COVID-19

3/18/2020: A Message to Young Generation

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Dear young friends,

We are all aware of the coronavirus outbreak, COVID-19, and the White House has already declared a national emergency. 

A lot of colleges have closed their campus and asked their students to move out of on-campus housing. A lot of states, counties, and cities have placed “Shelter in Place” orders.

Could you have imagined this on March 1st? I think most people would have thought Trump was kidding or crazy if he declared that we would enter such a chaotic situation in the next two weeks.

It has caused a lot of trouble for the younger generation. 

Some are in high schools, working hard for AP or Honors classes or preparing for SAT/ACT tests.
Some have just started their college life, planning their first spring breaks.
Some have just started dating, dreaming of a romantic getaway during the break.
Some are in band or orchestra, practicing day in, day out, getting ready for their debut.
Some are seniors in college, preparing a big party to celebrate graduation.
Some have just landed their first job, and are looking forward to receiving their first paycheck.
And since spring is here, it’s an excellent season for gatherings, parties, and outdoor sports activities.

And now, you are told that all of these activities are prohibited. I’m sure you’re thinking: How dare you? I don’t want to put my life on hold because of this virus.  

If I were you, I would feel super angry and frustrated too. I totally understand.

But I still want you to calm down, take a deep breath, and read this article.

Novel Coronavirus, or COVID-19, or SARS-CoV-2, is the trouble maker. We need to get to know it so we can fight it correctly.

I have collected the following papers about the virus. I hope that after reading them, you get a more cogent picture of this virus, and then you can make the correct decisions during this pandemic. 

I’d like to add that these papers — all COVID-19-related — were written by medical doctors, biologists, and even math scientists. 

【How does this virus infect humans?】

The first paper is about why COVID-19 can infect people; it’s published on ACM.

Receptor Recognition by the Novel Coronavirus from Wuhan: An Analysis Based on Decade-Long Structural Studies of SARS Coronavirus

Some of these terms might be unfamiliar to you, but that’s perfectly normal. 

I don’t want to recite its content here, but I do want to point out that that one word (ACE2) is so eye-catching since it appears in the paper so many times.

The main idea of this paper is that the ACE2 found in the human body can easily be attacked by this virus.

【What is ACE2 and how is it distributed in the human body?】

ACE2: angiotensin I converting enzyme 2 [ Homo sapiens (human) ] has the explanation and the distribution chart.

Note that this is collected in the US National Library of Medicine National Institutes of Health.

If you continue to read this page, open the detail page in the expression part (extend the expression part and click on the detail link on the right side below the bar), and you will see how it is distributed in our human body. 

The first chart displays the amount of ACE2 in each organ.

You can even sort the list by the RPKM value — hopefully you can find something that will alarm you. I will mention it later.

【Symptoms】

This paper (Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

) is written by a group of Wuhan doctors who are in the front line of the battle with the virus and published on the Lancet, which is a weekly peer-reviewed general medical journal. It is among the world’s oldest, most prestigious, and best known general medical journals.

This paper gives us first-hand information about the symptoms a person experiences when they are infected with COVID-19.

From this paper you can conclude that most of the patients are elderly people, especially with pre-existing conditions. 

Another interesting fact is that there are more male victims (73%) than female (27%).

Most of the patients do not have a high fever.
76% of patients have a cough.
55% of patients have Dyspnoea.
44% of patients have myalgia or fatigue.
29% of patients have a respiratory rate of more than 24 breaths per minute.
28% of patients have Sputum production.
8% of patients have headaches.
5% of patients have Haemoptysis.
1% of patients have Diarrhea.

When looking at the percentages for these symptoms and the data involving ACE2, some questions may arise. 

Why does it cause patients to feel myalgia or fatigue? 

Why is the percentage for patients who have diarrhea so low when there is a strong expression of ACE2 in the small intestine? 

Is there something still missing in the puzzle of COVID-19? 

Bearing in mind these questions, I found this paper, “Angiotensin-Converting Enzyme 2 (ACE2) and ACE Activities Display Tissue-Specific Sensitivity to Undernutrition-Programmed Hypertension in the Adult Rat” published on AHA Journals, which is an official journal of the American Heart Association.

