Corona Daily 197: Why a Needle?

The world plans to inject needles into a few billion upper arm muscles to save itself from the coronavirus. Why needles? Why can’t the vaccine be given orally like medicine, or glued on like a nicotine patch? In my childhood, we were warned that a dog bite would require fourteen abdominal injections. (The reason why many of my friends and I are not dog lovers). In fact, there is a word – trypanophobia meaning fear of needles. It is estimated that up to 10% of people may be so afraid of needles as to refuse to take injections.

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Hypodermic literally means under the skin. Hypodermic needles have a long history.

Christopher Wren, a British architect (note: not a doctor), used a cut-down technique to intravenously inject dogs in 1656. By 1660, the experiment was tried on human beings. The experiments proved fatal for the recipients. There was no knowledge about the required dosage, or sterilizing utensils. The method was abandoned for almost 200 years after that. In the nineteenth century, metal syringes were used. Sherlock Holmes used them to self-administer cocaine. In 1946, an all-glass syringe was developed, and in 1956, a disposable syringe. Plastic syringes with metal needles became the norm. After AIDS, disposable needles became a necessity.

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There are a few successful oral vaccines such as the polio vaccine. Easy to administer, their acceptance rate is higher. They can’t accidentally injure someone with needles. Storage and distribution are not a problem, no cold chain is required. Imagine how efficient the covid oral vaccine distribution would have been. A sweet pill couriered to you, no freezers, no queues, no nurses. They are also environment friendly. Every year nearly half a billion needles are thrown in landfills; in 2021, this number will exceed a billion. Annually, 75 million of the discarded needles are infected with blood-borne diseases.

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Our bodies have several natural barriers: hair in the nose, wax in the ears, acid in our bellies. Destructive chemicals and cells in our immune system are for our protection. Vaccinations need to bypass these barriers, while keeping the vaccines’ delicate components intact. Pfizer and Moderna vaccines contain RNA, which is so sensitive that vials need to be deep frozen, Pfizer in temperatures below winters in Antarctica. An injection into the upper arm ensures our cells can respond to the RNA before that genetic material degrades.

Fatty areas don’t have enough blood supply. Traditionally the buttocks were thought to be the right location for inoculation. (Imagine presidents and prime ministers taking down their pants on TV for the shots). But layers of fat don’t contain the appropriate cells to initiate an immune response. Antigens may also become defunct if they remain in fat for long. Research has indicated thicker skinfolds evoke a lowered antibody response to vaccines. Scientists suggest the length and diameter of the needle should be customized to each patient. That may be the most impractical suggestion for the covid vaccines.

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Oral vaccines are challenging because of the highly acidic GI (gastro-intestinal) environment in the stomach. The enzymes in the GI tract can degrade the fragile antigenic proteins before they can induce an immune response. Which means a higher dose of antigen is needed for an immune response as compared to the shots in the arm. Larger doses increase the risk of higher tolerance to the dose rather than protection. Oral vaccines are a real challenge, particularly for a new epidemic like covid.

The University of Sydney tried to use a liquid jet injector. Other attempts include a Band-Aid like patch made of 400 microneedles, a nasal spray vaccine and an oral tablet. None of them seem likely to succeed before the end of the pandemic.

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The hypodermic needle, manufactured in billions, may be the greatest medical device invented. Whether we like it or not, it continues to be mankind’s main weapon to save lives.

Ravi                                                                                 

Corona Daily 198: The Paranoid Grandpa in the Bunker

Try to go to Google images and search for Vladimir Putin in a mask. Can’t find it?  Because he has never worn one. No doubt a mask would dilute Putin’s manliness. Trump, Bolsonaro, Lukashenka, Johnson and several other alpha males tried not to wear masks and duly got infected. Putin has managed to stay corona-free. How? By going into isolation since last March. Except a single state television reporter who interviewed him in August, no journalist has met him face-to-face.

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Inevitably, Putin had to appear outdoors for the May day parade which happened on 24 June. The World War II veterans whom he would meet had to spend two weeks in quarantine at an isolated health resort. ‘We were bored, sat around and breathed the air’, said Lev Litvinov, a 100-year-old veteran.

Dmitry Peskov is Putin’s spokesman, whose job is to lie with a straight face. ‘This was about the veterans’ health; it was to protect them.’ said Peskov.

