The Covid-19 Chronicles: Carrying on, business unusual

USUALLY, I love grocery shopping.

I find the process luxurious and therapeutic, and I get a little high at the end.

This week, I went to the supermarket for the first time since the movement control order (MCO) came into effect. I went alone wearing a mask, without a handbag, I kept my cards and phone in a ziplock bag, and all else in my pockets.

Despite the MCO, the supermarket was crowded, but quiet. Many shelves were empty, and restocked staples quickly disappeared. People wore different masks in different ways. Every few minutes an announcement reminded customers to keep their distance of at least one metre.

After I left the supermarket and drove home, I washed my clothes and showered before I met my children. I felt exhausted, anxious and sad. Not the usual high I get after a usual grocery run.

But these are unusual times.

With the Covid-19 pandemic, an unprecedented public health emergency sweeping the globe, Malaysia and many countries have now imposed a strict MCO as a public health control measure.

Covid-19 is caused by SARS-CoV-2, a highly contagious virus. The Noble Laureate Sir Peter Medawar said viruses are “bad news wrapped in protein”.

The bad news is their genetic material, and the proteins are the shell and envelope that both protects and transports the genetic material to a new home.

The spherical-shaped SARS-CoV-2, like its predecessor SARS-CoV, has an envelope that contains spikes called the S protein, which act like a “key” to allow it to enter cells that have a special “lock” called the ACE2, which are abundantly found on cells in our lungs.

Viruses cannot survive and multiply on their own, but once inside the lung cells, the virus transforms it into a factory to make more copies of itself – until its newly hijacked home is destroyed.

In Covid-19, the immune response becomes overaggressive, inadvertently damaging further the lung tissues it was meant to protect, causing breathing difficulties that require ventilation support. For people who already have other underlying illness, this condition called “acute respiratory distress syndrome” may become fatal.

Alarmingly, unlike its predecessor, the S protein for SARS-CoV-2 is 10-20 times more likely to bind the ACE2. This is the key to SARS-CoV-2 contagiousness, allowing it to be efficiently passed from one person with Covid-19 to another two or three people.

This number rises dramatically if people are in crowded conditions, such as what was seen on the Princess Diamond cruise ship, where one person on average infected 14 others, or the tabligh event, which became the source of 1,117 new infections in Malaysia because people were in close contact for an extended period.

Under business as usual with people travelling on public transport, sitting in lectures and attending conferences, the number of Covid-19 patients will climb rapidly each day, and reach a high sharp peak until the virus has already made most people sick.

This would be disastrous because we would not have the resources to manage and treat so many people within a short span of time. The most vulnerable will not get medical assistance and many will die.

In public health, the most difficult interventions to implement are the ones that require people to change their behaviour. Vaccines have been effective public health tools for infectious disease partly because they require the least amount of behaviour change.

While vaccines do not prevent someone from getting infected (i.e. stop the virus/ bacteria from entering), they make the body more capable to clear the bacteria or virus and reduce the disease (i.e. the symptoms and problems associated with the infection).

For Covid-19, we do not have a vaccine to protect against the disease.

Repurposed vaccines originally developed for SARS will speed up the effort, but a lot of time is required before safe and effective vaccines can reach the people they need to protect.

That is why our current strategy is to avoid more infections, to buy some time until we have more tools at our disposal.

This strategy requires us to change our behaviour.

These behaviours include staying home when ill (isolation/ quarantine), and practising good hygiene like covering coughs and washing hands to reduce the risk of transferring viruses across different surfaces.

Recently, the behaviour change required has been even more extreme. We are required to change the way we live our daily lives in order to be as physically apart as much as possible, so that the virus will run out of people they can reach and infect – i.e. “social distancing”.

Think of a mandatory game of “pass the ball” in a community, where the ball needs to be passed within a short window of time or it drops, and one ball multiplies into three balls each time it is passed.

If there are many people around, the game progresses rapidly. But if there are fewer people around to receive the pass, it takes a longer time for the ball to travel, and eventually, the last ball will drop. The game will end.

Similarly, if we stay physically distant from each other for a long enough period, the peak will not be as high or as steep. Instead it will be broader, distributing the number of new cases over a longer span of time.

Eventually, like the ball, the virus can no longer be passed on. The number of new Covid-19 cases will drop, and we reach the end of the epidemic, things will return back to usual. This is the hope that binds us together.

Many who are healthcare providers and frontliners, supermarket employees, essential service providers and others who have no other option but to go out everyday fulfilling their duty to provide for their families, risk their health and lives working under these unusual times. Conversely, the rest of us are constantly reminded to stay home.

But as cabin fever also hits boiling levels for many at home, the questions are now: How long must the MCO last? In that process, how many of us will still get sick or even die?

JP Morgan and the Malaysian Institute of Economic Research (MIER) independently predicted that the peak number actively infected, between 5,070 to 6,300 people, would occur around April 12-15, assuming 80% of the first MCO compliance is achieved.

This meant extending the MCO until April 14, but these encouraging figures are also a stern warning.

If we succeed with the MCO, this epidemic too shall pass with relatively less damage, health-wise and socio-economically.

But if we do not take the MCO seriously and fail to comply, the days businesses closed, and days we spent cooped at home, rationing food until the next anxiety-filled grocery run a.k.a “Operation: Get that Garlic”, may be for nothing.

We must do our part to behave under business unusual, to stay home, stay away, while staying connected in solidarity to prevent the spread of Covid-19.

So, thinking about the next grocery expedition, here are three parting thoughts:

1) Personal protection: Most people other than frontliners are at very low risk of getting infected. Ideally, supply of masks should be reserved for those at higher risk. But if you wear a mask make sure it is not worn for too long, and that your nose and mouth area are tightly sealed. Best protection is to keep your distance.

2) Contamination: There are some viral messages about SARS-CoV-2 being “airborne” or people getting infected from viruses on raw fruits and vegetable. Presently, this is not true. There are virus particles that can survive on different surfaces and in the air for a few hours, under specific conditions and with poor ventilation. But the main way it is spread is still direct contact with an infected person. If it makes you feel better, you can “dry” items under sunlight – the ultraviolet rays and heat reduces the virus survival. In general, washing your hands before doing anything that requires touching food or your face reduces any contamination risk.

3) Shopping etiquette: There have been many news announcements made to reassure consumers that stocks and supplies are plentiful. Buy enough you need for your household to stay at home for one to two weeks, but not enough to last an apocalyptic vampire war. (Looking at you, dude with 5kg sack of garlic).

Until next time, here is to doing the next grocery run under the MCO, without panic but with planning, without closeness in proximity, but courtesy and civility.

Here is to successful public health interventions and the end of the outbreak, when one can enjoy the luxury of simple pleasures like picking up a packet of cookies and leisurely reading the ingredients without worry.

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Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah is senior lecturer in Medical Microbiology at Universiti Sains Malaysia, and an affiliate of Young Scientists Network-Academy of Sciences Malaysia. She is active in science communication and infectious disease biomedical research. She was the first female Asian champion of FameLab, the world’s longest running science communication competition, in 2018. The writer’s views are her own.


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