Interview with biologist Douglas Rosenthal about COVID-19

The coronavirus keeps the world in a state of shock. Rather than fighting the structural causes of the pandemic, governments are only focusing on emergency measures. We talked to structural biologist Douglas Rosenthal about the dangers of COVID-19, the responsibility of us as citizens, and sustainable solutions to combat infectious diseases. Rosenthal is an evolutionary biologist and independent researcher for public health in the United States. He has researched human cells and the function of metabolic genes for 25 years, and is the author of several online publications.

Q: How dangerous is the coronavirus?

Douglas Rosenthal: It depends on where you are at the time of the local COVID-19 outbreak: initial level, maximum peak or late phase. How is the region's health system responding? How old are you? Are you immunologically vulnerable? What is your general state of health? To add an undiagnosable possibility: does your immunogenetics, the genetics underlying your immune defense line up against the virus or not?

Q: So, is all this fuss around the virus just a strategy to scare people?

Douglas Rosenthal: Not at all. COVID-19 had a case fatality rate (CFR) of between 2 and 4% in the initial phase of the outbreak in Wuhan. Outside of Wuhan, the CFR seems to drop more or less than 1% and even below, but it also seems to increase in points here and there, like places in Italy and the US. Its range does not seem very high compared to, for example, Severe Acute Respiratory Syndrome (SARS), which is 10%; the 1918 flu, 5-20%; H5N1 avian influenza,60%; and, in some points, Ebola, with a mortality rate of 90%. But, it certainly exceeds 0.1% CFR of seasonal flu incidence. However, the danger is not only a matter of mortality rate, but we also have to face, what is called, a community attack rate penetration: how penetrative is the outbreak among the world population as a whole.

Q: Can you be more specific?

Douglas Rosenthal: The global travel network has record connectivity. Without coronavirus-specific vaccines, antivirals, or any immunity right now, even a virus with only 1% mortality can pose considerable danger. With an incubation period of up to two weeks and increasing evidence of transmission before the disease - before we know that people are infected - few places would be free of infection. If, for example, COVID-19 records 1% of fatalities, the infection process of four billion people will result in 40 million deaths. A small proportion of a large number can still represent a large amount.

Q: These are alarming figures for a considerably less virulent pathogen ...

Douglas Rosenthal: Absolutely, and we are only at the beginning of the outbreak. It is important to understand that many new infections change over the course of epidemics. Infectivity, virulence, or both can be attenuated. On the other hand, other outbreaks increase in virulence. The first wave of the flu pandemic, the spring of 1918, was a relatively mild infection. It was the second and third waves of that winter, until 1919, that killed millions of people.

Q: But, some skeptics argue that fewer people are infected, and there are fewer deaths from the coronavirus rather than from the typical seasonal flu. What do you think?

Douglas Rosenthal: I will be the first to celebrate if this outbreak proves to be a failure. However, these efforts to dismiss COVID-19 as a minor danger, citing other deadly diseases, especially the flu, are a rhetorical ploy to portray the coronavirus concern as inadequate.

Q: So, the comparison with seasonal flu is misleading.

Douglas Rosenthal: It makes little sense to compare two pathogens in different sections of your epicurve, that is, your development curve. Yes, seasonal flu infects many people worldwide, and the World Health Organization estimates that up to 650,000 people die from it each year. However, Covid-19 is only at the beginning of its epidemiological development. And, unlike the flu, we have neither a vaccine nor a collective immunity to curb infection and protect the most vulnerable populations.

Although the comparison is misleading, both diseases are caused by viruses that belong to a specific group, RNA viruses. Both can cause illness. Both affect the mouth and throat, and sometimes also the lungs. Both are quite contagious.

These are superficial similarities that do not take into account an important difference between the two pathogens. We know a lot about the dynamics of the flu. We know very little about COVID-19, which is full of unknowns. In fact, there is a lot of information on the behavior of COVID-19 that we will not know until the outbreak is fully developed. At the same time, it is important to understand that it is not COVID-19 versus seasonal flu, but COVID-19 and the flu. The emergence of multiple infections capable of triggering a pandemic and affecting entire populations in combination should be the main concern.