COVID-19: Just when you think you’ve got it all figured out

Even after we’re in our last quarter of the year 2020, scientists are still striving to understand the virus — and some of their questions may never be completely answered.

If it seems like there’s a new revelation about the novel coronavirus every few days, that’s because there is. By its very definition, the novel coronavirus is one that we’ve never dealt with before, and scientists are learning about it on the fly. Plus, coronaviruses are known for their tendency to mutate rapidly and repeatedly due to their single-RNA-strand structure.

What’s that like for researchers and doctors on the front lines?

It’s like playing a game of Whac-a-Mole,” says Kathleen Dass, MD, an immunologist at the Michigan Allergy, Asthma & Immunology Center.

“Just when you think you’re on the right path, a new mutation pops up.”

In all fairness, scientists have whacked of a lot of “moles” thus far. But as our experience with, and the body of knowledge about, the virus continues to grow, they’re still popping up. Here are a few of the crucial coronavirus mysteries they’re still trying to solve. In the meantime, people are wondering when things will go back to normal and what a post-coronavirus life could look like.

How does the coronavirus spread?

Knowing how a disease is transmitted is critical to containing it. Like measles, some conditions spread through the air; that’s “aerosol” or “airborne” transmission. Like food poisoning, some are foodborne, and still others, like hepatitis A, spread via human waste.

The novel coronavirus, which causes COVID-19, spreads from person to person via “respiratory droplets,” but what hasn’t necessarily been clear is whether there can be an airborne transmission.

The reason for the confusion may be that airborne transmission and respiratory droplet transmission are not two distinct phenomena but rather two points on the same spectrum. Suppose a droplet lands on or near your nose or mouth. In that case, you can inhale it, says Barbara Saltzman, Ph.D., an epidemiologist and assistant professor in the School of Population Health at the University of Toledo. And if someone standing near you sneezes, those droplets travel through the air and land in your eye, nose, or mouth, add Nesochi Okeke-Igbokwe, MD, an internist, and health expert. It can also land on a nearby surface, and if you touch that surface and then touch your face, you can infect yourself.

However, what remains a mystery is how long the virus can live on various surfaces, in substances, and the air.

For this reason, and because so much transmission appears to be coming from asymptomatic carriers, experts recommend that people wear masks, not to protect themselves but to protect others and wash their hands frequently and thoroughly. For a mask to be effective, though, you have to use it properly.

How did it start?

At the end of 2019, a cluster of people in Wuhan, China, suddenly presented with severe pneumonia. All were infected with a virus that had never before been observed in any animal or the human, but it appeared to belong to viruses’ coronavirus family. But that’s not COVID’s origin story. After all, the novel coronavirus didn’t just appear spontaneously in humans. That meant it had to have started in some other animal. But which? And how did it end up infecting humans?

Initially, scientists saw similarities between the novel coronavirus and a coronavirus seen in bats. Since the cluster of infected people all had some connection to a Wuhan wet market where live bats were sold as food, many (mostly non-scientists) quickly assumed the virus came from eating the flesh of an infected bat. But scientists knew that didn’t sound right. First, this particular coronavirus does not spread through food. Second, it’s virtually unheard of that a coronavirus seen in a bat would be capable of jumping to a human.

So while the novel coronavirus looked like a bat virus, it couldn’t have come from a bat. That meant the virus would have had to have infected another animal in the interim. Scientists began looking at other animals. A recent study found that while this coronavirus virus looks genetically similar to one isolated in bats in 2013, it also bears a striking resemblance to coronaviruses recently observed in China’s pangolins.

This suggests that the virus may begin as a coronavirus in bats as far back as 2013 but then evolved over the next several years into a virus to which pangolins were susceptible. After that, it grew further until it became capable of infecting humans. Of course, none of this proves the novel coronavirus came from pangolins.

First, the study is brand new and only preliminary. Second, there still might be another animal (or animals) in whose bodies this virus mutated and evolved until it was finally transmittable to humans. And until we know the answer, it will be virtually impossible to figure out exactly when, where, or how the virus made the jump to humans.

Did that “evolution” happen in a lab?

There are a few COVID-related conspiracy theories you shouldn’t believe, at least two of which presume the novel coronavirus was developed in a laboratory. For better or worse, the United States government effectively fact-checked that a few weeks ago when it announced that it was commencing an investigation into the possibility that the virus began in a lab. The reason? Some infectious disease experts believe that lab origins can’t be ruled out just yet. That investigation is underway at this time.

