Man-versus-Virus v 1.0 First 6 chapters-page setup pdf

From Prehistoric Pandemics to COVID-19
Man vs Virus
By Mostafa Tanim
Translated by:
Ashrafuz Zaman
Edited by:
Ashfaque Swapan and Dr. James Acquah

Dedication
To all physicians, nurses and all other healthcare
professionals who continue to provide tireless service
worldwide during this pandemic crisis. They are the true
warriors for humanity.
To the scientists and researchers working day and night in
their search for new medicines and vaccines. They are our
real heroes. My gratitude to all of them is boundless.

Introduction and Acknowledgement
This is not just a book of biological science and health
guidelines, or a book to bring familiar facts together. That
is not the objective of this book. All aspects of the virus
and pandemic are discussed here. This book goes beyond
that. Besides viruses, the book also takes a look at related
interesting topics like what happened in the past, what
might happen in the future, what other threats human
civilization faces. It would not be an exaggeration to say
that this is almost a comprehensive book about the
unexpected Covid-19 pandemic.
While the book is written in a way to be accessible to
everyone, but there is no shortage of scientific
information. Having said that, those without a background
in medicine or biological science will find it an easy,
interesting read.
Health and biological science professors, physicians and
other specialists reviewed the first draft of this book
despite their hectic schedule during this pandemic. They
are Mashiul Chowdhury MD, clinical associate professor of
medicine, Drexel University College of Medicine and chief
of infectious diseases, Cancer Treatment Centers of
America; writer and pediatrician Shahab Ahmed MD;
Masud Baksh MD, Shenandoah Memorial Hospital,
Dr. Hossain Uddin Shekhor, professor of biochemistry and
molecular biology, University of Dhaka, Bangladesh; Dr.
Farzana Musawir, clinical pharmacy specialist, University
of Maryland Medical Center; Dr. Ishrat Rahman, professor
of biology, Montgomery College, Maryland; Samina Hasan,
clinical case manager, Loudoun County INOVA Hospital,
Virginia; writer and journalist Ashif Entaz Rabi; writer and

architect Anwar Iqbal; Dr. Aminur Rahman, professor,
George Mason University- all provided invaluable help. My
manuscript reviewer Dr. James Acquah, Chief Operating
Officer, XPAND Corporation, Herndon, Virginia, provided
invaluable suggestions — my heartiest thanks to him.
I hope readers will enjoy the book. Please follow the
health guidelines during this pandemic and develop good
habits that you adhere to even after the pandemic is over.
Stay safe and healthy.
Mostafa Tanim
Herndon, Virginia, USA
November 09, 2020

Table of Contents
Virus: Basic Information ● 6
The Enemy Is Not Invisible Any More ● 8
Coronavirus – A Closer Look ● 13
Did Anyone Know? ● 23
How Do Pandemics Spread? How Can
We Manage a Pandemic?
● 28
How Devastating Will Covid-19 Be? ● 38
Pandemics: Attacking Us Again and
Again ● 43
Smallpox: A Lethal Virus but also a
Source of Optimism ● 50
Viral Rumor, and Rumors about the
Virus ● 55
Is Civilization In Imminent Danger? ● 60
How to Protect Your Mental Health
during the Covid-19 Pandemic ● 63
Covid-19 Checklist ● 66
The Post Novel Coronavirus World ● 68
About The Author ● 72
References ● 73

CHAPTER 1
Virus: Basic Information
• Virus is a Latin word. It means “venom” or “poison”
in Latin.
• We cannot use conventional methods to classify
viruses as either living or dead. A virus contains
genetic coding, either DNA or RNA. But a virus does
not eat or breathe. It has no metabolic source. It
enters the cells of living organisms, such as animals
or plants, and replicates. It thrives as a living
organism inside the cells of other organisms.
Outside host cells, it acts like a non-living
substance.
• Millions of species of viruses exist on earth. We
have explored only about five thousand in some
detail. Over 99 percent of viruses remain
unexplored.
• The study of viruses is known as
virology (vai•raa•luh•jee).
• What if viruses did not exist? Scientists differ in
their opinions on the possible consequences. Some
scientists think the world would be overwhelmed
with bacteria. Although both viruses (20-300
nanometer) and bacteria ( 500-5000 nanometers)
are very tiny organisms, bacteria are much larger
than viruses, (about 100-fold larger). Viruses not
only get inside plants and animals; they can get
inside bacteria and cause disease.
Through genetic mutation, viruses are constantly
changing the world of living organisms. A virus can
replicate only within a living cell. It cannot do so on

its own. To put it simply, viruses do not reproduce
like other living organisms; they replicate.
• It is impossible to eradicate viruses. If all the
world’s viruses are set in one continuous line, it
would run across the moon, sun, our solar system,
our galaxy, and reach the next galaxy. This path
would be so long that its length would be
measured not in miles but in light years. It would
be a total length of 200 million light-years! [1]
• The first virus was discovered in 1898. While
conducting research on disease in tobacco plants,
scientists found the existence of an unknown
microorganism. But microscopes in those days
were not powerful enough to see the virus. It is
only after the invention of electron microscope in
1931 that the virus was first actually seen in 1935.
Chapter 2 of this book, “The Enemy is not Invisible
Any More,“ covers this topic in greater detail.
• Four microorganisms cause diseases in humans:
viruses, bacteria, fungi and parasites. Together,
they are called pathogens.
• Antibiotics kill bacteria but do not affect viruses.
However, some antiviral drugs work on certain
viruses [2] .
• Viruses cause almost two-thirds of microbial
diseases in humans. Common viral diseases
include:
i) The common cold
ii) Influenza/flu
iii) Chickenpox
iv) Polio
v) Jaundice (hepatitis)
vi) Measles
vii) Dengue fever

viii)
AIDS
• Not every virus infects humans. Each virus has a
specific host. Viruses cannot replicate outside that
specific host. But viruses sometimes migrate from
one host to another and start replicating by
changing characteristics by mutation or
recombination. When a virus migrates from other
vertebrate animals to humans and then replicates,
it is called a zoonotic virus. Almost 70 percent of
viruses infecting humans are zoonotic. The rest
have been infecting humans since the very
beginning of human evolution. Zoonotic viruses can
cause serious and lethal infections in humans, such
as AIDS(caused by HIV), SARS, MERS and more
recently, the novel coronavirus. They change form
and learn how to survive in humans by first thriving
in animals. We shall discuss this in greater detail in
Chapter Three.
• The first species of coronavirus was discovered in
1965. But we did not know anything about the
current coronavirus at that time. That is why we
have termed this virus “novel coronavirus.”
• Covid-19 is the disease caused by novel
coronavirus. Covid stands for “Coronavirus
Disease.” The scientific name for the virus is
“severe acute respiratory syndrome coronavirus-2”
(SARS-CoV-2).
The International Committee on Taxonomy of
Viruses (ICVT) is the organization that names
viruses.
The name of a virus is usually different from the
disease it causes. For example, the human

immunodeficiency virus (HIV) is the name of the
virus which causes the disease AIDS.
The disease caused by novel coronavirus first
occurred in Wuhan, China, in November 2019.
Since then, the number “19” found its way into the
disease’s name. At first, the virus was termed
“2019 novel coronavirus.” The SARS pandemic was
another earlier coronavirus pandemic in 2003. That
is why WHO decided to call the present virus the
“Covid-19 virus” to distinguish it from SARS and
other previous coronaviruses. [3]
Although the novel coronavirus has three different
formal names (SARS-Cov-2, Covid-19 virus, and
novel coronavirus), the disease caused by it has
only one name: Covid-19.

CHAPTER 2
The Enemy Is Not Invisible Any More
We often hear that this is a war against an invisible enemy.
it is certainly a war, but the enemy is far from invisible.
Even non-scientists like us can take a look at this virus
under an electron microscope. We can actually take a
picture of it through an electron photomicrograph.
However, it is so tiny that we cannot see it through an
optical microscope. The use of the term "invisible," I think,
is misleading because it sounds a little scary and ghoulish.
The fact of the matter is that this virus, very much like any
other virus, is an enemy we can fight. The more we know
about its characteristics and exactly how it attacks us, the
better we will be able to protect ourselves. This is a pretty
new (novel) virus, so our knowledge about it is still
rudimentary. The more we find about it, the better we can
prepare ourselves. Factually speaking, the virus is not an
“enemy.” It is a danger to us the same way cyclones,
tornadoes, earthquakes and locusts are. Locusts actually
have a nervous system and are more developed creatures,
whereas this virus is not. It harms us through biochemical
processes in cells of the people it infects. We must
understand those processes. Once we know enough about
it, we can guard ourselves against it.
We humans are immersed in a sea of pathogens. There
are countless pathogens around us and inside our bodies.

