ANATOMY OF A KILLER: COVID-19

Introduction

The scope of this paper is to briefly make the reader aware of the recent pandemic that has thrown the entire world off-balance and explain with hard facts, how this virus has affected, if not changed, the lives of millions. The aim is to touch upon the most pressing issues around the pandemic and give a sense of what is being done by the big organizations and governing bodies around the world to bring life back to normal.

The general layout of this paper is relayed through the figure below:

A Brief History and Exposition of the Virus

There are multiple terms with which this virus is being addressed, some of which are Corona, Coronavirus, COVID-19 and some people have gone as far as to even call it the Chinese virus because of its origin in China. To clear out the basic terminologies, according to the World Health Organization (WHO), COVID-19 is the disease which is caused by the SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) virus. This virus is a member of the family of viruses known as the Coronavirus, which also includes viruses like the SARS and MERS.

COVID-19, a cousin of SARS and MERS, can lead to cough, fever, shortness of breath, muscle pain, headache, chills, loss of taste or smell and in some cases even death.

The virus mainly spreads through person-to-person contact which can be airborne (breathing, coughing, sneezing) or surface transmission and thus it is essential to continually wash hands after touching any surface and maintain a physical distance of at least 6 feet.

The journey of the virus in the human body is understandably a complex biological process, thus it is important to explain it in the simplest of ways possible for anyone to comprehend. So, the journey starts with the virus entering the body through the nose/mouth/eyes and from the windpipe it enters the air-sacs inside the lungs where air exchange occurs. Once the virus enters the air-sacs, it uses its spikes to lock itself within cells and replicates itself to eventually kill the cell. If many air-sacs collapse, the person has to be placed on a ventilator to support breathing.

The Origin and Spread of COVID-19

This might sound like a controversial topic but this virus was not created inside any laboratory as has been debunked by scientists. The disease was first reported in late December, 2019 at the Huanan seafood market, popularly known as wet market, in Wuhan, capital of China’s Hubei province. It is not yet clear however as to how this virus was transmitted to humans. The most popular theory is that since it originated from the live animal market in Huanan, it is likely that it may have originated in bats, which serve as a reservoir hosts to many viruses and as it did to other SARS-CoV viruses. Scientists believe that the virus was not transferred directly from bats to humans but through an intermediary animal, the illegally imported Malayan Pangolins.

The first death related to the virus was reported on January 11, 2020 in Wuhan, China and since then the cases haven rose exponentially, especially in Europe and the Americas and affecting more than 200 countries around the world.

The tree-map below aims to give a timeline of important events that have happened in these past few months.

Current Situation

At the time of writing this paper, there have been 2.8 Million confirmed cases and 199K deaths globally. To get an idea of the rate of spread of this virus among different countries, consider the following graph:

Containment Measures and Medical Progress

As seen above, the virus has spread to unimaginable proportions throughout the world and caught everyone off-guard. No country was prepared to battle such a killer even though countries were warned often warned by scientists that a pandemic was on the verge of breaking out and the world is not ready for it. Despite these warnings, most world leaders chose to overlook this possibility and are now struggling to cope with the scenario.

That being said, each country has responded to this pandemic in their own way, learning on the go from their peers and employing ingenious ways to prevent the spread of this disease. Losses in terms of lives and economies are inevitable during such emergencies but the way countries have reacted has been a defining point in where they stand at this moment in time. While some countries have slacked off and simply refused to succumb to the fact that the virus is certainly above humankind, other countries have risen to the occasion and taken such measures that are commendable beyond words. To get a better perspective of these contradictory approaches, let’s take a deeper look at what a developed nation such as the USA has done and what a developing country like India has done to win this battle, with no political bias of any sorts. From the very beginning, when the first case was detected in USA around February, the government did not pick the signs and neglected the severity of the situation despite seeing China’s struggle. It declared National Emergency on March 13 but it was too late since just a week later the cases starting rising exponentially. With weak and partial lockdown regulations, miscommunications between center and state governments and a casual attitude from the country’s leaders, US has found itself in a quagmire with 930K confirmed cases and 52,546 deaths as of April 25, 2020 in spite of having a world class healthcare system. On the contrary, India responded in a rather draconian manner, imposing a complete nationwide lockdown for 40 days, continually testing and contact-tracing resulted in containing the number of cases to 24,942 and 779 deaths, which despite being high is a commendable number given the fact that it is one the most densely populated countries, with a total population of around 1.3 Billion and having a broken healthcare system.

This clearly explains the importance of following strict and proactive measures to contain the spread of this virus. It is important to know why a lockdown is so important. The primary purpose of imposing such strict measures is to just buy some time in order get healthcare systems in place to support the rising number of patients because as discussed above, no country was prepared for such a virus. It helps prevent hospitals from getting overwhelmed by the number of patients at a given time, thus lowering the number of deaths. Another crucial element in this battle is getting people tested, so it also gives time for companies to manufacture testing kits and for countries to have enough testing capacity.

The focus thus far has only been on lives of people without addressing the livelihood of people. The lockdowns have inevitably brought global economy to shambles. Thus, the most pertinent question now becomes till when should lockdown be imposed and when can life go back to normal. It is really hard to tell when lockdown should end but it is very clear that in order for life to go back to normal, it is essential at the very least to get an antibody to build immunity against the virus, but this would still be a temporary solution. The permanent solution is to get a vaccine ready and administered as soon as possible.

Current treatment: The current therapies for COVID-19 patients include drugs that have been used to treat malaria and autoimmune diseases; antiviral drugs that were developed for other viruses, and antibodies from people who have recovered from COVID-19. Recently, doctors have started using convalescent plasma therapy to treat patients and it has shown rapid recovery in some patients in China and India.

