Apr
24
2022

Immune System Responses against Covid-19 or anti-Covid Vaccination

By | immune system, Infectious Disease, Prevention, vaccinations

This article is about immune responses against Covid-19 or anti-Covid vaccination.

Investigations of the immune system showed that people who had Covid-19 and subsequently were vaccinated had an immune response that lasted for at least one year. In the following a discussion follows about the details why this is so.

The WHO confirmed more than 430 million cases of Covid-19 since the pandemic started. 4.9 billion people or 63.9% of the world population received at least one vaccination as of late February 2022.

How vaccination against Covid-19 works

The vaccine attacks the spike protein of the Covid-19 virus (SARS-CoV-2). The body produces antibodies through B cell activation. These are lymphocytes that originated from the bone marrow (hence B cells). They are capable of producing large amounts of antibodies that target the spike protein of the virus. It takes at least two vaccinations with the Pfizer vaccine to get a good antibody response. A booster vaccine brings the antibody titer even higher.

Cell-mediated response by killer T cells

When the virus enters a cell, the antibodies are no longer effective. Here the T killer cell comes into play. T killer cells are lymphocytes that were thymus processed (hence the name T cells) and activated by the vaccine. T killer cells function as a second line of defence. These immune cells specialize in detecting virus-infected cells. They immediately destroy these cells before the virus has a chance to replicate and shed more virus copies into the blood stream. It is the T cell response that prevents hospitalizations and deaths. Media coverage misled the public to believe that the bulk of the immune response would be from antibody production. However, the truth is that the T cell response is what is responsible for recognizing Covid-19 variants and why people survive Covid-19 with very little complications.

Long term immunity

When people had a Covid-19 infection the activated B cells that produced antibodies and the T killer cells get converted into memory cells. With a re-infection the memory cells can reactivate themselves to turn again into active B cells producing antibodies and T killer cells. The key for immunity with multiple vaccinations is also the memory cell pool. Those with two Pfizer vaccinations and a booster vaccine are much more immune to Covid-19 than those who only received one or two vaccinations.

Waning immunity

Following an infection with Covid-19 the immunity comes to a peak at 3 months after the start of the infection. The CDC said that people who are 90 days post-infection do not require a quarantine when they meet someone with an active Covid infection. By about 6 months immunity is declining. This is also true for people after double vaccination and a booster vaccine.

Hybrid immunity

The immune response after either a natural infection with Covid or following vaccinations with anti-Covid vaccines lasts only about 6 months. On the other hand, scientists observed that people recovering from Covid infections who subsequently received an anti-Covid vaccine just once had a very strong immune response that lasts for over a year. This is called hybrid immunity. This type of immune response triggers a very strong antibody response that is lasting longer. Immunologists are now researching whether the hybrid immunity is achievable with an improvement to vaccines. Results of this will not be available for several years.

Immune System Responses against Covid-19 or anti-Covid Vaccination

Immune System Responses against Covid-19 or anti-Covid Vaccination

Conclusion

The immune response to Covid lasts for about 6 months; the same is true for the immune response after a vaccination. But when a person comes down with Covid and he or she receives a vaccination one month later, the immune response lasts for over one year. Scientists call this hybrid immunity. At this point experts recommend to have a booster vaccine every 6 months. But immunologists are researching for ways to incorporate the mechanisms of hybrid immunity into vaccines, which likely will not be available for several years.

Avoid deliberate exposure to Covid-19

Some persons who read about the response after a Covid infection and a vaccination misinterpreted this. They took this as an “invitation” to expose themselves to the virus in the hope to boost their immunity. However, a Covid infection remains an illness with potentially serious consequences. There is no way to predict whether the course of an infection will be mild or extremely severe. In addition, a significant number of patients come down with “long covid” and struggle with breathing problems, lack of energy and more. Covid is still here, and our best protection remains the full vaccination including boosters and hygienic measures. This involves masks, frequent hand-washing and disinfection of surfaces in daily life.