Since March, though, anyone wanting to meet Putin must first quarantine for two weeks. Putin has several residences, mainly Novo-Ogaryovo, the presidential estate outside Moscow, and Bocharov Ruchey, a presidential retreat in the Black sea city of Sochi. Since March, two large health resorts in Sochi have been exclusively reserved for people to quarantine for two weeks before meeting Putin.

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Moscow is the nerve center of Russia, and Putin is expected to be there to govern the country in these difficult times. But Putin loves to be in Sochi. Weather is much better, atmosphere relaxed, and in the unlikely event of a coup, he will be away from danger.

How to have your cake and eat it too? Well, Putin has created a twin conference room in Sochi identical to the one in Novo-Ogaryovo residence. The beige chairs, wallpapers, telephones, a Dell computer screen, Russian flags. In both places, there are microphones on Putin’s desk. Whenever he has videoconferences, Moscow people are happy to feel their president’s proximity. In reality, he is in Sochi.

Peskov said the president’s work spaces outside Moscow and in Sochi are not identical. The president has no identical offices. When the investigative reporters pointed out that the presidential planes are located in Sochi, Peskov said Presidential planes can be based outside Moscow. When he was probed about the flight records for the presidential plane flying from St Petersburg (which Putin had visited) to Sochi, Peskov said the flight movements were classified information which he couldn’t discuss.

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Three disinfection tunnels have been installed, one for Kremlin, and two for Putin’s two residences. These are Russian-made tunnels that look like the giant scanning machines at the airport. Walking through the tunnel feels and smells like passing through a cloud of pool-water mist.

To meet Putin even for five minutes, a person must first quarantine in the prescribed hotel for two weeks, and then walk through the disinfection tunnel.

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Putin’s paranoia is not pandemic-born, it has just become worse. A couple of years ago, at the G20 summit in Japan, while everyone else drank from wine glasses, Putin used the mug he was carrying from Russia.

“This is because he is constantly drinking tea from that Thermos.” Said Peskov when asked to explain this strange episode.

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Russia recently admitted the real covid toll is three times the official statistics, which would bring Russia to a third place in terms of covid deaths. The deaths are suppressed by a Russian regulation that puts covid as the cause of death only where an autopsy confirms presence of the virus. Putin knows the true picture. He also knows how reliable the Russian vaccine, Sputnik, is. Putin has not taken the vaccine, nor has he shown any inclination to. His age group (60+) is eligible since 26 December.

“As to whether he will take the vaccine, and if he does whether he will take it in front of the cameras, you should ask the president.” Said Peskov.

But then, to ask, a journalist may need to quarantine for two weeks and then go through the disinfection tunnel.

Ravi   

Corona Daily 199: The Sumo Wrestler

Kotokantetsu had entered the world of professional sumo wrestling after middle school. Once he joined the stable, he couldn’t complete his studies, but that was any way not expected of sumo wrestlers.

The 1500-year-old Japanese sport has 650 fighters that make up the six divisions. But only 60 in the top two divisions are the privileged ones. They make good amounts of money, are allowed to marry and have children. They are even permitted to own a mobile phone. The bottom four divisions are unpaid. They live and train together under a stablemaster. Once you join a particular stable, it is for life. Stables are not football clubs where you can jump from one to another.

Wrestlers in the bottom four divisions are aspiring to reach the first two divisions. Kotokantetsu, 22, also had that dream. Since the pandemic began, young wrestlers have been testing positive. In April, Kiyotaka Suetake, 28, became the first one to test positive. His condition rapidly worsened, and he died due to multiple organ failures. The World Sumo Champion, Hakuh0, 35, tested positive on 5 January, after losing his sense of smell. He has since recovered.

Japan’s New Year Grand Sumo tournament (2021) is currently going on. It will end on the coming Sunday. Kotokantetsu went to his stablemaster before the start of the tournament. He bowed, and recalled the heart operation he had a couple of years ago. That put him in a high-risk category. He wanted the stablemaster to excuse him from taking part in this month’s tournament.

Neither the stable nor the stablemaster had helped him when he had required the heart surgery. His divorced mother was forced to raise funds. But Kotokantetsu didn’t mention that.

