What it means to live with the virus

On Feb. 17 this year, I taped an hour-long interview with Dr. Edsel Salvaña, director of the Institute of Molecular Biology and Biotechnology of the UP National Institutes of Health in Manila. Dr. Salvaña was among the first Filipino infectious disease experts to closely follow developments surrounding the novel coronavirus outbreak first detected in Wuhan, China.

The total number of coronavirus infections worldwide at that point was no more than 70,000. Deaths from COVID-19 stood at 1,700 — all mostly in China. We had three cases in early February in San Lazaro Hospital, all travelers from Wuhan. Two recovered and were able to return to China. But one of them, who had initially tested negative, died from complications caused by pneumonia.

That interview was first aired on my podcast, “Conversations with Randy David,” on March 5, well before the first lockdown over Metro Manila and Luzon. The 2-part interview is still available on Spotify, Stitcher, and Apple Podcasts under the “PumaPodcast” channel. I have since listened to it a couple of times, wanting to get a sense of how scientific knowledge of the virus (SARS-CoV-2) and the disease it causes (COVID-19) has evolved in the last few months.

In February, as China battled the disease, locking down entire cities and provinces and ordering people to stay home, we could still view the evolving pandemic with detachment. We were stunned by the draconian quarantine measures the Chinese authorities were putting in place, and wondered if this was proportional to the severity of the threat or this was just a function of the Chinese way of doing things. We watched in awe as additional hospitals and isolation centers dedicated to COVID-19 patients were built in a matter of weeks.

I remember asking Dr. Salvaña if he thought that catching the virus was tantamount to a death sentence. “Absolutely not,” he told me. “From what we know, this virus is less deadly than SARS and MERS. If you’re relatively healthy, chances are 98 percent of the time, you’re going to make a full recovery, unless you have the risk factors.” This was before studies would later show that the disease tended to cause lasting damage not only to the lungs but sometimes also to the heart and other organs. Later reports also indicated that some patients had to go back to the hospital with graver symptoms than on their first confinement. This led specialists to ask if reinfection was possible in recovered patients.

It was natural for scientists to look at COVID-19 through the prism of existing models of similar infectious diseases. There is enough evidence to show that while the new coronavirus is not as lethal as other known coronaviruses, it is far more contagious. There is continuing debate, however, over whether it’s spread primarily through droplets or through aerosols suspended in the air like smoke. Dr. Salvaña did not think it was airborne.

When I first asked Dr. Salvaña about face masks, he was emphatic about their use by sick people to prevent them from spreading the virus. There is much less evidence, he said, about their usefulness as protection against catching the virus. Accordingly, he did not believe it was necessary for people who did not have symptoms to wear one. This view, as we all know, has since been superseded.

What has made face masks the first line of defense against the virus is increasing evidence of asymptomatic and pre-symptomatic transmission. It is now believed that as much as 40-45 percent of infections are passed on by asymptomatic coronavirus-positive individuals. This adds an entirely new dimension to an already elusive and persistent pathogen. It can make the most diligent testing and contact tracing efforts frustrating.

With this bit of information, we may imagine how the virus quietly spread in our communities in those crucial months when RT-PCR tests were given only to those who had symptoms and had a history of travel or exposure to infected individuals. The strict community quarantine measures may have contained the outbreak and limited it to a few hotspots. But the overnight easing of these restrictions in the name of reopening the economy clearly unleashed the virus. Today, to our horror, we are finally seeing those daily surges in infections that we had expected much earlier.

We should be better prepared by now, but we are not. We thought we had done everything to stop the virus, and indeed, in those early days, it did look like we had contained it. We have grown tired of our restraints, and we can’t wait to free ourselves of them. Yet, the virus appears to be just starting to make its presence felt in our midst.

How do we protect ourselves against an almost invisible threat like this, except by assuming that it’s lurking around us all the time? As antisocial as they may be, face masks or shields and physical distancing seem, in the absence of a safe and effective vaccine, to be the only defenses available to us as we venture back into a reopened society. Masks and distancing will not suppress the virus but, as a New Yorker article puts it, they “will allow us to hide from the virus while scientists do their work.”

The scientific work we await is not just about vaccines, but about a lot of other things—the production of safe and effective antiviral drugs, and faster and more accurate tests. On a personal level, apart from wearing masks in public and frequently washing our hands, we can do a lot to control surges by practicing the so-called 3 Ds of respiratory-virus hygiene. These are keeping Distance and limiting the Diversity and Duration of our face-to-face encounters outside the household.