Dec
26
2020

Hormones Play an Important Role in Survival from Covid-19

By | andropause, Hormones, immune system, Infectious Disease, Menopause

I am describing here that hormones play an important role in survival from Covid-19. There are two publications that illustrate that point.

Estrogens protect women against Covid-19

A study from Dec. 4, 2020 covering 17 countries and involving nearly 70,000 women discovered these principal findings.

  • Women aged 20 to 50 have moderately higher Covid-19 infection rates than men
  • In all of the age groups men have higher mortality rates than women
  • Beyond the age of 50 the fatality rate from Covid-19 is 50% higher in men than that of women
  • Postmenopausal women above the age of 50 and on estradiol supplementation had 50% less mortality from Covid-19 than women without estradiol supplementation

The researchers said about the study: “In a nutshell, it’s likely that the apparently protective effects of 17β-estradiol, a naturally occurring, abundant female hormone, relate to a key property of this molecule: it attenuates the so-called “cytokine storm” that’s thought to underlie much of the cellular-scale and organ/tissue-level damage wrought by a SARS-CoV-2 infection, via dysregulation of a patient’s immune response.”

Men need enough testosterone to fight Covid-19

Another study from September 17, 2020 pointed out that males have much worse outcomes with Covid-19 than females. Men are affected by Covid-19 twice as often as females and they experience a much more severe course with a higher mortality. The authors also point out that there is a direct correlation between lower serum testosterone levels in men and inflammation severity by cytokines and poor clinical outcomes. The decline in total and free testosterone in aging men leads to serious pulmonary complications and the need to treat the patient in the ICU. The Covid-19 coronavirus utilizes Angiotensin-Converting Enzyme II (ACE2) for entry into the host cell. A male requires testosterone for ACE2 expression. Lower testosterone causes higher mortality in men. In contrast, if testosterone in a male is too high, blood clots can form in the circulatory system, which often lead to complications and deaths in patients with Covid-19.

Vitamin D levels and course of Covid-19

There are three major effects that vitamin D has.

  1. A strengthening of the epithelial barrier not allowing the coronavirus to penetrate into the lung tissue as easily.
  2. Release of defensins and cathelicidin, two crucial antiviral polypeptides, that eradicate the SARS-CoV-2 virus in the system.
  3. Interruption of the “cytokine storm”, an overwhelming inflammation which is responsible for viral pneumonia to develop. Without the cytokine storm there is no damage to the lungs, and people do not need treatment in the ICU. This is particularly important for people above the age of 60 and for people with pre-existing diseases.

Similarly, with the stabilizing effect of vitamin D regarding the immune function more severe forms of Covid-19 can turn into less severe forms with a better outcome.

Discussion

Research showed that in women estrogen has a modifying effect on the course of Covid-19. In males it is testosterone that leads to an improved course of Covid-19. Both sexes require adequate doses of vitamin D, which helps to strengthen the epithelial barrier. In addition, enough vitamin D releases defensins and cathelicidin, two crucial antiviral polypeptides that eradicate any virus in the system. Vitamin D also interrupts the “cytokine storm”, an overwhelming inflammation, which is responsible for viral pneumonia to develop. All of these factors together modify the course of Covid-19 and improve the probability of survival from this otherwise serious viral illness.

Hormones Play an Important Role in Survival from Covid-19

Hormones Play an Important Role in Survival from Covid-19

Conclusion

Two lines of research showed that both women and men do better with Covid-19 when their hormone levels are either adequate or are substituted to normal levels. Women in menopause taking estradiol for postmenopausal symptoms had 50% less mortality from Covid-19. Men who were testosterone deficient and were put on testosterone supplementation do better with respect to Covid-19. In aging men total and free testosterone decline and serious pulmonary complications occur with a need to treat the patient in the ICU. On top of hormones both men and women benefit from high doses of vitamin D, which strengthens the epithelial barrier. Vitamin D also releases defensins and cathelicidin, two crucial antiviral polypeptides that fights the SARS-CoV-2 virus directly. In addition, vitamin D interrupts the “cytokine storm”, an overwhelming inflammation which causes the viral pneumonia. Taken together the hormones and vitamin D can improve the outcome of Covid-19 significantly.