The stable master looked at him and replied: You either compete, or leave the sport forever.

Kotokantetsu spent a bad night. Next day, he announced he was retiring from the sport. Once he was out of the stable, he was interviewed on YouTube. (Sumo wrestlers are not allowed to use social media in any form). In tears, he said he felt devastated. Now, he is forced to cut off his traditional wrestler’s topknot, the distinctive hair bun, and thrown on the street after eight years in the sport, with no qualifications, no savings and no job in the middle of the pandemic.

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Before Kotokantetsu’s quitting, the stablemaster had issued a statement, in which he said: “It doesn’t stand to reason that you want to drop out of the tournament because you are afraid of the coronavirus. There are people who will say they don’t want to go to work because of covid. He is one of them. But if everyone says that, work will not happen. And if he can’t deal with that, he needs to think about whether to stay or not.”

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Sumo wrestling is heavily regimented. Heya, the stable, is an all-male boarding house. Women, because they are considered impure, are not allowed to take part in the sport, they are not even allowed close to the ring. Only wrestlers in the top two divisions are allowed to have families, but if due to poor performance or injury any of them is demoted to the third division, they must leave their wives and children and be part of the all-male stable. Driving is not allowed, because no sumo wrestler will fit between the driving wheel and the seat. They don’t eat anything for breakfast, eat a heavy lunch made of large amounts of rice, and must take an afternoon nap after lunch.

Wrestlers in the four lower divisions have no rights. The oyakata (stablemasters) treat them like slave labour. Bullying is pervasive, and many stablemasters exploit the teenagers ruthlessly.

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The average life expectancy of a sumo wrestler is ten years shorter. In the name of the ancient tradition, this inhuman sport and the heyas continue, even glorified.

Coronavirus has managed to highlight the issue, like it has many others.

Ravi 

Corona Daily 200: A Tryst with Mona Lisa

First-time visitors to the Louvre are stunned when they enter Mona Lisa’s room. The world’s most famous painting is shockingly small. She is behind a glass cage. Dozens of Japanese tourists with extravagant cameras block your way. You are barely allowed 30 seconds before being shoved out of the room. Seeing the Mona Lisa is the most anti-climactic part of the Louvre visit.

Though she and her smile look young, Mona Lisa is more than 500 years old. In August 1911, when life was simple and security slack, the painting was stolen. Even Pablo Picasso was interrogated as a suspect (no, he hadn’t stolen it). She was found in 1914 with an Italian employee of the Louvre, who thought she deserved to be in her creator’s, Leonardo da Vinci’s land, and not in France. Then in 1956, a Bolivian man threw a rock at her, slightly damaging her left elbow. When she travelled to Tokyo in 1974, a woman threw red paint. In 2009, a Russian woman bought a ceramic teacup at the museum shop, and threw it on the painting, shattering its glass.

Now Mona Lisa is behind bulletproof glass, visitors are socially distanced even since before the pandemic. Inside the glass cage, humidity is maintained at 50% and temperature at 18 C.

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A year ago, the Louvre was doing exceedingly well with a blockbuster Leonardo da Vinci exhibition to mark the 500th anniversary of the master. Louvre had to be shut between March and July, and after a brief reopening with severe restrictions, closed again since October. It remains shut until now. In 2020, it suffered a drop of 72%, from the 9.6 million visitors in 2019. The majority of Louvre visitors are from abroad. World War II was the last time it was shut for so long.

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Earlier, any renovation work was carried out on Tuesdays, the weekly off. As a result of the pandemic, the Louvre has seven Tuesdays a week. Curators, restorers, conservators and other experts now work five days a week to complete major renovations and beautifications. In the Sully Wing, workers are sawing parquet for a giant new floor. In Louis XIV’s former apartments, restorers wearing surgical masks climb scaffolding to tamp gold leaf onto ornate moldings. Some work is simpler, like dusting the frames of nearly 4500 paintings. Some is long-drawn like the makeover in the Egyptian antiquities hall. The ambitious plan includes hanging 40,000 explanatory plaques in English and French next to art works.

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Last month, Louvre in collaboration with Christie’s arranged a novel auction to raise funds for charity. It auctioned not only tangible items, but experiences as well. I will mention two.

