I think the concern is that it is more transmittable than SARS/MERS, although with a lower mortality rate. While 2% is much lower than 10 and 35%, it is quite high compared to flu. It is mostly caution, monitoring the situation to catch if there could be any potential that this more contagious version starts to show signs of changes where it will increase mortality rate and/or change in the vulnerable population. If the healthy starts dying... then it's time to worry.

The ease and rate of transmission can both be worrisome signs, but the new cases in China seem to be plateauing. The transmittability of an infection depends both on the virulence of the organism and the state of the host's immune system. I agree with you that if the virulence of COVID-19 proves to be high to the degree that healthy individuals with intact immune system could not overcome the illness and fall victims, it will be very worrisome.

Thank you, Dr. Kou Hayakawa. Your insight and contribution are much appreciated. You are very spot on regarding homeostasis and moderation. To achieve harmony in the state of homeostasis , balance is the key which is accomplished by moderation. Unfortunately, moderation has too often been countered by greed and ignorance. I will take time to read more of your work.

H.flu, Mycoplasma , and H. pylori infections are all treatable and do not necessarily cause mass fear, not to mention panic. The mortality rate that comes out from South Korea and Japan are, so far, reassuring. If the mortality rate is very low to non-existence in healthy individuals, why is there so much fear? Could the social medial in this information age where most information is available at the touch of the fingertip play a role in this epidemic?

I believe most infections have co-infection factor whether it's symbiotic relationship or merely opportunistic. I think most are probably opportunistic. Depending on the host's defense mechanism, opportunistic infection could be the cause of the deterioration in the common illness such as "cold" or "flu". We have known "cold" and "flu" for a very long time, but we don't talk about it on the news every five minutes or make it as the subject of almost every conversation from the economy, politics, and even the Olympic.

I agree with you that sleep and nutrition are very important to keep healthy mind and body. The body rests and repairs during sleep while the mind explores and recharges. Good nutrition also plays very important role in replenishing and making available substances that the body needs to stay alive and to defend itself. However for most people in developed countries, the issue is no longer nutrition because they can get all the nutrition the body need and wants. The real problem is, of course, the tendency for people to overindulge and to consume the wrong diet. Since what we eat is a very personal and complex issue, I'm more interested in learning how the body defends itself naturally by using everything that the body already has from within such as repairing damaged DNA or cells and boosting the immune system. I'm very interested in professor Yoshinori Ohsumi work regarding Autophagy which is triggered by fasting and shows that the body has already most everything it needs to take care of itself. The problem and the key question is "how do we achieve that balance and to what moderation?" because all of us are somewhat different from each other, and actually, not at all created equal.

I haven't been able to read every pdf files you referenced, but could you tell me in how many words you like, the fact you mentioned above that "autophagy is not present in human".? Why doesn't autophagy apply to human? I know many researches start at simple microorganism level, but I need to know more about the claim that you're making. Forgive me for being ignorance, but this is how I learn.

Yes, many of the works on "autophagy" were done on yeast and non-mammalian cells, but we should think of autophagy as a "process which may not have the exact same elements" to accomplish the job but has the exact same result. I've read few research articles done on mammalian cells which make me believe in the process of autophagy in most living things because it's a part of survival and propagation of the species.

Of course, humans have some regenerative power. We can't grow our fingers and hands back after being chopped off, but the largest organ in human body, the skin regenerates all the time. It's true that not all organs behave the same way or possess regenerative characteristic, but a few do.

Humans "metamorph" through his actions and doings and not through physical transformation.

Thank you, Dr. Kou Hayakawa, for your insight.

The mortality rate being reported will not be accurate due to the lack of testing and under reported of symptoms because of the mild symptoms or the similarity with other common upper respiratory illnesses that many people are already familiar, and not to mention the people that have the virus but have no symptoms. Again, I think the more important information that should be emphasized is WHO and what kind of patients that actually make up the mortality number. We need to know the breakdown of that number by age and their health status prior to the virus.

From what we have learned about the virus so far, I will just assume that the virus has already spread throughout the world and the reason some countries show no infection may be due to the lack of testing and its symptomatology.

Complacency or overreaction both seem to be occurring at the same time. Are we too complacent regarding the ramification of the COVID-19, or are we overreacting on a common illness that most of us are already familiar? Speaking to medical colleagues and lay people alike over the weekend, I was a bit surprised at the indifference that most people here have. Most seem to be very complacent regarding the virus thinking that it's just another variant of the "flu". On the other hand, some governments and even the financial markets throughout the world seem to be reacting in a bipolar fashion. Some countries especially those that have more aging population could especially be more vulnerable to the threat from the virus due to their co-morbid conditions and weakened defense mechanism of their immune system. It's very critical to prevent the spread in such situation.

Other than the obvious unknown of whether or not COVID-19 is only seasonal and will soon taper off and disappear in the summer months, we have ONE big difference that we know from the other known Corona viruses and the flu viruses. The main difference is the ANTIBODIES that our bodies produce during infection. Our immune system has already been accustomed to the other respiratory viruses because we have been exposed to them numerous times before, and the immune system has already produced the antibodies to fight the infection. With COVID-19, it's a new virus that the body is not familiar and does not yet have the antibodies to fight.

