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Do I need to smoke to protect against SARS-CoV-2


Incredibly cool art by Chinese artists dedicated to the fight against the epidemic. I took it here .

The new virus is rapidly expanding its range, dispersing the population of entire countries to a remote place and making them afraid of each other. I have a feeling that soon it will not be too much fun. I adhere to the prediction that most will somehow get sick with SARS-CoV-2 . However, this does not mean that you need to rush out the window of the tram at the first coughing neighbor.

Found some interesting facts about smoking. There is a suspicion that vapers and consumers of nicotine gum will have a bonus. But it is not exactly.

Let's try to go over the basic facts dryly and choose the most correct strategy from the point of view of game theory. For example, what is more profitable, getting sick now or hiding to the last? And I highly recommend watching a post fromMilfgard, in order to know which transport is safer to travel in and what to do if someone nearby coughs in the car.

While writing this material, there were many others on this topic. I apologize right away if I repeat myself somewhere.

UFO Care Minute


The pandemic COVID-19, a potentially severe acute respiratory infection caused by the SARS-CoV-2 coronavirus (2019-nCoV), has officially been announced in the world. There is a lot of information on Habré on this topic - always remember that it can be both reliable / useful, and vice versa.



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Judging by the fact that infection with the new strain is confirmed in almost all countries, the virus has already gone into the population and it is extremely unlikely that it will be possible to localize it. China's success can only be rejoiced, but people are not able to continuously live like a submarine under continuous quarantine. Quarantine is a cool thing if you have a leak in the laboratory where they work with the Marburg virus and there is a clear list of infected personnel. They isolated people, set the laboratory on fire , planted them in separate boxes and wait for the result. At the end of quarantine, we have no media left and the virus is dying.

If the number of infected is unknown, and they are scattered throughout the world, then you can only stop the outbreak with restrictive measures. The virus will stop only in one case - when it will have no one to infect. This can happen only in three cases:

  1. You have a significant population of people who are genetically immune to the new virus. Apparently, this is not our case.
  2. You vaccinated a significant number of people
  3. People gained resistance by having a new virus.

Now the vast majority of people are susceptible to SARS-CoV-2 and have no immunity. Approximately after 60-70% of people become ill and receive immunity, the next infected person will not be able to spread the disease further, and the pandemic will begin to fade away by itself and will take on the character of episodic local outbreaks.

Therefore, although China itself has achieved excellent results, it will only delay the inevitable. Now immunity to the new virus has received only 0.005% of the population of China. This is negligible. It is worth loosening the strict quarantine measures a little and everything will start all over again.

Why did past coronavirus epidemics such as MERS-CoV fade away? They had a very difficult infectionfrom person to person. The main reservoir was one-humped camels, upon contact with which infection occurred. Plus quarantine measures were able to crush the epidemic in the bud. According to various sources, the base reproductive number was less than unity (0.69) . This suggests that one patient infects on average less than one person per cycle of the disease. Atypical pneumonia of 2002-2003 SARS-CoV had a reproductive number of 0.8 , which also made it possible to completely suppress the epidemic. The new virus infects humans more rapidly and spreads rapidly.

Can we hold out until the development of a vaccine?


No, it seems that the vaccine in a reasonable time will not have time to develop and replicate. The most optimistic dates are no earlier than 2021. It is necessary to carefully work out all the studies, since there is a danger that the vaccine will cause a more serious disease in healthy people vaccinated with an unsuccessful vaccine. At the same time, judging by the same source, immunity to coronaviruses is relatively unstable and there is a risk of re-illness after a few months.

Why then are all these measures needed? First of all, in order to smear the peak of the disease and provide an opportunity to mobilize the medicine of all countries. Normally, the number of equipped beds in hospitals varies from 0.3 to 1.2% of the population. In Russia it is 0.71% in all directionsincluding gynecology, maternity wards and surgery. Moreover, it is understood that they are maximally loaded for optimal efficiency. The reserve, if any, is small.