However, some believe the viral evolution described above is sufficiently complicated to shed serious doubt on the coronavirus-as-biological-weapon theory. That being said, “serious doubt” is not the same thing as “disproving,” so for now, there remains the possibility that the virus came about in a lab. If it did, that does not necessarily mean it was developed as a biological weapon. It could have occurred spontaneously in a lab, the way it would in nature. But right now, it’s too soon to reach a definitive conclusion on any of this.

How do some people become superspreaders?

Based on what we know of COVID-19, it only takes a single person to spread to a large group of people. But some people seem to be more capable of doing that than others, and those people are called superspreaders. Some experts, including Amy Baxter, MD, Associate Clinical Professor of Emergency Medicine at Augusta University and a member of the CDC’s ED-COVID panel, theorize that superspreaders have high viral loads and spray a lot of salivae when they speak, or perhaps possess a more potent concentration of viral particles. However, no one is yet able to say why some people may be prone to becoming superspreaders. Even more vexing, according to Dr. Nesochi, is that “we can’t predict who is or will be a superspreader,” at least not at this time. Because superspreaders may or may not be asymptomatic, that’s one reason masks could be helpful, notes Dr. Baxter. After all, a superspreader wearing a mask is less dangerous to others than a superspreader not wearing a mask.

Are there even superspreaders? Or are there just superspreader events?

What if it’s not that some people are “better” at spreading the virus, but rather that some situations offer a better setup for a prolific spread? According to Dr. Nesochi, “superspreaders actually do exist, and these individuals tend to transmit the disease disproportionately and have the propensity to infect many people.” However, she adds that “superspreader events” facilitate the spread of infection as well. Not only can mass gatherings of people be problematic, but certain activities are also more likely to increase the spread of COVID-19, points out Dr. Dass. Such activities include singing, working in an intimate environment, and exercising, increasing droplet transmission. It also appears that the novel coronavirus spreads more easily indoors than outdoors. In any event, identifying potential superspreader events will ultimately improve our ability to contain the pandemic.

Why do some people get infected but not experience symptoms?

The fact that someone can host an infectious disease without experiencing illness is nothing new to scientists—or historians. Have you ever heard of Typhoid Mary? Starting in the late summer of 1906, Mary Mallon, employed as a cook by a wealthy New York City family, single-handedly initiated an outbreak of typhoid fever that infected more than 3,000 people. Mallon never experienced a single symptom.

Since the beginning of the COVID-19 outbreak, people have been found to have contracted the virus without ever experiencing a symptom. At this point, researchers estimate that anywhere from 25 to 80 percent of people who are infected with the novel coronavirus have no symptoms at all. Unfortunately, if not impossible, it is difficult to predict who might be an asymptomatic carrier, Dr. Nesochi tells Reader’s Digest. That said, Dr. Dass points out that if someone tests positive for COVID-19 antibodies, we may trace some infections back to that person.

Why do some people get so sick?

In the early days of the pandemic, it was believed that only the elderly and people with specific comorbidities (including obesity, diabetes, heart disease, and cancer) were susceptible to severe, extended, and even life-threatening symptoms and complications from COVID-19.

But as global infections began climbing into the millions, it became apparent that some young, otherwise healthy people were getting very sick and sometimes dying from COVID-19. So, what gives? Scientists trying to make sense of COVID-19’s capriciousness have suggested that the immune system goes into overdrive in some people, setting off a deadly inflammatory reaction.

Why in some and not others? According to Dr. Saltzman, “how and why the virus affects different people in different ways is something we’re learning as we go, and we’re trying to learn it as quickly as possible.” Some recent data suggests men are at a higher risk than women and some minorities are at a higher risk than Caucasians. While there are likely various complicated factors involved in that, some scientists believe there may also be something genetic at work. In May, the MIT Technology Review announced that 23andMe would offer free genetic testing to 10,000 people hospitalized with COVID-19 to discover answers and some means to predict who’s at most significant risk.

Why do some children develop multisystem inflammatory illness?

At the outset of the pandemic, it appeared that children were not susceptible to COVID-19. Or, at least, they didn’t exhibit symptoms. Later, asymptomatic children were found to be carrying the virus and capable of spreading it. The passage of time has also revealed that some children do become sick with COVID-19. Some have even died from it. Now, the novel coronavirus has let us in on another one of its dark secrets: It can cause something called multisystem inflammatory syndrome in children (MIS-C).

