Viruses and Vaccines

Let me begin with a disclaimer.  Our knowledge of viruses and vaccines is imperfect as is my own understanding of that knowledge.  This is my best understanding of the current science.

I studied food and beverage technology when I was an undergraduate as well as medical microbiology and immunology.  I graduated in 1981 from the University of California at Davis. There has been an explosion of knowledge about viruses and the human immune system which I have followed with great interest.  I thought it might be helpful to share what I've learned.

The Covid pandemic has caused hardship and conflict far beyond the actual medical manifestations of the virus itself.  For that reason, I am writing this post to talk about the basic scientific concepts related to viruses and vaccines.  I will not address the social and political phenomena beyond saying that this is not the first time there has been conflict about the measures necessary to slow an epidemic.  For those who are interested you can read the Wikipedia article about the 1771 Moscow plague riots here.   https://en.wikipedia.org/wiki/Moscow_plague_riot_of_1771 

It is important to understand that viruses have evolved side by side with complex organisms for millions of years.  One should not misinterpret their simple structure as a lack of sophisticated and complex mechanisms.  Viruses are essentially genetic material wrapped in a delivery system so the level of complexity is limited only by the potential of their genetic material which is almost unlimited.

Viruses are different from bacteria in that they are not capable of reproducing on their own.  Since viruses are nothing more than a package of genetic material they require a host cell to provide the mechanisms to reproduce.  There are also many different kinds of viruses.  A retrovirus like HIV (which causes AIDS) and HTLV (which causes lymphoma) actually reprograms host cells while influenza viruses and coronaviruses hijack the cell mechanisms to reproduce themselves.  We won't go into retroviruses, which are extremely difficult to treat, and focus on common RNA viruses.  Notable human diseases caused by RNA viruses include the common cold, influenza, SARS, MERS, COVID-19, Dengue Virus, hepatitis C, hepatitis E, West Nile fever, Ebola virus disease, rabies, polio and measles.  These are the viruses most commonly and effectively treated with vaccines.

Here are some basic FAQs about these viruses and the vaccines to treat and prevent them.

1) What is a novel virus like the Spanish Flu of the early 1900's or Covid-19 and why are they so dangerous?  Viruses mutate very quickly but once you have had a virus you will likely have some immunity to mutations.  Seasonal flus are variations of flu viruses that have infected humans before.  They tend not to kill as many people or make them as sick because our immune systems have seen something like them before.  A novel virus is a virus that the human population has never seen before.  It has jumped from another species.  The Spanish Flu of the early 1900's was a swine flu that is still present in the human population but its subsequent mutations are less harmful now as we discussed earlier.  The Covid-19 virus is originally thought to come from bats and is new to the human population.

2) What are swine and avian flus and why are they important?  Swine flus come from pigs and avian flus come from birds.  Each of them presents a different danger and challenge.  The swine, avian and human flu strains are not exactly the same but similar so they sometimes jump between species.  Birds are a problem because they travel vast distances and are the perfect mechanism for spreading viruses.  Pigs are less mobile than birds but exist in very close proximity to humans.

3) Are all viruses airborne and what about masks and hand washing?  No, some viruses require physical contact while others can be passed by breathing the same air.  In addition, many viruses can be spread both ways so you can get them from either breathing the same air or touching a surface with virus on it.  It's very difficult to protect yourself from airborne viruses and masks offer limited protection to the wearer even if worn properly.  What a mask does do very effectively is reduce the ability of an infected person to spread the virus.  Hand washing is important because some viruses can survive on surfaces for hours or even days.  Hand washing is critical to avoid infecting yourself with viruses present on common surfaces.  Soap and water works best because the outer shell of viruses is lipid (fat) and protein. Soap is very effective at dissolving the outer layer of a virus and killing it.  Alcohol and chemical based disinfectants are not always as effective as soap.

4) How do vaccines work and are they completely safe?  There are many different types of vaccines but the basic mechanism is the same for all of them.  Vaccines introduce components found on the outer coating of viruses which our immune systems recognize as foreign and cause us to develop an immune response to fight the actual virus later.  The first vaccines were made by killing the actual virus and injecting the dead virus.  Vaccines today have very different mechanisms to introduce those components but the basic immunological response is the same.  Vaccines are never 100% safe.  One of the reasons for testing a vaccine it to check to see how safe and effective it is.  If its effectiveness is high and side effects are limited then it is deemed worth the risk.  Basically it has to save a lot more people than it harms.

5) What do quarantines and lockdowns do and what is herd immunity?  Quarantines and lockdowns slow the spread of viruses.  Since viruses have a limited ability to survive outside of a living organism reduced contact and increased distance between people will reduce the spread of a virus.  Herd immunity is a condition reached when enough people are immune to the virus either from previous infection or immunization so that the people who remain cannot spread the virus to each other very easily.  One question that policy makers face is whether to allow a virus to spread unchecked so herd immunity will be reached more quickly and the economic impact of quarantines and lockdowns are eliminated.  Sweden used this strategy.  The problem is that more people might potentially die because the healthcare systems could get overwhelmed and more people will be infected before a vaccine is developed.

Viruses will be with us and challenging us for the foreseeable future.  We never know when we will have more epidemics but we are sure to have them.

