COVID-19: Let the body fight the virus

With the present round of Covid-19, each one of us is living in an echo chamber of fear. There is panic at the invisible enemy felling people dear to us. The fear of the unknown is such that ignorance does seem to be bliss.

And yet the fact remains that notwithstanding the fury of the pandemic, a vast majority of us will survive either unscathed or just minimally singed.

Covid or no Covid, people survive because of their ‘Immunity’. It is too complex a phenomenon for the fancy products that claim to boost it like hair oil for bald heads. To put it simply, immunity cannot be enhanced by spending more money or following the ‘best’ doctor’s prescription. Immunity is developed over the years; and you either have it or you don’t.

Immunity is the body’s ability to fight the invasion of any pathogen (disease causing organism). As our immunity encounters the invader, there are various signs that indicate all’s not well. The most central to all symptoms is a phenomenon called inflammation. Rest of the story is putting warp and weft only.

Some 2000 years ago, ancient Romans coined this term and we have not yet found a better description. For any insult or invasion, physical (injury), chemical or microbial, the body mounts an immediate response that results in inflammation.

Recall a slap on the face. In no time there is redness, pain, swelling and there is local rise of temperature resulting in partial loss of function. Exactly the same phenomenon happens every time we encounter a micro-organism. It can be a localised inflammation as in a boil, furuncle, sore throat, or ear ache or the systemic inflammatory response involving the entire body manifested by fever, body ache and a feeling of being unwell.

As in any skirmish, battle or war, the magnitude of damage depends on the interplay between the virulence of the enemy and the state of defensive preparedness (immune response) with certain amount of acceptable collateral damage.

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To come to our Covid example, in more than 80 percent of the cases, the person doesn’t even realise that he has got infected (asymptomatic status). In the rest the illness spans a spectrum of varying intensity.

In the body’s immune response, inflammation remains the most potent tool initially. Clinically it is the period marked by high fever and feeling of being unwell. The virus by its nature tries to infect the lungs (pneumonia) and the inflammation tries to limit it. Mind you, both fever and inflammation are our body’s bid to fight the scourge.

If at any point, the involvement of the lungs goes beyond a critical limit, the body’s requirement of oxygen suffers (hypoxia) and the person may need oxygen supplement. The requirement of a life-saving oxygen supplement is determined not by X Ray or CT scan of the lungs but by a simple and inexpensive pulse oxymeter.

If the oxygen saturation count falls below 94 percent, self proning (lying face down) may revert it to the old level; if that does not happen, hospitalisation may be required. This goes on for first five or six days and thereafter, the viral replication stops (nine days after invasion of the virus).

Can any intervention alter this process and benefit the patients? An honest answer is a resounding ‘No’. There is no drug of proven efficacy yet against the coronavirus. The much-hyped Remdesivir was dropped from the list of approved medicines by WHO long ago. Antibiotics have no role in viral infections.

Any medication (steroids) to lower the inflammation at this stage amounts to giving the virus an unhindered free run which may cost the life of the patient. Sadly, a large number of patients are indiscriminately being administered steroids all over the country without any audit or accountability.

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The story changes beyond this point. Once the virus replication has stopped, the virus per se ceases to be a concern. The body’s defences gradually go back to their normal status and the patient recovers.

In some cases, however, the body continues to wage a relentless war even when the enemy no longer is a threat. The inflammation, that was meant to limit the virus with acceptable collateral damage, starts damaging the body itself.

During this process lot of toxic chemicals are released which starts damaging the healthy tissues. This is variously referred as covid storm, cytokine storm or inflammatory storm. The severity of the inflammation can be measured by certain tests like ESR, CRP, IL6 etc. If beyond the initial period these markers continue to be high, hypoxia persists and the fever remains unresolved, a carefully considered administration of steroids is live saving.

But indiscriminate use of steroids can increase the severity of the disease and lead to development of secondary bacterial and fungal infections. A smaller sub set of patients are prone to blood clotting as evidenced by rise in D Dimer necessitating treatment by blood thinners.

To sum up, Covid is a self-limiting infection which remains asymptomatic or like a minor viral fever for a great majority. Other than regular monitoring by pulse oxymeter, no other investigations are required in the first six days of treatment.

There are no known anti-viral drugs and antibiotics have no role. Oxygen therapy is invaluable if hypoxia does not resolve by self-proning. Steroids are harmful if given injudiciously especially in the initial days of the illness. Anti-coagulants (blood thinners) may be required in certain cases.

Learning about the coronavirus and how it enters the body—through the mouth and the nose—is central to our ability to fight it. Fear is of not much help.