Bats are getting a hard time at the moment. They seem to be being blamed for all of the infections threatening our species, from Ebola, Marburg, Rabies, Nipah, Hendra and now SARS Cov2. The name for these animal-related human infections is zoonoses. I can just imagine the bats cringing every time the news comes on wondering what they’re going to be blamed for next.
 
You have to admit, it’s not great PR to be associated with the scariest viruses known to cause deadly human infections. But is this fair? Are bats really MORE likely to be the source of infections in humans? Do bats harbour more nasty viruses than other animals? Or are they just getting a bad press and we should cut them some slack?

“What antibiotics should we start for Nipah Virus?” asked the newly qualified Doctor.
 
The Microbiologist nearly fell off his chair.
 
“What?! Nipah Virus? Who the heck do you think has Nipah Virus?” exclaimed the Microbiologist.
 
“I have a patient with a headache and confusion and I’ve been reading about the causes of encephalitis and want to treat them in case it is Nipah Virus” the Doctor replied.
 
The Microbiologist muttered to himself… the only one confused here was surely this Doctor… why did this always happen on a Friday… I’m the only one with a headache…
 
“Has the patient travelled? Have they had any contact with animals? Have they been in contact with anyone else unwell?” asked the Microbiologist.
 
“Well no, but Nipah Virus can cause encephalitis so we should rule it out at least” said the Doctor defensively.
 
The Microbiologist sighed, “let me tell you a bit about Nipah virus….”

The Editor-Chief-in-Charge is a curd nerd… she not only loves to eat cheese BUT she also makes her own cheese. There is nothing quite as tasty as homemade cheese but it’s certainly not fast food. In fact it’s a very, very, very slow food. It takes a day to make, a couple of days to press, and months or years to mature…. But it is great fun and it might surprise you to know that it is also a lesson in microbiology. [I wonder if the ECIC will still be a curd nerd after reading this?!]

So we have been let loose and lockdown is being de-escalated slowly but have we gone too soon? We don’t have a vaccine, treatments give only modest benefits and we’re not so good at social distancing on a beach! “Experts” are a little alarmed at the pace of release and I think we’re going to be stuck with Covid-19 for a while yet, so what shall I blog about this week?

One of the stories that keeps grumbling along in the background of Covid-19 is the potential to use antibodies from patients who have survived the infection to treat patients with active infection. It’s known as plasma therapy and it’s not as crazy it might at first sound.

The government are allowing us to visit the beach but are advising us to stay out of the water as there are no lifeguards on duty and do not want additional casualties in hospital. But there might be another reason for us to consider staying out too! Viruses!!! Really!!? Can you actually find viruses in the sea? It’s a simple question but not one many of us have considered before… including me, but then why would we?
 
You might think that seawater is too salty for viruses and that they would never survive in such a hostile environment. Alternatively you might think that if viruses can survive on surfaces like plastic, metal and cardboard then why not also in the sea. But do we know?
 
Well back in 1990 Scientists confirmed that viruses can indeed be found in seawater; while looking at seawater with transmission electron microscopes (TEM) they saw “something unusual” but they didn’t actually know at that time what it was… however they could see them! So they started to study them. Remember, TEMs can “see” much smaller objects than normal light microscopes; the limit of magnification of a light microscope is about 1,000x, not enough to see a virus, whereas TEMs can magnify 10,000,000x! OK I know you youngsters think 1990 seems a long time ago but in scientific terms it’s not that long, it’s only since these discoveries in the 1990s that they actually confirmed viruses were there, even though “infection” from contaminated seawater was suspected.
 
Further studies have shown that in fact there are lots and lots and lots of viruses in seawater….

As the saying goes, “there ain’t no flies on us, there ain’t no flies on us, there may be flies on some of you guys but there ain’t no flies on us!”
 
I had a great question last week from Michael Kamdar who asked me “if a healthcare professional who works within a hospital would have the flora of that of a normal person within the community or within a hospital?” Great question! And although I have no specific resources I can comment from experience… Firstly let’s go over the normal flora of non-hospitalised people.

SARS Coronavirus 2 (SARS Cov2), the cause of the infection Covid-19, is a zoonotic infection; it has been transmitted from an animal to a human. Genetic analysis of the virus has shown that SARS Cov2 is an intestinal bat coronavirus that has successfully made the jump from bats to humans, probably as a result of human contact with bat guano.
 
Although that sounds alarming, zoonotic infections are actually quite common and have been a problem for Homo sapiens/humans ever since we crawled out of the primordial slime millions of years ago.

So last week we looked at the question of how we generate enough immunity in the population to reduce the reproductive rate of SARS Cov2 to less than 1 and allow us to come out of lockdown. Whoopee!!! Our conclusion was that we need a safe and effective vaccine and that this will take ages to arrive, probably the end of next year at least, booooo!
 
What!? Am I really saying we need to stay locked up in our houses until Christmas 2021?! We’ll all go mad long before then….
 
OK so we can’t stay locked in our houses until then, but how do we come out of lockdown… the answer is carefully… (that reminds me of a joke, “how do hedgehogs have sex? … Carefully!” ha ha!!)… anyway… there is no rule book for this, no one has done it before, there is no manual that says do this, or do that… it’s a case of trying and seeing what happens… and that’s a bit scary. Especially as the media is likely to pick holes in any attempts as they do like a good melodrama.

So it’s the burning question… political parties are demanding answers and the Government are saying “not yet”… but what is it all about and how do we come out of lockdown due to Covid-19.
 
On the face of it this might seem simple. All the Government has to do is say “right, that’s it, everyone back to work, school, gym, parks, beach…wherever!” But it’s really NOT as simple OR safe as that.
 
In order to safely come out of lockdown we need to be sure that there will be no rebound in the number of cases, and at the risk of sounding alarmist there is a real possibility of this happening before we realise it’s too late.
 
Remember, it takes about a week to develop symptoms after exposure to SARS Cov2, and another week before all of your contacts become unwell. Although most people are fine it still doesn’t account for those who are not and those who end up in hospital during the second week of illness. This means that it takes at least 4 weeks (1 week incubation, 1 week contacts, 2 weeks illness) before we “see” the effects of any change in policy about the lockdown. AND it will take a further 4 weeks for things to settle down again if we go back into lockdown! That’s 2 months… that’s up to end of July! We do not want to get this wrong so a careful cautious approach is what is required. I know I don’t like it either but…

One of my biggest concerns around the current Covid-19 pandemic is that all of the normal things that make people sick haven’t gone away. This concerns me because whilst Covid-19 is on the minds of healthcare staff they may inadvertently delay considering all of the other clinical problems that will continue to be going on in the background. Patients will still be coming in with appendicitis, UTIs, heart attacks and strokes; in fact ANY acute medical or surgical problem that happens in a normal day in the NHS.