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As well as reducing the risk of coronavirus spreading social distancing could make people’s symptoms milder if they do get the illness, scientists say.
It can do this by reducing a patient’s viral load – the number of particles of the virus they are first infected with.
Having a high viral load gives a bug a ‘jump start’ and raises the risk of a patient’s immune system becoming overloaded in its battle against COVID-19.
People can slash their chances of a massive initial infection by staying away from others who might be ill and by sticking strictly to the rules against close personal contact which millions of people around the world are now faced with.
Someone infected indirectly by touching a door handle could ultimately end up with milder symptoms than someone who inhales an infected person’s cough, experts say.
And this is because it gives the immune system more time to get a handle on the infection before it gets overwhelmed and symptoms start to show.
Therefore medics, who can come into face-to-face contact with gravely ill patients, are more likely to get seriously ill because they are exposed to higher quantities of the virus by the infected breathing into their faces.
Religious leaders – who are often vulnerable to the life-threatening illness because they tend to be older – can also come into close proximity with the sick.
Sixty priests and sixty doctors are among the thousands of COVID-19 victims in Italy. At least two medics have already died in the UK after testing positive.
‘In general with respiratory viruses, the outcome of infection – whether you get severely ill or only get a mild cold – can sometimes be determined by how much virus actually got into your body and started the infection off,’ says Professor Wendy Barclay, an infectious diseases expert at Imperial College London.
‘It’s all about the size of the armies on each side of the battle, a very large virus army is difficult for our immune system’s army to fight off.’
The way viruses make people ill is by multiplying rapidly once inside the body and building up in such large numbers that the body takes weeks to destroy them all.
WHY COULD A LOWER INFECTION DOSE REDUCE SYMPTOMS?
Everybody who contracts COVID-19 will develop huge amounts of the virus inside their body, but people will become first infected with different quantities of it.
Someone who breathes in the cough of a seriously ill patient in the height of a fever, for example, will be exposed to more viruses than someone who touches a door handle that was coughed on two days ago.
Most of the coronavirus symptoms are caused by the immune reaction which is triggered when the virus is discovered in the body.
In a bid to destroy the viruses the body ratchets up its internal temperature to kill them, causing a fever, and uses huge amounts of calories to send immune cells out into the blood to attack the viruses, causing tiredness and aching.
Being exposed to a smaller number of viruses at the start may mean the body can start off with a smaller immune response.
More viruses, however, would mean a need for a bigger reaction which could produce worse symptoms and then raise the risk of it tipping over into sepsis later on in the illness.
This process is inevitable once someone has caught an infection, but it is possible for people to first become ill with only a small dose of a virus.
This can, in theory, make it easier for their body’s immune system ‘army’ to cope and to fend off the early infection.
In fact, for coronavirus, it seems likely that a large majority of patients become ill under this circumstance and take an unusually long time to notice they’re sick.
Because of this, people appear to be spreading COVID-19 more widely than they would if they had a more serious disease.
Dr Michael Skinner, also from Imperial College, said that if someone starts off with a massive amount of the virus it could overload their immune system.
The virus would get a ‘jump start’ in such circumstances, he suggested, because it would be able to build up faster before the body had time to respond.
Dr Skinner said: ‘We must be more concerned about situations where somebody receives a massive dose of the virus (we have no data on how large that might be but bodily fluids from those infected with other viruses can contain a million, and up to a hundred million viruses per ml), particularly through inhalation.’
He said that this would be a ‘rare event’ and it was unlikely that people outside of hospital staff would be exposed to massive amounts of the virus.
Scientists do not think that people’s viral load will increase if they are exposed to more infected people after they first become ill themselves.
Nor do they think there is not likely to be a build-up of the virus from multiple sources before it reaches a threshold that makes them ill.
Dr Skinner added that if someone is infected with a large viral load: ‘The virus receives a massive jump start, leading to a massive immune response, which will struggle to control the virus to allow time for acquired immunity to kick-in while at the same time leading to considerable inflammation and a cytokine storm.’
Uncontrollable inflammation (swelling) caused by the body’s immune system can be devastating and cause deadly conditions such as kidney failure or sepsis.
It is known to be a contributing factor to severe illness and death among COVID-19 patients.
And a ‘cytokine storm’ happens when white blood cells go haywire and can cause kidney or lung failure and death.
Professor Jonathan Ball, a virology expert at the University of Nottingham said: ‘It is possible that individuals with pneumonia who have a higher viral load might develop more serious disease, but disease development is complex and no doubt many factors will have an impact.’
A scientific paper published in British medical journal The Lancet this month suggested that a high viral load was linked to worse symptoms.
