Scientific Importance Of Social Distancing And Fomites That Aid the Spread Of Coronavirus While social distancing is the most effective part of containing COVID-19, it is equally important to understand fomites as it can spread infections passively

The novel coronavirus, or COVID-19, is a pandemic outbreak of respiratory infection caused by the Severe Acute Respiratory Syndrome (SARS) COVID Virus2 (SARS CoV2). As on March 31, 2020, more than half a million people have tested positive and nearly 38,000 people have died due to COVID-19. The outbreak started in the city of Wuhan of Hubei province in central China in November 2019.

Coronaviruses are widespread in nature and are known to cause disease in birds and mammals including humans. Coronaviruses have been known to cause bowel disease in cows and pigs.

Viruses are mostly species-specific but can occasionally jump species and cause disease in humans, called zoonosis (diseases acquired from animals). Coronaviruses in humans are a known cause of respiratory infections including common cold. The individuals in a community population who are resistant to the infection provide herd immunity. When viruses jump species, infections spread rapidly as there is no herd immunity and may be more virulent. This is especially valid in zoonosis acquired from wild animals. The Coronavirus SAR CoV1 had a high mortality rate of 20 per cent people and was traced to bats through Civets from Guangdong, China and caused the SARS pandemic in 2002 that affected 29 countries. Transmission of coronavirus infection from camels led to the Middle East Respiratory Syndrome outbreak in Saudi Arabia in 2012.

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Viruses are genetic code hackers. Just like a computer hacker, the virus inserts its nucleic acid (genetic code). The positive strand Ribonucleic acid introduced into the cell takes over the functioning of the cell and starts multiplying using the cells machinery like the ribosomes, endoplasmic reticulum and Golgi complex. Millions of newly cloned viruses are produced and the viruses are extruded into the lumen of the respiratory tract by exocytosis or cell rupture. The act of coughing and sneezing releases millions of infective viruses along with the respiratory droplets.

The Need for Social Distancing

Social distancing, social isolation and quarantine are the most important part of containing COVID-19. Quarantine is the restriction of movement of people who have been exposed to a communicable disease without a diagnosis, while isolation is performed on patients who have tested positive for the disease.

The goal is to prevent the virus from infecting others. An infected person secretes the virus in millions through respiratory droplets. The incubation period, time from infection to symptoms, of COVID-19 can vary from two days to two weeks. Although peak viral excretion occurs during the symptomatic phase, it starts earlier and can occur even when the patient has no symptoms. It is during this period when one is seemingly healthy that infection can be transferred to contacts by social contact and gatherings.

Social distancing by all people including healthy individuals therefore would prevent spread of infection by those who are asymptomatic and later develop the disease.

Role of Fomites: How Fomites can Foil Social Distancing

Fomites are inanimate objects, which can spread infections passively as opposed to vectors (like mosquitos), which are living organisms that actively transmit infection. Although social distancing can prevent direct transfer of droplet infectious particles, spread of infection can still occur by fomites. Objects such as surfaces of tables, chair, handlebars, doorknobs and elevator buttons, or in the bus, trains or airplane that can transmit viral particles by harboring droplets on their surfaces.

It is seen that the SARS CoV2 virus can be airborne for up to two hours in a closed space (like a room or aircraft cabin) after a cough or sneeze and therefore can be inhaled by others in that confined space. The infectious droplets can also settle on fomites and be picked up by just touching the surface and touching the face particularly the nose, mouth or eyes. Virus has been seen to be viable up to three days on the surfaces with shorter duration on metal and longer on cardboard and plastic. Virus has also been isolated from the cabin of the cruise ship the Diamond Princess 17 days after evacuation, alerting us about the role of fomites even weeks after the initial deposition of infected material.

The clinical features of COVID-19 as seen in China suggest that 80 per cent of infected people develop mild disease such as common cold or mild flu, 15 per cent develop severe disease with breathlessness due to pneumonia and 5 per cent of the patients develop critical disease with respiratory and multiorgan failure and are at highest risk.

COVID-19 as yet has no proven therapy. The World Health Organization (WHO) has launched a multicenter "solidarity' drug trial to evaluate the efficacy of anti-viral and anti-malarial drugs in 10 countries. No effective vaccine is available as of now against SARS CoV2, although many are under development. The WHO has said that it may take up to 18 months to develop an effective vaccine.

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