Name Change to COVID-19, Boosting Your Immune Response to Viral Infections
Welcome to another MedCram coronavirus update! And we’ve got some news today. This is for the 12th of February 2020. So the new name that the WHO has given the virus is called SARS-CoV2, and the disease that it causes is being known as covid-19. So that’s the new nomenclature. This is the name of the virus, and this is the name of the disease, sort of like HIV and AIDS. This is the virus, this is the disease.
And let’s take a look at the update. Again, just the word about these numbers. We believe these numbers are probably under-reporting here. We don’t know how much they’re underreporting. It’s because only the most severe cases in China are actually being tested. If you look here of the total deaths and total recovered, that leaves another 40,000 people that are somewhere between death and totally recovered. So only time is going to be able to tell that.
If we go to our friends over at Worldometers, you’ll see here a nice graph of where we are and total cases. We can see that it’s kind of been leveling off a little bit. If we go to the log rhythmic, you can see again a little bit more of a leveling off. It is unclear whether or not that is related to the number of test kits like we were talking about, or whether or not there’s an actual leveling off. It’s kind of interesting to see. Something that they’ve added, that we talked to them about, is this case outside of China, and we’ll get to that here.
So we go down to the bottom of this page. Now they start looking at total cases excluding mainland China. And in terms of those cases, we are not seeing a leveling off but more of still this epidemic. So it looks as though things are still taking off outside of China. We are not seeing an asymptotic leveling off but rather still going up. When we look at cases per day, we can see here that just in the last couple of days we’ve had the most number of cases outside of China being diagnosed.
I want to talk a little bit about the viral infection itself and immunity. For that, we’re going to draw out a little bit of a schematic here how this happens. So the first thing that happens is, of course, you have this virus particle, which will draw as stars, and these stars are outside the body, so this could be an airway, this could be inside the GI tract, etc., etc. So this virus goes in and latches onto cells receptors, and it causes the cells to become infected with the virus, and of course, the virus takes over the machinery of the cells, and it causes it to make more of it and proteins, and so these cells will be coded with these proteins on the outside.
And of course, more particles are made. These cells explode and they release more and more of these virus particles. So what is going on at this point is you’ve got here on the blood side, you’ve got things called cells, which are blood cells, and one of those cells is called an antigen-presenting cell. And so these cells start to go in and extravasated from the blood into the tissue, and they’re able to recognize these cells that are abnormal because of these abnormal proteins on the surface. So, these antigen-presenting cells envelop and destroy these virally infected cells.
So let’s show a little bit more of a close-up of how that happens. So we have this antigen-presenting cell, and inside the antigen-presenting cell is the cell that is infected with virus, and it’s got virus particles on it. And so what’s very important with this antigen-presenting cell does is it presents the antigen. So here is the antigen presented on the outside of that cell. This is the most important thing that the antigen-presenting cell can do because what it then does is it meets up with something called a TH1 response, or a CD4+ cell. And this cell here is the mastermind behind your cellular mediated immunity because this antigen here will latch on to this CD4 positive TH1 cell, and it will release Il-12, which is a chemical that comes from the antigen-presenting cell, that stimulates this cell to go and fight anything that looks like this on it, that antigen.
And so there’s major responses that can occur. Number one is that these TH1, CD4 cells will then stimulate another type of cell called the cd8 cells, and those are killer cells, and they go out, and all they do they will kill any cell that has those antigens on it. That’s a very important thing, and the way that that happens is it has little proteins on the surface that will recognize this and cause docking to occur. So you want that connection to be very, very tight.
Another thing that this TH1 can do is it can stimulate, in the blood and tissue, B cells and these B cells will produce antibodies that look like this, and these antibodies will bind to these antigens and neutralize them. So this really is immunity. And this is the key that allows you to survive a viral infection.
Let me be very clear about this. This is probably one of the most important things that you can have going for you when you have a viral infection; this is what determines whether or not you get admitted to the floor, or whether or not you go to the Intensive Care Unit, because if this reaction does not occur correctly, and this immunity doesn’t get on top of the viruses quickly and limit them, kind of quarantining this, then you get wide viral infections all over the body, and the amount of infection causes more immunity which causes more inflammation, and that’s why people die.
And so, while the best way to prevent you from ending up having something bad happen from coronavirus is to avoid getting the virus in the first place. If you do get coronavirus, you want your immune system working perfectly. And wouldn’t it be nice if there was something that we could do to enhance this Il-12 response to enhance the ability of this binding to occur, to enhance the ability of cd8 killer cells to bind their targets and to destroy, to enhance the ability of TH1 CD4 cells to create and stimulate actually these B cells to make antibodies?
因此，预防冠状病毒最终导致某些不良后果的最佳方法首先是避免感染该病毒。如果您确实感染了冠状病毒，则希望您的免疫系统运转正常。如果我们可以做些什么来增强这种Il-12反应，从而增强这种结合的发生能力，增强cd8杀伤细胞结合其靶标的能力，并破坏，增强这种能力，那不是很好吗？ TH1 CD4细胞产生并实际上刺激这些B细胞产生抗体的能力。
Well, there actually is something that we can do that can enhance this. Number one. It’s not a drug. Number two. It’s absolutely free. There’s no money involved. Number three, you can do it anywhere. And I’m sure by this point, you’re probably saying what possibly could this be? And are you pulling my leg on this? This is probably one of the biggest things that you can do to protect yourself from this viral infection causing a problem, or any other viral infection, and there are absolutely no side effects to it, and the answer is sleep.
