REVIEW TOWARDS COVID-19 MODE OF TRANSMISSION
(AN EFFORT TO VANQUISH WORLD PANIC)
Reason to write:
Research regarding SARS CoV-2 as the cause of CoVID-19 hasn’t been done very much. Writing on that matter is usually dominated by Chinese intellectuals. Meta-analysis needs to be done to prove what they said is fact.
On the other hand, world has been thrown into panic because of CoVID-19. It is getting worse nowadays. So that, there needs many writings published in order to reduce the panic. And one of them is this writing.
Goblet cell is the target cell for SARS CoV-2 to live. Destruction of goblet cell causes the body’s immune system to be disturbed, specifically the thick and sticky mucous liquid in human respiratory tract will be diminished. This causes SARS CoV-2 easier to invade the lung. Hence, it will cause lung inflammation or pneumonia in infected individuals.
There are news being spread, people are refusing other people to be buried in their region if they were dead because of CoVID-19. There even a professor that were being refused to be buried in a region by these people because the suspected cause of death was CoVID-19. People are not shaking hands anymore. There are people trying to open the door with their bodies (not with their hands). There are people washing their hands for more than 50 times a day. People are afraid to touch paper money. There are doctors wearing rain coat, surgical gloves and google glass every time they’re treating their patients. There are even people wearing hazmat suit while they are doing groceries. All of these things happen because of the fear of CoVID-19 infecting them.
There hasn’t been any research on how long SARS-CoV-2 are able to live outside of human body. Based on virus data before, taken from SARS-CoV (SARS/MERS agent) then it is considered that SARS-CoV-2 can live outside of human body from 2 hours to as long as 5 days. With that as a basic there have been controversies among experts to determine CoVID-19 mechanism of transmission, whether it is from droplet infection or airborne infection or both?
WHO states that CoVID-19 transmission is by means of droplet infection (Laboratory Testing for Coronavirus Disease (CoVID-19) in Suspected Human Cases, Interim Guidance March 19th 2020/WHO). Droplet infection is the entry of microbes that are located in the liquid of infected person into other uninfected human respiratory system. Meanwhile airborne infection is the entry of microbes from surrounding air after we inhale that air into our lung.
With the basic of WHO statement above, then the transmission of CoVID-19 is through droplet infection. Or after that individual coughing, sneezing, or talking loudly for a period of time then the infection may happen.
When we are sneezing, ±40.000 droplets with the speed of 100 meters/second are expulsed. When coughing, ±3.000 droplets are expulsed. Meanwhile after talking quite loudly for around 5 minutes around 3.000 droplets are being expelled either (the same as coughing).
Big sized droplets, >5µm, is called large droplets. Meanwhile small sized droplets, ≤5µm, are called micro droplets or droplets nuclei. Most of large droplets will be restrained in upper respiratory tracts (oropharynx, nasopharynx, trachea). Whereas droplet nuclei can penetrate until lower respiratory tract (bronchus and alveoli). Large droplets can easily enter into our respiratory system if we stay <1 meter from the infected individual. While droplet nuclei can spread much further than 1 meter. After droplets from coughing/sneezing/talking fall into the earth then micro droplets will be formed. And this micro droplet liquid will dry up after 20 minutes.
Conclusion from above writing is the strongest infection from CoVID-19, if thousands of large droplets entered our respiratory tract, they would still be trapped in the upper respiratory tract. Mucous secretion from goblet cell is causing them to be trapped in there or died. If goblet cell is acknowledged as target cell of SARS-CoV-2, then destruction of goblet cell would cause the loss of mucous fluid as to make these viruses now able to reach alveoli. Immunological or apoptotic reaction which happens in alveoli will cause pneumonia to occur in these individuals.
SARS-CoV-2 that fall into the earth, before 20 minutes has lasted, can also potentially able to infect human. Because the remaining fluid that still available in the droplet will give virus it’s much needed nutrition. And if wind blew them then the transmission is through airborne infection (can’t be said as droplet infection anymore). And the virus range to cause infection will increase because its smaller size can easily be blown away by the wind. These micro droplets can easily enter alveoli even when goblet cells are still plenty in number. But if goblet cells were starting to deteriorate then it will be even easier for them to reach alveoli.
