Shortages, Immunity, & Can a TB Vaccine (BCG) Help Prevent COVID-19 (Lecture 43)
Welcome to another MedCram COVID-19 update. We can see that we’re almost at 400,000 total confirmed worldwide. If we look here at the new daily deaths in the United States, we can see that that is increasing. There’s been some interesting quotes in the news here from March 24th, and they anticipate that the peak number of cases is still two to three weeks away in New York. The governor of New York has said that they need 37,000 ventilators at that point, and they need to get another 30,000 because they’ve got about 7,000 now at this point.
There’s an ominous warning coming from New York saying that because they’re first, what is happening there could be what’s happening in your community in about four to six weeks. They are also saying that hundreds of thousands of people probably have already had COVID-19. They didn’t know that they had it and have recovered, and they’re echoing what we’ve said here earlier, which is that antibodies should be checked for because if they’re positive for the antibodies, then they don’t need to stay home, they could go to work.
Which brings me to this news that was on Yahoo! Fever map could show just how crucial it is to stay home to stop COVID-19 spread. This is a smart thermometer made by Kinsa which is able to upload the data from people who are taking their temperatures and put it on a map. What they’ve shown here through this article, we’ll put a link to it, is that in Florida, there are a number of people who have had elevated temperatures more than they would have guessed for this time of year.
If you look at the data, the blue is what would be expected. You can see here as you go from February 14 to May 14, the percent of illness should be dropping as we get out of the flu season. That’s the typical range that we see, and we can see here the observed in yellow. Then, when we hit a certain amount outside of that range, that shows an atypical disease pattern, and of course, this doesn’t require any testing no serological data. As soon as the temperatures taken, this is uploaded to the database. During this point, there were isolation measures that were put in place, and we can see an immediate drop. It is an interesting way of checking to see if there is a response to public policy.
The article goes on to quote Mr. Singh the CEO of Kinsa, in the example above, Singh says that the spike in the fever coincides with reports of Miami residents and tourists ignoring guidance around recommended distancing. The steep drop-off, however, follows after more extreme measures, including beach closure and other isolation tactics, were adopted in the area. Singh says that they’re regularly seeing that areas, where residents are ignoring social distancing, are seeing spikes. As soon as those are implemented, the lockdowns and other measures, within five days of those aggressive actions, you begin to see downward dips in the curve’’.
It’s interesting to note that we know from other data that five days is about the median incubation period for SARS-CoV-2. They’re not actually testing for COVID-19 with temperature, but as is pointed out, fever is a key and early symptom of COVID-19, so bear that in mind.
I wanted to take this to a bird’s eye view. If this represents the total population, then obviously not the whole population is going to be infected. There is some debate on exactly what percent of the population is going to be infected with COVID-19, but let’s say it represents it by this, we’ll call this infection, and there are a number of issues that could make this proportion go up or go down.
We know that some of the things that they’re employing right now to allow it to go down, social distancing, or isolation, or even some medications that would be called prophylaxis. Prophylaxis is a medication that would prevent the infection. We don’t have anything that’s FDA approved, but that’s where it would go at this point. So what are things that could make the number of people with infection go up? That would be apathy or just carelessness. We’re trying to do social distancing and isolation to reduce the number of people in the population that might get the infection.
That’s important because what we have over here, if you can imagine that these bars are on wheels, is we’re trying to get these car trains, if you will, through a tunnel that has a capacity for the healthcare system. And there are certain things that will increase the capacity of the healthcare system, and there are certain things that will decrease the capacity. We’ll get to that. But there’s one other intermediate step that really has not been looked at that seriously.
That is this car right here. We don’t know exactly how tall these are; they’re not drawn to scale. But these are the people here from the infection that will be going to the hospital. They will be going in through the tunnel. Hopefully, they are shorter than the tunnel. Otherwise, there’s going to be a problem.
So what are the things that are going to increase the height of the tunnel that will allow it to go inside? Personal protective equipment on healthcare workers that allows the capacity to be higher because they’re able to do more; having ventilators that would increase the capacity of the healthcare system; medications, not only clinical trials to see what medications are appropriate but also the manufacture and the delivering of those medications, are going to be key as well.
Well, what would decrease this? Well, if healthcare workers have to be quarantined because they didn’t have personal protective equipment, or if there is no PPE either because people are taking the masks or they’re just not enough masks for healthcare workers to use. So where we are seeing a lot of resources spent right now is for the development at the making of personal protective equipment.
We are getting the government involved in trying to convince manufacturers to make more ventilators. The FDA is waiting for these clinical trials to be completed so that it can decide whether or not it’s going to indicate those medications for use in COVID-19.
But of course, we have other medications that haven’t been labeled for use in COVID-19, and we’re using those as off-label at this point because there are no medications that are FDA approved for COVID-19. We are starting to get manufacturers to make a lot more medication.
So we have focused a lot of energy in trying to get this tunnel increased in size because we know that there’s a lot of people coming down the pike. There’s going to be quite a number of people going through, and as it turns out, we know that about 20% of the people that become infected will end up needing to go to the hospital to get hospitalization; about 80% of those will simply have a mild case. So 80% no hospitalization.
What’s happening over here? Well, we’re having a lot of time and effort being put into social distancing, isolation, and things of that nature. So up to this point, this is where we’ve seen most of the effort being made to handle this situation with COVID-19. The question remains: what else can we do? May I suggest to you that where we need to be focusing as well is on this center section because the question really boils down to: why is it that 80% with an infection will not need to go to the hospital? And the answer is very simple. The answer is your immune system.
