pattern for epidemics.
Then the other risk as well as the waves is we don’t know if this virus could become endemic that it could be present all the time. So, there’s just so many unknowns at the moment, but yes, to answer your question, it’s certainly possible there could be further waves of this virus, yes, or very similar viruses to it that mutated from the original virus.
LASTING AFTER-EFFECTS OF THIS ILLNESS
Alex Smith: You’ve also spoken about the after-effects of being so sick even for those who recover. I mean, things don’t just instantly go back to normal for some people, and I would add the string of science papers I’ve noticed about the long-term damage and people treated in intensive care units, including people on ventilators, which extreme cases of this coronavirus often require. What have you heard about that?
John: Well, it’s well known that ventilation is a very high-risk medical procedure. We only carry it out for the sickest individuals, and as you say, there can be long-term complications. But generally, if there’s infectious diseases, there can be what we call “sequelae,” things that come after the disease. So, after any viral illness for example, there’s going to be tiredness for a period of time. Very often you can get post-viral depression. You just feel down, sometimes for a few months after a viral illness, and as well as that, viruses can damage particular parts of the body.
So, for example, there’s a virus called coxsackie virus, which can damage the heart muscle or the viruses can cause scarring in the lungs for example and cause lung problems later on. Now, this particular virus, it’s not quite clear what sequelae might be. There is some data that some people get damage to the heart with this virus. So, it’s possible that there could be cardiac sequelae, and there’s also some evidence that it can cause scarring in the lungs in some people perhaps due to excessive amounts of inflammation. So, they could be ongoing lung damage and shortness of breath after the virus.
Now, whether it affects other organs or not, we don’t know. There’s some people who believe it can cause damage to the liver and some people who feel it might affect the kidneys, but I haven’t read any scientific papers on that yet. But the risk of sequela where the virus is is always there, but the Chinese data just seem to be showing that people can make a full recovery because what we have to always bear in mind with the COVID-19 is the epidemiological evidence so far indicates that 80% of people will have a mild illness.
So, 80% of people that have it have a very mild illness. They might be off work for a few days, but it’s basically going to be mild, and they should make a full recovery, and if you look on the Johns Hopkins website, the number of recovered patients is going up quite dramatically. Now, the Chinese started this, and their criteria for saying that the patient has recovered are actually quite exacting. The patient had to feel better. They had to have no fever for 10 days. They had to have an improving chest X-ray or CT scan, and they had to have two negative smears of the virus showing that the body had cleared the virus. So, it was actually quite a high bar for deciding whether someone was actually cured of this virus.
I would expect most people to make a full recovery and return to full health, but there could well be a minority of people, probably those who’ve got comorbidities or more severe disease that do have longer-term sequelae of the virus yet, but the numbers of those have not yet been quantified. We would hope it would be fairly small.
Alex Smith: So, most of us should be fine, really?
John: 80%, 81% of people should have a mild illness and make a full recovery. That is the current epidemiological thinking from the data that we have, yes.
CANADA BEHIND IN PREVENTION
Alex Smith: So, here, in Canada, I’m a bit pessimistic. I feel we’re miles behind. We have flights from Iran, Italy, and China still arriving daily, and when they come, the passengers are politely asked to self-isolate upon arrival, but we presume they take transit. They stay with families. Some will not comply. I worry we’re being too polite, and that will lead to more deaths here. Plus Canada, unlike Britain, has not published any plan, so we’re all in the dark as to whether the government even has a plan. Have you heard much about Canada from your correspondence?
John: Not a lot, no, but I certainly think the government needs a plan because there’s no doubt in my mind that Canada will not be exempted from this pandemic. It’s going to go everywhere unless something changes quite dramatically. Now, throughout this, I’ve been very disappointed with governments and the World Health Organization and organizations like CDC in Atlanta for the lack of proactivity. They always seem to be reacting. So, the World Health Organization would say, “Well, we’ll stop flights to China if it becomes necessary.”
Even now, one of my chief health officers had said there may come a time in England where we need to stop shaking hands, but that time is not yet. I disagree. I think we need to be changing our behavior now. We have to be anticipating the virus because it has quite a long incubation period sometimes, and people are going to be shedding the virus in the incubation period. So, I feel that a lot of governments and the World Health Organization have been reacting to events once that happened, as indeed was the case to a large extent in Italy, but then you find lots of cases pop up because people have been incubating it and has been spread before the symptomatic cases developed.
So, I feel it’s really time for from what you say, for Canada to start being proactive. I think then you need to assume that the virus will be there in a few weeks’ time and start behaving accordingly and taking appropriate measures now. The fact that we’re still doing so much international traveling just bemuses me to be quite honest, and the fact that things are going on mass participation events, still going on. It’s almost like a form of denial that we’ll start worrying about this virus when a lot of people start getting sick, but by that time it’s already spread.
So, the key thing is we need to switch from reactivity to proactivity, and that should be the mantra, I believe, of the World Health Organization and all world governments that are planning for this because what greater responsibility does a government have than to look after the health and well-being of its people?
Alex Smith: Well, and the word is always keep your hands away from your eyes and your nose and your mouth, and I had to go to Vancouver last weekend and help stock up my child with some food just in case there is a quarantine, and I tried on the way there and on the way back to just do that, and it’s ridiculously hard to do. We have these habits that just keep bringing our fingers back to our face. I think for me the only way that I could handle this is to self-isolate until this goes by.
