The carrier of many things/Wikimedia Common

Worldwide, more than 1.5 million people per year were dying from lung infections – 60 percent of them caused by viruses –  before the coronavirus SARS-CoV-2 emerged earlier this year to spawn a global pandemic panic of death and fear.

Those earlier deaths warrant some serious thought as Alaska today begins to unlock from COVID-19-sparked restrictions on dining out, sharing a drink with friends, going to the movies or the club, attending church services and more. 

This does not mean the severe acute respiratory syndrome (SARS) coronavirus that causes COVID-19 is gone. It is most certainly still lurking somewhere in the state given that viruses are in general “The Terminator” of pathogens.

“Most common illnesses are produced by respiratory …viruses,” University of Arizona researchers Stephanie Boone and Charles Gerba observed in a peer-reviewed study in Applied Environmental Microbiology. “Unlike bacterial disease, viral illness cannot be resolved with the use of antibiotics. Prevention and management of viral disease heavily relies upon vaccines and antiviral medications. Both vaccines and antiviral medications are only 60 percent effective. Additionally, to date there are no vaccines or antiviral drugs for most common enteric and respiratory viruses with the exception of influenza virus and hepatitis A virus (HAV).”

Boone and Gerba were not writing about the pandemic coronavirus SARS-CoV-2. Their paper preceded the coronavirus’s evolutionary appearance by 13 years. But the Boone-Gerba examination of infectious disease is as pertinent now as it was when published in 2007.

People are masking up today because of what Boone and Gerba, along with a world of other microbiologists, long ago observed: Viruses are hard to kill, and “viral disease spread is most effectively deterred by preclusion of viral infection.”

Far better than slowing the spread of a virus – “flattening the curve” as it has come to be called – is preventing the spread of a virus. This is the reason why villages in rural Alaska have tried to lock out the world.

On the state’s far western coast, the Dillingham-based Bristol Bay Area Health Corporation (BBAHC) continues to push Gov. Mike Dunleavy to shut down the state’s most profitable salmon fishery and the planet’s biggest producer of wild sockeye salmon.

A vast expanse of wilderness sprinkled by a few clusters of human habitation, the Bristol Bay area has a year-round population of only about 6,500 people. But each summer, some 15,000 more show up from the Lower 48 states, Asia and Europe to fish the Bay’s waters and staff its fish-processing plants.

Dunleavy has declared the Bay fishery an “essential business” and allowed fishing to go ahead. The BBAHC – which runs a tiny, 16-bed hospital – wants the Alaska State Commission for Human Rights to intervene and stop that.

The health corporation complains that Dunleavy has agreed to let non-fishing communities in non-coastal Alaska lock out visitors, but is bowing to powerful fishing interests to keep businesses open along the coast.

“Our hospital is too small. We can’t take care of these folks coming in,” BBAHC CEO Robert Clark told reporters Wednesday.

To protect the 6,500 people living in the region of from any risk of encountering SARS-CoV-2, the BBAHC wants to put 15,000 people out of work.

An employee of Trident Seafoods who flew into Dillingham this month was flown out after testing positive for SARS-CoV-2. The largest seafood processor in North America, Seattle-based Trident has promised to test everyone it flies into the Bay and evacuate any who tests positive.

So far, there is no indication the infected Trident employee has infected anyone else. But SARS-CoV-2 has spread invisibly in elsewhere in the world, which brings this back to the work of Boone and Gerba.

The invisible enemy

‘”For centuries it was assumed that infectious diseases were spread primarily by the airborne route or through direct patient contact, and the surrounding environment played little or no role in disease transmission,” they wrote. “Over the years studies have changed the perspective on viral transmission to include a more complex multifactorial model of disease spread. There is now growing evidence that contaminated fomites or surfaces play a key role in the spread of viral infections.”

When the Centers for Disease Control (CDC) starts talking about the “community spread” of SARS-CoV-2, this is what it is talking about, the disease reaching patient “Y” sans direct contact with patient “X.”

“Fomites consist of both porous and nonporous surfaces or objects that can become contaminated with pathogenic microorganisms and serve as vehicles in transmission,” the University of Arizona scientists observed. “During and after illness, viruses are shed in large numbers in body secretions, including blood, feces, urine, saliva, and nasal fluid. Fomites become contaminated with virus by direct contact with body secretions or fluids, contact with soiled hands, contact with aerosolized virus (large droplet spread) generated via talking, sneezing, coughing, or vomiting, or contact with airborne virus that settles after disturbance of a contaminated fomite (i.e., shaking a contaminated blanket).

