April 17, 2020

Rebound

When we get infected with a microbe (a bacteria or virus), our body first creates an antibody called IgM, which is the initial immunoglobulin that fights the infection. Later a second immunoglobulin called IgG shows up. Usually when we develop IgG, it means that we are becoming immune, which will help protect us from re-infection. The IgM antibody doesn't stick around for long after the IgG arrives and the acute infection resolves. If the IgM is still there when we find IgG, we can better pinpoint when the infection started. But the truth is that these details vary with each virus. Someone can have antibodies to Herpes but still get outbreaks, and a positive antibody to HIV is how we diagnose HIV, but the virus is still reproducing in the body. But generally having a specific IgG present means someone is immune to that microbe. But that immunity can wane, like with tetanus, which is why we get Tetanus shots every 10 years. Right now the science is still not clear on how long immunity will last with this coronavirus. Lots of research focusing on this area is ongoing.

Some good news today is that the UW Virology Lab is going to start testing for antibodies to the SARS-CoV-2. This can help us start to understand how many people have been infected, and it can help find people who had COVID-19 and use their plasma that is filled with Sars-CoV-2 IgG to treat ill patients. We are hopeful that this knowledge can help us start to open up again.

Living in Seattle is a lucky place to be during this pandemic, we have responsive leaders, a world class medical school, and lots of really smart people that are invested in guiding us through this. Our Public Health Department published this wonderful glossary to explain all of the epidemiological terms we are throwing around. Looking at it can help you understand the reasoning behind the recommendations of the CDC, WHO, and the governors of most states. A good example is the “Reproductive Rate” or Rnaught (R0). It is not about the virus reproducing, but about the number of people infected by one person. It can change with behavior and other factors. We have lowered ours from an initial rate close to 5 infections from one person to closer to one infection per person. This information is used by the IMHE model to show we can start re-opening safely the week of May18

I fear that people are starting to bend the restrictions here and in other states and that our R0 (Rnaught) will start to rise again, even before the restrictions are lifted. I understand people getting antsy and worried about the economy, as well as getting cabin fever. I am worried that some, who are scared, isolated, lonely, are being easily influenced and radicalized by what they see on the Internet. There are signs of that happening. Many of those are starting to protest and meet in large groups. This can, sadly, spread the virus to more areas. I understand that they are willing to take these risks for their perceived freedom. I understand that many are worried about their livelihoods. They are not afraid of dying, but they will likely, unwittingly, be vectors to their families and communities. What this means for those of us who are more vulnerable to the coronavirus is that we need to not get complacent, keep washing our hands, and limiting our contacts for the time being. It may get worse before it gets better. I wish it were different. But for the nurses, I weep. They did not ask for this.

Tough times. I wish things could be lighter. The main thing we have to get us through this is each other. Even from a distance, we can share a conversation, photos of beautiful flowers, a laugh. Kindness is key. And Recipes and solutions when all you can get is rice flour.

Wash your hands.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.kingcounty.gov/depts/health/communicable-diseases/disease-control/novel-coronavirus/glossary.aspx

https://www.seattletimes.com/seattle-news/health/uw-coronavirus-model-says-washington-state-can-start-safely-reopening-the-week-of-may-18/

https://komonews.com/news/coronavirus/uw-to-tackle-covid-19-outbreak-with-antibody-blood-testing

https://www.seattletimes.com/seattle-news/health/have-you-recovered-from-covid-19-the-uw-medicine-virology-lab-wants-to-test-your-blood/

https://www.seattletimes.com/nation-world/nation/virus-fueled-conspiracy-theories-take-aim-at-hospitals/

https://mnnurses.org/want-my-death-make-you-angry/

https://cooking.nytimes.com/recipes/1021001-rice-flour-poundcake