How to be treated in the first week after infection
We asked to answer these questions of our compatriot, who now lives in Los Angeles, USA, Doctor of Biological Sciences Peter Ignatov, professor, specialist in the field of infectious immunology.
– Pyotr Evgenievich, it used to be that if a person got SARS, it is necessary to take drugs that increase immunity. But in the case of coronavirus, this rule does not work. After all, serious complications, as doctors explain, occur precisely because of the too strong immune response of the body to infection. It turns out that at the beginning of the disease, immunity should, on the contrary, be suppressed?
“This is not entirely true.” Suppressing immunity, especially at the onset of the disease, is unnecessary and even very dangerous.
There are two types of immune response: cellular and humoral. If the answer to your question is very simplistic, then I believe that the cellular immune response in coronavirus infection should be weakened, and the humoral one, on the contrary, should be strengthened.
But at the beginning of the infectious process, all immune reactions trigger the same cells of innate immunity. Therefore, in the early stages of the disease, it is better not to suppress anything, but to activate processes that induce immunity specifically to the humoral type. Separation and their mutual antagonism will develop in the later stages of the disease.
– What is the difference between a cellular immune response and a humoral one?
– With the cellular type of the immune response, lymphocytes are at war with the infection, capable of detecting and recognizing cells infected with the virus in the body. These are killers. They kill our infected cells, thus eliminating, at once, the entire “factory” for the production of viruses.
This seems to be good. But upon closer inspection it turns out to be not very necessary. In most acute respiratory diseases, infected cells still die when the virions exit them. Everything develops very quickly, and killers, often just do not have time to find them.
Much more successful with coronavirus infection is another strategy: to pre-suppress the ability of the virus to invade healthy cells. To do this, block the adhesive properties of its surface S-protein. Then the virus simply will not be able to infect healthy cells, and killer cells will no longer need to kill them.
Antibodies are the most effective blocking agent here. They are produced by our body in the process of a humoral type of immune response. This is a completely different mechanism than the cellular response.
Now, by the way, various technologies are proposed for creating artificial antibodies and antibody-like trap molecules that block the adhesion of the virus to cells. Some drugs also demonstrate the ability to change the adhesive properties of the viral S-protein – low molecular weight heparins, for example. So, these areas of antiviral therapy are now very promising.
“But why should we give preference to only one type of immune response?” Let the war with the virus go on in the body on two fronts.
– The cellular and humoral types of the immune response are in a fairly antagonistic relationship to each other. If the cell type gains an advantage, it suppresses the humoral response, and vice versa. In this way, the body saves resources and focuses its protection mainly on one type, but on the most destructive for this pathogen.
But SARS-CoV2 tricks our body. It causes the production of special proteins, which, like a computer virus, integrate and disrupt the signaling pathways in our macrophages. This forces them to intensively produce pro-inflammatory cytokines. If pro-inflammatory cytokines are produced in very large quantities, they literally “drive crazy” the immune cells, and they quickly begin to destroy their own body. This phenomenon is called the “cytokine storm.”
In addition to the fact that these cytokines induce mass inflammatory reactions throughout the body, they actively include the launch of a cellular immune response, which is ineffective for the body in terms of protection. And, in turn, this entails the suppression of humoral immunity and a decrease in the production of antibodies that neutralize the coronavirus.
Coronavirus “learned” to provoke a type of response that is beneficial to it, since it reduces the production of dangerous antiviral antibodies for it. Thus, he avoids an effective attack by the immune system. Such tricks of pathogens are not uncommon in infectious diseases and are called “immune deviations.”
– Is it possible to help the body adjust immune responses?
– Yes. As I said, it is necessary to activate the reactions of humoral immunity and, conversely, if necessary, to suppress cellular.
To suppress cellular immunity, 1) corticosteroids are usually used, 2) chloroquine is a well-known blocker of cellular immunity, it is often prescribed for the treatment of rheumatoid arthritis, lupus; 3) monoclonal antibodies – blockers of pro-inflammatory cytokines and other inflammation initiating molecules; 4) reprogramming of cells (macrophages in particular), etc.
– Do such drugs have side effects? Can I take them on my own, at home, if the person just got sick? Or is it dangerous?
“You shouldn’t do this yourself.” These substances are unsafe and have a lot of side effects. The suppression of inflammatory reactions induced by a massive “cytokine storm” is usually carried out in a hospital setting, at the stage of development of serious pathologies in the lungs and other organs.
– And what drugs can activate the humoral immune response?
– They are also quite famous. For example, cholecalciferol (or vitamin D3), which acts in the body like a hormone. Receptors for it are found on many cells and especially on macrophages. The inclusion of these receptors exerts a very strong effect on them, forcing them to cancel the production of pro-inflammatory cytokines.
Instead of pro-inflammatory cytokines, macrophages begin to synthesize anti-inflammatory cytokines, which naturally suppresses inflammation in the body. They also trigger the process of humoral immune response. That is, this vitamin is able to act as a kind of switch that cancels the “wrong” and triggers the “right” immune response mechanism for this disease.
