Coronavirus is the latest pandemic that has emerged from Wuhan, China and has spread across the world, including in Thailand, France, Philippines, US, Australia and India. But it is not an ordinary pandemic. Despite its low mortality rate as compared to previous coronavirus (CoV) epidemics, it’s much worse. Because, this time the epidemic has occurred in the age of ultra-fast (mis)information through digital media.
A combination of one or more elements such as the speed and reach of social media and its influencers, viral scientific misinformation, irresponsible news reporting, conspiracy theories, and overnight appearance of non-peer reviewed science has influenced the way coronavirus is impacting global health. As a result, epidemics in this age are becoming ‘misinfo-demics’– the phenomenon where epidemics upscale to become more dangerous due to viral misinformation.
An example of such misinformation was recent advice from the Narendra Modi government to resort to Ayurveda, homoeopathy and Unani medicines to prevent the new coronavirus strain from infecting people, or the WhatsApp forwards with viral unscientific advice doing the rounds. These ‘treatments’ were not backed by any evidence-based research, in both ‘Western’ as well as traditional Indian medicine systems.
A new research paper has estimated that over 371 people have died, exceeding the count of the previous SARS outbreak, while more than 75,000 people have been infected just in Wuhan, China. Recently, three cases of CoV infection were confirmed in Kerala and three suspected cases were reported in Delhi.
The novel coronavirus
Coronaviruses (CoVs) are large, enveloped and positive-stranded RNA (Ribonucleic acid) viruses that can be categorised into alpha, beta, delta and gamma types. Out of these, the alpha and beta CoVs are known to infect humans.
However, the novel CoV infection is spreading faster than SARS, a previous CoV infection, due to its high incubation rate. The scientists at Imperial College, UK estimate that each coronavirus patient infects on average 2.6 others, making it almost as infectious as yearly influenza outbreaks. While the common influenza virus has a short incubation period and is self-resolving, the 2019-nCoV can be incubated for up to two weeks, hence increasing its chances to infect other people. So, someone who is infected with CoV would be able to pass it on to someone else, even if they aren’t yet displaying any symptoms.
When the current outbreak began at the end of December 2019, this new type of coronavirus (2019-nCoV) was found infecting and killing people in Wuhan. These cases were identified by a batch of pneumonia-like cases in Wuhan, where most of the patients described exposure to the nearby Huanan seafood market that had live animal stock. By 10 January 2020, researchers from the Shanghai Public Health Clinical Center sequenced the full genome of 2019-nCoV virus from nine patients’ sample and swiftly published the report in The Lancet on 30 January 2020.
What makes it different
Earlier, the human coronaviruses (HCoVs) had been considered trivial because of their mild phenotype and were known to cause the ‘common cold’ in healthy individuals. However, in the last few decades, two pathogenic HCoVs, the Severe Acute Respiratory Syndrome coronavirus also called ‘SARS-CoV’ (2002, China) and the MiddleEast Respiratory Syndrome coronavirus called ‘MERS-CoV’ (2012, Saudi Arabia), have emerged with a high prevalence of infections causing many deaths.
So, SARS shares many clinical features with MERS, such as cough, fever, severe atypical pneumonia, but patients with MERS have major gastrointestinal symptoms often paired with acute kidney failure. Also, MERS requires mechanical ventilation in 50-89 per cent of patients.
In comparison to the 2019-nCoV, the SARS and MERS were much more fatal. The WHO reported that the SARS and MERS fatality rates were around 9.5 per cent and 34.5 per cent, but of the 2019-nCoV is just 2-5 per cent.
A dangerous trend
Despite these differences in the SARS, MERS and 2019-nCoV epidemics, the ongoing 2019-nCoV epidemic prove to be more dangerous. During the previous epidemics, the role of disinformation spreading through social media and WhatsApp forwards was not as high as it is at this moment, despite evidence-based health workers’ advice against it. From bat soup videos, alternative unscientific treatments and preventative methods, planned outbreaks, racist videos about Chinese food habits, to conspiracy theories about CoV as a ‘bioweapon gone rogue’ in Wuhan have emerged during this outbreak.