“Once a fomite is contaminated, the transfer of infectious virus may readily occur between inanimate and animate objects, or vice versa, and between two separate fomites if brought together. (One study) recovered 3 to 1,800 plaque-forming units (PFU) of rhinovirus from fingertips of volunteers who handled contaminated doorknobs or faucets. (Another study) demonstrated that 65 percent of virus could be transferred to uncontaminated hands and 34 percent to the mouth.”

Scientists have yet to definitively confirm SARS-CoV-2 transmission by fomites, but they have documented the ability of the virus to survive for long periods of time on stainless steel, glass, cardboard and other surfaces.

And Chinese doctors who tracked a COVID-19 outbreak in a shopping center in that country concluded fomites or inhaled aerosols in a confined space were the only logical explanations for how the disease infected 17 people in an eight-story building.

“Our findings appear to indicate that low-intensity transmission occurred without prolonged close contact in this mall; that is, the virus spread by indirect transmission,” they reported.

“…The rapid spread of SARS-CoV-2 in our study could have resulted from spread via fomites (e.g., elevator buttons or restroom taps) or virus aerosolization in a confined public space (e.g., restrooms or elevators). All case-patients other than those on floor seven were female, including a restroom cleaner, so common restroom use could have been the infection source. For case-patients who were customers in the shopping mall but did not report using the restroom, the source of infection could have been the elevators (or elevator buttons.)”

Neither SARS-CoV-2 aerosols or fomites were found in the mall, which was not surprising given the time between the infections and the start of the investigation. But SARS-CoV-2 was found “on a doorknob at a patient’s house.”

The CDC is now trying to tamp down fears people could get infected from packages, cash, countertops and more by telling the public that “the virus does not spread easily” in this way, while admitting “COVID-19 is a new disease and we are still learning about how it spreads.”

“The relative role of droplet, fomite and aerosol transmission for SARS-CoV-2, the protection provided by the different components of personal protective equipment (PPE) and the transmissibility of the virus at different stages of the disease remain unclear,” says the lastest advisory to health care workers from the European Centre for Disease Prevention and Control (ECDPC).

Chinese doctors who studied the rooms of COVID-19 patients found the SARS-CoV-2 virus all over the place – “on floors, computer mice, trash cans, and sickbed handrails,” and in the air.

“The rate of positivity was relatively high for floor swab samples, perhaps because of gravity and air flow causing most virus droplets to float to the ground,” they reported. “In addition, as medical staff walk around the ward, the virus can be tracked all over the floor, as indicated by the 100 percent rate of positivity from the floor in the pharmacy, where there were no patients.

“The rate of positivity was also relatively high for the surface of the objects that were frequently touched by medical staff or patients. The highest rates were for computer mice, followed by trash cans, sickbed handrails, and doorknobs.”

The examination raised concerns about providing full-protective gear – not just masks – for health care workers, and the suggestion all protective gear should be changed after leaving a patient’s room.

The Chinese reported no infections among their health-care workers, but that has not been the case elsewhere. The ECDPC late last month reported 20 percent of the cases in Spain and 10 percent in Italy involved health-care workers.

New normal

As the U.S. – and Alaska – attempt a return to something approaching normal after a long, long lockdown, the question of how SARS-CoV-2 moves from person to person is more important than ever because as of today, state officials say you are on your own.

“It’s the responsibility of individuals, businesses, and organizations to minimize the spread of COVID-19,” says the official statement. “We encourage all to follow local, state, national, and industry guidelines on ways to conduct business and activities safely.”

Having largely escaped the pandemic – Alaska has seen only 402 cases and 10 deaths – Alaska’s political leadership has decided it’s time to let Alaskans make their own decisions on the risks and how to deal with them.

No one has said so officially, but Alaska is now basically on the controversial Swedish plan.

Senior centers, prisons, and some institutions still have restricted access. Plans for “large public gatherings such as festivals and concerts” must be approved by the state.  People arriving in Alaska from Outside must quarantine.

But otherwise, businesses are free to open and Alaskans are free to move about.

Consider it Alaska’s unmasking. Or not.

The state is still recommending a “face covering when in a public setting in close contact with others,” which may or may not be practical. You might be able to wear your mask to the theatre, but it’s hard to enjoy that big tub of popcorn with the film while wearing a mask.

Even more so a night on the town. Neither the experience of dining out nor going to the bar to have a drink with friends is compatible with a mask. How much you should worry about this – if you’re prone to worry – is hard to say.

