Tag: Immunity

“This Too Shall Pass”

This phrase has a long history dating back to biblical times in one form or the other.  Though the origin of this saying cannot be pinned down, it seems particularly pertinent to what we are experiencing as a nation today.  It is a reminder that regardless of our troubles today with coronavirus and the overwhelming impact it often has on our daily lives,  it will indeed ultimately pass.  We have been damaged physically, emotionally, socially and economically.  Thousands of lives have been lost,  but we and the rest of the world will get over this sooner or later.  Hopefully, we will all be smarter and stronger having gone through this so that we are better prepared for the next pandemic which is sure to come at some point.

So now one wonders what is next with outbreaks of the virus occurring in different parts of the country when it just began to look like we might have had things under control.  Keep in mind that this should not have been unexpected.  The virus is here to stay until one of two things happens.  First, the virus may mutate itself out of existence meaning that it changes in such a way that it becomes less capable of attaching to and invading human cells.  However, there is a caveat to this first scenario since the virus could also mutate in such a fashion as to make itself more likely to attach to a human cell and replicate.  The second thing that could happens, which we should hope for, is that so-called “herd immunity” develops.  This occurs when a large portion of the population either asquires the illness, survives and produces antibodies to the virus; or, a vaccine is given which also creates immunity.  When immunity develops in either fashion, the virus is less likely to enter a host to replicate, cause illness and spread to other susceptible people.  Those who were either sick and have recovered and those who have had the vaccine can no longer harbor the virus and thereby prevent it from replicating and invading the remaining susceptible individuals.  In those who have been vaccinated and developed antibodies, the virus is not longer able to attach to the host cell and enter it to cause damage to the cell and replicate itself.  In those who have acquired the immunity by having had the illness, antibodies likewise develop which prevent attachment of the virus to the susceptible cell so the virus once again cannot replicate and spread.  Either way, the chain of transmission is thereby blocked and the incidence of viral infection decreases in a population.  However, there is a caveat here also in terms of those who have naturally acquired immunity through infection; namely, that some individuals who have had the illness and recovered may theoretically become carriers of the virus.  Not enough is yet known about this virus to make any comments about a carrier state.  Remember that our objective here is “flatten the curve.”  That does not mean that we have eliminated the virus.  What is means is that we have reached a point where the rate of new cases occurring has slowed and reached a plateau making it much easier to control the pandemic.  Hopefully at some point the virus will have disappeared, but that may never completely occur.  Instead, what we may see is a situation similar to the influenza virus where we have to deal with a new strain or strains every year.  In the meantime while we await the development of vaccines and antiviral medications, we try to identify and isolate infected people as quickly as we can, maintain social distancing in a reasonable way in order to minimize exposure, and we try to resume our lives as close to normal as possible.

How And When Will The Pandemic End?clear-glass-with-red-sand-grainer-39396

We do not know yet how and when the pandemic will end, but it will will end.  This does not mean that the virus itself  will completely disappear though it may.  Instead, we may see this coronavirus  or other similar coronaviruses popping up periodically in different places for years to come. 

 

Lessons To Be Learned

This Sars CoV -2 coronavirus is “novel.” Its combination of easy transmissibility and its wide range of symptoms makes it somewhat unique, but there are lessons that can be learned from previous pandemics like the Spanish Flu of 1918. This pandemic lasted over two years and came in three waves that killed 50 million and 100 million people.  Exactly why the virus became extinguished remains unclear. There were no vaccines for it and no effective treatments.  It has been estimated that over a period of two years 500 million people worldwide were infected and somewhere between 50 and 100 million people may have died.  Several theories for its disappearance have been postulated, but it seems likely that this was due to a combination of factors.  One of these might have been that the virus mutated to a less pathogenic form which often happens with viruses.  Social distancing once it was used more aggressively likely decreased the rate of transmission.  Also, as time went on more and more people got exposed to the virus and became immune leading to so called “herd immunity.”  When enough people in a population are immune either through naturally occurring infection or immunization, the likelihood of transmitting the virus to the remaining others in the population who are not immune decreases dramatically.  This is where we are hopefully heading now.  

What happens next and how soon this pandemic ends depends on a combination of factors in addition to the development of herd immunity.  This includes the natural history of the virus itself, in other words, will the virus mutate to a less aggressive form; how effective the vaccines are; how good we get at discovering new antiviral medications; and how good we get at treating the inflammatory effects of the viral infection such as the so called “cytokine storm.”

Through all of this turmoil just remember that “this too shall pass.”

white and black moon with black skies and body of water photography during night time
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A Tale of Two Illnesses

We in the U.S. are currently battling two major illnesses that may change the social fabric, customs and morality of our country for years to come if not forever.  Both are very different but certainly intertwined.  Together they will test our strength as a nation.