There are ten times more pathogens in our body than the
number of body cells. Most of these are bacteria. As
these are very small, they constitute about 1-3 percent of
our body weight [4] . Most of the bacteria inside our body
are harmless; some such as some intestinal bacteria, are
essential for our healthy survival. For a long time, people
knew nothing about the existence of these minuscule
microbes which are well beyond the power of human
eyesight.
The Dutch scientist Antonie Van Leeuwenhoek (1632–
1723) first looked at microbes in 1676. He was a cloth
merchant by trade and was familiar with the magnifying
power of lenses. He used those to count the number of
threads in clothes. He developed an improved lens to
magnify objects and was astonished to find quite a
different world that is invisible to the naked eye and even
under the microscope made before him. He could see
bacteria and red blood cells and was fascinated by the
sheer large number of what he called “animalcules.”
His invention opened up an entire world of microbes to
humankind. In his own words: "I then most always saw,
with great wonder, that in the said matter there were
many very little living animalcules, very prettily a-
moving."
Humans have faced pandemics for centuries. The first
known pandemic, the Antonine Plague, happened about
2,000 years ago. It claimed about five million lives. This
was a devastating toll at a time when the population of the

world was far, far smaller than now — an estimated 150
million. It was most likely caused by the smallpox virus.
Later on, pandemics caused by bubonic plague, cholera,
malaria, polio, smallpox, kala azar and Spanish flu have set
back human development considerably. Nonetheless,
humans have survived pandemics and moved on with their
development of civilization.
Humans did not know in early times that pandemics are
caused by pathogens. They were aware that the diseases
were contagious. People who got infected were thought to
be sinners, and society shunned them. Louis Pasteur in
1861 came up with “germ theory,” which proved that
bacteria cause many diseases.
The German scientist Robert Koch in 1882 discovered the
bacteria that cause tuberculosis and cholera. He is also the
scientist who discovered the relationship between
antibody and immunity and the mechanism of how
vaccines may protect against certain diseases.
“Much of the basis for modern medicine, as well as the
field of immunology , can be traced back to these two
scientists.” [5]
It was another 125 years following the findings of bacteria
by Leeuwenhoek that we got to know about viruses. We
have researched viruses and know much more about it.
Public health experts were always concerned that a virus
may infect and affect the entire world. We have been
planning a defense against it. Almost all countries have

health departments to research infectious diseases and
plan for protection against them. The World Health
Organization (WHO) has been quite active in planning a
defense against a pandemic. When Wuhan in China had
the first novel coronavirus infection, it created a huge,
immediate response in the whole world. International
airports became more vigilant and started to quarantine
people coming from virus-infected areas. While protective
measures were taken, not everyone heeded the warnings,
nor did all countries pay attention promptly.
In the past two centuries, almost all countries have
created a public health department. Dr. John Snow of
Britain is the pioneer of public health. It was his research
on a cholera epidemic that led him to develop the
concept. It is discussed in more detail in Chapter Six,
"Pandemics in Different Eras."
When someone is sick, they may be treated by a physician,
go to a hospital, or have relatives and family members
take care of them. If they die, their family and relatives
suffer most from the loss. What happens when the entire
population of a city or a country suffers from a disease?
Suppose there is a high level of arsenic in the water supply
in a certain city or country. That would be devastating for
the health of everyone who lives in that area. This is
beyond the scope of treatment or care by a single
physician or a hospital. Who will investigate this problem
and find the remedy? Who will perform research, give
guidance and restrictions as necessary to save the

population? That is when the public health department
comes in. It looks at the entire population's problem and
works on resolving it. That is the role of WHO, CDC and
similar organizations. They work around the clock to
protect us from similar public health hazards. The branch
of medicine that deals with pandemics is epidemiology.
Epidemiology helps us tackle pandemics by using data,
statistics and all available knowledge about the pathogen
causing it. Epidemiologists use contact tracing techniques,
determine the exponential rate of spread, the mode of
spread, and, most importantly, put in extra effort to find
the source of the pathogen by tracing patient “zero” – the
first infected person in the community or country.
Let's digress for a moment. There is a 750-mile fault line
that passes through California named the San Andreas
fault. This is where two tectonic plates -- the Pacific Plate
and the North America Plate -- bump into each other.
Tectonic plates are floating plates under the surface of the
earth (part of the mantle zone of the earth, which is superhot)
formed by irregular slabs of solid rocks. There are
several such large plates and multiple smaller plates. The
thickness of the large plates ranges between 20-50 miles.
Compared with the earth's diameter, which is about
7,917.5 miles, these plates are quite thin in the grand
scheme of things. If you think of the earth as an apple, the
tectonic plates are like the skin of the apple! So here we
are - all the drama, fights, music, love and hate of our lives
happening over this thin skin!

The San Andreas fault was discovered in 1897. Every year,
the two plates move away sideways from each other by an
inch. During this motion, friction may cause an
earthquake. San Francisco had a huge earthquake in 1906.
Scientists predicted another major earthquake around
1997, which eventually took place in 2004. Scientists have
drilled into the tectonic plate. USGS (United States
Geological Society) predicts a 7 percent chance of an
earthquake with a magnitude of 8 on the Richter scale
happening in California within the next 23 years. A Richter
8 earthquake would be a massive, devastating earthquake
(Richter is a logarithmic scale; an 8 on the Richter scale is
10 times greater than 7). They also have an estimate of
how many people will perish in that earthquake. If it
happens, it’s quite likely that most people will not know
the cause of it. They will not know that scientists had
predicted it a long time ago. The US government, of
course, has paid attention to it and invested in the
research to find out all about it.
Likewise, for a long time, scientists have worried about a
virus causing a worldwide disaster. The precautions they
were urging within three months of the novel coronavirus
outbreak did not come out of the blue. Years of research
and knowledge were behind what they are telling us now:
social distancing, hand washing, wearing mask, etc. If all
the countries had paid attention to the recommendations
right from the beginning, perhaps Covid-19 would have
been contained now.

The virus was first detected from a disease of the tobacco
plant. In 1886, farmers noticed that some tobacco leaves
get mottled and yellow from an unknown disease.
German botanists thought it was a bacterial disease, but
they could not detect any bacteria under microscopic
examination of the leaves.
They were puzzled by the absence of bacteria in the
diseased tobacco leaves. They tried several ways to
identify what caused this disease. "Is it a poison?" the
botanists wondered. They poured juice from diseased
tobacco plants onto healthy plants and found that healthy
plants also became diseased. Now they realized that
whatever is causing the disease is present in the juice of
diseased plants. But why couldn’t they see any
microorganisms? They infected healthy tobacco plants
with all known bacteria, but it did not cause the same
disease they called “mosaic disease” of tobacco. Dmitry
Ivanovsky, a young Russian scientist, had a brilliant idea.
He filtered the juice from diseased tobacco plants through
a very fine filter which should stop bacteria. The filtered
juice caused the same disease when applied to healthy
plants.
So, if this is not bacteria, what is it? Ivanovsky’s research
did not go far, as he had moved on to explore other
scientific questions.
Six years later, in 1898, Dutch scientist Martinus Beijerinck
performed the same experiment independently. He
concluded that the diseased plant's juice contains a

microbe which is so small that it can pass through bacterial
filters. He discovered some biological characters of this
microbe. It is pretty lifeless outside a living cell and starts
to replicate once within a host. But it is so tiny that it
cannot be seen even under a microscope. He named it
"filterable virus." Now we simply call it “virus.” It took
another 37 years for us to "see" a virus. Finally, in 1935,
the first virus was seen and photographed using an
electron microscope.
It is hard to understand how tiny a virus is if we say it is
about 100 nanometer in size. For a better perspective,
consider this: An average bacterium is 10 times larger than
a virus. A red blood cell is 10 times larger than bacteria.
The width of a human hair is 10 times larger than a red
blood cell. The width of an average human hair is about
100,000 nanometers [6] .
So, the width of a human hair is 1,000 times more than
the size of an average virus! Does it give you an idea of
how tiny viruses are? This tiny size makes it extremely
difficult to research viruses.

Picture 1: Tobacco mosaic virus, electron
photomicrograph (x1,600,000)
I’m not saying for a moment that we all need to have a
thorough knowledge of biology, microbiology and virology
to fully understand the dangers of viral diseases. That’s not
what this introduction is about. What I do say is that we
need to know the long history of the progression of human
endeavor, the steps taken and hurdles faced by
researchers to acquire the knowledge that benefits us all
today in everyday life. If science were even one tenth as

popular as Hollywood movies (or football, or baseball, for
that matter), we would not face such an uphill battle in
tackling Covid-19 on a global, state and personal scale.
Neither would we be frustrated or feel helpless. We would
be confident in the knowledge of what we are facing and
have faith in our ability to figure out how to deal with it
best.

