To an increasing extent, the coronavirus SARS-CoV-2 dominates human life in Europe. There is a lot of speculation about the medical aspects, but the concretely foreseeable social consequences are falling behind more and more, despite the fact that competent scientists, such as the German top-virologist Prof. Christian Drosten from the Charité, are urging to base political decisions on an interdisciplinary scientific discussion [1]:
Now is the time when politics absolutely needs a few days of rest to get advice. Not always from the same people, but also from other disciplines. And it is imperative that we now allow policymakers to be calm about such important decisions as school closures. It is harmful now when political journalists say that “we are doing what we always do. That is, we take a quote from this expert, play it to the public and create an urgency for politicians to address this mood that is created in the people, by making decisions”. I think, at this point it is bad for politicians to simply decide quickly and then have to correct the course because the decisions were too grave. Political journalists should now try to work a bit more like science journalists – with more background and with a little more calm.
So let’s take the time to look at the new coronavirus from different angles.
The natural interplay between humans and viruses
Viral effects on the human body can be detected quite clearly already at the end of the Neolithic period [2]. To this day, much of human immunity can be traced back to the natural interplay between the virus and humans.
The spreading of a new (or sufficiently modified) virus can in principle come to a standstill due to two effects: Either when the pathogen for whatever reasons loses its virality, as in the SARS pandemic 2002/03 [3], or when the number of immunized persons relevantly exceeds the number of non-immunized persons.
Prof. John Ziebuhr heads the Institute of Medical Virology at the University of Giessen. He describes the process regarding SARS-CoV-2 as follows [4]:
” At the moment, we assume that every person infected in a society without immunity, as we currently have, infects three other people on average. The spread of the virus can only be stopped if each infected person infects less than one other person. If two-thirds of the population had contact with the virus and are therefore immune, two of the three people that each would infect are gone. The virus will then continue to circulate, but will no longer find people who are massively infected. At least that’s the theory.”
Upon request, Prof.Ziebuhr confirms that the virus will spread extremely widely, no matter how much we restrict our daily lives:
“The question is only in what time. Does it happen within six months, or twelve, or will it take even longer? Measures are designed to slow down the outbreak as much as possible. This makes a lot of sense so that our actually well-functioning hospital system does not collapse due to the large number of patients who need treatment in the intensive care unit. This is a real danger at the moment.”
Lockdown effects – the Canary Islands as example
The Canary Islands are an all year round tourist destination, with 13.2 million tourists in 2019 and a turnover of 15,071 million €. [a]
[a] https://turismodeislascanarias.com/sites/default/files/promotur_indicadores_egt_2019_en.pdf
In connection to the Spanish lockdown decree (in effect since 15 March 2020) , the regional Canary goverment gave order to disconnect the islands completely from the international flight and sea traffic for an unlimited period. The primary effect is the shutdown of the whole tourism sector. Tourism is a fundamental sector in the economy of the Canary Islands, generating more than 40% of all jobs and 35% of the GDP. [b]
[b] https://www.mincotur.gob.es/en-us/crisis-thomas-cook/Paginas/index.aspx
Already without this shutdown unemployment is a relevant problem for the Canarian society, especially for the youth:
– 54.6% unemployed persons under 20 years
– 31.9% unemployed persons between 20 and 24 years
– 17.5 % unemployed persons between 25 and 54 years
– 17.4 % unemployed persons over 54 years
But is not only the big hotel chains which are affected by the shutdown. There are also lots of small businesses directly related to tourism which have to close their doors now [b]:
“Tourism is, by its nature, a horizontal sector, having an impact on practically every sector of the economy, and it is capable of generating induced income in sectors such as commerce, leisure and the services in general which our visitors use, whether they come through a tour operator or independently.”
Half a year ago the Canarian tourism sector experienced a challenging situation because of the bankcruptcy of the UK based travel company Thomas Cook in september 2019. The main problems for many companies and self-employed individuals arising from the failure of Thomas Cook were [b]:
– lack of short-term liquidity
– drastic worsening of the balance sheets
If we assume the most favourable scenario according to Prof. Ziebuhr, the whole Canarian tourism sector would need to shutdown for at least 6 months, and the entire summer season would be cancelled. How will individuals react on these severe life changes?
The people behind the numbers – the forgotten factor?