In order to prevent vitamin D3 deficiency in the body, it can be taken daily in small doses (1-2 thousand units), but during treatment these doses should be significantly higher. For a short period, this is not dangerous, but in any case it is better to consult a doctor, since there are contraindications.
– If you had a fever now and stayed for a day, what dose of vitamin D3 would you take?
– If a coronavirus infection is suspected, I would start taking vitamin D3 at a dose of 10-15 thousand units per day, or maybe more. But I would take it in such a dose only until the symptoms of the disease are reduced or stopped. Then the dose must be reduced to preventive. Vitamin D3 is a very active product and in large doses works as a powerful medicine. Therefore, its prolonged use in very large doses is dangerous and even toxic to the body.
– How else can you help humoral immunity?
– Actually, there are a lot of stimulants of humoral immunity, both among pharmaceuticals and among products of natural origin. Zinc preparations, for example, enhance many enzymatic processes in cells and activate B-lymphocytes. These are known stimulants of humoral immunity and antibody production. Their use in various countries has already demonstrated a good therapeutic effect with COVID-19. Moreover, some American doctors recommend very large doses of zinc, but not all people easily tolerate them. With increased acidity, zinc can irritate the stomach.
Gammaglobulin preparations or fragments thereof also work well. It was shown that the introduction of products of this kind significantly enhances the synthesis of antibodies in the body. Even a simple transfusion of blood plasma can stimulate this process.
– Do you mean donor plasma with antibodies to coronovirus? Or is it just a usual plasma transfusion, a routine procedure that is done, for example, after operations, so that the patient recovers faster?
“Yes, I mean the usual plasma transfusion.” The processes of antibody formation can also be stimulated by preparations of non-specific human gamma globulins and even their fragments. And hyperimmune plasma or serum, with antibodies to coronavirus, is considered a very effective medicine for this disease.
– As a microbiologist, what advice would you give to a person who is most likely infected with the coronavirus? Is it worth taking any medications urgently? Call a doctor? Go for a CT scan of the lungs? Get into bed? Or, conversely, move more, walk around the apartment? Do breathing exercises?
– I believe that you should move as little as possible. Need to lie down! Remember how many complications the flu brought on the feet gives. The body mobilizes all forces to fight the virus, and various stresses, hypothermia, physical activity, etc., absolutely definitely reduce the activity of protective reactions in the acute infectious process.
If possible, you should definitely consult a doctor and listen to his recommendations. By the way, do not forget about the “second opinion”, that is, the recommendations of other doctors. Any doctor is not the Lord God and may be wrong.
Of course, it is necessary to be treated as soon as possible and intensively. Inaction or insufficiently effective action is not able to neutralize the harm that the rapidly multiplying infectious agent causes to the body. I already said that in the absence of medical care I would start taking vitamin D3 and zinc preparations as soon as possible.
You need to be very careful about taking immunomodulators and interferonogens, since most of them will stimulate undesirable pro-inflammatory reactions and will further worsen the situation.
Chinese doctors report the good effect of liquorice (licorice) preparations on AS, as well as hyperserpine, a bioflavoid from the peel of lemon and orange.
The available drug omeprazole can increase the pH in the endosomes of cells and thus impede the replication of coronavirus. It also enhances the effect of antiviral drugs, protease inhibitors, in particular.
When sore throat, I would recommend rinsing with a warm solution (not boiling water!) Of burnt sugar. You can add salt and a little soda to it. By the way, burnt sugar (without salt and soda, of course) is useful just to dissolve and eat somewhere 15-20 grams. in a day.
Recently, more and more works have appeared on the treatment of COVID-19 with inhalation of drugs. With such delivery directly to the bronchi and lungs, doses of drugs are required an order of magnitude smaller than usual. Moreover, they act much more efficiently and mainly only locally. Inhalations can be done using ordinary nibulizers, which are sold in any pharmacy.
In the early stages of the development of the disease, inhalation of even an ordinary soda solution can be useful. And if the question arises about the inhalation of any medicine, then be sure to consult your doctor.
Temperature up to 38-38.5 degrees is better not to bring down. Defensive reactions of innate immunity function better at such temperatures. If higher, paracetamol or ibuprofen can be used. Paracetamol is weaker, but is considered safer in terms of suppressing the antiviral response.
You can use interferon preparations – alpha, beta, lambda. But gamma-interferons can provoke undesirable reactions in coronavirus infection.
As for antibiotics, their use in the early stages of the disease (including for the purpose of prevention) is a rather debatable issue. Usually they begin to be used with difficulty breathing, when secondary microflora joins pathological processes. The most effective with COVID-19 is still recognized as azithromycin, which not only inhibits the microflora, but also directly inhibits the replication of coronavirus. It also enhances the effect of certain antiviral drugs. However, other antibiotics used to treat respiratory infections can be effective.
Therefore, it is better to have an antibiotic in stock, but use it only in accordance with the doctor’s recommendations, since you can make a mistake with the dosage, the dosage regimen, and in addition, there are also contraindications here.
And with serious difficulty breathing, do not hesitate and urgently need to require hospitalization.
So the choice is not small, and there is no need to just walk around the apartment. We must lie and be treated!
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