The data that's coming out of China is reassuring and points to the fact that it's following the predictive path experts are hoping. The slowing of the rate in South Korea is also reassuring.

By some recent estimate, COVID-19 could be 10 times more lethal than the flu. The more severe cases of COVID-19 cause severe respiratory distress which may require mechanical ventilation for some patients in ICU. The illness according to some authority isn't just confined to the respiratory system, but it could spread to the central nervous system and causes neurological symptoms. I think this is the real deal, and we should not underestimate the potential threat to life, young or old. We should be cautious and prudent but not panic.

Law makers and regulators are now scrambling in an attempt to stem the spread of this disease and to calm people's fear without creating widespread panic. The "punishment" for not following the regulation to help stop the spread is "you may kill your grandfather" as stated by the governor from Washington state.

While we're all waiting for a piece of human history being unfolded and made right at this very moment, I would like to offer some thoughts to consider and maybe prudent advice to follow.

Throughout human history, we have gone through quite a bit of disastrous infectious diseases from the Bubonic Plague to the most recent Spanish flu which took way too many lives. Other than the medication that kills the offending organisms or viruses, we're left to our own defenses to avoid being sick. Hygiene and measures to help prevent the spread are definitely on the forefront of the must do. The other aspect that hasn't been discussed or even suggested is to stay healthy and to keep the immune system in top shape.

Here are my suggestions to keep us healthy and the immune system in top shape which do not cost anything nor require to swallow snake oil:

1) Have enough rest at night for 6-8 hours of uninterrupted sleep. More sleep than 8 hours is not necessary and not recommended.

2) Eat balanced healthy diet. Do not over eat. To give the body more than it needs may not be healthy. Be in tuned to your body and how you feel. Feeling a little hungry but feeling great do not necessarily imply the body needs food right away. Learn about your own personal body requirements but not overdo it. More is not always good, and less is not always bad, but extremism is almost always detrimental.

3) Mild to moderate exercise for 20-30 minutes a day or at least every other day. It doesn't have to be stressful exercises. Walking exercises can be done by most people. Too much exercises can be more stressful to the body. Stay active.

4) Learn how to meditate to keep the mind healthy. Avoid extreme emotion such as extreme anger or hate. Learn to have a positive attitude. Change the things you can, and let alone the things you cannot or just pray. Good luck everyone and be kind.

Survival of the fittest, does it apply to humans? Humans have evolved and developed very complex social and emotional state of being. We no longer revolve on only "eating to stay alive", but there are many other things in our life that are just as important as the food that sustains our body. I have witnessed first hand how much sacrifice a family does to save their loved ones young or old. If survival of the fittest holds true for humans, the world will definitely not be as populated. I think this current pandemic crisis should serve as another reminder that we humans are special and that we could and should work together to overcome this crisis. This pandemic will affect us all young and old alike, maybe not in similar fashion, but for the younger and stronger, it is wise to think that we're in it together and that if you're lucky, you'll also be old and weak some day.

Isn't the Covid 19 a humbling reminder that a very small and seemingly insignificant entity such as a tiny virus that can't be seen by naked eyes can wreak havoc the lives of millions or even billions? Even the most modern and up-to-date medical discoveries and cutting-edge technologies are no match to combat its viciousness that threatens our existence and not to mention the "fear" that it has created which in itself has other ramification in our lives. As merely humans, we should be humbled to know that a very tiny entity can wipe us out.

It is not because of any of your suggestions. It is because the virus needs to survive and makes more effort at it. I believe the virus evolved within the human population, developing its virulence therefrom. However, the virus is not that intelligent because after wiping out the human population, its stable state will not survive without its host.

Thank you both, Kou and Maurice. It sounds like a very "novel" idea for a novel virus, "smoking and drinking". I have to laugh, but your explanations are plausible. I like them because they're ingenious, very wicked and controversial. Like most things in life, the unintended consequences often overwhelm the good intentions. "No good deed goes unpunished". The virus, just like most pathogens, requires a host to replicate and populate to do its harm. Both DNA and RNA viruses must infect the host cells to instruct and build more viral components to multiply. Without host cells, virus can not replicate. Virus can not multiply in non-living cells.

Thank you, Kou Hayakawa, for your thought and references. I agree wholeheartedly with the concept that neither deficiency nor excessiveness is good for health. It's rather easy for people to understand that deficiency is not healthy, but most people have the tendency to harbor the feeling and thought that "more is better". The studies you're referencing regarding biotin and sleep are quite fascinating though very technical and challenging to read and absorb all of the technical details in the studies. I agree with the importance of good and balanced nutrition and restful sleep at night which the studies support.

It's quite a provocative thought and statement to say that the virus has a predilection to infect people with "nutrition excess" because that idea is definitely against the grain of "more is better". Recently, the CDC found that traces of the virus were detected 17 days after the cruise ship cabin was vacated. We're learning more and more about the virus as time passes. For the time being, adopting common sense approach which science has proved is the most logical and safest way to live. We don't really know how long the virus stays in the environment and remains infectious because the PCR (polymerase chain reaction) machine only detects the DNA materials of the virus which is not the same thing as the whole intact virus. An intact virus is needed to infect cells. Hand washing and not touching the face with unwashed hands is the most prudent advice. Although this is a respiratory virus which is typically transmitted through the respiratory system such as the nose and the mouth, the eye can also be the port of entry using the lacrimal duct which drains into the nose as a way to the respiratory system. Many respiratory illnesses also have ocular symptoms as part of their constellation of symptoms. Stay safe and practice common sense approach to life.

