by The Welthi Bureau, August 20th, 2020
It is been almost 4 months that we have been living with COVID-19, we have changed our lifestyles and slowly we are learning to live with it. Still how long this virus will remain? Why some people are becoming sick and some people are recovering fast? And when will the vaccine arrive? If vaccine comes, will it completely help us in preventing Corona virus infection and will that vaccine not have any side effects? These are frequently asked questions now a days and we don’t have precise answers for any of these questions as on date.
Then what can we do, what is in our hands?
First of all, we need to understand how COVID 19 affects different people in different ways. In some patients, it is very mild that is only fever for one or two days and body pains for 2 to 3 days and later they will be alright. While in others, fever will come down initially but may reappear, along with extreme tiredness and breathing problems which needs oxygen support and in very few critical cases, ICU admission will be required. Some may get COVID positive report but absolutely no symptoms. Generally children do not have much symptoms. Young people can have one or two days of mild symptoms and in elderly above 50 to 55 years, those with uncontrolled diabetes, kidney disease, obese and other chronic problems can have severe symptoms. Males can have more symptoms than females and so, should be more careful.
Answers for the above questions can be derived by understanding the way our immunity responds to the virus. Knowing this can make us understand why different people have different symptoms and whether you can get reinfected with Covid, and whether the vaccine will help you to develop the immunity against the virus.
Dr. Raj Kiran, Consultant Rheumatologist said, “Our immune system is like military which fights against viruses or bacteria entering into our body and trying to damage our system. In blood we have basically 3 different types of cells , Red cells carrying oxygen to tissues, platelets preventing bleeding, and white cells mainly providing immunity. In white cells we have different types like neutrophils, macrophages, T cells and B cells any many more cells, like how our military have different departments. Body’s immune response works in 3 phases. At first, one type of white cells identify virus, second they will take help from other cells to kill virus, and third, once the virus is cleared they will stop this process.”
Soon after identifying virus, white cells release different types of cytokines, among them gamma interferon are very important to kill virus. This is first response to stop virus and is called innate immunity. This is very strong in children and gradually becomes weak in aged people. In the next step, white cells will carry part of this virus called antigen and present it to more specialized white cells called T cells.
Now some of this T cells will kill virus, by releasing some cytokines called IL 6, TNF alpha and some will help another type of white cells called B cells to produce antibodies. So, antibodies are produced by B cells generally after 5 days. There are two types of antibodies, of which, one is IgM which comes first and stays for few days and second one is IgG which can stay for more than a month. T cells and B cells form adaptive immunity. The patients who are recovered from COVID infection can have antibodies in their blood and this can protect them from reinfection. Plasma is a component of blood, so, the patients who are completely recovered from Covid will have these antibodies and they can donate their plasma to other patients who have severe Covid infection.
Once virus is cleared from our body, a group of cells called regulatory cells will inform white cells to stop producing cytokines which is the last phase. Some T cells and B cells after clearing virus go and take rest without doing anything. They will only become active when body gets re-infected, so they are called memory cells. Some diseases like Chicken pox and measles can have life time memory and Covid is expected to have memory for 3 to 4 months to 2 years in different people. With vaccines, people can develop antibodies and memory which may help.
In elderly people , obese patients and patients with heart and kidney problems, in whom the first step of immunity that is innate immunity is weak, the interferons are not produced and virus escapes and multiples fast and increases in numbers before we go into second step of adaptive immunity . At second step if too much of virus is present, to clear this our immune cells produce lot of chemicals called cytokines and among them IL6 and TNF alpha are important. When they are produced in excess it not only kills virus infected cells but also many normal cells, mainly in lungs. This condition is called hyper inflammation or cytokine storm, which is a very critical phase. Virus might have been cleared by now from body but cytokine storm will cause all problems. To control this excess immunity which is damaging our body we have to use steroids and anti IL6 injections called Tocilizumab.
Our survival depends on how our body responds to virus and hyper inflammation. Our severity also depends on doses of virus which we inhale. If we are getting exposed to virus repeatedly, there is high risk of developing complications.
After understanding this complex immunity process the question is what is in our hands which we can do to save ourself and others from Covid 19.
First thing is, during this pandemic if you develop fever inform your family doctor, discuss with him about possibilities of COVID. Don’t delay act immediately to save yourself and others. If typical symptoms of Covid like fever, body pains, throat pain, cough and breathing difficulties are present, isolate yourself and strictly avoid meeting aged people.
Now a days anti-viral tablets and injections are available, which can be prescribed by your doctor and they can be very effective if used in early stages of COVID especially in aged people and people with other chronic health problems in reducing the severity of Covid. Certain home remedies like drinking warm water and steam inhalation can help. Keep checking your temperature and oxygen saturation by pulse oximeter after 3 minutes walking and inform your doctor if it falls below 96 %.
Young people usually recover fast, but biggest mistake what most people do is once they recover they come out and start working immediately. Rest is very important if you are infected with COVID. If you don’t take rest and work normally there are chances your immunity can become further weak. If you meet people without taking necessary precautions, there are chances you might get re-infected, the second time being more severe, as well as chances you might infect others. So strict isolation and social distancing is must for at least 14 days or till you become completely alright. Discuss with your doctor when you can resume to normal work.
People who have not been infected with COVID should continue to maintain social distancing, hand hygiene and should stop smoking. We should do regular exercises and take healthy diet which includes lots of fruits and vegetables to enhance the immunity. But once you had contact with COVID positive patient, take rest, isolate yourself and watch for symptoms and inform your doctor soon. So don’t delay, act immediately.
A BRIEF PROFILE OF DR. RAJ KIRAN
Dr. Raj Kiran Dudam, is a Rheumatology Consultant at Hyderabad Rheumatology Center, Begumpet and a profound medical professional with 15 years of extensive experience in treating Rheumatic Diseases. With MD in Internal Medicine from Gandhi Medical College and a Fellowship in Rheumatology from NIMS Hyderabad, Dr. Raj Kiran is renowned for his impeccable service and exceptional expertise in the domain.
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