This text includes part of this blog.

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Nov
28
2020

Mental Illness and Covid-19

By | alcohol, Anxiety, depression, Drugs, exercise, food, schizophrenia, Sleeep, stress, Stress management

A topic less discussed is mental illness and Covid-19. Covid-19 has been noticeably around us since March of 2020. With the various social distancing and quarantining methods people become more or less isolated emotionally. Social gatherings are outlawed depending on where you live. This helps to interrupt the spread of the virus, but it makes people feel more stressed as their relationships get interrupted.

Symptoms of stress

The CDC sums up that stress during a pandemic can cause the following:

  • Fear of your own health and the health of your loved ones
  • Loss of your job or financial support
  • Changes in eating habits
  • Changes in sleep pattern with lack in concentration
  • Increase in use of tobacco, alcohol or other substance consumption
  • Chronic health problems may deteriorate
  • Worsening of Mental health conditions

The more isolated we are, the more stress we feel. This undermines our stress coping mechanisms, makes us more anxious and more depressed.

Develop coping skills

Taking care of your family and friends may relieve your stress, but it needs to be balanced by taking care of yourself. Although you are physically isolated from others when you are in quarantine, you can stay in contact with others by phone or video chats. This makes you less lonely and isolated.

Take care of yourself. This includes eating well balanced meals, exercising regularly and getting enough sleep. Avoid the consumption of alcohol, tobacco and drugs. Share with a family member or friend how you feel. Maintain friendships through the phone, emails, social media and computer chats. This builds a strong support system for you.

Avoid too much exposure to news stories. Seeing negative stories about Covid-19 over and over again can be undermining, so take a break from the news media. Go for a walk. Take a nap.

Suicide

Sometimes depression can get out of control to the point of driving a person to the brink of suicide. In the US major depression is the leading cause of disability for ages 15-44.  At any given year 16.1 million American adults (about 6.7% of the U.S. population age 18 and older) suffer from major depression. 10.3% of Americans have thought about suicide. If you feel that way, do not act on this impulse. Call 1-800-799-4889. That is the National Suicide Prevention Lifeline & Chat.

Medical literature about the psychological impact of Covid-19

In a July 2020 publication the authors pointed out that Covid-19 infection is a significant psychological stressor. There is the fear of getting the virus and uncertainty about the future. Pre-existing anxiety and depression disorders get accelerated from the stress. In addition, mental disorders like schizophrenia with psychosis may worsen. This may require more antipsychotic medication to control it.

A Kaiser Family Foundation poll found in March 2020 that the Covid-19 pandemic has caused a major impact on US citizens. 45% of respondents said that the pandemic has affected their mental wellbeing significantly. If you are scared, depressed or anxious, you are tense and you have problems falling asleep, you are not alone. You can seek and receive help!

Prevention of mental disease from Covid-19

Here is some practical advice from the World Health Organization.

  • Stay informed.
  • Have a daily routine. Get up and go to sleep at regular times. Eat healthy balanced meals. Exercise regularly. Have your work routine and also find time to rest. Do things that you enjoy.
  • Watch the news only to be informed, but limit news watching to a minimum. This will keep anxiety and depression in check.
  • Stay in contact with close friends by phone and computer technology.
  • Keep your alcohol consumption low. If you did not drink before at all, don’t start drinking in an attempt to deal with boredom, fear, anxiety or social isolation.
  • Take breaks from screen time. This reduces tension.
  • Video games: doing this may relax you for a short time. But longer video game activities can make you tense; you should balance this with the rest of your daily activities.
  • Social media. Use this for honest communication. Keep it brief. If you see misinformation, point out the truth.
  • Helping others: if you can, help others in the community with shopping or other chores.

