A central player in the fight against the novel coronavirus is our immune system. It protects us against the invader and can even be helpful for its therapy. But sometimes it can turn against us.
How does our immune system react to the coronavirus?<p>The coronavirus is — like any other virus — not much more than a shell around genetic material and a few proteins. To replicate, it needs a host in the form of a living cell. Once infected, this cell does what the virus commands it to do: copy information, assemble it, release it.</p><p>But this does not go unnoticed. Within a few minutes, the body's immune defense system intervenes with its innate response: Granulocytes, scavenger cells and killer cells from the blood and lymphatic system stream in to fight the virus. They are supported by numerous plasma proteins that either act as messengers or help to destroy the virus.</p><p>For many viruses and bacteria, this initial activity of the immune system is already sufficient to fight an intruder. It often happens very quickly and efficiently. We often notice only small signs that the system is working: We have a cold, a fever. </p>
Is there an immunity? How long does it last?<p>The good news is that it is very likely there is an immunity. This is suggested by the proximity to other viruses, epidemiological data and animal experiments. Researchers <a href="https://www.biorxiv.org/content/10.1101/2020.03.13.990226v1" target="_blank">infected four rhesus monkeys,</a> a species close to humans, with SARS-CoV-2. The monkeys showed symptoms of COVID-19, the disease caused by the coronavirus, developed neutralizing antibodies and recovered after a few days. When the recovered animals were reinfected with the virus, they no longer developed any symptoms: They were immune. </p><p>The bad news: It is not (yet) known how long the immunity will last. It depends on whether a patient has successfully developed neutralizing antibodies. Achim Hörauf estimates that the immunity should last at least one year. Within this year, every new contact with the virus acts as a kind of booster vaccination, which in turn might prolong the immunity.</p><p>"The virus is so new that nobody has a reasonable immune response," says the immunologist. He believes that lifelong immunity is unlikely. This "privilege" is reserved for viruses that remain in the body for a long time and give our immune system a virtually permanent opportunity to get to know it. Since the coronavirus is an RNA (and not a DNA) virus, it cannot permanently settle in the body, says Hörauf.</p><p>The Heidelberg immunologist <a href="https://www.klinikum.uni-heidelberg.de/immunologie/immunologie" target="_blank">Stefan Meuer</a> predicts that the novel coronavirus will also mutate like all viruses. He assumes that this could be the case in 10 to 15 years: "At some point, the acquired immunity will no longer be of any use to us because then another coronavirus will return, against which the protection that has now been formed will not help us because the virus has changed in such a way that the antibodies are no longer responsible. And then no vaccination will help either."</p>
How can we take advantage of the antibody response of the immune system?<p>Researchers are already collecting plasma from people who have successfully survived an infection with SARS-CoV-2 and are using it to treat a limited number of patients suffering from COVID-19. The underlying principle: <a href="https://www.dw.com/en/coronavirus-drugs-can-antibodies-from-survivors-help/a-52806428" target="_blank">passive immunization.</a> The studies carried out to date have shown positive results, but they have usually been carried out on only a few people.</p><p>At best, passive immunization is used only when the patient's own immune system has already started to work against the virus, says Achim Hörauf: "The longer you can leave the patients alone with the infection before you protect them with passive immunization, the better." Only through active immunization can one be protected in the long term. At the same time, it is difficult to recognize the right point in time.</p><p>PCR (polymerase chain reaction) tests are currently used to find out whether a person is infected with the coronavirus. With the help of PCR, it is not possible to tell whether or not there is reproducible viral RNA; it is just a proof of whether the virus is still present, dead or alive. A PCR test cannot tell us whether our immune system has already intervened, i.e. whether we have had contact with the virus in the past, have formed antibodies and are now protected. Researchers are therefore working on tests that check our blood for the presence of antibodies. They are already in use in Singapore, for example, and are nearing completion in the USA. With the help of these tests, it would finally be possible to gain an overview <a href="https://www.dw.com/en/corona-confusion-how-to-make-sense-of-the-numbers-and-terminology/a-52825433" target="_blank">of the unclear case numbers.</a> In addition, people who have developed antibodies against the virus could be used at the forefront of health care, for example. An "immunity passport" is even under discussion.</p>
