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Unilateralism in the treatment of the COVID-19 pandemic. A Biologist’s Perspective

Thursday, 05 November 2020
by Dr. Aggelina Metaxatos, Research Scientific Staff, Institute of Environmental Research and Sustainable Development (IERSD) of National Observatory of Athens (NOA)
Unilateralism in the treatment of the COVID-19 pandemic. A Biologist’s Perspective
Major crises and threats strengthen the Science-Policy Interactions and reveal gaps in Analysis

Humanity has waged long wars against many different, sometimes imaginary threats. In 1958, in the Republic of China, a relentless four-year war was waged against an animal species that would hardly be declared an enemy: the little sparrow. The real cause of this war was the miserable policy of the Party that threatened China with famine. The "enemy" was none other than the endemic arboreal sparrow: a small, cowardly bird that had the misfortune to be included in the" Four Pests Campaign" along with mosquitoes, flies, and rats, well-known carriers of dangerous pathogens. Mao's authority declared war because the "experts" defined the sparrow as a competitive species in grain farming (https://en.wikipedia.org/wiki/ Four_Pests_Campaign). The leader's authority and the "excellence" of the party turned China's people into a ruthless killer of millions of small birds, which caused a severe ecological disaster and the great Chinese famine. Although modern man's faith that he can exploit the natural resources as he likes failed, it is still dominant.
 This historical campaign  and others similar show that the respective leaders, having the power of "authority" and the "infallibility" of the expert, can present the craziest idea as a threat or salvation and transform the people, with the help of media, in a mob or irrational entity with "revolutionary" dynamics. 
 
Modern people believe that they are invulnerable, but nature remains unknown and possesses incredible comic mood and humor. It always reminds us, often in a tragic way, that dogmatism is the only invincible enemy of humankind. If people do not respect the natural laws and boundaries will always be at risk. Human laws and institutions and mainstream trends like the politically correct or fashion are flimsy structures and chimeras, often far from man's logic and real needs. According to Hippocrates:" Nature is the most hegemonic force of all" a still valid saying despite impressive technological development.

Huge spending is being made on new governance services such as independent authorities, NGOs, organizations, etc. but studies in philosophy, logic, and ethics that would guide technology in meeting real social needs such as public health are outside the expectations of modern Western societies and are discredited and underfunded.

Today we see that the "centers of excellence" announce contradictory or even unreliable conclusions about the new virus. We still do not know the exact time of onset of the COVID 19 or its effects, nor of course, its course and treatment, while all countries have adopted the same basic hygiene measures.

Epidemic and pandemic are ancient Hippocratic terms, as old as human settlements. So, the question is broader: can a zoonosis be drastically reduced or controlled in the 21st century; 

Historical data does not support this idea; since tuberculosis, a very old zoonosis that has decimated humanity for thousands of years remains a threat. Although there are already vaccines and drugs to treat tuberculosis, it causes hundreds of deaths in Greece and many other countries every year. 

"Forgotten" diseases such as diphtheria appear along with new zoonoses today, demonstrating that public health in the large cities of a globalized society is constantly threatened, by either pathogens or anthropogenic activities. 

Therefore, the new pandemic forces us to rethink and demystify the unilateralism in technology's progress, which cannot solve medical problems without comprehensive and multidisciplinary knowledge and combinatorial thinking. Even today, many leaders and opinion-makers with tremendous power behave about the pandemic's control, as Mao did then.

Evidence of interspecies transmission underlines the need for an integrated and innovative approach against the pandemic.
 
This pandemic's treatment focuses on human-to-human transmission (intraspecific transmission) and social isolation is the basic rule, while, for thousands of years, the isolation of animals from humans was the rule for health protection. The modern way of life and the influence of fashion as an omnipotent means of manipulating the people have imposed the equalization of people with animals, an unscientific, irrational idea. In nature, individuals from different species are separated and do not live in close contact; different species nest apart. This separation also shapes the beauty of the different landscapes with the characteristic biodiversity in each habitat. Today, the pandemic's solution is man's isolation from a man but not humans' isolation from animals that are possible carriers of the virus. This measure has serious consequences for society, but not for the pandemic.

Given the very close association between domestic animals and their owners and their tremendous population in big cities of Europe, the emerging and quickly spreading public health crisis raises many urgent questions. Could the widely disseminated SARS-CoV-2 be transmitted to other mammals like pets or farm and aquatic animals, which become reservoirs or infection sources? 

