Immunology of COVID-19

 

The pathology of the virus

There are a combination of things specific to this virus and the immunology in general.  COVID-19 is similar to SARS COV-1. SARS stands for Severe Acute Respiratory Distress. Lessons we have already learned with SARS are useful in evaluating the seriousness of COVID-19. The name of the virus responsible for this pandemic is SARS-COV-2. The illness and disease suffered by people infected with SARS-COV-2 is COVID-19. It is analogous to the use of the terms HIV which is the virus that causes the symptoms we know as AIDS.  When you hear discussion of COVID-19 that is the disease that is caused by SARS-COV-2. 

 

The Two Basic Questions

For everyone in society, the two basic questions are how do you not get the virus. The second is, if you get the virus, how do you avoid serious illness or death.  

First, how do you not become infected?  This guidance is the same as for any virus. Avoiding exposure is the first, best move.  The social distancing we are all now doing is the main means of avoidance. The Centers for Disease Control (CDC) guidance is appropriate and something that health care practitioners are taught from their first days of their academic programs.  The current social distancing, however, is not designed to reduce the number of infections. It is designed to reduce the rate of those infections so that those patients in need of hospitalization arrive at hospitals at a manageable rate. What most of the experts are not saying is that, eventually, most of us will be exposed to SARS-COV-2 and will be infected.  

 

What Infection Looks Like for the Majority of Patients

For the typical person who becomes infected with SARS-COV-2, they don’t have symptoms for five days. This means they can be unknowingly infecting others during those five days.  Generally speaking, the time between your first symptoms, and when you have a peak of symptoms is about seven days. On a good note, there are plenty of people who become infected and do not develop any symptoms or very mild symptoms.  The patients who respond the best are those whose immune systems are the best fortified at all times to insure a robust response.

That strong immune response means activation of natural killer cells and a TH1 response.  TH1 one cells promote natural killer cells and promote cytotoxic T lymphocytes cells.

The other important part about the immune response is ensuring that your body is not suffering chronic inflammation before you become infected.  Here is why that is important.  A normal immune response to a pathogen, an invader, like a virus such as SARS-COV-2 includes inflammation.  That normal Inflammatory response helps your body clear the virus. Chronic inflammation, on the other hand, weakens the body, tissues, the immune system and many other aspects of the operation of the body.  So, if your body is already chronically inflamed before you become infected, the peak of your inflammatory immune response will be much higher than it would be for an otherwise healthy person. That unusually high peak of inflammation that your immune system uses to fight the virus can release what is known as a cytokine storm.  

 

Cytokine Storm 

Cytokines are proteins released by many different cells in the body, including those of the immune system where they coordinate the body’s response against infection and trigger inflammation. The name ‘cytokine’ is derived from the Greek words for cell (cyto) and movement (kinos).  When SARS-COV-2 enters the lungs, it naturally triggers an immune response. That response recruits immune cells to the lungs to attack the virus. That event results in inflammation. However, if a patient is already chronically inflamed, that additional inflammation now becomes excessive or uncontrolled.  This hyperinflammation is difficult to control and once it is out of control it can result in severe respiratory distress and death. This can seriously harm or even kill the patient. Cytokine storms are a complication of SARS-COV-2 and many other viruses in the corona family. They are also associated with diseases such as multiple sclerosis and pancreatitis.

 

Reducing Chronic Inflammation

Several important lifestyle factors contribute to chronic inflammation.  The most important and easiest to control is nutrition. Poor quality food, excessive animal protein and deficient fruits and vegetables are all responsible for chronic inflammation.  Insufficient sleep and poor response to stress along with smoking and alcohol consumption round out the list of the most common factors.  

Taking supplements such as curcumin and Omega 3s has been shown in scientific studies to quiet the immune system response and reduce inflammation.  Tylenol is a good pain reliever, but it has been shown to deplete glutathione. Glutathione is an antioxidant that is essential for reducing lung inflammation.  Many things in medicine as in life are a matter of balancing relative harm. Untreated headache pain also causes an increased release of cortisol, a hormone that is released in response to stress.  Chronically elevated cortisol also depresses your immune system.  

The goal of promoting and supporting your immune system should be foremost in your daily decisions about nutrition, supplements, rest, exercise and stress management.  Vitamin D is necessary for your immune system and it is also anti-inflammatory. Vitamin C is a well studied antioxidant as well. We have made recommendations about Melatonin which is detailed in its own blog.  We have a range of supplements you can take to support your immune system as well as that of your children and loved ones.  However, this is not a short term protection. The future of life in the age of pandemics means we all need to change our focus to annual physical check ups and begin to monitor our health and that of our loved ones, especially the fortification of their immune systems, day to day and week to week.  Having regular visits with our functional medicine practice will enable you to stay on top of your immune system to insure that the next wave of COVID-19 patients who need hospitalization does not include you.  

 

As a final note, one of the leading experts advising the President on policies such as social distancing, has already stated that COVID-19 symptoms are going to come around again in Fall 2020.  The time to get your immune system running in top form is now.  Call us at today at 903-255-6398 to begin your telehealth visits and prepare your immune system for optimal health.