Our Autoimmune Response to COVID-19
Inappropriate regulation feeds an appetite for self-destruction.
Note: This article was originally published on Medium.com on September 8, 2020. My account has been deleted (by me) due to Medium’s unfortunate policy of banning authors they do not agree with. All of my Medium articles have been transferred to my Substack site (including others not sent by email to subscribers), so now readers can see just how prescient and/or completely naive I was in 2020.
Back in April, I wrote an optimistic piece that featured an analogy of the United States response to the Covid-19 pandemic as a person responding to a viral infection. I pointed out that the response usually starts out non-specific, with more collateral damage, and then gradually becomes more specialized, targeted, and effective over time, with less damage. As with an immune response, it takes time for states and countries to find the most targeted and effective strategies that cause the least damage.
During the last few months, after initial mismanagement, some leaders began to implement measures that directly protected people with higher risk of severe disease and death, like those in long-term care facilities. Yet many have stubbornly adhered to blanket mitigation policies that have harmed everyone, even those at very low risk for severe disease. The repercussions of one-size-fits all policies will be especially harsh for poor individuals in developed countries, and even worse in developing countries. Treatable diseases have gone, and will continue to go, untreated. Livelihoods have been, and will continue to be, lost. Indicators of mental health and substance abuse have worsened, and will continue to decline. The tragic consequences of these damaging responses could be felt for years.
As a result, I began to think of many of these state and national responses as akin to self-destructive, autoimmune responses to infection. An analogous example in humans would be an autoimmune response to infection with the bacteria Streptococcus pyogenes, the bacteria that is known for causing strep throat. In most people, strep throat is easily treated with antibiotics. But if left untreated, a small portion can develop rheumatic fever. In this case, the ongoing immune response to the bacterial infection results in production of antibodies (proteins that bind and help clear germs) that bind to the heart and other tissues, causing immune activation and damage. In this case, the immune system overreacts and destroys otherwise healthy tissue.
I think the same thing has happened with the pandemic response. The initial signals from the “index case” (China), and subsequent early spread (e.g. Italy) were confusing and terrifying, and many leaders panicked, sending mixed signals that started out calming and quickly morphed into apocalyptic panic. Due to human nature and instant worldwide communication, these signals spread faster than the virus. Although it was known prior to the pandemic that blanket lockdowns and quarantines of healthy individuals were unnecessarily destructive, many leaders ignored this accumulated wisdom. What began as a heavy-handed response in China soon spread with a cascade of copycat policy making, as each leader succumbed to a second pandemic that may be described as “shutdown fever”. Once enacted, these harsh, non-specific mitigation policies are very difficult to stop. Many leaders have continued to hold onto the pretense of successful mitigation as long as possible, even in the absence of clear evidence of their efficacy. But once the curtain comes down, it can’t go back up.
This is a problem of inappropriate regulation. The immune system has mechanisms of regulation, too, and if they fail, autoimmune disease results. For example, there are immune cells called regulatory T cells that actually recognize “self” proteins. But when they do, instead of killing cells or helping others to destroy pathogens, they release anti-inflammatory and inhibitory signals that prevent other cells from becoming activated. Not surprisingly, people that lack functional regulatory T cells develop systemic autoimmunity. Inflammatory cells cannot be stopped from indiscriminate destruction of self-tissues.
But why does this happen? What makes some people more susceptible to developing an autoimmune disease? Certainly, genetics plays a role, like in the rare event when someone is born without regulatory T cells. However, environment is also a key factor. In recent decades, researchers have uncovered a likely answer: Early microbial exposure helps drive our immune systems towards tolerance of beneficial microbes and self-tissues. In other words, if anti-inflammatory cells like regulatory T cells don’t get the right signals early on, immune cells won’t be as good at their jobs. Microbes are an integral part of that message. This means that some of the advantages of a near-sterile modernity that decrease microbial colonization or exposure early in life, such as improved sanitation, antibiotics, and C-sections, come with a price.
Similarly, a lack of uniting challenges instead of first-world problems and manufactured crises, have weakened wealthy populations, rendering them susceptible to gross, self-destructive overreaction. As technological advances and tremendous wealth have given us an unprecedented level of safety and security, minor threats to this new order are often hyper-exaggerated. A culture of safetyism has arisen, to borrow the term from Jonathan Haidt and Greg Lukianoff, authors of The Coddling of the American Mind. It extends beyond the concept of emotional safety that has so perniciously infected college campuses, to include a widespread belief that collective action will enable the public to completely remove any risk from infectious disease outbreaks. As a result of popular demand for swift and strong action from helicopter leaders, many national responses to the pandemic have been dangerously non-specific, effectively destroying livelihoods and educational opportunities for millions of young and healthy people, while neglecting those most at risk. Once this pathway is started, it is difficult to stop.
As for autoimmune diseases, they cannot be cured, only managed. Treatment includes administration of immunosuppressive drugs, which target the immune pathways that are important for inflammation and disease. These drugs allow many patients to live normally, as long as the treatment is continued. If the treatment is stopped, the symptoms return.
For our own destructive autoimmune response to Covid-19, there are signs that more specific pathways are being targeted in some places. When enough healthy people are infected and recover, developing long-lasting immunity, transmission of infection decreases. This is happening in places where disease was once rampant, often despite harsh mitigation efforts. Schools and businesses are opening, while long-term care facilities and hospitals continue taking precautions, as they should. There is room for optimism once again.
What is the most effective treatment for a self-destructive, autoimmune response to the Covid-19 pandemic? Start with liberal, repeated doses of the truth. The trumpeting of misinformation to advance political agendas has been enormously destructive, regardless of what end of the political spectrum it originates. Polls have revealed a widespread ignorance regarding numbers of COVID deaths and an inflated perception of relative risks of severe disease and long-term complications, especially for young and healthy middle-aged people. If the results of these polls are not just a reflection of poor math skills, how could so many people develop these wildly inaccurate beliefs? Numbers and statistics are often presented without explanation, nuance, or context by the media or leaders. And context is critical to public understanding of disease pathology and community spread. Ultimately, an honest reckoning for the media, combined with accountability for leaders in democratic elections will send a clear message of a desire to regulate our destructive impulses and return to normal life.
Hi Dr. Templeton - I found your substack via The Brownstone Institute and find your voice to be one of the most compelling in all the noise of the pandemic information in the metaverse.
There is one question I haven’t found a good explanation for. What are the long term memory immune system response differences between vaccination and recovery from infection? Hypothetically, if the world vaccinated as many people as possible (including children, and young healthy adults), would that have the same affect as those same children and young, healthy adults having recovered from infection and producing memory cell responses? My question is on three levels: 1) long-term individual protection from COVID-19 and future variants, 2) on a population level how protected a community would be going forward, and 3) would one or the other have a more beneficial outcome with regards to fewer or less lethal variants in the future?
Thank you and keep up the great work!
Please (if you have time ) advise me ,if you have been infected naturally by covid-19 or by vaccine induced , if your immune syesem is stuffed then most likely you will be too ?
I know that is being simplistic but I have been unable to get a copy of your Oct 22nd article quoted by a Jack Phillips a reporter from an auzzie newspaper - your fame is spreading.
Regards
Peter(from NZ )