Kirsten Hokess in the lab
Bryant Professor and Department Chair of Science and Technology Kirsten Hokeness (right), a respected expert in immunology, virology, microbiology, and disease, shares perspective on the impact of coronavirus (COVID-19).
A conversation with immunologist Kirsten Hokeness, Ph.D., about the impact of coronavirus (COVID-19)
Mar 13, 2020

Bryant Professor and Department Chair of Science and Technology Kirsten Hokeness is a respected expert in immunology, virology, microbiology, and human health and disease. With the coronavirus (COVID-19) quickly changing the way everyone in the world is living and working, we asked Dr. Hokeness to share some perspective on the virus and its impact from a scientific perspective.

 

What’s the difference between this “coronavirus” and the strain of coronavirus that causes the common cold? What does the term “novel virus” mean?

Coronaviruses are a family of viruses that are linked in several ways. First, their physical structures are similar and are in fact named for the crown-like spikes on their surface. Second, they are zoonotic which means they are initially spread to humans from animals. Third, they typically cause respiratory illnesses that range from mild, like the common cold, to more severe respiratory conditions such as pneumonia and have the potential to be fatal. COVID-19 is “novel” because it is a new member of the family (or strain) that has acquired the ability to infect humans. 

Since it is a novel virus, there is no vaccine yet, so we have to rely on preventive measures like social distancing and quarantine to limit spread. COVID-19 appears to replicate vigorously and quickly in the host with an estimated incubation period (time from acquisition to symptoms) of about 5 days. 

What exactly is a virus, and how does it spread?

Viruses are biological agents that exist only to replicate. Essentially, they are extremely small units of genetic material (DNA or RNA), that contain the information on how to make more particles. This is packaged into a protein coat and in some cases surrounded by a lipid envelope. Since they do not have the right machinery, they must use a host cell to copy themselves. Viruses need to gain access to the inside of the body so they will enter via a number of portals of entry by touch, exchange of saliva, through respiratory secretions from coughing or sneezing, contaminated food or water or through vectors (such as insects and ticks) that can transmit viruses. 

COVID-19 is spread primarily from person to person via respiratory droplets that are produced as a result of coughing or sneezing. When people are in close contact these droplets can spread and land in the mouth or nose of susceptible individuals or droplets can potentially be inhaled.  It is also possible (though not the main route of spread) that individuals can become infected by touching surfaces that contain the virus and then touch their mouth or nose. The most recent studies have indicated that the virus can last in droplets for a few hours and on surfaces up to a few days, depending on the type of surface it is (stainless steel and plastic is about 3 days). Data regarding spread and how long the virus can remain viable on surfaces is still being interpreted. 

What makes it so challenging to stop the spread of viruses and in particular, COVID-19?

Each virus has different challenges with respect to containment. Factors to consider are the route of transmission, immunity in the population, incubation period, how early in the infection the virus can spread from person to person, the dosage required to make someone sick, the severity of the disease, ability to mutate and diagnostics. With respect to COVID-19 there is little to no natural immunity in the population. The only possibility of some natural protection would be from cross-reactivity with other coronaviruses, which may limit the severity of illness because the immune system could mount a slightly faster response.  

Since it is a novel virus, there is no vaccine yet, so we have to rely on preventive measures like social distancing and quarantine to limit spread. COVID-19 appears to replicate vigorously and quickly in the host with an estimated incubation period (time from acquisition to symptoms) of about 5 days. The viral load in patients prior to showing symptoms is impressive which suggests that spread can occur before symptoms appear which makes it difficult to contain as unknowingly infected people interact in our communities. 

The symptoms mimic many other respiratory illnesses, so before measures were taken to limit spread, people are out in the community spreading the virus because they aren’t that sick.  Viruses that cause much more severe illness right away tend to self-contain much faster because people stay home. 

Lastly, measures must be in place to diagnose patients in order to protect other community members from acquiring the infection. There are currently questions as to whether there are enough tests in the U.S. Indications from health care workers now are that only people who are very sick, have traveled to restricted countries, or who have known exposure to infected individuals are being tested. This means many people are walking around infected and don’t know it. This increases the complexity and difficulty of limiting the spread. As more tests are made available this pressure will be alleviated.

People like to have answers and have them quickly. Not knowing the answers as we study this virus in the scientific and public health realms in real time, can be a real source of anxiety. 

Why is COVID-19 causing so much fear and such dramatic measures to be taken around the world?

Things that are unknown undeniably heighten levels of anxiety and fear. This is a new virus that emerged and spread across the globe very rapidly, to the extent that the World Health Organization (WHO) has declared it a “pandemic.”  That word alone can be fear-provoking as it doesn’t happen all that often. 

People like to have answers and have them quickly. Not knowing the answers as we study this virus in the scientific and public health realms in real time, can be a real source of anxiety. 

Additionally, COVID-19 is causing fatalities, which is always concerning. The most recent estimates indicate a 3 to 4 percent mortality rate with this virus whereas the flu is under 1 percent. We have yet to determine an accurate mortality rate, as it is calculated based on the number of confirmed cases, which in many circumstances, particularly here in the U.S., is underreported at this point. The mortality rate is much higher for some populations. Studies from China show mortality rates to be as high as 15 percent for those over 80 or who have underlying medical conditions. But that number drops with age showing about 1.4 percent for 50-somethings, and as low as 0.2 percent for those between 10-39, which is more like what we see with the flu. 