The first of these is Covid-19. While as a whole the country seems to be doing better handling this pandemic, we are by no means out of danger.  More illness and death is yet to come.  However, keep in mind that as time goes on and more and more people are exposed to the virus more herd immunity will occur, and that is really what we need in order to overcome the threat of pandemic. We achieve that “herd immunity” in two ways (see The Dilemma of Immunity).  One way is by immunization.  The second way is through naturally occuring infection.  This means that as more and more people are exposed to the virus naturally in the environment and recover, then fewer and fewer people are left susceptible to the virus.  The corollary to this concept is that people who have had the disease and recovered would be unlikely to spread the disease to the remaining others who might still be susceptible.  Hence there will be less communicability as time goes on.  This may seem obvious, but it is an important concept and probably as important as immunization if not more so.  However, there are some caveats to be considered here.  For example, we are assuming with good reason that having had the infection confirms immunity. While this is likely it has not yet been completely validated at this point. Neither has it been validated that the immunity will be lifelong..  Another issue which remains open yet is whether the virus will mutate to such a degree that prior immunity will no longer be effective as often happens with the influenza virus for which new vaccines are required on a yearly basis.  Of course the alternative is also possible; namely,  that the virus will mutate and become in and of itself less infectious as time goes on.  We will likely have a vaccine (or vaccines) for Covid-19 early next year and newer antiviral medications will likely be developed in the months ahead as well.  Also, very importantly,  other medications to treat the lethal inflammatory sequelae of the virus will soon be developed thanks to our robust pharmaceutical industry.  All of this should save lives. However, other new viruses and infectious agents will also likely come to our shores in time to come, and we will need to be better prepared for this future possibility.  Please see my previous blog about what we have learned from this pandemic (seeWhat Have We Learned From Covid-19).  In the meantime our experience with Covid-19 has had dramatic effects on how we live our lives and conduct our business.  There is no more hand shaking. Social gatherings are limited.  People walk around in fear of getting a dreaded illness, which by the way, has a mortality rate far lower that initially projected.  People are wearing face masks in situations where there is no rational reason to do so (see Pandemic). Uncertainty about our economic future and security is causing fear and panic in the population leading to unreasonable doubts about our survival as a nation.  We will survive the Covid-19 pandemic and other infectious disease threats that may follow. Not only will we survive these threats, but will will do well once we learn how to cope with them.

The greater threat to our health, both individually and as a nation, is the emergence of various anarchist groups threatening to overthrow our government and the rule of law without which no society can survive.  The widespread violence and destruction that we are now seeing and the inability of local governments, particularly those in left wing democratic cities, to control this is a greater risk to the health and wellbeing of the nation as a whole compared to any viral pandemic. We can face pandemics together as one nation and do what is necessary to overcome them if we put petty politics aside and use good judgement.  Instead, what we see happening is our politicians using this pandemic as a political tool to destroy the opposition putting power before country.  Beyond this we see some of our elected leaders, principally socialist democrats, on a state and local basis permitting, condoning and even encouraging rioting and destruction.  There is absolutely no doubt that we have social problems that need to be urgently addressed, but destroying the country is not the healthy way to do so.  The wanton destruction of private property, the desecration of  monuments, the attacks on law abiding citizens does nothing but create more fear and hostility at a time when what we need is unity.  The health of the nation and its citizens depends on it.  To destroy our government and our institutions, as the leftists and particularly the anarchists want to do, is like seeing a sick patient in the hospital who has an excellent chance of recovery and saying he has to be euthanized because he is not worth saving.

Pandemic

More on masks….and the Confusion Surrounding Their Use

So much has already been written and discussed about the appropriate use of masks during this pandemic, but it still remains a confusing topic especially for those who are not front line care givers, first responders or in high risk occupations.  For those of us who are, the need to wear all the appropriate personal protective equipment (PPE) including the N-95 face masks and the like is quite clear.  The risk of exposure for such individuals is great, and therefore so is the the need for protection.  However, for those who are not on the frontline wearing a mask may simply be an expression of  an unreasonable fear or perhaps confusion about what should be done to protect oneself and others in a low risk environment.  A lot of this fear and confusion may be perpetuated by governmental authorities who feel that they need to control in every aspect what we do as individuals because ordinary people are not really capable of making sound judgements regarding their own care.  Dr. Fauci says he wears a mask because he wants to protect himself as well as others and also because he wants to make a mask a “symbol” for people to see that it’s “the kind of thing you should be doing.” However, do we really need a symbol in place of real information about what we should be doing and why so we can make our own sensible judgements?  Or, is the promotion of this “symbol” just something to help enforce compliance with a lot of rules and regulations that at this point in the pandemic are of questionable value?  Countless times I have seen people riding alone in cars with face masks on, riding bicycles on country roads or walking along deserted streets with face masks on.  Just recently I saw a woman leave her suburban house to walk down her driveway to her mailbox with mask and gloves on to pick up her mail with no one within a hundred feet of her.  I don’t think the use of a mask in situations such as these reflects symbolism or appropriate protectiveness to any degree.  Instead, I think this type of behavior reflects a paranoia engendered by the media and to some extent by governmental bodies which are confused, but none the less determined, to control our activities by telling us what we need to do even though there may be little or no proof that what they are telling us is indeed correct.  So having said all of this let’s take another realistic look at how and when masks might be used in the daily lives of ordinary people and not those of first responders, front line care givers or workers in high risk occupations.  To do so let’s also take a realistic look at how this virus spreads realizing that there is still a lot that needs to be learned. 