In this paper, they conducted a study on adult rats and found that “ACE2 mRNA is widely expressed and coregionalized with ACE” in tissues. “Moreover, tissues involved in blood pressure homeostasis (lung, heart, and kidney) express high levels of both enzymes. Enzymatic assays reveal that ACE2 and ACE are coactive in these tissues.” Also,“ACE2 and ACE activities are increased only in the lung.” 

Their conclusion was that “ACE2 and ACE are coexpressed in numerous rat tissues and that their increased activity in the lung of FR30 rats may participate in hypertension programming.”

They also believe “In humans, ACE2 was found at various levels in 72 tissues that also express ACE mRNA.”

Their reference paper (Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme) published on  AHA Journals tells us in more details; “ACE 2 is highly expressed in testis, renal and cardiovascular tissues and notably also in tissues from the gastrointestinal system including ileum, duodenum, jejunum, caecum and colon.”

Now the puzzle seems to have been solved. 

【How it spreads】

This paper —  Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient published on Jama Journals — tells us that the most possible ways for the virus to spread are: 

  1. Through close contact with people who carry viruses or touching “dirty” things that have the virus. 
  2. Inhaling air that has droplets of the virus.

Note: JAMA Journals is the Journal of the American Medical Association. It is a peer-reviewed medical journal published 48 times a year by the American Medical Association. It publishes original research, reviews, and editorials covering all aspects of biomedicine.

【How long the virus can survive on a surface】

Imagine this: a person is a carrier of the virus. He enters a building with a sliding door. He enters the elevator, touches the elevator buttons, and goes to the desired floor. He grabs the handle of the door and opens it, he does something, and leaves. 

Now you come in, and since there is no one else in the building, you think it’s safe and you will not get infected, right? 

Read this paper NOW

Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents

This paper was published in the Journal of Hospital Infection, which is a peer-reviewed medical journal published by Elsevier on behalf of the Healthcare Infection Society.

This study didn’t include COVID-19, but the author tells us “They think the results might also extend to the COVID-19 virus.”

I have chosen some life span numbers for the SARS virus, since COVID-19 virus is also called SARS-CoV-2 and they share some similarity.

Metal: 5 days, wood: 4 days, paper: 4-5 days, glass: 4 days, plastic: 4-9 days, PVC: 5 days.

The virus can live for days on those surfaces, which include buttons in the elevators or remote controls, knobs and handles on the doors, surfaces of windows and tables, etc, you name them.

NOW do you still think you are safe when the building is empty?

That’s why it’s so important to have good personal hygiene habits and to get public areas disinfected very often.

【Higher Risk of infection】

Following video is a combined clips from briefings from our officials and professionals, it shows that even for adult, the most educated experts, it’s super hard to keep good hygiene habits:

Do you think you can do a much better job than them?

Most of you are energetic and like having a social life, so you don’t like to stay in one place for a long time. Therefore, you have a much higher risk of being infected.

Personal hygiene habits (avoid touching the face/mouth/nose/eyes after touching knobs/handles or shaking hands) and social distancing are a must now.

There is one more scary feature of this virus that puts you in even more dangerous situations.

【Asymptomatic transmission】

All the officials suggested that healthy people don’t need to wear a mask, only sick people do.

I would say that’s true for most of the diseases, but not for this one.

This virus can hide itself; people can spread the virus before showing obvious symptoms. 

If you are experiencing myalgia or fatigue, do you think you are still healthy? From the previous section, we already know 44% of patients feel this way; Tom Hanks is one example.

You might think you are just too tired, something like a good sleep will fix. You don’t treat yourself as a potential virus-carrier, as millions of other tired people do.

That’s why there is an eruption of confirmed cases. When the virus-carriers show obvious symptoms, by that time it’s too late. They might have already spread the virus to multiple people in the last couple of days.

Here is one case in China: Presumed Asymptomatic Carrier Transmission of COVID-19 , which is published on Jama. 

Here is another case in South Korea:  the study of early cases in South Korea , which is already collected in the US National Library of Medicine National Institutes of Health.

The South Korean cases show that “three of the confirmed patients were asymptomatic when they were diagnosed.” 

So masks are needed when shopping, but are also highly-demanded by the medical team, so masks should be reserved for medical staff, since they are our soldiers now and they need to be fully armed especially when there is a severe shortage of masks.

When we go out we’re jeopardizing lives, but doctors/nurses go out to save them. 