Experts pay little attention to data on the interspecific transmission of zoonosis. Simultaneously, the governances invest public money in finding a drug or vaccine to treat or control the disease COVID 19. The current medical approach is restricted in the drug-pathogen relationship and underestimates the eco-systemic or individualized dimension

The treatment of the disease with drugs, of course, gives immediate (albeit reversible results) and is the foundation of the economic expansion of pharmaceutical companies that have high profitability and so, both economic and political power. There is much public concern about discovering a vaccine or drug against the virus, which causes a struggle for profit by increasing competition between companies and countries, while the pandemic is rapidly spreading worldwide.  On the other hand, studies prove the infection of animals (bats, ferrets, cats, dogs, monkeys, etc.) by the virus, possibly a spillover from bats to humans becoming a pandemic [1, 2]. Although the virus is believed to spread almost exclusively by human-to-human transmission, there are indications that some mammal species may contribute to the ongoing COVID 19 pandemic epidemiology [3, 4]. Previous studies showed that new virus cross species barriers and based on the One Health model the veterinarians and animal specialists should be involved in a cross-disciplinary collaboration in the fight against this pandemic.

Although contamination routes are not completely identified yet, the virus is transmitted mainly through respiratory droplets emitted through fomites by hand-to-mouth, eye conjunctiva, or saliva. As a result, close contact facilitates the transmission of the virus between infected people and domestic or farm animals (mink, cattle, sheep, bat, primates, horses, etc.) because of their receptor homology [1, 3, 5]. Thus, these animals could be intermediate hosts for the disease. Studies have found that companion animals living in areas of high human infection can be infected and the observed seropositivity rates in animals were analogous to those of humans. Although animals were not tested positive in PCR test, 3.4% of dogs and 3.9% of cats had measurable SARS-CoV-2 neutralizing antibody titers [6]. Briefly, they suggested that dogs warrant further investigation regarding SARS-CoV-2 susceptibility in contrast to previous studies. Consequently, the results so far show that understanding the risk factors associated with the spread of the disease and their potential to infect other species requires urgent investigation, especially in countries with many stray pets. 

In Greece, the pet population is huge, and many hundreds of thousands are stray pets or live freely around garbage bins without any veterinary care. This prevalent but irresponsible practice of keeping stray or unattended animals should be a source of concern for the spread of diseases in the community and/or other wild animals living around suburban hills or parks. In this context, surveillance programs for domestic animals' infection and their role in spreading the disease throughout the ecosystem should be urgently implemented particularly, in countries with huge populations of stray animals or pets. Interspecies transmission may be more likely under certain environmental conditions with high animal population densities. When contact detection becomes more accessible, serological surveillance of pets can be supported to develop a comprehensive knowledge of the disease's spread and the pandemic dynamics to control all possibilities and sources of transmission.

The impact of human-related threats in the aquatic and marine ecosystems

In addition to this virus's aforementioned ability to cross species barriers, the possibility of its further crossing the boundaries between terrestrial and aquatic habitats should also be considered.
 
SARS-CoV-2 can be shed from patients in feces for prolonged periods [7, 8]. Respiratory samples remained positive for an average of 17 days, in (55%) of cases with fecal samples positive for viral RNA, while the fecal samples remained positive more, about 30 days after the onset of the first symptom. Their conclusions are that the viruses could remain viable in the environment for days and, as result, fecal-oral transmission would be possible. Along with the extremely alarming conclusion that there is a possibility of prolonged duration of viral miscarriage in the feces for almost 5 weeks after the patients' respiratory samples were tested negative [8], they pose two more serious issues to be investigated.

First, the passive or non-passive transmission of SARS-CoV-2 by insects; second, its introduction into the aquatic and coastal environment through drains, insects, infected animals or bathers swimming in the sea, and debris. It is known that cockroaches play an important role in the transmission of more than 100 serious zoonoses such as tuberculosis, cholera, typhoid, polio. On the other hand, they are also carriers of rotaviruses, coronaviruses, parasites, and fungi. They are restless, active insects moving endlessly between clean houses and dirty spaces (sewerage systems, garbage bins) while mechanically transporting and spreading pathogens everywhere [9]. Remarkably, the new virus's first hosts are insectivorous mammals, such as bats, civets, and pangolins.

Control methods such as improved environmental sanitation, good practices in waste management, and proper sewage disposal systems should be ungently imposed and considered against SARS-CoV-2.  

