World War III
The Battle between Covid-19 and our Immune System
(With acknowledgement and apologies to Professor Graham Le Gros, a world-renowned and acclaimed immunologist and Chief Executive of the Malaghan Institute in Wellington, and Jamie Morton of the NZ Herald, who wrote the illuminating article upon which this piece is based. Neither is however responsible for any errors, or opinions expressed in what follows, nor are they responsible for the final section on the economics of our Covid-19 response. Tony Poole)
The “goodie” in this war is our immune system. The “baddies” are the pathogens – the things which attack our immune system. Pathogens are often categorised as some bacteria, plus funguses, parasites, protozoa, and in this present “war”, viruses.
The first known virus was discovered by scientists in about 1892; since then approximately 5,000 virus species have been identified of the probably millions of types of viruses that are presumed to exist in our environment. Viruses are found in almost every ecosystem on Earth and are the most numerous types of biological entity.
Viruses can infect all types of life forms, from human beings and animals and plants down even to another of the “baddies”, bacteria. A virusis a living, sub-microscopic (i.e., it can’t be seen even through a conventional microscope) agent, that replicates itself inside the living cells of the organism that it invades (i.e., us in this case).
When a virus infects us, it does so by attacking susceptible cells in our body. The host cells (or receptors) are then forced to rapidly produce thousands of identical copies of the original virus.
These attacks are well known to our immune system, “which really is one of the most sophisticated and remarkable features of the natural world” said Professor Le Gros, who continues by saying there’s not a single pathogen that our human immune system doesn’t know (or at least can’t work out) how to deal with.
Viral infections in Human beings are therefore well known to our immune systems, and generally provoke an immune response that usually eliminates the infecting virus.
Some viruses however, including those that cause AIDS, HIV infection, and viral hepatitis, evade these immune responses and can result in chronic infections and death, although several antiviral drugs have been developed to at least prolong life if not actually cure the patients in these cases.
As Professor Le Gros said, there is not a single pathogen that our immune system doesn’t know or at least can’t work out, how to deal with. But sometimes, it needs time to figure out how to meet alien threats it’s never previously encountered.
Like the deadly coronavirus behind Covid-19. “That’s what makes this virus such a big deal, as it’s come completely out of the blue,” said Professor Le Gros; “There’s just no immunity to it, of any kind.”
So, our present 4-level lock-down system is designed to give our immune system time to work out the genetic code of the virus, and destroy it, before it destroys us (or at least an unacceptably high percentage of us).
The freshly-identified coronavirus causing the Covid-19 disease (SARS-CoV-2) is more than just an alien to our defence system, it’s what Professor Le Gros describes as “a rather clever alien”.
Firstly, it belongs to a family of coronaviruses (its cousin is the
better-known common cold virus), which have singled-stranded ribonucleic acid (RNA) as their genetic material.
Secondly, “This is a big RNA virus – the biggest actually – and it has features that can do all sorts of things,” Professor Le Gros said.
Thirdly, “what’s really special about this virus is that it chooses certain receptors that are found throughout our bodies”. Specifically, the virus attaches itself to cells by using its outer “spike” proteins, something which plays a big part in how quickly it spreads within us and to other people. Just as threatening, the receptor that it targets, called ACE2, happens to be highly present in our respiratory cells.
“So, (the virus) quickly finds its way deep into your lungs, and starts causing big problems there.”
The receptor ACE2 has hosted this havoc before, acting as the receptor in the Sars coronavirus which infected more than 8000 people and killed 800 in the early 2000s. “This virus also has a recombinant ability where it can mutate its spike protein quite quickly, allowing it to flick from one receptor to another,” continued Le Gros; “this is a relatively clever way of mutating and recombining.”
Some people were left doubly exposed as they didn’t have immune systems with specific receptors for, or responses to, RNA viruses, and fared much more poorly when infected. Le Gros suspects this rare trait might explain some cases of young people being killed or left critically ill after catching the virus.
For the rest of us, the main problem is that our immune system doesn’t have any existing memory, or “playbook”, to beat the virus. “When it infects us, it’s not that it happens in any sort of subtle way. It’s just that we haven’t built any immunity to it.”