First, the virus can indeed spread between people interacting in close proximity.  For example, speaking, coughing, or sneezing can spread the virus from an infected individual to an uninfected individual.  However, the key words here are “close proximity.”  Usually that means within 6 to 9 feet of each other.  In light of this evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (for example, grocery stores, pharmacies, subways, buses, public buildings, etc. ) especially in areas where there is significant evidence of disease spread.  However, keep in mind that simple cloth masks will only help prevent large droplet transmission and not small airborne viral particle transmission.  So simple cloth masks may help somewhat in certain circumstances where close proximity is an unavoidable issue because large droplets will be retained by the cloth mask.  However, small airborne viral particles will not be retained by a cloth mask, nor will a cloth mask filter out such particles and prevent them from being inhaled by someone else.  So for the person with the virus who is coughing the cloth mask will help stop the droplets containing the virus from settling on another person, but it will not stop the tiny airborne viral particles themselves from being dispersed to others.  For the person who is not infected and wearing a cloth mask, the cloth mask will only help prevent the large droplets from reaching that individual but not the tiny airborne viral particles themselves. To help prevent airborne viral particle transmission which would be necessary in situations of close contact, an N-95 mask or better would be needed. Therefor, it makes very little sense to wear a mask of any kind when you are out and about away from people like when going for a walk or bike ride on country road, driving in your car alone, walking along a beach, etc.

 

More on Other Modes of Transmission

The coronavirus can live for hours to days on surfaces like countertops and doorknobs, but how long it survives depends on a number of factors like the texture of the surface, heat and humidity.  There is also evidence for fecal oral transmission.  A lot still has to be learned about how long this virus can survive outside the body, but as of now it seems that you are much more likely to catch it directly from another person than from surfaces.

Finally a Word About Mutation of the Virus

 

Viruses can mutate and that can cause a problem in terms of vaccines and treatments. However, mutation is not always a bad thing. Sometimes mutations can lead to a weakening of the virus so that it eventually dies out. The Sars C0V -2 virus seems to have a slower mutation rate than the influenza virus so that may be a good thing for vaccine development.  

The Dilemma of Immunity

While we await the development of  vaccines for SARS-CoV-2 virus here are a few things to consider. First, will this virus be very much like the influenza virus meaning will it have a yearly variation or mutation requiring a new vaccine every year ?  The answer to this is very likely “yes” since in many respects this virus is like the influenza virus.

Second, how effective will the vaccine be? There are likely to be several different variations of this vaccine produced in the U.S. and elsewhere. It is very likely that we will not know for quite some time which will be most effective.

Third, there is the whole question of herd immunity. Most epidemiologists would agree that anywhere between 40-60% of a given population has to be immune either by prior exposure and subsequent immunity (so-called “naturally acquired immunity”) or immunity acquired through immunization. Since this virus is highly contagious, it is likely that the percentage of immune individuals in a society would have to be on the higher side in order to prevent or limit the likelihood of epidemic spread. Remember that in order for the virus to survive it needs to propagate. It does so by infecting the cells of a susceptible individual, replicating in those cells, spreading to other cells in that individual, and then moving on to infect other individuals in a community as the infected individual sheds viral particles one way or the other.

The fourth point to consider is the following, and herein the lies the dilemma. If we acknowledge that we need 40% to 60% of the population as a minimum to be be immune either by vaccination or naturally acquired infection in order to stop the spread of the virus, then by limiting naturally acquired infection by social distancing we may actually be increasing the susceptibility of our population as a whole to the virus as time goes on especially if the vaccines which we are banking on fail to provide the degree of protection that we anticipate. If these things happen, then we may actually end up prolonging the pandemic rather than shortening it. Remember the Spanish Flu epidemic of 1918-1919 occurred in two waves and only stopped when enough people world wide had acquired the infection and developed immunity. There was no vaccine at that time. Presumably as this happened the virus had fewer hosts to invade and within which to replicate.  As replication decreased there was less virus being shed into the environment so fewer and fewer people came into contact with the virus gradually allowing for its extinction and thereby putting an end to the Spanish Flu pandemic.  Either something of that kind happened or there was a spontaneous mutation of the virus which made it less lethal and infectious. 

This is not say we should not be working vigorously on vaccines for SARS CoV-2. We should definitely be doing so, but keep in mind that naturally acquired immunity may really be what saves us in the long run. This is essentially the route that Sweden has taken in allowing herd immunity to take place in an albeit partially controlled manner. They did not go into a draconian lockdown, but encouraged social distancing to minimize rate of exposure so as not to overwhelm their health care system all at one time. It seems to be working for them although some would disagree with their approach and results. Only time will tell whether their approach really did work for them and whether it is applicable to other countries around the world. Each country and population may be different.  There may not be a “one size fits” all approach that will ultimately work for the entire world. In the meantime work on a vaccine, or vaccines continues, as does the work to find therapeutics both to prevent viral replication and to treat the destructive  inflammatory processes caused by the infection itself.