That’s right. Sleep, and enough of it, greatly enhances the ability of the antigen-presenting cell binding to the TH1 and promoting Il-12; sleep also prevents the breaking up of this binding site with cd8 killer cells with the antigen. I will show you the research that’s done this. I have peer-reviewed papers in extensive research over the last 20 years that sleep has a tremendous effect on your immune response against viruses.
I will show you a paper here. Here we have on the left side a cytotoxic T cell. This is the cd8 cells. This is the cells that kill. And here we have an infected cell with either CMV or EBV in the paper. So what they showed was that there is a G-protein receptor here on the cell, and when it is activated by either isoproterenol, epinephrine, or norepinephrine. These are hormones typically that are elevated in wakefulness; that these wakefulness hormones would activate this receptor in the killer T cells, and it would cause an inhibition of these beta 2 integral proteins that allow binding to these infected cells and destruction.
And so the opposite was true when the patients were sleeping because these hormones were at very low levels that prevented the inhibition of this Gas, G protein which caused better binding and more effective killing of these infected cells.
So do you know how much sleep in adults in the United States should be getting? According to the recommendations, and you can look this up at the CDC, they should be getting between seven and nine hours a night. Do you know how many people actually get at least 7 hours of sleep per night? About 60 percent. That means there’s about 30 to 40 percent of us that are getting less than seven hours a night. These are the people that are at the highest risk for the effects of sleep deprivation, and these are exactly the same conditions that a lot of our health care workers in the United States are under. These are physicians; these are nurses; these are respiratory therapists who are chronically sleep-deprived because of shifts, because of working at night, and these are the ones that are gonna be on the front line dealing with this virus.
Think about a lot of the physicians that are working in China right now, and all of this is to the detriment of their immune system. At the beginning of the night when you go to sleep, normally, let’s say around 10:00 p.m., the first thing that occurs is that you should be having more slow-wave sleep at the beginning of the night, and towards the end of the night more REM sleep.
Well, they’re starting to see that slow-wave sleep is integral in the production of growth hormone, and growth hormone has tremendous effects on immunity. And this is especially involved, as the papers will show, that I’ll upload to the description, in the secretion of Il-2 12, which is what we recall is the thing that causes the antigen-presenting cell to stimulate the TH1 response with the CD4 cells. So that’s tied to slow-wave sleep. This is the sleep right here that occurs, generally speaking, between 10 p.m. and 1 a.m. in the morning. And this is the sleep that we cut off the most by going to bed late. And so we’re losing out on growth hormone, and our immunity stinks because of it.
I want you to think what’s happened to our ability to sleep over the last number of decades. So this is when we would normally go to sleep, around 9:00 to 10:00 p.m., and occasionally people would wake up in the middle of the night and be awake for a little bit and then they would get up again in the morning, around 5:00 to 6:00 a.m. This is the time that we used to have for sleeping. And how much time is that? So for about 9 to 5 would be about eight hours of sleep according to the CDC and most of the research. Plenty of time! But what’s happened? Because we’ve moved away from an agrarian society to more of urban society. We’ve had to push this back because we have to get up earlier because of traffic. And what’s happening is we’re living out in the suburbs. We’re living further out, and all the jobs are in the cities, and so there’s traffic, and so sleep has taken a big toll there, and we’re not able to get as much sleep.
But on the other side, there’s also been a push. And why is that? Because of electricity. And the other thing is electronics. So think about iPad, smartphones in general, 20 years ago, television, movies, internet, all of those sorts of things. And so the key here though is all of this is light that is stimulating the eyes, and when you stimulate the eyes with bright light, it pushes your circadian rhythm and delays it, and so what you’re losing out on is sleep there. And so what’s happened is we’ve gone from society where we were getting eight hours of sleep before, and now getting five to six hours of sleep. That is going to translate into decreased immunity.
So the question is, how can we get this back? Because I believe this is one of the things that we can do in the face of this coronavirus, that we don’t have to ration, we don’t have to worry about “do we have enough of this to go around for everybody in an epidemic?” because this is something that’s available to everybody, is getting plenty of sleep to help with immunity.
In addition to me being a pulmonary and critical care specialist that takes care of the unfortunate effects of the virus with people with ARDS and on the ventilator, I also happen to be a sleep specialist, and I know that there are a lot of people out there that have problems with sleeping. Some have insomnia, some have sleep apnea, some have a number of these things. And for each person, it might be an individual thing, but there are some basic things that we can do to improve our sleep.
And so for the next couple of updates, I am going to talk a lot about coronavirus, or as it’s called now SARS-cov-2, or COVID-19. But we’re also going to talk about practical things that we can all do as individuals to help bolster our immunity, and be prepared for anything that might come. Thanks for joining us!