Vaccines: According to Dr. Soumya Swaminathan, chief scientist of World Health Organization, on an average a vaccine takes 10 years to be made. This number seems terrifying but there are a number of labs across the globe who are working tirelessly on making new vaccines and there are currently 6 vaccines that are ready to start being tested. This gives hope that the COVID-19 vaccines will be ready in record time, within 12 months.

The Great Lockdown Recession

While it is pertinent to implement lockdowns to reduce the number of cases and thereby reduce deaths, it also takes a toll on the economy of the country. Every country has been hammered by this virus and there have been an unforeseen number of job losses. Taking US alone, the unemployment rate has gone over 20 million people.

According to the International Monetary Fund(IMF), the global GDP growth for 2020 in January was 3.3% and in these 3 months, the projections are have fallen to -3.0%. This makes the Great Lockdown Recession the worst recession since the Great Depression (1929-1939) and way worse than the Global Financial Crisis of 2007/08.

The important point to note is that even though this virus has taken a toll on the overall economy of the world, there is optimism that if policies are set well, this period will only be a suspended animation and once things start getting back to normal, which could be by the end of 2020 or early 2021, businesses will start functioning as before and the supply-demand balance will be re-established. However, there are a lot of variables associated to both the lives and livelihood of people and countries and businesses will have to be proactive and not be complacent.

Symptoms Prediction with ARSOM

Using a dataset of around 300 patients, an attempt is made to predict under what combination of symptoms does a patient not recover, in other words, predicting the combination of symptoms that might put a patient to higher risk. The main variables considered are age, gender and 55 unique symptoms that these 300 patients showed.

The aim of this experiment is to provide a basis to eventually be able to get a more comprehensive data and accurately predict the symptom combination that leads to higher number of deaths, thus signaling the medical staff to take preventive measures well in time.

This problem appears to be somewhat related to the prediction of Unplanned ICU Transfers based on a number of pre-existing diseases and thus, the optimization model built by Professor Chun-An Chou as referenced in his paper “Mixed-integer optimization approach to learning association rules for unplanned ICU transfer” is adopted to optimize the initial rules derived using the Apriori algorithm in R. These rules are then used to develop matrices a,b and c as described in the paper and used in the ARSOM model(run in Python) which finally gives the optimized rules, that is, the most probable combination of symptoms that would result in the patient not recovering.

Final Thoughts

The aim of this paper is to give the reader a general understanding of this crisis and to spread as much awareness as possible by explaining key concepts in a way that can be grasped by one and all.

As the world comes together to fight this virulent enemy, the dilemma of what must be done next has sparked many important conversation among stalwarts from potentially all industries and has made one thing clear that it cannot be an either or decision, that is to completely focus on only saving lives or to focus entirely on saving the country’s economy. Finding the right balance is of utmost importance and that is what’s giving most decision makers sleepless nights.

So to conclude with, there is certainly no one-size-fits-all model to solve the current problem but I would like to share my opinion on what could be done in general to alleviate the situation. To begin with, countries must continue relying on mathematical models that forecast the rise and fall of cases, as they have done so far and continue with partial or complete lockdowns till the time the curve reaches its bottom mark. This serves two purposes, one it helps buy time to get healthcare facilities and infrastructure in place and two, it prevents ensures that when lockdown is lifted and businesses start running per normal, the number of active cases are at the lowest, thus decreasing the chances of people coming in contact with infected individuals. The spread would still be unavoidable but it would certainly decrease the rate of spread.

Lifting of the lockdowns has to be done in an extremely controlled manner as well. State governments must segregate localities according to the severity of cases and plan distinct policies and regulations for each individual locality.

Policies of physical distancing and the compulsion of having to wear a facial covering at all times when in a public setting are things which go without saying but besides this, a crucial element of post lockdown period would be continuous and rigorous testing. This necessity of testing cannot be stressed enough.

The world has certainly suffered enough but with adequate testing, better governmental decisions and the tireless efforts of healthcare workers and scientists, there is a lot of optimism that the near future is going to improve and soon life will get back to normal.

References

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2

https://www.yalemedicine.org/conditions/covid-19/

https://www.webmd.com/lung/coronavirus-transmission-overview#1

https://www.visualcapitalist.com/visualizing-what-covid-19-does-to-your-body/

https://www.theguardian.com/world/2020/apr/15/how-did-the-coronavirus-start-where-did-it-come-from-how-did-it-spread-humans-was-it-really-bats-pangolins-wuhan-animal-market

https://www.nature.com/articles/s41591-020-0820-9

https://www.nytimes.com/article/coronavirus-timeline.html

https://www.whitehouse.gov/presidential-actions/proclamation-declaring-national-emergency-concerning-novel-coronavirus-disease-covid-19-outbreak/

https://www.weforum.org/agenda/2015/11/these-are-the-worlds-most-densely-populated-countries/

https://www.health.harvard.edu/diseases-and-conditions/treatments-for-covid-19

http://www.ox.ac.uk/news/2020-04-23-oxford-covid-19-vaccine-begins-human-trial-stage

https://www.visualcapitalist.com/every-vaccine-treatment-covid-19-so-far/

https://blogs.imf.org/2020/04/14/the-great-lockdown-worst-economic-downturn-since-the-great-depression/

Chun-An Choua, Qingtao Caoa, Shao-Jen Wengb, Che-Hung Tsaic. Mixed-integer optimization approach to learning association rules for unplanned ICU transfer. Artificial Intelligence In Medicine