Recently, a small number of otherwise asymptomatic children have been suddenly stricken by fever, stomach pain, rashes, and heart problems. Medical tests reveal the presence of the novel coronavirus or, as Dr. Dass points out, COVID-19 antibodies, which indicate an infection occurred previously, perhaps asymptomatically. Some children have died of the syndrome, and now scientists are urgently trying to figure out what is causing some MIS-C, why it affects some but not others, and how best to prevent and treat it. “Treatment modalities for MIS-C are being researched at this time,” Dr. Nesochi tells Reader’s Digest. So far, some children with the severe illness have responded to steroids or intravenous gamma globulin.

Children also face other potential issues during the pandemic, including emotional ones.

How many people have been infected?

One of the pandemic’s most enduring mysteries involves trying to ascertain how many people have been infected. The problem with that begins with the very words that make up the question: Are we trying to determine how many people have been sick with COVID-19? Or are we trying to determine how many people have been infected with the novel coronavirus that causes COVID-19? If it’s the latter, we’re challenged by several things, including:

  • The finite number of tests available
  • The limited number of people who would be interested in testing in the absence of symptoms

If it’s the former, the challenges include:

Some believe the number will always be lower than reality. Others believe the number is overstated. Perhaps time will shed light on this mystery.

How many people have died from COVID-19?

Another mystery is how many people have died from COVID-19, and like the dual mysteries of how many people have been infected with the coronavirus or ill with COVID-19, the problem with this one begins with what we mean when we ask it. Attempting to define “death from COVID-19” has become a significant point of contention. Just a quick perusal of your social media feed will turn up questions such as:

  • Did someone die from a heart attack and test positive for the virus in their autopsy? Did they die of COVID-19? The issue here is that COVID-19 has been known to cause heart attacks, so should the cause of death be attributed to COVID-19 or a heart attack?
  • If someone dies of a heart attack in the hospital while being treated for COVID-19, did they died of COVID-19? The issue here is similar to the one above, though the person was actively treated for COVID-19 at the time.
  • If someone dies from comorbidity associated with an increased risk of dying from COVID-19 (such as an existing lung ailment), his death from COVID-19?

As with the mystery of how many people have been infected, this one may only reveal itself with time.

After getting infected, are you immune?

Initially, it was assumed that once you were infected with this coronavirus, you would be immune. After all, that’s what happens with other coronaviruses, reports Live Science. But lest we forget how mercurial COVID-19 has proven to be, recall how surprised we were to learn that its symptoms might include a loss of one’s sense of taste or smell, or that it might present as an ugly rash on the toes. Soon after, we learned that COVID-19 could cause deadly blood clots and heart attacks. Only recently, we learned that it could unleash life-threatening inflammation on otherwise healthy children. So, really, would it be all that surprising to know that humans might be able to get infected with the virus twice? That’s a possibility we might well need to prepare for, according to White House Health Advisor Dr. Anthony Fauci, who nevertheless makes room for the case of a brief window during which an infection can confer immunity.

How will the pandemic end?

What the future holds is always mysterious, but when it comes to COVID-19, the mystery is packed to the gills with every other mystery surrounding it and the sheer ambiguity of the question itself. When we ask, “how will it end,” what do we even mean? 

Pandemics have ended in one of two ways: Either the illness is eradicated biologically speaking, or the fear of it evaporates in society. For example, the smallpox pandemic ended once an effective vaccine was created and used so widely that the result was a full biological eradication of the illness.

By contrast, the polio pandemic ended from a social standpoint because most children on our planet have access to the polio vaccine. The Spanish Flu pandemic seemed to have ended socially and biologically and at roughly the same pace. In that case, people became sick and died much more quickly than with COVID-19, so as people died and survived and acquired immunity, the illness had less and less chance to spread. As a result, it started affecting fewer people and eventually disappeared.

Some predict the current pandemic will end socially before it ends biologically. That seems to be happening already, at least in states where restrictions have been lifted, and life seems to be going back to some “normal.” Some say the pandemic can’t end until a vaccine or a cure is identified.

Some claim in the interim, the virus will change, losing potency. Some claim this is already happening, but many disagree, and the World Health Organization (WHO) has issued a warning that countries with declining coronavirus infections could still face an “immediate second peak” if they let up too soon on measures to halt the outbreak. Most likely, it appears we won’t know the pandemic has ended until it’s already been over for some time.

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