In every case, it is crucial for our immune system to balance the threat it faces with the response it deploys against that threat. “Simply because of the sheer number of bugs that are out there, and the fact we have to respond to them all, we can never have the total package,” he said. “So, our immune system is reactive, and will always respond appropriately to the type of pathogen we get infected with.”
“That means there is always a foot race between the bug growing inside us and our immune system, which might say, ‘okay, this type of bug is bug number 5672, let’s start putting together a package of immune responses to deal with it’.
“So, the immune cells have to start replicating to catch up. If you have 10 bugs in your system, it’s easier to get on top. People like healthcare workers, unfortunately, are dealing with massively higher levels of bugs, and thus the virus can stay far ahead of their immune system.”
On the flipside, things can go awry when our immune systems push back too hard and inadvertently make us sicker. One of the most lethal examples of this is what’s called a cytokine storm. When our immune system detects a virus, it can over-react by sending a surge of immune cells and their activating compounds – cytokines – straight into our lungs.
This doesn’t just inflame the lungs and build up fluid, causing respiratory distress characterised in Covid-19 by violent bouts of coughing, but also opens the door for contamination by a secondary bacterial pneumonia, boosting the risk of death.
“In essence, the more lung function you ordinarily have, the far better off you’ll be against this virus,” Le Gros said. “So many of the people dying from it already have compromised lung function, so the virus just comes along and takes the last 10 per cent of it they’ve got left.”.
Vaccines and anti-virals
If we visualise the millions of components of our immune system as an army, we might see a division overseen by generals, with a tier of colonels below them. Using this analogy, figuring out how to create these virus-fighting senior commanders is much harder than simply expanding the number of soldiers below them and then marching them into battle. This latter “is what we call broad-spectrum stimulation of the immune system, or non-specific immune stimulation.”
It’s just that effect which scientists hope to create by repurposing the century-old BCG (Bacillus Calmette-Guérin) vaccine, typically used as a kind of blanket protection for children against severe forms of tuberculosis.
Other scientists have been racing to engineer vaccines that induce more specific responses – and promising clues have been popping up around the world. From one of Australia’s first Covid-19 patients – an otherwise healthy woman who turned up at hospital with mild to moderate symptoms – scientists drew blood samples at different points of the infection that shone a light on how her immune system responded and fought the virus. Three days after she was admitted, the researchers observed large populations of several specific immune cells – often a tell-tale sign of recovery from a flu infection – and correctly predicted her recovery. Hidden inside that specific response, they hope, is the secret to a vaccine for Covid-19.
Scientists at California’s Scripps Research Institute may also have found some exciting new leads by using an antibody – remarkably, extracted from a survivor of the Sars epidemic 20 years before – to pin-point an Achilles’ heel potentially shared with the new coronavirus.
Le Gros, part of a burgeoning effort in New Zealand to create a vaccine here, said the key would be to find a solution that the entire population could safely use. It’s the inherent risks that come with vaccines – such as the potential to dangerously trigger allergies, or prove ineffective in certain groups – that largely explain why they take years to produce and roll out.
“We also need to be aware that there is a lot of hype about out there, with biotech companies saying we’ve found something amazing that can do this or that. Really, we just need a good old-fashioned simple vaccine to deal with this virus.” In the short term, researchers here and around the world are turning to anti-viral drugs as possible treatments for sick Covid-19 patients. “Anti-virals may offer some help for those people who are seriously infected, or perhaps give immuno-suppressed people a better chance against the virus until a vaccine comes along.”
Anti-viral drugs fall into three main groups: polymerase inhibitors, protease inhibitors and others.
Polymerase inhibitors work by blocking the enzyme that allow the virus to replicate its nucleic acid coding strand, while protease inhibitors – commonly used against HIV – act by blocking an enzyme that processes proteins that the virus needs for growth.
Chloroquine – best known for its use by travellers for protection against malaria, and dangerously touted by US President Donald Trump – is among the other possibilities, but scientists have stressed there’s not yet any clinical evidence to show it’s effective.