The easiest way to illustrate this is with an example. If you are not doing anything at all, then a huge number of people are very ill with you. Here is a fairly simple formula: the average incubation period is from 2 to 20 days . Take 5 days as the average duration of a transmission cycle from one person to another. In addition, we will also need R 0 , the reproductive number. It reflects the average number of people that one patient infects during the period of his illness. Under conditions of quarantine measures, reducing the number of contacts between people, this number may decrease. For SARS-CoV-2, the data on R 0 vary depending on the model chosen by the researchers. One recent study gives R 0= 3.58 for transmission from person to person, and R 0 = 2.3 when transferring from an animal reservoir to a person. In fact, now only human-to-human transmission works.

Thus, the number of new infections per month will increase by (R 0 ) n times, where N is the number of 5-day transmission cycles. That is, in a month we will receive an increase of 3.58 6 = 2105 times. If on the first day we have 100 patients, then in a month we will receive 210,500 new patients, of which 42,100 (20%) will be in serious condition and will require hospitalization. At the same time, the same mechanical ventilation is often no more than 4 per hospital, and they are already occupied by patients with other pathologies. Imperial College London’s


various epidemic response scenarios

in itsan article of March 16 adheres to lower reproductive numbers, but even they predict an eight-fold excess of health resources during the peak of a pandemic, subject to strict quarantine measures.

If you do not press hard measures R 0 , you will very quickly exceed the possibilities of healthcare and get significantly more deaths instead of 4%. Therefore, quarantines are likely to be. The virus will not be defeated, but simply extended over time. Young people with a probability of 99.8% are not at risk, but it’s better to hide older parents better until 60% receive immunity.

From a risk point of view, it may be attractive to become one of the first to become infected when there is no overloaded hospital. However, given the time of incubation, you may be faced with the fact that there will be no more space in a couple of weeks. Plus, you very strongly substitute not only yourself, but also vulnerable groups of the population - patients with chronic diseases and the elderly.

It is more optimal to try to get into 40% of those who are not sick and wait for the vaccine. Moreover, in the next couple of months they will finalize the treatment protocols and will already purposefully give remdesivir / lopinavir or other effective options. This should greatly improve the picture with mortality.

What about smokers' risks?


The situation is extremely interesting and controversial. As already known, ACE2 protein is a key factor for virus fixation and penetration into the cell. The larger it is, the worse for the patient in terms of risks of infection and the rate of infection.

On the one hand, there is an article for February 19 on the first 140 patients , among whom there were abnormally few smokers (1.4%) compared with the national average (in the region of 30%). On the other hand, there is a preprint that proves an increase in ACE2 expression in the oral mucosa and lungs of smokers and model mice.

It gets even more interesting when we raise an article for 2018 - Nicotine and the renin-angiotensin system. It proves a decrease in ACE2 with prolonged exposure to nicotine on the body.

The result is incomprehensible. Smoking is definitely harmful. If you smoke and become infected, then the risks of dying are 14 times greater than the rest . Smoking was the main risk factor among those surveyed. On the other hand, it seems that vapers and people on nicotine patches with less damaged lungs are less likely to get infected due to decreased expression of ACE2.

What to do if you come from another country?


My friend works in the clinic. Recently, they were assembled on a planning meeting and the situation was formulated with a survey of patients something like this: “A week ago, we asked everyone with a cough if they came from China or Italy. Now we are just asking if there were trips abroad. We’ll not ask anything in a week. ”

Now, if you come from any country, you must lock yourself up for 14 days. Moreover, this is not optional, but necessary. Normally, you should call about this from your clinic. If you are not contacted, you can call your own clinic or hotline and please them with your arrival from Myanmar or the Azores. Similarly, they will open a sick leave.

UPDIn fact, there seems to be a legal conflict here. You are really obliged to observe quarantine only if you were handed a summons with the described regime (isolation or hospitalization). Here is a detailed analysis .

You don’t have to go to the clinic to get sick. Just call the registry, they will come to you depending on the priority of the call. Home bypass will now be enhanced. In many clinics, you simply won’t get thermometry at the entrance and you will be sent to a separate quarantine entrance, where an infectious disease specialist in an antiplague suit will be waiting for you. Further on the circumstances. Perhaps they will be hospitalized for a couple of weeks in an infectious diseases hospital or sent home for treatment.