Is it possible to become infected and/or ill several times with the coronavirus?<p>"According to all we know, it is not possible with the same pathogen," says Achim Hörauf. It is possible to become infected with other coronaviruses or viruses from the SARS or MERS group if their spike proteins look different. "As far as the current epidemic is concerned, it can be assumed that people who have been through COVID-19 will not become ill from it for the time being and will not transmit the virus any further," he says.</p>
How long before you're no longer contagious?<p>A study <a href="https://www.nature.com/articles/s41586-020-2196-x" target="_blank">carried out on the first coronavirus patients in Germany</a> showed that no viruses that are capable of replication can be found from day eight after the onset of symptoms, even though PCR can still detect up to 100,000 gene copies per sample. This could change the current quarantine recommendations in the future.</p><p>According to the Robert Koch Institute, patients can currently be discharged from hospital if they show two negative PCR samples from the throat within 24 hours. If they have had a severe case of the disease, they should remain in domestic isolation for another two weeks. For each discharge, whether from hospital or home isolation, they should have been symptom-free for at least 48 hours.</p>
Why do people react differently to the virus?<p>While some people get off with a mild cold, others are put on ventilators or even die of SARS-Cov-2. Especially people with <a href="https://www.dw.com/en/coronavirus-who-is-particularly-at-risk-and-why/a-52710881" target="_blank">pre-existing conditions</a> and older people seem to be worst-affected by the virus. Why? This is the hottest question at the moment.</p><p>It will still take a very, very long time to understand the mechanistic, biological basis for why some people are so much more severely affected than others, virologist Angela Rasmussen told <em>The Scientist</em>. "The virus is important, but the host response is at least as important, if not more important," her colleague Stanley Perlman told the magazine.</p><p>Stefan Meuer sees a fundamental survival principle of nature in the different equipment and activity of our immune systems: "If we were all the same, one and the same virus could wipe out the entire human species at once. Due to the genetic range, it is quite normal that some people die from a viral disease while others do not even notice it. "</p><p>Achim Hörauf also suspects immunological variants that could be genetically determined. Since interstitial pneumonia is observed with the coronavirus, the focus is probably on an overreaction of the immune system. However, it is also possible that each person affected may have been loaded with a different dose of the virus, which in turn leads to different outcomes. And finally, it makes a difference how robust the body and lungs are: Competitive athletes simply have more lung volume than long-time smokers. </p>
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By Charli Shield
At unsettling times like the coronavirus outbreak, it might feel like things are very much out of your control. Most routines have been thrown into disarray and the future, as far as the experts tell us, is far from certain.
Eating Well<p>Without a vaccine, none of us can entirely eliminate our risk of contracting coronavirus. And experts say that's still 18 to 24 months away.</p><p>But eating as healthily as possible is important not only for our physical health, but our <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y" target="_blank">psychological well-being,</a> too. A healthy diet has been shown to reduce our risk of chronic illnesses such as cardiovascular disease, diabetes and obesity, as well as <a href="https://www.ncbi.nlm.nih.gov/pubmed/26317148" target="_blank">depression</a> and anxiety.</p><p>You don't have to follow a particular diet, just avoid processed foods as they tend to be high in sugar. </p><p>The best foods for our mental health are generally the healthiest foods. Complex carbohydrates, found in fruit, vegetables and whole grains, provide important nourishment for our brains as they slowly release energy, which also stabilizes our moods.</p><p><span></span>A balanced diet ideally includes a variety of foods high in vitamins A, B, C, D and E, as well as the minerals iron, zinc and selenium.</p><p>B vitamins, found in green vegetables like broccoli and spinach, beans, bananas, eggs, poultry, fish and beetroot, are important for our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772032/" target="_blank">brain</a> and it's happiness chemicals, serotonin and dopamine. A lack of B6, B12 and folate (B9) are common in cases of depression. </p><p>It's also vital to look after our gut health, which a growing body of research shows has a remarkable impact on our <a href="https://www.ncbi.nlm.nih.gov/pubmed/25415497" target="_blank">mood and behavior</a>. Prebiotics and probiotics, found in fermented foods like kefir, tempeh, sauerkraut, kimchi and yogurt can <a href="https://www.ncbi.nlm.nih.gov/pubmed/26645350" target="_blank">reduce inflammation</a>, <a href="https://jphysiolanthropol.biomedcentral.com/articles/10.1186/s40101-016-0101-y" target="_blank">boost our moods </a>and cognitive function.</p><p>In its tips for coping with the stress of the coronavirus outbreak, the World Health Organization (WHO) reminds us not to "use smoking, alcohol or other drugs to deal with your emotions." They recommend speaking to a health worker or counsellor if you're feeling overwhelmed. </p>