How can we help ourselves?
The most obvious way to protect ourselves against Covid-19 is to avoid catching it in the first place, by practising good hygiene and social distancing. As for helping our immune system, Le Gros said the basic tenets of good health apply: a well-balanced, nutritious diet and plenty of exercise.
“If you think back to Captain Cook and the Endeavour, his sailors were getting scurvy and dying with horrible, black boils everywhere, simply because their immune systems were giving out because they weren’t getting enough vitamins,” he said. “Thankfully, we don’t live in that environment here in New Zealand. People in impoverished communities in the developing world are all the more susceptible because they might only be living on carbohydrate-based meals with little protein and no vitamins.”
Young, healthy Kiwis can generally be assured they are getting what they needed. But for elderly people, an extra boost may help their immune systems. “Your grandmother, for example, might just have a cup of tea and a cookie to see her through most of the day, and otherwise live on a very minimal diet. That’s where supplements can be important. As we get older, our gut also becomes less absorbent, so we need higher concentrations of certain things to get the same amount as a younger person.”
I am quite fascinated by the realisation that our immune system is not in fact something static, but instead is dynamic – it can change to meet each new infection, while also continuing to remember how to deal with all of our old infections as well. If we change Professor Le Gros’s statement at the foot of the first page of this article ever so slightly, it could read “[our immune system] really is one of the most sophisticated and remarkable features of God’s world”. I personally have no problem with accepting evolution is an explanation of how life developed on this earth, because it still leaves unanswered the question why did life evolve. Only in God can we answer that question. In a way, it seems that evolution still goes on, helping the survival of the Human race, through changes to our immune system; because our immune system has the ability to adapt to meet each new attack upon it – even an attack that it has never had to deal with before.
So, the good news is that our immune systems will win – it will eventually get on top of this virus. But the bad news is that we individually may not survive. Until immune systems generally can learn about the virus and how to defeat it, many individual immune systems may die along with their human hosts. Further, until a vaccine can be developed to give us artificial immunity, there is nothing to stop the virus coming back again and again and fighting other wars with our immune systems.
It is not yet known how long this virus can survive on its own – possibly just a matter of hours, or under ideal circumstances perhaps as much as two or three days. It is generally transferred by an infected person sneezing; some droplets of the sneeze may land on a surface, and die after an indeterminate period of time, unless they are picked up by another human coming into contact with that surface (usually) by touching it, and then be transferred to internal organs by those hands touching their (or someone else’s) nose, eyes or mouth. Other droplets of the sneeze may be directly ingested into the second person from the sneeze itself.
This is why it is important to sneeze into one’s elbow; and also, to thoroughly and regularly wash and dry one’s hands – Covid-19 viruses seems to be killed relatively easily by a 20+ seconds soap (including soft-soap) and water wash, followed by a good drying.
How does shutting down the economy help?
Because a virus will die if it does not find a receptor cell within (probably) 3 days at the most, most countries are trying to kill off Covid-19 by denying it receptor cells. Our level 4 lockdown is at the extreme edge of such schemes.
We are scheduled to move from level 4 to level 3 of the lockdown shortly after this Messenger is published, but level 3 is still quite restrictive. Our economy can tolerate such restrictions for only a relatively brief period of time, for the following reasons:
All countries now have what is sometimes referred to as a dependent economy. Dependent, in this sense, means each working person produces relatively few (perhaps even none at all) of the goods and services we personally consume each day; instead we produce just one, or even just one part, of a good or service, and then exchange our surplus production for all of the other goods and services we need. Money is the mechanism which enables this to happen. This interaction between all the people in a country, and all the countries of the world, produces social interaction between people on a huge scale; which is just the sort of climate of behaviour that Covid-19 needs to thrive.
Economies can be “shut down” like our economy has been, for only a relatively short period of time, before the economy too will die. The reason is that vast sums of public money must be pumped into an economy to sustain it with our level 4 followed by level 3 type of lockdown; but there is only a limited amount of such money that it is practicable to create. When that limit is reached, further creation of money leads to rapid inflation until people lose faith, firstly in money, and then in the economy itself, because money devalues so quickly that it becomes worthless.
