COVID and Credibility

One week is a long time sometimes. I have been waiting for some five days to make this post. On Tuesday that I received a message in one of the WhatsApp groups that I am part of, questioning the credibility of the WHO.

Speaking of WhatsApp, I gave a talk at work about being a drop-out of the WhatsApp University. Check out the redone home version of the video here if it interests you. If you are into satire, you might enjoy it. I even made some literature for the university.

Coming back to the message, it said:

Breaking News: The World Health Organization has taken a complete U turn and said that (asymptomatic) Corona patients neither need to be isolated nor quarantined, nor social distance….and it cannot even transmit from one patient to another….see the video (What the hell is WHO’s credibility & what has the whole world been doing these 4-5 months!!)

What a strong statement that was! Indeed, what is the credibility of the WHO? After all, what has it done? They have been hand-in-glove with China¹ as they spread the virus all around the world, right?

WhatsApp: the living example of Chinese Whispers.

Did the WHO say that the transmission from asymptomatic people is rare? A loaded question. Before we answer that, though, should we not try to understand what an asymptomatic case is? Can COVID-19 be truly asymptomatic? Here is the short clip that circulates with the message:

Talk about the beauty of a WhatsApp message. Context is unnecessary baggage. Now, for the sake of curiosity, watch the entire video by scrolling all the way to the beginning. And once done with that, watch this video, where Dr Maria Van Kerkhove clarifies her statement. Am I absolving the organisation of the error in their communication? No, they did mess up. But what is also true is that news outlets latched on to the statement and did some headline management. WhatsApp is alternate media today—or rather, water-cooler (or in the desi sense, panghat)—on steroids.

Let us talk science. Some sense.

WARNING/disclaimer: Do not take this post as medical advice. I am not a medical or paramedical student or practitioner. I read. I collect information, ask questions and get queries answered. That is how I know what I know; not through formal education in physiology or training in medicine. What I have written here is true to the best of my knowledge, and the evidences as of date support these statements; my posts rest on the massive shoulders of the works of the scientific community. This post is for the purpose of general knowledge and reasoning, and should be treated as such.

Any pandemic is multi-faceted. Apart from the ever-interesting, never-tiring conspiracy theorists, we have—in this case—virologists, epidemiologists, immunologists, and other -ists who play their respective roles in handling the situation for the betterment of humankind. The ultimate goal is survival of the species.

Initial fact-checking

The modus operandi of WhatsApp University is to appeal to your confirmation bias. We as people want to hear what we want to hear in situations that seem out of control. This pandemic is one such situation. At this point, as normal human beings, we tend to look not for evidence-based conclusions, but on bias—what we would like to hear. ‘People need not go into quarantine’ is something we want to hear, because, yes, quarantine sucks. The natural human response is to latch on to such selective statements and feel that everything is back to normalcy; that this was a bad dream and we are back in July 2019.

But can we afford that? How do we know one way or another? By placing facts on the table and looking at them critically.

Let us start with the message:

(asymptomatic) Corona patients neither need to be isolated nor quarantined, nor social distance [sic]

What does Dr Kerkhove say in reality?

It still appears to be rare that an asymptomatic individual actually transmits onward.

Okay, is that not the same thing as the message? If an asymptomatic individual does not pass on the disease, then why are we quarantining them? Why the social distancing? They are benign, right?

Hmm.

In reality, ‘appears to be rarely transmitting’ is different from ‘does not transmit’. The latter has certainty. This is like ‘The Sun appears to rise in the east.’ and ‘The Earth rotates about its axis.’

Now, let’s add some context to the statement made by Dr Kerkhove.

… much of that is not published in the literature. From the papers that are published, … we are constantly looking at this data, and trying to get more information from the countries that truly answer this question. It still appears to be rare …

(Notice the use of “still”; a dead give-away that the statement is not a U-turn.)

How science works

Science is not some magic. Science is a process. Unlike religion, which has ready answers to most questions (and God’s will for the rest), science works on observation and evidence.

Coronaviruses are not new. Our first discovery of them was generations ago²; SARS-CoV-2 is a new strain. We have started with a lot of unknown, because we don’t know the virus fully yet. Meaning, we know some members of its family, but we do not know this particular guy. As already mentioned by the community, SARS-CoV-2 does exhibit characteristics of SARS-CoV-1 (or rather, the SARS virus). We know which direction to go, but we do not have the map, so to speak.