Furthermore, special attention is required to prevent the spreading of disease in aquatic and marine habitats. The SARS-CoV-2 can survive on surgical masks and other plastic materials for several days [10]. The dirty masks and gloves are floating in the open waters after disposal as marine debris. Globally, this debris, together with the untreated sewage and infected recreational users (swimmers or pets), can introduce the SARS-CoV-2 to aquatic habitats. While the distal origin of SARS-CoV-2 is likely terrestrial, coronaviruses also occur in aquatic mammals and other metazoans [11]. Coronaviruses may be detected in marine and freshwater ecosystems as free virions, while the true microbial diversity in water reservoirs has been poorly studied [11] and underestimated.

In countries such as Greece, with a huge coastline and many aquaculture cages, it is necessary to understand the biology of coronaviruses in the marine ecosystem through broad viral and microbial surveys. The increase in cases of COVID 19 in the summer, when animals and people huddle together on Greek beaches, is a source of concern. The widespread belief that pathogens do not survive in the sea is wrong. More research is needed to know how long SARS-CoV-2 survives onshore or at sea and understand the interaction of infected animals and bathers with eutrophic and depredated seawater. Human constructions have penetrated and altered the landscape in the coastal zone, and vessels have occupied the space, undergoing profound changes in seawater quality and marine biodiversity that call for closer attention from the governments.

Dealing with the SARS-CoV-2 virus and preventing its rapid and dangerous spread is a global challenge that primarily requires universal coordination under the auspices of WHO. However, it is also appropriate to manage the COVID 19 spread regionally, given the potential variability of the spread of zoonosis in terms of weather conditions and other environmental factors or different social traditions and habits.

The adaptation of microorganisms to various environments or habitats is a given and widespread fact not only for viruses. Bacteria of the genus Neisseria is a useful paradigm that demonstrates the multifactorial etiology of epidemics or pandemics in general.

The genus Neisseria contains the important pathogens N. meningitidis and N. gonorrhoeae [12]. The first description of Neisseria was in 1879 when A. Neisser observed small diplococci within cells of people with gonorrhea and conjunctivitis. N. meningitidis was isolated from the cerebrospinal fluid of patents with meningitis by Weichselbaum in 1887. 

While over time it has been demonstrated that the commensal Neisseria species colonize the oral and nasopharyngeal cavities of humans and a far wider range of organs in many animals from pets to penguins. Despite available vaccines against certain strains, N. meningitidis is still an important cause of septicemia and meningitis and a major public health concern being on the CDC list of urgent threats.

Insects have been the focus of research for centuries as vectors of disease. Neisseria was first shown to be associated with insects in 2007 in fly species associated with humans. Besides, flies have been implicated in gonococcal conjunctivitis epidemics in Australia [13]. Potential environmental reservoirs and transmission have been invoked to explain the seasonal outbreaks of meningococcal disease in sub-Saharan Africa during the dry season. Besides regional wind speeds and surface dust concentrations are good predictors of the incidence of meningitis, which further links meningitis epidemics in Africa with environmental risk factors [14]. Further circumstantial evidence comes from studies of the persistence of N. meningitidis on environmental surfaces, which indicate that the bacterium can survive desiccation from hours to days [15]. Free-living Neisseria was first reported in Japan from the soil; later, it was isolated from contaminated water, soil, sediment in Mexico [12].

Vice versa, from aquatic to terrestrial habitat, the bacterium Dietzia maris was first isolated in halibut [16] and later in Carp [17]. Years later, it was found in the intestine of the larva of the parasitic fly Wohlfahrtia magnifica, which is obligate parasites of warm-blooded vertebrates [18]. The W. magnifica is widespread throughout Eurasia, one of the main species that cause myiasis in most domestic animals. Current evidence on the clinical significance of Dietzia sp shows their potential role as human pathogens, with the overall aim of alerting the medical community for this genus [19]. All these findings, made by using new methods and techniques, like molecular analysis, demonstrate the multifactorial etiology of epidemics and their potential relation with fauna diversity and environmental parameters.

An Epilogue  

A lesson learned from COVID 19 pandemic is that in nature, the living and non-living elements are interconnected in various ways, following principles and conditions that man must not disrupt. 