Do massive existential concerns in the form of an economic crisis pass by people without a trace? The evidence casts doubt: [10]:
Like the US researchers led by Michael T. French now, alcohol abuse is rising significantly in deteriorating macroeconomic conditions, not only among those who have lost their jobs, but also among those who fear for it. The detailed evaluations show that the development can be seen in all population groups, genders and ethnicities, most clearly in young adults between the ages of 18 and 24.
Using the example of the economic crisis of 2008/09, the Medical Journal found a significant increase in the suicide rate: [11]:
The 27 European countries were those hit hardest, with an increase of 4.2 percent and 18 American countries (up 6.4 percent). In Europe, the suicide rate increased especially among 15-24 year olds, which is likely to be related to high youth unemployment. In America, it mainly affected 45-64-year-olds.”
“Suicides are just the tip of an iceberg,” Chang said. For every completed suicide there would be 30 to 40 attempts, and for each attempt another ten people with suicidal thoughts. In addition, the economic crisis of 2009 was far from over. According to initial estimates, the suicide rate is expected to have risen by another 10.8 percent in 2010.”
It is essential in this context that chronic stress, such as a prolonged economic crisis, can bring the immune system out of balance.[12][13] Chronic stressors have a negative impact on almost all functional measures of the immune system. Both natural and specific immunity are negatively affected.[14]
The role of the immune system in Covid-19
Any virus, however dangerous, is nothing without its host cell, which it needs for to multiply. With the primary intention of its spread, it would of course be counterproductive for a virus to kill its host. In any case, a virus contains foreign biological information that activates the natural control mechanisms of the human body.
The gateway for SARS-CoV-2 is the enzyme ACE2, which is expressed in many cells, such as in the heart muscle cells, in the vascular cells of the heart, in the kidneys, in the intestines and in the lungs.[15] There is the main entrance for the virus, which is mainly transmitted by droplet infection in the air we breathe.
However, the lungs are far from sterile [16]:
It has only been known for a few years that bacteria, fungi and viruses also live in the lungs – actually in all humans. The totality of these microorganisms is called the microbiome. Scientists are still investigating the function of this lung microbiome in detail.[
In the media, pneumonia in current COVID-19 cases is mainly blamed on the new virus. Would it not make sense to determine as many components of the lung microbiome as possible in such patients by type and quantity in order to gain an overview of the interactions?
Research teams at the Charité developed a model of human lung tissue that can simulate essential characteristics of pneumonia. They first infected the tissue with influenza viruses and then with pneumococci (bacteria) to simulate severe pneumonia.
Due to their structural differences, viruses and bacteria are rendered harmless by the immune system in various ways [17]:
We have been able to demonstrate that the anti-virus immune response is harmful to the subsequent control of a bacterial infection with pneumococci.”
This research suggests that the overlay of the viral infection by Sars-CoV-2 with a bacterial infection may be the cause of the life-threatening pneumonia observed in Covid-19. So far, no information has been made public about other players, such as influenza viruses, whose occurrence would not be uncommon this winter.
Unprotected at the mercy of the virus?
This potential explanation for the serious illnesses in individual cases of Covid-19 shows that we are dealing with a complex system. But the human organism would not have survived millennia of interaction with viruses if it were not able to handle advanced challenges such as these.
In the case of SARS-CoV-2, Prof. Drosten describes in his podcast of 17.3.2020 the discovery that the viruses are mainly active in the throat area in the first week of infection, before descending into the deeper airways in the second week. This gives the body the lead for its immune response before fundamental bodily functions such as breathing can be impaired [18]:
With this virus, the seroconversion happens with high reliability already at the end of the first week in these patients. This is something I was both surprised and pleased about, because this suggests that in the event of this infection, immunity very quickly sets in. And of course you can speculate a lot about why this is so and why it is so different from SARS. And there are two clues.
One is theoretical and easy to understand. If we have a virus that is already replicating in the throat before it goes into the lungs, then we actually can count the whole time that the virus is already replicating in the throat, for immunisation to develop. In other words, we say the antigen stimulus, i.e. the stimulus caused by the presence of a virus, on the immune system already goes off. And perhaps it is the case that at the moment when the virus then migrates down into the lungs at the end of the first week, these patients are already so far that they actually make an immune reaction, because there was this advance in the throat before. And this is a good situation. Maybe this protects against infection of the lungs. Thinking around the corner, this is a very interesting hypothesis.