This is at least partly because of what is known as the velocity of circulation of money. The velocity of circulation is the speed with which a unit of currency (say, $5) changes hands, usually during each year. When person A spends $5 buying something from Person B, that $5 becomes person B’s income, which she/he may then spend, and so it becomes person C’s income, and so on. If this happens 10 times in a year, that $5 will change hands 10 times, as it finances the exchange of $50 worth of goods.
That is easy to understand, but difficult to calculate, because money used for different purposes has different velocities of circulation. For example, $5 spent on groceries will change hands quite quickly and quite often. But if it is saved, its velocity of circulation stops, at least until it is spent again.
So instead of calculating the velocity of circulation on each bit of money, the average velocity of circulation is calculated on all the money in the economy. Simply put, if Gross Domestic Product is worth (say) $1,000 billion this year, and the quantity of money is (say) $100 billion, then the average velocity of circulation of that money must have been 10.
This is a gross oversimplification, but hopefully it illustrates the point.
If the Government uses up all of its own money propping up the economy during the lockdown, it asks the Reserve Bank to create some more (how the Reserve Bank does this can wait for another day!). In the illustration above, the Reserve Bank knows that each $1 billion it creates will fund $10 billion of production. But actual production may not increase anything like that amount, if indeed at all, because the Government will spend all of the created money, not producing goods and services but merely propping up the wages of people who are temporarily out of work. So, in general terms the economy will have more money, chasing the same number of goods. Prices will rise, so the value of money will fall; which is what inflation is.
Controlling the rate of inflation is the primary purpose of the Governor of the Reserve Bank. We have had a series of very enlightened Governors of the Reserve Bank, and for more than 20 years they have given us a stable economy by carefully and successfully controlling the quantity of money in the economy, even during the Financial Crisis of 2007 – 2008.
Not all countries have been so lucky. For example, in the 1980s Argentina had inflation in excess of 100% pa. People spent their Argentinian money as quickly as possible because its value kept dropping; all important contracts, and people’s savings, were transacted in American dollars. The economy virtually stalled.
Even in New Zealand, during one year of the Muldoon era of Government in New Zealand, our inflation peaked at above 12% pa, and over a five-year period of that era, inflation enabled me to almost pay off the (admittedly modest) mortgage on my home, entirely out of income. This meant the lender of that mortgage received the same amount of money back-again as he lent, but it was worth much less.
The chaos caused by the outbreak of Covid-19 would be insignificant, compared to the chaos of a meltdown of our economy due to rampant inflation. The Government’s insistence that NZ does not want to have to return to level-4 lockdown is, I suggest, because the Government knows we cannot do so, because it would destroy our economy.
While the Reserve Bank can do some things to reduce the rate of inflation; for example, it is considering removing the LVR (Loan to Value Ratio) on first homes, which would probably slow down the velocity of circulation of some money created to boost the economy, but the general overall effect of creating money to bail-out the economy would still be inflationary.
In the last 4 pages or so I have tried to summarise the entirety of monetary economics, probably with limited success, to illustrate that no one in their right mind would want to go back to the era of out-of-control inflation.
For this reason, the Covid-19 virus in NZ must be quickly brought under control, OR New Zealand must allow it to take its course with more people dying. There is no other alternative.
A final thought, beginning with some hard facts:
13 New Zealanders have died from Covid-19 up to Tuesday 21 April.
None of these people were part of the labour force of New Zealand.
In 2020, during the first 14 days of the lockdown, 8 people died in road crashes.
In the same 14-day period last year, road deaths were 32 (a higher than normal number), and 16 the year before.
Over the 27 days the country had been at level 4, the number of deaths from Covid-19 was less than the number of road deaths over a 14-day period in either of the previous two years.
Over Easter (part of level 4), there were no road deaths in 2020.
Deaths are hard to take, and one death cannot really be compared with another. But shouldn’t we be a little bit more worried about, for example, our road toll, and a little less paranoid about Covid-19?
