The coronavirus is dangerous because it has a long incubation period where infected individuals can transmit the virus before showing symptoms. The virus binds to ACE2 receptors which are found in many organs in the body, including the lungs. This allows the virus to easily enter cells and hijack their machinery to replicate. While most cases are mild, especially in younger people, the virus can still spread rapidly during the asymptomatic phase. Social distancing is important to prevent the virus from continuing to infect new hosts.

1. The coronavirus’s survival mechanism is
what makes it so dangerous
alexandra yepes gomez
Mar 24 · 5 min read
For most people, Covid-19 seems to be pretty mild. And it takes a while-to
the tune of five days to two weeks -to cause symptoms, if it does at all.
Unfortunately, that’s exactly what makes the novel coronavirus so
dangerous. In the period that an infected person is asymptomatic or mildly
ill, they could transmit the virus to dozens of other people through water
droplets expelled by coughs or sneezes, transferred on skin and other
surfaces. One person in South Korea, known only as patient 31, transmitted
the virus to over 1,100 people as she went about her life.
So what is it about this particular virus-SARS-CoV-2-that makes it act this
way? Scientists are beginning to understand those stealthy transmission
dynamics at a biological level.
All viruses are intracellular parasites. Their only mission in life, if you can
call it that, is to use the mechanisms of human cells to make copies of
themselves. The tricky task is finding a way into the cells where they can
replicate. The novel coronavirus, SARS-CoV-2, isn’t particularly good at
that. Research so far suggests that it sneaks in through a single cellular
door: a membrane protein called ACE2.
Angiotensin converting enzyme 2 receptors, or ACE2 receptors for short,
are a part of the sympathetic nervous system. Their job is to bind to a
hormone (conveniently called the ACE2 hormone) as part of the body’s
stress response. The ACE2 hormone plays a role in constricting blood
vessels, which raises blood pressure.
The virus that causes Covid-19 can latch onto the ACE2 receptor
undetected-likely because of its animal origins. The adaptive immune
system-the part that creates antibodies that help identify pathogens
quickly-hasn’t had a chance to learn what SARS-CoV-2 looks like yet. This
means the virus can use a molecular phishing scam to sneak into the cell.
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Once it does, the cell is doomed: SARS-CoV-2 takes control of the cell’s
genetic reproduction tools, relentlessly replicates itself, and bursts through
the cell membrane-the microbial equivalent of blowing up a building and
not looking back.
People with diabetes or high blood pressure-who are typically older adults-
often take a class of drugs called ACE inhibitors. These drugs limit the
constriction of blood vessels and, in doing so, make ACE2 receptors more
prevalent throughout the body. Some scientists hypothesize that this is
why people with these conditions have much more severe cases of Covid-
19.
“The ACE2 receptor is found pretty abundantly through a lot of our
organs,” says Panagis Galiatsatos, a pulmonologist at Johns Hopkins
Bayview Medical Center. They’re on cells on the tongue, and along our
esophagus. They’re on cells in the kidneys and heart, and the end of our
gastrointestinal tract-which is why stomach symptoms, like loss of appetite
and diarrhea have been observed.
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Most worryingly, ACE2 receptors appear on cells in the most delicate part
of the lungs: the alveoli. They’re responsible for the vital gas exchange of
taking in oxygen and releasing carbon dioxide. Damage to these cells is
what causes some of the most common symptoms of the virus, like
shortness of breath. Coughing is a result of the lungs trying to expel the
infection.
The body isn’t completely defenseless against this novel infection: Even
without the initial help of the adaptive immune system, the body’s innate
immune system kicks in within hours of a novel infection. Cells that are

3. infected send out distress signals that alert others to the viral invader. The
innate immune system can start to contain the virus by eliminating
infected cells, telling the adaptive immune system to kick into gear, and
even creating fevers to try to cook it off.
That immune response may also play a role in the mild nature of most
infections. “Everyone is at risk,” of getting Covid-19, says Erin Sorrell, a
microbiologist at Georgetown University who studies emerging infectious
diseases. People who are younger may have a better innate immune
response that prevents them from getting sick, or a balanced innate and
adaptive response that helps them get rid of symptoms quickly.
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That, combined with the pathway taken by SARS-CoV-2, helps explain why
the Covid-19 pandemic looks so different from two other diseases caused
by coronaviruses: SARS and MERS. These viruses bind to more cellular
receptors, Galiatsatos explains, and can replicate more quickly. Severe
symptoms appear that much faster. Even though 9.6% of people with SARS
and 34.4% of people with MERS died, the viruses made people so sick so
quickly that they couldn’t spread as easily to others.
Early research has also shown that people who are asymptomatic can shed
enough virus to be infectious, Sorrell explains. So while the death rate of
Covid-19 seems to be much lower than SARS and MERS-scientists are still
calculating it, but it seems to be between 1% and 4% depending on the
care available-Covid-19 spreads much faster between people because they
don’t know they’re shedding it. Even if the death rate is 3% in the US, for
example, across the entire population that would lead to over 10 million
deaths, about the population of North Carolina or Greece.
This is where the real danger in Covid-19 lies, and why there’s been so
much emphasis on social distancing. The virus can only survive if it
continues to find new hosts. By staying isolated while feeling well for 14
days, you’re eliminating the chance that you could pass on the virus to
someone else. The minute you go outside again and someone else passes
the virus onto you, “you reset the clock,” says Galiatsatos.
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. . .
Originally published at https://qz.com on March 24, 2020.
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