Another option would be especially fun for the conditional therapist if you start to cough happily under the tales of a vacation in Florence. Since SARS-CoV-2 is classified as a particularly dangerous infection, the standard protocol is activated. The doctor closes the door, closes the window and for some reason closes the water. After that, he calls the head doctor and everyone is evacuated in antiplague suits. The cabinet is filled with napalm with disinfectants, and the doctor automatically goes to a two-week quarantine at home.

How do they get infected?


Air


Coughing in any enclosed space creates a cloud of drops that hang in the air, settle on surfaces and infect everything around. Then, the droplets settle and form infected surfaces, from which the virus can be transferred contactually through the hands into the eyes and oral cavity. Then the mucus and droplets dry, and the virus is picked up in the form of the finest dust particles and spreads in a large radius.

Here, you immediately need to highlight several options for the transmission of the virus through the air.
The first - droplet - these are the very droplets with which the patient sneezed. A lot of viral particles are extremely contagious.

The second is airborne, an airborne dust variant that can travel far away. It is considered low-hazard due to the small number of particles and how the transmission method has not been proven. In order to successfully infect a person, a certain minimum infectious dose of virions is required, which can successfully attach to a specific receptor on the host cell.

Viruses like measles and rubella, therefore, have a reproductive number of more than 10, which spread even through ventilation. SARS-CoV-2 virus cannot do this. Here are the latest aerodynamic studiesand the concentration of viral RNA in the air of Wuhan hospitals. Judging by the results, the toilet was the most infected place for patients, where 40 copies of RNA per cubic meter were found in the air, which is not enough for infection. At the same time, regular wet cleaning and airing solve this problem.
When infected with an aerosol, a person immediately receives a dose of virions in his lungs, where the primary reproduction begins. It can be assumed that in this case, the primary symptom will be bronchitis and cough.

Slime, saliva, and more


This is the second critical factor. We touch the door handles, handrails, etc., after which we drag it all into our mouth and eyes. The primary point of virus fixation will be the oral cavity, where ACE2 receptors are also present. From eyes to mouth, the virus will wash away a tear through the nasolacrimal canals into the nasopharynx. In this case, the primary symptoms of the virus multiplying are likely to be a sore throat. The lungs, in theory, will affect a little later, when the number of virions in the blood rises above a critical level.

Protection


To get started, worry about hand protection. Always carry sanitizers with you to handle your hands. Now it’s quite difficult to buy them, but you can try to make something out of the means at hand.

I like the option with any alcohol and wet wipes. You need to pack wet wipes in a plastic container or with a plastic valve. The usual closing sticker is simply washed off with alcohol. Then you pour at least 100 ml of alcohol there. Salicylic alcohol, boric alcohol, aseptoline or even triple cologne will do. Although the latter will smell. If you do not find alcohol in the pharmacy - go to large stores that sell consumables for soldering and repairing electronics. They always have isopropyl alcohol - it also works great, but it smells stronger.

Surfaces can be perfectly treated with a solution of sodium hypochlorite, which is "White." It costs 17-25 rubles per liter and perfectly kills all living things, starting from 0.1%. It is also used directly in medicine for the treatment of wounds and other purposes in a solution of 0.06%. But I would not advise doing this at home. The risks of burns are very high if you count something wrong. But to wash the floor with them or wipe the door handles - the norm. Cheap and cheerful.

Respirators must be used to protect the respiratory system from viral aerosol. Any gauze bandages, scarves or regular medical masks will not give you full protection. They do not provide a reduction in the number of viral particles below the infection threshold. Although it is better than nothing at all.

Therefore, you need respirators with a protection class of FFP2 or FFP3, which is even better. It was possible to buy them at construction stores, but now they have been sold out almost everywhere. In principle, they can be used repeatedly, but after prolonged wearing, you need to process them.

Optimal - heat to about 70 degrees in the oven or a hairdryer. Coronaviruses are unstable and will quickly collapse.

Summary


Now it will be difficult for everyone, especially doctors. Do not panic - this is the stupidest thing you can do. Do not eat handfuls of antibiotics - they will not protect against the virus.

Just keep a small supply of food for 2-3 weeks and carefully follow the WHO recommendations. Take care of the safety of older relatives. They need you now.

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