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How Does the Coronavirus Behave Inside a Patient? by Siddhartha Mukerjee
An article in The New Yorker by Siddhartha Mukherjee, titled “ How Does the Coronavirus Behave Inside a Patient?,” from 2020 is a lengthy, technical, and deeply illuminating one. It focuses on the coronavirus itself—how it behaves once it enters the body—and why the initial amount of virus to which a person is exposed may matter greatly.
While much more research is needed, Mukherjee explains that the initial viral load appears, at least for now, to be an important key to understanding how the virus behaves inside the body. Drawing from earlier research on SARS, influenza, Crimean-Congo hemorrhagic fever, and measles, he shows that the amount of virus present at the beginning of infection may shape the severity of illness that follows.
He writes:
“What sparse evidence we have about coronaviruses suggests that they may follow the pattern seen in influenza. In a 2004 study of the coronavirus that causes SARS, a cousin of the one that causes COVID-19, a team from Hong Kong found that a higher initial load of virus—measured in the nasopharynx, the cavity in the deep part of your throat above your palate—was correlated with a more severe respiratory illness.”
Mukherjee goes on to note that nearly all SARS patients who initially had low or undetectable levels of virus in the nasopharynx were still alive at a two-month follow-up. By contrast, those with the highest levels had a mortality rate of twenty to forty percent. This pattern held regardless of age, underlying conditions, and other factors.
He also draws on research into Crimean-Congo hemorrhagic fever, where the same pattern appears: the more virus present at the start, the greater the likelihood of death.
Perhaps the strongest analogy, Mukherjee suggests, comes from measles research. Rik de Swart, a virologist at Erasmus University in Rotterdam, cautions that measles and COVID-19 are very different diseases caused by very different viruses. Still, measles research offers a useful lesson: the severity of illness can relate to the dose of exposure.
As de Swart explains, the interaction between a virus and the immune system is “a race in time.” The virus tries to find enough target cells to replicate, while the immune system tries to eliminate it. A large initial dose gives the virus a head start, resulting in greater viral spread, more infection, and potentially worse disease.
Although much remains unknown, this analysis is consistent with what public health experts have been telling us: limit exposure. Social distancing, stay-at-home orders, handwashing, good hygiene, avoiding touching one’s face, and reducing contact with others all matter. They do not simply reduce the chance of infection; they may also reduce the intensity of exposure.
Siddhartha Mukerjee, by the way, is a world reknowned, giant in cancer research. In 2011, he received the Pulitzer Prize for his book, “The Emperor of All Maladies: A Biography of Cancer." Much deserved, too.
I “read” it cover to cover on Audible for many hours of listening and marveling, while taking long walks and working out at the gym.
What surprised and moved me most was the rare quality of thinking and writing I encountered in Mukherjee’s work—an intellectual life situated at the intersection of cell biology, historical analysis, and clinical practice, rendered in a lyrical and deeply humane prose style.
A lot of story telling, he helps us to see science not only as a technical enterprise, but also as a deeply human one.
That is why his work reminds me, once again, why the humanities are needed now more than ever. We need science, yes. But we also need history, narrative, ethics, metaphor, and meaning-making to help us understand what science is telling us—and what it asks of us.
Mukherjee is also the author of The Song of the Cell: An Exploration of Medicine and the New Human, which I have not yet read, but now very much look forward to reading.
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