A study of masks worn by Korean hospital patients with COVID-19 found that the virus quickly accumulated on the outside of the masks.

“The paper by Seongman Bae and colleagues’ study regarding the effectiveness of surgical and cotton masks in blocking SARS-CoV-2 presented several unexpected findings,” doctors at the Mayo Clinic felt compelled to observe in reaction to the study. “Seongman Bae et al evaluated the amount of virus coughed through a surgical or cotton mask at a distance close to eight inches in four patients. Virus was recovered at this distance, but more surprisingly, virus was identified on the outer surface of the masks, but not on the inner surface after coughing. The authors conclude that surgical and cotton masks are ineffective at preventing the dissemination of SARS-CoV-2. This is likely to aggravate ongoing controversy regarding personal protective equipment (PPE).”

Mayo worried the study might discourage health-care workers from wearing masks and argued that the paper’s main contribution to the SARS-CoV-2 discussion was to recognize “the significant contamination of the outer surface after coughing. Masking alone without the combination of meticulous hand hygiene, proper doffing and physical distancing, may risk spread of SARS-CoV-2. This article should not be interpreted as advice to the public to forgo masks or evidence against droplet precautions effectiveness for healthcare workers,” it argued when the study came out in April.

In a world reopening to commerce, however, the dynamics change. A SARS-CoV-2 sufferer wearing a mask, and repeatedly pulling the mask down to able to eat or drink, is going to be getting SARS-CoV-2 all over his or her hands and spreading it everywhere: glasses, silverware, plates, tabletops, salt and pepper shakers, chairs, and who knows where else.

The Korean study raises many questions as to the use of masks in public. If all the mask is doing is limiting the range of the spread of emerging SARS-CoV-2 pathogens is that a good thing or a bad thing?

Is it better to have them spread lightly all over the floor of your local Costco or concentrated on the facemasks and clothes of Costco shoppers who then end up with SARS-CoV-2 all over their hands and spread it everywhere?

The best argument that has been made for masking is that it can’t hurt, but what if it does?

Boone and Gerba again:

“If viruses remain viable on surfaces long enough to come in contact with a host, the virus may only need to be present in small numbers to infect the host. After contact with the host is achieved, viruses can gain entry into the host systems through portals of entry or contact with the mouth, nasopharynx, and eyes. Host susceptibility to viruses is influenced by previous contact with the virus and the condition of the host immune system at the time of infection.”

In the case of COVID-19, infection is also influenced by other factors yet unknown. There might be a genetic predisposition that makes some people vulnerable. And there are already well-documented co-morbidities – cardiovascular diseases, diabetes, obesity and age high among them – that make some people at greater risk of dying if they do come down with COVID-19.

Eighty-six percent of the 2.1 million who’ve experienced the disease to date have survived. Another 1 million to 2 million are thought to have caught the disease but escaped official classifications as sufferers because their symptoms were mild or lacking.

As of today, Worldometers reports almost 2.8 million more have the disease, but only 2 percent are in critical or serious condition. Medical treatments for dealing with SARS-CoV-2, the virus responsible for COVID-19, are improving weekly as was the case with HIV, the virus responsible for AIDs.

Scientists have yet to develop a vaccine to prevent AIDS, but the death rate has fallen from 16.2 per 100,000 in 1995 to 1.6 per 100,000 in 2017, the last year for which data is available, according to the website Statista.

In the case of AIDS, the solution to staying disease-free was fairly simple: avoid sex and blood transfusions with untested blood.

In the case of COVID-19, the solution is somewhat similar: avoid everyone. If unable to do this –  most humans don’t function well as hermits – stay away from people (6 feet is recommended but more doesn’t hurt) when in public and when you get home wash your and hands firmly up to your forearms to kill an SARS-CoV-2 fomites you might have picked up.

And, if you want, wear a mask of some sort. It won’t protect you, the evidence is pretty clear on that, but there are suggestions, although there is no real evidence, that it might help protect others or at least make them feel safer.

And many want to feel safe.

Having following Asia into the world of masked masses bound to the idea that “if it saves even saves one life,” it will be most interesting to see how the government decides to tell people its OK to take the masks off in a world where it increasingly looks like COVID-19 is here to stay as have so many other infectious diseases – flu, HIV, tuberculosis, cholera, MSRA, rabies, malaria, bacterial pneumonia, ebola, dengue, and more.

The list is long. As a species, we’ve adapted. As individuals, many remain vulnerable.

Wash your hands.