Covid-19 epidemics from perspective of physician-scientist

This is not political statement. It is my personal quest of finding facts and sharing them with my friends, family and whoever wants to listen.

There is a lot of blame and misinformation going on about COVID-19 so I am trying to provide some explanations here.

I am MD with PhD in microbiology and I have had NIH funded lab where I performed thousands times all the tests I am talking about here so I think I may know more than an average lay person.

What WHO does? Saves lives and goes where nobody wants to go like to contain Ebola epidemics etc. For example:
In 2020 500,000 children under the age of five will die from diarrhea. Five and a half million yes million children under the age of five will die from mostly preventable disorders.
World Health Organization made huge strides in reducing children death by supplying simple solution of powder of glucose and salts to rehydrate the kids.
WHO efforts eliminated small pox from the world.
Check the facts yourself at this link
https://www.who.int/news-room/fact-sheets

So not supporting WHO is just plain not American – we always tried to help the poor and oppressed around the world.

Why do I get upset when people blame WHO for dropping the ball on everything when it comes to COVID-19?: nothing makes me more upset when people with zero education and knowledge make statements which they replicate from news.

Early identification of any disease depends on data.

WHO epidemiologist work on data send from each country. If NJ does not include cases from nursing homes in their report to the state then we as country will provide inacurate information to WHO. WHO doesn’t have soldiers in China or USA to police accuracy of reporting.

So I am sure WHO and all of us lacked total picture of numbers in China, but this is not WHO fault. To call something a pandemic you need to have accurate data. Time will show if and how delay in sending real data to WHO would make any difference.

Time to establish diagnosis : you can only detect something when u know what to look for.

First you have to have a clusters of disorder which occurs more commonly than expected or has unusual severity like severe pneumonia. To detect that something is going in population you have to have excellent reporting system of each case of a disease and then statistics tools to identify abnormal pattern of disease or admits to hospital

In China in December/January someone identified strange pattern of people with severe pneumonia.
Now remember you can only test what u know.

Penumonia can be caused by bacteria and viruses.
Older people typically have bacterial pneumonia.

To diagnose a reason for pneumonia the organism has to be grown in culture and seen in large number under microscope. Well you have to use cell cultures to grow viruses and the effect on cells of most viruses look the same. I am amazed that the virus was determined to be a cause of the problem so quickly.

To identify the virus as new you have to gather samples from many patients then sequence them and analyze them. Virus mutate so getting sequence from one or two patients is not enough.

When I used to work in one of so called IVY leage medical schools in Manhattan it took on average three months to get sequencing results back. I bought my own sequencer so I can have results in few days.

Still if I wanted to sequence something I would have to get a grant which takes 9-12 months if u r lucky 5% of scientists. Often it takes years. So again fact that across the world four thousand of covid-19 sequences have been done and publish now is staggering success of scientists working together.

The virus was first sequenced in China, Australia and Taiwan.

Once u have a sequence of 30,000 long virus you can start developing diagnostic tests.

In January the sequences were available to public and WHO released protocol to detect covid-19 virus.

This test is based on detection of small fragment of virus using even smaller markers called primers.
Even my 11 year old son can design dozen of primers as he did but to test them in the lab you need to synthetically make them takes week to two. Then test different combinations of primers against positives and negatives. WHO checked the primers and released them to public domain in January.

Unfortunately CDC decided they want to design own primers and test them first which takes few weeks of u work round the clock.

We know that CDC test had to have some adjustments made to work.

There is a huge hurdle in usa to perform new diagnostic tests they have to be cleared by fda and state health departments so until FDA lift the restrictions only CDC was able to test.

Push from NY governor and others lifted blocks to test in more labs.

Now equipment to test cost around $100,000 in USA depends on machine quality you want to get. You have to put extra precautions protecting your lab techs= more money. So cost is an issue with more testing.

Problems with testing are biologically driven. The Covid-19 virus mutates very quickly thus the regions used to identify the virus may be mutated and virus not detected.

Because of such high mutation rate of the virus I am sceptical that vaccine giving lasting protection will be developed soon. It may be rather something like flu vaccine needed every year. I hope I am wrong.

But WHO already signals that presence of antibodies may not be preventive from being infected.

Last but not least

The sequence of virus does not predict how the virus is transmitted. This can only be determined from large epidemiological studies – it requires honest reporting and tracing contacts. In case if covid-19 when people die left and right most of epidemiologist who are physicians are in trenches saving lives so no wonder that it took time to determine the mode of transmission. BTW both DT and CDC were claiming for long time that the virus is not transmitted by asymptomatic patients or direct contact. Something we know is not true.

So yes you can blame WHO for dropping whatever Or you can stop living in a fantasy word of ignorance, misinformation and before typing any answer please actually learn how things work.

What could have save lives : CDC and US government to utilize WHO primers early on instead of waisting time developing own tests. Second lifting restrictions on test development early on. Third putting maximum resources to perform massive testing and self isolation. CNN FOX News NYT WP and all agencies to focus on education rather than pushing political propaganda and bickering.

This was written especially for my dear friend Charlie Bischoff, I appologize for calling you dumb, you know I love all my doc brothers and sisters in arms but please stop with the nonsense 🙂