WHAT IS SOCIAL DISTANCING?
The best way of the reducing the amount of the coronavirus someone is infected with is to be strict about social distancing, according to experts, in order to make sure any viruses are well diluted in the air or spread thinly before they reach the airways.
Social distancing measures are used to slow the spread of disease by keeping an appropriate distance between people.
This is two metres (6’5″) in the UK and US, but is 1.5 metres in Australia.
This is because coronavirus can be transmitted by coughing, sneezing, or being in the same space as someone who has the coronavirus for a long period of time.
The aim of social distancing is also to limit physical contact with each other as much as possible, with the encouragement of working from home, avoiding crowded spaces and public transport as much as possible.
Social distancing is a behavioral method that buys time for scientists to develop a vaccine.
However, World Health Organization Director-General Tedros Adhanom Ghebreyesus has said ‘on their own, these measures will not extinguish epidemics’. He has urged for testing to be done on large scale in order to contain cases.
Social distancing measures are:
- Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19) – these symptoms include high temperature and/or new and continuous cough.
- Avoid non-essential use of public transport – when possible, alter your travel times to avoid rush hour.
- Work from home, where possible – your employer should support you to do this.
- Avoid large gatherings and small gatherings in public spaces – pubs, restaurants, leisure centres and similar venues are currently closed as infections spread easily in closed spaces where people gather together.
- Avoid gatherings with friends and family – keep in touch using remote technology such as phone, internet, and social media.
- Use telephone or online services to contact your GP or other essential services
The study looked at 76 coronavirus patients in Nanchang, China, who had been admitted to hospital and tested positive for COVID-19.
The researchers, led by Dr Wei Zhang, wrote: ”The mean [average] viral load of severe cases was around 60 times higher than that of mild cases suggesting that higher viral loads might be associated with severe clinical outcomes.’
At least 80 per cent of coronavirus patients are believed to have only a mild illness similar to a cold, while some might develop more severe breathing problems.
The most seriously ill end up in hospital with pneumonia and in intensive care units have a survival rate of around 50 per cent.
Dr Wei and colleagues added that high viral load also seemed to raise the risk of a serious illness in patients with SARS, a similar virus that caused an outbreak in 2002.
They wrote: ‘This finding suggests that the viral load of SARS-CoV-2 might be a useful marker for assessing disease severity and prognosis.’
Researchers at the University of Oxford agreed that studies seem to show that a higher viral load makes coronavirus symptoms worse but there was no solid proof.
An analysis by the Nuffield Department of Primary Care Health Sciences reads: ‘The evidence suggests an association of viral dose with the severity of the disease.
‘However, the evidence of the relationship is limited by the poor quality of many of the studies’.
To avoid becoming infected with a larger viral load the best thing people can do is to stay away from others who are or might be ill, Dr Wendy Barclay said.
The viral load would be higher if someone coughed directly into your face than it would if they were two metres away and the viruses were dispersed in the air.
So when in public people should always keep their distance from others, Dr Wendy Barclay told The Telegraph, especially if they are coughing or sneezing.
Wearing gloves, washing hands and avoiding touching their face can also protect people from picking up the viruses in public places.
And if someone is living with someone infected with the coronavirus they should try to avoid close contact with them – stay two metres (six feet) away, if possible.
This includes stopping hugging and kissing, sleeping in separate beds if necessary and making sure they regularly clean often-touched surfaces like door handles.
Dr Barclay added that it would be sensible not to share towels or cutlery and crockery.
Anyone who is showing symptoms of coronavirus (coughing, fever or shortness of breath) should try to cut themselves off from healthy housemates as much as possible.
‘The point of social distancing is that by standing further away from someone when they breathe or cough out the virus it likely means fewer virus particles reach you,’ Dr Barclay told the Telegraph.
‘Then you get infected with a lower dose and get less ill. Your own viral load, that starts off the battle, is going to be lower and you’ve got more chance of winning it.’
A higher viral load is not only more dangerous for the patient themselves but also for people around them, because it makes them more infectious.
The more of the virus there is inside someone’s body, the more they will therefore breathe out and expel in coughs and sneezes – a process called viral shedding.
This raises the risk of them infecting someone else.
Professor Ball, from the University of Nottingham, added: ‘We know that the likelihood of virus transmission increases with duration and frequency of exposure of an uninfected individual with someone infected with the virus.
‘We also suspect that the amount of virus that an infected individual is producing – sometimes referred to as the viral load – and potentially shedding, will also impact on transmission; the higher the viral load the more infectious someone is likely to be.’
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