The behaviour of the virus and our body’s response to it makes the study of this virus technically complex. We are gathering information on the nature of this virus. As long as there exists an unknown in a certain area about the virus, the scientific literature would have the tone of unknown, such as ‘may’, ‘appears’, ‘seems’, ’evidence suggests that’, etc.

Scientists base studies on observations and evidences that they have. Any study that holds water undergoes a series of analysis; the level of criticism is high in the scientific community (as it should be). The scientists present their findings and the inferences. That goes for peer review, where the larger community read the documentation and verify what the scientists presented is indeed true or not. They carry out experiments to verify the claims and compare results to ensure integrity. If what the scientists presented clears this peer review, the community accepts the submission.

This is true for as long as someone else gives evidence against it.

But how can this happen? The submission underwent peer review, right? How can all the scientists who reviewed it be wrong? Surely they are all involved?

Perhaps not impossible, but unlikely. Can you buy all scientists in the world?

Then how does that happen?

Technology.

Take the case of the model used for the Solar System, for example. Up until a point, the entire world believed that the Earth was at the centre of the universe, and that the Sun and the other planets went around it. This was because at the time, given the technology we had, that is what we could observe. Later, Copernicus proposed that the Sun was in the centre and in fact, the Earth, like the other planets, went around it³. Then Kepler built on the idea, and tried to explain planetary motions. The basis of much of today’s understanding about the planetary movements is Kepler’s laws.

Another example is the atomic model proposed by Dalton. One of the statements he had made about atoms was that atoms were indivisible. The world accepted this view until 1897, when J.J. Thompson proved the divisibility of atoms—he proposed the Pudding Model. Rutherford disproved the model to introduce the Planetary Model of atom. But that model had its flaws as well. Neils Bohr built on top of the quantum theory and introduced the Bohr Model.

In science, we consider sticking to absolutes dangerous. Such behaviour stalls growth. Nobody is the ultimate. Nobody takes anybody’s word for it. But does the introduction of the Pudding Model mean that Dalton loses his credibility?

Loss of credibility

On reading the message, I engaged in a discussion in one of the groups. The conversation took a turn towards why there was no analysis done on the root cause, and how no one was holding China responsible. That was geopolitics. That is a different branch altogether. To me, China taking responsibility of spreading the virus is of no consequence at all. Will China resurrect every economy in the world affected by the pandemic, or bring back the dead? If so, I will support the obsession. Otherwise, how we contain the pandemic, and reduce further damage is of real use to me.

Second, someone made a statement about a PhD doctor in Tamilnadu, who gave an interview. The argument said that the statements made by her in the interview were still valid, while the WHO kept changing their stand on the situation. I have watched the interview. The doctor studied coronaviruses. Her statements were not one bit in conflict with those of the WHO’s. No surprise.

Obsession with China

I do not like it when people focus too much on the origin of the problem rather than the solution to it, while the problem is claiming thousands of human lives. There was a point when the US and China engaged in a blame-game of sorts⁴. That is politics, not science. If this is the direction you want to go in, please don’t hijack science. Accepting or denying the possibility that the virus escaped from a Chinese lab⁵ is immaterial to me. I don’t see the relevance of it in the fight against the pandemic.

Like it or not, the virus is out now. The disease has affected millions, as https://covidbynumbers.com/ shows; in India alone we have crossed the one-million mark. Of what consequence is the investigation of its origins to the handling of the pandemic? Okay, some say, ‘Well, China has managed to contain the virus. How did they do it? Because they have the technology to contain the virus; they are not giving it to the rest of the world.’ Well, even if we do entertain that line of thought, we must ask ourselves, ‘Will China share the treatment methods if at all it has any?’ and understand that the WHO is not an intelligence agency. In the world outside of fiction novels, a scientist’s job is in science.

Update (11 May 2021): Grain of salt, but a detailed article by Nicholas Wade points at the higher plausibility of the virus having escaped the Wuhan Institute of Virology, rather than having originated in nature.

While I still stand by that holding China responsible—no matter how right or wrong—will be of no consequence to the current pandemic, the article does indeed raise legitimate red flags on the regulation and possible future funding of experiments involving farming of highly infectious viruses in the lab. It also throws light on the possible bad judgement (assuming no malice until proven otherwise) on part of the authorities holding positions of high responsibility, including at the WHO and the NIH.

