Is the initial viral load determines asymptomatic and COVID 19?

Modi government has terribly defeated India in two fronts viz., preventing the spread of coronavirus despite stringent lockdown and destroying the economy, life and livelihood of millions of people. 

The question is how a new pathogen that spreads so rapidly across the world can show great disparity and discrimination in its infectivity or in other words causes infection at different levels in different people? 

Majority of the people reported to have shown no clinical evidence after the viral entry and the rest have presented a little symptom (mild symptoms) and then the virus disappears to the space. 

If the virus is a true pathogen, it may not show such disparity in its infectivity.  Then we must ask the question as whether the game of viral load and immunology the real culprit of COVID 19 in some people? 

It has been established even in a deadly pathogen like Hepatitis B virus that the viral load only contributes to higher viral kinetics, priming the immune response and determining the clinical outcome.   The study entitled “the size of the viral inoculum contributes to the outcome of Hepatitis B virus infection” was published as early as 2009 in the journal of virology, an official journal of American Society for Microbiology. 

The above study was conducted in Chimpanzee, genetically the nearest animal to man and found that the lowest and highest viral load when injected in animals produced immune response and simultaneously the logarithmic spread of the virus was also observed.   Ironically in both situation, the hepatic cell involvement was near 100% and required prolonged period for viral clearance.  When the animals were challenged with intermediate viral load, all the different intermediate inoculums of the virus had primed the immune response much before the logarithmic spread of the virus and the virus got terminated or cleared spontaneously from all the animals with least immunopathology.

When the viral load is the key determining factor even for a deadly pathogen like Hepatitis B virus for both eliciting immune response and clearance means, should we not consider the possible game between the viral load and immunology may be resulting in varied clinical conditions seen in COVID 19 cases.  Does that indicate even the lesser chance of viral multiplication in vast majority of people or only very small viral inoculum may have been entering into the system of vast majority of people which is sufficient to elicit T cell mediated immune defence to evict the virus much before its multiplication reaching the level required to produce serious medical complication.  Therefore the vast majority of people remain asymptomatic but may turns positive for the virus by RT PCR.  The virus that was detected in such people may be nothing but the genetic material and not the ‘full’ virus.

Another possibility also the above game of viral load and immune response suggests and that is, the viral transmission with reference to high viral load between man to man may not be taking place effectively and may not be possible even in a country like India.  Those who develop uncomfortable symptoms of COVID 19 may be due to the initial high load of the virus are unlikely to move in the public space so easily due to their health situation and hence high viral load from such severely infected people reaching the general population is quite unlikely.  Further the viral load required to produce severe infection in Indian population in general may be high and within the Indian population also a possible diversity may exist with reference to susceptibility and resistance.  Travellers’ diarrhoea is the best example. 

Another important question also we must ask about what modification may happen to the virus when it enters in vast majority of people and get evicted by the host immune response due to the low initial viral load. 

Are those viruses become deadly subsequently or benign because they have tasted the human host and hence might have realized that it is better to be benign than aggressive.  On the contrary, the deadly clinical condition evoked by high viral load (?) in some COVID 19 patients may offer the virus a greater chance to train its virulence to live in human host. 

If we juxtapose the study findings of Hepatitis B on novel coronavirus, we can hypothesise that the pandemic may not disappear soon however the vast majority of people may not have to worry much about the virus. 

Lower initial viral load when hits the host, the chance of immune priming is high; much before the spread of the virus.  We must accept the fact that novel coronavirus is not a fully evolved as a human pathogen, likely to have poor virulence and also might have entered the human host accidently.  Therefore the virus load that gets discharged from the asymptomatic and mild symptomatic people is going to be low and hence the transmitted virus may not harm the recipient due to the low inoculum size.   Therefore to prevent the viral spread, imposing lockdown and other norms may not be required and naturally itself the virus may leave majority of the people and may still continue to hunt the weaker ones. 

The world may not have to worry about the viral hunt of weaker hosts and such hunt does not reflect the existence of the virus in the country to a pandemic level and the possibility of second or third wave or another pandemic are quite remote.     

The viral spread may be possible from man to man but the required load of the virus to cause full blown COVID 19 may not be happening between people.  The asymptomatic and those presenting with mild symptoms of COVID 19 may carry the virus and may spread but load of the virus may not be adequate to cause severe infection.  May be due to this possibility, vast majority of people remains asymptomatic and experience auto clearance of the virus in due course of time. 

From the evolutionary stand point, the vast majority of people who show no symptoms or mild symptoms may be the indicator of the effort of the virus to become benign and doing everything possible to live with man.   

In any case, the virus is going to live with man, may be forever and hence lockdown and quarantine measures can only limit or delay the spread and the spread of the virus across India is imminent and inevitable.   Best way to help man is help the virus first to know the man and become friendly. 

Even for a pathogen like Hepatitis B virus, the viral load is critical to cause infection. 

Time has come we must realize the simple tent of viral pathology, load, immune response, clinical outcome and viral clearance etc., instead of selling fear across the society in the name of compassion and forewarning. 

The required initial load of the virus may not be getting shed from man to man in normal situation and hence vast majority of people show mild to no symptom.  Immunology and protective immunology both may be working against the virus.  When the virus enters at the level that is required to cause disease couples with the newness of the virus, the immune recognition may be quite threatening, in some and ultimately affecting the host more adversely than the virus.

Today the political fortune and economic fortune of several political parties and ‘medicos corporate’ in general in India is deeply linked with the viral pandemic.  For the medical fraternity, the virus pandemic is an economic fortune and for the political class, it is a political fortune.  Similarly for the scientists also the virus has come as fortune to tap more research funding. 

Therefore all of them collectively and individually are not going to leave the virus even if the virus decides to leave us.   Therefore all we can wish is the early entry of the sister or brother of the present novel coronavirus so that all of them would leave the poor novel coronavirus to focus on its sister or brother.