Deadly & Highly Contagious Covid-19 Virus: Manipur's Strategies to Prevent & Win the War Against It

Joykumar Thokchom *

Figure 1: Image: Colorized scanning electron micrograph of an apoptotic cell (greenish-brown) heavily infected with Covid-19 virus particles (pink) isolated from a patient sample
(Courtesy: National Institute of Allergy and Infectious Diseases, USA)

Ever since mysterious and deadly virus which later named as Covid-19 (Corona Virus Disease 2019) by World Health Organization (WHO) causing SARS-Cov-2 disease was detected in Wuhan, China in November 17, 2019, it has spread to more than 200 countries in the world.

To date USA has been the highest infected country in the world with over 140,000 cases with 2,457 death even though Italy has been the hardest hit country in the world with a staggering casualty close to 11,000 ways surpassing the official death toll from the originating country i.e. China with only 3300.

The virus (Figure 1), which is now a worldwide pandemic, has infected at least 718,116 people across the globe and killed 33,887 precious lives. Of those who have contracted the virus since it began, 150,917 people have recovered as of March 29, 2020 [1].

In this pandemic situation, India also got hit by this highly dangerous and contagious virus. First infection case in India was reported on January 30, 2020 in Kerala from three students who had returned from Wuhan, China. Thereafter, the transmission escalated in the month of March which were mainly linked to people with a travel history to affected countries.

On March 12, a 76-year-old man who had returned from Saudi Arabia became the first victim of the virus in the country. As of today March 29, 2020, India's confirmed cases crossed 1000 with 27 death. For a highly populous countries like India with a poor health infrastructure and system, it is predicted to have an enormous impact to deal with it in coming weeks.

For this rapidly spreading disease, even the landlock tiny state of Manipur has also detected its first case on March 24, 2020 from a 24-year-old student who returned from UK. It is a frightening situation for the state which has very limited resources to face and deal with such a horrendous pandemic.

Before going into the details for deploying different strategies for Manipur's to win the war against this deadly & highly contagious Covid-19 virus pandemic, some of the useful information and data on this virus are described in the following:

1. How a person gets infected with Covid-19 virus?

A person can get infected with the virus in three main mechanisms listed here:

(a) Exposing/inhaling mucus and saliva droplets from an infected person during talking, sneezing, and coughing. There are reports claiming that such droplets are of 5 micron in size containing lots of viruses in a single droplet itself and they can travel about 6 to 7 feet or 2 meters normally before falling down to the ground due to gravity; however, if the infected person speaks loudly in the form of singing or shouting then the droplets are much tinier and become airborne with less impact from gravity and thus can travel much further to spread to a wider number of people;

(b) Direct contact with the infected person's hands, nose, mouth, and poop. There are reports of wide spread of this virus due to hand shaking among common people and directly contacting infected person's nose and mouth and in turn touching his or her own nose, mouth or eyes;

(c) Touching things and surfaces infested with the virus from an infected person. There are reports claiming that Covid-19 can survive for 3 hours in air, 4 hours on Copper surface, 24 hours on Cardboard surface and 72 hours on Plastic and Stainless-Steel surface (Figure 2) [2,3].

2. What are symptoms of Covid-19 virus infection?

Some of the most common symptoms of Covid-19 infection are:
(a) Fever (high temperature)
(b) Dry cough
(c) Shortness of breath
(d) Mild overall body ache
(e) Loss of smell and taste senses (30% patients experience this)
(f) Loss of appetite

Figure 2: Viability of SARS-Cov-2 (Covid-19) and SARS-Cov-1 in aerosol and on Plastic, Steel, Copper and Cardboard Surfaces

3. Age wise fatality (death) percentage due to Covid-19 infection

Many of the reports from different countries suggest that the number of death due to Covid-19 virus is much more for the aged old patients as their immune system is week. Similarly, the recovery rate for those patients having medical history such as chronic lungs condition, cardiovascular problems, diabetes, kidney transplant patient taking immunosuppressant medicines, cancer patients taking anti-cancer medicines, and lungs accumulated with nicotine due to smoking are also very low.