CHAPTER 3
Coronavirus – A Closer Look
While researching different viruses, Tyrrell and Bynoe in
the 1960s found that viruses are responsible for what we
know as the common cold. The common cold has nothing
to do with cold weather; it is caused by various viruses.
The US-based National Institutes of Health (NIH) has more
information on this “common cold.” About two hundred
types of viruses cause the common cold, of which
rhinovirus has the major share of cases. [7] The second most
prevalent virus for the common cold is a coronavirus. But
it is not the novel coronavirus that caused this pandemic.
Four other types of coronavirus are known to us since the
1960s which attack the human upper respiratory tract,
such as sinuses, the larynx and the nose. These cause
symptoms of common cold such as sneezing, coughing,
runny nose and fever. It is well established that exposure
to cold or sudden temperature change does not cause the
common cold. The common cold is entirely a viral
infection. Two other types of coronaviruses, SARS and
MERS, attack the lower respiratory tract, mainly lungs. This
is a severe infection and can be lethal. So, coronavirus
infection varies from a relatively trivial common cold to
what can be a fatal disease.
"Cold” viruses have a seasonal variation. Coronavirus
infects us mostly in the winter, whereas rhinovirus in the
spring, summer and fall. Each virus has its favorite season.
This makes us vulnerable to one or the other cold viruses

throughout the year. You will often hear people say: “I
caught a cold because of the change of season.” There is
little scientific reasoning behind this statement. Each virus
has a predilection for a certain season with some
overlapping. Why do we get more attacks of the common
cold in winter? That is because we spend more time in
confined spaces with recirculating air, easily infecting one
another.
A word about influenza in this context. Commonly known
as flu, it is an infection by three viruses, influenza A,
influenza B and influenza C. There is even an influenza D,
which primarily infects cattle. The symptoms of flu are
similar to the common cold, with fever thrown in
occasionally. According to a Mayo Clinic article, flu-like
symptoms include fever, generalized malaise and body
ache. The symptoms are more severe than that of a
common cold. But both conditions are usually self-limiting,
and people recover on their own within a week.
The research of Tyrell and Bynoe (1965) identified multiple
similar viruses that cause common cold-like symptoms.
This genus of the virus was named "corona" as they
resemble a crown. So, the pandemic of 2020 is not by
simply any coronavirus, it is the result of infection by the
'novel' coronavirus or COVID -19 virus.
Below is an electron photomicrograph of coronavirus:

Picture 2: OC16 coronavirus under electron microscope
(1967)
There are four main types of coronaviruses. Alpha, Beta,
Gamma, and Delta. Four types are known to infect
humans: 229E (alpha coronavirus), NL63 (alpha
coronavirus), OC43(beta coronavirus) and HKU1 (beta
coronavirus) [9] .
Other types of coronavirus infect animals and not humans.
But evolution and mutation change viruses and non-

human pathogens can then begin to infect humans. That is
what happened to SARS-CoV and MERS-CoV viruses. The
novel coronavirus (2019-nCoV) is infecting humans now
the same way by changing its characteristics [10] .
There is 96 percent similarity between a known bat virus
and the Covid-19 virus. There is also speculation that the
virus propagated through an intermediate animal,
possibly pangolin [11] before reaching human. Once it
started infecting humans, it then spreads rapidly from
human to human.
Since this is a new virus, we were not aware of its
biological behavior. It takes time to explore it in full detail.
But time is not a luxury we can afford.
Thanks to electron microscopic examination, we have now
discovered how the virus gets into human cells and which
organelles it attaches to. The picture below is from a
scanning electron microphotograph, taken on February
2020 in Montana, U.S. It shows the novel coronavirus in
yellow, a human cell membrane in blue and purple. The
novel coronavirus is not invisible to us any more, we can
trace it even within human cells.

Picture 3: Novel Coronavirus invading into patient’s body
cell
Science has taken huge strides since Dmitry Ivanovsky and
Martinus Beijerinck discovered the virus. We now know
about the genetic sequencing of many viruses, how a virus
gets into host cells, how it replicates once it is inside cells.
The host is a living organism, maybe an animal, a plant,
rodent, cats, bats, mosquitos, or even a microscopic
bacterium. Viruses cannot survive outside a host for long
and cannot replicate outside a host. It uses the substances
within the host cell and sends biochemical instructions to
the host cell's ribosome to create exact or near exact
replicas of itself. These instructions reside in a place called
the genome, either DNA or RNA. A virus has either DNA or
RNA, but never both.

The novel coronavirus does not have DNA. It only has
RNA. So, it is an RNA virus. RNA viruses usually cause
deadly diseases like AIDS, SARS and Ebola. On the other
hand, hepatitis B is a DNA virus.
Viruses have an outer shell called a capsid. Some viruses
are enveloped, meaning the capsid is coated with a lipid
membrane known as a viral envelope. The capsid acquires
the envelope from an intracellular membrane in the virus'
host.
By means of the capsid or envelope, a virus attaches to the
host cell and gains entry into it. That's all it is: a genome
(DNA or RNA) and a capsid/envelope covering it. Nothing
else. It is not even a complete cell. It’s almost as if it is an
instruction waiting lifelessly for an opportunity to get into
a host cell and replicate. Once inside, it gets energy from
hijacking the host cell's infrastructure. The ribosome is the
part of a cell that is needed for protein synthesis; the virus
doesn't even have one of its own. It uses the host cell's
ribosome for protein synthesis, sends RNA instructions to
it, and gets its agenda realized. It makes the host cell
create a replica of itself, like a parasite. But it’s much more
dangerous, because it creates billions of replicas within
host cells.
There are three ways viruses enter into the host cell:
endocytosis, penetration (for non-enveloped viruses), or
fusion (for enveloped viruses). Before the virus can take
charge of the host cell, the viral genome (DNA or RNA)
must get out of its shell or capsid, a process called
“uncoating.” Once the virus's replicas are produced by the
host cells in accordance with the viral genome's
instructions, the replicas get out of the host by a process

called “budding.” During the process of getting out of the
host cell, it damages the host cell wall and may destroy the
host cell completely.
Picture 4: A cross sectional image of a novel coronavirus
[12]
The protein coat not only protects the virus; it is also the
key to attacking the host cell. This acts like a key that
attaches to the host cell receptor. The key must be very
specific to the receptor on the surface of the host cell.
Otherwise, it will not be able to open the "lock" to enter
the host cell. That is why all viruses cannot infect all hosts.
When you look at Picture 4, the pointed spike-like
structures on the surface gives it a crown- like appearance,
hence the name “corona” (Latin for “crown”). These are
the keys that attach to the human cell surface receptors
and gain entry into the cells. There is a protein on the
human cell surface called ACE-2 (angiotensin converting
enzyme 2). The coronavirus attaches to ACE-2, which is

the receptor for novel coronavirus. The specificity of the
novel coronavirus and ACE-2 is key for the virus to gain
entry and infect the human cell [13] . The ACE-2 receptor is
present in abundance in the lungs, intestine, kidney and
endothelium of blood vessels. That is why the lung is easily
infected and damaged by the novel coronavirus and why it
may even cause respiratory failure leading to death. The
drugs used to treat hypertension and diabetes cause an
increase in ACE-2 receptors on human cells. That is why
people with diabetes and hypertension are more
susceptible to a Covid-19 infection.
It is vital to research and find all we can about this
receptor to protect us from the novel coronavirus.
“if you can prevent attachment and fusion, you will
prevent entry”. [14]
Some anti-viral drugs prevent the viral capsid/envelope
breakage, which contains the genome (DNA or RNA) inside
the shell. Some prevent the metabolism in the host cell so
that the virus cannot replicate. There are multiple ways of
how viral infection may be contained.
Outside the host cell, the virus is an inactive, extremely
tiny particle. It is not even a complete cell and cannot
perform a normal cell's functions on its own. It is an inert
particle when outside a host cell, for example, on the
surface of a table or doorknob. Soon, it is destroyed by
either heat or other adverse environmental factors.
The susceptibility of a virus largely depends on its ability to
survive outside a host cell. For example, suppose you drop
a key on the road, and it is run over by a car. The key may
bend, warp, or be destroyed. Now this key will not work

on a lock it was intended for. When the virus is destroyed
or changed, it loses its ability to invade and infect the host
cell. If viruses were living organisms, we could say that it
died. But outside the host, it is not a living organism, so
the word “dead” is not quite right to describe a virus when
it changes and loses its virulence to invade the host cell.
We can say it is destroyed, or more technically, not
virulent anymore.
Some pathogens cannot live outside hosts at all, such as
malarial parasites. It is not a virus, it is a parasite. It has
two hosts, mosquito and human. It directly transfers from
one host to the other. There is a lot of controversy over
whether the virus is living or non-living. Let us be clear
about one thing: Inside a host cell, it replicates and acts as
a living microorganism. Outside a host cell, it is a non-living
microscopic particle.
How many copies of itself can a virus make? When
someone has a common cold, twenty thousand
rhinoviruses are sprayed out in one sneeze! A person
infected with novel coronavirus spreads about three
thousand particles in a single cough like an aerosol, each
of which contains many viruses.
This is explained in greater detail in Chapter 4.
You mustn’t think for a moment that that the virus will
infect humans after making millions of copies of itself
inside the host cells and ultimately win. We humans are
equipped with an immune system for protecting us against
diseases. Our immune system detects the virus invasion
by recognizing substances, known as antigens, on the
infecting pathogen’s surface and starts to produce millions