Sleeping Soundly<p>Sleep is essential for our bodies to repair cells, clear toxins, consolidate our memories and process information. There's good evidence that sleep deprivation can have major impacts on our health — negatively affecting our <a href="https://academic.oup.com/sleep/article/36/7/1059/2453875" target="_blank">psychological wellbeing</a> concentration and even our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792375/pdf/aasm.36.11.1597.pdf" target="_blank">emotional intelligence</a>.</p><p>It can also increase our risk of developing <a href="https://www.sciencedirect.com/science/article/abs/pii/S0149763416302184?via%3Dihub" target="_blank">chronic health conditions</a>, like diabetes, obesity and heart disease.</p><p>Just like our schedules for eating, working and exercising, it's important to sustain a regular sleep routine. For most people, between six to nine hours a night is sufficient. Going to bed and waking up at a similar time each day can help maintain a sense of normality, and help you follow through with plans.</p><p>If you're finding it difficult to get to sleep because you're lying awake worrying, try to limit your consumption of the news before bed. It can also be helpful to reduce your exposure to screens in the evening, as the effect of the blue light on our retinas can disrupt our sleep quality.</p>
Exercising Enough<p>Exercise releases chemicals in the body that <a href="https://link.springer.com/article/10.2165/00007256-199724010-00002" target="_blank">make us feel good</a>, and it's also been linked to better sleep, reduced stress and anxiety, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/29108442" target="_blank">improved memory</a> and cognition.</p><p>Team sports may be off the agenda, but you can certainly still exercise on your own, says Marcus Thormann, owner of a high-tech fitness studio in western Germany. He recommends moderate movement for 30 minutes per day, as backed by <a href="https://www.who.int/dietphysicalactivity/factsheet_adults/en/" target="_blank">the WHO</a>. </p><p>"You can even break that up into 10 minute sections — 10 minutes in the morning, 10 in the afternoon, and 10 in the evening. When you've established that as a daily routine, then your day will be better structured as well," he told DW.</p><p>Many fitness instructors — yoga and pilates, personal trainers, dance teachers — are offering their classes online during the outbreak, some of them for free. All you need is a mat or towel on the floor and a reliable internet connection. </p><p>Or, as Thormann points out, just a good dose of creativity. "I saw a social media post about a guy who used his 7-meter balcony, so about 20 feet in length, to run an <em>entire marathon</em>." </p><p>While that's "a very extreme example," Thormann says, there are many ways to stimulate your body's circulation. He suggests "walking up and down the stairs in your home, or in your building, for example. Or, you could jog in place inside, or do some shadow boxing, or jumping jacks, or sit-ups, or push-ups."</p><p>While the area you can roam outside might be limited during lockdown, going outdoors, even briefly, has been shown to improve people's <a href="https://www.pnas.org/content/112/28/8567" target="_blank">state of mind</a>. Even if a short walk once per day is all you can manage, research suggests <a href="https://www.nature.com/articles/s41598-019-44097-3" target="_blank">just two hours a week</a> in nature is linked with better health and wellbeing.</p><p>But be careful not to exercise if you have flu-like symptoms, or if you feel exhausted.</p>
Social Connection<p>Now more than ever, we need our friends. Evidence shows that <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316" target="_blank">social connectedness</a> is as important for our health as diet, movement and sleep.</p><p>No, you can't have a dinner party or a picnic in lockdown — in person! But not all social interactions have to be face-to-face to be meaningful. Try recreating them through video calls — you could organize a virtual dinner via apps like Zoom, Houseparty or good old Google Hangouts, or take a friend on a virtual walk or do a housebound activity together, like craft or drawing. </p><p>Think of it as being distantly social</p>
Calming Activities<p>While it might seem like the world is only talking about one topic right now, enforced social isolation could also provide the perfect opportunity for many people to take a break from the news cycle. </p><p>What do you usually not have time for? Gardening, cooking, pickling, puzzles, craft, sewing, learning to meditate, building furniture, reading that pile of books on your bedside?</p><p>Now could be the perfect time to do them all, or some, or half of a few — whatever you can manage.</p><p>Through it all, remember as the <a href="https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2" target="_blank">WHO has advised</a>, to "draw on skills you have used in the past that have helped you manage previous adversities."</p>
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