Dogs on the Loose in Ukraine

I remember getting my vaccinations at the travel clinic before my first visit to Ukraine about five years ago.  In addition to significant presence of tuberculosis, there were cases of polio and lots of stray dogs that could be carrying rabies.  I immediately thought of the 1957 film Old Yeller about a boy who adopts a stray dog that, at the end of the movie, he must kill because the dog contracts rabies.  Rabies is almost unheard of in the U.S. today.  If you go to the CDC website and look at the notifications for Ukraine you will find the following.  "Rabid dogs are commonly found in Ukraine. If you are bitten or scratched by a dog or other mammal while in Ukraine, there may be limited or no rabies treatment available." Yikes!

So, when I arrived in Kherson Ukraine the first thing I noticed was stray dogs, lots of them.  I have been around dogs all my life so I was not particularly afraid, just careful.  Many of the stray dogs were very friendly and came up to me but I resisted the temptation to pet them.  After living in Kherson for about four years now I have seen the rather interesting and complex situation with dogs here.  

There are three different kinds of dogs roaming around unsupervised.  There are the neighborhood dogs.  They are the dogs that live in the yards or common areas around apartments and other buildings.  They have a territory and people feed them regularly.  In fact, many of them are quite overweight.  They can be very aggressive if they do not recognize you.  Then there are the pack dogs.  The video in this post is of a pack that had decided to follow a couple of girls in my neighborhood.  They don't tend to stay in a particular area and may or may not be aggressive depending on the pack.  They are somewhat of a danger to people but considerably more dangerous for the other stray dogs and cats which can present a good meal, especially in the winter months. Finally, there are the unsupervised pets, rarely leashed and often aggressive if they are protecting their masters. I have found them to be the most aggressive of all the dogs and just as likely not to be vaccinated as any of the stray dogs.

I carry a can of pepper spray just in case I get cornered but I've never had to use it.  I used to carry a small collapsible baton but, as I talked about in an earlier post, it got me into trouble with the police here.  In general, I find that if I leave the dogs alone they return the favor.

Neighborhood Shop Kherson Ukraine

This is a shop we frequent in the Tavrichesky district of Kherson Ukraine. 

Healthcare for Expats in Ukraine

 

When I first came to Ukraine in early 2016 I bought travel medical insurance which included evacuation in case of a serious medical issue.  I continued to buy travel medical insurance until I began flying round trip from Ukraine to the U.S. instead of from the U.S. to Ukraine.  A quick side note, a round trip ticket from the U.S. to Ukraine and back is almost double what it costs for the exact same airline and flights if the ticket is from Ukraine to the U.S. and back.  To solve that mystery you'd have to understand the airline pricing systems which use mysterious algorithms to set ticket prices to maximize profits.

When I could no longer buy travel insurance and I had my temporary residence permit I decided to go ahead and get minor medical care done here in Ukraine and maintain an insurance policy with a high deductible in the U.S. for any major medical issues.  So far, that has worked out well, especially in the last year when medical care is actually somewhat more accessible here than it is in some cities in the U.S. that are overwhelmed with Covid.

My experience so far with medical care here in Ukraine has been positive.  My wife is Ukrainian and I have a very good friend who is my doctor here in Ukraine which really helps.  Having someone who can help you figure out where the good care happens and help you to navigate the hospital and clinic visits is a must.  

My first medical issue was a raging case of the flu that turned into a serious sinus infection.  We went to the doctor my father-in-law liked and quickly received a chest x-ray to make sure I didn't have pneumonia.  The chest x-ray cost 60 hryvna.  The x-ray machine looked like it was from the 1960's but it worked and I didn't have pneumonia.  The doctor was professional, competent and very polite.  She gave me a prescription for antibiotics which resolved my sinus infection within a few days.  All in all, a very positive experience.

My second medical issue was an attempt I made to cut off my thumb while cutting a watermelon.  Luckily the cut was not serious but did require stiches.  The first place we went turned out to be the orthopedic hospital.  They bandaged my thumb and we paid them 100 hryvna which seems to be the customary "gift" for non specialty care.  Then we went to another hospital and the first receptionist asked if I was registered to receive medial care.  I was not so he told us we had to leave.  My wife, who fights like a gladiator asked the other receptionist to help us, which she did.  A few minutes later I was in an examination room with a nurse and a surgeon.  About 15 minutes after that I walked out with stiches and a prescription for antibiotics.  My wife tipped the doctor 200 hryvna for this visit.  Again, a very positive experience, except for the first receptionist.  The cut healed perfectly and I removed the stiches myself after about a week.

My late father-in-law, had a number of surgeries before he passed away and they all seemed to go well.  He had a hearth valve repair and had part of his colon removed.  He ultimately died of colon cancer but died with significantly less suffering than my father in the U.S. where they kept him alive for about a year with surgeries and chemotherapy.

Although I have looked at medical insurance here it doesn't seems to make much sense.  Insurance companies here are not very well regulated and medical care is not expensive by western standards.  The medical care also seems to be much more available if you have the money to pay for it when compared to place like Canada where there is socialized medicine but long waiting periods for care.

There are many horror stories about the medical care here in Ukraine so I think one has to be careful to make sure  the doctors have good reputations.  That requires some local contacts and a little patience to do some research.  That said, good medical care is available in Ukraine at reasonable prices.

Antique Style Art

My sister-in-law makes antique style art from images and photos on wood and she made a piece with the Caravela logo for me for Christmas.  Thanks Tonya!  If you'd like to see more or order a piece you can do so at her Instagram store https://www.instagram.com/odd_wood_shop/.