of antibodies against the infecting organisms. Antibodies
are "Y" shaped proteins that attach themselves to the
antigens on the infecting pathogen's surface and
neutralize the virus invader
[15] . Each antibody is
specifically produced against an infecting pathogen. Most
often the antibody wins in this battle against pathogens,
and we remain healthy. Sometimes, the pathogens beat
the antibody and keep infecting the host, and we suffer
from illnesses.
It may take the immune system several days, even weeks,
to produce the precisely correct antibody against a new
pathogen. But once it is produced, it stays in the immune
system's memory. Next time the same virus (or other
pathogens such as bacteria or parasite) enters the body,
the immune system doesn't need to go through a lengthy
trial-and-error process to produce the right antibody
against it. Instead, it can produce the right antibody from
its memory quite rapidly and neutralize the invading
pathogen before it can get out of control and cause severe
illness.
Because of the antibody, many infectious diseases are
automatically cured in a few days. The immune system's
memory is the main reason vaccines are effective against
infectious diseases. A vaccine is really an attenuated or
dead virus (or other pathogen) that trains the body’s
immune system to produce the right antibody, but itself
doesn't have the virulence to cause illness.
When a virus infects the pluripotent reproductive cells or
stem cells, it changes the host cell's DNA. Thus, the virus
attaches to the host's reproductive cells or stem cells and
is present in their subsequent replication. The virus's DNA

is permanently incorporated into the host cell and is
carried out in all offspring of the host animal/plants.
Scientists discovered that 5 to8 percent of human DNA
came from viruses. This is a very new area of microbiology,
and we still do not know if this viral DNA has any benefit
for humans. Research on this fascinating area continues.
Here's some more information about DNA and RNA for
interested readers.
DNA stands for deoxyribonucleic acid. RNA stands for
ribonucleic acid. The double helix is a term most of us are
familiar with. It resembles two threads intertwined
together. DNA has a double-helix structure. RNA has a
single strand.
Picture 5: DNA and RNA

The National Human Genome Research Institute of NIH defines
DNA thus: DNA contains the instructions needed for an
organism to develop, survive and reproduce. To carry out
these functions, DNA sequences must be converted into
messages that can be used to produce proteins, which are the
complex molecules that do most of the work in our bodies. [16]
The RNA structure is quite similar to DNA, but there are
some differences. Three different kinds of RNA serve some
quite specific functions. The genetic coding inside DNA is
translated by RNA to synthesize specific proteins. RNA is
carried inside into the ribosome, where protein synthesis
takes place.
mRNA (Messenger RNA) creates a copy of the genetic
code and takes it inside the ribosome. Protein is
synthesized inside ribosome according to the code carried
into it by mRNA.
tRNA (Transfer RNA brings the necessary amino acids into
the ribosome as needed for the specific protein synthesis.
Amino acids are the structural components of protein.
rRNA (Ribosomal RNA) remains inside the ribosome.
Ribosomal RNA (rRNA) associates with a set of proteins to
form ribosomes. These complex structures, which
physically move along an mRNA molecule, catalyze amino
acids' assembly into protein chains. They also bind tRNAs
and various accessory molecules necessary for protein
synthesis (NIH).
Ishrat Rahman, professor of biology at Montgomery
College, explains RNA and its functions: “Suppose DNA is a
cookbook. It is written in coded language, and we need a

decoder to read it. It is a rare book, so instead of taking
the book to the kitchen, we photocopy the recipe page
and read it in the kitchen. Here, the book is the DNA; the
photocopied page is the mRNA. Then we go shopping and
buy the necessary ingredients from the grocery store. This
procurement is done by tRNA. tRNA gets the amino acids
necessary for protein synthesis. The grocery store is the
cytoplasm of the cell. The cook is the rRNA. The cooking
range, necessary pots, and pans are already in the
ribosome. All that is needed is to rearrange the proteins in
the correct order to make a copy of the virus (virion). Now
we see that the virus has the cookbook where the DNA or
RNA contains the coded recipe. Once the message reaches
inside the host cell, different RNAs take part in getting
requisite amino acids to synthesize the protein and make
copies of the virus. This is an oversimplification of viral
replication, but it gives you a basic idea about it.
The mutation of the novel coronavirus is worrisome.
Viruses mutate rapidly, especially RNA viruses. Sometimes
when a virus makes a copy of itself, there are minor
mistakes in the synthesis of the copy. As a result, a virus's
copy is not an exact replica, but a slight variation. This is
called a mutation. So, the mutated virus is a little different
from its original form. The subsequent copies of this
mutated virus will be different from the original viral form
too. Most often, the mutated form of the virus cannot
survive by infecting cells of the same type as before and is
destroyed on its own. Sometimes, the mutated virus is
more virulent or can be non-responsive to drugs and
vaccines developed for the original virus.
Scientists think that it is highly unlikely that this novel
coronavirus will mutate and become more virulent. To

quote virologist Nathan Grubaugh of Yale School of public
health, “The rate at which this virus is mutating or evolving
is not unexpected; it’s exactly what we would expect for a
virus like this. All viruses continuously evolve and there
shouldn’t be anything alarming about the process in
general.” [17]
https://www.cell.com/trends/microbiology/fulltext/0966-
842X(94)90126-0
Zoonotic Virus
Every virus has a specific host. It can survive and replicate
only within that host. The same virus does not infect other
hosts. But sometimes, the virus changes its form and
attains the ability to infect a new host and replicate itself

within it. When a virus that once infected animals, has
evolved and now can infect humans, it is called a zoonotic
virus. Seventy percent of the viruses which infect humans
can infect other animals, too. That pretty much tells us
that these are zoonotic viruses. At first, they were
infecting animals only, then with time they evolved to
infect humans. Most zoonotic viruses came from rodents,
hooved animals, primates, carnivores and bats. Zoonotic
viruses may come from birds, too. In the recent past, most
serious viral infections occurred from zoonotic viruses,
such as influenza, HIV, SARS, MERS and Ebola. Other
viruses have been inside host cells for thousands of years
but cannot cause serious illness because the host is so
used to it. For example, the SARS virus cannot cause
disease in bats, as it has been inside the bat cells for
hundreds of thousands of years. On the other hand, when
the same virus gets into human cells, it can cause serious
illness, because its interaction with humans is new. [18]
We also need to keep in mind that some non-zoonotic
viruses can cause serious human disease as well [19] .
Picture 6: Bat, the zoonotic virus carrier

HIV came from chimpanzees, SARS from bats, Hepatitis B,
dengue from primates. Common cold coronavirus (OC43),
measles, mumps came from domestic animals and
influenza from wild fowl. Sometimes zoonotic viruses are
transmitted through chain of two or more animal hosts to
reach humans [20] .
The novel coronavirus does not spell an end to viral
pandemics. It’s almost certain that new zoonotic viruses
will come in from the wild and start a pandemic from time
[9,14,15,16]
to time.
Some may think that the novel
coronavirus is a laboratory-made virus, but that does not
diminish the probability of another zoonotic virus
pandemic.
Viruses can infect humans suddenly after millions of years
of being pathogens only to other species. That is not the
case for other pathogens like parasites, bacteria and fungi.
Those pathogens (parasites, bacteria, and fungi) that did
not infect humans for thousands of years are unlikely to
start infecting humans now. That is because other than
viruses, pathogens do not evolve or mutate rapidly to
become human pathogens [21] .
Among millions of types of viruses, we have studied
probably only 1 percent of them. We have gene
sequencing of only those viruses that we have studied. The
more we know about viruses, the better equipped we shall
be to protect ourselves. We will have vaccines and
effective treatment against those viruses. We have to keep
in mind that the novel coronavirus is not going to be the
last virus to cause a pandemic. Consequently, the more

time and money we invest in research, the safer we will be
in future.
Words by themselves are meaningless without
commensurate effort. The only sensible option is to
invest significantly in research, ensure significant
advancement of science and technology, raise awareness
of decision-makers and ordinary citizens about the
devastating, existential hazard posed by a pandemic long
before it hits us. What else is the alternative to save
civilization from this kind of catastrophe?