A Message from our Priest in Charge
Reverend Bob Driver
I feel I should be more worried about Covid-19 than I am. I mean, I get asthma, though not as badly as some it’s true. Contracting the virus would no doubt put me out of action for quite a while, if not for good. Perhaps it’s because I have yet to come across anyone who has had the virus; maybe I have faith in Jacinda’s “Levels” or in the tremendous work being done by nurses and doctors.
When I was five years old, I contracted something called osteomyelitis which I believe is caused by a bacterium rather than a virus. Well, whatever, I was very sick, couldn’t eat anything without bringing it up. Our doctor eventually found out what it was and I was despatched to Winchester hospital in an ambulance, my sister as I subsequently learned saying, “I hope he doesn’t come back!” I hasten to add my sister is these days a highly compassionate person with friends who happen to be sick.
Fortunately, by 1955 which is when this disagreeable distemper occurred, penicillin was available; without that, I would have had my kneecap excavated or even removed completely. So much depends on when you get sick. As it was, I received a shot in my backside every morning for 5 weeks, my leg in traction so getting out of bed was impossible – bedpans were the order of the day.
Winchester hospital was designed by that well-known ecclesiastical architect, William Butterfield (he of All Saints’, Margaret Street fame, the great Anglo-Catholic “shrine” in Westminster). Hence the pointed Church-like windows in the hospital, with long, hanging cords so you could open them. I seem to remember some of the glass was coloured.
I was in the boy’s ward of the children’s wing; the girls were next door. One of the older boys took great delight in coming over to my bed, taking my beloved golliwog and throwing him around the ward. When my mother came to visit in the afternoon, he was of course full of courtesy and good will. I still have my golliwog – he is minus an eye and most of his mouth is missing, but he still wears the blue cardigan I knitted for him, under instruction of my mother. I did suggest we put him in the window in place of a teddy bear a couple of weeks ago; Anne said, “For heaven’s sake don’t!”. Come to think of it however, I have never had a down on black people – maybe because I had a golliwog? He was a present from an elderly lady in the village, Mrs Newell, to celebrate my arrival in this world; with great kindness he was given, and with great gratitude received.
From time to time I was visited by a real little minx from next door – she succeeded in taking a clockwork mechanism my father had given me to keep me occupied. I never saw it again. But I also remember falling in love with a pretty girl called Annabelle. She would become a friend of my sister’s at school. I told my sister about this not too long ago, and she of course relayed it to Annabelle who was highly amused.
Butterfield, bless him, had provided a balcony for the children’s ward and on hot summer days, we would be wheeled out, beds and all and given sloppy vanilla ice cream. However, being already an avid railway enthusiast, I was more interested in watching the progress of the “Bournemouth Belle” (a Pullman train) and others, through the deep cutting immediately south of Winchester station – all steam hauled in those days of course.
Well, after 5 weeks in hospital, I walked, a little stiffly through the gardens they had there and how wonderful everything seemed. Flowers had stunning colours, there were sounds and scents I hadn’t experienced for ages; resurrection! And how good to get back home.
Many years after this, and important medical person described Winchester hospital as “A Medical Slum”. And indeed, I had just been home a couple of days when I was bedridden again! This time with Salmonella. No doubt the sloppy ice cream had something to do with it. This was considered a public health issue, and my parents had weekly visits from someone who took away samples of my effluent.
Maybe this is why I’m not too bothered about the present. “We Christians”, someone once wrote, “we die before we die!” and therefore we are prepared for the final curtain.
A prayer for those who are sick with the virus or other things:
“Father, your son accepted our sufferings to teach us the virtues of patience in illness. Hear the prayers we offer for the sick. May all who suffer pain, illness or disease realise they are chosen to be saints and know they are joined to Christ in His suffering for the world”.
And lines from the hymn, “Alone with None but Thee, my God”:
The child of God can fear no ill, His chosen dread no foe; We leave our fate with Thee, and wait Thy bidding when to go. ‘Tis not from chance our comfort springs, Thou art our trust, O King of kings.