Is it the immune system rush or the virus that is claiming lives?

Interesting enough. Right?

The world is waiting for the time when it will slip from the grasp of the coronavirus, popularly addressed as Covid-19. Beginning from Wuhan followed by large scale devastation in Asia, Europe and America, it has caused 184,280 deaths in total.

No this is not a joke. This is powerful enough to inject fear and insecurity within us.

Earlier, there was an observation that the elderly and people with underlying conditions formed the chunk of victims of the virus. But this idea got totally eliminated when youngsters also started falling prey. No one got to know the real scenario until the virus turned out to be indiscriminately affecting both young and old. In addition, it is also not revealing its plan of movement once it has invaded a human body. A section of people affected by the virus got sick to such an extent that the doctors lost hope in their survival. On the other hand, many others keep feeling better leading to the recovery.

The above level of unpredictability depends on how a human body handles the virus rather than the invading nature of the virus. This is an interesting point which deserves a thought.

Whenever it comes to drugs, antivirals work in the early stage of the infecton. It is the immune system which comes to the forefront in the later stages and threatens to kill us. This action can be improved.

Loss of taste and smell is one of the complications of COVID19 patients as young patients are complaining of sudden inability to taste. Is it that the virus as the potential to affect the olfactory nerve? Is it attacking the nerves which may cause long term impairment? The virus has also reported to cause brain inflammation that leads to permanent damage. Once it enters the human body, it takes days to take full control of the host cells by tricking the immune system. Once the damage is realized by the immune system, the response is often harsh and not calculative which is when patients crash.

Among the many inflammatory markers which are predominant in critical COVID19 patients, D-dimer is the protein which is predictor of mortality. Doctors in Wuhan, China, have observed a 4-fold rise in D-dimer in highly critical patients thereby suggesting that a test could be an early marker of who is entering the dangerous phase.

D-dimer is one of the vital components of a hyperactive immune system known as ‘cytokine storm’. In this storm, the body gets overwhelmed with cytokines (a signaling molecule released by the body to activate immune system in order to eliminate a virus) sounding a fire alarm that continues to ring even after the firefighters and the ambulances have arrived.

Now, the focus will shift from treating the infection to tamp down the hyperactivity of the immune system so that it does not kill the person or cause a permanent damage. The challenge is to strike a balance where neither the cytokine storm nor the infection goes uncontrolled. Cytokine storm is common in dengue, influenza and Ebola cases.

Blocking the action of cytokines is one of the priorities right now, as suggested and debated by healthcare providers. Interleukin 6 (IL-6) is a cytokine which peaks up leading to respiratory failure and medications which blocks the IL-6 have to be developed. Researchers are working to find a solution on the same line and clinical trials are ongoing. Even if the researchers come up with interleukin inhibitors, there will be a shortage in supply of these drugs as they are used in rare cases by people with compromised immunity and are very expensive.

Relying on available corticosteroids is the last feasible way but this is a controversial opinion among the medical fraternity. As it have more side effects than being target-specific. A person on corticosteroids has an even higher chance of getting a secondary infection. This too have mixed results. Infectious Disease Society of America (IDSA) issued guidelines on the inclusion in a clinical trial in case of acute respiratory distress.

Keeping in mind the already overwhelming healthcare system and the immunity factor, maintaining a good health and best possible immune system must be written in bold and capital in our daily lives.

Our immune system is dependent on the kind of environmental interactions and the communities we were brought up; the genetics and the intake of food and air. Those who will be critically ill due to Covid-19 will be the ones who have a bad sleep. One night of a disturbed sleep leads to a rise in IL-6 level. Unfortunately, people who do not take a break from work when sick or are unhappy with their families or do not have proper food and clean air to breathe have higher probabilities to carry the burden of severe life-threatening disease.

In conclusion, our immune system need to be very strong.