Thank you, Dr. Kou Hayakawa, for the statistic and the breakdown of the numbers of each viruses and countries. As a researcher, you must already know that numbers and statistic can be manipulated and engineered in addition to the possibility of the inaccuracy of the method used and other human factors. Having said that, I'm not at all insinuating that those numbers and statistic are wrong. I only would like to emphasize that numbers could be misleading, and the big picture or the important message could be lost or not emphasized. In medical field, we're used to the facts that opinions and "the facts" themselves can change rather drastically. To be dogmatic is often more harmful than not because there are too many unknown still in medical science. It's always good to keep an open mind and be able to adjust accordingly when more knowledge is obtained, and the best way to do it is to have some room for mistakes by continually doing a balancing act throughout our lives.

Dr. Kou Hayakawa, thank you very much for contributing to this discussion. Your knowledge and generosity to share your opinion are much appreciated. I would like to learn more of what you're thinking. I will set aside the Covid -19 discussion for now and will take some time this week to reengage in your observation regarding symbiotic relationship of humans and microbes. I understand the importance of Biotin as one of the essential vitamins required to maintain good health. You have done research on fucoidan and published scientific papers which have made me a believer in the complex sulfated polysaccharide found in that gentle sea plants. However, I still yet to understand the connection between biotin which you mentioned frequently and fucoidan. Forgive my ignorance, but biotin is a vitamin that can be easily obtained from numerous common foods most people eat, and fucoidan is complex polysacchharide found in seaweeds that only certain culture consume. Is there a relationship between the two, or am I misunderstanding something? Thank you, sir.

Here is my simple and common sense approach to this virus and pandemic. We don't have effective treatment yet for the Covid-19 as of to-date other than supportive care for the victims. We do not have a vaccine for it. We know that it's very contagious. We don't have enough test kits and ventilators, etc which worry the governments and policymakers and which is understandable. How about focusing on the fact? The fact is what do you do when you're tested "positive" or "negative"? What does it really mean? If you're negative, does it mean that everything is alright? And if you're positive, what does it imply? Does it mean that you will spread the virus to everybody you come in contact? I've read cases that you're initially negative only to convert to be positive a few days later. The very fact that it's contagious and we have no effective treatment yet, the answer should be obvious that "WE ALL SHOULD STAY HOME AND SELF QUARANTINE" for 30 days whether we're positive or negative because the only solution is "NOT TO LET THE VIRUS JUMP FROM PERSON TO PERSON", and the best way to do it is to isolate and self distance from each other whether you're tested positive or negative. The solution is still the same. The testing and the result are good for scientists and epidemiologist but have nothing to do with policy making because we already know that its' very contagious and that "negative" can become "positive" in a matter of time. Testing is not the solution. Staying home is. If anybody feels sick, just like any other respiratory infection, go get treated just like any other flu or respiratory illness. We don't have the cure for this virus other than to stop it on its own path of jumping from person to person. Stay home.

"We have many beneficial symbiotic relationships with microbes" is probably an understatement. Our bodies rely on microbes and the symbiotic relationship to stay healthy. The gut system is a good place to see this evidence. Nobody has to be an astute scientist to know that the feces produced in the gut system are full of "germs" or microbes. Mechanisms such as infection by outside organism or the use of antibiotics that disrupt this symbiotic relationship will usually make us sick or at least cause undesired side effects such as diarrhea and feeling ill. The opposite relationship that does us harm also exists and can be seen in more and more diseases from heart diseases and diabetes to cancers. Untreated common infection that causes "sore throat" can cause heart disease, infection by virus or other pathogen to the beta cells in the pancreas can result in diabetes, and hepatitis C virus infection to the liver may result in liver cancer are a few examples of diseases that may originate from infections. Many other infections may also infect the fetal development in uterus and cause birth defects.

As far as the Covid-19 is concerned, we yet have to develop immunity and resistance to this infection such as seen in "herd immunity" phenomenon when many people are infected or vaccinated. We've already seen that many infected people are able to fight this infection unharmed because whether their immune systems are "stronger" or simply "the viral load" is less or some other factors still need to be answered. But, I think it's safe to say from what we have learned in science in immunology that intact and strong immune system has very important role in fighting infection. Vaccination is nothing more than a purposeful act of infecting oneself with a much safer pathogen that will trigger the immune system to fight and remember the pathogens through the "adaptive" part of the system. And, of course, it works. If the term "vaccination" is not agreeable to some people, let's just use the term "more safe infection" instead because both are definitely infections that may trigger the immune system response.

While parasites and viruses can cause us harm or even kill us, there are some attributes of viruses that we actually posses, maybe through evolutionary process of infection or even symbiotic relationship? The gene that's responsible for learning and memory called "Arc" sends its genetic material from neuron to neuron in the same method found in viruses. Can the "Arc" gene learn its behavior from viruses? Out of "darkness", life will find "light" with the hope that "humanity" is larger and stronger than any pathogen.