Regardless of the numbers, people are dying, and this leads us to take drastic measures. From a public health standpoint, it is important to get ahead of the virus and try to limit the casualties. No one wants to get this wrong (especially in an election year), and that in part drives the need to take drastic measures. Also, the media, including social media, are expanding and magnifying the focus on the virus, so that further drives this fear.    

It is difficult in a fluid situation to determine whether there is overreaction to this disease, but if a small period of time in the grand scheme of things, where social distancing is enforced is going to save lives, it won’t be considered an overreaction. 

Some skeptics have been comparing COVID-19 to other pandemics that infected and caused more fatalities around the world. Can you comment on the opinion of some that there is an overreaction to COVID-19?

COVID-19 is the same family of viruses that caused the SARS and MERS outbreaks so it is easier to compare these three scenarios with respect to the idea that there may be an overreaction to this virus. With respect to mortality rates, COVID-19 appears to have a lower mortality rate in comparison but overall, we are seeing far more deaths associated with the virus because of its ability to spread.

The SARS outbreak infected about 8,000 people, killing roughly 800. This virus didn’t spread globally as we are seeing with COVID-19 so the effects were far more localized. Similarly, MERS has a very high mortality rate at 34 percent, but between 2012 and 2020 it killed 866 people out of the 2,519 confirmed cases. 

To put those outbreaks into perspective in terms of the numbers of people affected at an alarmingly rapid pace, this current outbreak has around 132,000 confirmed cases with 4,955 deaths (as of March 14th) and this is still climbing exponentially. For every person infected, the virus will infect another 2.4 people, so this is not expected to slow anytime soon. Neither SARS nor MERS were as rapidly transmittable from person to person as COVID-19 appears to be. 

It is also a great test of our healthcare infrastructure to handle a disease outbreak, and we have seen some areas where we can greatly improve already as a country in our ability to handle a disease of pandemic proportions. Outbreaks like this also have a dramatic effect on the ability of our healthcare workers to continue to take care of critically ill patients that are not infected with coronavirus, while trying to stay healthy themselves.   

This pandemic will continue to put strain on ERs and ICUs, patients may be taken care of in hallways as we are seeing in other countries. So, while the virus may not appear to be that dangerous on an individual level, its proliferation is real, and establishing containment as soon as possible is imperative to protect not only coronavirus patients but also others that are critically ill.  It also shows the importance of consistently ensuring enough funding for the scientific community to be prepared. This type of funding has been cut in recent years and it is clear in this situation that the scientific community has to be prepared to battle this.   

It is difficult in a fluid situation to determine whether there is overreaction to this disease, but if a small period of time in the grand scheme of things, where social distancing is enforced is going to save lives, it won’t be considered an overreaction. 

We are stronger as a community than we are as individuals so rely on each other, provide support where necessary and keep forging forward. Expect the unexpected but know that this too shall pass. There is a lot we will all learn from this experience. 

In addition to the helpful information you’ve provided here, and provided by the CDC and WHO, what other insights and perspective might you offer to help the Bryant community and broader community better understand and manage through this crisis?

The interdisciplinary and all-encompassing nature of disease and human health is not often understood, and this pandemic will give us great insight into how to better handle the next emerging disease that will come. There is a need for collaborative efforts between individuals, organizations and the government to be able to fight disease and the need to find solutions rather than point fingers. The economic impact of this pandemic is only just being seen. We have seen many industries already suffer tremendously, but these drastic measures will be felt on an individual level as well, and the country will have to be prepared to help. Italy, for example, has suspended mortgage payments for the time being during their crisis. 

It is important to manage stress and remain calm to the best of our ability. The anxiety and concern about coronavirus are natural and expected.  And while it is important to remain informed and be as prepared as you can, you still must step back, take a breath and think logically. Anxiety and stress can heighten your risk for getting ill, so it is important to keep things in perspective. This is a good story for media, and we are inundated by it so it is imperative to not get consumed by the constant coverage. Pay attention, check in regularly but don’t let it overwhelm you.  Be sure to get information from trusted sources such as the CDC or WHO and be careful of all the misinformation that is also available.

We are stronger as a community than we are as individuals so rely on each other, provide support where necessary and keep forging forward. Expect the unexpected but know that this too shall pass. There is a lot we will all learn from this experience. 

About Professor Hokeness

Kirsten Hokeness, Ph.D., is an expert in immunology, virology, microbiology, and human health and disease. Her research currently focuses on examining mechanisms of immune suppression following exposure to microbial volatile organic compounds and determining the role of cytokines and chemokines during infection with Clostridium difficile. Additionally, she is looking at how students perceive health information and make choices regarding their health and vaccines. She has been the recipient of funding from Rhode Island’s INBRE (IDeA Networks of Biomedical Research Excellence) program. 

At Brown University, where she earned her Ph.D., Hokeness studied immunity to viral infections, and wrote “Characterization of Cytokine/Chemokine Networks Critical during Murine Cytomegalovirus Infection.” She teaches Biology, Introduction to Biotechnology, Microbiology, Biology lab, Ecology lab, Foundations of Pharmaceutical Science and Immunity and Disease. Currently she is chair of the department and serves as the pre-health adviser. 

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