I am deliberately not saying explanation, but I am saying a hypothesis. An idea that could explain why some patients, even though they are very young, still get a fast, difficult course. Because it is conceivable that some persons do not get infected in the throat first, but immediately inhale a high dose of virus from the air into the lungs and that the infection starts right there. In these cases it is more like with the severe SARS virus, the original SARS virus.
So for each of us, the key to successfully coping with Covid-19 lies in our own immune system, which regulates resilience to foreign bodies and information. It does this with the help of both innate and acquired mechanisms to learn and to filter, what can be tolerated or even used, and what is recognized and combated as harmful – a fine balance. An as yet unknown virus has the chance to enter the body and replicate there, before the body decides whether and by what means it will neutralize the virus. This is why influenza viruses actually have to mutate every year to produce flu symptoms.
Knowing this, the majority of people need not fear these symptoms. As a rule, there will be little response to exposure. And viruses are not designed to kill their host.
So how can you strengthen your immune system?
The Charité’s aforementioned studies of the lung microbiome already suggest that there are no plug&play solutions here. Harvard University has summarized its many years of research as this: [19]
The idea of boosting your immunity is enticing, but the ability to do so has proved elusive for several reasons. The immune system is precisely that — a system, not a single entity. To function well, it requires balance and harmony. There is still much that researchers don’t know about the intricacies and interconnectedness of the immune response. For now, there are no scientifically proven direct links between lifestyle and enhanced immune function.
But that doesn’t mean the effects of lifestyle on the immune system aren’t intriguing and shouldn’t be studied. Researchers are exploring the effects of diet, exercise, age, psychological stress, and other factors on the immune response, both in animals and in humans. In the meantime, general healthy-living strategies are a good way to start giving your immune system the upper hand.
In this respect, Covid-19 seems to be overlaying with other factors, such as pneumococci, that confuse and overload the body’s filter system. What may contribute to such an overload?
The social factor
A study by the John Hopkins School of Medicine showed that even chronic, subclinical mild depression can suppress an elderly person’s immune system [12]:
Participants in the study were in their early 70s and caring for someone with Alzheimer’s disease. Those with chronic mild depression had weaker lymphocyte-T cell responses to two mitogens, which model how the body responds to viruses and bacteria. The immune response was down even 18 months later, and immunity declined with age. In line with the 2004 meta-analysis, it appeared that the key immune factor was duration, not severity, of depression. And in the case of the older caregivers, their depression and age meant a double-whammy for immunity.
As expected, the normal aging process makes us weaker. But a longer-termed depressive mood showed to be the main factor for a poorly functioning immune system. This is not just the case for the elderly. Young people are responding to a lack of social contact and support, as a Carnegie Mellon University study with students after flu vaccination showed [12]:
Small networks and loneliness each independently weakened immunity to a core vaccine component. Immune response was most weakened by the combination of loneliness and small social networks, an obvious health stress facing shy new students who have yet to build their friendship circles.
With regard to measures to contain the Corona pandemic, the aspects of unwanted social isolation and the effects of longer-term unemployment should therefore be taken into account.
In the sense of salutogenesis, restrictions of personal freedom must not only be comprehensible and accepted, but must also be conceivably temporary and thus manageable.
Also the importance of sunlight and vitamin D, as well as of exercise and body experience for the immune system, should also be incorporated into meaningful measures.
The preservation of social distance must not degenerate into house arrest for responsible citizens, which prevents all outdoor activities even under the threat of fines, as is currently the rule in Spain and Italy.
No alternative?
Based on this knowledge, we can use the experience of countries with different strategies to guide our policies. In Italy, Spain and France, the authorities are resorting to restricting fundamental rights.
On the other hand, Sweden and Iceland choose transparency and less restrictive measures than the other European countries. Quarantine measures are adapted to the need in order to limit social stress.[20][21] Swedish state epidemiologist Anders Tegnell warned that there was no ‘secret formula’ that could accurately predict where the road would lead [22]:
The basic data is so uncertain. It is not possible to know.
A statement of Socratic wisdom that should be incorporated into any risk assessment.
