The Viral Paradox

RAJGOPAL NIDAMBOOR

There’s this celebrated story of a patient, with flu, who went to his physician with the illness. The latter quickly scribbled a prescription in his customary difficult-to-decrypt handwriting. The patient put it in his pocket, but forgot to go the chemist. Each morning, for two years, he displayed it to the conductor as a train season pass. It got him twice into the movies, once into the soccer ground and also a concert. It gave him a raise at work — as a ‘note of recommendation’ from his boss. One day, he unwittingly misplaced it. His daughter picked it up, ‘played’ it on the piano, and won a scholarship to pursue lessons at a music school.

Witticisms apart, influenza, or flu, a contagious infection, is more than something we all dread. This is primarily because most viral illnesses, such as flu, not only involve the respiratory tract — they are also the most common illnesses we encounter in life. While it has been a practice to relate to viral disorders, according to the anatomical region affected — or, seasons — based on the given virus’ affinity — there are no fixed rules for a virus to affect a particular region. A virus may sometimes produce symptomatic infection at a different site — a location which may not be its favourite ‘abode.’

Viruses are transmitted in a multiplicity of ways — swallowing, inhalation, bites, or stings, of insects, such as mosquitoes, other parasites, and ticks. While our body has a number of defence mechanisms in place to ward off a virus attack, including physical barriers, like the skin, yet a virus has the capability to ‘pull up’ the body’s immune defences. These fortifications begin with white blood cells [WBCs], such as lymphocytes, which learn to assault and ‘demolish’ the virus, or the cells it has infected. When the body ‘outlives’ the virus attack, the lymphocytes keep the ‘information’ of the invader and respond more quickly and effectively to a subsequent infection by the same virus. This is labelled as immunity.

The most common viral infections affect the nose, throat, and airways — with sore throat, sinusitis, the common cold, and influenza. In medical parlance, also popular lingo, they are called upper respiratory tract infections [URTIs]. In children, viruses can cause croup, laryngitis, bronchitis and bronchiolitis. There are also other such ‘bugs,’ viz., rabies and encephalitis viruses, that affect the nervous system. Viral infections can, likewise, affect the skin, and cause warts, or other cosmetic aberrations. Certain common viral infections include herpes too. There are eight types of herpes viruses. One of the types may cause a childhood illness — Roseola infantum — and, cancer [Kaposi’s sarcoma] in AIDS patients. All of the herpes viruses may cause life-long infection, because the virus remains within its host cell in a dormant [latent] state. Sometimes, the virus reactivates and produces further episodes, or relapses, of the illness. Reactivation may also occur rapidly, or after several years following the initial infection. Besides, some viral infections are pervasive among children, especially in day-care settings.

There is a virus called cytomegalovirus which can cause serious infections in the new-born and in individuals with a compromised immune system. This virus is also implicated in an illness analogous to infectious mononucleosis [an acute feverish illness] in some people who, otherwise, have a healthy immune system. It is also known that some viruses affect the DNA of their host cells and cause cancer.

There are a host of conventional antiviral medications used, for example, in influenza, or other viral illnesses and also ‘prevention’ plan. They work by interfering with viral reproduction. They may be prescribed when a person has an apparent, or recent, exposure to someone afflicted with the illness. Needless to say, such medications are used during epidemics — to protect people who have not been vaccinated, or are at a risk of complications. This group includes senior citizens and patients suffering from chronic illnesses. Antibiotics aren’t useful in viral infections. However this may be, when a person has a bacterial illness, in conjunction with a viral illness, an antibiotic, along with vitamin C, probiotics, zinc, and other supplements, may be a typical prescription.

Viruses are also more than just smart. They reproduce inside the cells using the cells’ own metabolic pathways — they only have a limited number of metabolic functions unlike bacteria. Bacteria are fairly large organisms; they generally replicate by themselves outside of the cells. Bacteria also have several metabolic functions against which antibiotics are specifically targeted. This is the bright spot. On the downside, antiviral drugs and vaccines are complex; they are not easy to develop and they take time to be made available for use. Picture this: of the wretched spectre of certain resilient microorganisms perplexing us in a ‘battle of attrition.’

This is also how the puzzling wheel has turned full circle — in spite of glittering advances in modern medicine. Call it the paradox of flu, and other viral illnesses, including COVID-19, or what you may.

You may have possibly heard of yet another difficulty — viruses can often develop resistance to antiviral drugs. They can also multiply rapidly because of a host of factors, including central air-conditioning and heating systems, not to speak of the relative ease of international air travel. This also causes new strains of viral illnesses to being spread ‘at the double’ — the best examples being swine flu and the new scourge, the catastrophic coronavirus.

Coronaviruses [CoV] are a large family of viruses — they trigger illnesses, right from the common cold to certain severe illnesses, viz., Middle East Respiratory Syndrome [MERS-CoV] and Severe Acute Respiratory Syndrome [SARS-CoV]. A new strain, the novel coronavirus [nCoV; now called COVID-19] that was not formerly identified in humans, which originated in Wuhan, China, with calamitous intent, has proliferated in several countries in Asia, Europe, North America and the Middle East. The virus spreads principally through contact with an infected person — when they cough, or sneeze, or through droplets of saliva, or discharge, from the nose. Thousands have been infected, leaving the WHO to declare it a pandemic. While much remains mysterious about the virus, including how many people may have mild symptoms, or asymptomatic infections, and whether they can transmit the virus, the exact dimension of the present, on-going viral conundrum is far too complex and not as ‘simple’ as it appears to be on the surface.

The common signs of COVID-19 infection include respiratory symptoms — viz., fever, cough, shortness of breath and breathing difficulties. In severe cases, the infection could lead to pneumonia, severe acute respiratory syndrome, kidney failure and death — especially in elderly patients with co-morbid illnesses, such as hypertension, diabetes, asthma, among other disorders. The good, old standard recommendations to prevent infection through regular hand washing, with soap and water, not touching the face, covering the mouth and nose when coughing and sneezing, thoroughly cooking meals and avoiding any close contact whatsoever with anyone showing apparent, or perhaps ‘no obvious symptoms’ of respiratory illness, such as coughing and sneezing, are just as good as any.

Yet, one thing is clear. Our world will not be the same again. The sinister ‘phantom’ of coronavirus and the loss of thousands of innocent lives are certainly going to change us too, also medicine, and treatment protocols, and just about anything and everything we think we know, or do not know, today. It will transform the globe, no less — if only we are willing to learn from human, technological, political, ideological, hegemonical, and other foibles, and also from history, to making the world a better place to live in, especially for future generations. Else, we will fail as we have failed, or botched, ourselves — at this desolate moment in time.

— First published in Madras Courier