The new pandemic makes us revise the modern approach for the use of natural resources and lead us to study nature through a thorough investigation of real causes without political, economic or other obsessions. Thus, it reveals the importance of Aristotle's view:
 
“Επειδή το ειδέναι και το επίστασθαι συμβαίνει περί πάσας τας μεθόδους, ων εισίν αρχαί ή αίτια ή στοιχεία, εκ του ταύτα γνωρίζειν (τότε γαρ οιόμεθα γιγνώσκειν έκαστον, όταν τα αίτια γνωρίσωμεν τα πρώτα και τας αρχάς τας πρώτας και μέχρι των στοιχείων»

When the objects of an inquiry, have principles, causes, or elements, it is through acquaintance with these that knowledge and understanding is attained. For we do not think that we know a thing until we are acquainted with its primary causes or first principles, and have carried our analysis as far as its elements (Aristoteles PHYSICS, BOOK 1 Translated by R. P. Hardie and R. K. Gaye).



ENDNOTES
  1. Shi J, Wen, Zhong  et al. 2020 Susceptibility of ferrets, cats, dogs, and other domesticated animals to SARS–coronavirus 2. Science, 368, 1016–1020.
  2. Sit T, Brackman, SM Ip, Tam.. et al.  2020 Infection of dogs with SARS-CoV-2. www.Nature.com https://doi.org/10.1038/s41586-020-2334-5.
  3. Sun  et al. 2020 COVID-19: Epidemiology, evolution, and cross-disciplinary perspectives. Trends Mol. Med. https://doi.org/10.1016/J.molmed.2020.02.008
  4. Metaxatos A 2020. Integrated treatment of coronaviruses in the 21th century (In Greek). http://eranistis.net/wordpress/2020/04/08
  5. Leroy et al. 2020 The risk of SARS-CoV-2 transmission to pets and other wild and domestic animals strongly mandates a one-health strategy to control the COVID-19 pandemic. https://doi.org/10.1016 /j.onehlt. 2020. 100133
  6. Paterson, Elia, Grassi.. et al. 2020 Evidence of exposure to SARS-CoV-2 in cats and dogs from households in Italy https://doi.org/10.1101 /2020.07.21. 214346doi: bioRxiv preprint
  7. Hindson J 2020 COVID-19: faecal–oral transmission? Nat Rev Gastroenterol Hepatol 17 (5) 259 
  8. Wu Y, Guo, Tang,  Hong.. et al. 2020 Prolonged presence of SARS-CoV-2 viral RNA in fecal samples The Lancet. https://doi.org/10.1016/S2468-1253(20)30083-2
  9. Gwenzi W 2020 Science of the Total Environment 753 141751 https://doi.org/10.1016/ j.scitotenv.2020.141751
  10. Chin A, Chu, et al. 2020 Stability of SARS-CoV-2 in different environmental conditions The Lancet Microbe Doi: 10.1016/S2666-5247(20)30003-3
  11. Mordecai GI and Hewson I 2020 Coronaviruses in the Sea. Front. Microbiol. 11:1795. DOI: 10.3389/fmicb.2020.01795. 
  12. Liu G, C. M. Tang and R. M. Exley 2015 Non-pathogenic Neisseria: members of an abundant, multi-habitat, diverse genus. Microbiology . 161, 1297–1312. 
  13. Brennan R, Patel and Hope 1989. Gonococcal conjunctivitis in Central Australia Med J Aust 150, 48–49 
  14. Molesworth AM, Cuevas, Connor, Morse, and Thomson 2003 Environmental risk and meningitis epidemics in Africa Emerg Infect Dis 9, 1287–1293
  15. Swain, C. and Martin D. 2007 Survival of meningococci outside of the host: implications for acquisition Epidemiol Infect 135, 315–320
  16. Harrison FC 1929 The discoloration of halibut Canad J Res 1, 214–239
  17. Nesterenko OA, Nogina, Kasumova , Kvasnikov  et al. 1982  Rhodococcus luteus nom. nov. and Rhodococcus maris nom. nov. Int J Syst Bacteriol 32, 1–14
  18. Toth EM, Hell, Kovacs et al. 2006 Bacteria isolated from the different developmental stages and larval organs of the obligate parasitic fly, Wohlfahrtia magnifica (Diptera: Sarcophagidae) Microb Ecol 51, 13–21
  19. Koerner R, Goodfellow and Jones 2009 The genus Dietzia: identification and clinical significance FEMS Immunol Med Microbiol 55, 296–305



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