The reason why we know that’s the case is that people who are older, have more comorbidities typically have weaker immune systems. Those that are younger typically have stronger immune systems. That’s exactly what we’re seeing in this situation. Older folks tend to be the ones that need to go to the hospital; that’s not a big surprise. There are exceptions, of course, all the way up and down. There are young people that end up going to the hospital and there are elderly people who become sick but then recover on their own, but by and large, the 20% that end up at the hospital have a lower immune system generally.
So, in fact, the way that this box gets increased is if you have a bad immune system, and the way that this comes down is if you have a good immune system. And not much resources as of yet has been put into making sure that we have a good immune system. And I think this is a good area to look at because if you had a good immune system here to prevent you from going to the hospital, it also can work that a good immune system here might have prevented you from getting the illness in the first place. So I think having a good immune system is of paramount importance.
There are two reasons why that’s the case. Because for you personally, if you’re able to improve your immune system, then you’re not going to the hospital. But even more important, if you’re not going to the hospital, that means the hospital doesn’t need to deal with you and can concentrate their efforts on somebody else.
Now notice that we’re dealing with about an 80% and 20% differential there. That means if we can just improve the immune system by a short amount, in other words, if we can improve the immune system instead of 80% go to 85%, so that 85% don’t need to go to the hospital. That means this 20% drops to 15%; that’s actually a 25% drop in hospital admissions, which would be a massive impact at the hospital level. Of course, we’re all hoping that if we can reduce this, then we can finally slip this car right into the tunnel without a problem.
Hopefully, all of these things – working together, social distancing, isolation, a good immune system, medications, delivered when they need to be, personal protective equipment, ventilators, clinical trials yielding good medications – all of these things can work together so that when we have the peak hit, we’re able to take care of all the patients that we need to take care of.
There are two components to your immune system. There is something called the innate and the specific. The innate portion of your immune system is made up of components of the white blood cells, which are the soldiers of your military immune system that basically indiscriminately take anything that’s foreign and destroy them. It doesn’t need to have specific knowledge of specific antigens. That’s why it’s known as innate; whereas the specific has to be taught and shown specifically what the foreign antigen is, so it can make antibodies against that specific and foreign antigen.
So if you have here a pathogen. When the pathogen comes, it must penetrate through the innate immune system first. Now, what are the components of the innate system? You have things called natural killer cells, you have macrophages. These are cells that eat up the foreign substance, munch it up and take little pieces of it and then present it to the specific portion of the immune system so that they can see what parts of it look like, and then make sure that they can identify it later. Also, neutrophils are part of that innate system.
So generally, what happens is you have a pathogen, it gets eaten up by either natural killer cells, macrophages, neutrophils. The macrophages generally speaking take pieces of it and present it to the specific arm that’s called an antigen-presenting cell, that’s a macrophage. And there are two types of cells here, there are T cells and there are B cells, and generally speaking, the T-cells are the things that are involved with cell-mediated immunity where there are cells that are problems. These T cells can kill them. There are T4 helper cells which can help communicate as well.
The B cells on the other hand secrete antibodies which neutralize antigens, be aware of that. What is going on around the world? There’s something called the BCG vaccine. Now, the BCG vaccine is given in various parts of the world; it’s an injection that’s given in young children to protect them from tuberculosis even though it’s not tuberculosis. There is a crossover between the vaccine and the innate immune system’s response to tuberculosis.
The reason why they’re doing this in different parts of the world is because they have noticed that when they give the BCG vaccine to young individuals, not only do these young individuals have a natural killer cell, macrophage, neutrophil response or the innate response, they also have a specific response against it, which is helpful in trying to kill tuberculosis. But they’ve also noticed something else, it seems as though the specific arm of the immune system is talking to the innate after it gets revved up with the vaccination, and it’s using a carrier called IL-1 beta.
Now when this happens, it not only revs up the specific but it revs up the innate as well to the point where when they give the BCG vaccine, they’re noticing a reduction of 30% in viral infections.
There were some criticisms of this study, but by 2016 a review was done that was published in the British Medical Journal that showed that there was an excess reduction in mortality after the BCG vaccine was given. That couldn’t be explained solely by the prevention of tuberculosis.
So more studies since 2016 had confirmed that this is what it is that’s going on. In fact, it culminated in a study where they gave the BCG vaccine and they noticed that it protected against a completely different pathogen, the yellow fever virus in a weakened form which is also seen as a vaccination. Something that was new and interesting was that when you stimulated the specific arm of the immune system it also stimulated the innate arm.
Therefore, if you could rev up the immune system by giving a specific antigen that maybe not even related to the thing you’re trying to protect against, a boosted innate immune system could be protective against another virus, and that’s exactly what they’re hoping on doing here with COVID-19.
So there’s a number of studies all across the world including Greece, the Netherlands, Australia and the UK that’s looking at giving the BCG vaccine to elderly population and high-risk people like physicians, nurses, healthcare workers., etc. If they can give them the BCG vaccine, they’re hoping that the innate immunity will go up enough that they might not get the infection. I’ll put a link in the description below to the article describing this technique: Can a century-old TB vaccine steell the immune system against the new Coronavirus?
But you can see here on this graph. We’re looking at the areas in red as we’ve mentioned. The other area that we should look at is the areas in green even if it helps a little bit. A lot of the problems that we’re having over here in red is the system trying to get the PPE out to enough hospitals that they can use it, our medications we’re having shortages trying to get enough of these things out to the hospital.
So we’ll ask a different question, what are some things that we can do without having to worry about a healthcare delivery system that can improve our immune system? So for future updates, we are going to take a look at the data of things that can improve your immune system.