CHAPTER 4
Did Anyone Know?
There actually was an eerily premonitory movie in 2011…
You may think that the coronavirus pandemic came out of
the blue. Nobody could possibly predict it and nobody had
time to prepare for it. This is absolutely false. A pandemic
was expected to happen. The only question was when.
There are six more catastrophic events that may occur
anytime. We talk about it in greater detail in Chapter 9 .
Many of you have seen the movie Contagion. There are
some bone-chilling similarities between the present novel
coronavirus pandemic and the one shown in Contagion,
made in 2011. In Contagion, there are repeated warnings
about not to shake hands, and advice to wash hands
frequently. I learned about the origin of handshaking
culture from this movie. In the ancient world, when two
strangers could not fully trust each other, they would
extend their right hands to show that the hands did not
hold any weapon. Then they would feel safe and could
talk. Contagion imposes a ban on this age-old culture of
the handshake, because a virus can travel from one’s hand
to another, then from the hand to the mouth. We touch
our faces about two to three thousand times each day. Did
we notice this before? Most of us did not. The virus can be
present on doorknob, the elevator button, on table
surfaces and God knows where else. From these surfaces it
passes into someone’s hand, then to the mouth and

respiratory tract, and then is transmitted from person to
person.
Picture 7: Movie Contagion
All the things that we are facing now during the Covid-19
pandemic -- the rumors discrediting science, stores
running out of food, water and hand sanitizer - were
vividly highlighted in Contagion. Looking back, the movie
was an eye-opener. It described in minute detail how a
pandemic (fictional in 2011) started, how research was
done, how it spread from country to country, what its rate
of spread and its death rate was. The CDC and WHO came
into the picture often.
Contact tracing is a vital and fascinating part of tackling a
pandemic. Who were the people in close contact with the
patient? From whom might the patient have contracted
the virus? Who has the patient spread the virus to? It is
like detective work: Finding this information is crucial to
getting a handle on the pandemic and stopping its spread.

Eventually, contact tracing finds patient zero, the first
person to have caught the disease. It is difficult to
ascertain all the facts about the pathogen and the
pandemic until patient zero (more generally known as the
“index case”) is pinpointed.
Did a writer in 1981 know about this pandemic?
There is an eerie similarity between “Eyes of Darkness”
and the present-day novel coronavirus pandemic. The
comparisons went viral on social media. Dean Koontz
wrote the science fiction novel in 1981, and the book
became a New York Times bestseller. His fans claim that
Dean Koontz predicted the novel coronavirus pandemic 39
years before it happened. He mentioned “Wuhan-400,” a
microbe synthesized in a Chinese laboratory. Some fans
posted photos from his book, highlighting the similarities
with this pandemic. Reuters, The New York Times and
many other organizations researched the facts along with
the fiction of “Eyes of Darkness.” It turns out that although
there are some similarities, there are many more
differences as well. His fictional pandemic started in
Wuhan, China in 2020. That matches the novel coronavirus
pandemic. But he said that the specific virus in his novel
does not thrive in other animals, which is not true for
novel coronavirus. He named his virus Wuhan-400 (which
in his first edition of the book was named Gorky-400),
which has a 100 percent fatality rate. That does not hold
true for Covid-19, which has a death rate of 1-2 percent in
the infected population. So ultimately, although there are

some surprising similarities, there are a lot of differences,
too.
Picture 8: Writer Dean Koontz’s fans highlighted the line
on a page citing “Wuhan-400” microbial weapon
The theme of the “Eyes of darkness” novel was that China
created a virus that only infects humans with a 100
percent fatality rate. So, once this virus is spread in a city
or a country, everyone will be killed by the disease. Since
this virus will not infect other animals (because humans
are the only host), once everybody dies from it, the virus
will not thrive. China can then invade the country quite
easily without fearing the deadly virus infection.
Eventually, Reuter’s comparative analysis of the “Eyes of
Darkness” and the present novel coronavirus pandemic
concluded that the novel and the actual pandemic have
only a few things in common [22] . Meanwhile, Dean Koontz
has been mum about the comparisons.

There is a term for this kind of writing: fictional prophecy.
This goes all the way back to Jules Verne.
Bill Gates Warns…
Picture 9: In 2015, Bill Gates, at a TED talk, warns the
world about the threat of a contagious virus.
In 2015, Bill Gates presented a theory in TED talk: The
main threat to human civilization is a viral infection. More
people will die from viral infections than from war,
bombing and hunger, he said. He predicted that it might
happen in a few decades. Sadly, it took much less than
even a decade. It happened in five years! He predicted this
after observing the devastating effects of the Ebola
epidemic in Africa. Many scientists, infectious disease
experts and physicians have been trying to warn us of the
danger of viral infections. And it’s not just only
epidemiologists and microbiologists. Politicians like former
US Presidents George W. Bush and Barack Obama have

repeatedly tried to hammer this point. But we have been
oblivious to these dire warnings. That, alas, is common
human nature. Ordinary folks like us, politicians and
decision-makers tend to ignore a problem until it hits us.
Politicians like to invest in areas where the result is more
tangible. When a rocket reaches the moon or Mars, it gets
huge publicity. On the other hand, in a plan to prepare for
a pandemic, the visible return on investment is hard to
quantify. During the Ebola pandemic, Bill Gates said that
we should not worry only about Ebola. We need to
prepare for other future viral infections too. After the
novel coronavirus hit us, is there the slightest doubt about
how right he is?
There is a rumor making the rounds even about Bill Gates
and his predictions. Some suspect that he is somehow
involved in creating this viral pandemic. Rumor travels at
lightning speed, far quicker than truth; having to choose
between a colorful rumor and a drab fact, people will
choose a rumor – and spread it – every time. We talk
about this in greater detail in Chapter 8.
“If anything kills over 10 million people in the next few
decades, it’s most likely to be a highly infectious virus
rather than a war,” Gates said. “Not missiles, but
microbes.”
So, what is the takeaway from all of this?
It all boils down to the fact that warnings of a viral
pandemic were plainly before our eyes, not as a fictional

novel, but from analysis of data and science, like a weather
forecast. Many predicted it and warned us about it, but we
did not pay attention. Even the most advanced countries
of the world, it turns out, were utterly unprepared.
Perhaps we shall learn a lesson from this experience and
be better prepared for the next pandemic.

CHAPTER 5
How Do Pandemics Spread? How Can
We Manage a Pandemic?
When we look into recommendations and findings from
reputable health organizations such as WHO, NIH, CDC and
respectable news agencies such as the BBC, The New York
Times, The Washington Post, there is unanimous agreement
that we still have a lot more to learn about the novel
coronavirus spread and the nature of Covid-19 disease. New
research is ongoing and new information is emerging even as
we speak. Not everything is definitive yet. The CDC and other
organizations are very open about acknowledging this
provisional nature of our knowledge.
The symptoms of Covid-19 are dry cough, fever and
generalized weakness. If these are accompanied by
respiratory distress, pressure in the chest and inability to
move around, one should seek medical help [23] . It may
progress to pneumonia.
Once the virus invades the lungs, it makes millions and
billions of copies. When the lungs cannot expand and air
exchange cannot occur, a ventilator is needed, which is a
mechanical way to aerate the lungs. Otherwise, patients
may die from respiratory failure.
Immunity plays a huge role in Covid-19 patients. Older
people, patients with pre-existing lung disease, diabetic,

and overweight people are at increased risk. A balanced
diet and exercise may have a protective role by improving
the immune system.
The incubation period of the novel coronavirus is 2-14
days. The time from contracting the disease to the
beginning of symptoms is the incubation period. In simple
terms, it means that from the time of contracting the
virus, symptoms may be totally absent for 2-14 days
before flaring up. But the person will remain potentially
infectious to others during this period. So, they will keep
infecting others without knowing they are infected. As
long as the infected person keeps infecting others, it is the
contagious period. The common cold or influenza have an
incubation period of 1-4 days. The contagious period is
only one day before the symptoms start. So, influenza or
common cold patients can spread the disease for only one
day without knowing they have the disease.
What is noteworthy is that novel coronavirus-infected
patients can infect others without knowing it for about
14 days. This is the main reason why it spreads so easily
from person to person. Another reason is that this virus
can survive on solid surfaces such as steel, plastic and
glass for a long time.
There are two ways to get the infection. One is directly
from an infected person; the other is to get the virus from
a surface where it has been sitting outside the host. It
enters the human body through three routes: nose, mouth
and eyes. That is why we constantly hear the warning: “Do

not touch your face.” The hand is very easily contaminated
with the virus. If we wash our hands for 20 seconds with
soap or use hand sanitizer containing at least 60 percent
alcohol, the virus can be largely avoided. But if we touch
our face before we clean our hands, it can enter our body
quite easily.
Sneezing or coughing by an infected person produces a
gust of droplets of particles, spread out like an aerosol in
the immediate area. These are very tiny particles that float
in the air for a variable time. If the particle is very tiny, it
will remain suspended in air for a long time. A bubble or
water particles in the cloud can remain in the air or travel
a long distance. What about the droplets of aerosols
coughed by a coronavirus-infected person? In February
2020, scientists thought the virus is present only in the
larger droplets and then quickly settled on the ground.
Then a research article published in the New England
Journal of Medicine in March 2020 pointed out that the
virus is present in small droplets as tiny as 1-5 micron as
well, which is one-thirtieth the width of a hair! With the
larger droplets, the probability was high that it wouldn’t
travel for more than six feet. That is why we heard so
many warnings about maintaining a distance of six feet
from other people. But now it seems that the virus may
travel further in small droplets and remain suspended in
air for about three hours. If an infected person spreads his
breath, aerosol-style, in the air inside an elevator, another
person inhaling this air may contract the virus even after
the infected person is gone.