Treatment for Mental disease from Covid-19

When you notice anxiety, depression or a flare-up of psychotic symptoms from schizophrenia, it is important to see your health professional right away. You may need some counselling. Others may need an antidepressant (for depression) or an adjustment to your antipsychotic medication. Some patients with milder depression or anxiety may benefit from cognitive/behavioral therapy. Most importantly, know that help is available! More info about cognitive therapy for suicide prevention.

Mental Illness and Covid-19

Mental Illness and Covid-19

Conclusion

Mental illness and Covid-19 is a huge topic. People definitely have experienced more anxiety and depression since the Covid-19 epidemic. This is because our lifestyle is suddenly restricted. We may have to go through a 14-day quarantine. But we also cannot participate in large gatherings with more than 50 people. Often, we have to wear masks in stores. In areas with high cases of Covid-19 there is also a severe restriction regarding with whom you can visit, leading to feelings of isolation. All of this can lead to mental illness. Essentially there are two ways of coping with this. First, we need to get a routine that makes us more resistant to mental illness. Secondly, if this fails, seek the advice of a health professional right away.

Seek mental illness treatment right away

When you catch mental illness early, it is much easier to treat. Milder cases of depression or anxiety may benefit from cognitive/behavioral therapy. More severe cases often require medication. In this outline I have discussed mental illness during the Covid-19 epidemic. I have not discussed the cases where people came down with Covid-19 coronavirus and got affected in their brain function from the virus. These cases need treatment by a neurologist and psychiatrist, and they are much more complicated.

Sep
05
2020

How to Manage Clot Formation with Covid-19

By | blood clots, heart attack, immune system, Infectious Disease, Inflammation, Lung Disease, Mortality, Stroke

A publication in the Canadian Medical Association Journal describes how to manage clot formation with Covid-19. A significant amount of cases among Covid-19 patients come down with clotting problems. This means that an infection with SARS-CoV-2 (or Covid-19 coronavirus) may initially present with a fever and cough. But a few days later it can suddenly turn into a dangerous disease with severe clots, multiple organ failures and death.

Clot occurrence with Covid-19

It is important to realize that most patients with SARS-CoV-2 do not need hospitalization. But physicians admit 10 to 15% of patients to the hospital. Of these 20% end up with treatment in the Intensive Care Unit (ICU). Of all the hospitalized patients between 5% and 30% develop some form of thrombotic event. Notably, complications of clot formation can be a stroke, a heart attack, a pulmonary embolism or a deep vein thrombosis in the leg. In a recent study from the US 400 random hospitalized patients with Covid-19 144 patients were admitted to the ICU. 4.8% had radiologically confirmed deep vein thrombosis. Overall there were 9.5% with thrombotic events that developed during the hospital stay.

How does a coagulopathy develop with Covid-19?

Truly, SARS-CoV-2 enters the body cells through an interaction of its viral spike protein with the angiotensin-converting enzyme 2 (ACE2) receptor. To explain, numerous organs and tissues express this receptor. This includes lung alveolar type 2 epithelial cells, endothelium, the brain, heart and kidneys. To emphasize, ACE2 leads to angiotensin II degradation. With the SARS-CoV-2 stimulation of the ACE2 receptor there may be an accumulation of angiotensin II, which causes a procoagulant state. Injury of the endothelium explains inflammation in the lining of the blood vessels in multiple organs. Commonly affected organs are lungs, heart, kidneys and intestines. The inflammatory reaction is what can lead to clot formation. When part of an organ has died off because of mini clots that destroyed part of the organ, this process can eventually lead to organ failure. Lung failure, heart failure and kidney failure can develop in these sick patients.