The CoV-bioweapon rumour, amplified globally through influencers, had started last week from a pro- Donald Trump website called Zero Hedge. Soon after, several versions of it quickly reached India. On 31 January, a group of Indian molecular biologists at IIT Delhi uploaded non-peer reviewed research over a pre-print website that suggested that new ‘insertions’ of nucleotide sequences have been found in the new CoV strain (2019-nCoV), which are similar to the HIV (AIDS) virus. The study directly concluded that these insertions were not random through evolution of the virus but fortuitous, proposing a likelihood of the 2019-nCoV designed for bioweaponry.
Several virologists around the world questioned not the data, but the legitimacy of its untested conclusions. Dr Silvana Konermann, a biochemist at Stanford promptly reviewed the Indian lab’s research and concluded that the similarity of the nCoV virus is not only with HIV but with 13 other viruses, which is probably caused by chance. As a matter of fact, viruses exchange genetic material with other viruses. So, if the insertions are fortuitous, it could also be an early host infection with the HIV virus, rather than a case of bioweaponry. Also, the CoV is an RNA virus rather than a DNA, and hence, its mutation rate is very high, which allows it to change properties very quickly.
Furthermore, even the latest Lancet paper on CoV gene sequencing from nine patients in China suggested many differences in the virus isolated from the same household.
It is also unlikely to be a bioweapon, or a terrible one at that, due to its low mortality rate as compared to the SARS and MERS. Despite that, Indian social media influencers had made a false conclusion about 2019-nCoV as a bioweapon from China without understanding the pathology of a virus.
New developments in research
Based on the genomic data, researchers in North Carolina, US, have already initiated measures to develop tools to counter 2019-nCoV using the SARS-CoV and MERS-CoV as prototypes. Remdesivir, a broad-spectrum antiviral, an RNA polymerase inhibitor, as well as lopinavir or ritonavir and interferon-beta (called MIRACLE trials), have shown hopeful results against MERS-CoV in pre-clinical models, thus becoming effective candidates for researching the possible treatments against the 2019-nCoV. These drugs are routinely administered as anti-virals, while social media conspiracy theorists questioned the use of anti-virals used for HIV that were also used for CoV infections in China, adding to the ’HIV-like CoV’ story.
During the SARS epidemic, researchers sought the genomic sequence of SARS-CoV and levelled to a phase 1 clinical trial of its vaccine in 20 months. This timeline has been since compressed to 3.25 months for other viral diseases. The hope is to move even faster with the 2019-nCoV using messenger RNA (mRNA) vaccine technology instead of a DNA vaccine. Similarly, other vaccine researchers are trying to build viral vectors and subunit vaccines.
The recent Lancet data indicates that 2019-nCoV is similar to SARS-CoV in its amino acid sequences. Previously, the ACE2 receptors were shown as the entry points into human cells for the SARS-CoV virus. Further, new pre-print data published on 22 January suggests that the 2019-nCoV may also be able to use the ACE2 receptors as their entry points into the human cells. This has important implications for developing treatments in halting further CoV pandemics.
Scientists, researchers, virologists are racing against time to find a cure, which is so far just restricted to isolation and monitoring. It is not surprising that social media has unverified misinformation, both scientific and non-scientific, circulating regarding a major health scare.
However, what is shocking is that India, one of the few countries with rapid scientific advancement in many areas, is releasing government advisories that contain a mountain of pseudoscience to counter the latest nCoV epidemic. Further, a group of scientists made an irresponsible, false conclusion about the CoV mutations, which no one questioned in India.
Thus, any false advises or misinformation related to the CoV should be curbed by the government, social media platforms, scientists and health workers to reduce the impact of the disease. While China is arresting those spreading misinformation on the CoV, the Modi government was the one giving out false advice. Perhaps it was not the best strategy by the Chinese government because not everyone has the tools to fact-check information. The Modi government should organise campaigns to raise awareness against misinformation, and not give unscientific advice via the Press Information Bureau.
Sumaiya Shaikh is an Indian-origin Australian neuroscientist, researching the neuroscience of violent aggression, in Sweden. She is the science editor of the fact-checking portal Alt News, India. Views are personal.
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