Dr. Chris Magryta column: Quick bits on coronavirus
By Dr. Chris Magryta
Salisbury Pediatric Associates
• New strains of SARS2 — Recent data has shown that there are new circulating strains of the SARS2 virus (COVID-19) in Europe and Asia. It appears that the newer versions have slight genetic modifications to the spike protein on the viral surface that is increasing the infectivity. In the UK, the new strain started showing up in September. The good news is that there has not been a change in the morbidity or mortality related to the mutation.
• COVID prevention strategies may be putting off influenza and viral upper respiratory season. (Jones et. al. 2020) The Southern Hemisphere did not have a significant upper respiratory viral season this past winter. As the Northern Hemisphere follows suit now with winter, will the same low viral URI rate persist? This appears to be the case, but it is too early to say for sure. We have yet to see any influenza in children this year. According to the CDC, of almost 30,000 tested patients, only 75 had influenza or 0.3%. This is extremely low volume for this time of the calendar year. (CDC flu stats)
Is this a reflection of children being heavily quarantined with increased at home education? This may be as children are a major vector for influenza’s spread every year. Is it that more people were vaccinated this year and the flu vaccine was more effective? All possibilities, we shall see.
• Translational research has shown us that SARS2 can cross the blood brain barrier and that was expected by the clinical picture in humans. (Rhea et. al. 2020) This is unfortunate as the SARS2 viral particles have the ability to enter the protected space of the brain can cause significant damage if these particles trigger inflammation in the brain tissue. Under normal conditions, as the viral particles are detected in the brain by microglial cells, they should recruit cytotoxic T cells to the area to kill the pathogen. (Moseman et. al. 2020)
The hiccup, I suspect, happens when the number of viral particles supersedes the brain’s ability to detect and kill the virus. With COVID-19, the at-risk individuals that get very sick and survive the illness are likely to have overwhelmed all segments of the immune system including the brain. Especially at-risk individuals would be those with inflammatory neurological conditions like Alzheimers.
The take-home point is the same. Reduce all risk related to inflammation systemically and poor viral surveillance and killing so as to avoid any neurological damage.
• How do kid’s immune systems evade the SARS2 virus? Children have the ability to see the virus, develop a rapid response, not experience any symptoms, not shed virus and ultimately become immune. In one study, children never tested positive for PCR infectivity yet developed neutralizing antibodies. (Tosif et. al. 2020) Adult infected COVID-19 patients had anti-spike IgG, IgM and IgA antibodies as well as anti-nucleocapsid IgG antibodies, while children predominantly only developed antibodies against the spike protein and not the nucleocapsid. The nucleocapsid antibody is a later finding as it is in response to the massive viral replication. (Weisberg et. al. 2020) Thus, the lack of it in children indicates that they are rapidly developing a robust immune response to the virus before it replicates widely. (Nogrady 2020)
Couple this immunological knowledge with the fact that children are also lacking large numbers of ACE2 receptors and furin proteases and we find a multifaceted reality as to why children are less likely to get sick, have significant disease if they do get sick and to have mostly avoided the scourge of SARS2/COVID-19.
Thank God for small blessings in an otherwise nightmarish infection.
• Having antibodies to the spike protein or nucleocapsid offers at least 6 months of immunity against SARS2. (Lumley et. al. 2020) This study was performed in healthcare workers who remain exposed to the virus over time. This is further great news and should be part of the vaccine rollout plan. If we test the population at large especially healthcare workers that have been sick already and survived, we could allocate the limited vaccine resources to SARS2 naive individuals.
• Infectivity is higher in symptomatic COVID-positive people versus asymptomatic. (Sayampanathan et. al. 2020) This study shows us, as expected, that people that are ill with COVID are more infectious than those that are seropositive but have no symptoms.
• The anaphylactic reactions that some people are having may be due to a new packaging chemical called PEG or polyethylene glycol that has never been used in a vaccine before. It is a widely used chemical in toothpaste, shampoo, creams and even stool softeners.
“PEGs were long thought to be biologically inert, but a growing body of evidence suggests they are not. As much as 72% of people have at least some antibodies against PEGs, according to a 2016 study led by Samuel Lai, a pharmaco-engineer at the University of North Carolina at Chapel Hill, presumably as a result of exposure to cosmetics and pharmaceuticals. About 7% have a level that may be high enough to predispose them to anaphylactic reactions, he found. Other studies have also found antibodies against PEG, but at lower levels.” (de Vrieze 2020)
True to human immune nature, a foreign chemical can be targeted by the adaptive immune system as a foreign agent. By developing an antibody against the chemical structure of PEG, the immune system can cause a local inflammatory response when PEG is reencountered in the future. Being directly injected into the muscle as with a vaccine may be a scary immune alert signal in a small subset of humans that then experience a severe allergic reaction.
To me, this data set is more a reflection on the reality that we are bombarded by chemicals all of the time. PEG in toothpaste and shampoo cannot be necessary so much as just done. It is a miracle that we are healthy at all considering the chemical exposure that we are undergoing on a daily basis. The de Vrieze article is worth the read.
Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Email him at firstname.lastname@example.org.