What stands out in the article is the fact that leaving science in the hands of those with a political agenda is detrimental to humanity: be it opaque governments, scientists who have a lot to lose by speaking up, or any governmental or non-governmental body that does not respect regulations or uses loopholes to achieve its goals.

And until I get reliable evidence for intentional bio-warfare, I will continue to call it a conspiracy theory. Not that it matters to anyone.

We don’t know

In science, more important than knowing something is knowing what we don’t know about it. In case of SARS-CoV-2, a lot is unknown. And knowing these aspects of the virus will take time. Today, we have a certain understanding of the virus, much better than what we had three months ago. This understanding could be better three years from now, because more evidence would have emerged by then.

The numbers that epidemiologists have given are truly scary. Perhaps they are wrong, or not. What is important is that the virus is new. Six months is a short time to understand a virus. Epidemiologists base their statements on mathematical modelling building on other similar virus outbreaks. That is all we can do at this point because this is the first time the world is facing this virus.

That said, stay away from panic-inducing pieces of “news”.

General behaviour of a virus

One prevalent question in these WhatsApp circles is, ‘How come the virus does not survive in temperatures above 27 °C, but survives in the human body at 37 °C?’ Counter question: How can most people survive the summer in Rajasthan when the temperatures are well beyond 40 °C? That will bring you to a simple answer: The human body has conditions that support the maintenance of integrity of the virus. Plain air and exposure to the elements is not that environment.

A virus is a lifeless particle, made up of a complex chemical structure. Chemicals react with their surroundings. Like how the chemicals in our skin react with the ultraviolet radiation present in sunlight. Within the human body, the virus latches on to a cell wall and invades the cell. Then, it injects the genetic material that it carries and transforms the cell. When these cells multiply and replace the dead cells in the tissue, the tissue becomes what it isn’t designed to be.

Virologists have not shown certainty in the claim that hot weather stops the virus from spreading—the understanding is that the spread slows⁶. Stop listening to politicians. They are not experts in virology. Most politicians cannot even tell the difference between a bacteria and a virus. Populists sell this idea of “common sense” and discredit all scientists by terming them “quacks” and “intellectuals” in a derogatory sense. To me, that is a way of manipulation. Nothing new; Galileo underwent a similar treatment, if you want an example.

The case of asymptomatic transmission

Let us look at what an infection is, what our immune system is, and how an infection spreads. First, what is an infection?

When a foreign object like a virus, or a parasite like a bacteria, or any pathogen enters our body and causes disease, we call it an infection. Bacteria generally feed on cells and damage the tissue. Viruses invade the cell and change the characteristics of the cell, use the cell’s reproductive capabilities to multiply and change the tissue itself, not allowing it to function the way it should. This causes disruption in the functioning of our body.

Our body has the immune system to guard us from such situations. Broadly, we can say that there are two lines of defence:

The system of antibodies
The T-cells

Antibodies are the first line of defence. When the body detects the presence of, say, a virus, it triggers the immune system to produce antibodies. These antibodies typically work as chemicals that do not let the virus bind itself to the cells. When the virus cannot bind with the cells, it cannot reproduce. Over time, the virus disintegrates.

Next, the T-cells in our body start to hunt down the cells that the virus had hijacked, and kill those cells to stop them from multiplying. The T-cells keep attacking every infected cell they come across, until there are no more of them.

In some cases, the body tries some physical responses as well, such as a fever, to aid the process. This is the point that we show symptoms. The lymphatic system is also the drainage system of the body. When needed, the system makes fluids that trap and flush the virus out of the body. These fluids could contain active viruses in them, because your body is still dealing with the virus.

For the sake of clarity, let me be clear. In most cases, if the antibodies and the T-cells are able to deal with the pathogen, apart from your being unlikely to show symptoms, you are also unlikely to spread the infection. It depends on the viral load of viable virus you are putting out and what stage of the infection you are at. If the body is flushing out the virus to try to reduce the number of them present in your system, or to reduce the damage to tissues, the viruses could still be potent—because the immune system has not “dealt with” them yet. This is when you are most infectious.

Sometimes, when the lymphatic system kicks in, and is unable to track down every infected cell and kill it, the system gives an exaggerated response and ends up creating a cytokine storm. This is harmful to the body. Also, in some cases, the body creates too much phlegm to flush out the pathogen. This results in the fluid filling up the lungs, making it hard to breathe.

