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THE CORONAVIRUS FROM THE HORSE'S MOUTH - INTERVIEW WITH DR. RAYANE RAFEI


Introduction by Dr. Ali Raddaoui

It is possible that the Coronavirus is here to stay, at least for the foreseeable future; it’s all over the place, on social media outlets, on the airwaves, TV channels, printed media, and our very own daily conversations. I am Dr. Ali Raddaoui, owner and founder of idiomoptima.com, and I have the distinct pleasure to inviting renowned Lebanese microbiologist Dr. Rayane Rafei to weigh in on the Coronavirus and to share her expertise on many of the hot questions we are debating today.

Who is Dr. Rayane Rafei? Rayane is an Assistant Professor at the Faculty of Public Health at the Lebanese University. In 2014, she earned a doctorate in microbiology from the Lebanese University and the University of Angers in France. She is an active member of the Team of Laboratoire de microbiologie, santé et Environment (LMSE). LMSE is affiliated with Doctoral School for Science and Technology, and the Faculty of Public Health at the Lebanese University. Dr. Rafei has published more than 20 articles in internationally peer-reviewed journals. Dr. Rafei can be contacted at rayanerafei@hotmail.com

1. Dr. Rayane Rafei, welcome to the program. Please fill our audience in on the background to the current Coronavirus crisis.

COVID-19 is not the first pandemic experienced by humankind over history; many deadly pandemics occurred such as the Plague, smallpox, cholera, and the Spanish Flu. What these pandemics have in common is that the infectious agents can spread all over the world by means of accelerated human mobility, and by that I mean ease of national and international travel, military deployments, migration waves, mass tourism, etc.

In the last century, the human population witnessed many pandemics caused by flu-causing viruses namely influenza A Spanish Flu (H1N1),1918-1919, Asian Flu (H2N2), 1957–1958, Hong Kong Flu (H3N2), 1968–1969, and Swine Flu (H1N1), 2009.

This pandemic has its origin in the last flu pandemics since it is caused by the novel coronavirus named SARS-CoV-2, even though influenza and the novel Coronavirus are respiratory viruses sharing many clinical symptoms such as fever, cough, chills, and headaches.

2. In what sense is the Novel Coronavirus new?

Coronaviruses are a viral family encompassing four well-known human coronaviruses (229E, HKU1, NL63, and OC43) all causing the common cold. However, the discovery of the Novel Coronaviruses (SARS-CoV in 2002 and MERS-CoV in 2012) has changed the history and impact of such a family because these viruses were responsible for severe acute respiratory infections. Unfortunately, the SARS-CoV and MERS-CoV had high fatality rates of 9.63% and 34.45% respectively. In numbers, of 8,096 SARS-CoV confirmed cases, 774 died, and of u2,519 MERS confirmed cases, 866 died. Luckily, these recent coronaviruses did not put healthcare systems under severe strain and were not declared pandemics outright because of their limited outbreaks. Even though the novel Coronavirus (SARS-CoV-2), is less fatal than the two recent 2002 and 2012 coronaviruses, it has killed 302,169 persons as on 16 May, a number 184 times higher than the combined number of deaths caused by both MERS and SARS.

3. That’s very interesting. Now, how is the current COVID-19 pandemic different from earlier ones?

Well, the current pandemic caused by SARS-CoV-2 is significantly different from conventional influenza pandemics. Consider the fatality rate for example. The fatality rate caused by the common seasonal influenza viruses for persons who become sick is .1%. That of the 2009 Swine Flu pandemic of .02% is also much lower than COVID-19. Loss of life caused by COVID-19 surpassed 3% and peaked as high as 15% in some countries. Here is an interesting statistic for you to go by: as of 16 May, if we divide the number of COVID-19-related deaths (302,169) over global cases (4,434,653), the crude case fatality rate for COVID-19 is 6.8%. In actual fact, the picture is much more complex as this number is being revised down. Other studies estimate a lower fatality rate of 2.3% for COVID-19. Even though the 1981 Spanish Flu was, by far, the deadliest influenza pandemic killing 20 million, its estimated case fatality rate (2.5%) seems akin to that of COVID-19 (2.3%). The higher number of deaths can be attributed to the circumstances surrounding the Spanish Flu, namely poor sanitation, weakened medical systems, and more generally World War I. Our modern world boasts way better sanitation and more robust healthcare systems. Meanwhile, let’s keep in mind that if the 6.8% fatality rate of COVID-19 drops, it will be as bad as the 1918 Spanish flu. If it continues on its current trajectory, COVID-19 will be almost three times as deadly.

4. What differences are there in the profiles of those who succumbed to these pandemics?

There are significant differences in the patterns and profiles of those who die by COVID-19 and those who died of the Spanish Flu. Many younger people aged 20-40 and more pregnant women lost their lives fighting off the Spanish Flu than those aged 50 and beyond. What this suggests is that at that time, older people did have immunity because they may have already been infected by similar viruses years earlier. This is not the case with the Novel Coronavirus (SARS-CoV-2), since anyone, regardless of age, race, gender, ethnicity and so on risks developing COVID-19. Generally speaking, though, SARS-CoV-2 is known to cause minor symptoms in children; adults aged 20-40 are likely to develop less severe symptoms than older adults. It is also possible that some groups of people have a higher level of immunity against SARS-CoV-2, but more studies should be conducted to verify this claim.

5. How different is the Coronavirus in terms of its potential to spread?

This is a good question. For starters, COVID-19 is much more infectious and contagious than the conventional influenza. During the Swine Flu, an infected person was likely to transmit the virus to 1.4 to 1.6 persons. COVID-19 infected persons, on the other hand, could infect on average 2 to 2.5 persons, but recent estimates predict high contagiousness and the potential to transmit infections can go as far as 5.7 persons.

6. Finally today, what kind of role has social media played in the current pandemic?

That’s another great question. Now, this is the first pandemic ever to go out of hand in the era of social media so to say. Social media may have been a boon for confined people during quarantines and lockdowns in that they have helped reduce physical contact and have made social distancing easier. Interestingly though, they have also been conduits for spreading misinformation about the disease with the speed of light.

Doctor Rayane Rafei, I thank you for your time and insights. I hope to be able to meet with you soon to continue this conversation.

My pleasure, Dr. Ali. Thanks for inviting me.

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