On Thursday, June 25, Chief Abiola Ajimobi, a former governor of Oyo state, one of Nigeria’s thirty-six states, died from COVID-19 complications. The actuality of COVID-19, whether natural or manipulated in origin, dawned on his passing. In this installment, I address the complex complexities of COVID-19, in other words, some of the troubling puzzles about contraction and transmission. They center on fomites, air, sex, antibodies, and the strains of the virus. We are condemned to the prevailing abnormalities without understanding them.
Today, the basic fact of COVID-19 is that it is a respiratory disease that is transmitted through respiratory droplets and person-to-person contacts. Correspondingly, the basic preventive measures are hygienic practices of frequent hand washing; respiratory good manners; physical distancing; environment sanitation, and masking in public. Despite these, we still live largely in the dark about a controversial virus whose universe is yet to be fully understood. Indeed, the above given are being daily controverted by emerging knowledge on COVID-19.
The dispersal of COVID-19 through fomites is dreadful as it is controversial. According to Lois Zoppi, fomites are inanimate objects that are carriers of infectious diseases and agents. Otherwise known as passive vectors, they include countertops, handrails, doorknobs, light switches, mobile phones, ATMs, and, window sills, bathing tubs, tap heads, wash basins, clothing, and so forth. The nature of fomites is further explained by Stephanie A. Boone, Charles P. Gerba in their article, “Significance of Fomites in the Spread of Respiratory and Enteric Viral Disease”. They accented “the significance of fomites in the transmission of viral disease by clarifying the role of fomites in the spread of common pathogenic respiratory and enteric viruses” and argued that “contaminated fomites or surfaces play a key role in the spread of viral infections” and that “Viral transmission is dependent on interaction with the host as well as interaction with the environment”.
Aforementioned, fomites serve as vehicles in transmission. Body secretions such as blood, feces, urine, saliva, and nasal fluid shed during and after illness contaminate fomites thereby further expanding cycles of transmission of the virus. Also, the virus’ survival on fomites is determined by the fomite properties, nature of the virus, and environmental factors. While epidemiological data are problematic, evidence abounds that the disinfection of fomites and hands stops viral transmission. Viruses as obligate parasites are only able to complete their life cycle with a suitable host. What is sure that non-enveloped enteric viruses could remain on surfaces than enveloped respiratory viruses for about two months or more. WHO’s recent advice to the effect that infectivity on fomites is uncertain because the laboratory environment is different from others complicates the puzzle.
If fomites present problems, the precarity of the air we breathe in is the most dangerous. COVID-19 chooses this medium to penetrate the mouth, nose, and eye (mucosa and conjunctiva) portals to invade man. Once you are infected the same virus attacks your respiratory organs and consequently shutting down other vital organs of the body. The whole essence of physical distancing is also partly to prevent the droplet nuclei from spreading to another person. The one metre distance may not be enough. There is emerging evidence that COVID-19 can be aerosolised. Angela Fritz writing in Washington Post’s newsletter on COVID-19 noted an important development in the pandemic, which experts call “toilet plume”. It arises from “aerosol droplets forced upward by a flush appear to spread wide enough and linger long enough to be inhaled.” Worrisome is the presence of COVID-19 in the feces of patients. According to WHO sources, this contravenes earlier finding in which no airborne transmission was discovered among 75, 465 COVID-19 cases in China. The air conundrum is deepened by brimming evidence that air conditioning vents aggravate the spread of COVID-19 viral droplets. However, there are standard vents that could filter particles out of old air while letting in the fresh air. In the context of COVID-19, WHO has noted that airborne transmission may be possible in specific conditions such as “procedures or support treatments that generate aerosols are performed; i.e., endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation”. It seeks further validation of airborne transmission beyond the above circumstance “to determine whether it is possible to detect COVID-19 virus in air samples from patient rooms where no procedures or support treatments that generate aerosols are ongoing”.
Sexual intercourse is cut in the web of COVID-19. Research outputs from China have shown that men who have recovered from coronavirus should abstain from sex to avoid passing the virus through semen to their sexual partners especially women. COVID-19 virus was found in controlled semen samples from patients whose symptoms had faded. Indeed, one of the patients in the study, at Shangqui Municipal Hospital in Henan Province, tested positive for COVID-19 in his semen 16 days after coming down with the virus and three days after clinical recovery. The report noted that previous researchers had found only 27 viruses in human semen. The current study confounds the scientific community that is yet to find a solution to the riddle of “how long after COVID-19 infection does detectable virus persist in semen in those with a semen-positive result?” The research team which conducted the study published in the Journal of the American Medical Association averred that COVID-19 could be “seeded to the male reproductive tract, especially where there is local inflammation”. Observers agree with this study that COVID-19 could be contracted through sexual contact with implication reproductive health.
The question of antibodies compounds the intricacy of COVID-19. Although previous studies had found that most people who became infected developed antibodies, a new study by scientists in the Wanzhou district of China shows that antibodies is ephemeral as people who develop them after infection could lose them a few months after, between two to three months. This is corroborated by laboratory tests by NHS England which affirmed that “a positive result shows a person has had coronavirus.
But crucially, it does not prove they have immunity against future attacks or whether they could transmit the virus to others”. This may have nudged Dr. Zania Stamataki, a researcher in viral immunology at the University of Birmingham, to regard as puzzling immunity in COVID-19 as antibody tests do not substantiate protection. A dodgy dynamic of the antibody test is that people with other recent coronavirus infections could test positive for antibodies in ways that are at variance.
COVID-19 belongs to the genre of RNA viruses and the rule of the thumb is change. No wonder that COID-19 is reported to have 14 strains. In Nigeria, there are about four strains, namely, China, America, Europe, and the D614G mutation linked to increased transmissibility. Experts, such as Dr. Benjamin Neuman, the head of the biology department at Texas A&M University-Texarkana, have observed that they are more or less of the same lineage and therefore have no implication for a curative vaccine. But the claims of strains are not without controversy. For sure, the emergence of new strains may require a new vaccine to halt dissemination.
So far, there is no solution to the above riddles. Perhaps, we need to increase existing preventive practices. Regarding fomites, hand washing is an effective method of preventing the spread of bacteria and viruses through direct contact with fomites. It is advised that people should wash their hands after sneezing, coughing, changing diapers, touching dirty objects, and using cutting boards among other things. Besides, using appropriate disinfectants to clean surfaces can help to prevent fomite transmission. Concerning the threats from the air, medical masks such as N95, FFP2 or FFP3 becomes invaluable; and closing the lid of a toilet before you flush is a useful additional protocol. On the sex trap, like HIV/AIDS, a condom is advised in intimate relations.
Akhaine is a Professor of Political Science at the Lagos State University.
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