Thus, such highly vulnerable group of people are recommended to be extremely careful in preventing the exposure to this deadly virus. According to the report generated from different countries the average death percentage rates for different age group is presented in the table:

Table: Age-wise death rate in percentage due to Covid-19 [4]

Age group	Percentage fatality (death) rate
20's, 30's, & 40's	0.1%
50's	0.5%
60's	2%
70's	7%
80's & above	12%

4. How to prevent and combat Covid-19 virus infection?

Some of the most useful strategies for preventing and combating Covid-19 virus are:

(a) Maintain at least 6 feet or nearly 2 meters from another person,
(b) Stop exchange of things e.g. phones,
(c) Wash hands with soap regularly and thoroughly,
(d) No touching of face with hands,
(e) Wear N-95 face mask when going out to crowded places,
(f) Disinfect restroom regularly,
(g) Use local wine (Yu) as hand sanitizer if commercial ones are unavailable,
(h) Keep body in alkaline state to minimize Covid-19 multiplication,
(i) Drink lots of clean water to keep body cells in alkaline state,
(j) Eat lots of green vegetables especially rich in Zinc to boost body to kill Covid-19 virus,
(k) Reduce eating those meats which increase body acidity to prevent multiplication of Covid-19 virus,
(l) Check vital signs such as body temperature (fever), smell and taste senses, body ache, and dry cough regularly and if any of these signs is detected then isolate immediately at least for 14 days

5. How to detect the presence of Covid-19 during infection

Some of the symptomatic conditions demonstrated within few days of infection are fever (high temperature), dry cough, shortness of breath, mild overall body ache, loss of smell and taste senses (only 30% patients experience this, and general loss of appetite. However, the scariest part is that there are about 20% asymptotic (not showing any such signs at all) cases even after infection.

This group of patients are high risk to large number of people because they can stealthily spread this virus without even knowing by themselves. This is where a proper checking e.g. polymerase chain reaction (PCR) method described below for this virus especially for those suspected persons by not only checking their body temperature is highly necessary.

Three of the widely practice methods for checking Covid-19 virus are:

Method #1: detecting the presence of specific piece of RNA only present in COVID-19 virus using polymerase chain reaction (PCR) method. In this method if a swab is taken from a person's mouth who has this virus and when this swab is put (mix) to PCR chemical then rapidly millions to billions copies of this virus will make within about 3 to 6 hours and if so then it is confirmed that the person has the virus.

Method #2: analyzing the blood sample from a suspected person and try to detect the presence of specific antibodies that the body could have created to fight the virus. If such specific new antibodies are present in the blood sample then the person is confirmed to be infected with the virus. This test takes one or more days.

Method #3: Genomic Research Center, Academia Sinica (Taiwan) has claimed to have developed a rapid screening method using a paper strip containing a secret chemical reagent formula to quickly test the presence of Covid-19 virus in saliva within 15 minutes.

In yet another breakthrough from Taiwan, National Taiwan University College of Medicine Professor Lin Shih-ming has claimed the development of a cheap hand held diagnostic tool to detect the functioning of lungs and their health including amount of fluid produced in them in order to check whether the safe levels are exceeded or not due to Covid-19 infection.

This test is non-invasive done by simply placing the handheld device on side of the abdomen to detect the presence of Covid-19 virus by monitoring electromagnetic frequency to assess the health of the lungs within 30 to 45 seconds. The approval for these fast track methods are pending but predicted to happen within 90 days.

5. Treatment (Medicines & Vaccines) for Covid-19 infection

As of now there are no medically approved or proven medicine to treat this new virus. However, there are some reports from different countries about the successes for some therapeutic medicines in treating this disease but understanding about specific dose and efficacy of these drugs are still under investigation and trial.

One of most widely tried medicine is the anti-malarial (anti-Dengue) drug i.e. Chloroquine or Hydroxychloroquine. They have been used case by case basis in China, South Korea, and other countries and found to show high success rates in speedy recovery of Covid-19 patients. The dose used for these trials is not fully standardized yet; however, it is reported to prescribe only 200mg twice a day orally to ensure no known negative side effects.

In addition to these trials, some other reports mentioned that taking 220mg Zinc Sulphate once a day in combination with Hydroxychloroquine works more effectively in killing the virus in the body. In yet another small sample size study set up on Covid-19 patients in France, it was reported that addition of another medicine - Azithromycin during hydroxychloroquine treatment reinforced in significant reduction/disappearance of COVID-19 virus in patients [5].

Not only this, most recently there had been a claim from Russia Federal Medical-Biological Agency (FMBA) as well on the benefit of using yet another anti-malarial drug i.e. Mefloquine (brand name Lariam) which was originally developed by US Army for successful treatment of Covid-19 patients in Russia [6].

Specific dose for this particular drug is not yet put out in the public domain. It is better to know that these results are based on limited trials as there are no wide spread trials and approval for these medicine as of yet in the world. This medicine should only be given to those patients who are in advanced stage when other forms of remedies are ineffective as the last resort to save life.