Staying home will highly reduce the demand for surgical masks by normal people, and it will also reduce the possibility of getting infected. Then we will not rush to the hospital to increase the burden of our medical system.

【Long Term Effect】

By now, you might still think it only puts older people in danger; you are young, you can survive, and you will be okay afterward.

I would like you to think TWICE.

Even though there is no paper or numbers to share with you about SARS-CoV-2 (COVID-19) itself, we have data for its cousin SARS (Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study, published on Nature magazine). 

We thought SARS was a deadly virus which had an outbreak in 2003.

Doctors and scientists believe that COVID-19 can out-perform SARS by a significant margin. Here is the paper (Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19 implicate special control measures.) about the comparison. 

Do you still remember where ACE2 is distributed the most? It has a strong presence in a lot of tissues, and the 5th organ that has the most ACE2 is the testis. 

Because ACE2 can be found in so many tissues, the virus has the potential to dig holes everywhere in your defensive wall. This is why 44% of patients feel myalgia or fatigue.

There are studies that show that only destroyed lungs cannot 100% be recovered. How can you be 100% sure that other damages will fully recover?

Now imagine the aforementioned scenarios if some of the damage done to your body is permanent: 

You feel extremely tired soon after you warm up for sports.

You cannot carry your bride into the car.

You are easily out of breath so you cannot climb the stairs, carry your kids, or help clean up the house.

You might not have enough energy to have intimate activities with those closest to you. 

And this list can go on and on.

Do you still want to take those risks?

【When it will end】

Experts in the medical field and epidemiologist believe that we either wait for the vaccine to be available or 60% of people get infected and generate the defense wall (expert comments about herd immunity).

Right now, American scientists are working hard on the vaccines, but it won’t come out in the next 12 months for extra safety concerns and studies. What we can do in the meantime is compress and slow down the outbreak.

One the other hand, UK PM warned their people, “Many families will lose loved ones before their time to coronavirus”.

【Potential Collapse of Our Medical System】

We need to patiently wait for the vaccine, or delay our turn to be one in the 60%.

And we certainly don’t want the worst thing to happen.

Once a patient needs medical treatment, it might last a couple of weeks or even months for people in serious condition to recover. From the 15-year-tracking SARS study, we already know that some patients take years to recover, so it will be a long road to recovery once we need medical care. 

Once more cases are severe, our medical resources will soon be fully occupied.

New patients seeking medical treatment will rapidly pile up.

Once the virus gets widely spread in the community, it will also cause a significant loss of medical staff if we don’t adequately prepare (the Seattle cases) . 

When more patients start to seek medical care, it will worsen our whole medical system. 

Most new patients with pre-existing conditions will find it hard to survive, especially the older ones.

There will be a percentage of patients with mild symptoms that turn into severe ones, which will burden our medical system even more.

And then our medical system will collapse, by that time, we will have no choice any more, we will be totally defeated by the virus, and our manufacturing, agriculture, finance, and tourism will all collapse, and our country will be battered.

So it’s the time everyone needs to take action to prevent this worst scenario from happening, especially the young generation, since the future is yours.

And finally I want to share this analysis with all of you. It will show you how everything goes if we don’t take action today.

That’s also why the federal government has declared a national emergency and shelter in place orders have been enacted. That’s why President Trump has declared this to be a war.

Remember: the future belongs to you, and now it’s already in your hands. Protect it by following the orders, or destroy it by continuing to hold parties and gatherings. It’s all up to you.

One small step you make today, it will have a big impact for the future.

【My Suggestions】

First, build better hygiene habits, especially cover coughs and sneezes with your elbow, wash hands more frequently; No hugs or kisses if you are not 100% sure if both of you are COVID-19 free, it’s better to keep enough distance with each other, 6 feet per California shelter in place guidance.

Second, If you already have the symptoms listed in the symptoms section, I would strongly recommend you get tested or do a self-quarantine. It will reduce the amount of people who get infected due to being in close proximity with you. 

At last, do your best to stay home; avoid close contact with others. Social-distancing is key. 

Today’s patience will be highly paid off tomorrow, and that will be the best investment everybody will have ever made in this century.  

And I really appreciate you for reading to this very end.

Stay safe and keep healthy.

Sincerely,

Q. Shao


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