Unfortunately, nature and life in general don't always follow what is known and predictable. The saying, "mother nature is neither cruel nor kind", applies to everything in our universe. To balance is to sacrifice. Nature is full of imbalanced and inequitable phenomena. Perfection is only to be countered and balanced by blemish and failure. Living science such as biology is just "that". It's still alive and continues to grow and will continue to surprise us.

Recent observation regarding the behavior of Covid-19 is another reminder of how nature can trick us and be at its mercy. The fact that the virus is spread more readily in older adults and not children is very curious. During "cold" and flu season, children are usually infected more readily before adults for obvious reasons. The fact that the immune system and other organs in children may not yet be fully developed has been theorized to be the reason. According to one theory, the ACE 2 receptors that the virus attaches are less developed in young children so the virus does not hijack the cell. Another theory is the immune system itself. We all like to believe that a strong immune system should protect us from illness. But, what about a hyper-aggressive immune system that can cause more damage through its inflammatory response? Hydroxychloroquine is a hot drug that is often talked about in the media recently and becoming in short supply. The drug is used to treat both the Malaria parasite and inflammatory arthritis, but it's not known to kill any viruses, at least not that I'm aware currently. So why does it work in certain anecdotal circumstances? Is it because of its anti-inflammatory property? If so, it points to the immune system that goes awry and causes more damages than maybe the infection itself. The answer is still in the making in the study of ever-changing living biology and mother nature.

This so-called generational pandemic has certainly caused a major social impact and loss of many lives. Will humans behave differently and learn a lesson from this? Will we become less of a social creature after this? My feeling is "no". Once the truth and the science emerge, we're still part of mother nature and a social creature. Social distancing, which I think is a misnomer and should be physical distancing, will be a thing of the past and a reminder of a difficult time in history.

Fever is probably the most common sign that the body produces that's regulated by the hypothalamus to indicate that there's something going on inside the body, typically due to the immune system reaction to infection but not always. Fever usually does not require to be treated. The underlying cause of fever should be found and treated instead. Fever as part of the defense mechanism usually is accompanied by pain and inflammation. Many of us including the health care providers may choose to "treat fever" due to these associated pain and inflammation which is, of course, not completely appropriate. The answer to whether or not "to treat or not to treat fever" can be complicated depending on the underlying diagnosis and the degree of the fever. Before the discovery of penicillin, syphilis was once treated by inducing the body to produce fever through both mechanical way and infecting the body with malaria parasite. Low body temperature or hypothermia in sepsis usually carries a more dire prognosis indicating weaker immune system to fight the infection. However, the high energy cost of high body temperature in addition to vascular collapse in septic shock will play into the decision making for the appropriate treatment. Attempt to normalize the body temperature seems to be natural thing to do. Fever in sepsis may be a good indication that the immune system is working, but hyperthermia is not so good for the CNS especially the cerebellum which is not very tolerant to the effect of heat.

Like any other infection, fever is also being produced in Covid-19 infection which is not very specific at all. The respiratory symptoms of pain and distress from Covid-19 seem to be the more significant problem. Both Hydroxychloroquine and Azithromycin are being experimented in treating Covid-19 both due to the anti-inflammatory effects and possible anti-viral effects in Azithromycin even though antibiotics are used mainly to treat bacterial infection and not viral infection. The vaccine to prevent tuberculosis(TB) in countries where TB is still prevalent is being studied for possible option until the more specific vaccine is available. The BCG vaccine is for tuberculosis, and tuberculosis is bacteria and not virus. This is indeed very fascinating. The thinking behind this experiment is that the BCG vaccine will stimulate and boost up the immune system to fight other pathogens including the Covid-19. Ingenuity is often born out of necessity, but hope is the engine for tomorrow.

Do you think Can any person who has been the recovery of the Coronavirus be continued to transmit the infection to other people?

It is a positive-sense single-stranded RNA genome and does not differ from other viruses, but fears come from the lack of an effective treatment or vaccine As well as the sudden emergence and speed of spread

Thank you, Mohammed Almajidi. There are still too many things about the virus that we don't know and still under study. We still don't have clear data to show the exact timing the virus is being shed from infected people. I think it's safe to assume that the virus continues to be shed days after a person recovers. However, we don't really know the exact time or the amount of virus load that is being shed from the recovered person. We don't know how much viral load it takes to infect a "normal healthy person"? We know that viruses such as the other respiratory viruses including the common cold and flu viruses exist in the environment ubiquitously all year round, but during cold months they're more plentiful and create the "flu season". We know that the viral load must be quite high in the environment to infect a normal healthy person in a typical flu scenario. In Covid-19, I think we still don't know regarding the viral load to cause infection that overwhelms the immune system. I would like to believe one of the main reasons the people that get infected and then recover without being sick could be because the amount of viruses that enter the body are small which the immune system is able to overcome. The antibody response is different for everybody. Some people may have very strong response while others have no response at all with no detectable antibodies. I think we've seen some data out of China to show that phenomenon. I've seen patients that have completed the series of common hepatitis B vaccine with no detectable antibodies to the virus. Many viruses such as herpes viruses that cause chicken pox and genital ulcer never leave the body once they infect the body. We don't have yet medication to kill them other than suppression therapy for recurrence and chicken pox vaccine for prevention for people that never have chicken pox. Since Covid-19 is new to our immune system, any scenario could be a possibility including the virus never leaves the body completely and future mutation that may cause a weaker or stronger virus. My gut feeling is that we will continue to be threatened by this virus until we have the vaccine and the effective medication to treat infected people without hospitalization especially requiring artificial ventilation. I sure hope I'm wrong.