You could buy at the auction a private concert in your honour in the reception hall of the French kings. The Salle des Caryatides has fine pieces from the Greek and Roman antiquities, including Diana of Versailles, Sleeping Hermaphroditus and the Three Graces. As was done for the French Monarchs, the musicians installed in the balcony will perform for you. You and your loved one, while sipping a flute of champagne become French Royals for an evening.

This experience was sold at the auction for Euro 42,000.

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Another experience was called the Mona Lisa mania. Each year, the celebrated painting is taken out of her glass cage once. The conservators inspect the condition of the thin poplar panel. The winner at the auction is invited to be part of that singular moment. You will be able to look straight into the eyes of the uncaged Mona Lisa, and be as close to her as no ordinary visitor ever can. This magical experience comes along with a free private tour of the Italian masterpieces in the Grande Galerie.

This experience was sold at the auction for Euro 80,000. The winning bidder and the Louvre management will agree to a date for the tryst with Mona Lisa.

Ravi 

Corona Daily 201: A Riotous January

2021 has started with riots. This month, violent protests have happened in at least seven countries.  

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The Dutch government banned all school parties (no birthdays, costume shows, musicals) from 4 January to 12 February. Starting 23 January, Netherlands has curfew between 21.00 and 04.30, a first since World War II. Fine for violations is 95 Euros ($115). Coronavirus seems to have no knowledge of Brexit. Its UK variant is effortlessly moving from Britain to Europe. The Dutch government is naturally worried. Bars and restaurants have been closed since October, schools and shops were shut in December.

Since last weekend, protesters gathered in at least ten cities defying the lockdown, attacking police, looting stores, and destroying property. On Sunday, police deployed dogs, water cannons and horse-riding officers to disperse a demonstration in central Amsterdam. Two hundred arrests were made. In Urk, young people set ablaze a coronavirus testing centre, as if that was a way to reduce the number of cases.

Eindhoven in the South saw the worst violence, with rioters throwing stones, knives and fireworks at the police, damaging the railway station. The mayor called them “the scum of the earth” and feared the Netherlands was headed towards civil war.  

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Israel, with a sudden increase in cases has introduced a strict lockdown. From today, Israel’s only International airport will be shut for a week. The ultra-orthodox Jewish community had sought exemptions from lockdowns, arguing their customs don’t allow forgoing religious education, gatherings for weddings, funerals and worship.

On Sunday, as the police tried to clear religious gatherings and classes, the orthodox crowd started throwing rocks on them. Rioters burned trash and toppled street signs and light poles in several cities across Israel. In Bnei Brak, a bus driver was pulled out, attacked with pepper spray, and the bus completely torched. Several surrounding buildings were evacuated as the blaze damaged electrical lines. In some places, police used stun grenades and water cannons.

Secular Israelis are upset because the recklessness of the ultra-orthodox areas is nullifying the lockdown efforts of others. Haredi communities (ultra-orthodox) account for 35% infection, though they make up only 10% of the population. Images of Haredi weddings and crowded synagogues are going viral on social media.

Israeli elections happen on average every six months, the next one is in March. PM Netanyahu needs the support of the ultra-orthodox Jews for his coalition. He is relaxed about enforcing restrictions on this community.

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Since last weekend violent protests have erupted in at least 15 locations across Tunisia. More than 600 people have been arrested, most of them aged 15-25. Army is on the streets, protecting government buildings. The riots are in response to declining living conditions, poverty and unemployment. Unemployment among young has risen from 15% pre-pandemic to 36%. Tunisia has lost its vital tourism sector, including ancillary industries that provide goods and services to tourist resorts.  

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On 6 January, while Trump’s army was raiding Capitol Hill, in Hong Kong the Chinese government was busy arresting pro-democracy opposition. More than 1000 officers arrested 53 individuals (including one American) accusing them of “subverting state power”. On the pretext of the pandemic, Hong Kong elections have been postponed by a year to September 2021. The arrested individuals were potential candidates who had dared to run unofficial primaries.

