How Does the Coronavirus Behave Inside a Patient? by Siddhartha Mukerjee

View article HERE.

March 26, 2020


This article by Siddhartha Mukerjee that appears in the The New Yorker is a lengthy, technical one the corona virus itself.  While much research needs to be done, the initial load of the virus, at least for now, seems key as follows:

"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. Nearly all the sars patients who came in initially with a low or undetectable level of virus in the nasopharynx were found at a two-month follow-up to be still alive. Those with the highest level had a twenty- to forty-per-cent mortality rate. This pattern held true regardless of a patient’s age, underlying conditions, and the like. Research into another acute viral illness, Crimean-Congo hemorrhagic fever, reached a similar conclusion: the more virus you had at the start, the more likely you were to die.

 Perhaps the strongest association between the intensity of exposure and the intensity of subsequent disease is seen in measles research. “I want to emphasize that measles and covid-19 are different diseases caused by very different viruses with different behaviors,” Rik de Swart, a virologist at Erasmus University, in Rotterdam, cautioned when we spoke, “but in measles there are several clear indications that the severity of illness relates to the dose of exposure. And it makes immunological sense, because the interaction between the virus and the immune system is a race in time. It’s a race between the virus finding enough target cells to replicate and the antiviral response aiming to eliminate the virus. If you give the virus a head start with a large dose, you get higher viremia, more dissemination, higher infection, and worse disease.”"

Although more research is needed, this analysis is consistent with all that's been said regarding limiting one's exposure to the virus such as through social distancing, observing stay-at-home orders, good hygiene, not touching your eyes, and so on.

-Angela Valenzuela