Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses, and on it goes.
• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS–CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• Personal Protective Equipment (PPE)- PPE are any item that covers any part of the body with the design and intent of keeping viruses in the environment from infecting the wearer of the PPE. PPE’s include all masks (which includes respirators), face shields, eye shields, gloves, gowns.
• Ventilator- a ventilator is a machine that can force a person unable to breathe to inhale and exhale and control both effectively.  They are sometimes called respirators, but during this pandemic the word respirator is now reserved for reference to a tightly fit mask.
• Live Virus Swab– this is the swab which attempts to swipe live virus from one’s nose or throat to see if you are currently infected.
• Antibody Test- (aka serology test) this is the blood test which looks for antibody to the SARS-CoV-2 virus to see if you have been infected in the past.

Spreadability

This has been said before but it remains true through today.

The SARS-CoV-2 is very contagious, half or more infected have no symptoms, therefore it is spreading invisibly, with the only hope to know where it is spreading is testing.

If as we leave our homes to work and play, we will see more people infected.  Our ability to keep the new cases from igniting into large hot spots, is to do the three actions all have been talking about:

1. Test enough people to identify as close to all the infected as possible
2. Trace all their contacts so we do not miss the path of transmission
3. Isolate all found to be infected so that the spread can be slowed or stopped.

We already know that certain places are heavily infected- nursing homes, meat packing plants, and nursing homes, so tracking and isolating should start there, but should also include the whole nation, or the virus’ spread will ignite as we go back to work and play.

Severity

What Makes You Sick When A Germ Infects You- The Germ or You?  COVID-19 Has Its Own Answer and Teaches us Much

On its surface this seems like a silly question, of course it’s the germ that makes me sick when a germ infects me.

After all, if some germ fails to infect me, just how will its infection make sick?

One clue that not all is as it seems has to do with fever.  It turns out that a fever from a germ does require that germ to infect you, no germ, no infection, no fever from that germ’s infection.

But.

It’s not the germ that causes the fever.  How do we know?  I someone has no immune system, and gets an infection with the same germ that “gave me” a fever, guess what happens?  They develop NO fever.  They can’t.  Now you may ask, who has no immune system, but but many people who must have their leukemia treated with a bone marrow transplant have to have their bone marrow completely wiped out to rid as much of the leukemia from their bodies, leaving them without an immune system until the new bone marrow grows in.  And if their immune system is completely wiped out, if they get an infection, often the germ can grow, but no fever happens.

This observation is bolstered by many others to prove that fever is produced, by my body when I  have an infection.  So yes, it was the germ that made me sick, no germ, no infection, no illness.  But the germ does not cause all my troubles when I am sick, my body’s immune system gives me plenty of troubles, including fever.

So now we need to ask, why would any system be designed to make you sicker as part of getting better?  We don’t know the answer to this question, but we know it happens, and all the time.

We’ve learned that fever in an infection is created by one’s own body, the result of a variety of chemicals created and secreted by some of our white blood cells.  These cells and others of our immune system also secrete certain compounds that make us feel achy, tired, in a word, sick.

So why?  The answer lies at the heart of the deep mysteries of one of the grand powers of an organism- inflammation.    Inflammation is a rare word in biology, it says exactly what it means.  The basic purpose of the immune system is to detect a threat, and destroy it.  How does a cell in our body, an immune system cell, destroy an enemy?  Quite literally it burns it.   It burns it with chemicals that attach oxygen very vigorously to the threatening germ or cell, and that is what burning is.  A fire attaches oxygen vigorously to wood.  In the case of inflammation, oxygen attaches vigorously enough to destroy the target, to literally burn it, but it does not do so enough to cause an actual flame to appear.

What is the chemical our immune system cells burns our enemies with?  Some are hydrogen peroxide, hypochlorous acid, and the hydroxyl radical.  Most of us are familiar at least with hydrogen peroxide, it bleaches out color by attaching oxygen to the color, so we know it can attach oxygen to all sorts of items.

Thinking about how our immune system protects us, the aptness of the word inflammation is clear.  The cells that protect us do so by burning our enemies, enflaming them, or simply put, inflammation.

The burns our immune system throws at the dangerous germs are designed to destroy the germ or cell that threatens, and nothing else.

But here is where it gets messy.  The burning of the enemy almost always burns us too.  Think again of the mosquito bite- it injects a foreign chemical and our immune system tries to destroy it.  So far, so good, but the inflammation almost always bothers the cells around the foreign chemical.   The foreign chemical, if left alone, would cause little harm, would simply wash away in the flow of the body’s fluids, but the bothering of the cells around the chemical leaves a red bump that can be very intensely itchy.  In this example of inflammation, we are the source of the problem more than the outside force.

COVID-19, inflammation, and the damage done

We have heard so much about what this virus, the SARS-CoV-2 virus which causes COVID-19, can do to a person.  As readers of Real Answers know, it seems the virus is on the attack all over the body.  As time goes on, the stories doctors and nurses share of what they see happening during this illness only grow.  It began as the story of viral pneumonia, but now we know people infected with the SARS-CoV-2 virus can suffer clotting problems leading to clots in legs, lungs, even storkes.  People with the COVID-19 illness have been observed to suffer heart damage, kidney failure requiring dialysis, liver failure.  The list seems to be growing.

So what is causing all these troubles, the SARS-CoV-2 virus, or our body’s response, our inflammation?

A look at the lung might be helpful.

We now know that when one first breathes in the SARS-CoV-2 virus, and it lands in the lungs, the virus attaches to cells that are near where the tiny airway tubes become the tiny air sacs of the lungs.  The SARS-CoV-2 virus attaches to these cells, and the infection in the lung begins there.  The virus enters these cells, makes a zillion copies in these cells, pops these cells as they copy.  At this stage most of the harm done is by the virus, not our body.  And that damage shows up as fluid in the lung and some decrease in the lung’s ability to function.  In these early days, people may have no symptoms, or mild symptoms, including fever and cough.

But then at some point, the body notices it is under attack, and it responds.  Cells of our immune system swarm to the infection to kill the virus and the cells copying the virus.  The swarmed area can become heavily inflamed as the attack gets very intense.  The good news is that this attack on the attack reduces the numbers of  the SARS-CoV-2 virus in the lung, and fewer copies being made.  But the packing of the lungs with immune system cells, attack chemicals, increased fluids, all can lead to the lungs becoming quite severely swollen, and in some cases so swollen that the lungs become very stiff and air cannot move through them well.  If the inflammation gets bad enough, the lungs cease to function, and death follows.   This phase of the illness is created and executed by our bodies, a response to the virus, but a response crafted by our immune system.  In this phase, the harm is done by our own bodies.

Putting It Together

And so, putting the whole story together, we see both types of harm coming from being infected by the SARS-CoV-2 virus- the virus can attack our lung cells, and our immune system can attack the virus and the cells that contain it.  Both virus and body create harm, even though all flows from the virus being present.

BOTTOM LINES

1. The virus remains very contagious, and spread can ignite hot spots, unless small outbreaks are detected with testing and tracing so that isolation can stop the spread.
2.  Although you have to be infected to be sick, the virus itself is at the heart of all the results of infection, but the way the harm actually happens is caused by two main ways:  The Virus and The Body.  The virus attacks our cells, but our immune system creates inflammation to clear the virus, and that inflammation can cause severe troubles.

So, as we leave our homes to go back to work and play, we need to remain careful, the virus remains all around the entire nation.  Only careful tracking with testing, tracing and isolating can keep us safe, and we should respect the very severe inflammation we now know it can cause across many areas of the body.

To your health,
Dr. Arthur Lavin