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Urology Pearls

Virus development was improbable, relentless

Shahar Madjar, MD, Journal columnist

Life has become unrecognizable. Marquette’s stores and cafes are closed, the streets are empty and there is an eerie, deafening, penetrating silence in the air. Through my kitchen’s window, I saw two squirrels in my backyard, looking at me, then at each other, possibly wondering why I have become a prisoner in my own home. And Dr. Anthony Fauci, a 79 year old immunologist, and a member of the White House Coronavirus Task Force is seriously considered for the title Sexiest Man Alive.

The more interesting story, for me, is actually a chain of improbable events. It goes something like this: There are millions of different types of viruses in the world. They consist of genetic material wrapped in an envelope of protein.

The genetic material within a virus can mutate. This is how new types of viruses emerge. This is how the Coronavirus-19 came into existence. It belongs to a rogue family of viruses (a close relative had caused the SARS epidemic in 2002 and in 2003). The newly formed virus found its way into a bat, or a group of bats. Bats don’t usually get sick because they are somehow quite immune to viruses. The bat was possibly hanging in a dark cave, upside down, minding its own business, until it was caught and brought, dead or alive, into the market in Wuhan city in China. This is how the catastrophe began!

Not all viruses are very infective, but COVID-19 is. Not all viruses are deadly, but COVID-19 is. On its surface, there are spike proteins that attach to human cells within the lungs. Our cells allow, perhaps invite, the virus into them. Our cells are the “landlords” who give the virus the key to the house, then lend the virus their system of replication, as if the virus was a welcomed guest. The virus replicates and multiplies within the cells and then escapes the cells through a labor-like process called “exocytosis.” The virions (baby viruses) can then disseminate through droplets, produced during sneezing, coughing, even speaking (especially when using words that start with the letter “T”, or “P”, so don’t utter the words toilet paper).

The virus isn’t an enemy in the usual sense of the word. It doesn’t possess the ambition of an emperor set to conquer the world, or the malevolence of a villain. It is an inert creature without a shred of consciousness or motivation, incapable of designing or executing a plan. It is a creature that couldn’t have existed on its own, call it “a parasite,” if you wish, that relies entirely on living cells of much more complex living organisms such as bats and humans. Its virulence is the result of multiple highly-improbable events.

And still, if you insist on using the metaphor of war (and I am taking the liberty to do so), the battle against COVID-19 is that of unequal combatants. And humanity will be victorious.

It is true that we are currently losing the first phase of the battle. The virus had spread wide and deep into our communities and took many casualties. We reacted slowly, and in initial disbelief. Then, our next reaction was to withdraw: we retreated into our bases in an attempt to avoid the devastating effect of defeat in the hands of an army that would have won mainly because of its sheer numbers. To minimize the devastation of this first phase, we should all practice physical distancing, wash our hands frequently, and wear face masks in public. Soap will flush trillions of the enemy combatants off our hands. The other measures will cut their “wings.”

A good commander would tell you that, in a war, retreat is a step you take to improve your position. Now that we have retreated, it is time to regroup, reinvent and reimagine. As a multi-cellular organisms with consciousness, intelligence, and imagination, we are perfectly positioned to win this war. How? By tracing the multiple improbable events that have led to this pandemic in the first place and taking action: by separating sources of contamination from population centers; understanding modes of transmission; inventing and manufacturing simple, effective physical barriers to the spread of the virus; designing simpler ventilating devices that would buy us time; developing medications that would block attachment of the virus to cells and its replication, as well as medications that modify the immune response to the virus; and, lastly, deal the virus its final blow by developing a safe and effective vaccine.

At the time I am writing to you, scientists are are diligently working on all of these different avenues of combatting the virus. The road might be difficult, but we will prevail, we will win the war against this pandemic, and in its course we might develop the tools to overcome, better yet, prevent the next one. Meanwhile, keep your physical distance, wash your hands regularly, and wear a mask! Stay safe.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.

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