After 20 minutes or after the fluid has been dried up, SARS-CoV-2 ability to infect human will also diminish. Potentially lower compared when it is still fresh when it falls. More than that it is also depends on where the virus located when it falls and the amount of viral load in the droplet. After the fall the transmission method will then change into airborne.
Research above is research based on corona virus not specifically SARS-CoV-2.
The longer virus are outside of human body (outside of its target cell), the weaker it becomes. What has been found on items above is not identical with the viral load. The only thing certain is the virus was found in the surface but how many of them that still last after that is still unknown. These viruses will be spread through airborne infection. But the spread won’t be easy. There needs quite high viral load level to make it happens. Sufficient viral load places for example are in doctor’s/nurses’ changing room. The occurrence of thousands of people being infected at the same time in Wuhan city was an extreme example from airborne infection. Viral load in Wuhan’s sky was astronomically high at that time. Whereas this phenomenon could only happen because the leakage from Wuhan virology laboratory. The high viral load in Wuhan’s sky caused millions of people inhaled the virus. Thus, CoVID-19 was born.
The effects of understanding CoVID-19 transmission as above writing has said will then have implication like this:
- Wear mask all the time.
- Washing hands only as needed. The same with disinfection usage for hands. Muslims should be grateful because they are told to wash their hands at least 5 times a day (Wudu)
- We don’t have to wear gloves all the time, unless when entering isolation room or meeting with CoVID-19 patients in observation in ER.
- Google glass don’t have any certain reason to be worn.
- Surgical cap or head cover should only be used in isolation room and in ER after receiving CoVID-19 patient in observation. But washing head several times a day is important. Muslim should be grateful because they are told to wash their head at least 5 times a day (Wudu).
- We shouldn’t be afraid to touch any objects, including door knobs or paper money. Unless it’s located in isolation room. Therefore shaking hand is not a problem either.
- Universal personal protective equipment (PPE) which is hazmat suit or somehow rain coat should not be used at all unless in isolation room or meeting with patient in observation in ER.
- Washing dead bodies is not a problem. If it is done in isolation room or mortuary. The same with drying up the body with towel after being washed up. In religious law washing up the body is simple, it is only by running down the water through all the body. Before the process takes place we should disinfect the whole body first. After washing it up there is no reason to not shrouding it up. And after that we perform prayer in the mortuary. There should be no need for the coffin, either slightly before being buried or when being brought into the burial site. Everything because the viral load is too small for it to be infectious or there is no virus there anymore whatsoever after all the disinfection and washing up were done. If there is still virus there then the virus’ strength will be much weaker and will then die in no time.
If we are certain that there will be no virus anymore after table/chair/cupboard/etc has been cleaned up by disinfectant, then why are we still in doubt that CoVID-19 body hasn’t been sterilized after all the disinfection that we have done?
- Friday prayer can be done if ideal requirement to perform the prayer is met. Ideal requirement for all Friday prayer participant is to wear mask, age below 65 year old and are not suffering from cough, flu, etc, the mosque should be disinfected properly too. If this ideal requirement was not met then the Friday prayer should be better off postponed.
Obligatory prayers and tarawih prayer are better to be done in home not in mosque. Because the meeting frequency is too often, even when ideal requirement just like in Friday prayer has been met, it’s still too risky. Whereas for eid prayer, other than the fact that it’s Sunnah, the crowd number will be so high. Hence, it’s better not to be done.
May this writing will reduce the world panic because of CoVID-19 outbreak.
Aamiin ya robbal ‘aalamiin.
- President of the Republic of Indonesia
- Jakarta Local Government
- Indonesia Ulema Council
- Muhammadiyah Central Bureau
- NU Tebu Ireng grand administrators
- NU Jakarta grand administrators
- Kompas daily
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- KH. Abdullah Gymnastiar
- Ustadz Abdul Somad
- Ustadz Adi Hidayat
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- KH. Hasan Abdullah Sahal
- Buya Yahya
- Ustadz Felix Siauw
- Cak Nun