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On 23 January, 3700 Russians were arrested during anti-Putin protests across Russia. Alexei Navalny, a 44-year-old brave man with nine lives, survived Novichok poison in his underwear (no limits to the depths Putin can reach to get rid of his opponents). Despite threats, Navalny returned from Germany and was duly imprisoned for fictional crimes by a court-in-name-only. He then released a remarkable two-hour film called Putin’s Palace (92 million views in one week). The Russian demonstrators finally, loudly and publicly called their dictator a thief. The next protests will happen on 31 January, and may become a weekly affair like in Belarus.

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Indian farmers are up in arms over new farm laws. In today’s tractor rally, one farmer died and eighteen cops are in hospital, one of them critical.

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Of all the January protests and riots, the Washington riot was the odd one out. It was the only one ordered by the man in power.

Ravi 

Corona Daily 202: New Luxury

In this daily column, I have talked about businesses that have boomed during the pandemic. One of them is the selling and renting of ISLANDS. Mr Krolow runs Private Islands inc for the past 22 years. 2020 was the busiest year for his company. He said he was flooded with calls, some from “young men hoping to start their own country”.

Before the pandemic, an island was a vanity purchase, a toy for ultra-rich elderly males who already owned yachts and jets. Now the new wave of island buyers is driven not by ego, but the desire to escape the virus. Some wealthy clients are so paranoid they ask for large agricultural plots on the island so as to be self-sufficient.

The billionaires who expect the pandemic to last long are using prefab homes for new construction. The prefab is put on the pallet and a helicopter drops it on the island.

For complete isolation and privacy, sometimes staff stay on a smaller island close by. By turning the lights on, the owner can summon them in small boats.

The island buyers want their safe haven to be peaceful as well. Recently a lovely island in the eastern Mediterranean, a real bargain for $7.4 million, didn’t find buyers because both Turkey and Greece have claims on the surrounding waters.  

Some of the well-known populated islands were bought in previous centuries. The Dutch had purchased Manhattan in 1626 for $24. As to the islands offering protection, this is what Shakespeare wrote in Richard II.

This fortress built by nature for herself, against infection and the hand of war,

Which serves it in the office of a wall, Or as a moat defensive to a house,

Against the envy of less happier lands, this blessed plot, this earth, this realm, this England.  

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British billionaires were obsessed with Greek islands in the past. Now they prefer isolating in the Seychelles or the Irish sea. North Americans have shifted their preference from the South Pacific to Bahamas, Belize and Panama. Bahamas is close to the USA, has no taxes, is economically and politically stable, and offers speedy internet.

Travel restrictions have been one of the problems for brokers as well as buyers. In July, a 157-acre Horse Island off the coast of Ireland was on the market for £ 5 million ($6.5 million). An unnamed European man fell in love with the scenery, the seven houses, a pier, helipad, gym, tennis court, all of which he watched on video. The package included own electricity, water and sewage systems, three beaches, and farming pastures. The mystery buyer bought the Horse island without visiting it.

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Twitter’s owner Jack Dorsey now lives on an island in French Polynesia, thousands of miles from the USA. He blocked Donald Trump while enjoying the safety of his island. Kim Kardashian, a media personality, spent her 40th birthday with close family and friends on an island near Tahiti, and for the benefit of the world shared the celebrations on Instagram.

Yoshihisa Midorikawa, a Tokyo entrepreneur, bought Iseshima island, which was used for the G7 summit in 2016 after a single visit. “I wanted my own country where I wouldn’t have to worry about becoming infected with the coronavirus”, he honestly said.

Larry Page, Google’s co-founder, has chosen a modest option. He lives on his $46 million super-yacht based in Fiji. Fiji has introduced a ‘Blue Lanes’ scheme which allows yachts to enter Fiji, and the owners can quarantine on their own yachts or boats. So far, nearly 100 boats have entered Fiji under the scheme.

Maldives with 1200 small islands is another attractive destination. It recently opened Ithaafushi-the private island-spread over 32,000 square meters. It is rented out for $80,000 a night.

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The information presented here is of academic, rather than practical, interest. If you feel upset about the island buying business, I will leave you with one thought: the size of your house and the size of your happiness are not necessarily correlated.

Ravi 

Corona Daily 203: The Discovery of the UK Variant: Part Final

Professor Andrew Rambaut, who received the email from South Africa, is in charge of fitting the mutations on the evolutionary tree.

