Dip in Daily New Deaths; Research on Natural Killer Cells & COVID-19 (Lecture 50)
Welcome to another MedCram Covid-19 update and I’m so glad to be back with you. I’ve completed my week of being in the Intensive Care Unit and I just wanted to give a shout out to all of the nurses and respiratory therapists, hospitalists and the other specialists that I work with throughout the week and I especially want to thank all of the donning and doffing buddies that I had.
So basically when you go into an isolated room, there’s somebody watching you to make sure that you’re doing everything correctly step by step, so you don’t infect yourself. And I’ll tell you those are lifesavers to have to remind you what to do.
If this is a war against the virus then the Intensive Care Unit and the emergency room are literally the trenches in that warfare. And more than anything else those respiratory therapists and nurses go into that room several times every couple of hours risking their lives to help save other lives and it’s important to have that body armor in place.
There have been so many developments since we last talked and we will get to those things as the week progresses.
Interestingly, Finland continues to be leading the pack in the Nordic countries in terms of the least amount of deaths per 1 million population and the number of new deaths. And we’ve talked about this before in terms of their practices with Finnish saunas. We showed some scientific evidence that heat followed by cold could be beneficial for boosting your innate immunity specifically monocytes and natural killer cells.
And that led me to this article on NPR, which featured Dr. Corey Casper and this institute in Seattle, known as the Infectious Disease Research Institute, launches Covid-19 immunotherapy trial. They’re aware of the studies coming out of Asia looking at these patients that had deficiencies in their immune system particularly while it was being infected by the Covid-19 disease and the SARS-CoV2 virus.
The interviewer asks, I understand that you’re looking particularly at a group of patients who are seriously ill, hospitalized, but not yet quite on a ventilator. Why are you looking at that group in particular?
And that’s an interesting question because, as we’ve talked about before, there are three phases of intervention in this disease. And we showed it here. When you become infected at day 0, you’ve got about a five day period where you don’t know that you’re infected and you’re asymptomatic, and then at day 5 you develop symptoms of cough and perhaps even fever until finally shortness of breath ensues by day number 12, which is about seven or eight days later and then you go to the hospital where there is a quick downturn.
And I’ll tell you by experience in the hospital in the Intensive Care last week talking to my colleagues. It was not unusual to see some of these patients coming in with shortness of breath and literally within 12 hours coding, basically their heart stopping. So you go from shortness of breath to being ventilated intubated, having blood pressure fall and then heart-stopping. That wasn’t the story for all of the patients, but for a certain subset that was definitely a grim reality.
So that may leave just a small amount of room here for when they come in maybe perhaps even a day or so and we did see that data coming out of the articles in the New England Journal of Medicine at the very beginning of this outbreak showing that there was maybe about a day or so between when they were admitted and when they went to the Intensive Care Unit. So yes, there is a small window here, but let’s not overlook this large period before hospitalization.
I think that’s one of the key things. And that’s the second phase, third phase in the hospital, and of course here in the first phase, which is before infection. And that would be the purpose of isolation trying to prevent people from becoming infected.
So, let’s see what the good doctor in Seattle answers with. He says here “there’s a critical moment in the treatment of patients with Covid-19. It is where they have already been hospitalized, but not yet sick enough to require the support of an intensive care unit or a ventilator, where we think we can make the most impact.
At that time, there are very few available therapies, but being able to provide a therapy that can both destroy the virus and help regulate the immune response to the virus, we think will be an enormous benefit to clinicians.”
And the interviewer asks “tell me a little bit more about how this works.” And he goes on to talk about “the natural killer cell.“ This is the cells that were all born with. This is the innate system and these natural killer cells go around and eat up parts of the virus in addition to killing the virus, cells that are infected with the virus.
They also go around secreting cytokines in a way that they as they put it “orchestrate the effective immune response.“ So going on the interviewer asks, “is there something about Covid-19 in particular that you think this might be a really great match?” Well, he also points out the observation that we talked about last week when we talked about innate immunity and that’s that these natural killer cells and monocytes part of the innate immune system are found to be very low.
You can see in this article that we’ve already referenced before in update 46. The monocytes are very very low here in comparison to where they should be in healthy subjects.
And so going back to that interview they talked about what they could do about that. They say here. “It’s one of the reasons we think that because these patients with low numbers of natural killer cells progressed to severe disease. We think that if we can provide effective supplements of natural killer cells, these will allow these patients to control this disease more effectively.”
The interviewer points out that they just got approval from the FDA to start trials. And what’s the timeline look like to make that more widely available for people who are sick. And they say here that “within the month of April“, they’re looking to see if they can get patients treated with this new therapy.
Now the reason why I think this paper is very important is because many people, they look at these studies that we presented in update 46 and 47, and say okay while you’re looking at these certain treatments and all they’re doing is increasing the number of cells or maybe even the function of cells, but those cells and the presence of those cells and even the function of those cells are simply surrogates. In other words, they are markers maybe of immunity.
Clearly here though, you can see that there is at least a subsection of research which is going on in this case in Seattle that believes that simply increasing the numbers may have a benefit improving the chances relatively early on in the infection of changing the course of that infection.
Remember back in update 46 we showed this paper that was published in 1999 out at the University of Toronto that in subjects that were exposed to cold water after being in warm water there was also a similar effect in terms of leukocytes, granulocytes, lymphocytes and monocytes, but more specifically in natural killer cells as you can see here. So in sitting at 38 degrees Centigrade, after sitting in a cold bath, there was a significant increase in the number of lytic units in natural killer cells.
In fact, it led the authors of this paper to say the following “the parameters evaluated were those components of the immune system that we hypothesized would be the most responsive to such a challenge,” referring to going into the cold, “natural killer cell activity was included because natural killer cells represent one of the first lines of defense against virally infected cells, tumor cells, and certain microorganisms.”
“Our findings that the selected aspects of immune function measured in this study were not adversely affected by a moderate exposure to cold air are reassuring. Indeed, we have demonstrated that exposing subjects to a cold environment chamber at 5 degrees Centigrade for two hours in this case can be immunoenhancing and that moderate exercise can further augment the response of certain parameters to subsequent cold exposure.”
So I want to emphasize once again here they were looking in Seattle at increasing the amount of natural killer cells at this point in the hospital stay. I’m wondering what would happen if we were able to increase the number of natural killer cells here as soon as the subject feels the symptoms of a virus coming on, especially in this current Covid-19 environment. Is it possible that implementing that kind of a strategy might augment the immune system, thereby reducing the number of people that would require hospitalization?
And we’ll have more on that the rest of the week and the week to come. Okay, we’ll see you for the next update. Thanks for joining us.