Support for self-regulation
There are many ways in which responsible citizens can promote their own resilience:
- Vitamin C through fresh fruit and vegetables, lactobacteria or dietary supplements [23]
- Vitamin D due to sunlight, fatty fish or as a dietary supplement [24]
- Vitamin A by liver, sweet potatoes, carrots, along with some fat [25]
- Iron and zinc from organ meat, egg and dairy products, or dietary supplements [26]
- Immunomodulators with medicinal herbs such as Echinacea, Baptisia, Thuja, Eleutherococcus, Pelargonium and Uncaria [27][28]
- Sufficient and restful sleep [29]
- Hardening, hot-cold applications [30][31]
- Mental training and meditation [31]
Maintaining public health is a challenging task, especially in the case of scientifically unsecured forecasts. The primary task of politics in these times is to secure the public and private health systems, as well as to promote independent research to the best of their ability. From a social point of view, the free, individual health care by every fellow citizen is the best barrier against the temporary overload of the health system
sources:
[1] https://www.ndr.de/nachrichten/info/coronaskript126.pdf
[2] https://de.wikipedia.org/wiki/Viren#Erforschungsgeschichte
[3] https://de.wikipedia.org/wiki/SARS-Pandemie_2002/2003#Abklang
[4] https://www.spiegel.de/wissenschaft/medizin/coronavirus-wie-sieht-die-zukunft-nach-dem-ausbruch-aus-a-4f1f91c6-eb02-4423-acbf-06fa25987914
[5] https://www.spiegel.de/panorama/schleswig-holstein-untersagt-touristen-zutritt-a-3ed8bc38-f81d-42fa-8b19-4ce585e9fae9
[6] https://taz.de/Skandinavier-sind-sich-nicht-einig/!5668534/
[7] https://www.tvsh.de/fileadmin/content/Infothek/Download-Center/STB_SH_Sonderveroeffentlichung_WiFa_2018.pdf
[8] https://www.welt.de/regionales/hamburg/article173818053/Schleswig-Holstein-Landeshaushalt-2018-beschlossen.html
[9] https://www.ndr.de/nachrichten/schleswig-holstein/Coronavirus-Wir-fahren-soziale-Leben-runter,corona718.html
[10] https://www.pressetext.com/news/20111015004
[11] https://www.aerzteblatt.de/nachrichten/55880/Wirtschaftskrisen-erhoehen-Suizidrate
[12] https://www.apa.org/research/action/immune
[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465119/
[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/
[15] https://www.deutsche-apotheker-zeitung.de/daz-az/2020/daz-11-2020/mit-loeslichem-ace2-gegen-covid-19
[16] https://www.tk.de/techniker/gesundheit-und-medizin/behandlungen-und-medizin/copd/tk-plus-bei-copd/dmp-news/mikroorganismen-in-der-lunge-2059164
[17] https://www.charite.de/forschung/forschung_aktuell/pressemitteilung/artikel/detail/forscher_heben_immunblockade_gegen_bakterien_auf/
[18] https://www.ndr.de/nachrichten/info/coronaskript130.pdf
[19] https://www.health.harvard.edu/staying-healthy/how-to-boost-your-immune-system
[20] https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/aktuellt-epidemiologiskt-lage/
[21] https://www.covid.is/data
[22] https://www.di.se/nyheter/1400-folj-folkhalsomyndighetens-presskonferens/
[23] http://www.medizinfo.de/immunsystem/selbst/vitaminc.htm
[24] https://www.focus.de/gesundheit/gesundleben/vorsorge/news/vitamin-d-schluesselhormon-des-immunsystems_aid_487672.html
[25] https://de.wikipedia.org/wiki/Vitamin_A
[26] https://www.focus.de/gesundheit/ernaehrung/gesundessen/zink-hilft-bei-erkaeltung-zink-staerkt-immunsystem-haut-und-naegel_id_4723229.html
[27] https://www.aerzteblatt.de/archiv/8114/Pflanzliche-Immunmodulatoren-vermindern-Stressreaktionen
[28] http://phytotherapie.at/08_Bauer%20mod..pdf
[29] https://www.haz.de/Nachrichten/Wissen/Uebersicht/Neue-Studie-Wie-Schlaf-das-Immunsystem-staerkt
[30]https://www.focus.de/gesundheit/gesundleben/alternativmedizin/hydrotherapie/kneipptherapie/abhaertung_aid_21239.html
[31] https://www.planet-wissen.de/video-kaelte-trainiert-das-immunsystem–das-beispiel-wim-hof-100.html
