COVID-19 DISASTER AT THE DORMITORIES 

CRISIS IN SINGAPORE

Contrary to what most people think, I do NOT blame the Govt for the viral disaster in the dormitories. Why?

(1) The dormitories are the way they are for many years and there had not been any significant efforts clamouring for change over the years. So the outcry over their living conditions is a mere reaction to the widespread infections there, not a sudden realisation that we have not treated the foreign workers right.

(2) Let’s imagine for a while, if you can, that we are very lucky and there had been NO cases at the dormitories, do you think anyone will be talking about them?

(3) The dormitories are the way they are because it is the result of an economic imperative to provide housing for masses of foreign workers at the lowest cost. It was not meant to be pandemic-proof.

(4) We had gone through SARS (2003) and H1N1 (2009) without involvement of the dormitories.  They are a problem this time because we are all surprised by the very high transmissibility of SARS-CoV-2. The way it became out of control was not predictable.

(5) It is unfair to blame the Govt for not doing anything earlier because there is not much they can do once the outbreak starts. It’s already too late. Even now, those cramped conditions still persist. The sheer number (323,000) of dormitory workers precludes any quick remedial action to change the space dynamics of the lodgings. 

(6) Under very difficult conditions, the Govt has done admirably by quickly isolating, gazetting and locking down the dormitories and close down most parts of the construction industry. The fact that we have modest and falling local transmission while the cases explode at the dormitories attest to their hard work and success in preventing spillage of the fire into the local community. This is what we should be thankful for.

(7) Though the Government don’t say so, they are probably in the midst of shifting out large swathes of workers into alternative lodgings to rectify the overcrowding and prevent further increases of case numbers.

(8) You can’t help but marvel at how our tiny Singapore is still able to cope with the 11,178 cases and daily increases of more than 1,000, with rational management and harnessing of limited resources.

(9) So, instead of admonishing and condemning our own Govt who are already facing sharp criticism from observers, I think we should give our full support and give them confidence to overcome this unforeseen crisis.

(10) In short, if it had been any other epidemic or any other virus, the dormitories in its present state will not attract any due attention from anyone. It is unfortunate that this SARS-Cov-2 happens to spread so easily.

Covid-19 Viraemia Iron Displacement Theory 

A proposed pathophysiological explanation

https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173/1

The basis of my theory of the pathophysiology of SARS-CoV-2 is based on and an extension of the above paper by Liu wenzhong and Li hualan who used conserved domain analysis, homology modeling, and molecular docking to postulate that in an infection, the ORF8 and surface glycoprotein of the SARS-CoV-2 virus bind to the porphyrin of the heme of our hemoglobin while its orf1ab, ORF10 and ORF3a proteins act to unbind iron from the heme and release it into the plasma as ferrous or ferric ions.

So my theory goes like this:

(1) 80% of the infected are mild and they recover because their immune system is strong enough to clear the virus from the mucous membranes of the nasopharynx, bronchial tree and perhaps the superficial parts of the lung parenchyma where it replicates. If this superficial infection is not cleared in good time, it will enter the bloodstream causing a sudden deterioration after about 1 week of infection.

(2) Unlike classic SARS and the MERS viruses, SARS-CoV-2 has the tendency to enter bloodstream through perhaps the alveoli in hosts with weak immune system or whose immune system is weakened by prolonged infection. Significant viraemia occurs in about 20% of hosts.

(3) Once in the bloodstream, in the mechanisms as described by Liu wenzhong and Li hualan above, the virus binds to hemoglobin, thereby unbinding iron from heme, releasing ferrous or ferric ions into the plasma which is carried in the bloodstream as non-transferrin bound iron (NTBI) to all parts of the body. 

(4) Iron in this form is highly toxic because it is a catalyst for the formation of reactive oxygen species which causes oxidative damage and inflammation in many organs contributing to organ damage including the lungs itself producing the typical uniform ground-glass appearance on chest CT scan. This ground-glass appearance may not be a sign of pneumonia as asymptomatic patients also show this radiological sign (a sign of undetected viraemia).

(5) Meanwhile, the displacement of Fe from the hemoglobin causes prolonged and profound hypoxemia that may not be correctable by O2 and/or ventilation.

(6) The combination of oxidative and/or hypoxic damage of multiple organs leads to their failure and eventually to death.

If this theory is correct, there are several implications:

(1) Early signs like high fever and chills, severe headache, body aches and joint pains, fatigue, diarrhoea, skin rashes and neurological symptoms are signs of early viraemia and should be recognised/treated as such.

(2) Once infected, the key to preventing severe illness and and death is early supportive care and early administration of anti-viral treatment (if available) to all patients to prevent viraemia.

(3) If no such reliable or safe anti-viral is available, high dose anti-oxidants may be administered prophylactically and maintained throughout the illness.

(4) This may explain why Chloroquine/Hydroxychloroquine seems to have some therapeutic benefit because it may inhibit the binding of ORF8 and surface glycoproteins to the porphyrins and prevent the action of orf1ab, ORF3a and ORF10 proteins in unbinding Fe from the heme. Big efforts should be expended to ensure its safety if used.

(5) Since the problem in severe/ critical cases is not lack of oxygenation or ventilation, but an inability of pre-existing haemoglobin to carry oxygen and an abundance of toxic iron in the plasma, a blood transfusion/exchange transfusion may the appropriate treatment once viraemia is significant.

6) Patients with Type A blood type have more severe symptoms than those of Type O maybe because the binding of iron to their heme is probably genetically weaker, and therefore iron is more easily displaced from it.

I may be horribly wrong, but this theory explains many of the peculiar things about Covid-19. I welcome all criticisms.

                                                           

WHAT IS THERE FOR US TO BELIEVE IN?

When we couldn’t stop it at the gate,

We knew it was already too late.

The sky grew darker day by day

As time for containment melted away.

While it started slow, it soon surged

Till pain, despair and death converged.

Though we heeded the early sign,

It’s a new plague of a different kind.

We stood around wringing our hands,

Lost in the ruins of our broken plans.

We stopped work and skipped class,

But the enemy is still within us.

What is there for us to believe in,

But human spirit and our will to win?

With drumbeats of battle in every heart,

We fight for our lives two metres apart.

                                                         dl