Thank you again, Dr. Kou Hayakaya. Your knowledge of Oriental vegetables and their medicinal properties is amazing. I'm grateful to be learning from you and thank you for your contribution in the discussion. I can remember eating seaweed soup during special occasions such as birthday celebration and such. Before the discovery of synthetic medicine through chemistry, human ancestors made medicinal concoctions to deal with illnesses and diseases using plants purely through instinctive trials and errors. I definitely agree with you on the beneficial effects of plants and vegetables including algae and seaweeds. There's much to be learned out there from what's available naturally instead of the synthetic substitute produced in the labs.

I understand your sentiment regarding genetics and gene therapy. I'm interested to learn more behind the sentiment. Pure knowledge should not be classified as good or evil. The intention and how the knowledge is being used can be good or bad. The knowledge of genetics is not a bad thing, but to apply the knowledge to alter mother nature will for certain have unintended consequences and even catastrophic ramification. The use of CRISPR technology that we learned from bacteria to alter gene such as done by the Chinese research to alter the CCR5 receptor to make the body resistant to the HIV virus is one very important example of controversial use of the knowledge. Genetics, however, is a very important aspect of how we deal and adapt to diseases going forward which is usually done through mother nature and not the laboratory. CRISPR is a way some bacteria deal with invading pathogens and must have been developed naturally through millennia. The question for us humans is, of course, what happens if we start messing around and changing the speed and the way our genetics evolves?

While other respiratory viruses may also affect the CNS (central nervous system) and cause neurological manifestation and symptoms or even directly infect the brain cells to cause encephalopathy, the incidence for CNS involvement in flu and other respiratory viruses are quite rare. The milder neurological symptoms such as headache, mild dizziness, or even the lost sense of smell and taste are disturbing enough for many patients. But, stroke or cerebrovascular accident (CVA) that occurs in few younger Covid-19 patients who in normal situation would not have such risk is very disturbing. We know it's a respiratory virus and may affect the olfactory system peripherally through the nostril and nasal cavity, but whether or not the BBB (blood brain barrier) is penetrated by the virus to directly attack the brain cells to cause stroke and encephalitis still needs to be determined. To know whether or not the brain cells are infected, which also contain ACE 2 receptors which are used by the virus, autopsies need to be done and brains examined.

Diseases such as lupus (SLE) and Guillain-Barre are known to be caused by the immune system and have neurological manifestation. Lupus affects many organs in the body and may cause stroke by producing abnormal antibodies such as the antiphospholipid and anticardiolipin antibodies which cause the formation of blood clots in the blood vessels which in turn may cause stroke through embolism. If that is the case, why do these patients have such strong immune response to the virus? Can some of the medication to treat autoimmune diseases be used in such patients?

Thank you, Dr. Kou Hayakawa. I enjoy reading your posts and comments. Unfortunately, some of your remarks and comments leave me feeling a little confused or even in total disagreement. I try not to second guess the meaning of your statement and not to misunderstand your statement, but I need some clarification regarding your last post. You stated that humans do not have IgG nor interferon. Animals including humans produce both immunoglobulin and interferon to fight infections or antigens inside the bodies and as parts of our own natural defense mechanism. Almost every cell in our body can produce interferon as part of its natural defense when invaded especially by viruses. Interferon and the antibodies work together to defend infection and as part of our immune system. We now can produce certain type of antibodies and interferons usually designed for targeted therapy in the laboratory.

It is, however, true that our immune system may not be able to produce antibodies to "every antigen" exists out there in nature, but, there is no doubt at all that our body produces immunoglobulins that fight infections and most antigens that invade us. Otherwise, we won't exist and will all perish prematurely. Living things have immune system to defend itself to stay alive. They may be called immunoglobulin, interferon, or just "protein X", but regardless of the name, there exists a chemo-reactive mechanism inside each organism designed to defend itself. However, not everybody has the same immune response. An issue that is still not fully understood and explained. Some people may have completely different responses to antigens or no response at all. Conditions such as allergy and autoimmune diseases clearly demonstrate how the immune system is not really your friend and is quite variable.

Your statement regarding "immunotherapy for cancer is not possible at all in humans" needs clarification and more explanation. Immnunotherapy has been widely used in medicine for a very long time. From vaccine to allergy desensitization to cancers and autoimmune diseases, all have some component of immunotherapy as some of our therapeutic arsenals as a treatment choice. I'm a clinician by education and training and not a biochemist or microbiologist. I personally prefer logic and pragmatism in deciding appropriate therapy. Real patients are not just about what studies in the labs that are proven true and efficacious. Clinicians are not the ultimate judges that determine the outcome. Many medical treatments may not have rigorous studies that support the practice, and some may not even have any scientific proof at all. How do you tell patients that we don't really know the science of acupuncture or hypnosis or how exactly they work on some people? Immunotherapy is, of course, possible and can be used to treat certain diseases including certain cancers.