Adequate vitamin D blood levels are important for the immune system

By all means, vitamin D is very important for the integrity of the immune system. With vitamin D blood levels below 15 to 20 ng/mL (37.5–50 nmol/L) the immune system is paralyzed, and any viral or bacterial infection tends to overwhelm the body. Of course, this is the reason why the mortality due to Covid-19 coronavirus is highest in patients with these low vitamin D blood levels. People with secondary illnesses (diabetes, arthritis, autoimmune diseases, cancer) and patients above the age of 60 have the lowest vitamin D blood levels and have the highest mortality rates. This publication describes this in more detail.

Best vitamin D blood level is in the upper normal range (50-80 ng/mL)

Above a vitamin D blood level of 30 ng/mL (=75 nmol/L) a patient’s immune system is functioning normally. However, the immune system is strongest at a vitamin D blood level of 50–80 ng/mL (125–200 nmol/L), which is the upper range of the normal level for vitamin D in the blood.

Keep in mind that vitamin D toxicity occurs only above 150 ng/mL (375 nmol/L).

Specific effects of vitamin D on Covid-19

There are three major effects that vitamin D has.

  1. A strengthening of the epithelial barrier not allowing the coronavirus to penetrate into the lung tissue as easily.
  2. Release of defensins and cathelicidin, two crucial antiviral polypeptides that eradicate any virus in the system.
  3. Interruption of the “cytokine storm”, an overwhelming inflammation which is responsible for viral pneumonia to develop. Without the cytokine storm there is no damage to the lungs and people do not need treatment in the ICU. This is particularly important for people above the age of 60 and for people with pre-existing diseases.

In like manner, with the stabilizing effect of vitamin D regarding the immune function more severe forms of Covid-19 can turn into less severe forms with a better outcome.

Treatment of patients with Covid-19 who have clotting problems

Patients need to be assessed with respect to their risk of developing clots. This publication describes that high risk patients have elevated D-dimer levels. When blood clots dissolve the body produces D-dimer, a protein fragment. Normally the D-dimer test is negative in a person that does not produce clots. But in sick patients with Covid-19 who form clots this blood test typically shows D-dimer >2500 ng/mL. In addition the tests show high platelet counts (more than 450 × 109/L), C-reactive protein (CRP) >100 mg/L and an erythrocyte sedimentation rate (ESR) >40 mm/h.

Indeed, with this constellation of blood tests in a severe Covid-19 case in the ICU setting, the physician uses heparin intravenously or subcutaneously to counter clot formation. However, this needs to be balanced against the risk of causing severe internal bleeding.

Separate from the anticoagulant effect, heparin seems to also suppress inflammatory cytokine levels. In addition, heparin suppresses neutrophil chemotaxis and migration. Physicians rescued many patients from death using heparin therapy.

Risk versus benefit clinical trials of heparin therapy are required

At this point there are only retrospective clinical trials available to describe risk versus benefit of heparin therapy. Some show no difference, others do. There are two international clinical trials on their way to shed more light on this situation. Until the results of these clinical trials are available, physicians need to treat patients to the best of their knowledge.

How to Manage Clot Formation with Covid-19

How to Manage Clot Formation with Covid-19

Conclusion

Clot formation in sick Covid-19 patients is responsible for many deaths in Covid-19 patients. The SARS-CoV-2 (or Covid-19 coronavirus) causes a cytokine storm with injury to the lining of the arteries. This can affect multiple vital organs and the condition may lead to organ failure. This activates the clotting system and causes clots all over the body. When this process occurs, patients get very sick and the death rate climbs. Physicians were able to rescue some patients with heparin therapy. Two international clinical trials are on the way. Hopefully  these trials answer questions about this newer treatment method. The downside of heparin therapy is the complication of massive bleeding, which causes deaths as well. When it comes to Covid-19, don’t rely on curative medicine. Strengthen your immune system by preventative therapy like vitamin D3 that can interrupt the cytokine storm.

And even with a “well-prepared” immune system it is extremely important to follow all the guidelines of distancing, disinfecting and wearing face masks. We need all the help we can get!