So, is it not obvious that wearing a mask will protect us?
The CDC first said that masks are unnecessary, but in
March 2020, agreed that masks would protect people.
Now it is universally accepted that masks will protect us
and everyone around us.
How long can the virus survive on hard surfaces? Outside
the host, the virus is not a living organism. So, the terms
“living” and “dead” do not strictly apply to the virus. The
real question is how long will it remain viable to infect a
host? Multiple factors influence the viability of the virus.
Temperature, humidity and velocity of air -- all play a role.
Our present knowledge about the novel coronavirus tells
us that it survives longer in cold temperatures. Richard
Grey of the BBC, a futuristic science writer, wrote, “It
survives about three days on a solid surface like plastic and
steel in 21-23 degrees Celsius (70-73 degrees Fahrenheit).”
But if the temperature is 4 degrees Celsius, it can survive
up to 28 days! It is worth mentioning here that the
temperature in a refrigerator is about 4 degrees Celsius.
The SARS virus, another coronavirus, is rapidly destroyed
at a temperature of 56 degrees Celsius (132 degrees
Fahrenheit) and higher.
Another important note: The temperature of the healthy
human body is pretty much fixed. Once it infects the
human host, the outside ambient temperature becomes
irrelevant.
The Massachusetts Institute of Technology is very diligent
in publishing novel coronavirus information on their

medical website. The website has a Q&A section, as
information tends to change quickly as we acquire new
information about the novel coronavirus on an almost
daily basis. They have thoughtfully appended the date to
all answers so that the reader may realize that this may be
old news, and newer facts may have been discovered after
this. [24] I am posting below some information from the
MIT website with proper credit and the date of posting.
Covid-19 FAQs from the MIT Website
What is the 2019 novel coronavirus?
The 2019 novel coronavirus, or Covid-19, is a new
respiratory virus first identified in Wuhan, Hubei Province,
China. It’s called a “novel” — or new — coronavirus,
because it is a coronavirus that has not been previously
identified.
February 29, 2020
Where did Covid-19 come from?
Covid-19 is the same type of coronavirus
as MERS and SARs, both of which originated in bats. Many
of the first people to contract Covid-19 in Wuhan either
worked or frequently shopped at a large seafood and liveanimal
market, suggesting animal-to-person spread.
February 29, 2020
What are coronaviruses?`
Coronaviruses are a group of viruses that have a crownlike
(corona) appearance when viewed under a
microscope. Common human coronaviruses usually cause
mild to moderate upper-respiratory tract illnesses, like the
common cold, with symptoms that last only a short time.

However, two other human
coronaviruses, MERS and SARs, have been known to cause
severe symptoms and even death.
January 30, 2020
What are the symptoms and signs of Covid-19?
According to the Centers for Disease Control and
Prevention (CDC), symptoms of Covid-19 include fever
greater than 100.4°F (38.0°C), chills, dry cough, fatigue,
shortness of breath or difficulty in breathing, sudden loss
of sense of smell or taste, nasal congestion, runny nose,
sore throat, nausea or diarrhea, muscle or body aches and
headache. These symptoms typically begin gradually.
Not all affected individuals will exhibit all symptoms, and
there is now evidence that up to 40 percent of infected
individuals will have no symptoms at all. If you are
concerned about symptoms you are experiencing, call MIT
Medical’s Covid-19 hotline at (617) 253-4865 to speak with
a clinician and get advice about what to do next.
August 20, 2020
How does Covid-19 spread?
According to the Centers for Disease Control and
Prevention (CDC), the virus is thought to spread mainly
between people who are in close contact with each other
(within 6 feet). The virus spreads through respiratory
droplets produced when an infected person coughs,
sneezes, or talks. These droplets can land in the mouths or
noses of people who are nearby or may be inhaled into the
lungs.
It may also be possible to get Covid-19 by touching a

surface or object that has the virus on it and then touching
your own mouth, nose or eyes. However, scientists do not
believe this is the main way the virus spreads. To minimize
the possibility of contracting the virus in this way, the CDC
recommends frequent hand-washing with soap and water
or using an alcohol-based hand rub. The CDC
also recommends routine cleaning of frequently touched
surfaces.
April 7, 2020
What does “close contact” mean?
The CDC defines “close contact” as either (i) a “prolonged
period of time” spent “within approximately 6 feet (2
meters) or within the room or care area” of an individual
who has been positively diagnosed with the virus or (ii)
“direct contact with infectious secretions.” Examples
include sharing eating or drinking utensils, close
conversation, or kissing, hugging and other direct physical
contact. “Close contact” does not include activities such as
walking by a person or briefly sitting across a waiting room
or office.
January 30, 2020
If I were exposed to Covid-19, how long would it take for
me to become sick?
The time between exposure to a contagious illness and the
onset of symptoms is called the “incubation period.”
Based on what has been seen previously with
similar viruses, the CDC has estimated the incubation
period for Covid-19 to be in the range of 2–14 days.
April 7, 2020

What underlying health conditions or other factors may
increase my risk of more severe illness or other
complications of Covid-19?
The risk of severe illness or death from Covid-19 increases
steadily with age. Eight out of 10 Covid-19 deaths reported
in the United States have been among individuals aged 65
years and older. Certain underlying medical conditions also
increase your risk for severe illness. These include type 2
diabetes, serious heart conditions, sickle cell disease,
COPD (chronic obstructive pulmonary disease), chronic
kidney disease, immune deficiency and obesity, defined as
a body mass index (BMI) of 30 or higher. Other medical
conditions, such as asthma, smoking, and pregnancy may
also increase an individual’s risk of severe Covid-19 illness.
September 8, 2020
Who can get tested for Covid-19?
If you are concerned about symptoms you are
experiencing or have been in close contact with someone
who has tested positive for Covid-19, you can be tested at
MIT Medical if you live or work on campus or at another
MIT facility and/or if you get your primary care at MIT
Medical. Call MIT Medical’s Covid-19 hotline at (617) 253-
4865 immediately, and we will arrange for you to be
tested. If you do not live or work on campus or at another
MIT facility and you do not get your primary care at MIT
Medical, you should call your own primary care provider
for advice about what to do next.
If you need a Covid test for travel, documentation, or
another reason, and you get your primary care at MIT
Medical, you can be tested at MIT Medical. Call our
Primary Care Service at 617-258-9355 to make an

appointment. NOTE: Insurance does not cover testing that
is not medically necessary, so you will be billed for the cost
of this testing.
If you are coming to campus regularly, the Covid Pass
app will notify you when you need to be tested. But,
remember, if you have symptoms or have been exposed to
someone who has tested positive for Covid-19, do not
come to be tested at the Covid Pass testing site. Instead,
call MIT Medical’s Covid-19 hotline at (617) 253-4865.
September 10, 2020
How can I protect myself from Covid-19?
There are four main ways to protect yourself from Covid-
19:
● Pay attention to personal hygiene.
● Practice social distancing.
● Wear a face covering in public.
● Keep surfaces clean.
See Four ways to protect yourself and others from COVID-
19.
June 8, 2020
How long does Covid-19 live on surfaces? Is it safe to
handle mail and packages? What about take-out food?
While it is theoretically possible to get Covid-19 by

touching a surface or object that has the virus on it and
then touching your own mouth, nose, or eyes, this is not
the main way the virus spreads.
A study in the New England Journal of Medicine reported
that, in laboratory tests, the virus was detectable for up to
72 hours on plastic and stainless steel surfaces, up to 24
hours on cardboard, and up to four hours on copper. But a
detectable amount of virus may not be enough to cause
infection. In fact, most viral particles die relatively quickly
outside of the body. Even on stainless steel and plastic, the
half-life of the virus — the length of time it takes for half of
the microbes in a given sample to die — was 5.6 and 6.8
hours respectively. On cardboard it was less than four
hours.
While mail and packages could have small amounts of
infectious viral particles on them, the risk is relatively low.
To be safe, wash your hands after opening packages or
mail. Similarly, any small risk from take-out containers can
be mitigated by transferring the food to your own dishes,
disposing of the packaging in which it was delivered, and
washing your hands before eating.
June 8, 2020
How long do Covid-19 particles remain in the air? Is it
safe to go outside for a walk, even if I take stay six feet
away from passers-by?
A study in the New England Journal of Medicine reported
that Covid-19 viral particles could remain suspended in the
air for as long as half an hour. However, while this
research showed the virus remaining airborne longer than
originally thought, it also showed that the particles