A week before that, he had noticed many genomes, mostly from Britain, with something unusual. He called Dr Ravindra Gupta to his computer to take a look. Dr Gupta is an Indian-origin HIV biologist listed by Time Magazine as one of 100 most influential people in 2020. He has a bouquet of medical degrees from Cambridge, Harvard and Oxford. He teaches at the University of Cambridge, and as luck would have it, is visiting faculty at a research institute in Durban, South Africa.

When Dr Gupta looked at the computer screen, he saw a “wow moment”. At that time, impending vaccine authorization was the biggest news, and here was a new avatar with 23 mutations, 17 of them causing changes in the protein. This rattled him.

It was as shocking as seeing a cousin with dark hair and brown eyes, on a family tree that exclusively has blond members with blue eyes.

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If Mr Covid Virus is a storyteller, he definitely loves dramatic irony.

On 2 December, Boris Johnson boasted that UK was the first country in the world to authorize a covid vaccine for humans. The poor fellow needed some antidote of good news against Brexit.

Things happened at a breakneck speed after that announcement. On 4 December, South African scientists presented to the WHO the findings about the new variants. On 8 December, the British genomicists and public health officials concluded there was a new UK variant. On 11 Dec. Neil Ferguson, the leading epidemiologist, not-so-fondly called Professor Lockdown, became very concerned and warned Johnson about the new variant. He recommended a strict lockdown. On 19 Dec. professor Rambaut released a paper about the new variant. On 22 Dec. government scientists proposed a strict lockdown including closure of schools to suppress the new variant.

Boris Johnson, so close to his Brexit dream, feeling largehearted, allowed people to gather for Christmas. He postponed the England-wide lockdown to 4 January.

Within a month of becoming the first country to approve a vaccine, UK was in the throes of the new variant. Earlier UK said the variant was only more transmissible. This week Boris Johnson said it is deadlier as well, perhaps 10%-30% more.

Today, it is spread to more than 50 countries, including Argentina which was added this week. USA scientists have predicted that by the end of March the UK variant will be the key variant in the USA.

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The variants from South Africa and Brazil are a particular threat to immunization efforts, because they both contain a mutation associated with a drop in the vaccine efficacy. A South African team analyzed 4000 different mutations to find those that would make the vaccines useless. South Africa and Brazil variants have the biggest impact.

Another team in Durban took serum, the antibody-containing blood sample, from six covid ex-patients. In all cases, the neutralizing power of the antibodies had substantially weakened, which left the scientists extremely worried.

In the UK, Dr Gupta and his team have demonstrated evidence of a reduced antibody response against the UK variant among individuals, age group 64-85, three weeks after they received the Pfizer vaccine. Though reductions were expected, more data from real life will be needed before concluding anything about the impact on vaccination.

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Next few months are critical to find out how worried we should be about the new variants. It is better to take extraordinary steps to suppress the variants where possible. Israel, probably the most successful country in vaccine implementation, on Friday tightened its lockdown. It discovered cases of the UK variant. Every day, Israel now witnesses 8000 new cases, and the rate of spread is rapid.

Today, Hancock, UK’s health secretary, said UK is a long, long, long way from easing restrictions. UK has extended its national lockdown till 17 July. That shows the level of threat posed by the new variants.

Ravi 

Corona Daily 204: The Discovery of the UK Variant

Those of you who have tested for Covid know that a person wearing PPE inserts a swab into your nostril, rotates it causing an uneasy ticklish sensation. If your travel, or job or playing sport depends on the result, you spend one or two days on tenterhooks. This is one test where a negative result is welcome.

Do you know what happens to that sample of your nasal secretions? Once the sample is analysed, in most countries, it is destroyed. Not so in Britain.

All the labs in Britain, after testing swabs for the virus, dispatch the leftover material in refrigerated vans to the Wellcome Sanger Institute, a genomics central lab. That lab stores them in spacious freezers. The robots then take over, separate the positive samples and deposit them in tiny, muffin-sized plates. Machines then map their genomes, producing 30,000 letter-long genetic codes that get uploaded to an internet library.

British biologists then decide where to place the different virus mutations on the evolutionary tree. This tree is a bit like a family tree with pictures posted against each name. Siblings may have lots of similarities to each other and to their parents. Cousins may also share certain features like the colour of eyes or hair.