John: Yeah, I mean, the other possibility of course is to wear gloves to remind yourself. Now, people talk a lot about face masks, but face masks don’t actually provide very much protection from this virus unless they’re very good quality face masks. So, for most people that wear face masks, the main advantage is it stops you touching your face. So, I think it’s just a match of getting into these good habits.
Now, if we think about lifts buttons and self-service checkouts and basically the screens and surfaces all over the place that we’re obliged to touch. So, I think when you’ve been out in a public area, when you’ve been touching surfaces, the key thing is to just really have some method of stopping you putting your hands to your face till you get home and wash your hands thoroughly, and you have to wash your hands in a particular way, so the health service, the World Health Organization, me, myself, quite a few people have put out videos on hand-washing to show the proper way to do that because what will happen is the soap will actually mobilize the sebum on the surface of the hands, allowing the virus to be washed away, and as well as that, the virus has a fatty outer coat.
An ordinary soap will dissolve that outer fatty coat of the virus, and that will kill the virus almost straightaway. The other thing to use is hand gels, strong alcohol hand gels can be effective as well, but as you rightly say, it’s very hard not to touch your face because this virus will not get in through the intact skin in your hands. It’s going to get in through the mucous membranes of the mouth and nose and the eyes. That’s how it’s going to get in. So, perhaps wear gloves to remind yourself to not put your hands to your face and then when you get home, take the gloves off and wash your hands very thoroughly and frequent hand-washing throughout the day.
RESHAPING THE ECONOMY AND SOCIETY
Alex Smith: And throw them out. “Bin them,” as you say. You can’t use them again. So, Bill Gates saw all this coming. His foundation and John Hopkins even ran a simulated outbreak game last October where the threat was a coronavirus. Still most of the world did not prepare, and America seemed like the least prepared. Personally, I wonder if this outbreak is really a test for something even worse in the future. Do you think a disease could reshape our economy and our social life?
John: The answer to that is very simple, yes, absolutely, it could. We live in a strange period where people don’t die from infectious disease, but infectious disease has been a major cause of human suffering and death throughout the ages. If you go back into the Bible, you read about various plagues. In 1348, the Black Death, the bubonic death arrived in my country having spread to Europe and probably killed about 50% of the population, and we’ve talked about this pandemic in 1918-19 that killed perhaps between 50 and 100 million people globally. No one’s really sure.
Now, I’m not a specialist/virologist by any means, but I’ve been teaching student nurses for 25 years now that a new viral pandemic is inevitable. It’s not the case of if, it’s a case of when. Virologists have been saying this for a long time. There will be further pandemics, and of course, we’ve actually seen this. HIV was a viral pandemic, and previous influenza have been viral pandemics, but there’s so many viruses in the animal reservoirs that there’s possibility of this zoonotic spread from animals to humans of a novel virus, and if that virus mutates to allow human-to-human transmission, then pandemics are certainly possible.
Now, it so happens that this particular coronavirus that we’re suffering from now, the COVID-19, has relatives by transmissibility, but that’s genetically determined but has relatively low case fatality rates. We’re not quite sure what it is. At the moment, it’s looking like one to 3%, but there’s another very similar coronavirus called the Middle Eastern Respiratory Syndrome virus, MERS virus. That’s not as transmissible as this virus, but it has a mortality rate of about 35%.
So, in one sense we could consider ourselves very lucky that although we got a relatively high transmissibility, it’s got a relatively low case fatality rate. In the future, there could certainly be a virus that’s got a high transmissibility and a high case fatality rate. It could be way, way worse, and it could happen in the future, and as things are now, it’s taking about 18 months to develop vaccines for this.
So, there is always the potential for a viral pandemic. There always has been. We’ve just had a good run lately. We’ve had a lucky run for the last 100 years where there hasn’t been a massive viral pandemic, but they have always been a risk and will continue to be a risk because there’s untold billions of viruses live in the natural world. They are parts of the ecosystems, and there’s nothing we can do about that.
Alex Smith: As we wrap this up, John Campbell, is there anything else that you would like to leave with our listeners?
John: I think we need to act together on this. This virus is a common enemy. We need to fight it. We need to fight it as a combined humanity. We need to look after those that are vulnerable. We need to look after those that are sick, and we need to readjust our attitude really and how we are interacting with this world. If this acts as a wake-up call, that could be a good thing because we depend on the ecology of our planet. We cannot live independently of it. We need to live with it in harmony.
So, if that teaches a little bit of humility about the frailty of human life, that it can be taken away by infections and other environmental things at any time, then maybe we’ll walk more softly on the surface of our planet, and that will be a good thing.
Alex Smith: From the UK, we’ve been speaking with Dr. John Campbell, the man who has trained nurses in many countries and specialized in online teaching as well. He’s doing it now via YouTube. I check it out every day. His site is campbellteaching.co.uk. You can order his two books there. Thank you, John, for generously stepping up to help us in this hour of need and speaking with us on Radio Ecoshock.
John: It’s been a pleasure, Alex. Thank you for having me on the show.
Alex Smith: I’m Alex Smith reporting.
Announcer: Check out the Radio Ecoshock website. We’re at ecoshock.org.