In US an advanced drug (Remdesivir) originally developed for treating Ebola virus and Marburg virus infections developed by Gilead Sciences (California) has shown some successes in small sample studies for treating Covid-19 patients both in USA and China [7,8].

There are also some already existing drugs which are currently under trials for fighting Covid-19 virus based on the mechanism of countering "cytokine storm" in which the virus causes patient's immune system to overreact. Those drugs are Actemra by Roche (Switzerland) and Kevzara by Sanofi (France) and Regeneron (USA) [9].

6. Strategies for Manipur to fight and win the war against Covid-19 virus

As dreadful Covid-19 virus pandemic rampage the world, Manipur also cannot escape the surging bonfire of this invisible enemy. Unfortunately, a student returning from one of the Covid-19 virus hard hit countries (UK) became the first confirmed case in the state on March 24.

At this difficult situation, this case can be considered as blessing in disguise because it has helped to increase the state's alertness and awareness for keeping the surroundings clean in addition to developing self-discipline for society's common good in order to fight this pandemic together.

As the state is under the influence of surging pandemic there are no known or established procedures for it to fight and win the war against this pandemic. However, following are some of the anecdotal strategies for the state to keep its population safe and win the fight:

1. Monitor state's border land entry points (Jiribam, Moreh, Mao, Tamphalong, Jaisami, Teddim Road and Guite Road) using valid test protocols such as thermo scan plus PCR test (only temperature scan commonly practice currently is risky as 20% of the Covid-19 infected person do not show symptoms e.g. fever)

2. Maintain quarantine centers at the entry points to keep the incoming people for a day to know their PCR test result in the following day in order to make sure that they don't have the virus;

3. If some of them are positive then quarantine them for a period of at least 14 days before letting them proceed towards the state after taking their phone numbers to contact them if any complication arises later;

4. Sanitize all the goods/vehicles coming from outside at the entry points;

5. Follow the above procedures at the lone International airport as well;

6. Strictly enforce for the health care professionals working at those quarantine centers or hospitals housing Covid-19 virus positive patients to wear protective gears (suit, hand gloves, face mask, and shoes) all the time;

7. Create internet infrastructures to enable students to attend online classes;

8. Promote e-governance and e-commerce for minimal people to people contact;

9. Encourage local populace to promote local farming and business for common good and self-reliance;

Conclusion

Covid-19 virus is a real and dangerous pandemic overwhelmed the world currently. There are no available medicines/vaccines for curing this new disease yet, though there are some trial ones are available. At the moment, this dreadful virus can only be kept at bay by following the safe health practices, maintaining social distancing, and self or controlled quarantine protocols.

Manipur can defeat this invisible enemy in the form of pandemic by educating and following the set of rules strictly without being panic and out casting those selfless hard working medical or service professionals.

In a way Manipur is blessed for being a place securely surrounded by hills in all directions because it is much easier to manage in such high risk and monstrous crisis. Making the best out of the worst, the people of the state could consider this hardship as great opportunity for building a sense of common good for the state's welfare and long-term self-reliance.

References

1. https://www.worldometers.info/coronavirus
2. Source: www.livescience.com
3. "Aerosol and surface stability of HCov-19 (SARS-Cov-2) compared to SARS-Cov-1", NV Doremalen et al., medRxiv (https://doi.org/10.1101/2020.03.09.20033217)
4. Prof. Kim Woo-Ju, Infectious Diseases, Korea University Guro Hospital, Seoul
5. Int. J. Antimicrob. Agents. 2020 Mar 20:105949. doi: 10.1016/j.ijantimicag.2020.105949
6. https://sputniknews.com/russia
7. Holshue ML et al. (Washington State 2019-nCoV Case Investigation Team) (March 2020). "First Case of 2019 Novel Coronavirus in the United States". The New England Journal of Medicine. 382 (10): 929–936. doi:10.1056/NEJMoa2001191
8. Johnson CY (10 February 2020). "Scientists Hope an Antiviral Drug Being Tested in China Could Help Patients". The Washington Post. Retrieved 19 March 2020.
9. Coronavirus Drugs Already in the Pipeline, David Payne, Staff Economist, The Kiplinger Letter, Kiplinger, March 27, 2020, 1:20 PM EDT

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* Joykumar Thokchom, Ph.D., wrote this article for e-pao.net
The writer is a Sr. Director at BrightVolt, Inc. USA
He can be contacted at joykumar_th(AT)yahoo(DOT)com
This article was webcasted on March 30, 2020.

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