Nearing The End

It is becoming increasingly clear that an overly aggressive immune system plays a role in the decline and death of patients with the SARS-COV-2 virus, yet in all but the sickest patients it appears that corticosteroids are not helpful.   A key signaling protein that has been linked with poor outcomes is interleukin-6 (IL-6).  IL-6 is a particularly potent attractant for macrophages.  Macrophages are the “attack dogs” of the immune system and can sometimes harm good tissue in their aggressiveness.  Instead of administering corticosteroids which are more or less indiscriminate in suppressing the immune system some researchers are proposing the use of IL-6 inhibitors.  These agents already exist and are used clinically in the treatment of rheumatoid arthritis and other autoimmune disorders.  Tocilizumab has been approved for the treatment of the SARS-COV-2 virus in China but results of its effectiveness are unknown at this time.  Other researcher have singled out another signaling protein, IL-1 as an even more specific target in the immune cascade.  Inhibiting IL-1 would have less impact on the number of helper CD4 and suppressor CD8 T cells, both crucial in fighting viral infections.  Most of those treating COVID-19 patients believe the patient is harmed by the effects of the virus and the body’s reactionary immune response.  If that is the case therapy may ultimately include a combination of an antiviral drug and an IL-6 inhibitor.  The antiviral drug remdesivir has shown promise in treating hospitalized patients.  A study published in The New England Journal of Medicine showed clinical improvement in 36 of 53 patients treated with the medication.  Numerous treatment trials are underway in hopes of finding effective therapies until such time that one or more vaccines has been approved.  At this point we seem to find ourselves in a “trial and error” situation many times.  The number of new infections in several hot spots like New York and California is decreasing.  That success is most likely due to the aggressive approach toward mitigation by those states and perhaps with a little help from Mother Nature.  If SARS-COV-2 follows the course of most upper respiratory viruses the curve will continue to flatten as temperatures rise.

Most viral upper respiratory illnesses are more prevalent in the winter months and tend to wane or disappear completely in the warmer months of late spring and summer.  Airborne viruses are most often found within tiny droplets emitted when an infected individual coughs or sneezes.  These droplets remain suspended longer when the air is cold and dry; thus there is more opportunity to inhale or otherwise come into contact with these virus-laden droplets.  In warm, humid air these same droplets fall to the ground more quickly, allowing less opportunity to infect another individual.  Most upper respiratory viruses (including the influenza virus) is more often seen in the winter months although the virus can always be found somewhere.  Another prime factor in the finding of viral seasonality is the fact that during winter months people spend more time indoors in close proximity.  Many of our seasonal holidays that are commonly associated with large family gatherings are also found in the winter months.  What better way to spread a virus than with family hugs, kisses and sharing food and drink together.  As Dr. Fauci stated, we may have to rethink the age-old custom of handshakes since our hands are frequently laden with contaminants.  Perhaps “hand sanitizer” will become the new item that we will “Never Leave Home Without.”



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