It is possible that previous infections by certain antigen or viruses may cause some protection to the current Covid-19 due to the crossover antibodies produced previously that may be effective against the novel Corona virus. But, there's still too much about the virus that we don't yet know. My prevention method is very simple until a vaccine is found: "use common sense and be responsible". There's no need to panic or be overly anxious. This is part of nature. We will all get sick and eventually die one day. Live and enjoy life well and be considerate to others.

Mutations of the virus may be the key to how we eventually emerge from this pandemic and may offer some explanation to the susceptibility and severity of the disease. According to the most recent report, 14 mutations have been identified on the spike proteins. It is also speculated that the mutated virus is also more contagious which causes more rapid spread of the virus from person to person. However, according the published report from Pasteur Institute in Shanghai and Peking University, the more aggressive and deadly strain of the virus appeared during the early stages of the outbreak in Wuhan. Mutation is not always a bad thing. Mutation may make effective vaccine difficult to achieve, but it may also weaken the virus naturally in term of its lethality. Let's hope for it to be the case.

We are afraid of SARS-CoV2 viral infection (COVID-19) as it is highly transmissible and there is no vaccine or definitive treatment.

Kou Hayakawa

Dear Prof. Hayakawa,

Very interesting discussion. However, the company Marinova has announced before that fucoidan is not active against corona viruses ( https://www.marinova.com.au/news/fucoidan-and-novel-coronavirus/). If you have any document proved such hypothesis, please provide it to us.

Kind regards,

Ahmed Zayed

Variation of such viruses are definitely usual as that of influenza, however., the current trend in international and domestic politics due to hot social media, the challenge getting worse, on day to day bases. The drama is that every opposition blaming the ruling party and vasa versa.

@Kou Hayakawa

Thank you very much for your reply. I appreciate your point of view.

Social distancing and the practice of good hygiene may be viewed as inconvenience and a little sacrifice for rich people in rich countries, but the practice could inevitably cause more sufferings and even early death to poor people living in poor or much less developed countries. Places where clean water is still scarce and where essential daily activities such as eating and using the bathroom are still communal including a crowded living quarter where many people share the same room, social distancing and good hygiene are utterly impossible. For those unfortunate poor people, what could they do? Which one is going to get them first, to be hungry and die because there's no work and no money or to catch the corona virus and fight for your life? This is the fact and problem that even the brightest scientists can not solve.

Is the Covid-19 pandemic really worse than the "fear" itself which has caused its own pandemic? The perception may be skewed from the truth or reality. The fear may cause other unintended consequences but will eventually wear off because people will get tired and would like life to return to usual. The previous flu pandemic in the early nineteenth hundreds eventually died down and morphed into the common flu that we now know. The small pox was eradicated due to the vaccine and no natural host for the virus. The Yersinia pestis bacteria that caused the "Black Death" or the "Plague" and caused 3 pandemics are now curable by using antibiotics. If history is to repeat itself, the Covid-19 will also wane down either through immunity or mutations. Mutations can occur in either or both the host and the virus. One evidence that has come out from this stay home culture is less pollution and less environmental destruction. We should respect the natural boundaries that exist among species and not to take everything out there and destroy natural habitat of organisms just because we can.

I really appreciate your generosity, Dr. Kou Hayakawa, who has been tirelessly and enthusiastically sharing your research and knowledge and promoting the significance of biotin and fucoidan. I wish the earth produces enough of those seaweeds for all to enjoy and be healthy. My question to you, Dr. Hayakawa, is about the fucoidan supplements that are widely popular and available at the local stores. Are the supplements as good as the claim and the same as the natural food form found in Japan? I know some supplements are not as authentic as the claim or as useful. I did get sick earlier in the season and put practice what I preach regarding intermittent fasting. I will write about my anecdotal experience another time. There are many things in our lives that we can learn if we just pay attention and recognize what works and what doesn't. It may not always be explained scientifically , but the body and the self often know best.

A little suggestion to stay healthy until the magic "pill" to eliminate and combat the virus is discovered is to increase our sense of well being. Intermittent fasting such as suggested by "Gustav van Niekerk" ( in the discussion of Fasting and Autophagy in July 2019 ) to boost the immune system and sense of well being is one very simple way to keep the mind and body sharp while still enjoying what we have as humans.

The effect of this pandemic is now far beyond just the threat to people's health. It has now become political and economic issues. Many people have lost their jobs and many small business are no longer in operation. People are scared of the uncertain future not knowing their own livelihoods. To make matter worse, unfounded medical news and misinformation continue to flood the media and form varieties of opinions which have become the source of political punching bag. I will attempt to leave the economic and political aspects out of the discussion and concentrate in science and medical aspect of the discussion.