disperse quickly. This means that unless you are physically
close to an infected person, you are unlikely to be at risk
from viral aerosols.
So, by all means, go for that walk! Exercise and fresh air
are important for both physical and mental health,
especially at this time. Your risk of becoming infected by a
stray bit of airborne virus while out on a walk and
maintaining a safe distance from others is minimal.
April 7, 2020
Can I get Covid-19 from airborne particles that end up in
food?
Probably not. While we are still learning more about the
virus, according to the CDC, there is no evidence to
support transmission of Covid-19 associated with food.
This is not surprising based on what we know about the
varying paths organisms take to make people sick.
Respiratory viruses, like Covid-19, typically attach to cells
in places like the lungs and cannot survive the acidic
environment of the digestive system. In contrast, the
microorganisms that cause digestive illnesses, like
norovirus and salmonella, survive the acid in stomachs and
make people ill by attaching to the cells inside people’s
guts.
In addition, any viral particles landing on food would not
be expected to remain viable for long. Unlike bacteria,
viruses cannot grow inside food, so any amount of virus in
food would diminish over time, rather than grow.
When it comes to food and Covid-19, the biggest risk is

contact with other people — like cashiers, restaurant staff,
or people delivering food. Minimizing or completely
eliminating those contacts will greatly reduce any risk
associated with food.
April 7, 2020
When do I need to wear a mask?
The CDC recommends that individuals wear non-medicalgrade,
cloth face coverings in public settings where it may
be difficult to maintain social distancing, such as grocery
stores. This recommendation is based on evidence that
individuals may be at their most contagious in the 48–72
hours before symptoms are noticeable. In addition, it is
now estimated that up to 25 percent of infected
individuals remain asymptomatic and may unwittingly
infect others. If everyone wears masks, this might help
prevent those who are unknowingly infected from
spreading the illness.
However, the CDC emphasizes, they are not
recommending that individuals purchase surgical masks or
N-95 respirators that are desperately needed for frontline
healthcare workers. Rather, the CDC recommends making
your own. You can sew a mask or use a 3D printer; the
links below are a good place to start, but lots of other
patterns and how-to videos are just a web search away.
This video, for example, shows you how to create a no-sew
face covering using a T-shirt or face towel and a couple of
rubber bands or elastic hair ties.
Do-it-yourself face masks
● DIY cloth face mask

● How to make a face mask
● Simple respiratory mask
June 8, 2020
What is an “N95 mask,” and do I need one?
An N95 mask, or an “N95 particulate-filtering facepiece
respirator,” is a medical-grade respirator that is designed
to fit tightly around the nose and mouth. When worn
correctly, it forms a tight seal on the wearer’s face and
blocks out at least 95 percent of small airborne
particles, according to the CDC. While very uncomfortable
to wear, this type of heavy-duty mask is recommended for
any healthcare provider who is caring for a patient with an
illness that may be transmitted through particles or
droplets in the air.
No, you don’t need an N95 mask. There is no
recommendation from any public health agency that
members of the general public wear N95 masks. However,
the CDC recommends that individuals wear non-medicalgrade,
cloth face coverings in public settings where it may
be difficult to maintain social distancing. Because the virus
is often spread by individuals who are asymptomatic, your
face covering will protect others, and their face coverings
will protect you.
June 8, 2020
Should I wear disposable gloves when I go out in public?
No, while it may be possible to get Covid-19 by touching a
contaminated surface and then touching your own mouth,
nose, or eyes, experts at the CDC do not believe this is the
main way the virus spreads. In addition, people who wear

gloves often end up touching their faces as often as
anyone else, and sometimes even more often, because
gloves can give people a sense of false security, which
makes them less attentive to good hygiene practices.
Although the CDC does not recommend that the general
public wear disposable gloves to prevent the spread of
Covid-19 or other viruses, they do recommend wearing
disposable gloves if you are caring for someone who is ill,
particularly when handling their laundry or potentially
coming into contact with their bodily fluids.
April 7, 2020
What should I do if I have been in close contact with
someone who was later diagnosed with Covid-19?
If you have been exposed to a person with Covid-19, it
could take up to 14 days to know if you will get sick.
During that time, it will be important for you to selfmonitor
for symptoms and practice social distancing to
avoid infecting other people if you do have the virus:
● Take your temperature twice a day, morning and
night (and at least 30 minutes after eating,
drinking, or exercising and 6 hours after taking any
temperature-lowering medication, such as
ibuprofen or aspirin). Write down your
temperature in a log.
● Be alert for any other symptoms of Covid-19,
including cough or difficulty in breathing.
● Call your healthcare provider if you have a cough,
trouble breathing or a fever (temperature of
100.4°F or 38°C). DO NOT go to an emergency

room, urgent care clinic, or healthcare provider’s
office without calling ahead.
● Stay home as much as possible, and avoid close
contact with other people, even people you live
with.
April 7, 2020
Is it possible to live with someone who is selfquarantining
because they are sick with Covid-19 or may
have been exposed to the virus?
Yes, it’s possible, but it isn’t easy. The individual who is
self-quarantining must stay as separate as possible from
other people sharing the living space. They should stay in
their own bedroom and, if possible, use a bathroom that is
not shared with others. If the self-quarantining individual
needs to come out of their room for any reason, they
should wash their hands and wear a mask. If there’s only
one bathroom, set up a bathroom rotation in which the
self-quarantining individual uses the bathroom last and
then disinfects it thoroughly (read more about proper
disinfection techniques).
Clean and disinfect commonly touched surfaces
frequently. This includes countertops, doorknobs, light
switches, and bathroom surfaces. Wash your
hands frequently.
Do not share any items with the self-quarantining
individual. This includes dishes, drinking glasses,
silverware, towels, phones and remote controls. If
possible, use a dishwasher to clean and dry dishes and
silverware used by the self-quarantining individual. If this
is not possible, wash them by hand using detergent and

warm water. Dry them thoroughly, using a separate dish
towel.
April 7, 2020
Should I cancel house-cleaning services?
Maybe. There’s no one-size-fits-all answer. Taking into
account your individual risk of complications from
contracting the virus, such as age or underlying medical
conditions, it may make sense to suspend house-cleaning
services during this time. However, recognizing that
house-cleaners are often immigrants and low-wage
workers, you may want to consider continuing to pay
them if you can afford to do so.
If you do continue to use house-cleaning services, it’s
important to take precautions that protect both you and
the cleaners. Even though they are there to make your
house clean, they could still transmit the virus to you, or
you to them, if either of you were infected. Make sure
your cleaners don a fresh pair of disposable gloves when
they enter your home and change them often while they
are working. Stay at least six feet away from your cleaners
while they are in your home. Ask them not to come if they
feel sick, or if you become ill. You might also think about
trying to limit the amount of time they spend in your
home each time they visit; perhaps more time-consuming
cleaning jobs, like washing windows, can wait another
month or two.
There’s no way to remove all risks associated with having
people come into your house to clean, but being vigilant
about following these precautions will mitigate these risks
if you continue to use house-cleaning services during this

time.
April 7, 2020
Can I donate blood or plasma during this time?
Yes, if you are healthy with no symptoms of upperrespiratory
illness and no underlying medical conditions,
and you haven’t traveled recently, then
donating blood, platelets, or AB Elite plasma is one of the
safest and most effective ways you can help our medical
community right now.
According to the Red Cross, employees at every blood
drive or donation center follow strict safety protocols that
include changing gloves often, wiping down donortouched
areas after every collection, preparing the donor’s
arm with an aseptic scrub, using sterile collection sets, and
conducting mini-physicals to ensure that each donor is
healthy and well. They are also practicing enhanced
disinfecting of equipment, providing hand sanitizer for use
throughout the donation process, and spacing beds to
follow social distancing practices between donors.
You can make an appointment online at one of these local
donation centers:
● Children’s Hospital
● Massachusetts General Hospital
● Dana-Farber Cancer Center & Brigham and
Women’s Hospital
Or go to the Red Cross website and enter your zip code to
book an appointment at a location close to your home.
April 7, 2020

I’ve heard that the most serious Covid-19 symptoms
involve pneumonia. Does having had the pneumonia
vaccine give me a measure of protection against this type
of pneumonia?
No. The pneumonia vaccine you got protects against a
specific type of pneumonia caused by the Streptococcus
pneumoniae bacteria. That vaccine will not protect against
the type of viral pneumonia caused by Covid-19.
April 7, 2020
You can visit the MIT website by clicking on this link and
find the latest information .
https://medical.mit.edu/faqs/COVID-19

CHAPTER 6
How Devastating Will Covid-19 Be?
Let us start on a positive note. All experts agree that the
Covid-19 pandemic will end one day, like all others before
it. We have had Ebola, SARS, MERS and swine flu (H1N1) in
the recent past. In 1918, the Spanish flu was a devastating
pandemic during the First World War, killing 50-100
million people. It spread more among soldiers, as they
lived in close quarters. When the war was over, soldiers
spread out, and the pandemic gradually died down. This
theory is changing as many researchers now think the
soldiers took it to different part of the world.
Picture 10: Novel coronavirus
Even though significant progress has been made to date,
we do not have any Covid-19 vaccine available for mass
immunization, or any definitive treatment for the disease.