Britain has generated more than 165,000 sequences, meaning analyzed and placed on the evolution tree that many mutations of the coronavirus. To give a perspective, the USA with five times larger population has sequenced 74,000, Germany 3,400.

The sequencing campaign began very early, on 4 March, when the number of infections in Britain was less than 100. A Cambridge microbiologist, Sharon Peacock, sent emails to all British genomicists, asking each one to call him back. Setting aside rivalries and egos, they formed a consortium which managed to raise £20 million ($27 million) of government funds in two weeks. The importance of this effort would be understood many months later.

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One of the several covid patients admitted to a hospital in Cambridge in May 2020 was a man in his seventies, with lymphoma. Strong anti-cancer drugs had reduced his immunity. In an isolation room, he struggled to breathe. He was given all available treatments, including plasma with antibodies from recovered patients. Every test continued to be positive, the virus refused to leave him.

He fought on for 101 days in the hospital. Britain’s sequencing efforts meant each of his swabs was analysed and sequenced. In total, the virus particles coursing through the man’s lungs were sequenced 23 times, a real scientific treasure.

The patient died in August. Because he was isolated, it was assumed he hadn’t infected anyone. His weak immune system and the prolonged infection had given the virus a playground to perform several mutations. Dr Steven Kemp, an infectious disease expert, called the patient the gold standard patient.

One of the patient’s mutations, named 69-70del, changes the shape of the spike protein. Another N501Y, can help the protein bind more tightly to human cells.

Dr Kemp searched for those changes every day in the global database. There seemed little to worry about.

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On another continent, doctors and nurses at a South African hospital group noticed a strange spike in the number of covid patients in their wards in late October. The lockdown restrictions had been relaxed; spring had started for this southern hemisphere nation. But the numbers were now growing too quickly.

“Is this a different strain?” One hospital official asked in a group email in early November. Was this the same coronavirus or a new dangerous mutation?

Professor Tulio de Oliveira, a geneticist at the Nelson Mandela School of Medicine in Durban began analyzing swabs, couriered in dry ice packages. On 1 December, he emailed Andrew Rambaut, a British scientist, and asked him to review some of his findings: a series of strange mutations on the virus’s outer surface.

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Continued tomorrow.

Ravi 

Corona Daily 205: Everybody Pees and Poops

The field technician, wearing an orange safety vest, a surgical mask, lab goggles, and plastic sleeves that covered his arms; stood at a sewer with two crowbars in his hands. He hooked the crowbars under the manhole cover and pushed it open. From inside he removed a bottle. He held the bottle filled with liquid to the light. It was not too cloudy. He carefully poured its contents into specimen tubes he was carrying. The tubes would be sent to a lab for analysis.

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Newsha Ghaeli, an Iranian who grew up in Canada, and Mariana Matus, a Mexican, are two young women who met at MIT during their PhDs. Mariana’s doctorate was in computational systems and systems biology, and Newsha's in urban studies and planning. What interested them was the sewer systems. They felt sewers were like human guts. Just as the labs can tell a lot about an individual’s health by sampling their gut, would it be possible to tell about the health of the community/ neighbourhood by sampling its sewage?

The two founded Biobot in 2017 to check the spread of opioid in the community. They procured permission to take samples from the manhole closest to their lab. They realized the manhole covers were too heavy. Initially they would ask for help, and then move in with a 20-foot pole and a container for scooping the sewage out. Not surprisingly, the job was not something to look forward to. Over time, they designed a collection device with a filter that sat inside manholes and took samples regularly in a 24-hour cycle. An intern devised a magnetic manhole-opener. Both ladies managed to fall sick and get rashes, so they developed meticulous protocols and PPE. By the time they reached this stage, covid happened.

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Biobot was the first wastewater epidemiology team in the USA to successfully detect the coronavirus. On 25 March, they launched a nationwide campaign soliciting wastewater samples. They offered their analysis free-of-cost.

As one sewer department executive said poop is a great equalizer. In the underground gutters, whites and blacks, rich and poor, homeless and presidents, kids and elderly are not distinguishable. This presents several advantages for community testing. It is a large pool of people that allows measuring where the virus is, and whether it is increasing or decreasing. Aggregate testing is of course anonymous, and can give early warnings to the public health department.