There's still no vaccine and no magic cure for the virus. However, we now know more regarding the virus and the disease it causes. We also have better treatment now compared to 3-4 months ago. So that's good. Social/physical distancing helps reduce the transmission so fewer people should be getting sick if we practice this prevention method. The virus may not be going away anytime soon, but we can buy more time to come up with the vaccine and better treatment with the ongoing studies and evidence learned from current cases. Until a vaccine or herd immunity is achieved, it's very likely that the virus will continue to be a threat unless it mutates to become less deadly but much more contagious. I know it's quite difficult to imagine the virus to become more contagious than what it is now, but for the virus to mutate to become less deadly, it has to become more readily transmissible for it to survive. Highly contagious and deadly versus more highly contagious but less deadly.

Since it's very contagious, when will the population achieve herd immunity? Approximately 2/3 of the population is required to be infected and develop robust immune system against the virus to have the herd immunity desired. Some argument can be made to speed up the process just by letting the customary life return to its normalcy prior to the pandemic so the virus can spread quicker naturally. Everybody dies eventually. That is the fact. Many more people will suffer and die if prevention method is not done and the virus spread uncontrollably. That is also the truth. Physicians are there to help ease suffering and prolong life. Most people would rather die tomorrow than today. Why is common sense so difficult to follow?

It's a respiratory virus and transmitted through the respiratory system which begins and ends at the nose and mouth. If the virus can not enter or leave the respiratory system because of a strong physical barrier such as afforded by the N99 and N95 medical grade masks, why is this very simple and obvious prevention method not implemented everywhere on earth? The cost to make the masks is minuscule compared to the economic and lives lost the virus has caused throughout the world. I'm only guessing that simple common sense and intelligence are two different things and that people prefer cure over prevention. Love and compassion are only words found in old books for the world is becoming more alone and selfish.

A recent finding noted in "Antiviral Research" done by researchers at Rensselaer Polytechnic Institute shows that heparin or the blood thinning medication used to treat thrombotic condition has the ability to interact with Covid-19. Heparin, a sulfated polysaccharide, can bind to the spike protein of the virus. If this finding can be applied in clinical situation, it is indeed great news because heparin may lessen the impact of the virus on human cells by binding to the virus and neutralizing it before it can infect human cell. Heparin, however, doesn't come without any side effect. It may cause bleeding complication in some people.

Dr. Kou Hayakawa who has frequently contributed to this discussion has done his own research on another form of sulfated polysaccharide called fucoidan or the edible seaweed. Much to Dr. Hayakawa credit, he's been very clear and adamant regarding the benefit of fucoidan in human. Based on the research above, the similar sulfated polysaccharide found in fucoidan will attach to the virus the same way. The larger the molecule, the better the attachment will be. Again, if this finding can be applied clinically, fucoidan could be better than heparin because it may have no to much less harmful side-effect compared to heparin. Not only fucoidan is much less harmful, but it's naturally occurring food substance that's actually delicious for many people. Many thanks to Dr. Kou Hayakawa for his work and contribution.

The phrase "no good deed goes unpunished" may be used to defend the theory and argument regarding the "hygiene hypothesis". The widespread promotion and recommendation to keep cleanliness and personal hygiene as a way to combat the pandemic may produce unwanted side effects or punishment in the future as hypothesized in the "hygiene hypothesis". According to the hypothesis, both allergic diseases and autoimmune diseases could be the byproducts of the lack of exposure to various microorganisms especially during very young age starting in utero or the mother's womb. We have already had a brief hygiene discussion with Ligen Yu in "autophagy and intermittent fasting" sections. I personally believe that reducing personal cleanliness such as not washing hands, etc will only increase the risk of infection and not at all decrease the risk of allergy or autoimmune disease.

Early exposure to rich variety of microbes is beneficial in establishing strong and healthy microbiome on and in our biological system especially the guts and respiratory systems. We think that when the normal microbiome is altered or certain microorganisms are no longer present, the environment is changed to such that pathogens will now overwhelm the immune system and overburden the remaining native microbes. This theory helps the popularity of supplements such as the pre and probiotics. Some studies claim that probiotic supplement increases the microorganism population and restore the gut and respiratory flora. The question regarding taking supplement is obvious. What's the likelihood that the supplement will actually stay in our system? If it stays in the system, how long does it stay or does it imply that our system is now dependent on the supplement that we need to continuously consume the supplement? And of course, does the new microbiome actually help or work as intended?

The susceptibility and the severity of the Covid-19 infection in different people may depend on the robustness and strength of the microorganisms that make up the respiratory microbiome. The microbiome has significant role in influencing the immune system. The symbiotic relationship between the immune system and microbiome may be the ultimate defense mechanism the body has against diseases especially when the symbiosis is optimal. Autophagy is, of course, another important mechanism that keeps our system going and healthy.

"DO NOT GIVE AND DO NOT RECEIVE" means don't give the virus to somebody else and don't get the virus yourself by not following the basic common sense that we already know about the Covid-19 disease by practicing simple hygienic procedure. This simple hygienic procedure of washing hands and self distancing when talking to others is actually more powerful than any vaccine ever produced because the virus will never get to you for your the immune system to react. It's like a defense system that's ready to shoot all the missiles down when they arrive, but the missiles never arrive. Think about that. Self distancing and wearing mask is the most potent remedy.