In other words, the response that the immune system gives to the virus, kills us before the virus does.

Now think about whether you want to “boost” your immunity.

Asymptomatic and pre-symptomatic manifestations

In an article that I read⁷, Dr Beda Stadler calls it a “joke” to think that an asymptomatic person could infect a healthy individual. That is one perspective. In science, we do not take anyone’s word for it. The WHO’s documentation does not exclude the possibility that asymptomatic people can pass on the disease⁸.

Absence of evidence is not evidence of absence.

Notice that the document says “no documented asymptomatic transmission”; it means that asymptomatic transmission is not documented—not that it doesn’t exist or is not possible. Dr Kherkove mentions that a “a small subset of studies … two or three studies” seem to show that it is rare that asymptomatic transmission can occur.

And then, if you listen to the talk of Dr Kherkove and Dr Michael Ryan, you will see her differentiate between the terms, asymptomatic and pre-symptomatic.

In simple terms, an asymptomatic individual is one whose body “killed” all the virus without so much as a sneeze. In this case, the virus entered the body, tried to bind itself to cells, but the body detected this before the virus could do much. The antibodies entered the blood stream and blocked the virus from further binding. Meanwhile, the T-cells came in, identified the cells that the virus had hijacked, and killed them. The number of cells killed were so less that the tissues generated no pain signals. The whole operation was silent.

Most cases are not this across the world. (With exceptions like Karnataka, where the percentage of asymptomatic cases was a whopping 96%⁹ in June 2020, which later decreased to 62.5%¹⁰ by the first week of July.) The long incubation period, according to the article⁷, indicates that the immune system is working to get rid of the infection. At some point, the body does raise the temperature or expel phlegm. You begin to show symptoms. In most cases, while testing, a person, even though COVID-positive, may not yet show symptoms. These individuals later develop symptoms. Some people who have a certain level of pain tolerance, may perhaps not remember being ill. Or they may think their temperature is slightly higher than usual because they “feel under the weather”. Or in some cases, they are in denial.

In case of a truly asymptomatic individual, the chances of them spreading the infection is “very rare”, says the WHO—as it has kept saying for so long. And the WHO is a body that works with experts, aids in research and puts out guidelines for everybody, mainly for those countries that do not have the facilities to conduct extensive research on the subject.

That said, based on anecdotal evidence on the ground, an interview with a WHO Chief Scientist¹¹ and an NEJM paper¹², asymptomatic transmissions do seem possible, and do seem to occur.

To question the credibility of the organisation on the basis of our misunderstanding of a cherry-picked segment of a statement they put out is rather rich. We at least have the responsibility of first getting our facts straight before making a sweeping statement like:

What the hell is WHO’s credibility

The organisation has always maintained that we are still learning about the virus, and will update their recommendations and policies based on the new evidences that emerge.

Let us not be lazy. This is a time when the science around the virus is evolving. Countries around the world are conducting studies to understand the virus. The methods of prevention may change as new evidences come out. One theory or method may replace another. That does not make everybody else a fool. Science is not a game of Sudoku, in science, there could be more than one solutions, and one may work better than the other based on circumstances.

Presently, keeping ourselves updated with the current information is important for the health and safety of ourselves and our loved ones. Follow my blog (or my Facebook page), if you want a wholesome picture of the situation (as wholesome as an engineer can make it), or better yet, follow the WHO (or if you are in India, the ICMR). Dig a little deeper before jumping to conclusions. If you cannot do that, at least don’t make hasty conclusions or spread false information. Be wary of the media outlets that involve in headline hunting. Even if no source is trustworthy, we can perhaps rely a little more than the others, on BBC, and WHO. In India, you could follow the ICMR, or follow the COVID-19 coverage put together by The Hindu and ThePrint. Ignore high-decibel debates and “experts” that make too much noise. Stay grounded.

And for the sake of sanity, please stay away from WhatsApp University.

But wait, should I be scared of asymptomatic transmission

You should be cautious of asymptomatic transmission. I have made a post about preventing the disease; read it. Read the official WHO documentation about the different modes of transmission¹³. While there is no guarantee that following all the measures will save you from the disease, you will greatly reduce your chances of infection.

And relax. Our body has some level of immunity to the disease; if not, wouldn’t we be looking at over fourteen million deaths by now?