Over the last few months, Biobot analysis found that infected individuals shed the covid-19 virus in their stool, regardless of whether they have symptoms. Moreover, infected individuals shed most frequently immediately after contracting covid, and start shedding a week before the symptoms.

Individual patient testing, on the other hand, gives results for only those who test. Asymptomatic patients may never test (but they still shed the virus when infected). By the time the results are available, it may be too late to do anything about them.  

The wastewater surveillance, by tracking a community regularly, can warn much in advance. Schools can be shut or reopened. The level of restrictions can be modified.  

*****

This community gut analysis was used in the past by epidemiologists to track polio. But Biobot has taken this obscure practice to another level. Their reports (see a sample) track genome copies per liter of sewage. Already 400 cities in the USA are using their services. Biobot’s sewage tracking currently covers 13% of US and 6% of the Canadian population.

With the danger of recurring diseases and epidemics, this underground source to track them may become universally important.

Ravi 

Corona Daily 206: The Diblings

Bryce Cleary was a medical student when one day a woman from the hospital’s fertility clinic came looking for sperm donors. Bryce volunteered. He was told his sperm would be shipped to the other end of the USA, and a maximum of five couples would receive it. In 1989, he donated and then almost for three decades forgot all about it. His wife gave him an Ancestry.com kit for Christmas.

Three months later, Bryce was staring at the message from a young woman who was identified as his daughter by the website. And then the second, and the third. Allee, 26, wrote to him that she had gone to the fertility clinic, where the staff member had secretly given her a piece of paper: Profile for Sperm Donor 8928. Hair color: brown. Eye color: gray/blue. Occupation: professional, science related. Religion: Baptist.

Bryce Cleary was the donor 8928. Using that clue, he found, or rather his biological children found him. He was told a maximum of five, but so far there are 19. The Washington Post gives a fascinating account of his story titled Nineteen Children and Counting.

Eli Baden-Lasar’s photo-story in the NYT magazine is equally incredible. Raised by two mothers, he always knew he was conceived with the help of a sperm donor. He is an amateur photographer. He began looking for his half-siblings, get to know them, and make a photo session. He found 32. To his embarrassment, one of them was his school friend.

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The history of sperm donation started in 1884, with an older rich man and his young wife seeking treatment for conception. The doctor decided the old husband was infertile. He anesthetized the wife, and inseminated her with the sperm of the best-looking student from his class. (In 1909, the student revealed it in an article).

In the 1970s, the first Cryobanks opened in the USA. The anonymous donors were usually college students, and no paper trail was left. In the 1980s, single women and lesbians began looking around for donors. They were still anonymous, but the California Cryobank would print catalogues of their physical descriptions, without names. After AIDS, the business grew, frozen sperm was found to be safer.

In 2000, Ryan Kramer, a 10-year-old child prodigy, along with his mother, created the “Donor Sibling Registry”, for children like him to enter the donor number to find the father and half-siblings. (Sometimes called Diblings). Now, every year, the website matches at least 1000 people, most of them siblings.

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23andMe, founded in 2006, specializes in genetic testing. (A normal human cell has 23 pairs of chromosomes). You send them a saliva sample, and the company generates reports charting your ancestry and genetic predispositions. Even if you are not born of a sperm donor, you may find people related to you.

In June 2020, 23andMe published a study that showed people with type O blood may be at a lower risk of catching covid-19. (Being O+, I welcome the study). They analyzed 750,000 participants.

The Donor Sibling Registry simply relied on the donor numbers to link the half-siblings. 23andMe and Ancestry.Com go a step further and offer DNA testing for better results.

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DNA testing and advanced facial recognition software would eventually make anonymous donations impossible. There is also an adoption movement that demands each child has a right to know their biological roots. California Cryobank now makes it mandatory to reveal names to offspring once they turn 18.

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The rising costs and tedious procedures are making some women opt for the cheaper option. Euphemistically called Natural Insemination, the woman meets the man through website advertising. If he is found to be worthy, they have a physical relationship until she gets pregnant. Kyle Grody, the founder of the FB group Sperm Donation USA follows this system. As mentioned two days ago, he has sired 40 children in this natural fashion.

With the climbing sperm costs in the pandemic, this ancient method of donation may become popular.

Ravi