How and when will this pandemic end? Experts have some
predictions and are forecasting likely scenarios.
Summer heat will gradually kill the virus. It is plausible,
but scientists still do not know the nature of the virus. We
already passed summer; there is no sign of its dying down.
Even though it was somewhat subdued in summer, it
flared up again in fall.
Quarantine may solve it. If all the patients are
quarantined, it will not infect a new population. But
absolute quarantine is nearly impossible. It is not even
practical to detect everyone with the infection and isolate
them.
Social distancing will stop the spread of disease from
person to person. Therefore, fewer and fewer people will
be infected. Now that scientists know the mode of
transmission, they are urging people to maintain a
distance of at least six feet between persons. A handshake
is completely forbidden, and social get-togethers are a nono.
No large gathering should be permitted. This will
prevent the growth of the pandemic. Wearing a mask is a
must when in a crowd or in a closed space with others.
Vaccine. Once we have an effective vaccine, it will protect
people. A lot of research is going on for vaccines, and the
light at the end of the tunnel does not seem too far.
However, it is at least months away. Vaccines need lots of
trials before it can be administered to people. Usually, the
first trial is on laboratory animals, and if successful, then
on human volunteers. There are three stages of a clinical
trial which any drug or vaccine must undergo before being
used on humans. It’s particularly important to find out the

effects of the vaccine on people who use other
medications, have underlying diseases, or have an
alternative lifestyle. It takes time to find out all the side
effects of a vaccine and declare a candidate vaccine as
safe.
The FDA (Food and Drug Administration) is the final
authority to approve any drug or vaccine in the US. To get
this approval, first, a drug must be tried on twenty to
eighty volunteers. If found to be safe, it is administered to
a few hundred volunteers to gauge its efficacy. After
crossing this hurdle, a large clinical trial on a few thousand
volunteers in different age groups and demographics is
performed. Some vaccines for Covid-19 are already in
clinical trials, and hopefully we shall have a safe and
effective one soon.
Antibody. Once most of the population develops
antibodies against the novel coronavirus, it will not cause
disease in that group. Usually, when a microbe infects a
person, the body produces antibodies against it.
Knowledge of that antibody persists in the body for a long
time, sometimes forever, and gives immunity against that
infection. As a result, the same microbe cannot cause
disease in the person with antibodies in the system. We
are still unsure what type of antibody is produced against
the novel coronavirus and how long it lasts in the body
after the first infection. Immunity from coronavirus
depends on these factors.
Antibodies play an interesting role in preventing diseases.
Antibodies are immunoglobulins, which are produced in
the B lymphocytes, a type of white blood cell. They
circulate in the blood stream throughout our bodies.

Microbes have antigens, a protein, present on bacteria,
viruses, fungus and parasites. The antigen is the key the
microbe uses to get into host cells, or in other words,
opens the lock of the host cell. Chemicals and non-living
organisms, such as pollens, have antigens too. When a
foreign (non-self) substance gets into the body, our
immune system detects it as an "enemy" and begins to
produce antibodies against it. This is the body's attempt to
protect us from injurious outsiders, such as pathogens or
allergens. There are innumerable types of antibodies, each
specific to a certain invader. Billions of antibodies are
produced against a specific antigen. Once produced, the
antibody neutralizes the antigen and protects us from that
microbe.
Let us take a closer look into immunity. Suppose a virus
has the key to open the lock of a host cell. The antigen
present on the surface of the virus will attach to the host
cell surface protein. The viral antigen's key must be a
perfect match for the lock on the host cell surface. This
attachment is crucial for the virus to gain entry into the
cell. The antibody is a Y-shaped structure that attaches to
the antigen on the viral surface and blocks it. Thus, the
virus is neutralized and cannot use the “key” to enter the
cell. To neutralize a virus, the antibody must be quite
specific for it.
When our body is exposed to a new virus, it can take days
and sometimes weeks to produce the specific antibody to
neutralize the new virus. The immune system starts a trialand-error
process by continuously producing different
types of antibodies. Once the right antibody is produced,
the memory of this virus, more specifically the viral
antigen, usually remains active forever. When the same

virus enters the body again, the immune system
remembers it from prior exposure and immediately
produces the right antibody against it. In subsequent
exposure, the virus is neutralized quite fast, before the
onset of disease.
Many diseases are cured or self-limiting because of our
immune system's ability to produce the correct disease
antibodies. Antibody and immune-memory are key players
behind a vaccine. A dead or attenuated live pathogen is
introduced in the body by a vaccine. This pathogen cannot
cause disease, as it is not virulent enough or is dead. But
the immune system reacts to it and produces the specific
antibody to fight it, and of course, saves the information in
its immune memory. This specific antibody's faster
production from immune memory protects us when the
actual virulent microbe attacks us.
Convalescent Plasma therapy is a wonderful tool
occasionally used in the treatment of severely ill patients.
If someone survives an infectious disease, there is enough
antibody present in the blood. Blood has two components:
cells and plasma. The antibody is present in the plasma.
The plasma, rich with antibody, can be taken out of a
recovered patient and transfused into a sick patient. The
antibody present in the plasma will fight the pathogen in
the recipient patient and may cure the disease. This type
of immunity is called passive immunity. The patient did not
produce the antibody but borrowed someone else's
antibody to fight the disease. Some countries and
institutions have treated Covid-19 patients with plasma
therapy. FDA considers it a promising treatment in
severely ill patients (recently approved) but is still at an
experimental phase for Covid-19. Another important
aspect of plasma therapy is that the donor does not have

to donate blood cells to donate more plasma, which he
would have to do in the case of direct blood donation.
According to “Covid-19 Herd Immunity: Where Are We?”
an article published Sept. 9, 2020, in the science magazine
Nature: “Through vaccination or infection with novel
coronavirus, if 67 percent of the population develop
antibodies by either means, it will produce herd
immunity.” [25] , , also referred as “community immunity”.
The concept of herd immunity comes from American
livestock veterinarians in the early 20th century, when
they tried to protect cows from certain epidemics. Herd
immunity implies a situation when almost the entire
population acquires immunity. Herd immunity protects
against the spread of the infection.
We cannot fight Covid-19 on one front only. All the
weapons that we can marshal must be utilized to save us
from the crisis. Now the big question is this: How dire is
novel coronavirus?
Novel coronavirus is not necessarily a fatal disease. At first
it causes fever and cough of variable degree, quite like
influenza. Around 80 percent of Covid-19 patients will be
cured on their own. Similar to influenza, it is more
dangerous in the case of the elderly and people with preexisting
diseases. But while we have medicines for flu,
there is virtually no protection against the novel
coronavirus. The death rate in influenza is 0.1 percent (one
in thousand), but the novel coronavirus kills anywhere
from 1-2 percent of the people it infects. We can see that
the death rate is 10-20 times more than flu but getting
infected with Covid-19 is still not necessarily a death
sentence. What’s noteworthy is that country, locality and

many other factors play a role in determining the Covid-19
death rate. But then, this is true for determining the death
rate for any disease.
If Covid-19 is not a vicious, deadly disease, why is
everyone so worried about it? Why all these precautions,
quarantine, lockdown, travel restrictions? Perhaps the
most important reason is that we do not know everything
we need to know about this virus. This virus infects a
person, and before he or she is aware of it, the infected
person starts contaminating others. That is not usually the
case in influenza. Novel coronavirus spreads through
coughing, sneezing and the respiratory route. One infected
person, on an average, infects 2.2 people. All the
continents except Antarctica now have this pandemic. This
is the most widely spread pandemic after the Spanish flu in
1918.
A pandemic does not necessarily mean a deadly disease. A
pandemic is a widespread disease across countries and
continents, regardless of its severity. Why, then, is
everyone so worried about it? If we cannot control it now
or it limits itself, it will come back repeatedly. We are not
even sure if antibodies will protect against a re-infection.
Research is going on, but there’s still so much about it
that’s unknown. It may produce a new strain; it may
mutate and change its form, making available treatments
and vaccines ineffective.
Besides its health hazard, its economic impact on the
world has been devastating. Borders between countries
are locked down; travel has come to a standstill, industries
and businesses have been shut down. Even the 2020
Olympic games have been postponed, Haj, the annual
Muslim pilgrimage to Mecca in Saudi Arabia, has been

vastly modified. The entire world is feeling the impact of
Covid-19. Economists are predicting a recession and
economic downturn across all continents.
How does a lockdown help protect us against Covid-19?
Lockdowns have clearly caused an economic disaster, but
is it necessary? Let us take a critical look. If a country is
under total lockdown, the virus will not spread from
person to person. Even the viruses present outside the
host in the air or solid surfaces will be dead in a few days.
The infected persons will carry the virus for about three
weeks. Thus, after 3 / 4 weeks, the disease's progression is
totally halted, and the disease is completely eradicated
from that country.
It is true that this is a very theoretical scenario. Reality is
messier. A lockdown is never 100 percent successful; some
people will defy it. The disease will spread between family
members living in the same household. But it will not
spread exponentially and will be contained soon. This is
called “flattening the curve.” We discuss this in greater
detail later in Chapter 9.
Our civilization needs to prevent the spread of the virus
and contain it as quickly as possible. Health experts and
policymakers must step forward and come up with
definitive guidelines.