A little bit of good news in the midst of the increasing spread of the pandemic is both a welcoming and sobering information that we should be aware. The number of new cases is currently increasing both in Europe and the U.S. Experts predict that the worse is still yet to come especially in the U.S. The mortality rate of the hospitalized patients in the U.S is decreasing which means that the disease can be controlled with what we know and have right now. Doctors and hospitals are now equipped with knowledge and tools of what works and what don't from experience and new research information. Both new antiviral therapy and old but very potent anti-inflammatory steroid are being utilized to successfully treat the illness as seen in the successful treatment of the U.S president recently. Needless to say, we've come a long way since early this year when the virus broke out. And it has been a very difficult period of time for millions of people around the world, but with the combination of simple common sense and ingenuity by learning from experience and real science, we will overcome this pandemic. Science should not only be based on we believe as the truth but should also be supported by facts to work.

Surgeon washes his/her hands meticulously and scrubs the skin and nails thoroughly before the sterile gloves are put on in the operating room. Those sterile gloved hands will not touch anything that is not sterile including the skin he's about to cut to gain access to the body underneath. The skin will be sterilized usually by iodine solution before the sterile scalpel touches it. Hand sanitizers can be seen almost ubiquitously at any store entrances and many public places. People even carry around their own personal sanitizers ready to be used whenever they enter or leave a place. It's good that people are aware of simple hygienic procedure to prevent infection that can be transmitted by contaminated hands, but is it the correct procedure to prevent respiratory infection such as the Covid-19? The answer is actually NO. It doesn't really do much good to the sanitized hands if the hands will just eventually be contaminated again by touching other objects and surfaces that are not sterile. The most important information that the public is missing is the fact that you don't need to sanitize your hands every five minutes just because you enter and leave a different place as long as you don't touch your face. DO NOT TOUCH THE FACE especially the mouth, nose and eyes with un-sanitized hands to prevent the virus from entering the respiratory system. After a surgeon's hands are cleaned, he/she is not allowed to touch anything that's not sterile if he/she is to prevent infecting the patient. Mask and self distancing with proper use of hand sanitizer before touching the face are simple common sense and will go along away to combat the virus.

What a year this has been! Full of controversies, anxieties, miseries, and even deaths. Covid-19 is more than just once in a lifetime experience. It's a reminder how great and vicious the natural world can be. Humanity has survived numerous pandemic and diseases through perseverance, ingenuity, and understanding how nature works. Complacency and arrogance often go unnoticed until mother nature strikes back and gives back to us what we've done to her.

The vaccine is finally here. Thanks to the scientists who have been working on the new mRNA technology for many years. Like many other vaccines, this laboratory engineered piece of genetic material called messenger RNA will trigger the immune system to respond to the virus though indirectly. Questions and misunderstandings abound. There are people who do not believe in vaccines to begin with because of misinformation or misunderstanding in addition to questionable moral issues that often arise in the making of the vaccines. There's no doubt that vaccines save lives and prevent some diseases, but vaccines may also cause some unintended consequences such as allergic reaction and feeling ill because they trigger the immune system to be activated and respond to some antigen. There's one question that's intriguing but needs to be addressed because the facts of this mRNA vaccine are not fully understood or explained to the public. I was asked "whether or not we become Genetically Modified Organism or GMO when we get the vaccine in our system"? The answer is simply NO. It's true the vaccine contains genetic material that's engineered in the lab called mRNA. However, this mRNA only enters the cell and does not interfere with the nucleus and therefore cannot alter the cell's DNA. The mRNA in the vaccine carries the code for the spike protein of the virus which the cell uses as instruction to produce the protein. The cells with the spike protein then will trigger the immune response in hope that when the body is infected with the real Covid-19 virus, the immune system will recognize the spike protein on the virus and eliminate the invader. The mRNA code only has information for the surface spike protein that mimics the virus's own , but not the whole virus. So Covid-19 infection cannot be acquired through the vaccine. Furthermore, the mRNA disintegrates rapidly once the cell receives the instruction. Since the mRNA cannot enter the nucleus and cannot interact with the DNA, no gene has been modified or altered.

A novel idea that my colleagues, Ligen and Gustav, recently contributed in my discussion, "is fasting good for health", may be one way to keep the immune system healthy to fend off this vicious virus. Both Ligen and Gustav have done studies and written papers regarding fasting and autophagy. The science behind autophagy is now well known and set in motion by fasting and exercises.

Dear Ben Martinez,

The above question was asked in March 2020, when the first wave of the SARS-CoV-2 (Covid-19) coronavirus pandemic emerged. Much has changed since then. A number of countries have experienced the 2nd or 3rd wave of the pandemic caused by new mutant variants of the SARS-CoV-2 coronavirus. In addition, currently (January 2021), many countries are already undergoing programs to vaccinate citizens against Coronavirus with the use of highly effective, innovative, new generations of vaccines. Therefore, perhaps mankind will be able to solve the pandemic problem in 2021.

Regards,

Dariusz Prokopowicz

The novel coronavirus-19 is different from any other respiratory viruses due to its high transmissibility, morbidity, and mortality.